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Local News

Advocates Mark Affordable Care Act Anniversary with Success Stories, Warnings

Credit: iStock

by Erik Gunn, Wisconsin Examiner

With the Affordable Care Act another year older, patients who have benefited from expanded health care coverage along with boosters in Washington and Wisconsin used the 13th anniversary of the federal health care law Thursday to highlight its success and warn of renewed threats to its future.

“The ACA transformed our country, ensuring millions of people right here in Wisconsin had life-saving health care coverage,” said Gov. Tony Evers in a Zoom call with Protect Our Care, an ACA advocacy organization. 

Evers renewed his call for the state to expand Medicaid, or BadgerCare as it is called in Wisconsin, with a federal subsidy as provided for under the ACA. Expansion would open up the program to people with incomes up to 138% of the federal poverty guideline. 

“Studies have shown that in states that have expanded Medicaid, more people have access to health care,” Evers said, enabling them to use preventive health services and get earlier diagnoses and treatments for chronic conditions. “There’s no doubt that Medicaid is saving lives, as expansion states have seen,” he added.

Evers has put expansion in his 2023-25 proposed budget, after the Republican majority in the state Legislature removed it from both of his budgets in his first term. In addition to promoting the proposal on the Protect Our Care call, he made it the subject of his weekly radio address Thursday. 

He also marked the ACA anniversary in a press release Thursday with Commissioner of Insurance Nathan Houdek. 

A provision in the health care law enacted in 2010 requires insurers to spend at least 80% of their premium dollars on medical care and related health care costs and no more than 20% on administrative costs. The Evers-Houdek release said because of that provision, “Wisconsin residents received over $12 million in rebates in 2021” from health insurers. 

One such beneficiary was on the Thursday Zoom call. Mary, a retired nurse in Southeast Wisconsin who asked Protect Our Care not to use her last name, purchased health insurance at HealthCare.gov first from one carrier and later from another after she retired early and until she was eligible for Medicare. 

Some months after going on Medicare, she said, the first carrier sent her “a very nice check,” she said. Because the insurer had fallen short of the 80% threshold “they were required to issue me a percentage of my premiums paid as a rebate,” Mary said. “Whose ever bright idea that part of the ACA was, I am truly grateful.”

Chad Holmes of Wausau said that after going to work in broadcasting after college, he went without health insurance coverage for 20 years because he could not afford it. With the passage of the ACA, he was able to buy coverage he could afford, he said. 

In 2019 and again in 2020, he was hospitalized twice with pneumonia. His insurance coverage paid most of the bill, and he was able to work out a payment plan with his providers for his portion of the bill that came to a little over $200 a month. He paid that off last year.

“If I had not had medical coverage, I would have been paying that off for the rest of my life,” said Holmes. “It’s an incredible difference from what it would have been if this happened to me 15 years ago.”

Katerina Klawes of Milwaukee said because of the ACA, she has been able to afford expensive medications for a blood disorder. Klawes said that with several disabilities that have required repeated surgery, plus a history of cervical cancer, she has also benefited from the law’s ban on lifetime limits for coverage.

Without it, “I would be without health care, because I would have reached a lifetime limit within a few years,” she said.

Tax credits that were extended for three years in the 2022 Inflation Reduction Act also lowered the cost of health insurance premiums for her, Klawes said, from $200 a month in 2020 to less than a dollar a month currently.

Unless those tax credits are extended past their current expiration at the end of 2005, premium costs could skyrocket again. “It is not like the Affordable Care Act solves every problem in health care and we’ve moved on to something else,” said Joe Zepecki of Protect Our Care. “This is an ongoing issue.”

Zepecki said advocates are working to preserve and expand the ACA, while “there remain Republicans in Congress and in states like Wisconsin who would like to unwind some of the progress that we’ve made.”

On that point, the Biden administration on Thursday released a state-by-state analysis of the potential impact if Congressional Republicans succeed in making cuts to Medicaid, rolling back the expanded ACA premium tax credits or repealing the ACA altogether.

In Wisconsin, according to the White House forecast:

  • More than 200,000 Wisconsin residents who have purchased health insurance through the ACA marketplace (HealthCare.gov) might be unable to otherwise get health coverage.
  • Premiums for health plans purchased through the marketplace could rise an average of $6,700 a year for 27,000 state residents  and up to more than twice that amount for some.
  • Loss of the ACA’s protection for people with pre-existing health conditions could affect almost 900,000 Wisconsin residents.
  • Almost 500,000 Wisconsin residents could find themselves without the law’s limit on out-of-pocket health costs, and 2.1 million could wind up with a lifetime cap on their health benefits.
  • Patients could lose free preventive care that the ACA requires.

In addition to the impact of losing the ACA, the White House forecast also says other possible Medicaid cuts could reduce or eliminate services for the state’s 1.5 million Medicaid participants; cut as many as 1 out of 4 people from Medicaid if the Republicans impose new work requirements for participants; and worsen care for more than 225,000 people with disabilities or who are 65 or older and depend on Medicaid.

This story was written by Erik Gunn, Deputy Editor at the Wisconsin Examiner, where this story first appeared.

Wisconsin Examiner is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Wisconsin Examiner maintains editorial independence. Contact Editor Ruth Conniff for questions: info@wisconsinexaminer.com. Follow Wisconsin Examiner on Facebook and Twitter.