Letter to Insurance Companies

Tuesday July 18th, members of the State Legislature sent a letter to Wisconsin insurance companies selling plans on Healthcare.gov to encourage them to introduce "Low Out of Pocket" health plans. These plans have $0 deductible for prescription drugs, doctor visits, specialist visits and urgent care visits! Saving consumers thousands per year! Click here to check out a PDF of the letter.


Dear Insurer

We write to request that your organization offer on Healthcare.gov in Wisconsin low out-of-pocket health plan options starting next year. As you are aware, the deadline for insurers to submit final plan designs to the Office of the Commissioner of Insurance is July 22nd.

The Center for Medicare & Medicaid Services is encouraging marketplace insurers to offer insurance benefit designs known as standardized health plans to all healthcare consumers in 2017.  For reasons outlined below, we request that your company offer a standardized plan, or amend a submitted but not finalized plan, to reduce out-of-pocket burdens on our respective constituents.

Whether it is premiums, deductibles, prescription drug costs or related out of pocket costs, the high cost of healthcare is a concern that we hear often, from our constituents. With Wisconsin being one of the most expensive places in the country for healthcare, we believe that controlling these skyrocketing costs is imperative. One option for relief is in the design of insurance plans being introduced next year.

By one study, deductibles for marketplace plans increased by 46% on average in Wisconsin from 2015 to 2016. This is all the more concerning as many middle income consumers between 250% of the poverty line and 400% of the poverty line can qualify for tax credits to make the premiums more affordable on Healthcare.gov, but are ineligible for cost sharing tax credits that reduce deductibles and co-pays. This makes them far more susceptible to out of pocket cost concerns.

One option is to offer plans with lower out-of-pocket costs, such as the standardized plan design CMS is encouraging. In addition to being easier for the average consumer to compare, standardized health plans could eliminate the requirement that a deductible be met before medical services, such as primary care doctor visits, specialist visits, urgent care visits and prescription drugs are covered.

Much research has been undertaken in recent years showing that high deductible health plans are not the most effective way to guarantee quality affordable health coverage. Higher out of pocket costs can often dissuade consumers from getting timely medical treatment that would reduce or eliminate high cost crisis services.

There is still time before July 22nd deadline to submit final rates to the Office of the Commissioner of Insurance. We appeal to you on behalf of our constituents to offer standardized plans, or if that opportunity has passed, to adjust your proposed rates so as to reduce the burden of out of pocket costs on consumers. Together we can help ease the financial pressures on Wisconsinites and highlight that your company is working to protect struggling consumers from the skyrocketing costs of medical services and prescription drug costs.

Where possible, we in the Legislature will seek to address issues that reduce the overall cost of healthcare on consumers, but right now you have the opportunity to help our friends and neighbors with one of their most pressing concerns. We hope that you do so.


    • Debra Kolste, State Representative, 44th Assembly District
    • Chris Larson, State Senator, 7th Senate District
    • Terese Berceau, State Representative, 77th Assembly District
    • Evan Goyke, State Representative, 18th Assembly District
    • Gary Hebl, State Representative, 46th Assembly District
    • LaTonya Johnson, State Representative, 17th Assembly District
    • Melissa Sargent, State Representative, 48th Assembly District
    • Mark Spreitzer, State Representative, 45th Assembly District
    • Lisa Subeck, State Representative, 78th Assembly District
    • Dana Wachs, State Representative, 91st Assembly District
    • Dave Considine, State Representative, 81st Assembly District
    • Jill Billings, State Representative, 95th Assembly District
    • Christine Sinicki, State Representative, 20th Assembly District
    • Katrina Shankland, State Representative, 71st Assembly District
    • Fred Risser, State Senator, 26th Senate District
    • Tim Carpenter, State Senator, 3rd Senate District

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