OSHKOSH (NBC 26) — Health insurer, Common Ground, cuts Affordable Care Act Coverage in 11 Wisconsin counties, amid an uncertain future for affordable ACA coverage across the country.
- Common Ground cites a “rapidly shifting” industry as a reason for the decision.
- There are 24,000 Wisconsinites who will be impacted by this decision.
- As Common Ground cuts its ACA coverage, federal tax credits for the program are set to expire at the end of this year.
In early September, Heather Martens received a letter from her health insurance provider, Common Ground Healthcare Cooperative.
The letter informed her that her Affordable Care Act coverage was being cut starting Jan. 1, 2026.
“I was not happy, I depend on health insurance,” she says. “Common Ground has been absolutely amazing, so I’m really sad that I’m not going to get it anymore.”
In a statement to NBC26, Care Source, Common Ground’s parent company, said:
“Common Ground Healthcare Cooperative (CGHC) has made the difficult decision to exit 11 counties in Wisconsin for its marketplace product, impacting approximately 24,000 members. Current members in these counties will continue to receive high-quality care through the end of 2025 and can select a new health plan during the upcoming open enrollment period, which begins November 1st. This decision was not made lightly and is driven by the need to maintain sustainable operations amid rapidly shifting dynamics across the industry.”
Calumet, Dodge, Fond du Lac, Kenosha, Milwaukee, Outagamie, Racine, Sheboygan, Waupaca, Waushara and Winnebago Counties are those cut from Common Ground.
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In its letter to Martens, Common Ground also cited rising costs within the health care industry.
“Our decision to not offer health insurance in your area next year is due to rising health care costs and unexpected shifts in the use of health services,” the letter says.
Dr. Lynne Cotter, a senior health policy research manager for KFF, a non-partisan health policy organization, says it’s uncommon for an insurer to drop ACA coverage entirely. However, rising health care industry costs have been seen across the country.
As the open enrollment date looms, Martens is forced to look at other options. She has diabetes and asthma, and she says she’ll likely need a knee replacement soon.
“I want to continue to be cared for and feel good, and if I don't, I can't take proper care of the grandkids that I do have,” she says. “My everything will just fall apart.”
Martens says she is unable to afford health insurance through her income alone, and changes to ACA coverage next year could make it difficult for her to find a new insurer.
The enhanced premium tax credits were introduced in 2021 and were extended through 2025 with the Inflation Reduction Act. The credits made ACA coverage more affordable by increasing the amount of financial assistance enrollees could use.
The tax credits will expire at the end of this year.
When the tax credits expire, insurers will also raise their premiums because they expect healthy individuals will choose to drop their coverage, according to Cotter.
“So as healthier individuals exit the market, that means that sicker individuals remain and so overall, insurers have cited that as a reason- that they'll have sicker individuals that have to pay out more in claims-and they'll raise their premiums,” Cotter says.
Cotter says premiums are expected to double.
There are about 24 million Americans, and about 300,000 Wisconsinites, who use ACA coverage plans.
“So that’s a lot of people who could potentially be impacted by this rate increase,” Cotter says.
The Congressional Budget Office estimates that continuing the ACA enhanced premium tax credits for another 10 years would cost $350 billion- $35 billion each year.
“It's an expensive program that helps provide health insurance for people who need it,” Cotter says.
For Martens, without the current ACA credits, she would struggle to be able to afford insurance.
“I believe that every human being should have access to health coverage that’s affordable,” she says.
Currently, an extension for the tax credits is not included in the federal budget bill. However, the debate over whether the credits should be extended anyways is one of the reasons for the current government shutdown.
