Wisconsin’s unemployment rate sits near a historic low, but for thousands of rural residents the link between a layoff and losing health insurance has never been stronger.
Using county-level data from all 72 Wisconsin counties between 2014 and 2023, I tracked how shifts in local unemployment moved together with shifts in the uninsured rate. Before the pandemic, a one percentage point rise in county unemployment was tied to roughly a 0.21 percentage point rise in lack of insurance. After the pandemic, that same increase pushed lack of insurance up by 0.55 percentage points. The relationship more than doubled.
Almost all that vulnerability sits outside our cities.
In Wisconsin’s 46 nonmetropolitan counties, the unemployment-coverage link is strong and statistically significant. In the 26 metropolitan counties, which include the Milwaukee, Madison, Green Bay and Fox Valley metro areas, the same statistical model finds no significant relationship at all.
This is not a story about lazy or careless workers. It is a story about how policy design and geography combine to leave rural Wisconsinites without a net.
Wisconsin made a distinctive choice when the Affordable Care Act became law. The state expanded BadgerCare Plus to adults below 100% of the federal poverty line but declined the full expansion to 138% that most other states have now adopted. The Wisconsinites in that 100% to 138% income band, about $15,650 to $21,597 for a single adult in 2025, are sent to the federal marketplace instead of Medicaid.
Marketplace coverage in that range comes with subsidies, but also with deductibles, co-pays and out-of-pocket maximums that Medicaid would not impose. For a worker who just lost shifts, the marketplace can mean nominal insurance with effective noncoverage. My analysis found that the unemployment-coverage link is sharpest precisely for this low-income group, which is what the policy design predicts.
Rural labor markets compound that policy choice. They have fewer employers, smaller firms and less industry diversification. When a foundry, a paper mill or a dairy processing plant lays off workers, the next job in the same county is unlikely to offer group health benefits. Small firms, which provide a larger share of employment in rural areas than in cities, are far less likely than large ones to offer coverage, a gap documented in KFF’s employer survey.
The supports that help urban workers navigate a coverage transition are also thinner outside the metros. UW-Extension research found that only 63% of households in Wisconsin’s most rural counties had home broadband, compared with over 95% in metropolitan areas.
Healthcare.gov enrollment, marketplace navigator outreach and routine renewal notices all assume reliable internet. A working spouse in a rural area is also less likely to carry employer coverage to fall back on since rural jobs are concentrated in small firms and self employment that often do not offer health benefits.
The pandemic period offers one more piece of evidence. During the public health emergency, federal law required states to keep Medicaid enrollees continuously covered. Coverage held steady even as unemployment surged. The historical link between job loss and insurance loss weakened. Then the Medicaid unwinding began in 2023. Wisconsin disenrolled nearly 394,000 residents from BadgerCare Plus by mid-2024, most for procedural reasons like paperwork rather than actual ineligibility. The post-pandemic coefficient of 0.55 captures what happens when protective policy is withdrawn but the underlying vulnerability remains.
Three state-level actions would directly reduce the harm.
First, complete the BadgerCare Plus expansion to 138% of poverty so that workers in the transition zone are automatically covered when they lose their jobs. A Georgetown University analysis found that full expansion would cover more than 80,000 additional adults in that income band. Assembly Bill 1153, the BadgerCare Public Option introduced this year by Rep. Tara Johnson, D-town of Shelby; Rep. Robyn Vining, D-Wauwatosa, and others, addresses a related gap by letting any Wisconsinite buy into BadgerCare Plus regardless of income and deserves serious debate alongside full expansion.
Second, invest in rural enrollment navigators and renewal pathways that do not assume broadband. Coverage policy without enrollment infrastructure produces coverage on paper only.
Third, build administrative stability into BadgerCare Plus renewals so that procedural disenrollments do not strip coverage from people who remain eligible.
The federal Medicaid cuts enacted in 2025 will widen the rural-urban gap I documented. KFF estimates that the cuts will leave more than 50,000 additional Wisconsinites uninsured by 2034. Without state action, the workers already at the sharp end of the unemployment-coverage relationship will absorb a disproportionate share of that loss.
The link between losing work and losing health security is not a law of economics. It is the result of choices, and Wisconsin can make different ones.
Jiyue Wang lives in New Brunswick, New Jersey. He completed this research as part of his master’s degree in economics at the University of Wisconsin-Milwaukee. He will begin a Ph.D. in political science at Rutgers University in September 2026.
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