Wisconsin’s commissioner of insurance says the stalemate over Affordable Care Act subsidies at the heart of the government shutdown is already affecting available health insurance options.
Democrats in Congress insist that a short-term federal funding bill should include an extension of ACA tax credits that made more people eligible for financial assistance on the marketplace after they were passed in 2021. Most Republicans say the issue should be negotiated separately from other government funding.
Nathan Houdek is the Wisconsin insurance commissioner. He recently told WPR’s “Wisconsin Today” that the state hit a record-high 313,000 enrollments this year in the ACA marketplace, but that could change with fewer subsidies in place.
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“We’re very concerned about what not extending the enhanced premium subsidies is going to do for our ACA market as we go into 2026,” he said. “We’re very concerned that without the enhanced premium subsidies being extended, we’re going to see tens of thousands of people potentially lose that coverage.”
Open enrollment for next year’s insurance opens up in November.
On “Wisconsin Today,” Houdek talked about concerns for losing subsidies, rising health care costs and the upcoming start to open enrollment.
The following was edited for brevity and clarity.
Rob Ferrett: The enrollment period for marketplace coverage starts Nov. 1. How important is it that this subsidy issue gets resolved one way or another by then?
Nathan Houdek: I mean, the sooner the better. Frankly, this should’ve been solved months ago. Insurance commissioners, my colleagues from across the country, have sent I think four different letters collectively to Congress, going back to earlier this year, explaining the importance of making sure that these enhanced premium subsidies are extended.
And the longer this drags out, the more negative impact it’s going to have on people’s ability to get coverage. We can still make it work for next year’s coverage period. But the longer this drags out, the more challenging it’s going to be for people to get the coverage they need for next year.
RF: Republican and Democratic insurance commissioners seem to be on the same page. Are you generally seeing that kind of bipartisan support from your colleagues around the country?
NH: Yes, there is bipartisan concern from my colleagues in states across the country, red states and blue states. Because everyone is seeing a negative impact as we look ahead to next year from not extending the enhanced subsidies. In some states, we’re seeing premiums being filed for next year that are increasing by as much as 40 to 50 percent.
RF: The enhanced subsidies were passed under a COVID-related piece of legislation. This was kind of an emergency plan to help people out during a tough time. Is there a case to be made to say that the emergency is over?
NH: The reality is we continue to see health care costs overall increase. And as a result, we see health insurance costs increase because health insurance reflects the underlying cost of health care overall. Keeping the subsidies in place is really important to make sure that people can afford health care coverage as we’re seeing costs increase.
RF: What about downgrading options on the marketplace?
NH: One of the important things to remember about the Affordable Care Act marketplace is that there are certain guaranteed health care coverage aspects. You know that if you’re getting an ACA market health plan, you’ll be able to get access to maternity care and to visit your doctor and get the different care that you need.
The concern is that with some of these other non-ACA-compliant plans, that you don’t get that level of coverage, and on top of that, it can actually cost more for people. That’s really been one of the strengths and one of the benefits of the ACA marketplace is that it’s provided good, strong health care coverage that allows people to get the care they need for themselves and their families. And if they lose that coverage and have to go on lesser coverage with higher deductibles and higher out-of-pocket costs and less benefits, that’s very concerning for access to care for people across the state.
RF: Are you concerned that some insurance providers might withdraw from some markets in the state?
NH: Unfortunately, that’s a concern as we already look to next year. Insurance companies are looking at the market dynamics, looking at what makes sense for them from a business practice standpoint and having to make decisions about what plans they’re offering in the marketplace and what services areas they’re offering those plans.
We’ve been very fortunate. Over the last few years, we’ve seen more insurance companies providing more plan options in almost every corner of the state. Because of the subsidies being in place, people have been able to find ACA-compliant plans no matter where they live in Wisconsin at a very affordable rate. But that’s going to change. We’re very concerned that people, regardless of where you live in the state, are going to experience some pretty extreme sticker shock when the open enrollment period begins, and that will lead to people, unfortunately, dropping coverage.
