‘Nuclear option of doing nothing is so devastating’ — State proposal for $1 billion would offer some insurance aid, & ‘right- size’ hospitals, services
DOUGLAS — Dr. Joseph Gutman has seen plenty of upheavals in the nearly half century of his professional life in Miami, Baltimore, Arizona and now Wyoming . . . but stretched out on the living room couch of his Casper home, he offered a rather bleak characterization of the medical world since the pandemic.
“Covid is the modern equivalent of the Tower of Babel,” the nationally renowned endocrinologist said, his East Coast accent hanging on the words and his eyebrows raised as he continued. “Everyone is speaking a different language.”
By everyone, he explained, he means everyone – those in government, in the medical world and the public. And that, he contends, has helped lead us to this place – where health care, and rural health care in particular, is being threatened from multiple directions to the point some rural places may lose providers and hospitals.
Consider this:
• Health insurance customers are facing massive increases in premiums in 2026. In recent weeks, readers have shown the Budget their premium bills beginning in January, with one woman seeing a staggering $4,700 price tag to continue the same insurance plan for which she has been paying $700. Two others will see their premiums jump from roughly $400 and $500 to $2,775 and $3,200.
Every one of them said if they cannot find a better solution before Jan. 1, they will go without health insurance next year and simply pray nothing happens that requires medical care.
• The government shutdown for 41 days was focused on health care subsidies under the “very favorable" Affordable Care Act or ACA (according to most polls). That’s the same federal government program Republicans have dubbed ObamaCare, which has unfavorable poll numbers.
• The situation has Congress racing toward a solution before the Christmas recess, but the two sides remain far apart. (The House is currently scheduled to recess Dec. 15 but could extend its time in Washington, D.C. The Senate has days scheduled until Dec. 21.)
• The One Big Beautiful Bill passed by Congress earlier contains funding to states to handle the health care crisis. Wyoming stands to get as much as $1 billion, but nothing is guaranteed at this point – though the state has written its proposal and asked for the full $1 billion.
Memorial Hospital of Converse County CEO Matt Dammeyer has been tracking the situation with an eagle’s eye on possible outcomes to both the ACA and Medicaid/Medicare funding. He is optimistic something will be done, but like so many others, he doesn’t know what that something will be.
“No one knows because the nuclear option (of doing nothing) is so devastating,” he said. “The social carnage will be so devastating. It could be a small beating. It could be a massive beating,” the CEO said, adding right now it’s just a guess as to what may be done or not done.
But if nothing is done, he said, “what’s going to happen if your subsidies go away, your patient, your client base is going to go away as well, and (while) a lot changed in September, October and November, but I think you just can’t believe that the rug would get jerked out that fast and that hard, but then again, you saw this during the shutdown unprecedented levels of infighting between politicians.”
Dammeyer said that uncertainty already is creating havoc in the medical industry, in the insurance industry and in the public.
Health care catastrophe
All of this affects those who rely on health care, Gutman said, which is everyone at some point.
“There’s a very big emotional (disconnect) between the bean counters and the sick patient,” he noted.
And “the bean counters” can be at the federal government or insurance company or hospital/physician level. Each of those has a different, sometimes diametrically opposed, view of what should happen.
What that could lead to in the coming year or years, according to Gutman and Dammeyer, is a health care “catastrophe” with rural hospitals closing or becoming insolvent (some already are, even in Wyoming) or an increase in certain specialties disappearing from the rural landscape.
Both men, in separate interviews, pointed to the loss of many OB services in several Wyoming communities and the likelihood of “obstetrics deserts” spreading into more counties.
Dammeyer contends MHCC is well positioned to help pick up those OB pieces where it logistically can, like neighboring Niobrara or Platte counties, and where it makes economic sense, such as in Natrona County.
When MHCC administrators and board decided to buy an OB practice in Casper and invest in expanding OB services in Douglas rather than shuttering an unprofitable department, Dammeyer admittedly knew it was a risky maneuver.
But, he reasoned at the time, it was a risk worth taking just to keep maternity providers and services in Douglas – without expectant mothers from surrounding counties coming to MHCC, the 7-11 births (on average) per month wouldn’t have provided the income needed to keep the OB department open. That would have been a bad situation for Converse County patients, who are the number one priority because, as a county owned hospital, the public is the owner, Dammeyer said.
