ARI SHAPIRO, HOST:
The Republican plan to repeal and replace the Affordable Care Act has failed for now, and we've been looking at how Obamacare, as it's known, is doing in different states. Yesterday we heard from California, a state where consumers have options and the marketplace seems to be thriving. But as the president has pointed out, that's not true everywhere.
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PRESIDENT DONALD TRUMP: Many Americans lost their plans and doctors altogether. And one-third of the counties - think of it - one-third only have one insurer left. I mean the insurance companies are fleeing. They're gone, so many gone.
SHAPIRO: In fact, at least five whole states have just one insurer offering plans on the state exchange. One of those is Wyoming. Tom Glause is the commissioner of the Wyoming Department of Insurance. He says there are a lot of reasons why things are different in his state.
TOM GLAUSE: First of all, we do not have that population to attract a lot of people to the exchange. I think that it's also - as a rural state, our citizens do not like being told what they have to purchase. We are a frontier state, and that doesn't sit well with a lot of our people. The other problems that we've experienced is the cost. The cost of insurance on the exchange is high. The deductibles are high.
SHAPIRO: And so do you think this is a law that was designed for densely populated states that could just never work in a state like Wyoming, or do you think there are things that could attract more insurers to the marketplace?
GLAUSE: There are certainly things that can attract more insurers to the marketplace. Right now the uncertainty makes it nearly impossible.
SHAPIRO: You mean uncertainty about the future of the law, whether it'll remain intact, be repealed and replaced, or just collapse on itself or what.
GLAUSE: The uncertainty surrounding all of it right now - whether the administration will continue to appeal the decision in the House versus Burwell suit regarding cost-sharing reductions. The insurance companies don't know right now, and insurance companies do not react well to uncertainty.
SHAPIRO: Yesterday when we spoke to an insurance official in California, he told us that one of the big reasons for the success in his state is advertising and other programs that the state put in place to get people to enroll which keeps costs down, which keeps more insurers in the marketplace. Do you think Wyoming has done all it could in that respect?
GLAUSE: I read that with interest that he had stated that California spent $100 million in advertising. Interestingly, $100 million would fund all of the subsidies or the advance premium tax credits that the Wyoming consumers received for a year. However, I don't think that was a shortfall in Wyoming. Enroll Wyoming was very well-positioned to advertise and get the word out regarding the marketplace and the ACA.
SHAPIRO: Do you think any national plan can fit both the demographics of Wyoming and the demographics of a state like California? Or in your opinion, would a state-by-state approach be better?
GLAUSE: Whatever we wind up with, I think it's going to have to have a state-by-state approach. What works in California probably will not work in Wyoming. They've got 30 million people compared to our low population of 600,000.
SHAPIRO: What would you like to see from leaders in Washington right now?
GLAUSE: I would like to see them attack the root of the problem, and that is the delivery of health care services in the United States. We're trying to do this through insurance, and that will have limited success until we actually attack the problem head-on.
SHAPIRO: Tom Glause is Wyoming's insurance commissioner. Thank you for joining us.
GLAUSE: Thank you very much for inviting me, Ari, and the interest you have shown in Wyoming.
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