The average proposed rate increase of 12.6%, effective January 1, 2026 is expected to impact 13,677 members, based on membership as of March 31, 2025. The rate increase varies by plan, ranging between 4.4% and 20.5%. Rate changes vary by plan due to the impact of changes in benefits and rating adjustments to account for the non-funding of Cost Sharing Reduction (CSR) payments.
With the pending dire threat to several of these programs (primarily Medicaid & the ACA) from the House Republican Budget Proposal which recently passed, I'm going a step further and am generating pie charts which visualize just how much of every Congressional District's total population is at risk of losing healthcare coverage.
USE THE DROP-DOWN MENU ABOVE TO FIND YOUR STATE & DISTRICT.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
Wisconsin has the most competitive ACA markets in the country, at least in terms of the sheer number of insurance carriers offering policies on both the individual (14) and small group (16) markets. Their small group market is losing 2 carriers next year (All Savers and Common Ground Health Co-op), but it's still pretty robust.
The bad news is that it's once again extremely difficult to acquire Wisconsin's actual rate filings prior to the actual Open Enrollment Period launching, meaning I can only run unweighted average requested rate increases/decreases for the most part, although I've made a crude attempt at a partially-weighted average for the individual market.
With that in mind, individual market carriers are requesting unweighted increases of around 9.1%, while small group carriers are seeking hikes of around 7.4% overall.
It's been a long, long time since I've written about the "Sub26ers"...that is, the population of Americans age 18 - 25 who are enrolled in the same healthcare policy as their parents thanks to the ACA's provision mandating that insurance carriers allow them to do so. While I may be missing a more recent article, the last time I recall writing anything in depth about this was nearly a decade ago:
Long-time readers will remember that throughout the 2014 Open Enrollment period, there was much fuss and bother made by both the Obama administration, the HHS Dept., myself and some ACA detractors over the "sub26er" population: Young adults aged from 19-25 years old who are covered by their parents policies thanks to provisions in the Affordable Care Act requiring all new policies issued since 2010 to allow this.
At the time I was a bit obsessed with trying to suss out just how many Americans fell into this particular category. It was a tricky number to pin down for a number of reasons, but in the end it seemed to hover somewhere in the 2 - 3 million range, depending on your source.
Wisconsin has the most competitive ACA markets in the country, at least in terms of the sheer number of insurance carriers offering policies on both the individual (14) and small group (18) markets. They're losing two carriers in 2024 (WPS Health Plan in both markets and Humana in the small group market only), but it's still pretty robust.
The bad news is that it's once again extremely difficult to acquire Wisconsin's actual rate filings prior to the actual Open Enrollment Period launching, meaning I can only run unweighted average requested rate increases/decreases.
With that in mind, individual market carriers are requesting unweighted increases of around 6.8% (ranging from 1% - 15.7%), while small group carriers are seeking hikes of around 7% overall, ranging from a 25.9% reduction (wow!) to a 16.3% increase.
UPDATE 11/08/23: No changes to any of the individual market rate requests; a couple of slight changes to the small group carriers.
I'm pretty sure Wisconsin has the most competitive ACA markets in the country, at least in terms of the sheer number of insurance carriers offering policies on both the individual (15) and small group (20) markets.
The bad news is that it was extremely difficult to acquire Wisconsin's 2023 rate filings prior to the actual Open Enrollment Period launching this morning.
Overall, individual market premiums for unsubsidized enrollees are going up around 7.7%, while small group market rates are increasing by an unweighted average of 8.9%.
It's worth noting that two carriers (Health Tradition and Network) appear to be dropping out of the small group market, while one of the individual market players, Children's Community Health Plan, is changing their name to...Chorus Community Health Plan for whatever reason.
I'm pretty sure Wisconsin has the most competitive ACA markets in the country, at least in terms of the sheer number of insurance carriers offering policies on both the individual and small group markets. A total of 37 are present at the moment, although 5 of the small group carriers don't appear on the federal Rate Review database as of yet.
Unfortunately, this is yet another state where the enrollment data has basically been buried, so I can only run unweighted average rate changes.
With that in mind, the individual market rates look to be nearly flat (dropping by 0.8% on average), while small group plans are going up 4.4%.
I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.
Now that I've developed a standardized format/layout & methodology for tracking both state- and county-level COVID vaccination levels by partisan lean (which can also be easily applied to other variables like education level, median income, population density, ethnicity, etc), I've started moving beyond my home state of Michigan.
