The Healthcare.gov website, where people can sign up for health insurance coverage under the Affordable Care Act (ACA). Sunday, Dec. 15, is the deadline to enroll for people who want coverage to start Jan. 1. (Screenshot | Healthcare.gov website)

People who want to sign up for health insurance coverage under the Affordable Care Act in 2025 must do so by the end of the day Sunday, Dec. 15, if they want coverage to start on New Year’s Day.

“For accidents or injuries or when illness strikes, the last thing that anyone should have to worry about is how they’re going to pay for that, or whether they’re going to fall into some sort of medical debt,” said Milwaukee County Executive David Crowley during an online press conference Friday to draw attention to the Sunday deadline.

The Affordable Care Act (ACA) imposed new consumer protection provisions for health insurance plans, among them a requirement that people cannot be denied coverage or charged higher premiums because of their personal health history.

The act also led to the creation of a federal health care marketplace Healthcare.gov, where people can purchase individual health insurance plans if they don’t have health coverage through an employer or some other group source, including Medicaid or Medicare. Healthcare.gov provides information about the plans available in a person’s geographic area.

The ACA open enrollment period for individual plans started Nov. 1. Whether people are enrolling for the first time — because they’ve lost their coverage through work, for example — or renewing their insurance after enrolling previously in 2023 or before, “you should take advantage of this time right now,” said Joe Zepecki of Protect Our Care, a national campaign to support and strengthen the ACA. Protect Our Care organized Friday’s news conference.

People who sign up for a plan at Healthcare.gov must do so by Sunday, Dec. 15, to get coverage that starts Jan. 1.  For people who enroll after Sunday, 2025 coverage won’t start until Feb. 1. The final deadline for enrolling is Jan. 15.

People can get guidance in assessing their choices of plans through the statewide health insurance navigator, Covering Wisconsin (coveringwi.org).  In addition to the website, Wisconsin residents can call 414-400-9489 in the Milwaukee area or 608-261-1455 in the Madison area to reach a navigator with the organization. Both telephone numbers are available to residents anywhere in the state.

As of Dec. 1, 88,189 Wisconsin residents have enrolled in coverage during the current open enrollment period, according to the federal Centers for Medicare & Medicaid Services (CMS). That’s slightly short of the pace at the same time last year, when 99,950 people enrolled by Dec. 2, the Wisconsin Office of the Commissioner of Insurance reported.

Almost 250,000 Wisconsin residents — a record number — have been covered in 2024 under plans provided through the ACA website, Zepecki said Friday.

Expanded federal tax credit subsidies tied to the income of an applicant have reduced the cost of plans purchased through the ACA dramatically. Those subsidies have reduced the cost for about 61,000 Wisconsin residents, Zepecki said, and will remain in effect through 2025, making health plans much more affordable for people.

The enhanced insurance premium tax credit subsidies were first instituted with the enactment in 2021 of the American Rescue Plan Act (ARPA) in the first year of President Joe Biden’s term, and they were extended in the 2022 Inflation Reduction Act.

Zepecki said that for a 45-year-old Wisconsinite making $60,000 a year, the enhanced subsidy would save about $1,442 a year. For a 60-year-old couple with a combined income of $82,000 a year, “the difference in having the premium tax credits and losing them is more than $18,000 a year,” he added. And for a family of four with a household income of 125,000 a year, the premium tax credits would save more than $8,200.

“This helps almost everybody who’s in the [federal health insurance] marketplace,” Zepecki said.

Sen. Tammy Baldwin (D-Wis.) said making the subsidies permanent “will be at the top of my list as something that helps working families across Wisconsin and across the United States” in the 2025 Congress. She said they will be part of “a very robust debate” about the tax code as Republican lawmakers seek to extend tax cuts enacted in 2017 during Donald Trump’s first term as president.

“I know we have some folks who are more focused, sadly, on tax breaks for the wealthy and big corporations,” Baldwin said. “I’m going to be fighting for working Wisconsinites.”

