Changes Coming to Wisconsin’s ACA Health Coverage

Appleton, Wisconsin – Significant alterations are on the horizon that are likely to increase healthcare premiums for those using the Affordable Care Act (ACA) marketplace.

One of the providers, Common Ground Health Care Co-op, has informed customers in 11 Wisconsin counties that they will discontinue offering coverage next year.

This decision aligns with ongoing Congressional discussions regarding the potential extension of premium grants originally implemented during the pandemic.

The affected counties include Outagamie and Winnebago, home to nearly 7,000 customers enrolled with Common Ground.

Those impacted will need to explore new provider options starting November 1st, facing very limited choices.

Mike Orlinger, who depends on the ACA market for his health insurance, is worried about a premium hike if Congress doesn’t extend the grant. “We’re now paying almost $900 a month for coverage through the market. That’s just not okay. If these subsidies go away after this year, the looming premium increases are really concerning,” he shared.

While Orlinger might not be a typical customer, there’s a clear understanding of the challenges posed by shrinking options.

This situation has prompted some state lawmakers to highlight that the ramifications extend beyond low-income individuals. “The biggest issue I see is that many people don’t realize this impacts everyone. There’s a tendency to think that those who don’t need assistance are just fortunate,” one legislator noted.

Common Ground notified customers via email that their decision stems from escalating health costs and unexpected shifts in how health services are being utilized. “These trends are occurring both in our state and nationwide, making it tough for us to operate sustainably,” the message stated.

Aside from Outagamie and Winnebago, other counties affected include Calumet, Fond du Lac, Sheboygan, Waupaca, and Waushara.

“This is really a wake-up call when you see all those counties listed in the Common Ground communication. Even insurance providers are struggling to keep up with these issues,” Orlinger expressed.

State Senator Christine Dusler Alfheim pointed out that the insurance sector is in a state of disarray, with even many lawmakers grappling to fully grasp the situation.

Common Ground issued a statement saying, “Common Ground Healthcare Cooperative (CGHC) has made the challenging choice to exit the market in 11 Wisconsin counties. Current members will continue to receive quality care through the end of 2025 and will have the opportunity to select a different health plan during the upcoming open enrollment period which begins on November 1st.”