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Impact of the Affordable Care Act in Wisconsin

Hundreds of thousands of Wisconsinites have gained coverage, and millions more have had their coverage substantially improved

Today, the U.S. Department of Health and Human Services released an extensive compilation of state-level data illustrating the substantial improvements in health care for all Americans over the last six years. The data show that the uninsured rate in Wisconsin has fallen by 39 percent since the Affordable Care Act (ACA) was enacted in 2010, translating into 211,000 Wisconsinites gaining coverage. And, in addition to residents who would otherwise be uninsured, millions more Wisconsinites with employer, Medicaid, individual market, or Medicare coverage have also benefited from new protections as a result of the law.

“As our nation debates changes to the health care system, it’s important to take stock of where we are today compared to where we were before the Affordable Care Act,” said Secretary Sylvia M. Burwell. “Whether Wisconsinites get coverage through an employer, Medicaid, the individual market, or Medicare, they have better health coverage and care today as a result of the ACA. Millions of Americans with all types of coverage have a stake in the future of health reform. We need to build on our progress and continue to improve health care access, quality, and affordability, not move our system backward.”

Highlights of today’s data release include:

Employer Coverage: 3,521,000 people in Wisconsin are covered through employer-sponsored health plans. Since the ACA was enacted in 2010, this group has seen:

  • An end to annual and lifetime limits: Before the ACA, 2,142,000 Wisconsinites with employer or individual market coverage had a lifetime limit on their insurance policy. That meant their coverage could end exactly when they needed it most. The ACA prohibits annual and lifetime limits on policies, so all Wisconsinites with employer plans now have coverage that’s there when they need it.
  • Young adults covered until age 26: An estimated 41,000 young adults in Wisconsin have benefited from the ACA provision that allows kids to stay on their parents’ health insurance up to age 26.
  • Free preventive care: Under the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no extra cost to consumers. This provision benefits 2,804,258 people in Wisconsin, most of whom have employer coverage.
  • Slower premium growth: The average premium for Wisconsin families with employer coverage grew 4.0 percent per year from 2010-2015, compared with 7.4 percent over the previous decade. Assuming Wisconsin premiums grew in line with the national average in 2016, family premiums in Wisconsin are $4,100 lower today than if growth had matched the pre-ACA decade.
  • Better value through the 80/20 rule: Because of the ACA, health insurance companies must spend at least 80 cents of each premium dollar on health care or care improvements, rather than administrative costs like salaries or marketing, or else give consumers a refund. Wisconsinites with employer coverage have received $3,003,851 in insurance refunds since 2012.

Medicaid: 1,046,897 people in Wisconsin are covered by Medicaid or the Children’s Health Insurance Program, including 493,942 children and 140,021 seniors and people with disabilities covered by both Medicaid and Medicare. The ACA expanded Medicaid eligibility and strengthened the program for those already eligible.

  • 21,000 Wisconsinites could gain coverage: An estimated 21,000 Wisconsinites could have health insurance today if Wisconsin expanded Medicaid under the ACA. Coverage improves access to care, financial security, and health; expansion would result in an estimated 2,000 more Wisconsinites getting all needed care, 3,000 fewer Wisconsinites struggling to pay medical bills, and 30 avoided deaths each year.
  • Thousands of Wisconsinites with a mental illness or substance use disorder could get help: Nearly 30 percent of those who could gain coverage if more states expanded Medicaid have a mental illness or substance use disorder.
  • Wisconsin could be saving millions in uncompensated care costs: Instead of spending $20 million on uncompensated care, which increases costs for everyone, Wisconsin could be getting $280 million in federal support to provide low-income adults with much needed care.
  • Children, people with disabilities, and seniors can more easily access Medicaid coverage: The ACA streamlined Medicaid eligibility processes, eliminating hurdles so that vulnerable Wisconsinites could more easily access and maintain coverage.
  • Wisconsin is improving health care for individuals with chronic conditions, including those with severe mental illness: The ACA established a new Medicaid flexibility that allows states to create health homes, a new care delivery model to improve care coordination and lower costs for individuals with chronic conditions, such as severe mental illness, Hepatitis C, diabetes and heart disease.

Individual market: 224,208 people in Wisconsin have coverage through the Marketplace. Individual market coverage is dramatically better compared to before the ACA:

  • No discrimination based on pre-existing conditions: Up to 2,489,279 people in Wisconsin have a pre-existing health condition. Before the ACA, these Wisconsinites could have been denied coverage or charged an exorbitant price if they needed individual market coverage. Now, health insurance companies cannot refuse coverage or charge people more because of pre-existing conditions.
  • Tax credits available to help pay for coverage: Before the ACA, only those with employer coverage generally got tax benefits to help pay for health insurance. Now, 190,542 moderate- and middle-income Wisconsinites receive tax credits averaging $332 per month to help them get covered through HealthCare.gov.
  • Women pay the same as men: Before the ACA, women were often charged more than men just because of their gender. That is now illegal thanks to the ACA, protecting roughly half the people of Wisconsin.
  • Greater transparency and choice: Before the ACA, it was virtually impossible for consumers to effectively compare insurance plan prices and shop for the best value. Under the ACA, Wisconsin has received $6 million in federal funding to provide a more transparent marketplace where consumers can easily compare plans, choosing among 44 plans on average.

Medicare: 1,084,854 people in Wisconsin are covered by Medicare. The ACA strengthened the Medicare Trust Fund, extending its life by over a decade. In addition, Medicare enrollees have benefited from:

  • Lower costs for prescription drugs: Because the ACA is closing the prescription drug donut hole, 90,303 Wisconsin seniors are saving $94 million on drugs in 2015, an average of $1,036 per beneficiary.
  • Free preventive services: The ACA added coverage of an annual wellness visit and eliminated cost-sharing for recommended preventive services such as cancer screenings. In 2015, 481,012 Wisconsin seniors, or 75 percent of all Wisconsin seniors enrolled in Medicare Part B, took advantage of at least one free preventive service.
  • Fewer hospital mistakes: The ACA introduced new incentives for hospitals to avoid preventable patient harms and avoidable readmissions. Hospital readmissions for Wisconsin Medicare beneficiaries dropped 7 percent between 2010 and 2015, which translates into 1,373 times Wisconsin Medicare beneficiaries avoided an unnecessary return to the hospital in 2015. 
  • More coordinated care: The ACA encouraged groups of doctors, hospitals, and other health care providers to come together to provide coordinated high-quality care to the Medicare patients they serve. 13 Accountable Care Organizations (ACOs) in Wisconsin now offer Medicare beneficiaries the opportunity to receive higher quality, more coordinated care.
Content created by Assistant Secretary for Public Affairs (ASPA)
Content last reviewed on December 13, 2016
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