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Wisconsin Health Exchange Profile


Establishing the Exchange 

On November 16, 2012, Governor Scott Walker (R) notified federal officials that Wisconsin would default to a federally-facilitated health insurance exchange. After initial efforts to develop a state-based health insurance exchange, Governor Walker announced in July 2012, he would not take any action to implement federal health reform until after the November elections.

In 2011, Walker had issued an executive order to create the Office of Free Market Health Care to develop a plan for a Wisconsin health benefit exchange; however, almost a year later he closed the Office. Exchange establishment legislation failed to pass at the end of the 2012 legislative session. Prior to closing, the Office of Free Market Health Care had been seeking subcontractor assistance with the state’s marketing and outreach strategy and had completed actuarial and economic analyses to determine next steps in designing an exchange.

Under former-Governor Jim Doyle (D), Wisconsin’s Department of Health Services had investigated the information technology necessary for a state-run exchange and based on insight from over 40 healthcare stakeholders, created an exchange prototype to simulate eligibility determinations and the consumer enrollment process. The prototype was launched in December 2010, with much of the functionality required of an exchange website.

On April 5, 2012, Governor Walker signed into law SB 92, a bill prohibiting plans in a state exchange from offering abortion coverage, except in cases of rape, incest, or to avert severe physical impairment or death of the pregnant woman.

Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Wisconsin has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, United- Choice Plus, POS.

Exchange Funding

The Wisconsin Department of Health Services received a federal Exchange Planning grant of $1 million in September 2010 and a federal Early Innovator grant of $37.7 million in February. Wisconsin planned to use the Early Innovator grant to refine their exchange prototype into a single portal through which residents could access subsidized and non-subsidized health care and other state-based programs. In January 2012, the Governor announced the state would be returning the Early Innovator grant funding.

Next Steps

The federal government will assume full responsibility for running a health insurance exchange in Wisconsin beginning in 2014.

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