An Act to create 49.45 (59m), 49.471 (4m) and 601.59 of the statutes; Relating to: BadgerCare purchase option, basic plan, state-based insurance exchange, and granting rule-making authority. (FE)
SB1121 would direct the Wisconsin Department of Health Services to seek federal approval for several major health coverage changes. First, it would create a “basic health plan” under the Affordable Care Act for people with household income up to 200% of the federal poverty level. Second, it would establish a BadgerCare purchase option for certain individuals whose income is above current BadgerCare eligibility limits but who otherwise meet program requirements, allowing them to buy coverage through BadgerCare rather than through private individual insurance. The bill also requires DHS to explore allowing eligible purchasers to use federal premium tax credits and cost-sharing reductions.
The bill further requires the Department of Health Services to coordinate these purchase options with existing BadgerCare programs, address financial sustainability concerns, and report to the legislature by March 1, 2027 on waiver status and actuarial/economic analyses. It also directs the Office of the Commissioner of Insurance to develop and operate a state-based health insurance exchange, with access to the BadgerCare purchase option through that exchange, and authorizes OCI to enter agreements with the federal government and adopt rules needed to implement the program.
If enacted and approved by federal authorities, SB1121 would expand Wisconsin’s Medicaid-related coverage structure by adding a new state-administered basic health plan and a premium-based BadgerCare buy-in option. It would also shift Wisconsin from reliance on the federally facilitated exchange toward a state-based exchange, requiring new administrative systems, federal approvals, and rulemaking by DHS and OCI. The bill would affect low-income adults, some people above current BadgerCare income limits, and small groups of 50 or fewer employees that could be allowed to purchase coverage through the program.
The bill appears to have been introduced as a major health coverage expansion and administrative redesign, with broad sponsorship from many senators and representatives, suggesting significant support among its authors. However, the available record shows no committee transcripts or recorded votes, and the bill ultimately failed to pass pursuant to Senate Joint Resolution 1. Based on the text alone, the measure is framed as a policy effort to improve affordability, continuity of care, and access to coverage, but it also acknowledges the need to manage state financial risk and adverse selection.
The main points of contention likely concern the fiscal and market effects of creating a BadgerCare buy-in and state-based exchange. The bill itself flags issues such as adverse selection, state financial contribution, premium impacts in the individual and group markets, and long-term financial sustainability, indicating these are central concerns. Another likely point of debate is the need for federal waivers and state plan amendments before implementation, since the program would depend on federal approval and could face uncertainty or administrative complexity. Supporters would likely emphasize expanded coverage and affordability, while skeptics would likely focus on cost, implementation risk, and potential disruption to private insurance markets.