The cost of charity care provided by the Wyoming Medical Center has declined in recent years because more people obtained insurance through the Affordable Care Act insurance exchange, the hospital's chief financial officer said Tuesday.

"We did see a positive impact with our patients, and we have financial counselors who are able to help our patients obtain insurance through the insurance exchange," Yvonne Wigington said after meeting with the Natrona County commissioners during a work session.

Despite the failure of Congress to repeal and replace the Affordable Care Act, the Wyoming Medical Center pays close attention to the political scene and how that may affect the costs of care, Wigington said.

"We stay on top of, and research, any new tax laws or health care laws that would impact us, however, at this point in time it's a little difficult to predict the future," she said.

The Wyoming Legislature has repeatedly refused to expand Medicaid -- the federal health insurance program for the poor -- in Wyoming.

That has hurt the ability of hospitals in the state to further rein in costs because people are uninsured or underinsured, hospitals write off those costs for care and pass them along to patients who can afford to pay.

Two years ago, Wigington said Colorado accepted the federal offer of Medicaid expansion, and all it hospitals began operating at a profit.

She has not heard any discussion about bringing the issue before the Legislature in 2018, she said.

Even so, the Wyoming Medical Center has written off less charity care since 2011.

It declined from $34.5 million in fiscal year 2011 to $22.2 million in fiscal year 2017 that ended June 30, Wigington said during her presentation.

In the 2017 fiscal year, $16.8 million, or 75.8 percent, of that care was provided to Natrona County residents, and $5.4 million, or 24.2 percent was provided to people outside the county, she said.

However, the Wyoming Medical Center has had to write off an increasing amount of bad debt, Wigington said.

In fiscal year 2011, the hospital wrote off $19.9 million in bad debt from patients who do not pay for their care. That amount rose to $27.1 million in fiscal year 2017. Of that total, $20.1 million, or 74 percent, was from Natrona County residents.

Wigington attributed the increase in bad debt to rising deductibles of $5,000 to $10,000, and that's too much for some patients to pay.

Overall, the combined charity care and bad debt -- collectively known as uncompensated care -- written off by the hospital has declined from $54.4 million in 2011 to $49.3 million in 2017.

Wigington's report is a requirement of the non-profit Wyoming Medical Center's lease of the Natrona County-owned hospital assets, which mostly are located in the 1200 block of East Second and East Third streets.

The rent, in effect, of the WMC's use of the county hospital assets is to provide charity care, provide care for prisoners at the county jail (the county contributes $120,000 a year for prisoner care), handle involuntary commitments through an arrangement with the Wyoming Behavioral Institute, maintain adequate insurance for the property and employees, and to maintain the value of the hospital assets.

The lease is overseen by a five-member board of trustees called the Memorial Hospital of Natrona County. The county commission appoints the trustees. MHNC trustee Serena Cobb joined Wigington for the presentation.

Wigington said prisoner care has not followed the smoother trends of charity care and bad debt costs. It was $319,907 in 2011, dropped to $159,829 in 2012, rose dramatically to $600,963 in 2016, and fell to $422,260 in 2017.

Involuntary commitments have risen generally from $904,641 in 2011 to $1,421,395 in 2017, she said.

The Wyoming Medical Center also has increased the value of the county hospital assets from a base line of $62.9 million in 1995 to $288.7 million in 2017, Wiginton said.