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Wisconsin health insurance marketplace: history and news of the state’s exchange

Average premiums in WI decreasing for the second year in a row, thanks to reinsurance. WPS (Arise Health Plan) is rejoining the Wisconsin exchange for 2020.

Latest Wisconsin exchange updates

Wisconsin exchange overview

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

Wisconsin is one of the states that has done the least to preserve the Affordable Care Act’s provisions.

Wisconsin uses the federally run exchange, which means residents use HealthCare.gov to enroll in exchange plans. Wisconsin has a generally robust health insurance exchange, with 13 carriers offering plans for 2020 — far more than most other states, and an increase from 12 participating insurers in 2019. But coverage is localized, with counties in the southern part of the state generally having more insurer options than counties in the northern part of the state.

Almost two-thirds of Wisconsin’s individual market enrollees have coverage through the exchange (as opposed to off-exchange).

Wisconsin still has an operational ACA-created CO-OP. There were 23 CO-OPs in 2014, but Wisconsin’s Common Ground Healthcare Cooperative is one of only four remaining the country.

There were 14 insurers offering plans in the Wisconsin exchange in 2017, but three left at the end of 2017. Molina rejoined the exchange for 2019, and WPS (Arise Health Plan) is rejoining for 2020, bringing the total number of participating insurers to 13.

Rates were sharply higher in 2018, but a significant portion of the rate increase was due to the elimination of federal funding for cost-sharing reductions (CSR). The cost of CSR has been added to silver plans, which means premium subsidies also grew significantly in 2018, and they continue to be disproportionately large. Average rates decreased in 2019, thanks to the state’s new reinsurance program, and are decreasing again for 2020.

Former Governor Scott Walker, a Republican, pushed back against the ACA. Walker refused federal funding to fully expand Medicaid and before leaving office, he secured federal approval to impose a Medicaid work requirement in Wisconsin (which may or may not be implemented). But Walker lost the 2018 election to Tony Evers, who wants to expand Medicaid and would prefer to go even further, with “BadgerCare for All.” During his first year in office, Evers has continued to push for Medicaid expansion. In his 2019-2020 budget, he highlighted the money that Wisconsin is leaving on the table by not expanding Medicaid.

Another average rate decrease for 2020, and WPS (Arise Health Plan) is rejoining the exchange

Average premiums decreased in Wisconsin’s individual market in 2019, thanks to the state’s new reinsurance program. And the reinsurance program is successfully keeping a lid on premiums as it heads into year two, with overall average premiums decreasing again for 2020, by 3.2 percent (as opposed to increasing by about 9 percent, which would have been the case without the reinsurance program).

A total of 13 insurers will offer plans in the Wisconsin exchange for 2020, up from 12 in 2019. They filed the following average rate changes for 2020:

  • Aspirus Arise: 0.44 percent increase
  • Common Ground Healthcare Cooperative: 9.35 percent DECREASE (on top of a nearly 19 percent decrease in 2019)
  • Children’s Community Health Plan: 16.78 percent DECREASE
  • Dean Health Plan: 7.9 percent increase
  • Group Health Cooperative of South Central Wisconsin: 4.41 percent DECREASE
  • HealthPartners Insurance:  9.56 percent DECREASE
  • Medica Health Plans of Wisconsin: 12.22 percent DECREASE
  • MercyCare HMO Inc: 5.97 percent increase
  • Molina: 9.86 percent DECREASE (on top of an 18 percent decrease for 2019). Molina rejoined the Wisconsin exchange for 2019 (in seven counties), after exiting at the end of 2017.
  • Network Health: 7.45 percent DECREASE
  • Quartz Health Benefits: 1.32 percent DECREASE
  • Security Health Plan of Wisconsin, Inc: 4.69 percent increase
  • WPS (Arise Health Plan): 1.14 percent DECREASE (Arise Health Plan is rejoining the Wisconsin exchange for 2020, in rating area 11, after only selling plans outside the exchange in 2017, 2018, and 2019).

