For Adam Paul, healthcare is the largest source of financial stress. Paul owns Vintage Rose Bakery & Sandwich Shop in west De Pere with his wife, and both have medical needs that have forced them to navigate the insurance system.

Paul struggles with mental health, while his wife has a thyroid condition. For three months, the couple has been negotiating with their insurance provider in an effort to secure coverage for an MRI connected to her condition.

“Fighting with the insurance company, and owning a business at the same time, to get things covered is a nightmare,” Paul said. “It’s a constant fight of, ‘OK what is my health worth?’”

The financial strain also affects what Paul can provide as an employer. He said he “would love” to offer insurance to his workers, but his business is “way too small” to make that financially possible.

Paul shared his experience during an affordability roundtable held in De Pere last month. Former Democratic Party of Wisconsin chair Ben Wikler moderated the discussion, where other Brown County residents also described healthcare expenses as a significant financial burden.

Those concerns reflect broader priorities among Wisconsin voters. A September Marquette Law School Poll found that inflation and the cost of living ranked as their leading issue, while health insurance placed third and outranked data centers, abortion, schools and crime.

Republican U.S. Rep. Tom Tiffany and Democratic Milwaukee County Executive David Crowley, candidates for Wisconsin governor, both say they want to make healthcare less expensive and more accessible. Their proposals, however, present sharply different ideas about the government’s role in reaching those goals.

The financial pressure has built over decades. From 2000 through 2025, the cost of many essential goods and services increased faster than median incomes in Wisconsin, according to a report from Forward Analytics, the research arm of the Wisconsin Counties Association.

Hospital services recorded the largest increase among essential costs, rising 274% during that period. Median household incomes in Wisconsin increased by an estimated 90% over the same span.

Dan Sacks, a professor of risk and insurance at the University of Wisconsin-Madison School of Business, said healthcare accounts for about 18% of the nation’s gross domestic product. He also said Wisconsin hospital prices rank among the highest in the country.

According to Sacks, the healthcare sector has become “dominated by a relatively small number of very important health systems.” He said people who purchase insurance through the Affordable Care Act marketplace are facing higher costs after pandemic era subsidies expired at the beginning of the year.

Those subsidies had helped hold down ACA premiums. Sacks said tens of thousands fewer Wisconsin residents enrolled in ACA coverage this year compared with last year, while people generally are “paying more out of pocket for their healthcare.”

Another change is scheduled for the start of 2027, when Medicaid work requirements included in the One Big Beautiful Bill Act are set to begin. “In Wisconsin, the work requirements will apply only to childless adult BadgerCare members,” Sacks said.

Crowley’s proposal would open BadgerCare enrollment to any household that wants it, with premiums based on income. His plan also calls for targeted subsidies for small businesses, single parents, college students, farmers and gig workers.

Crowley also proposes expanding BadgerCare into comprehensive coverage that includes medical, dental, vision and mental health care. He described it as an alternative to private insurance for veterans, entrepreneurs, students, childcare workers and others who could pay into the system.

“It’s about creating BadgerCare as an alternative to for-profit insurance, giving our veterans, our entrepreneurs, our students, our childcare workers, anybody, the ability to pay into a system that’s going to be cheaper and is going to work well for them, so they don’t fall through the cracks,” Crowley told WPR.

Tiffany’s proposal takes a different approach, calling for hospitals and insurance companies to provide prices to patients upfront. It also would allow primary care patients to pay doctors directly through a subscription model and permit the Wisconsin Farm Bureau to offer health plans to members.

His plan seeks greater oversight of pharmacy benefit managers, which Tiffany says contribute to higher prescription drug costs. Tiffany said his administration would pursue affordability, additional resources and greater transparency from healthcare providers.

Crowley has criticized Tiffany for voting for the One Big Beautiful Bill Act and its Medicaid spending cuts. Tiffany has defended the legislation, citing its funding for rural healthcare, and said he supported a federal rule that could bring additional Medicaid funding to Wisconsin.