SUNDAY is the deadline for adults who want to sign up for health care in 2020 through marketplace exchanges created by the Affordable Care Act (ACA).

How healthy is the ACA in Wisconsin?

First, consider ways the ACA reformed the national rules over health care coverage. It said providers could not base coverage on pre-existing conditions. It outlawed dollar limits on coverage. It allowed young adults up to age 26 to be covered by their parents' policies.

The ACA meant that many in Wisconsin "could have access, for the first time, to affordable health care," Andrea Palm, secretary of the state Department of Health Services, said in a WisconsinEye interview last week.

HERE'S the ACA-in-Wisconsin patient's chart:

The number of ACA enrollees in Wisconsin hit a high of 242,863 in 2017, according to the UW-Madison Institute for Research on Poverty.

That number fell to 205,118 in 2019 - a drop of 15.5%. That was more than twice the 6.5% drop in ACA enrollees nationally, according to Kaiser Foundation.

Some Wisconsin counties saw much higher drops in the number of ACA enrollees than the statewide average of 15.5%, however, the UW institute reported.

The number of enrollees fell in Milwaukee County by 26%, for example. Other large drops came in Brown County, -21%; Manitowoc County, -20%, and Waukesha County, 16%.

In Rock County, the number of ACA enrollees fell 14% - from 5,517 in 2017 to 4,723 in 2019.

Statewide, one-third of all ACA enrollees this year lived in just four counties - Milwaukee, Dane, Waukesha and Brown.

One final statistic: This year, about 5% of Wisconsin adults got health care through the ACA, or Obamacare.

ALTHOUGH those numbers may suggest that the ACA in Wisconsin is sick, Palm and a UW-Madison researcher insisted last week that Obamacare has improved health care in Wisconsin overall and remains a critically important program.

Before the ACA, about 550,000 Wisconsin residents didn't have health insurance - a number that has dropped to 300,000, said Donna Friedsam, health policy programs director for the Institute for Research on Poverty.

"Clearly, we've picked up people - a large number of people -in our insurance coverage because of the ACA and other factors," including an improved economy that allowed some people to move into jobs with employer-provided health care, Friedsam said.

Friedsam also said research has shown that Wisconsin residents between ages 55 and 64 are most likely to rely on the ACA for health care.

Between 35% and 38% of the 205,118 ACA enrollees in Wisconsin this year may have been in that age 55-to-64 age bracket, she added.

ACA participation "definitely skews toward that older group of people who are nearing retirement but not eligible for Medicaid," Friedsam said.

Low-income residents are now the ones struggling to be able to afford in the ACA, Friedsam said. "They are the ones making $7 or $8 per hour," and should be covered by Gov. Evers plan to expand Medicaid, Palm added.

Friedsam said there were several reasons for the 15.5% drop in ACA enrollees in Wisconsin over the last two years. Wisconsin state government did not actively promote the ACA, for example, and "volatile" prices discouraged enrollment.

As Sunday's deadline nears, ACA health-care plan prices "have really stabilized" and residents in all 72 Wisconsin counties now have more than one health care provider to choose from, Friedsam said.

PALM said it's easy to get information on how to enroll in the ACA: Go to the healthcare.gov Website or dial the 211 helpline to be connected to a "navigator" who can guide someone through the process.

No one should avoid ACA enrollment because of fears it will be going away, Palm said. "Plans are set for 2020. People should get enrolled."

But Wisconsin's senior U.S. senator, Republican Ron Johnson, made repealing ACA his top campaign issue in 2010, when he won a first term.

Asked about his current position, a Johnson aide last week cited the senator's recent comments.

In a telephone town-hall meeting, Johnson noted that his daughter has a congenital heart defect and that he doesn't see the protection for pre-existing conditions as "up for debate."

"The good news is that there are ways of covering people with pre-existing conditions without causing premiums to double, triple and quadruple," Johnson said. "The faulty architecture of Obamacare caused that."

Steven Walters is a senior political reporter with the nonprofit public affairs channel WisconsinEye. Contact him at stevenscotwalters@gmail.com