In early November, the new tax bill was released by House Republicans with the buzz of the bill being around the idea that this new tax bill would help the middle class. A new tax plan geared toward lifting the middle and lower class would certainly be beneficial to many Wisconsinites. Unfortunately for Wisconsinites, an old saying rings true here, “If it’s too good to be true, it usually is.” While the bill does appeal to middle class families in terms of tax cuts, the problem is that the proposal is simply a ticking time bomb that will expire in just 5 years. That means that middle class families in Wisconsin will be stuck watching their taxes increase in 5 years while the richest among us enjoy disproportionately large tax cuts.
Critics of this new plan point to the fact that the GOP could have chosen to overhaul the tax code in a way that benefited middle class working Americans, but instead chose to give the more impactful cuts to higher-income earners. The structure of the plan is that everyone gets a cut now, which is great, but what has lead articles to call this plan a “con-job” on the middle class is that the good news will only continue for the top 1%. The plan is a bubble waiting to burst, and the middle class will suffer.
Another issue hidden within the plan is that it eliminates the ability for individuals to deduct qualified medical expenses. While the IRS currently allows medical expense deductions to be used on a multitude of medical issues including preventative care, surgeries, and even long-term care expenses for those that are chronically ill, the ability to use this tool will be gone. The burden of these costs will fall not only on the patient, but also on the families that help pay for this type of care.
The new plan also provides new obstacles that disproportionately affect women. The lack of deduction on qualified medical expenses lowers the availability of preventative care, deductions and credits that make it possible to afford a child have been taken out, and the overall lack of emphasis on the middle and working classes will severely cripple the ability of single mothers.
Last week, Republicans in the House passed this tax plan and the Senate is expected to have their turn after their Thanksgiving recess. Now is the time to contact our Senators and ask them to reject the dangerous tax reform plan.
At the end of October, the Wisconsin Alliance for Women's Heath joined dozens of other organizations* to speak out against a new proposal that would eliminate some of the protections and benefits that the Wisconsin Family Medical Leave Act (WI FMLA) provides to employees who are employed by a business that is covered by both the state and federal FMLA’s.
In 1988, Wisconsin became one of the first states to pass a state-level Family Medical Leave Act (FMLA). Congress followed Wisconsin’s lead and passed a federal FMLA in 1993. Both the state and federal FMLA allow employees who meet certain criteria to take unpaid time off of work if they become ill, have a child, or need to care for a sick family member. This advancement in employment policy has been of great benefit to workers, our communities, and the overall health of our state.
The Wisconsin FMLA and federal FMLA are not identical. In general, the Wisconsin FMLA covers more employees and provides more flexible leave benefits than the federal FMLA. Wisconsin employers who are covered by both the state and federal FMLA must comply with any provisions of the state FMLA law that provide greater family or medical leave rights than the rights established by the federal FMLA and vice versa.
This new bill - SB 490 - is an attempt to “federalize” the Wisconsin FMLA, which would reduce access to family and medical leave and reduce the quality of leave for many Wisconsin workers. If passed, this bill would remove the following protections and benefits that workers who have dual state and federal FMLA eligibility current receive:
Now is not the time to scale back Wisconsinites’ hard-won access to family and medical leave. If anything, Wisconsin should be working to expand job protections to more of its citizens to ensure that they can take time off of work in order to take care of themselves, a sick family member, or a new child. Because this attempt to “federalize” the Wisconsin FMLA would weaken some of the very important protections listed above, Wisconsin state legislators need to oppose Senate Bill 490.
*Organizations that jointly oppose SB 490:
On October 2nd, two new bills were introduced to the Senate concerning fetal tissue donations and the disposition of remains after a stillbirth or miscarriage. These bills are being supported by the “Heal Without Harm Coalition,” which is comprised of groups that largely oppose access to abortion.
The first of these bills is Senate Bill 423, a ban on fetal tissue donations for scientific research if the tissue was acquired after January 1, 2017. The language of the bill prohibits acquiring, providing, receiving, and using fetal body parts regardless of whether or not permission from the family has been provided. Along with a ban on the donation and use of fetal tissue, the bill also proposes a provision that requires all fetal body parts that are obtained as a result of an induced abortion to be entombed, inurned or interned. The responsibility of final disposition would become the responsibility of the facility providing the induced abortion.