(The gamble has paid off so far, with MHCC on track to see 250 babies born here in this fiscal year.)
The bigger concern, both men point out, is if more rural hospitals close in Wyoming and elsewhere in the country.
“Converse County doesn’t understand the blessing it has that most other places (in Wyoming) don’t,” Gutman said. “That is its ability to handle most medical needs for most people, and (it) is close enough to send people to Ft. Collins or Casper.”
While a hospital closure in Wyoming “is much less complicated than if a hospital in the Bronx closes,” it is also more likely to happen here because of the rural nature of this state and the lack of resources in some counties to support it, he explained. While he was talking in generic terms, he quickly pivoted back to MHCC.
“The hospital will never close . . . because the community (Douglas) will never allow it to close,” he suggested, noting – as did Dammeyer later – that the community and Converse County commissioners have proven again and again their support for the hospital and the administration’s vision to grow and expand services rather than shrink and abandon certain high-cost specialties, such as OB care.
The salvation?
Wyoming’s share of the One Big Beautiful Bill could hit $1 billion – though both men question whether that much money will flow to a state with a small population once the “bean coun- ters” do their work with proposals coming from 50 states. But Dammeyer, who offered some limited input to Wyoming’s proposal, said he is encouraged by the forethought and long-term strategy it contains.
The first two parts of the proposal (called Rural Health Transformation in Wyoming) deal with “right-sizing” services available, determining where and who would offer specific medical services.
The third part of the state’s proposal would partially cover major medical health insurance premiums using a state-run plan. It would cover only those without serious pre-existing conditions and only provide coverage for major health events, but it is something, Dammeyer said.
The state, in its application, wrote, “Where the previous two components focus on maintaining physical access to care throughout rural Wyoming, this final component covers financial access, particularly to emergency services.
“. . . Many people in Wyoming find the cost of health insurance to be unaffordable. This is due in part to the high unit prices insurers pay for medical care in Wyoming, but also due to the inclusion of the ten Essential Health Benefits under the Affordable Care Act —many of which go unused by generally healthy people.
“This component would give individuals and small employer groups the option of buying in, at cost, to a State-operated public benefit plan that only covers emergent episodes of care.
“This plan could be offered at a significantly lower price point than comprehensive health insurance.”
Other parts of the proposal say the state would use the funding for matching grants to further education for providers; make technology improvements at medical centers; broaden tele- health availability, and create a “Make Wyoming Healthy Again” public education program.
A chunk of the money would go into an investment fund with the interest on it funding health care needs in the future.
‘Right sizing’ Wyoming hospitals
If Wyoming’s proposal is accepted and funded, even at $500 million versus the full $1 billion, Dammeyer said the impact on hospitals and other medical centers across the state could make the system stronger by “right sizing” them.
MHCC is considered a critical-access hospital, which means Medicare pays a higher reim- bursement rate than to hospitals without that designation. That gives MHCC a leg up in staying competitive with larger institutions like Wyoming Medical Center.
What would “right sizing” do to MHCC’s future plans?
Dammeyer admitted he doesn’t know, but he isn’t too worried.
“I don’t want to sound over confident but, you know, we have a pretty good history that when one thing falls another thing can be found to replace it. I think the Trump Administration . . . I have no idea what they’re going to ultimately do, but I think that . . . they’re going to point to the rural environments to the fact that they’re pushing this (right- sizing idea).”
For its part, the state is pushing it.
Its proposal states: “. . . Medicare cost coverage has remained stable, even increased, for Critical Access Hospitals. This fact points to the central thrust of our goal: consolidate and right-size Wyoming’s rural hospital and EMS system around sustainable payer sources, such that, by the end of the funding period:
• “The smallest rural hospitals can focus on doing the basics well (e.g., emergency services, stroke and trauma, EMS, and labor and delivery), leveraging Medicare CAH reimbursement and swing-bed occupancy to stay viable, while cutting extraneous cost centers;
• “Elective procedures are funneled to larger (likely PPS) hospitals, to increase their viability by increasing service volume —and thus improve economies of scale and quality of care;
• “EMS agencies are interoperable on a regional basis, centered around entities like CAHs and fire departments that have existing bases of funding to support the fixed costs of readi- ness, and using regional medical dispatch to coordinate resources like Community EMS and interfacility transfers; and people have options for affordable health benefits that can cover emergency medical episodes.”
This story was published on Dec. 10, 2025.