How much more are ~40,000 WYOMING ACA enrollees *really* paying this year due to Trump/GOP policies?

IMPORTANT: See the original post in this series for an explanation of the methodology.

Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees being caused by the combination of Congressional Republicans allowing the enhanced federal tax credits to expire as well as other Trump Regime policy changes for well over a year and a half now.

I've written countless analyses of how much both gross and net premiums skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics...and recently it was confirmed that over 2.6 million ACA exchange enrollees had already been priced out of the market as of February, with the number almost certain to climb further throughout the rest of 2026.

As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so remaining enrollees as of February have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.

In most cases this means moving to plans with higher deductibles, higher co-pays & higher coinsurance costs. In many cases this has also included moving to plana with worse networks, referral requirements to see specialists and so on.

With that in mind, that's exactly what I've decided to set out to do: Calculate the average year over year increase not just in net premiums (that is, how much more ACA enrollees are having to pay each month) but also the year over year change in average out of pocket costs.

Let's look at WYOMING:

Here's a look at ACA exchange plan selections during Open Enrollment by household income level this year vs. last.

Like most states, Wyoming has seen enrollment plummet across most income brackets. Overall, plan selections have dropped by 5,000 people versus OEP 2025...which is a tiny number in the scheme of things but which represents an 11% year over year reduction:

Onto the main analysis:

Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by Actuarial Value (AV) category. The first table is based on official metal level tiers, but it's the second table which is critical, since a huge chunk of ACA enrollees are usually enrolled in CSR Silver plans (which include Cost Sharing Reduction assistance). CSR assistance dramatically boosts the AV of Silver plans up to Platinum levels in most cases.

As has happened in nearly every other state, the remaining ~40,000 Wyomingites who were able to sign up for coverage have been forced to "buy down" to worse coverage; enrollment in all of the high-value metal levels & AV categories is down, while enrollment in standard Silver and Bronze plans has jumped significantly (granted, "significantly" is a relative term given Wyoming's tiiny population).

As a result, the average actuarial value for enrollees dropped by 3 points.

By combining these numbers with the average gross premiums per enrollee I'm able to calculate an estimate of the average total medical expenses each enrollee racks up each year assuming an 80% average Medical Loss Ratio (as I stated in the original post, this can vary widely by carrier and year, so should be considered a very broad average only), which looks like so:

On average, Wyoming enrollees, who already pay among the highest gross premiums in the country, have seen their net premiums jump by 75% this year, while by my estimates they're also paying around 43% more in out of pocket expenses.

Combined, that's roughly a 55% average increase in total healthcare expenses on average...or a stunning $2,300 per enrollee.

Oh yeah...based on KFF's net data, average deductibles have also gone up ~45% this year and now average around $3,400 for single coverage. The maximum (theoretical) out of pocket cut-off for all ACA enrollees went up by over 15% this year as well, however, to $10,600 for single coverage.

Next up: NATIONAL AVERAGE!