Sen. Tammy Baldwin (D-Wisconsin) speaks Wednesday about the effort to extend enhanced Affordable Care Act insurance premium tax credits that will expire at the end of 2025. Nancy Peske, left, and Julia Harris-Robinson, center also joined the press conference. (Photo by Erik Gunn/Wisconsin Examiner)

With the loss of enhanced subsidies for the health insurance she has bought on the federal marketplace HealthCare.gov, Nancy Peske’s health plan will cost $1,163.50 a month in 2026.

That’s more than three times what she paid this year — $372 a month, Peske said Wednesday.

But if there’s one thing she wants everyone to know, it’s this: The higher prices for health insurance aren’t just something that she and other people who buy their coverage on the federal marketplace are facing.

Long before the ACA, Peske learned about “the premium death spiral,” she said.

“The more you raise the price, the more people drop out of the pool. This means you have to raise the price, which means more people drop out of the pool. And it goes on and on and on,” Peske said.

“It’s not just my health insurance that’s going to go up. It’s everybody’s — right?” she said. “We’re all in this together.”

Peske was one of two people who have relied on HealthCare.gov, created as part of the Affordable Care Act, who spoke Wednesday at a press conference in Milwaukee with Sen. Tammy Baldwin (D-Wisconsin).

Baldwin called the press conference  to draw attention anew to the skyrocketing cost of health insurance — and to the failure of Congress to address it in the stopgap spending bill that passed the U.S. Senate Monday, the U.S. House Wednesday evening and was signed by President Donald Trump.

“This is a health and wellness issue,” Baldwin said. “This is an affordability and cost-of-living issue, and this is a quality of life and dignity issue. And it touches every single one of us right now.”

A success amid ‘a broken system’

Health care in the U.S. is “a broken system that prioritizes profits over patients,” Baldwin said. Despite that, she said, the 2010 Affordable Care Act was an important advance for expanding health care access.

She said that was improved by enhanced federal subsidies enacted in 2021 to offset the cost of health insurance for people who must buy their own policies on the federal HealthCare.gov marketplace that was created by the ACA — making insurance more affordable and drawing record numbers of people to the marketplace to get health coverage.

The enhanced subsidies expire at the end of 2025, however, and until this week a Republican stopgap spending bill that passed the U.S. House in September stalled in the U.S. Senate as Democrats pushed unsuccessfully to extend the subsidies.  

“That is what is at the center of the government shutdown and debate in Washington, D.C.,” Baldwin said. “We know the impact of taking away these tax breaks. For 275,000 Wisconsinites, their health care [insurance] costs will double, triple or even more. For 30,000 Wisconsinites, they predict the price will be too high, and that those Wisconsinites will go without insurance altogether.”

A handful of Democratic Senators changed their votes Monday to advance the spending bill in return for a promise of a future vote on the subsidies, with the House taking up the revised bill Wednesday. Baldwin didn’t join them.

“I said the entire time that a handshake deal with my Republican colleagues to reopen the government and no real action to lower health care costs was simply not good enough,” said Baldwin of her vote against the bill.

She also forced an amendment to extend the tax credits for a year — a compromise, she said, because she wants them extended permanently, but one she offered “to avoid catastrophe for families across Wisconsin and give folks breathing room while we negotiate longer-term solutions.”

The amendment failed on a party-line vote.

“Every single Republican voted no on my amendment,” Baldwin said. “They chose to send a clear, unmistakable message that they are OK with jacking up health care costs on 22 million Americans.”

Early retirement, then sticker shock

HealthCare.gov user Erica Topps also joined Baldwin’s news conference. Topps took early retirement in April and bought a health insurance policy through the federal marketplace for herself and her college-age daughter that started in June.

At the marketplace open enrollment for 2026 that started Nov. 1, that plan’s premium increased by $1,200 a month and the deductible went from $6,700 per person to $10,600 per person, Topps told reporters She found another plan via the marketplace and is enrolling, but she’s concerned about the future beyond that.

“Part of my plan is to go back to work” so she can get health insurance, Topps told the Wisconsin Examiner, because it will be 10 years before she can qualify for Medicare.

Before taking early retirement, “I did my due diligence,” she said. “I feel like the rug was pulled out from under me.”

Peske is a freelance writer, editor and consultant. She is also a cancer survivor, whose diagnosis two years ago was covered thanks to her HealthCare.gov policy. Going without health insurance is unthinkable, but at the age of 63, she must wait another two years before she can go on Medicare, she said.

Peske told the Wisconsin Examiner that she will scrape together the money to afford her new premium. “I’ll not put a dime into my underfunded retirement account,” she said. She expects to “tighten the belt” on household expenses, “and I will probably cut into my savings.”