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WisCovered.com is operated by the Wisconsin Office of Insurance (OCI) to inform consumers seeking health insurance about their options, including BadgerCare and the Affordable Care Act's health insurance marketplace (Screenshot | WIsCovered.com)

People are getting health coverage under the Affordable Care Act (ACA) at a pace that approaches recent record-breaking years for the landmark federal health care law enacted 14 years ago.

In the first two weeks of November, when the annual open enrollment period to buy health insurance through the ACA’s platform Healthcare.gov began,  nearly half a million previously uninsured people in the U.S. signed up for coverage, according to the federal government. More than 2.5 million have renewed coverage that they purchased a year ago.

“We’re incredibly busy,” said Adam VanSpankeren, navigator program manager for Covering Wisconsin, a nonprofit that helps people looking for insurance. “There’s a lot of anxiety and people have concerns about the future of the ACA, but it’s not stopping them from getting coverage.”

Covering Wisconsin is federally funded and subcontracts with 44 navigator agencies across the state  — part of a program established under the ACA to guide people in assessing their options and choosing an appropriate health plan.

“Health insurance is really complicated,” VanSpankeren said in an interview. Navigators were included in the law to provide “people on the ground to explain to people how this works and how you sign up.”

To help spread awareness of coverage under the ACA, the Wisconsin Office of the Commissioner of Insurance (OCI) has been distributing information to community agencies, including local libraries and county health departments.

“Ensuring that everyone has access to high quality and affordable insurance on Healthcare.gov has been a priority of our office,” said OCI communications director Susan Smith. “Last year’s open enrollment period was the highest ever in Wisconsin, with over 254,000 people getting coverage.”

The open enrollment period to purchase health insurance for 2025 through the marketplace began Nov. 1. Through Nov. 16, according to the Centers for Medicare & Medicaid Services (CMS), 48,564 Wisconsin residents signed up.

While that’s lower than the same period a year ago, when nearly 59,000 people had enrolled, VanSpankeren doesn’t find that difference significant this early in the enrollment period.

People who enrolled last year are automatically renewed if they don’t change plans, and their enrollment numbers aren’t listed yet, he said. The full open enrollment period ends Jan. 15, 2025. For coverage starting Jan. 1, 2025, the deadline to enroll is Dec. 15.

Expanding health coverage

Enacted in 2010 and fully implemented four years later, the ACA instituted new standards for health insurance plans, including barring insurers from denying health insurance coverage or increasing premiums for people due to pre-existing health conditions.

The law required insurers to cover young people up to age 26 under their parents’ health plans, and required coverage for preventive care such as vaccines.

It also expanded the federal Medicaid program to cover families with incomes up to 138% of the federal poverty guideline. Under a U.S. Supreme Court ruling in 2012, Medicaid expansion was made optional, with states deciding whether or not to take part. Wisconsin is one of 10 states that has not done so. 

Healthcare.gov, the health insurance marketplace, was a central element of the ACA, because uninsured Americans are mainly people who don’t get coverage from an employer or through programs such as Medicaid.

“Most people get insurance from their jobs, but there are still millions and millions of people who don’t,” VanSpankeren said. Those include self-employed people and people with multiple part-time jobs and no health coverage. They also include people whose employers don’t offer insurance or offer plans that require employees to pay more than they can afford for coverage.

Under the ACA, plans sold directly to individuals and families must cover a list of essential health benefits. The federal health care marketplace requires insurers who participate to offer plans meeting the federal standards.

Having a government marketplace that sets minimum standards protects consumers, VanSpankeren said.

“There’s a lot of bad actors with bad products” — insurance plans that don’t meet the ACA’s standards, he said. Without Healthcare.gov to vet participating plans, “you have kind of a Wild West scenario.”

Outside the marketplace, unscrupulous operators, often from out of state, misrepresent the plans they sell, sometimes even switching people’s coverage without their knowledge, said Smith of OCI. OCI and insurance regulators from other states are working with CMS to address what “is still a national challenge,” she said.

Safe in 2025; after that, uncertainty

VanSpankeren said people enrolling this year are asking Covering Wisconsin navigators about what they’ll have to pay in the new year. The recent election is also on the mind of many.

