WASHINGTON — Wyoming, with an economy marked by farming, ranching and small businesses, has a disproportionate number of people without medical insurance. And by that measure and others, its people are among the likely winners if Congress approves a healthcare overhaul.
But if Republican Sen. Michael B. Enzi was expecting a pat on the back from his constituents for working with some of his fellow senators to seek bipartisan agreement on the issue, he was disappointed.
Last week, Enzi held a town hall meeting in his hometown of Gillette. And when he told the 500 people in the audience that he believed both sides could eventually strike a deal, it turned out that wasn't a popular thing to say.
A state legislator even stood up and demanded that Enzi pull out of the congressional talks altogether, and was widely applauded by the audience.
The scene in Gillette was replicated in towns across the U.S. last month, as screaming taxpayers filled TV screens with criticism of healthcare proposals. The clashes dramatized a conundrum faced by lawmakers such as Enzi who are seeking compromises.
Some of the most vociferous opposition to the proposals before the House and Senate comes from residents of rural states that could benefit most if the present system is revamped.
"The states that tend to be more conservative have a higher rate of people who are uninsured," said Ron Pollack, executive director of FamiliesUSA, which backs a healthcare overhaul. "As a result, healthcare reform is going to provide a disproportionate amount of resources to those states."
In Wyoming, for example, nearly 1 in 3 people younger than 65 went without health insurance at some point during the last two years, according to Pollack's group. A huge majority of the uninsured have jobs, but work for employers who don't provide coverage.
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Fewer options
The problem pervades other rural states as well, where a high percentage of employers are small businesses. Although there is a consensus in Congress for keeping the current employer-based system of medical insurance, that system is riddled with holes in coverage that disproportionately affect rural states.
In addition, both in the West and South, such states tend to set higher thresholds for Medicaid eligibility, leaving few options for low-income earners who can't afford individual insurance coverage.