Senate Bill 423 would largely impact the scientific community that uses fetal tissue to perform research. Members of the “Heal Without Harm Coalition” that support this proposal include Pro-Life Wisconsin, the Wisconsin Catholic Conference, and Wisconsin Right to Life. Groups such as Bio Forward, Medical College of Wisconsin, and the Wisconsin Alumni Research Board have registered against it. Click here to see who has registered for and against the bill.
The second bill in the “Heal Without Harm Coalition” package addresses the disposition of remains resulting from a stillbirth or miscarriage. The bill defines a stillbirth as a spontaneous or accidental death of an unborn child and does not include remains of an unborn child as a result of an induced abortion. The bill proposes several changes to the current Wisconsin system of dealing with remains from a stillbirth or miscarriage. The first change is that the medical facility where the stillbirth or miscarriage occurred would be responsible for the final disposition of the remains. The second change is that the facility must now in all circumstances notify the parents about their ability to obtain a certificate of birth resulting in a stillbirth, regardless of the age or physical development of the fetus. Under current law, a fetus must either meet a minimum weight or age retirement in order to be eligible for a certificate of birth. The bill also adds new informed consent rules that mandate parents be informed that they can choose to donate remains as an anatomical gift for research, organ donation, or other purposes. The facility would be required to provide the parents with informed consent language in writing regardless of gestation period or weight. Finally, the bill calls for a Department of Health Services study to look into the feasibility of a fetal tissue and cord blood bank for use in research.
Senate Bill 424, has not had any groups register against it yet, but several “Heal Without Harm Coalition” groups have registered in favor of it.
During a recent Assembly floor debate on AB 128 - a bill to deny coverage for abortions for state employees - Republican State Representative Scott Allen of Waukesha suggested that women reproduce for the sake of our labor market.
In case you'd like to share your feedback with Rep. Allen, here's some ways to contact him:
Phone (608) 266-8580
October 26, 2017
Dear Acting Secretary Eric Hargan:
Thank you for the opportunity to provide comments on the Department of Health of Health and Human Services’ (HHS) Draft Strategic Plan FY 2018-2022. As an organization that advocates for policies that promote the optimal health and security for women and girls in Wisconsin, the Wisconsin Alliance for Women’s Health (WAWH) strongly opposes any health policies or objectives that will limit women in Wisconsin from accessing critical health care.
It is also imperative that HHS, the nation’s foremost health policy organization, understand and orient all its activities on a foundation firmly centered in science. The HHS Draft Strategic Plan falls far short of this requirement by deviating from accepted science while introducing religious and other non-scientific prohibitions on essential care. HHS should put women’s needs first by working with physicians, the experts on patient care needs, rather than relying on the ideological interests of individuals and groups.
As you further refine the Draft Strategic Plan and as the Department puts this plan into action in the coming years, I urge you to make the following recommended changes that are critical to women’s health:
Ensure women have continued access to preventative primary care service as is provided under the Affordable Care Act.
The HHS strategy does not do enough to ensure that women have access to evidence-based preventive services. Section 2713 of the Affordable Care Act (ACA) enabled women to access preventive services with no cost sharing. Since implementation of the law, more than 62 million women now have coverage of women’s preventive services with no cost sharing.
We urge HHS to add “contraception” to the list of preventive services named in the strategy to expand access to healthier living supports, and support access to contraception as a preventive service for all women, regardless of their employer.
Access to contraception reduces unintended pregnancies and the need for abortion, and saves federal dollars. No-copay coverage of contraception has improved the health of women and families and contributed to a dramatic decline in the unplanned pregnancy rate in the United States, including among teens, now at a 30-year low. Women with unplanned pregnancies are more likely to delay prenatal care, and infants are at greater risk of birth defects, low birth weight, and poor mental and physical functioning in early childhood. Increased access to contraception is an American success story, enabling women to reach their professional and educational goals, and improving economic stability for women and their families. HHS should take steps to protect women’s access to all preventive services, including contraception, without cost sharing, regardless of their employer’s beliefs.
Ensure that the HHS Draft Strategic Plan supports policies that are in the best interest of overall women’s health and specifically women’s reproductive health.
