A health insurance provider will stop offering individual and family coverage through the Affordable Care Act marketplace in 11 Wisconsin counties next year, meaning about 24,000 people will have to find a new insurer.<\/p>\n
Common Ground Healthcare Cooperative plans to stop offering marketplace<\/a> plans in Milwaukee, Kenosha, Racine, Outagamie, Winnebago, Fond du Lac, Sheboygan, Calumet, Dodge, Waushara and Waupaca counties beginning in January.<\/p>\n A spokesperson for CareSource, the parent company of Common Ground<\/a>, said in a statement that it had made \u201cthe difficult decision to exit 11 counties.\u201d The spokesperson said about 24,000 affected members will continue to receive coverage through 2025 but will have to look for a new health plan when open enrollment begins Nov. 1.\u00a0<\/p>\n News with a little more humanity<\/p>\n WPR\u2019s \u201cWisconsin Today\u201d newsletter keeps you connected to the state you love without feeling overwhelmed. No paywall. No agenda. No corporate filter.<\/p>\n \u201cThis decision was not made lightly and is driven by the need to maintain sustainable operations amid rapidly shifting dynamics across the industry,\u201d the statement reads.<\/p>\n Common Ground will continue to offer coverage in 13 Wisconsin counties: Brown, Door, Green Lake, Jefferson, Kewaunee, Manitowoc, Marinette, Oconto, Ozaukee, Shawano, Walworth, Washington and Waukesha.<\/p>\n Common Ground has been offering ACA marketplace coverage in eastern Wisconsin since 2014<\/a>. On its website, Common Ground said the decision to discontinue coverage in parts of the state was not related to its recent merger with CareSource.\u00a0<\/p>\n \u201cThis was a necessary business decision made by Wisconsin leadership,\u201d the website reads. \u201cThe decision was driven by the rising cost of providing care in these counties.\u201d<\/p>\n As of December 2023, Common Ground was in \u201cgood financial condition,\u201d according to a report from state regulators<\/a>. The cooperative experienced \u201cnotable losses\u201d in 2021 and 2022, but had \u201cpositive financial results in 2023,\u201d the report states.<\/p>\n Common Ground\u2019s exit comes as ACA marketplace insurers across the country are planning to increase premiums next year by about 20 percent on average, citing higher costs and the expected expiration of enhanced pandemic-era tax credits, according to health policy nonprofit KFF<\/a>.\u00a0<\/p>\n Enhanced premium tax credits were signed into law during the Biden administration<\/a>, allowing families previously ineligible for ACA tax credits to become eligible. They helped lower premiums and drove record enrollment on the marketplace, according to the nonprofit Center for American Progress<\/a>. But the enhanced subsidies are set to expire at the end of the year unless they\u2019re renewed.<\/p>\n Dan Sacks, an associate professor of risk and insurance at the University of Wisconsin-Madison School of Business, said the expected end of enhanced tax credits likely factored into Common Ground\u2019s decision. That\u2019s because subsidies help people who wouldn\u2019t get insurance due to the cost gain coverage, he said.\u00a0<\/p>\n Without the enhanced premium tax credit, he said healthy people could choose to go uninsured, leaving the pool of customers smaller with a larger share being individuals with chronic conditions who are typically more expensive to insure.<\/p>\n \u201cGenerally, when they take away the subsidies, it\u2019s less profitable to offer insurance,\u201d Sacks said. \u201cIt makes sense that an insurer would want to drop out.\u201d<\/p>\n KFF also found<\/a> that the end of the enhanced subsidies would make ACA insurance premiums \u201can average of 4 percentage points higher than they otherwise would be.\u201d<\/p>\n Gov. Tony Evers joined 17 governors this week in sending a letter<\/a> to federal lawmakers, urging Congress to extend the enhanced subsidies to \u201cspare families a wave of sticker shock this fall.\u201d<\/p>\n \u201cFar too many are feeling the pressure of rising costs, and folks should never have to choose between life-saving healthcare and getting their prescriptions or putting food on the table and keeping a roof over their head,\u201d Evers said in a statement<\/a>.<\/p>\n Beyond plans to hike premiums, some insurance providers are leaving the ACA marketplace altogether<\/a>.<\/p>\n Another ACA insurance provider in Wisconsin, Chorus Community Health Plans, also announced<\/a> it will exit the Affordable Care Act Marketplace in 2026, a move affecting about 11,000 Wisconsinites in 15 counties, according to a statement from the provider. <\/p>\n The statement cited a \u201cmulti-year declining financial performance.\u201d Chorus\u2019 Affordable Care Act line of business produced an underwriting loss of $2.9 million in 2022 and a loss of $8.5 million in 2023, according to a report from state regulators<\/a>.<\/p>\n