For perspective, here’s a look at how premiums have changed in Wisconsin’s exchange in previous years:

2019 enrollment down about 9 percent, after falling about 7% the year before

During the open enrollment period for 2019 coverage, 206,970 people enrolled in plans through Wisconsin’s exchange. That’s about 9 percent lower than the 225,435 people who enrolled for 2018, and it’s down from a high of nearly 243,000 people in 2017.

Enrollment is lower in 2019 in almost all states that use HealthCare.gov, although some of the state-run exchanges have reported higher enrollment for 2019 (and many of them are continuing to allow people to enroll in January, whereas open enrollment ended December 15 in all of the states that use HealthCare.gov).

The drop in enrollment in 2018 was partially due to higher premiums for people who don’t get premium subsidies. And although average premiums dropped slightly in 2019 for people who don’t get subsidies, they’re still much higher than they were in 2017, making coverage fairly unaffordable for people with income just a little above the subsidy-eligibility cutoff point (400 percent of the poverty level).

And other factors contributed to the drop in enrollment for 2019, most notably the elimination of the individual mandate penalty after the end of 2018, the expansion of short-term plans and association health plans as alternatives to individual market coverage, and the Trump Administration’s decision to again sharply reduce funding for exchange marketing and enrollment assistance.

For perspective, here’s a look at QHP enrollment in previous years in Wisconsin’s exchange:

  • 2014: 139,815 people enrolled during open enrollment
  • 2015: 207,349 people enrolled during open enrollment
  • 2016: 239,034 people enrolled during open enrollment

Starting in 2019, Wisconsin is receiving federal funding for a reinsurance program that is stabilizing the individual market

In March 2018, lawmakers in Wisconsin passed SB770, and Governor Scott Walker signed on March 28 (Act 138). The legislation directed the state to submit a 1332 waiver to CMS, seeking federal funding for a reinsurance program in Wisconsin (Democratic efforts to include amendments in SB770 calling for a Medicaid buy-in program and a “robust rate review” process were unsuccessful).

Alaska, Oregon, and Minnesota had already established reinsurance programs, and saw much more stable premiums in their individual markets for 2018. Wisconsin is one of several states that adopted a similar program starting in 2019.

The Wisconsin Office of the Commissioner of Insurance published a draft of the 1332 waiver in March 2018, and the state submitted the final waiver proposal to CMS on April 18. The waiver proposal was approved by CMS on in July 2018, and will provide federal funding for the state’s reinsurance program for five years, starting in 2019.

Under the reinsurance program, the state will start to pick up 50 percent of the cost of a claim once it reaches $50,000. The state will continue to pay 50 percent of the cost until the claim reaches $250,000.

Rate filings in Wisconsin were due in early July (before the federal funding for reinsurance had been approved), so insurers in Wisconsin had to submit two sets of rates for 2019 plans — one based on the reinsurance program being approved (with lower rates that reflect the decreased risk to insurers), and one based on the status quo, without reinsurance. Ultimately, the lower rates were implemented, since the federal funding was approved.

Governor Walker’s office initially stated that average premiums for 2019 would be 3.5 percent lower in 2019 than they were in 2018, due to the implementation of the reinsurance program. In October, they revised that to an average rate decrease of 4.2 percent.

The reinsurance program is projected to cost $200 million per year. $170 million of that is expected to come from the federal government, in the form of pass-through savings. Because premiums will be lower while the reinsurance program is in effect than they would have been without it, premium subsidies (paid by the federal government) will also be lower, since they won’t need to be as large in order to make coverage affordable. The idea behind the pass-through funding is that the state gets to take the money that the federal government saves due to lower premium subsidies, and use it to fund the reinsurance program.

The state’s portion of the reinsurance program cost would come, in part, from savings due to the fact that the health insurance provider fee has been suspended for 2019. The money that the state won’t have to spend to cover the fee for the state’s group health insurance program (for state employees) and Medicaid managed care plans would instead be diverted to help fund the reinsurance program.

Insurer participation in Wisconsin’s exchange: Changes over time

2014 and 2015
The Wisconsin exchange had 13 carriers in 2014, but had 15 for 2015, with the entry of two new carriers:UnitedHealthcare and Managed Health Services Insurance Corporation (AmBetter).