We support HHS program and initiatives that serve and protect all individuals across the lifespan. Public health programs and policies must be based on research, evidence, and medical and health-related facts, and must be responsive to individual patient and consumer needs and wishes. However, we note that r
We are concerned that HHS is inserting concepts such as “the unborn” and life “from conception” into its strategic plan. These concepts run contrary to medical and health-related evidence and standards of care, and instead reflect one particular religious point of view that has no role in advancing and protecting the public health of a diverse population. Elevating a fertilized egg to equal status with a person is contrary to U.S. law and establishes a policy framework that would undermine the ability of women and others to make the best decisions for themselves and their families, including decisions impacting their health and wellbeing, and their ability to participate in public life. Such policies will impede the ability of HHS to cultivate and inform best practices for women’s health, and in turn, interfere with the ability of providers, particularly those who offer reproductive health services, to provide quality care to their patients.
In addition, one of the basic functions of government is to ensure the health and well-being of its population. Privileging embryos and fetuses over people threatens the capability of HHS to fulfill this function, and would deprive women of health care benefits that medical and health care experts recognize as critical to ensuring women’s health and wellbeing. Elevating the status of a fetus over the health needs of pregnant women would result in poorer maternal health and poorer birth outcomes. Moreover, adopting policies that give health rights to fetuses would also undermine a woman’s constitutional right to access abortion, and interferes with the patient-provider relationship by limiting the information, counseling, referral and provision of abortion services that a woman can receive, despite the fact that these are part of the standard of care for a range of common medical conditions including heart disease, diabetes, epilepsy, lupus, obesity, and cancer. The language is overly broad, confusing, and subject to misuse and abuse by creating a federal health care framework that invites HHS to refuse to participate in the orderly delivery of evidence-based health care services.
Remove all language that either promotes open-ended deference to religious entities or is unscientific and non-medical language that threaten women’s access to the full spectrum of health care services.
HHS should not prioritize the beliefs of religious and faith-based groups over the health care needs of my patients. The Draft Strategic Plan states that HHS will “promote equal and nondiscriminatory participation by faith-based organizations in HHS-funded or conducted activities,” (Line 361) and HHS will “affirmatively accommodate” burdens imposed on the exercise of religious beliefs and moral “convictions” by persons and entities partnering with HHS (Objective 1.3, Line 368). We urge that you to strike every mention of such language, which invites limitations on health care access based on non-medical religious or moral grounds.
The American Congress of Obstetricians and Gynecologists (ACOG) opposes federal, state and local legislation and regulations, hospital policies, and business decisions that threaten to create restrictive circumstances for patients and clinicians. Prohibitions on essential health care based on religious or non-scientific grounds jeopardize women’s health and safety. Where health care services are legally restricted based on religious or moral grounds, health care providers are required to withhold needed care, risking the health and life of their patients and deeply harming the sanctity of patient-physician relationship. The Draft Strategic Plan’s repeated commitment to accommodating faith-based entities alarmingly signals that HHS is prioritizing opinions and beliefs over scientifically based access and care needs. HHS should put patient care first and strike all language that promotes religious or ideological beliefs over my patients’ right to basic health services.
Along the same lines, as the nation’s health policy center, HHS policy and activities must be firmly based on scientifically valid and appropriate terms and evidence. The Draft Strategic Plan defines an individual’s lifespan from “conception” to “natural death” and identifies the goal of HHS as improving healthcare outcomes “for all people, including the unborn” (Strategic Goal 1, Line 115). “Conception” and “unborn” are lay terms that have no scientific validity and are generally not used in or by the medical community. Find the correct scientific definitions here.
Reliance on unscientific and non-medical terms threatens women’s access to essential reproductive health services, including birth control, assisted reproductive technology (ART), stem cell research, in vitro fertilization, and abortion. WAWH supports patients’ decisions on whether to have children, the number and spacing of their children, and to have the information, education, and access to health services to make these choices. Abortion is a necessary component of women’s health care and HHS should not support politically imposed barriers to abortion access.
As a result of the concerns articulated above regarding the HHS Draft Strategic Plan, we respectfully request that changes are made to this plan. We appreciate the opportunity to provide comments on the negative impact this plan would have on Wisconsin women.
Executive Director and Founder
Wisconsin Alliance for Women’s Health
Take Your Own Action and Submit Comments Now
The Legislature’s Joint Finance Committee (JFC) approved a modified version of the 2017-2019 Wisconsin state budget in early September that was signed into law by the Governor later that month. The $76 billion dollar budget included deep tax cuts for businesses and wealthy Wisconsinites. Lower- to moderate-income Wisconsinites didn’t fare as well under this version of the budget, which attempted to eliminate the Working Family Credit Program, a program that gives a small tax cut to families with lower incomes. Governor Walker has vetoed the elimination of the program, but it will certainly see a major decrease in funding. The JFC also rejected the very modest increase to the state Earned Income Tax Credit (EITC) that was proposed by Governor Walker and would have helped thousands of lower-income working families.
