Gov. Matt Mead lamented the $100 million that Wyoming left on the table by choosing not to expand Medicaid, and he expressed concern for the state's hospitals while discussing health care with the Star-Tribune recently.

Mead echoed some of the fears that many Wyoming hospital officials have expressed for months: that congressional proposals to overhaul the health care system may have negative effects on facilities here and that the state has suffered because it chose not to allow more people to qualify for Medicaid.

"The idea that we did not accept Medicaid expansion and things are going to be good just hasn't turned out," he said.

He said that because the state didn't expand Medicaid -- a proposal he supported in the past -- Wyoming has missed out on $100 million a year in federal aid. He added that in Wyoming, the program is currently facing a $20 million deficit.

"I'm not going back in time, but when you're turning away $100 million a year as a state because you don't want to be part of the (Affordable Care Act), I mean, it's a problem," he said.

He still supported expansion but said the Legislature likely would be even less interested in the coming session, given the uncertainty coming from Washington.

He thought the proposals from Congress to overhaul the Affordable Care Act were a "mixed bag." While he supported keeping protections for chronically ill Americans and allowing younger adults to stay on their parents' insurance plans for longer, he worried there wasn't enough in the bills to address Wyoming's rural nature.

"Rural states are different, and I wanted to make sure we weren't treated the same as a big state," he said.

"The ACA, there's certainly some room for improvement," he continued. "But to throw it out just because it's the ACA, I don't think that's a good idea."

He said he spoke with governors across the country and that they were "all over the board" when it came to health care reform. But he noted that Gov. Brian Sandoval, the Republican governor of Nevada who helped expanded Medicaid, came out against repeal because it had cut uncompensated care there and that care in general had improved.

Mead said he was concerned about what uncertainty would do to the insurance market in Wyoming. Blue Cross Blue Shield, the sole provider on the federal insurance exchange here, announced earlier this month that it planned to raise premium rates by nearly 50 percent. A spokeswoman for the company said uncertainty from Washington was to blame for the spike.

Hospital and health officials have said that uncertainty -- particularly related to the future of the individual mandate -- would cause prices to jump. Now that the concern has become a reality, the governor said something needed to be done to stabilize markets.

"They're going to get some push back on 48 percent," he said of Blue Cross Blue Shield, "but if you’re in that business and you don’t know whether you’re going to be under the (Affordable Care Act) or the brand new -- whatever that may be -- how do you calculate that?"

He noted that rates of uncompensated care -- essentially unpaid hospital bills for often uninsured patients -- remain high under the Affordable Care Act, and some rural hospitals are operating on 60-days cash. He predicted that those rates will increase as premiums become more expensive: As fewer people have insurance, more will use the emergency room as a form of primary care when their need is greatest and most expensive.

That will put a strain on hospitals.

"If (Congress) doesn't do anything, we have to watch out for our small hospitals, even our large hospitals, and I would anticipate there's going to be a greater expenditure by the state," he said.