Freelancers and small businesses account for 40% of the U.S. economy, Peske told reporters.

“Do you want everyone to go out of business?” she asked. “Should I just do what so many people do and get a much lower paying job at a company? Because I’m desperate for health care. I don’t think that’s the solution. I think you want to keep people like me in business, generating money, adding to the economy, and being able to live, to not die of cancer.”

Seeking inroads with GOP lawmakers

Baldwin said she has been talking with Republicans about finding common ground in increased transparency in the health care system, from insurance companies, pharmacy benefit managers and providers.

In addition, she told the Wisconsin Examiner after the press conference, she continues to have conversations with GOP Senate colleagues who have expressed interest in continuing the subsidies to avert the sharp hike in premiums.

None of them were willing to break ranks and vote for her amendment this week, however.

“Those discussions were happening informally, in quiet, not in the public spotlight,” Baldwin said. “But they were afraid to vote on something that they, probably, some of them want, because Donald Trump said you can’t talk about this before the government reopens.”

Baldwin said that the next step will be for the Democrats to settle on the bill that Republican Senate Majority Leader John Thune has promised they could bring to the upper chamber for a vote.

As much as she favors a permanent extension of the enhanced credits, if the Democrats go that route, “we know it will go down, and it will be on a pretty much a partisan vote,” Baldwin said.

“I want results, so that probably dictates towards supporting something that conceivably does respond to some of the concerns Republicans have raised,” she said. “I’d like to pick the path most reasonably likely to succeed on behalf of the people who sent me to Washington to fight for them.”

Rachel LaCasse-Ford, right talks to Sen. Tammy Baldwin about her use of the Affordable Care Act marketplace to buy insurance during a meeting Baldwin held with small business owners and others in Mount Horeb, Wisconsin, on Sept. 25. (Photo by Erik Gunn/Wisconsin Examiner)

Matt Raboin owns Brix Cider, a farm-to-table restaurant, and brews apple cider in the Dane County village of Mount Horeb.

His wife’s full-time job with benefits provides the family with health insurance, but for Raboin, the Affordable Care Act (ACA) has made an important difference for some of his employees.

“We don’t offer insurance ourselves,” Raboin said during a recent round table discussion set up by Sen. Tammy Baldwin (D-Wisconsin). “A lot of small businesses in small towns aren’t in a financial place to do that.”

Like Raboin, some of his employees get their coverage through a spouse or because they also work another full-time job that provides benefits. But over the years, the ACA and the HealthCare.gov marketplace created under the law have been a critical source of health coverage for many of his employees, Raboin said.

Recently he polled a number of them. One memorable response came from a part-time employee who also has a part-time job with a local church. She buys her health insurance on HealthCare.gov. Thanks to an increase enacted in 2021 in tax credit subsidies, she’s been able to afford the premiums, Raboin said she told him.

“So without it, she’s like, ‘I can’t keep working for you. And I don’t think I keep working for my church. I think I have to find a different job,’” Raboin recalled.

The ACA and HealthCare.gov have made it possible for millions more Americans and thousands more Wisconsin residents to obtain health insurance.

But less visibly, the health care marketplace that the ACA created has also helped support many small businesses. If the enhanced tax credit subsidies that lowered the cost of health insurance for millions over the last three years aren’t renewed, small business owners and employees say they could be especially hard hit.

Nearly half of people who get their health insurance through the HealthCare.gov marketplace are self-employed or small business owners, or else work for small businesses, according to KFF, an independent nonprofit that researches and reports on health policy.

To expand access to health care, the ACA created the HealthCare.gov marketplace to make buying health insurance easier for people whose jobs don’t provide coverage and who don’t qualify for government programs such as Medicaid.

To make coverage more affordable, the law provides tax credit subsidies for people with incomes up to 400% of the federal poverty guideline. Those subsidies were increased in 2021 and expanded to people with higher incomes.

The enhanced subsidies will expire at the end of 2025 unless Congress extends them — driving up the cost of health insurance for millions.

The enhanced subsidy “saves more than 230,000 Wisconsinites an average of $500 every single month,” Baldwin said during a Zoom press conference Tuesday.

For Chrysa Ostenso and her late husband, the enhanced subsidies lowered their premiums from nearly $2,000 a month to about $300 a month, Ostenso said.

Ostenso lives in Ladysmith, Wisconsin, where she and her husband operated an optometry clinic for more than three decades, raising four children along the way.

“We always struggled to afford health insurance but of course we had to buy it,” Ostenso said in an interview. “As a family of four kids with a small business, you can’t go without health insurance.”

