The Enhanced Subsidies Are Gone. In Wisconsin, DPC Practices Are Taking the Calls.

For a 60-year-old Wisconsin couple earning just above the cutoff for subsidy eligibility, holding onto a HealthCare.gov plan costs more than 800% more this year than it did last year.

That number is not a rounding error, but it also isn’t a premium increase. Wisconsin’s insurance regulators approved 2026 individual-market rates that rose 17.4% on average, with most plans landing between 9.4% and 19% and a few outliers above 33.3%. The 800% measures something different: what a particular household pays once the enhanced tax credits that had been absorbing part of that premium disappear. The Office of the Commissioner of Insurance modeled the difference county by county, and the spread it found tracks age and income at least as closely as geography — a 26-year-old earning $48,000 was modeled at 39% to 85% more, a family of four earning $130,000 at 102% to 312% more, and a 60-year-old couple earning about $85,658 at 221% to 812% more. Approved rates and household payments are not directly comparable figures, and the distance between them is the story.

Wisconsin Public Radio and FOX6 Milwaukee are both reporting the result: direct primary care practices across the state are fielding new patient inquiries at an unusual rate. Dr. Wendy Molaska, whose direct primary care clinic is in Fitchburg, told WPR she has been fielding a lot of calls from people looking for an affordable alternative to an expensive insurance plan. Dr. Anna Mirer, who operates Presence Primary Care in Milwaukee, told FOX6 she had received more inquiries from potential new patients in the past two weeks — a pattern she tied to the premium increases.

This is what happens when the price of the dominant alternative changes fast enough to shift purchasing behavior.

The Subsidy Expiration

Congress let the enhanced Affordable Care Act premium tax credits expire on December 31, 2025. Those credits — created in 2021 and extended once, in 2022 — had kept marketplace premiums affordable for millions of Americans by capping benchmark plan costs at 8.5% of household income.

Without them, the math changed fast. The Kaiser Family Foundation estimated that average annual premiums for subsidized enrollees who stayed in the same plan more than doubled — a 114% increase, from roughly $888 per year in 2025 to $1,904 in 2026. Nationally, approximately one in ten people who had ACA marketplace coverage in 2025 are now uninsured, according to a KFF survey conducted in March 2026. More than one million fewer Americans enrolled in a marketplace plan for 2026 compared to the prior year.

Wisconsin felt it acutely. Governor Tony Evers had warned in October 2025 that marketplace rates would skyrocket without renewed subsidies. The prediction held. The households hit hardest were the ones sitting just above the income cutoff for subsidy eligibility. A 60-year-old couple in Rice Lake earning around $85,000 was modeled to pay roughly 800% more for coverage in 2026 — an increase of more than $30,000 a year. No approved rate increase in Wisconsin came anywhere close to that; the highest outliers cleared 33.3%. What changed was that the credits covering most of that premium ended entirely.

Why Wisconsin’s DPC Ecosystem Is Responding

Wisconsin is not a DPC backwater. The state now has more than 100 DPC practices, many with multiple clinic locations. The ecosystem has been building steadily for years. What the premium shock did was introduce those practices to a new category of potential patient: someone who had insurance, who understood how insurance worked, and who watched their monthly payment jump by hundreds of dollars in January.

That person is asking a different question than someone who found DPC through a wellness article. They want to know what a DPC membership covers and — critically — what it doesn’t. They’re comparing a known quantity (their old premium) against an unfamiliar one (a flat monthly membership fee). For a meaningful share of callers, that comparison is coming out in DPC’s favor on the cost side.

Practices fielding those calls are learning to run a new kind of intake conversation. The patients inquiring now often have more insurance literacy than the typical early DPC adopter, and they arrive with more pointed questions.

The Blue Cross Blue Shield Response

Blue Cross Blue Shield has not been quiet. When the Wisconsin coverage surfaced, a BCBS spokesperson delivered what has become the industry’s standard DPC critique: “DPC models do not include quality and safety measures, integrated information technology and coordination of benefits across the care spectrum, all of which are essential in helping patients get the safe and effective care they need when they need it.”

There is genuine substance in parts of this argument. DPC is primary care only. A membership does not cover hospitalizations, specialist visits, most imaging, or emergency care. Someone who cancels their health insurance and enrolls only in a DPC practice is exposed to financial catastrophe if they need any of those services. DPC physicians have been making exactly this point for years — the standard recommendation is to pair a membership with a high-deductible plan that covers catastrophic costs, a combination that often costs less than comprehensive insurance while providing direct physician access.

The quality-measurement argument is a different matter. DPC practices do not feed claims data into the standard infrastructure BCBS uses to evaluate network providers. Whether that gap represents a real quality problem or a measurement mismatch is a question the research literature has not definitively answered.

The Legislative Picture

Wisconsin legislators tried to build a regulatory framework for DPC during the 2023–2024 session. The bill drew bipartisan support — DPC’s appeal to both parties has been a consistent feature of state-level debates. But it didn’t become law. The sticking point was a provision requiring physicians not to discriminate based on gender identity, which conservative advocacy groups opposed.

The result: Wisconsin DPC practices operate under general business and medical licensing law rather than a dedicated framework. That legal ambiguity has not stopped the model from reaching more than 100 practices statewide. But it leaves both physicians and patients without the protections that explicit state DPC statutes provide in most U.S. states.

What This Means

The Wisconsin story is a preview of what happens when a policy shock makes the dominant alternative abruptly unaffordable. The ACA subsidy expiration didn’t create DPC in Wisconsin — the ecosystem was already there. What it did was route a new kind of potential patient to DPC’s door: someone driven by necessity rather than preference, who is comparing DPC directly against the sticker price of insurance they can no longer afford.

Whether those inquiries convert to long-term memberships at a meaningful rate is something the data will show over the next 12 to 18 months. Patients coming in because insurance became unaffordable may still need insurance for the risks DPC doesn’t cover — and if they can’t afford that either, they’re navigating a harder problem than a DPC membership alone solves.

What’s clear right now is that the phones are ringing, the callers are not the patients DPC practices were originally designed for, and the practices fielding those calls are getting a real-time education in what demand driven by a market failure actually sounds like. That is different from demand driven by physicians choosing the model. And it requires a different kind of response.