Editor's note: This is the Wisconsin analysis in Patients Rising's Medical Bankruptcy in America series — a six-state review of approximately 900 federal bankruptcy filings and the role of 340B-participating hospitals as creditors. State-level analyses for Virginia, Wisconsin, Washington, Louisiana, Colorado, and Maine are publishing on a rolling cadence. Methodology available on request.

Wisconsin presents the most concentrated medical-bankruptcy pattern in our six-state series. Across 104 individual Chapter 7 and Chapter 13 filings from the Eastern and Western Districts of Wisconsin in January and February 2024 — just two months — the data shows the highest 340B exposure rate, the highest medical-debt rate, the densest verified-340B dollar accumulation per unit of time, and the most concentrated single-system dominance of any state we have examined.

The headline numbers

• 104 cases in a two-month window (January–February 2024)
• 92 percent of cases include medical debt — the highest rate in the series
• 65 percent of cases include verified medical debt to a 340B-participating Wisconsin hospital — the highest rate in the series
• $1,160,048 in verified 340B hospital debt
• Aurora Health Care appears on 48 of the 104 cases — 46 percent of all filings, the most concentrated single-system pattern of any state in the series

For context: this is more verified 340B debt than Maine produced across fourteen months, and roughly the same as Washington produced across eight. Wisconsin's data window is the shortest in the series. Its dollar accumulation is the densest.

Why the concentration is so sharp

Two structural features of Wisconsin's hospital market explain the pattern.

First, Wisconsin's hospital prices are among the highest in the United States. Per the RAND Corporation's hospital price transparency studies, Froedtert & the Medical College of Wisconsin charges private insurers approximately 392 percent of Medicare rates — the highest hospital system markup in Wisconsin and one of the highest in the country. Advocate Aurora runs at approximately 369 percent of Medicare. Bellin Health, the dominant Green Bay system, at approximately 365 percent. By RAND's national ranking, Wisconsin has the fourth-highest hospital prices of any state.

Second, the Wisconsin hospital market is overwhelmingly nonprofit and 340B-participating. The major systems — Aurora Health Care (now part of Advocate Health, 19 Wisconsin hospitals), Froedtert ThedaCare Health (18 hospitals, formed January 1, 2024, at the exact start of our dataset window), Ascension Wisconsin (18 hospitals), UW Health, SSM Health, HSHS, Bellin, ProHealth, Aspirus, Marshfield Clinic, and Children's Wisconsin — all participate in 340B at their major facilities. The for-profit hospital sector in Wisconsin is minimal.

High prices on a market dominated by 340B-participating nonprofits produces what the schedules show: a 65 percent verified 340B exposure rate, with most cases naming a major Wisconsin nonprofit system as the largest medical creditor.

The Aurora concentration

Aurora Health Care appears in 48 of the 104 cases — 46 percent of all filings. No other hospital system in our six-state series has reached this rate of concentration. The closest comparison is Bon Secours in Virginia (54 cases out of 275, or 20 percent).

Aurora's Wisconsin footprint consists of 19 hospitals plus more than 500 sites of care, employing approximately 40,000 people. Its largest facilities are Aurora St. Luke's Medical Center in Milwaukee (Level I trauma), Aurora Sinai Medical Center, Aurora BayCare in Green Bay, and Aurora Medical Center Summit in Waukesha County. Every major Aurora facility participates in 340B.

Aurora's parent integrated delivery network, Advocate Health, is the third-largest nonprofit hospital system in the United States, with annual revenues exceeding $27 billion and operations across Wisconsin, Illinois, North Carolina, South Carolina, Georgia, and Alabama.

The largest individual balances

Six cases account for approximately $652,000 of the $1.16M total — more than half the dataset from a small fraction of the filings:

• $200,000 to Aurora Medical Center, on a Delavan joint Chapter 7 filing by a truck driver and a corporate purchasing agent
• $180,000 to Froedtert Tosa Health Center, on a Racine joint Chapter 7 filing by a nanny
• $170,000 to Ascension SE Wisconsin Hospital, on a Pewaukee joint Chapter 7 with a three-year-old pending workers' compensation claim
• $60,000 to Ascension Wisconsin, on an Appleton joint Chapter 7 with both filers unemployed
• $22,000 to Bellin Health, on a Green Bay Chapter 13 filing by a non-emergency medical transport driver
• $21,000 to Aurora Health Care, on a Cudahy joint Chapter 7 filing by a food service worker

Four of these cases are profiled in detail in the case posts accompanying this synthesis.

