MARCH 20, 2026 PUBLIC HEALTH GROUNDCOVER NEWS Washtenaw Health Project reports significant drop in marketplace enrollment as premium costs surge WASHTENAW HEALTH PROJECT The Washtenaw Health Project reports a sharp decline in health insurance enrollment during the 2026 Health Insurance Marketplace Open Enrollment period, reflecting growing affordability challenges for local families. WHP assisted 551 individuals in enrolling in Marketplace coverage for 2026 — down from 804 enrollees the previous year, a 31.5% decrease. While enrollments dropped significantly, the need for help did not. WHP recorded 1,735 client encounters during Open Enrollment, only slightly lower than last year. “This year, we spent just as much time helping people understand their options,” said Jeremy Lapedis, Executive Director. “Many families kept waiting for Congress to lower healthcare costs, but when that didn’t happen, they had to walk away because they simply could not afford coverage.” The decline follows the expiration of enhanced Affordable Care Act (ACA) premium tax credits at the end of 2025, which had helped reduce insurance costs for millions. New eligibility restrictions included in H.R. 1 — known as the “One Big Beautiful Bill Act” — also bar permanent residents and work-authorized individuals earning under 100% of the Federal Poverty Level ($15,650 annually for an individual) from subsidies. Estimates are that ACA health insurance premiums more than doubled across the country for 2026. This mirrors what WHP staff saw, with some seeing premiums increase even more than that. After a modest increase in income, one couple who paid $0 per month for coverage in 2025 was quoted $1,409 per month for 2026 — more than $16,000 annually — along with a $21,200 deductible. Their total potential yearly exposure now exceeds $38,000. “These are working families who did everything right,” said Lapedis. “But healthcare coverage that costs more than their monthly rent isn’t realistic.” Statewide, Marketplace enrollment in Michigan fell from 531,083 in 2025 to 497,064 in 2026, a decrease of approximately 6.4%, according to federal data. Nationally, enrollment declined by about 5%, with new enrollment dropping 14%. Early reports suggest higher cancellation and non-payment rates may further reduce coverage numbers in the coming months as premiums come due. WHP’s sharper local decline reflects the disproportionate impact of subsidy changes on lower-income populations and immigrant communities in Washtenaw County. Although fewer residents ultimately enrolled, many sought guidance in evaluating options, understanding eligibility changes, and weighing difficult financial decisions. “We are seeing people forced to choose between health insurance — accessing medical care and their prescriptions, essentially — and other basic necessities,” said Lapedis. “The need for trusted, community-based enrollment support remains critical.” WHP continues to provide free, unbiased enrollment assistance to approximately 8,000 residents of Washtenaw County year-round. For help with health coverage options, visit WashtenawHealthProject.org or call 734-544-3030. 13 Education, conversations on cardiovascular diseases WILL SHAKESPEARE Groundcover vendor No. 258 A few months ago, I interviewed a retired University of Michigan doctor and research scientist, Dr. Max Wisgerhof, on the topic of cardiovascular diseases. (He is also a Groundcover volunteer.) His answers to contribute to my ongoing series on community health literacy. This article is a followup to the Groundcover November 28, 2026 article titled, “November is Diabetes Awareness Month.” Dr. Max was interviewed and made a huge contribution to our community’s understanding of diabetes. We hope this interview sparks intergenerational conversations on health and wellness across populations and socioeconomic status. WS: Define Cardiovascular disease. Dr. Max: Cardiovascular diseases are diseases of: the heart (“cardio”) and arteries, blood vessels that carry blood to organs (“vascular”). WS: How is cardiovascular disease connected to type 2 diabetes? Dr. Max: The high glucose and normal or high insulin in blood vessels in type 2 diabetes, by complex and unknown mechanisms, damage the arteries and the heart, which impairs their function. Major causes of cardiovascular disease are diabetes mellitus, high blood pressure, high blood cholesterol, abnormal genetics, with family history, body weight and others, known and unknown. Some major symptoms are pain from insufficient blood supply to the heart and the legs; shortness of breath from damage to the heart; discomfort from infection because of insufficient blood supply to organs like the toes. The diagnosis is by the primary care physician, using interviews, exams and tests. Treatments for cardiovascular disease are primarily healthy lifestyle, medications and surgery. WS: Kindly share your knowledge and professional experience on high blood pressure/hypertension with the Washtenaw County community. Dr. Max: High blood pressure and hypertension are synonymous. High blood pressure has two types: primary and secondary. Causes for primary high blood pressure are not specifically known, so we treat with the expectation of control of the high blood pressure. Suggested causes and/or aggravation of primary high blood pressure include: abnormal genetics; “high” sodium (salt) intake, as some persons are more sensitive than other persons to sodium; “high” body weight and its distribution; others, including “inactivity.” Causes for secondary high blood pressure are excessive production and effects of hormones, especially from the adrenal gland (aldosterone or other steroids, or noradrenaline); excessive production of a hormone-like substance from a kidney or kidneys, which can cause constriction of smallest arteries (arterioles), which causes high blood pressure; abnormal amounts of other hormones such as thyroid hormone (too much or too little) and, occasionally, estrogens. Symptoms are the same as above, and other damage to organs from the high pressure in the blood adversely affecting/damaging the organs supplied by the blood. WS: What are interventions and treatments? Dr. Max: There are non-specific interventions such as decrease in sodium intake, decrease in body weight, and/or increase in activity. Specific treatment of high blood pressure involves use of medication to decrease volume of blood fluid (diuretics), to decrease arteriole constriction, and to decrease heart rate which, when high, increases blood pressure. Treatment of secondary high blood pressure is to detect the cause, as above, and remove or counter the cause. FDA approved medications to treat high blood pressure, when prescribed and used as indicated, have greater expectation of benefit than risk of harm. Other treatments have variable certainty of benefit. “Alternative” treatments have less certainty and need to be monitored closely for benefit and for harm. WS: What do you think about prevention? Dr. Max: From an early age, achieve and maintain recommended sodium intake, body weight and activity. To detect early onset of high blood pressure, have blood pressure measured by recommended method yearly, or more frequently if increasing. Cardiovascular disease is a worldwide health issue. The World Health Organization noted that poor people in developing nations have major problems when it comes to access to treatment and prognosis. However, for developed nations such the United States, there have been major improvements in diagnosis, treatment and prognosis of patients with cardiovascular diseases. In fact, there is a better understanding of how the disease happens, why it happens and what is needed to save lives and improve the quality of patients’ lives. Some medical researchers in U.S. universities have suggested that poverty is highly correlated with cardiovascular disease. Major studies done in Detroit and other cities attest to the magnitude of the problems. We also encourage our readers to watch brief YouTube videos which are titled, “Heart and Blood Circulatory System,” “Cardiovascular Disease Overview” and “Understanding Cardiovascular Disease: Visual Explanation.”
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