“They want to know if a change in administration means anything for their plan,” VanSpankeren said. Current provisions in the law remain in effect through 2025, so “we can reassure people everything they’re doing today for the next year is good.”

Those provisions include enhanced tax-credit subsidies based on a person’s income that lower the cost of their health insurance premiums purchased on the marketplace. Those increased subsidies were first introduced in 2021 and extended in 2022 through the end of 2025.

Beyond next year, however,  ACA advocates are worried about their future.

Republicans, who will hold majorities in both houses of Congress starting in January, and President-elect Donald Trump have been openly hostile to the health law and tried repeatedly in Trump’s first term to end it without success.

On Friday, Protect Our Care, a national campaign to support and strengthen the ACA, highlighted a series of analyses looking at the impact of ending the subsidies after 2025. Protect Our Care also cited the ambition of Congressional Republicans to block their renewal.

KFF, a nonprofit health policy research, polling, and news organization, reported in a study in July that 92% of people covered under the ACA were subsidy recipients.

In a study published Nov. 14, the Center on Budget and Policy Priorities called for Congress to act by the spring of 2025 to give insurers time to set their rates for open enrollment a year from now.

“If Congress allows the improved tax credits to expire, nearly all marketplace enrollees, in every state, will face significantly higher premium costs,” the center stated.

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Health care advocate Laura Packard speaks at a Protect Our Care press conference Tuesday, Sept. 24. (Wisconsin Examiner photo)

Nearly 15 years after passage of the landmark federal law that expanded health care access across the country, health care remains a fixture on the ballot almost every November election.

This year is no exception. For advocates, health care is a central issue in both the national presidential campaign and in Wisconsin’s newly competitive contest for the state Legislature.

Sooner or later, virtually every American faces a struggle over how to pay for health care, Leslie Dach of Protect Our Care said during a visit to Madison Tuesday. Dach, a health advisor to President Barack Obama, founded Protect Our Care in 2017 to advocate for maintaining and strengthening federal health programs including the ACA.

“When you get sick, it takes over your life,” Dach said in an interview. “There’s no larger kitchen table issue in America. And it’s expensive, and a lot of people don’t have access to the care that they need, and so it’s a problem that affects really everybody — maybe not every day, but catches up with you at some point in your life.”

Besides being a personal issue, “it’s also a political issue now,” Dach added. The Affordable Care Act (ACA) remains under threat from Republican lawmakers. Some have also called for repealing all or part of the 2022 Inflation Reduction Act, including provisions making health insurance cheaper and allowing Medicare to negotiate the price of prescription drugs.

“The choices are very clear, and it’s both emotional and economic for people,” Dach said.

He was in Wisconsin for the second stop on the organization’s bus tour — a campaign to draw attention to the health care law’s increasing popularity and how it has been improved through laws such as the Inflation Reduction Act.

The Inflation Reduction Act extended tax credits that reduce the cost of health insurance policies that people buy on the ACA’s health insurance exchange through 2025.

Those credits have cut health insurance premiums by an average of $2,400 a year, said Joe Zepecki, Wisconsin representative for Protect Our Care, at a press conference outside the Protect Our Care campaign bus.

The 2022 law also capped insulin costs for Medicare patients at $35 a month and authorized Medicare to negotiate select drug prices. Starting in January, it will cap Medicare patients’ out-of-pocket drug costs at $2,000 a year.

“It is essential that everyone understands how they can benefit from these savings,” Zepecki said. “These policies are overwhelmingly popular. They touch nearly every household in America, whether you’re a senior or an individual struggling with a disability who’s having a hard time affording prescription drugs, a family purchasing your own health coverage, or a taxpayer who is sick and tired of lining the pockets of big drug companies.”

The Affordable Care Act also prevented insurers from rejecting patients or charging them higher premiums because of pre-existing health conditions — a practice that was routine until the ACA took effect.

“Insurance companies analyzed people with chronic conditions like cancer,” said Dr. Sophie Kramer, a Wisconsin physician for 35 years. “If you were born with a genetic heart condition or developed multiple sclerosis in your 30s, you were often out of luck.”

