How would expiring ACA subsidies affect Wisconsin health coverage?
Senate deadlocked over health care spending amid shutdown threat
Senators are deadlocked over Medicaid cuts and ACA subsidies as a government shutdown looms.
- The recent government shutdown is centered on a dispute over extending expiring Affordable Care Act subsidies.
- Democrats are demanding the subsidies be renewed, while some Republicans argue they should expire.
- Without an extension, millions of Americans could see their health insurance premiums double in 2026.
Tens of thousands of Wisconsinites could lose their health coverage if subsidies that help people buy health insurance under the Affordable Care Act expire, experts predict.
At the center of the government shutdown fight is a dispute over whether the subsidies should be extended. Without them, insurance premiums will spike and many individuals and families will be priced out of the market. Middle-income enrollees are expected to be heavily impacted by significantly higher costs, and those with an income above 400% of federal poverty guidelines, and would lose subsidies entirely.
Democrats are demanding Republicans include a renewal of the tax breaks that help pay for health coverage as part of any funding extension to reopen the government. The current subsidies are set to expire at the end of the year. So far, Republicans have not budged on the demands, saying the extension does not belong on a spending measure, and some have argued that Congress should let the subsidies expire.
House Republicans approved a temporary funding patch through Nov. 21 to continue at the same rate as before the shutdown. Senate Democrats have blocked approval of that bill in an effort to prevent Medicaid cuts that were part of President Donald Trump’s major tax-cut legislation and the expiration of federal subsidies for participants.
Here’s what to know about the Affordable Care Act, the expiring subsidies and why its a sticking point in the federal government shutdown debate.
How many Wisconsinites are insured under ACA?
Wisconsin saw record enrollment in ACA Marketplace for the 2025 coverage year, with 313,579 Wisconsinites selecting Marketplace plans. This represented an 18% increase from the previous enrollment period and is attributed to factors including enhanced federal subsidies from the American Rescue Plan and increased outreach efforts to raise awareness about coverage options.
Advocates and state officials have cited the increased enrollment as a sign of the ACA’s success in expanding coverage but have expressed concerns about how the potential loss of enhanced subsidies in 2026 could impact Wisconsinites.
“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,” Wisconsin Insurance Commissioner Nathan Houdek told WPR.
What is the Affordable Care Act?
The Affordable Care Act, known as ACA or informally as Obamacare, is a comprehensive health care reform law signed into law by President Barack Obama in 2010. The ACA expanded health insurance coverage for millions of Americans by expanding Medicaid eligibility and creating the Health Insurance Marketplace, online platforms that allow individuals and families to compare and purchase health plans, often with financial assistance.
Under ACA, insurers can no longer deny coverage or charge higher premiums due to a person’s health status or pre-existing conditions. Additionally, young adults are allowed to remain on their parents’ health insurance plans until age 26.
What do the ACA subsidies do?
A core provision of the ACA, the tax credits in question help Americans who don’t get coverage through work, Medicare or Medicaid afford health insurance. The subsidies adjust with people’s incomes.
In 2021, President Joe Biden and Congressional Democrats made the subsidies more generous and enrollment in ACA insurance more than doubled with the enhanced subsidies — growing from 11 million to over 24 million people. The policy was extended in 2022, but made the program temporary.
Without an extension, the extra help will expire at the end of 2025 and insurance premiums likely double, according to an analysis published in September by KFF, a health research group. The enrollment period begins Nov. 1 and without an assurance of subsidies, some participants might not sign up.
The loss of these subsidies would hit a lot of Republican-controlled states hard, where Medicaid health plan has not been expanded at the state level.
Why are Congressional Republicans looking to keep Trump Medicaid cuts and axe subsidies?
The GOP funding patch would continue Medicaid spending cuts approved as part of Trump’s major tax-cut legislation. An estimated 7.5 million will lose coverage under the program for lower-income families and the disabled over the next decade, according to the nonpartisan Congressional Budget Office.
Republicans said the cuts are mostly based on denying coverage to undocumented immigrants and requiring able-bodied recipients to work or volunteer for service for 80 hours per month. Experts said stringent requirements to document their work could discourage people who are otherwise eligible from applying.
Republicans say the Democrats’ proposal would open up subsidized ACA coverage to people who are in the country illegally, but undocumented immigrants are largely ineligible for federal health benefits and don’t qualify for comprehensive Medicaid coverage, Medicare or the Children’s Health Insurance Program. They also can’t purchase federally subsidized health plans on exchanges backed by the Affordable Care Act.
The Democratic plan would, however, restore coverage to certain categories of immigrants who would lose access to ACA due to the GOP tax-cut bill. Coverage would be restored to asylum seekers, refugees, people on work visas and students.
Undocumented immigrants have never been eligible for ACA subsidies and coverage. That would not change under the Democrats’ proposal.
Anna Kleiber can be reached at akleiber@gannett.com.
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