How much more are ~290,000 WISCONSIN ACA enrollees *really* paying this year due to Trump/GOP policies?

IMPORTANT: See the original post in this series for an explanation of the methodology.

Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees being caused by the combination of Congressional Republicans allowing the enhanced federal tax credits to expire as well as other Trump Regime policy changes for well over a year and a half now.

I've written countless analyses of how much both gross and net premiums skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics...and recently it was confirmed that over 2.6 million ACA exchange enrollees had already been priced out of the market as of February, with the number almost certain to climb further throughout the rest of 2026.

As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so remaining enrollees as of February have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.

In most cases this means moving to plans with higher deductibles, higher co-pays & higher coinsurance costs. In many cases this has also included moving to plana with worse networks, referral requirements to see specialists and so on.

With that in mind, that's exactly what I've decided to set out to do: Calculate the average year over year increase not just in net premiums (that is, how much more ACA enrollees are having to pay each month) but also the year over year change in average out of pocket costs.

Let's look at WISCONSIN:

Here's a look at ACA exchange plan selections during Open Enrollment by household income level this year vs. last.

Like most states, Wisconsin has seen enrollment plummet across nearly every income bracket, especially among enrollees who earn less than 100% of the Federal Poverty Level (FPL), which is due to the Trump Regime eliminating subsidy eligibility for around 1.4 million low-income legally residing non-citizens...and those who earn more than 400% FPL, since they're also no longer eligible for any financial assistance thanks to Republicans allowing the improved subsidies to expire.

The only income bracket which saw a year over year increase is the 300 - 400% FPL range, and I'm pretty sure much of that is due to households who usually earn slightly more than 400% FPL estimating their 2026 annual income at ~390% FPL who are now scrambling to ensure that their actual 2026 income doesn't inch over the cut-off threshold.

Overall, plan selections have still dropped by 7.1%, or over 22,000 people versus OEP 2025...and since then, effectuated enrollment has almost certainly dropped even further.

Onto the main analysis:

Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by Actuarial Value (AV) category. The first table is based on official metal level tiers, but it's the second table which is critical, since a huge chunk of ACA enrollees are usually enrolled in CSR Silver plans (which include Cost Sharing Reduction assistance). CSR assistance dramatically boosts the AV of Silver plans up to Platinum levels in most cases.

As shown below, most of the ~290,000 Wisconsinites who did select policies during Open Enrollment had to "buy down" to a worse plan to mitigate the damage.

As a result, the average actuarial value for enrollees dropped 2.6 points, from 73.6% to 71.0%:

By combining these numbers with the average gross premiums per enrollee I'm able to calculate an estimate of the average total medical expenses each enrollee racks up each year assuming an 80% average Medical Loss Ratio (as I stated in the original post, this can vary widely by carrier and year, so should be considered a very broad average only), which looks like so:

Average net premiums jumped by a whopping 50% on average...while, by my estimates, average out of pocket spending went up around 30% as well this year. Combined, that's an average net healthcare cost hike of ~39%, or around $1,700 per enrollee.

Interestingly, based on KFF's net data, average deductibles also went up around 20% or so, to ~$4,900 apiece. The maximum (theoretical) out of pocket cut-off for all ACA enrollees went up by over 15% this year as well, however, to $10,600 for single coverage.

Next up: WYOMING.