Geographic distribution

WI-1 alone contains both of the dataset's two largest 340B balances — the Delavan Aurora case and the Racine Froedtert case — plus a substantial number of Aurora-dominant filings across Pleasant Prairie, Lake Geneva, and Burlington.

Three pattern observations

First, the healthcare-adjacent worker pattern. Two of the six largest 340B balances belong to households where the principal earner works inside the healthcare delivery system that produced the bill — a non-emergency medical transport driver in Green Bay, and a food-service worker employed by a contract company that operates hospital and airport food services. The Maine dataset contains a similar pattern in a Rockport pharmacy technician case. Healthcare-adjacent low-wage employment produces exposure to the same hospitals as creditors.

Second, the workers' compensation claim delay pattern. The Pewaukee Ascension case is the cleanest example we have seen of how protracted workers' comp claim disputes pile catastrophic 340B hospital debt onto a household before the workers' comp system pays. Wisconsin's workers' compensation system administers approximately 25,000 claims per year; contested claims commonly take eighteen to thirty-six months to resolve. During that time, the hospital bills the patient.

Third, the middle-class fragility pattern. The Delavan case shows that 340B-hospital catastrophic billing is not confined to households below the federal poverty line. A two-earner household with $67,700 in combined annual income — squarely working-class, slightly below the local median — accumulated a $200,000 hospital balance and filed Chapter 7. This parallels our Washington Spokane Kadlec case ($179,000 on a $120,000-a-year household), with a lower-income, more typical working-class profile.

The 340B program in Wisconsin

Wisconsin's 340B-participating hospitals receive substantial drug-pricing discounts under the federal program. Industry estimates place Wisconsin's aggregate annual 340B savings at over $1 billion. The drug-pricing discounts flow into hospital pharmacy budgets, where, per HRSA rules, they are supposed to support patient care for the populations whose existence justifies the discounts.

The Wisconsin Hospital Association publishes an annual Community Benefits Report itemizing each member system's reported community contributions. The 2023 total across reporting hospitals was approximately $2.4 billion — including charity care, unreimbursed Medicaid, subsidized health services, community health improvement, education, research, and cash contributions.

What the Community Benefits Report does not contain is a line for patient bills owed by patients who subsequently declared bankruptcy. That number is not reported by any Wisconsin hospital system and is not, by any federal or state regulation, required to be reported.

The 104 cases in this dataset — 67 of them with verified 340B hospital creditor lines, totaling $1,160,048 in a single two-month window — represent the patient-side ledger of that unreported metric. Annualized, the pipeline accounts for more than $6 million in 340B medical-bankruptcy debt from Wisconsin alone. The full universe of Wisconsin medical bankruptcies, including cases not in our referral pipeline, would be substantially larger.

The Wisconsin hospitals receive the program's drug-pricing benefits without conditioning those benefits on patient-side cost reduction. That is, in the federal statute, by design.

What 104 Wisconsin filings show

• Forty-eight of 104 cases owe money to Aurora Health Care.
• Twenty-seven owe Ascension Wisconsin. Ten owe Bellin Health.
• Sixty-seven of 104 name a specific 340B-participating Wisconsin hospital on the schedule.
• The total verified 340B debt — $1,160,048 in two months — is the densest per-unit-time accumulation in the series.
• The single largest verified 340B balance — $200,000 to Aurora Medical Center on a working-class Delavan household — was billed to a household running a negative monthly margin before any payment toward the hospital debt.

Wisconsin charges some of the highest hospital prices in the United States. Its hospitals are overwhelmingly nonprofit, 340B-participating, and concentrated in a small number of large health systems. The bankruptcy schedules show what the result looks like at the patient level.

Methodology and aggregate data tables available on request.