2016
In October 2015, less than a week before open enrollment began for 2016 coverage, Anthem Blue Cross Blue Shield announced that they would pull out of the Wisconsin exchange in three counties: Milwaukee, Racine and Kenosha, where nearly a quarter of the state’s population resides. Anthem also announced that they would significantly reduce the number of available plans in 34 other counties in the state.

Network Health joined the Wisconsin exchange for 2016, offering plans in seven counties: Calumet, Milwaukee, Outagamie, Ozaukee, Racine, Waukesha, and Winnebago. The plans were also available outside the exchange.

2017
14 carriers offered plans in the Wisconsin exchange for 2017. Ambetter, United, Physicians Plus, and WPS (Arise Health Plan) exited the exchange at the end of 2016, but Children’s Community Health Plan and Aspirus Arise joined the exchange for 2017:

  • UnitedHealthcare also exited the individual market in Wisconsin at the end of 2016. United offered plans in 56 of Wisconsin’s 72 counties in 2016, but they had one of the two lowest-cost silver plans in just one of those counties.
  • Ambetter (Managed Health Services Insurance Corp.) also left the individual market in Wisconsin at the end of 2016.
  • WPS (Arise) announced that they would not offer plans in the exchange in 2017, but would continue to offer plans outside the exchange. According to their rate filing, They only offered off-exchange plans in 19.5 counties (out of the 39 counties where they offered coverage in 2016), and limited their off-exchange plans to Bronze and Catastrophic plans in 2017. Arise had a “small share” of the individual market in 2016. But Aspirus Arise (a new, separate entity) began offering coverage in north-central Wisconsin in 2017, on and off the exchange.
  • In their rate filing memo, Physicians Plus confirmed that their plans would only be offered outside the exchange in Wisconsin in 2017, and that they would exit the exchange at the end of 2016.
  • Humana left the individual market in Wisconsin at the end of 2016, as was the case in at least a handful of other states. Humana did not participate in the exchange in Wisconsin, so their exit only impacted off-exchange plans. According to Humana’s letter regarding their exit, there were 6,639 members whose coverage was scheduled to terminate at the end of 2016.
  • Children’s Community Health Plan (CCHP) is an HMO owned by Children’s Hospital of Wisconsin, and prior to 2017, they only offered coverage through Wisconsin’s BadgerCare Medicaid program. In the fall of 2015, CCHP expressed interest in offering plans on the Wisconsin exchange in 2017, and began working through the filing process involved. The proposal was approved, and CCHP began offering exchange plans in six southeastern Wisconsin counties in 2017: Kenosha, Milwaukee, Ozaukee, Racine, Washington, and Waukesha.
  • Aspirus Arise was a new carrier, offering HMO and POS plans in 16 north-central Wisconsin counties in 2017, both on and off the exchange. Aspirus Arise confirmed by phone that they are a separate entity from Arise Health Plan. The carrier was created in a joint effort in 2016 by Aspirus and Arise.

2018
In 2018, Wisconsin still had one of the most robust exchanges in the country in terms of the number of participating insurers, but Anthem, Molina, and Health Tradition Health Plans all left the exchange at the end of 2017, resulting in about 75,000 people needing to select new plans for 2018.

Anthem only offered one off-exchange plan in one county in 2018 (Menominee County, which has a population of just 4,500 and is one of the poorest counties in the state; off-exchange plans are not eligible for premium subsidies, so participation in this plan has likely been extremely low). The continuation of off-exchange coverage in Menominee County prevented a full market exit, which means that Anthem has the option to return to the state’s full individual market — including the exchange if they wish to do so — at any point in the future. A full market exit would trigger a five-year lockout from the state’s individual market, per federal regulations that pre-date the ACA.