Prevention and protection

Without the ACA in place, “many people had to take the risk of no health insurance or opt for expensive, extremely high deductible plans,” Kramer said. Preventive care such as mammograms to detect breast cancer or colon cancer screenings are often treated as out-of-pocket costs until the ACA required coverage for a number of preventive health care measures, she added.

“The passage of the ACA changed this,” Kramer said. “Since 2014  … one in seven Americans and over 800,000 in Wisconsin have benefited from the ACA. This is tremendous progress.”

Despite that progress, she and others noted, Republican politicians have continued to bad-mouth the ACA and run on promises to repeal it.

“Donald Trump has talked about terminating the Affordable Care Act in this campaign,” said Wisconsin Attorney General Josh Kaul, who after first taking office in 2019 withdrew the state from a lawsuit to block the ACA and joined a friend of the court brief to support the health care law. “Let’s be clear, there’s no replacement plan for the Affordable Care Act.”

Kaul referred to Trump’s statement at the Sept. 10 debate with Vice President Kamala Harris, the Democratic candidate for president, about what he would do to replace the ACA after working to repeal it.

“Donald Trump recently said he has ‘concepts of a plan,’ after nearly a decade of his candidacy and as President,” Kaul said. “So there’s no plan to protect people with preexisting conditions. There’s no plan to ensure that costs remain low.”

Protections for people with preexisting conditions are at risk, he added, “and it’s clear that we’re facing further restrictions on access to safe and legal abortion.”

Laura Packard, a health care advocate taking part in the bus campaign who has supported the ACA for helping her survive and get treatment for a cancer diagnosis, said that after Trump’s statement about “concepts,” his running mate, Sen. J.D. Vance (R-Ohio) “laid out what some of those concepts are.”

A Vance proposal to replace preexisting condition protections with “high-risk pools” for those patients “would allow insurance companies to pick and choose their customers again,” Packard said. As one of 135 million Americans with a preexisting condition, she added, “if insurance companies had the choice, they would choose not to cover us. And we need health insurance to stay healthy and to stay alive.”

Zepecki said the Protect Our Care bus will travel 12,000 miles and visit 17 states “with a simple message — lower costs are here and we are not going back.”

Legislative endorsements

Advocating for the ACA is just one example of the way health care policy is on the political agenda this fall.

The Committee to Protect Health Care (a separate advocacy group) announced Tuesday a $500,000 ad buy and its endorsements in this fall’s Wisconsin Legislature races.

The committee consists of doctors, other health care professionals and other advocates. It is targeting a dozen Assembly and Senate races with digital video ads, direct mail and text messages directed at about 300,000 Wisconsin voters in the 12 districts.

The group’s health policy agenda includes expanding Medicaid, known as BadgerCare in Wisconsin, under the ACA and extending Medicaid coverage for new mothers for the first 12 months after they give  birth.

The committee’s priorities also include support for a state board empowered to reduce the cost of prescription drugs in Wisconsin, support for a paid family and medical leave program, and measures to ensure that decisions about reproductive care are made by  patients and medical providers. 

The group calls for repealing an 1849 law that caused abortion providers to cease practicing in Wisconsin for a year and a half, for fear of felony prosecution, until a judge ruled in 2023 that it did not pertain to abortion,  and enacting guarantees for access to contraception.

All of those measures have been proposed in the Wisconsin Legislature in one form or another by Democratic lawmakers but rejected by the Legislature’s Republican majority, the committee noted in its announcement.

Candidates supported by the ad campaign as well as the longer list of endorsed legislative candidates were selected for their support of the organization’s agenda, according to the committee.

“For too long, our state legislators have refused to expand BadgerCare and repeal our state’s archaic, harmful abortion ban,” said Dr. Ann Helms, a Committee to Protect Health Care Wisconsin leader and a neurologist. “These candidates have an opportunity to finally take action, granting health care access to tens of thousands of Wisconsinites and ensuring all women in the state can access the reproductive health care they need.”

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