Exchange enrollment in Wyoming has remained level despite only two insurers offering coverage. The state’s few commercial carriers are retooling plans and offering designs aimed at the chronically ill. Medicare Shared Savings ACOs exist in Wyoming but there are not a lot of new participants. Medicaid expansion has failed to in the state legislature. Wyoming’s senate shot down an attempt to create a reinsurance program that would have reduced premiums for some residents in 2020 by as much as 17 percent. BCBS of Wyoming and Mountain Health CO-OP both submitted premium rate decreases for 2022.