Molina announced in August 2017 that they would exit the exchange in Wisconsin (and in Utah) at the end of 2017. Their total enrollment in Wisconsin, which included people with Medicaid and Medicare, was 130,000, and the Milwaukee Journal Sentinel reported that about 55,000 of those people had coverage in the individual market (it’s unclear what percentage of that population had on-exchange coverage, but it’s likely the majority; Molina did not market their ACA-compliant plans off-exchange for 2017, although some of their individual market enrollees likely had grandmothered and grandfathered plans).

Molina explained that Utah and Wisconsin were among the states where their marketplace performance had been “most disappointing” and that during the second quarter of 2017, Molina had spent 128 percent of the premiums collected in the Utah and Wisconsin exchanges on medical care (for reference, the ACA requires insurers to spend at least 80 percent of premiums on medical care as opposed to administrative expenses, but an amount of 100 percent or more is clearly unsustainable, as it means that the insurer is spending more on claims than it’s collecting in premiums, with no room for administrative costs at all).

Health Tradition Health Plans exited Wisconsin’s entire individual market at the end of 2017. Based on Health Tradition’s 2017 rate filings, their membership in 2016 was fewer than 10,000 people. But all of their remaining individual market enrollees needed to select new plans for 2018.

Gunderson Health Plan Inc. offered plans in the Wisconsin exchange in 2017, but there were no rate filings for Gunderson for 2018 on ratereview.healthcare.gov. However, earlier in 2017 there was a multi-insurer merger/acquisition that involved Gunderson.

Although Gunderson plans did not appear in the rate filings for 2018, Unity Health Plans filings were submitted. Unity already offered plans in the exchange in 2017, and their website noted that they were affiliated with UW Health/UnityPoint as the on-exchange insurance entity. But the Gunderson/Unity group transitioned to marketing plans under the name Quartz, and Unity’s website now redirects to the Quartz site. Quartz plans will be available in the Wisconsin exchange for 2020, but not Gunderson or Unity plans.

As rate filings trickled in around the country in the spring and early summer of 2017, there were initially 82 counties nationwide that didn’t have any exchange plans filed for 2018. One of them was Menominee County, Wisconsin, where 47 people were enrolled in exchange plans in 2017, and where Molina had been the only insurer offering exchange plans in 2017. Security Health Plan eventually stepped in to provide coverage in the exchange in Menominee County in 2018.

2019
Molina continued to offer one bronze plan off-exchange, in Shawano County in 2018. But the premium on that plan increased by 106.3 percent that year, and it was not actively marketed. But by continuing to offer the off-exchange plans, Molina avoided a full market exit and was able to rejoin the exchange for 2019. They offered silver and gold plans in seven counties in the exchange in 2019, and discontinued the off-exchange bronze plan that they had offered in 2018 in Shawano County (it really only served as a place-holder so the Molina would have the option to return to the exchange/individual market in 2019 or a future year).

2020
WSP (Arise Health Plan) is returning to the Wisconsin exchange for 2020, with plans available in rating area 11. This brings the total number of participating insurers to 13.

Medicaid buy-in failed to pass

In the summer of 2017, Democratic state lawmakers in Wisconsin introduced legislation in the Assembly (AB449) and Senate (SB363) that would have allowed Wisconsin residents to buy into BadgerCare, the state’s Medicaid program (Medicaid in Wisconsin has not been expanded under the ACA, but it does cover people with income under the poverty level, so there is no coverage gap in Wisconsin). The idea was that BadgerCare would serve as a public option, competing with private insurance plans in the individual market.

Citizen Action of Wisconsin, an advocacy group, supports the push for a public option in Wisconsin, and the Democratic candidates who vied to run against Republican Governor Scott Walker in 2018 expressed support for the Medicaid buy-in (including Tony Evers, who ultimately defeated Walker, and who wants to implement a BadgerCare for All program in Wisconsin). But the legislation faced an uphill battle in the Republican-controlled Wisconsin legislature, and did not advance in the 2018 session.

New Mexico lawmakers passed a similar bill in 2017, but Governor Brian Sandoval vetoed it. Colorado enacted legislation in 2019 that directs the state to conduct a study on the feasibility and costs of a public option, which could include a Medicaid buy-in program. But for now, there are no states where residents who aren’t eligible for Medicaid can buy into the program.

