Health insurance premiums increase as Affordable Care Act open enrollment underway in Wisconsin

The Affordable Care Act’s open enrollment season is underway in Wisconsin, and Brookfield resident Kristin Schlingman is facing a stark financial reality: a significant increase in her health insurance premiums. This has forced Schlingman and her 60-year-old husband, who is officially retired, to consider drastic measures, including whether one of them needs to return to work just to secure group health insurance coverage. Wisconsin’s individual market rates are projected to rise about 22 percent on average, according to the state insurance commissioner.

The Rising Cost of Coverage: A Deeper Dive into Wisconsin’s Healthcare Landscape

Wisconsin’s individual market rates are projected to rise about 22 percent on average, according to the state insurance commissioner. This increase follows a 26 percent jump from 2025 to 2026, largely due to the expiration of enhanced premium tax subsidies. Nationally, KFF, a health policy research organization, projects ACA monthly premiums for a 40-year-old will rise to $511 per month – a 13 percent increase before subsidies. This marks the second year in a row consumers are set to see double-digit percentage increases. Understanding these numbers requires some context. The enhanced premium tax credits were a temporary provision of the American Rescue Plan Act, designed to mitigate the financial impact of the pandemic. Their expiration has directly contributed to the current premium increases. Furthermore, the rising cost of healthcare itself – driven by factors like pharmaceutical prices, administrative overhead, and the aging population – is a persistent underlying pressure on insurance rates.

“We saved well for retirement and have had a budget that we’ve been able to live comfortably in,” Schlingman said. “However, that’s an extra $600 to $700 a month that we have to come up with. So something else has to (be) cut back or we have to dig further into our retirement savings… I don’t want to use up all my retirement paying for insurance.” Schlingman's situation isn’t unique. Many Wisconsin residents, particularly those in older age brackets and with fixed incomes, are finding it increasingly difficult to afford healthcare. The prospect of delaying or forgoing necessary medical care due to cost is a serious concern, potentially leading to poorer health outcomes and increased long-term healthcare expenses.

Navigating the Changes: Resources for Wisconsin Families and Understanding the Open Enrollment Period

Wisconsin's Covering Wisconsin program, run by the University of Wisconsin-Madison Extension, offers free guidance for consumers enrolling in health coverage. Director Allison Espeseth said some Wisconsin residents are seeing proposed prices for next year jump, impacting both the premium and the deductible. “For many of them, the prices are going up, both in either the premium or that deductible, which is the cost that you pay before the insurance kicks in,” Espeseth explained. “Some folks are seeing some lower costs, so it can happen. There’s always a range, which is always why we say it’s really important to go in to check it out. Don’t just make assumptions.” The open enrollment period is a critical time for Wisconsinites to review their coverage options and make informed decisions. It typically runs from November 1st to January 15th, although specific dates can vary. During this period, individuals can enroll in a new health plan or make changes to their existing plan. Outside of the open enrollment period, enrollment is generally restricted to those who have experienced a qualifying life event, such as losing a job or having a baby. Covering Wisconsin provides assistance with navigating this process, helping individuals understand their options and find plans that fit their needs and budgets.

Understanding Deductibles and Cost-Sharing

Espeseth’s mention of deductibles is crucial. A deductible is the amount you pay out-of-pocket for healthcare services before your insurance plan starts to cover the costs. Higher deductible plans typically have lower monthly premiums, but require you to pay more upfront for care. Understanding the deductible, copays (fixed amounts you pay for specific services), and coinsurance (a percentage of the cost you pay after meeting your deductible) is essential for choosing a plan that aligns with your anticipated healthcare usage.

Impact on Immigrant Communities: A Disproportionate Burden

Beyond price increases, upcoming changes under the Affordable Care Act will affect a wider range of Wisconsinites. Vanessa Silva, a bilingual benefits navigator for Family Health Center of Marshfield, reported that certain categories of lawfully present immigrants—including refugees, green card applicants, and asylum seekers—are set to become ineligible for remaining ACA tax credits or cost-sharing help. Silva recommends that consumers apply for financial assistance programs, even if they don’t think they qualify, to help with deductibles, out-of-pocket costs, and copays. The impact on this vulnerable population is particularly concerning. Many of these individuals have limited access to other forms of healthcare coverage and rely on the ACA subsidies to afford essential medical care. The loss of these subsidies could force them to forgo necessary treatment, leading to poorer health outcomes and potentially exacerbating existing health disparities.

The Family Health Center of Marshfield and its Role

The Family Health Center of Marshfield plays a vital role in providing accessible healthcare services to the community, particularly those with limited resources. As a bilingual benefits navigator, Silva’s work is critical in connecting individuals with the resources they need to access affordable healthcare. Her experience highlights the challenges faced by healthcare providers in navigating complex policy changes and advocating for their patients.

Potential for Future Solutions: State-Level Subsidies and Legislative Action

While the current situation presents challenges, there’s a glimmer of hope on the horizon. Marquette University Professor of Health Policy Lisa Grabert stated that recent elections have opened up the possibility of state-level subsidies to offset new costs for consumers. “With the flip of both chambers in the Wisconsin (legislature) and a trifecta of alignment, I think that becomes a more distinct possibility in the state of Wisconsin,” Grabert said. The concept of state-level subsidies is gaining traction in several states as a way to address the affordability gap created by the expiration of federal subsidies. However, implementing such a program would require legislative action and significant financial investment from the state. The political feasibility of such a proposal remains to be seen, but the recent election results suggest a renewed possibility for exploring this option.

The Bigger Picture: Healthcare Costs and Wages – A Growing Crisis in Wisconsin

The increasing costs of health insurance aren’t an isolated issue. Reports indicate that healthcare costs in Wisconsin are rising faster than wages, placing a significant strain on household budgets. Wisconsin governor candidates have offered opposing plans to address these rising costs, reflecting the ongoing debate about how to ensure affordable access to healthcare for all residents. This trend isn't unique to Wisconsin; it's a national problem. However, the state's demographics and economic conditions exacerbate the situation, particularly for low-income families and those living in rural areas where access to healthcare services may be limited. The disparity between healthcare costs and wages is contributing to financial instability for many Wisconsin families, forcing them to make difficult choices between healthcare and other essential needs.

Looking Ahead: Advocacy, Awareness, and the Future of Healthcare in Wisconsin

The increasing costs of health insurance are a stark reminder of the challenges families face as they navigate the complex landscape of healthcare in the United States. The situation highlights the need for proactive measures and community support. It is essential for Wisconsin residents to stay informed, actively seek out resources like Covering Wisconsin, and advocate for policies that promote affordability and accessibility in healthcare. Beyond individual action, collective advocacy is crucial. Engaging with elected officials, supporting organizations working to expand access to healthcare, and raising awareness about the challenges facing Wisconsin families can help drive meaningful change. The future of healthcare in Wisconsin depends on a collaborative effort involving policymakers, healthcare providers, community organizations, and individuals working together to find sustainable solutions.

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