Health insurance affordability woes force tough choices in Wisconsin

Imagine being too unhealthy to work but still being forced to out of necessity.

It is the dilemma facing a western Wisconsin family, who said high out-of-pocket costs and changes to federal programs put more pressure on their budget.

Sarah Burns, owner of Omega Bakery in Holmen, said it is now too difficult to find affordable coverage from Affordable Care Act marketplace plans. Her husband Rick, who has bipolar disorder and a history of suicide attempts, returned to work full-time, largely because the family needed health insurance after recently losing their BadgerCare coverage.

“I don’t think Rick would’ve taken a job if we didn’t have to worry about health insurance. His mental health would be significantly better than where it is right now,” Burns explained.

She worries the demands of full-time work could undermine her husband’s recovery after a previous mental health crisis forced him to leave his job. Their tough choices coincide with pending Medicaid work requirements under a major federal policy law adopted by Republicans. Major spending cuts are forecast in the coming years. Supporters said the changes reduce unnecessary spending and strengthen program accountability but healthcare advocates warn higher costs will leave more people uninsured.

Data from the health policy research organization KFF show Wisconsin’s Affordable Care Act marketplace enrollment fell by about 45,000 people from the previous year, following the expiration of enhanced federal tax credits.

Yet even with private insurance, Burns, who manages an autoimmune condition, pointed out she pays more than $300 a month out of pocket for medications, in addition to a slew of other medical expenses. She argued small businesses like hers and the one where her husband works need better options, so families are not left with subpar coverage offerings.

“Health insurance shouldn’t be tied to jobs. It can’t be tied to your place of employment. If we want Wisconsin to be having small businesses and to employ people, there needs to be affordable healthcare coverage,” Burns contended.

The Burns family is not alone. Other data show nearly 20% of Wisconsinites face a high medical cost burden compared with 15% nationally. In shining a light on the crisis, health advocates recently launched several campaigns in Wisconsin, calling on Congress to restore the enhanced tax credits, reverse Medicaid cuts and lower prescription drug costs.

Burns wants lawmakers to go further, advocating for universal health coverage or an expanded BadgerCare program which does not abruptly cut off adults whose earnings rise just above eligibility limits.

“Our family needs a universal healthcare program. Our family needs affordability. Our family needs our state legislators to realize that the middle class is completely dwindling down and dying because the rich keep getting richer and the middle class keep getting poorer,” Burns emphasized.

Judith Ruiz-Branch wrote this story for Wisconsin News Connection, a member of Public News Service.