Under Walker’s administration, Insurance Commissioner supported AHCA & return to high-risk pools

The day after House Republicans passed the American Health Care Act (AHCA), Ted Nickel, who was at that time Wisconsin’s Insurance Commissioner, voiced his support to the legislation. In a May 2017 MacIver Institute article, Nickel welcomed the potential return to high-risk pools under the AHCA, and waxed about the benefits of Wisconsin’s pre-ACA high-risk pool, the Health Insurance Risk Sharing Plan (HIRSP), which closed once health plans in the private market became guaranteed-issue, regardless of medical history.

Nickel stated that for three decades, HIRSP provided solid coverage to Wisconsin residents, and indicated that at least some of those residents are worse off under the ACA (it’s noteworthy that people who qualify for significant premium subsidies in the exchange are likely paying lower premiums now than they were under HIRSP, but not everyone qualifies for substantial subsidies).

HIRSP covered roughly 24,000 people in the pre-ACA days when health insurance was medically underwritten in the private market, making it among the largest high-risk pools in the nation. And premiums were only about 20 percent to 30 percent higher than standard rates. That’s much better than most states’ high-risk pools, however, as high-risk pools typically had rates that were at least 50 percent higher than standard rates, and in some states, they were double the standard rates.

Governor Walker initially indicated that Wisconsin would be open to pursuing an AHCA waiver to eliminate some of the ACA’s consumer protections, which would have created an opportunity to reinstate HIRSP (the AHCA would have allowed states to opt-out of the ACA’s essential health benefits requirements; they would also have been allowed to let insurers charge premiums based on applicants’ medical history if the applicant had a gap in coverage during the prior year). But by the next day, after significant backlash over the potential evisceration of protections for people with pre-existing conditions, Walker appeared to backtrack on his position, saying that the state was “not looking to change” the current pre-existing condition protections.

All of that is a moot point, since the AHCA was never enacted. But it did highlight the health care reform positions of Wisconsin’s governor and insurance commissioner under the Walker administration. Governor Evers appointed Mark Afable as the state’s new Insurance Commissioner in January 2019.

State objected to HHS re-enrollment plan

As outlined in the 2017 Benefit and Payment Parameters, Healthcare.gov implemented a new protocol for 2017 that allowed the exchange to automatically re-enroll people whose 2016 carrier would no longer be offering any plans in the exchange for the coming year. But the state of Wisconsin— along with Nebraska — objected to the idea that Healthcare.gov would automatically pick a new plan (for enrollees who didn’t make their own plan selection) if their 2016 carrier was exiting the exchange.

Governor Walker and Insurance Commissioner Nickel (who was elected president of the National Association of Insurance Commissioners in December 2016) argued that the government does not have the right to force people into contracts with insurance carriers, or to direct people to one carrier over another. They also noted that as far as they were concerned, the proposal to automatically re-enroll people in plans from different carriers essentially amounted to selling health insurance without a license, which is not permitted in Wisconsin (or any other state, for that matter).

The Wisconsin Office of the Insurance Commissioner issued a press release in which they informed consumers how to opt-out of HealthCare.gov’s auto re-enrollment. Consumers could, of course, simply select a new plan by December 15 in order to avoid auto re-enrollment. But if they did not wish to continue to have coverage through the exchange, they could also log back into the exchange by December 15 and follow the steps to opt-out of auto re-enrollment (this is available to all HealthCare.gov enrollees in every state; it’s not specific to Wisconsin, but Wisconsin officials have been vocal in letting their residents know about the opt-out feature)

On October 31, 2016, the day before open enrollment began, Nickel published a bulletin for insurers in Wisconsin, reiterating the fact that the state considers HealthCare.gov’s automatic re-enrollment to be in violation of Wisconsin insurance law, but noting that the automatic re-enrollment would happen anyway, for up to 37,000 Wisconsin residents (many of them likely returned to the exchange to pick their own plans or opt-out of auto re-enrollment prior to mid-December, and were thus not automatically re-enrolled in plans selected by the exchange).

