Health care in America is at a crossroads, with affordability and access dominating the national conversation. Recent interviews and legislative developments have shone a spotlight on the challenges and opportunities facing both urban and rural communities. As policymakers, insurance executives, and local officials grapple with rising costs and shifting federal priorities, the stakes for everyday Americans have never felt higher.
David Cordani, chairman and CEO of The Cigna Group, offered a candid assessment of the nation’s health care landscape during a recent appearance on Fox News’ “Special Report” with Bret Baier. Cordani didn’t mince words about the root causes of the current affordability crisis. "The affordability issue in America is something that most people agree to. That’s fundamentally based on two things: our population is getting a bit older and our health status is eroding—fully 60% of all Americans are dealing with at least one chronic illness and disease," he explained, according to Fox News. Rising pharmaceutical costs, he noted, are only making matters worse.
For Cordani, the best way to curb costs is prevention. "The best way to lower health costs is to avoid a health event from ever transpiring. The second-best way is, if you’re dealing with a chronic condition, to get the best possible care and coordination. A lot of that is pharmaceutical care, and most often, a generic drug is the best. If you’re confronting a major medical challenge, which a small but significant percentage of Americans do every year, it’s about getting to a center of excellence, and we work toward that each and every day."
He also pointed to recent industry-government partnerships as a sign of progress. In June 2025, the health insurance industry, including The Cigna Group, joined forces with the federal government—specifically Secretary Kennedy and Administrator Oz—pledging to expand access to services and create more public-private partnerships. "In June, the industry partnered with the federal government through Secretary Kennedy and Administrator Oz with a pledge to expand overall access to service and create more public-private partnerships to further improve overall affordability for the benefit of Americans. That’s how we move forward," Cordani said during the interview.
While national health care debates often focus on urban and suburban populations, rural communities face a unique set of hurdles. Nowhere is this more apparent than in Wyoming, where health officials are racing against the clock to secure up to $800 million in federal funding through the Rural Health Transformation Program. The program, created by President Donald Trump’s One Big Beautiful Bill Act, aims to distribute $50 billion over five years to support rural hospitals and providers, according to WyoFile.
Wyoming’s Department of Health has been crisscrossing the state, holding 11 public meetings and fielding surveys to gather residents’ input on how best to spend the potential windfall. Franz Fuchs, the department’s deputy director, emphasized the urgency and importance of public engagement. "We get one bite at the apple, for them to approve or deny it," Fuchs told WyoFile. "We really focused on public engagement, which I think is different from a lot of states. I know certain states have not done any of this, and so I hope it pays off."
The challenges facing Wyoming are daunting: vast distances to care, persistent nursing shortages, fragile hospital finances, and a steady erosion of specialty services. The state’s application for federal funds is due November 5, 2025, with Governor Mark Gordon set to review it by October 27. Health department staff have focused their outreach on narrowing priorities, aiming to outline strategic initiatives that reflect residents’ most pressing concerns. These include workforce shortages, preventative health options, maternity care gaps, behavioral health needs, hospital accountability, mobile health units, and transportation solutions.
Yet even as Wyoming eyes this unprecedented funding opportunity, advocates and officials alike are wary of overpromising. The same federal act that created the Rural Health Transformation Program also mandates a $793 billion reduction in Medicaid spending nationwide over the next decade. For Wyoming, that could mean nearly 200 jobs lost per year and a $140 million contraction in the state’s economy over five years, according to an economic analysis cited by WyoFile.
Further complicating matters, enhanced premium tax credits on the Affordable Care Act marketplace are set to expire at the end of 2025. Without renewal, thousands of Wyoming residents—between 11,000 and 20,000, according to Healthy Wyoming—could lose their insurance coverage due to rising premiums. Some 46,000 state residents currently rely on the ACA marketplace for health insurance, making the looming expiration a source of anxiety for families and policymakers alike.
Fuchs struck a note of cautious optimism about the federal program’s potential. "I think we want to be realistic," he said. "$500 million over five years, it’s certainly nice and we want to be responsible stewards of that money and try to make it go the farthest it can. At the end of the day, we’re just hoping to do the best we can with the money, make sure that it goes to good use and try to make these as sustainable as possible."
Back on the national stage, Cordani highlighted some bright spots in the fight for affordability. He cited a large employer in the Southeast whose health costs had risen less than 3% annually over the past five years, thanks to innovations developed by The Cigna Group. The company itself ended 2024 with a 27% revenue surge, reaching $247 billion—a testament, Cordani argued, to the value-driven approach that rewards companies for improving health outcomes rather than simply processing more claims.
Still, the broader picture remains complex. As Cordani acknowledged, "Our health status is eroding, but there’s also a cost challenge, which is significantly exacerbated by the rising cost of pharmaceuticals. And again, the President is focused on that." He stressed the importance of both improving affordability and expanding access to care, noting The Cigna Group’s “Commitment to Better” initiative, which aims to ease service access, expand supportive services, and deliver more value and affordability for individuals. "I’m proud to say that happened in early 2025," he told Fox News.
Public sentiment, as reflected in Wyoming’s town halls and surveys, echoes these national concerns. Residents have called for greater hospital accountability, more robust mobile health options, and better transportation to care facilities. Preventative health and behavioral health services have also emerged as top priorities. The hope is that by aligning federal resources with local needs, states like Wyoming can make meaningful progress—even if the road ahead is uncertain.
For now, the health care debate continues to rage from boardrooms to kitchen tables, with no easy answers in sight. But as leaders at every level push for innovation, coordination, and smarter spending, Americans are watching closely, hoping that the system can deliver on its most basic promise: affordable, accessible care for all.
