Back in December, the state with the smallest population in the country, Wyoming, looked like it might finally carry the ACA Medicaid expansion football into the end zone:

‘Let’s just get this done’: Wyoming Legislature to consider Medicaid expansion again in 2023

Medicaid expansion will be up for debate once again when the Wyoming Legislature convenes for its 67th session in January.

The legislature’s Joint Revenue Committee voted to advance the Medical Treatment Opportunity Act to the legislative session during a meeting this month.

It’s the same bill the legislature considered during the 2022 session, state staffers said.

The proposed legislation would allow Medicaid expansion to occur in Wyoming as long as the federal contribution to the program remains at 90 percent or higher.


With South Dakota becoming the latest holdout state to finally expand Medicaid to adults earning up to 138% of the Federal Poverty Level (FPL) under the Affordable Care Act last month, there's now just 11 states remaining which still haven't done so.

The smallest of these, which is also the smallest state in the country, is Wyoming, which has had a long & storied history when it comes to Medicaid expansion fakeouts. The "Equality State" legislature has considered expanding Medicaid to the roughly 19,000 residents who would become newly eligible for the program eight times since the ACA was signed into law in 2010, only to see approval of it fail at one stage or another every time.

 Well, according to this article by Katie Roenigk at "County 10" in Fremont County, Wyoming, it looks like the 9th time may be the charm:

South Dakotans Decide Healthcare


Back in January 2021, I. noted that:

...over the past few years, the voters of some of those states have decided to take it upon themselves to force their legislators/governors to expand Medicaid anyway, via statewide ballot initiative campaigns:

The 2023 ACA Open Enrollment Period is still ongoing in 6 states, and many people can still enroll in other states as well!

The 2023 OEP is the best ever for the ACA for several reasons:

  • Second, because several states are either expanding or retooling their own state-based subsidy programs to make ACA plans even more affordable for their enrollees;

There's also expanded carrier & plan offerings in many states/counties, and as always, millions of people will be eligible for zero premium comprehensive major medical policies.

If you've never enrolled in an ACA healthcare policy before, or if you looked into it a few years back but weren't impressed, please give it another shot now. Thanks to these major improvements it's a whole different ballgame.

Here's thirteen important things to know when you #GetCovered for 2023:

Back in 2019, long before the American Rescue Plan passed, I embarked on an ambitious project. I wanted to see what the real-world effects would be of passing a piece of legislation which would eliminate the Affordable Care Act's so-called "Subsidy Cliff" while also strengthening the subsidy formula for those who qualified. Call it "ACA 2.0" for short, if you will (that's what I do, anyway).

This legislation has been around in near-identical form under one official title or another for years, usually bundled within a larger healthcare package. In 2018 it was called the "Undo Sabotage & Expand Affordability of Health Insurance Act of 2018" (or "USEAHIA" which is about as awkward a title as I can imagine.

In 2019 it was rebranded as the "Protecting Pre-Existing Conditions and Making Healthcare More Affordable Act" or "PPECMHMAA," which somehow managed to be even more awkward.

So Close


With all 50 Republican Senators refusing to lift a finger to fight climate change, tackle prescription drug pricing or extend the enhanced ACA subsidies for over 13 million people, Democrats have watched helplessly as two of their own Senators (Joe Manchin and Kyrsten Sinema) have repeatedly blocked or otherwise stymied efforts to get these vital measures through the Senate.

The drama appears to finally be coming to an end this weekend, however.

Last week Sen. Manchin announced that he & Senate Majority Leader Chuck Schumer had come to an agreement on a heavily modified & pared-down version of what was once called the "Build Back Better Act"...newly christened as the "Inflation Reduction Act of 2022". He then spent the past week pushing the bill heavily on TV appearances/etc, and the rest of the Democratic leadership joined in a coordinated effort to promote the bill.

On the last episode of "Who Wants to Try and Appease Joe Manchin?," the entire Democratic Senate caucus, as well as President Biden, had basically given up on trying to get West Virginia Senator Joe Manchin to be reasonable after spending a solid year listening to him come up with one excuse after another not to pass an ever-shrinking domestic "soft infrastructure" agenda.

In the end, they accepted that the $3.5 trillion "Build Back Better" package, which was later slashed to around $1.6 trillion by the time it passed the House of Representatives last fall, wasn't going to happen.

Instead, they were going to have to accept a shadow of its former self: A roughly $300 billion healthcare-only package which would primarily accomplish only two of the major provisions of the original pacakge (and only part of those):

As depressing as it may be to see President Biden's original $3.5 trillion American Families Plan (that was the actual name of the "soft" infrastructure portion of the Build Back Better agenda; since then the "hard" infrastructure portion which passed has been rebranded as the "Bipartisan Infrastructure Bill" while the American Families Plan was rebranded as...Build Back Better) get whittled down to less than $300 billion, the good news (such as it is) is that it looks like at least that much is finally going to happen...probably:

It’s official. Democrats’ Manchin-ified health-care reconciliation bill is moving forward.

via Covered California:

Covered California Announces 2023 Plan Rates: Lower Than National Average Amid Uncertain Future of American Rescue Plan Benefits

  • California’s individual market will see a preliminary rate increase of 6 percent in 2023, due in part to the return of normal medical trends that existed prior to the COVID-19 pandemic and the uncertain future of the American Rescue Plan.
  • Despite the uncertainty, the rate change is below the national average thanks to Covered California’s 1.7 million enrollees and the state’s healthy consumer pool, which remains among the best in the nation.
  • Covered California also announced that a 13th carrier would join the marketplace, and an existing carrier would expand to become the second one to offer statewide coverage.
  • All Californians will have two or more choice of carriers, 93 percent will be able to choose from three or more, and 81 percent will have four or more choices.
New York State of Health

via NY State of Health:

ALBANY, N.Y. (July 11, 2022) – NY State of Health, the state’s official health plan Marketplace, today released Health Insurance Coverage Update: Impact of ARPA Subsidies. The enrollment report, which compares data from March 2020 to May 2022, describes how millions of New Yorkers have benefitted from access to affordable, comprehensive coverage through the Marketplace thanks to flexibilities permitted during the Federal COVID-19 Public Health Emergency (PHE) and ARPA premium subsidies. Currently, federal enhanced subsidies do not extend into 2023 and New York’s uninsured rate is expected to rise, reversing the progress in insurance coverage made since the start of the pandemic.

Read the Marketplace’s July 2022 Health Insurance Coverage Update: Impact of ARPA Subsidies