The October 31 bulletin laid out some guidelines for insurers to follow in the event that they received enrollments from HealthCare.gov that had not been initiated by the consumer (ie, that were automatic re-enrollments). Insurers that followed the guidelines did whatever they could to inform the consumers of the plan selection and gain consumer consent to enroll in the plan. By doing so, the carriers remained in compliance with Wisconsin insurance guidelines.

CO-OP still operational; one of just four left in the nation

Wisconsin is one of the states that has an ACA-created CO-OP. Common Ground Healthcare Cooperative received federal loans to get up and running, and has been offering health insurance in Wisconsin since the beginning of 2014. Initially, there were 23 CO-OPs offering plans in 25 states. But only four are still operational as of 2019; Common Ground is one of them.

By early 2017, Common Ground reported that they had experienced strong enrollment growth during in November and December, and had roughly 32,000 enrollees by that point. They had roughly 19,000 members in 2016, and their target for 2017 had been 30,000 to 35,000 enrollees.

Common Ground Healthcare Cooperative lost money in 2014 — as did all but one of the CO-OPs. Their claims exceeded premiums by almost $44 million, and they enrolled more than two and a half times as many people as they had expected in 2014. All carriers that ended up with higher-than-expected claims were supposed to get risk corridor payments to help cushion the losses, but HHS announced in October 2015 that payments would be just 12.6 percent of the amount due. This threw several CO-OPs into financial crises, and Insurance Commissioners across the country had to make some tough decisions regarding the financial viability of the CO-OPs.

But Common Ground survived. In November 2015, Common Ground announced that they were adding Bellin Health System to their Envision Integrated Care Network, which also includes Aurora Health Care. In 2015, there were 23,629 members enrolled in Common Ground Healthcare CO-OP plans.

Of the 11 CO-OPs that were still operational at the start of 2016, seven had closed by the end of 2017. Common Ground is among the four that are still operational. Although they lost nearly $17 million in the first half of 2016, they secured a capital infusion from an undisclosed source in September 2016 that allowed them to remain financially viable heading into 2017.

Common Ground’s average premiums increased by 63 percent in 2018. But for 2019, Common Ground decreased their average premiums by nearly 19 percent, indicating a new level of stability for the insurer. For 2020, Common Ground is again decreasing their premiums, this time by more than 9 percent. The CO-OP had about 29,000 members in 2017.

Bill to increase rate oversight did not pass

In September 2015, Wisconsin State Senator Chris Larson and State Rep. Debra Kolste announced the introduction of new legislation (AB359) that would have required Wisconsin to utilize a robust rate review process, much the same as many other states. Among other things, the legislation would have required the Insurance Commissioner to hold public hearings on proposed rate increases over ten percent, and would also have given the Insurance Commissioner the ability to deny rate hikes that aren’t justified by claims costs.

The legislation noted that “current law prohibits premium rates from being excessive, inadequate, or unfairly discriminatory”, and the state does have an outside actuary that reviews the rates. HHS also reviews proposed rates that include a premium increase of 15 percent or more (this threshold used to be 10 percent). But Larson and Kolste’s bill would have given the Wisconsin Insurance Commissioner far more regulatory oversight for health insurance premiums. However, it was considered unlikely that the bill would pass in the state’s Republican-dominated legislature; indeed, by mid-April 2016, the legislation was dead.

Wisconsin Medicaid – a unique approach…

Wisconsin has not expanded Medicaid under the ACA, but has taken a more proactive approach than most non-expansion states in providing coverage for people living in poverty.  Wisconsin dropped the existing BadgerCare Medicaid eligibility to 100% of poverty level, which resulted in 72,000 people losing BadgerCare eligibility.  Since subsidies for private Obamacare plans purchased in the exchange begin at 100% of poverty level, the residents who lost BadgerCare eligibility were able to purchase heavily subsidized plans in the exchange instead.

However, critics have noted that a lot of those 72,000 people (with incomes just over 100% of poverty) were probably unable to afford a private plan, even with the available cost-sharing and premium subsidies.