The modest change that Governor Walker proposed was to add $20 million dollars to the EITC to counteract the 2011-2013 state budget, which cut the program substantially, leading to a $114 million tax increase for lower-income families over the last four years. The state EITC program provides a mechanism that is designed to help move low-income families out of poverty by incentivizing work with a tax credit that helps boost household income. The way that the state EITC does this is by providing a “refundable” tax credit for workers that have not made enough to pay federal or state income taxes. This tax credit is important for families with children and has also been a particularly important poverty-reduction tool for women, especially women of color.
In addition to the state EITC, there is a federal EITC program which has received surprisingly strong bipartisan support and even has even been increased by Congress in recent years. While this bipartisan support in Congress should serve as an example of how important the EITC is, the Joint Finance Committee opted to reject this modest $20 million increase within a budget of $76 billion.
The question becomes one of priorities. The Joint Finance Committee rejected this plan to provide relief for lower-wage working families while simultaneously cutting taxes for the upper class. The Committee even approved the lowering of the alternative minimum tax and to eventually eliminate it starting in 2019. This alternative minimum tax is an annual tax that ensures those making between $200,000 and $500,000 pay a minimum amount in taxes regardless of how many deductions they have. This could equate to a $7 million dollar tax cut for those in this income bracket.
While some representatives may see these changes as “just cleaning up the tax code,” these are real dollars that impact working families struggling to make ends meet in Wisconsin. The willingness of the Joint Finance Committee to reject a small increase to a program that helps lift people out of poverty in favor of tax breaks for the wealthy is an incredibly disappointing omen for working families in Wisconsin.
After the several failed attempts to repeal the Affordable Care Act (ACA) finally ended in August, those that value access to healthcare celebrated the victory as the end of the Republican plan to strip coverage away from millions of Americans. However, just this last week Senators Lindsey Graham, Bill Cassidy, Dean Heller, and Ron Johnson introduced yet another version of “Trumpcare” that seems to be even worse than those previously rejected. While it may be easy to believe that this new version will also be rejected, it is gaining momentum and needs to be taken seriously by those that believe Americans should have access to quality healthcare.
The new Graham-Cassidy proposal was pitched behind closed doors to the GOP caucus, which means it was another proposal drafted in secret without input from Senate Democrats. The proposal is championed by the idea that by turning over control of health-care markets to the states, the state could develop any system that it wants. Republicans say this includes keeping the ACA if they want. The reality is that the plan cuts funding for the Medicaid expansion and subsidy funding so sharply that it would be zero in a decade. States would not be able to keep the program working as it is with funding being cut so deeply. The result of this would be an estimated loss of coverage for 32 million Americans in the next 10 years.
That huge loss in coverage is only one of the many problems that comes with repealing the ACA with this proposal:
By not including Democrats at any part of this proposal and moving recklessly forward with a partisan effort, the new version of this proposal will eliminate the progress that was made in health reform under the Obama administration and effectively end Medicaid as we know it. It is concerning that once again another proposal is being rushed into the Senate and that instead of moving toward a more bipartisan approach to healthcare, it seems Republicans are moving backwards. We need to stand with these programs that provide support for millions of Americans. The ACA has the opportunity to continue to expand coverage for Americans as it has for 20 million people already. For those who still care about access to healthcare in the U.S., the time for action is now.
While this was a monumental victory of preventing the ACA from being repealed recently should not be overlooked, the time to support the ACA is just beginning. The Trump administration still has two weapons to use to hinder the survival and success of the ACA. The first is the federal budget in which there will be attempts to undermine both Medicaid and the ACA. The second is the actions of the Trump administration in general. The key to defending the ACA is not only continued support, but also a bipartisan answer to some of the problems that the ACA faces.
