Despite Gov. Tony Evers' campaign to expand Medicaid during budget discussions, Republican opposition continues. The state's ACA marketplace continues to see large carrier participation and declining premiums, but remains largely unsuccessful in translating that into membership growth. Wisconsin's insurer pool is highly linked to health systems in state, making Wisconsin a state with many regional carriers. Overall commercial enrollment in the state is led by national carriers like UnitedHealth and Anthem, though some markets like Madison remain wholly controlled by local and regional stakeholders. The state began Medicaid redeterminations with the end of the COVID-19 public health emergency. Medicare continues to provide an opportunity for enrollment gains for carriers operating in the state, as Wisconsin's baby-boomer population continues to age into the program, but competition in the managed Medicare sector remains as fierce as ever, particularly after the largest health system in the state, Advocate Aurora Health, launched a new MA plan in partnership with Quartz.