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U.S. Senator Mike Enzi, R-Wyo., highlighted the unique health care challenges that Wyoming faces as a frontier state during a Senate health committee hearing today focused on understanding the cost of health care in America.

Enzi said that being from Wyoming, the least populated state in the nation, he is always interested in ways that the state can encourage or support competition to help drive down costs, because without competition, people cannot shop for lower prices.

“Our biggest city is 60,000 people. Our towns are all 40 miles apart. There are only 19 towns where the population exceeds the elevation,” Enzi said. “So we face some of the highest health care costs in the country. There are no competitive hospitals in any of the communities and we lack a lot of specialists.”

Dave Hyman, a professor at Georgetown University Law Center and a witness at the hearing, noted that he did not think there was magic solution for rural communities, but he did highlight the potential benefits of having states update their laws to help advance telemedicine and the utilization of physicians assistants and nurse practitioners that are less expensive to train.

Another witness, Dr. Melinda Buntin, the Mike Curb Professor and Chair of the Department of Health Policy at Vanderbilt University School of Medicine, suggested using creative ideas to create beneficial competition that hospitals could use to lower costs.

According to Buntin, this could include using targets and benchmarks that hospitals or groups of providers could use to compete against their own past or similar areas, and then share their results with state, federal or private insurers.

“I agree that it is a really large challenge for rural areas, and we probably can’t use the same method of competition as we do in urban areas, but we can get creative about the types of competition we introduce,” Buntin said.