While Republicans maintain that the ACA is failing, the facts refute that this is true. The ACA has expanded health insurance coverage to over 20 million people and current healthcare spending is below historical trends. That does not mean that the ACA is without flaw, but now that the fight to kill the ACA is over, the time has come for bipartisan support to improve the ACA. In order for the ACA to continue its success, premiums need to be lowered and the market needs to be stabilized. While in the past two years insurance markets have stabilized more and more, but there is still work to be done for 2018 and beyond. Due to policy uncertainty and the constant threat of repeal, there has been recent deterioration of the markets as insurance companies realize there is a looming possibility of pulled funding. It is this uncertainty that has hindered the ability of the ACA to complete the task it was commissioned to do. There are bipartisan ways in which this uncertainty can be alleviated such as:
Wisconsin Alliance for Women's Health (WAWH) Executive Director, Sara Finger, released the following statement regarding today's U.S. Senate vote on a motion to proceed with debate to repeal the ACA:
"From day 1 of the Trump Administration, the attempts to repeal the Affordable Care Act (ACA) have involved a direct attack on access to healthcare and our country's democratic processes. Today we witnessed an almost total breakdown of basic democratic norms that has resulted in the U.S. Senate voting to debate a bill for which there isn't even any text that is available to the public. Even more importantly, from what we do know about the range of substantive options being considered by Senate Republicans, somewhere between 22 and 32 million Americans will lose access to health care insurance if they are able to pass some version of ACA repeal. We are particularly disappointed that Wisconsin Senator Ron Johnson voted in favor of the motion to proceed, despite his vocal objections about many problematic issues surrounding the process of this debate.
Walker & DHS Ignore Concerns - Support Stealth Opportunity to Weigh in with Federal Leaders on BadgerCare
Throughout July, WAWH has once again been working on drafting comments in opposition to the proposed changes to the Wisconsin BadgerCare Program for Childless adults - this time at the federal level. If you are unfamiliar with the devastating negative effects that the waiver could have by requiring monthly premiums, limiting eligibility, requiring substance abuse screening and testing to qualify please refer to our past post. Bottom line, if approved, Wisconsin's proposed changes to BadgerCare would lead to less coverage, lower health outcomes and a high burden on the average Wisconsin taxpayer.
In a previous blog post, we noted that 1045 out of 1050 of the Waiver comments submitted were negative, we have since put in an open records request to get to the core of who really spoke out in opposition to these changes. The findings of this open records request was staggering. Not only were advocacy groups such as Wisconsin Council on Children and Families, ABC for Health, and Community Advocates a voice of the opposition, but almost every type of organization that can be fathomed. There were health care providers, health care policy experts, religious groups, free clinics, tribes, senators, physicians, hospital workers, hundreds of Wisconsinites and many more. It is clear that Wisconsin rallied around a single idea: these changes will negatively affect Wisconsin.
When looking the positive comments submitted, the list was drastically smaller and did not include a single health care organization in support. Out of the 7 Wisconsinites who weighed in with their support, two of them were Representative John Nygren and Lieutenant Governor Rebecca Kleefisch who are both well known to be in Governor Walkers’ corner.
With over 99% of the comments coming into the Department of Health Services being negative, you would expect to see big changes to the proposed plan. Instead, the comment process seems to have been a mockery that was pushed right past in order to seek approval at the federal level because very little was changed about the proposal.
Despite overwhelming push back to the proposal, DHS submitted their application to federal decision makers and eagerly hid information about when stakeholders could weigh in at the national level.
If it wasn't for some friendly advocates who happened to find the Wisconsin application and opportunity to comment buried deep in the DHS website, we might have missed the chance to weigh in all together. Unfortunately advocates only had a few days to weigh in and urge federal leaders to reject the Wisconsin application. To view WAWH's comments to CMS, link here.
Just understand that these proposed changes are being pushed past Wisconsinites despite the overwhelming opposition voiced by the very same Wisconsinites and organizations that chose to comment on these proposed changes.
UPDATE as of 7/26/17:
The results of the federal comment period are now finished and up on the Medicaid website here. Unsurprisingly, the federal comment period showed the same outrage as the previous state comment period. A total of 125 comments were submitted and only 2 of those 125 comments were in support of the proposed changes. While it may be spun to say that most of the comments had mixed feedback on the changes; that is not the case. Over 100 of the 125 comments were in complete opposition to the changes that are being proposed for BadgerCare. Among many concerns, Wisconsin citizens fear for an overall loss of coverage and a crippling cost to Wisconsin’s economy. While it is still unclear how these proposed changes will be dealt with at the federal level, it is very clear from the two comment periods that Wisconsinites have spoken strongly against these changes.