This is a guest column from Tom Hefty, former CEO of Blue Cross Blue Shield Wisconsin, who still watches health care trends in the state like a hawk.
Tom Hefty
WISCONSIN’S HEALTHCARE PARADOX
New reports are out on Wisconsin health care, and they confirm a Paradox—-a conflict between measures which should be aligned. Wisconsin has excellent physicians and good hospitals, but declining health care outcomes. The state has very profitable hospital systems, yet projected record price increases for 2026.
The latest Americas Health Ranking report covers 20 years of data for all 50 states. In overall health, Wisconsin has dropped from 7th best down to 20th—one of the largest drops in the country. Wisconsin’s highest ranking is in clinic health care—11th best in the country. But in health outcomes Wisconsin has dropped to 33rd overall, and even farther for children’s health outcomes down to 39th.
Why hasn’t the high quality of clinical care translated into better health outcomes—the Paradox.
There are five generally recognized national health care rankings. All show the same trends for Wisconsin health outcomes—down. Wisconsin is now middling at best in health outcomes, and in some measures far below the national averages—immunizing school children, infant and maternal mortality, opioid deaths, as examples.
At the same time, national forecasts released this month call for record increases in health insurance costs for 2026, with the official notices of rate increases going to customers in the next two months. Why hasn’t the hospital profitability for nominally non-profit health systems been reflected in lower costs to business and families—another Paradox? According to Rand reports, Wisconsin already has the highest hospital costs in the Midwest.
The next election for Wisconsin’s highest offices, Governor and Attorney General is just over one year away. Hopefully, those candidates and the election debate will help address Wisconsin’s Health Paradox—and propose some policy changes to address the causes for improving outcomes and lowering costs.
There are as many opinions as commentators on the causes of Wisconsin’s Health Paradox. But some myths deserve to be discarded in the debate.
The four myths of Wisconsin healthcare:
- Wisconsin’s failure to adopt Obamacare’s expansion of Medicaid impacted outcomes. Wisconsin did not adopt Obamacare because Wisconsin had already expanded Medicaid with Tommy Thompson’s Badgercare. Wisconsin without Obamacare’s red tape has the same percentage of the population with Medicaid as does neighboring Minnesota, which adopted Obamacare.
- The blame is shared equally between health providers and health insurers. Traditionally that finger pointing overwhelmed any serious debate. But according to the Wisconsin Commissioner of Insurance report released this month, half of the top ten health insurers are owned by Wisconsin health systems. UW Health in Madison controls Wisconsin’s largest health insurer. How can the hospital blame its own insurance subsidiary for increasing prices?
- If health care prices are contained, many small hospitals will go out of business. That ignores the fact that the Wisconsin health care market has changed substantially in 20 years. Few independent hospitals still exist. The largest hospital system in Wisconsin, Atrium Advocate Aurora is a non-profit headquartered in Charlotte, North Carolina. That system has 69 hospitals. Once the largest clinic in Wisconsin, Marshfield Clinic, is now run by Sanford Health, headquartered in Sioux Falls, South Dakota. Sanford is the largest rural hospital system in the country, operating 56 hospitals. Both Catholic hospital systems are now headquartered in St. Louis, Missouri. In many ways, Wisconsin no longer controls its own health care destiny.
- Wisconsin’s conservative culture is blocking good health care, an argument frequently used by liberals to explain Wisconsin’s low rate of immunizations for kindergarten students. Ignored is the fact that the Wisconsin immunization rate for infants and for senior citizens is above average. Also ignored is the fact that some schools and some school districts do a good job in immunizing school children. Others do not.
Wisconsin has a proud history of excellent health care and good health outcomes and competitive costs. Reflecting that success, UW Madison chancellor Donna Shalala was appointed Health and Human Services Secretary by President Clinton, a Democrat. She was followed in that national health leadership position by former Governor Tommy Thompson, a Republican.
That was more than 20 years ago. This year Wisconsin was noted in the London Economist for ranking 49th in immunizing school children. The 2025 WMC state chamber of commerce report on health care was titled, “An Arm and a Leg,” reflecting the high Wisconsin health costs.
Wisconsin has a Health Care Paradox today. Falling outcome rankings, especially for children’s health, despite excellent physicians and good hospitals. Wisconsin has high hospital costs, despite the market domination of large multi-state, non-profit health systems which claimed that the consolidation would lower costs and improve quality.
