The economy of Gillette, Wyo., has slumped along with the fortunes of companies like Devon Energy and Peabody Energy, which have slashed jobs because of the prolonged downturn in oil and gas prices.
Taxes on property, coal and oil support the county-owned hospital, but revenue has dipped because of dwindling population and a rising number of uninsured residents amid the layoffs. Wyoming, so far, has chosen not to expand Medicaid under the Affordable Care Act.
“We were really optimistic when the legislation was passed that there would be more folks with insurance and things would get better for hospitals,” said Dalton Huber, chief financial officer of Campbell County Health in Gillette.
The promise of the Affordable Care Act for hospitals was that bad debt—a figure that reflects bills a hospital can't collect—would shrink substantially under the law's coverage expansions. The reality, so far, is less uniformly dramatic, even though 20 million fewer Americans are uninsured. Even in states that agreed to expand Medicaid, the popularity of high-deductible plans in those insurance exchanges has added to hospitals' mounting concerns over how patients can pay those bills, if at all.