About 40,000 to 60,000 Wisconsinites who buy health insurance through the Affordable Care Act could lose coverage, the state’s top insurance official estimated, if Congress does not extend subsidies that make the health plans cheaper.
The subsidies helped drive this year’s record-high enrollment in the Affordable Care Act marketplace, with about 300,000 Wisconsin consumers signing up for coverage. That could be undone, Wisconsin Insurance Commissioner Nathan Houdek said, if the subsidies go back to previous, reduced levels at the end of the year, when increases to the financial aid expire.
“Many of the advances we’ve made … are at risk,” Houdek said. “It’s really critically important that Congress act.”
Democrats in Washington, D.C., have demanded that Republicans extend the increased subsidies as part of any deal to fund the federal government and end the shutdown, now the longest in the nation’s history. While some Republicans have expressed interest in extending them, most in the party are opposed or say they won’t discuss it until after the government is reopened.
“Democrats are the ones who set these subsidies to expire, not Republicans. And they should expire,” Sen. Ron Johnson said on X, essentially calling the subsidies a Band-Aid for the “failures” of the Affordable Care Act.
Houdek, the insurance commissioner, discussed the subsidies during a Nov. 4 kick-off event for the open enrollment season, when consumers may sign up for an Affordable Care Act plan or make changes to their coverage.
Consumers who cannot get health insurance through work or through a public program, such as BadgerCare Plus, may buy coverage through the marketplace set up by the Affordable Care Act, on HealthCare.gov.
The deadline to enroll is Jan. 15, though for coverage to begin on Jan. 1, consumers must sign up by Dec. 15.
This season is expected to be tumultuous. Without the higher subsidies, many consumers will notice a spike in premiums, in some cases two or three times what they pay now. What’s more, consumers will have fewer choices of plans, after some insurers pulled out of the marketplace in parts of the state or the region.
“This will be another unique, unprecedented year for enrollment heading into 2026,” said Cheryl Isabell, the Milwaukee community engagement lead for Covering Wisconsin, a program that helps people sign up for health coverage.
Most consumers shopping on the marketplace will qualify still for a subsidy to help with premium costs, but the subsidy will be smaller. Others whose income is too high to qualify will no longer get a subsidy and will have to pay the full sticker price of plans sold on the marketplace.
Houdek warned the uninsured rate could rise if those consumers decide their marketplace plan is not worth the cost and drop coverage. Roughly 5% of the Wisconsin population is uninsured, according to 2023 Census estimates.
He encouraged consumers to shop around and find the coverage that fits their budget and is right for their health care needs.
“There are still a lot of affordable options for people, regardless of where you live,” he said.
For help signing up for coverage, Houdek said to work with trustworthy resources, such as licensed insurance agents or navigators. Covering Wisconsin is the state’s navigator program and was created under the Affordable Care Act to provide free, impartial help signing up for coverage.
Consumers may visit coveringwi.org/enroll and use the site’s connector tool to plug in their ZIP code and find nearby appointments with a navigator or other enrollment assister. WisCovered.com also has resources.
“They can go straight to those websites or call and get their questions answered,” Isabell said.
Consumers may also turn to community health centers or free clinics for help, which typically have navigators or certified application counselors available, Isabell said. They include Sixteenth Street Community Health Centers, Progressive Community Health Centers, Outreach Community Health Centers and Milwaukee Health Services, Inc.
Hospital systems typically have counselors on staff, as well, she said.
Reporter Sarah Volpenhein can be reached at svolpenhei@gannett.com or at 414-607-2159.
This article originally appeared on Milwaukee Journal Sentinel: Up to 60,000 Wisconsinites could lose Obamacare coverage if subsidies expire, insurance official warns
Reporting by Sarah Volpenhein, Milwaukee Journal Sentinel / Milwaukee Journal Sentinel
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