The family’s high deductible plans required them to pay $6,000 a year out of pocket before insurance would cover their health care. By 2020, when the children were grown and the health plan just covered Ostenso and her husband, they were paying $1,979 a month, she said.

They hadn’t qualified for the original ACA subsidies. When the enhanced subsidies were enacted in 2021, however, Ostenso said their premiums went down to $300 a month, increasing to $500 a month in subsequent years.

“It actually meant freedom to go to the doctor, because we were spending so much money on our premiums [previously] that we actually couldn’t afford to go to the doctor,” she said.

Standoff over extending subsidies

In the weeks leading up to Tuesday night’s federal shutdown, Democrats in Congress demanded that Republicans rescind sweeping changes to Medicaid that were part of the major tax- and spending-cuts megabill that President Donald Trump signed July 4.

They also demanded an extension of the enhanced ACA subsidies.

Baldwin has coauthored legislation that would make the enhanced subsidies permanent. She spent part of the just-concluded congressional recess traveling Wisconsin and meeting with people who expect to see their health costs go up sharply if the increased subsidies end.

During Tuesday’s press conference, Baldwin related a conversation with a  bakery owner who worried about how she and her family will afford health insurance, “but also that increased costs on the [HealthCare.gov] exchange will mean that her employees at her bakery may have to quit to work for big companies that offer insurance.”

During Baldwin’s press conference, Gigi Gastevich, an artist who owns a retail space in Stoughton, said the ACA and the enhanced subsidies had made it possible for her to launch and grow her business.

Gastevich is a 15-year cancer survivor. When starting her business, she qualified for BadgerCare — Wisconsin’s main Medicaid program — which covered the ongoing medical monitoring she requires as a cancer survivor.

In 2025, with her income above the limit for BadgerCare, she found an insurance plan on HealthCare.gov that included her existing health care professionals in its network and had an affordable deductible.

The plan’s premium was $481 a month, Gastevich said, but the enhanced subsidy  brought it down to about $100 a month.

Without the subsidy, she said, she will have to switch plans — possibly losing her long-standing group of providers if they aren’t in the network. She said her choices include taking a high-deductible plan that would put some of the regular care she’s been recommended as a cancer survivor out of reach financially; or closing down her business. 

“[That] would mean not only abandoning my dream of entrepreneurship and being a self-employed artist, but taking away an income source for the dozens of artists and artisans whose American-made work I sell here,” Gastevich said.

It would also forestall her plans to scale up her business to sell her own line of textiles and employ others. “I won’t be able to do that if my health and well-being is tied to being on an employer-based health care plan,” she added.

Uncertain future

During her tour of the state, Baldwin stopped in Mount Horeb on Thursday, Sept. 25, where she spoke with Brix owner Matt Raboin and four other business owners as well as local health care providers.

The round table took place at the Upland Hills Health Mount Horeb clinic. The urgent care clinic is part of a broader system that includes a hospital in Dodgeville and clinics in surrounding communities.

Dr. Mark Thompson, Upland Hills CEO, said system executives expect to see about $400,000 a year in additional uncompensated care based on projections of people leaving the insurance rolls because they don’t think they can afford the new ACA premiums.

Jay Goninen sat in as a board member of the Upland Hills system, but he’s also an employer for whom the ACA has made it possible to provide health benefits.

Goninen owns a business that helps connect the auto repair industry with high schools and technical schools. For the last few years, he’s opted to have employees of the firm purchase health insurance on the ACA.

The company pays a portion of the cost. Goninen likens the arrangement to a common practice of employers who offer a group health plan and split the cost with their employees.

“I do really worry about just the individual person and their ability to afford to live right now, in general,” he told Baldwin. “It is tough.”

In addition to worrying about what will happen to employees who bought coverage at HealthCare.gov if they lose their subsidies, Raboin said he’s also concerned about the broader ripple effect in the community.

“Our clients aren’t rich,” Raboin said. “Not everybody can go out to eat all the time, and if you start taking away that expendable income, that’s less people coming out to eat. So I think it would depress the whole economy.”

Rachel LaCasse-Ford owns a campground with her husband and also heads the Mount Horeb Chamber of Commerce.

“I’ve never really had a job that offers health care,” LaCasse-Ford told Baldwin. “I’ve always worked in small business, so we have always used health care from the ACA.”

The enhanced tax credits “definitely benefited” the couple, she said. “And if those go away, that will make our budgets tighter, and it will make things more challenging for us.”

With every new job, LaCasse-Ford said, she considers its impact on their health coverage and whether she can stay with a nonprofit employer such as the chamber, work for a small business, “or if I need to look for a larger employer that offers benefits.”