As of the beginning of September, the state estimated that 25,800 former BadgerCare members had not yet enrolled in a subsidized plan through the exchange.  They initially had until June 30 to do so, but HHS granted them another special enrollment period during which they could apply for a subsidized plan in the federally-facilitated Wisconsin exchange. The Wisconsin Department of Health Services sent letters to the former BadgerCare enrollees who had not yet obtained new coverage, informing them of the special enrollment period.

But an additional 83,000 childless adults with incomes below 100% of poverty level were newly eligible for BadgerCare in 2014. Wisconsin created its own version of Medicaid reform without using the federal funds allocated by the ACA.  As a result, the state was able to make its own rules, and people in Wisconsin with household incomes between 100% and 138% of the poverty level are expected to purchase subsidized private plans — they are not eligible for Medicaid.

…but not fully expanded Medicaid

Technically, this means Wisconsin has not expanded Medicaid under the ACA (if it did, people with incomes up to 138 percent of poverty would be eligible for Medicaid and the state would receive federal funding for Medicaid expansion). Although Governor Scott Walker has received criticism from consumer advocates, among states that have not expanded Medicaid, Wisconsin is the only one without a coverage gap, since BadgerCare was expanded to cover everyone up to 100% of poverty level (in most states that did not expand Medicaid, eligibility limits are far lower than that).

Nevertheless, 19 Wisconsin counties and the city of Kenosha added referendum questions to their ballots in November 2014, asking citizens to weigh in on Gov. Walker’s decision to not fully expand Medicaid under the ACA. Voters passed all 20 of the ballot initiatives, but they are essentially just a way of communicating resident wishes to lawmakers, as the final decision on expanding Medicaid is up to the Governor and the state’s lawmakers.

Wisconsin’s go-it-alone approach to modified Medicaid expansion could end up being financially challenging, as the state incurred significantly higher Medicaid spending in 2014 and did not have the federal government funding Medicaid expansion as they would do if the state followed the guidelines laid out in the ACA (federal funding would have covered 100 percent of newly-eligible enrollees through 2016, and then the state would gradually pay a small portion of the new expenses, capping out at 10 percent by 2020).

Over four years, it’s estimated that the total cost to state and federal taxpayers for Wisconsin’s unique approach to Medicaid will be $2 billion more than it would have been under straight Medicaid expansion as called for in the ACA.

Wisconsin exchange history

Former Gov. Walker had previously expressed a preference for a state-run exchange rather than a “one size fits all” federally operated exchange. In 2011, Walker used an executive order to create the Office of Free Market Health Care to plan for a Wisconsin exchange.  Walker’s plan for a “free-market, consumer-driven approach” leaned heavily on an insurance marketplace implemented by former Gov. Jim Doyle. According to one state insurance expert, the only notable change proposed by Walker was to put the exchange online.

However, Walker showed a changed mindset in 2012, returning a $38 million federal grant and closing the Office of Free Market Health Care. In announcing his November 2012 decision to accept a federally operated exchange, Walker said the state would have no real control and much higher financial risk with a state-run exchange.

Wisconsin was one of only seven states with a federally facilitated marketplace that had at least ten carriers in 2014. But despite the robust competition, Wisconsin’s exchange rates were relatively high in 2014. The average premium for the lowest-cost bronze plan in Wisconsin in 2014 was $287, compared with $249 nationally.

Citizen Action of Wisconsin, a liberal-leaning group pushing for Medicaid expansion and a public option in the state, highlighted the very different ACA paths taken by Minnesota and Wisconsin, and placed some of the blame for Wisconsin’s high rates on the fact that the state ultimately took a hands-off approach to the exchange and also refused to accept federal funds to expand Medicaid.

Wisconsin health insurance exchange links

HealthCare.gov
800-318-2596

Wisconsin Office of the Commissioner of Insurance
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Wisconsin.
(800) 236-8517 / ocicomplaints@wisconsin.gov

State Exchange Profile: Wisconsin
The Henry J. Kaiser Family Foundation overview of Wisconsin’s progress toward creating a state health insurance exchange.

Wisconsin Department of Health Services


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.