June 28, 2018
Dear HHS Secretary Azar,
The Wisconsin Alliance for Women’s Health (WAWH) is writing to express our opposition to the Department of Health and Human Services’ proposed HHS-OS-2018-0008-000, which would enforce a "gag rule" on health care providers that participate in the Title X federal family planning program. WAWH advocates for women and families across the state of Wisconsin, many of whom depend on Title X funded services to access the healthcare they need. WAWH has serious concerns about how this rule will adversely affect women’s health in our state and across the country.
Title X is an important health care program that provides approximately 31,000 Wisconsin patients a year with access to essential services like birth control, cancer screenings, and other preventive care. If not for Title X funded services, many of these women and men would not have access to this care. The network of Title X funded providers is particularly critical in largely rural states like Wisconsin, as these providers are often the only affordable option, or the only option for such services, in several of the communities they serve.
If implemented, the Department’s proposed rule will either deny many low-income Wisconsinites who rely on Title X funded services access to care completely or compromise the quality of care they receive from Title X providers. The rule would lead to these results for three reasons.
First, the proposed rule would impose new regulations that are designed to make it impossible for patients who rely on Title X funded services to get birth control or preventive care from reproductive health care providers that also provide abortions, such as Planned Parenthood. This is particularly problematic in Wisconsin, as Planned Parenthood serves 86 percent of our state’s Title X patients. There is no feasible provider network in Wisconsin that would be capable of absorbing the patients who rely on Planned Parenthood to provide them with Title X funded care. In fact, Wisconsin patients have already suffered at the hands of similar state-level restrictions when our Governor and Legislature blocked all state funding from Planned Parenthood, which lead to the closure of five rural, family planning health centers in Wisconsin. No other provider has stepped up to serve these patients, meaning thousands of women, men and young people lost access to critical preventive health care like sexually transmitted infection (STI) testing and treatment, cancer screenings, and birth control. These service cuts were the result of a state funding prohibition that created a $1 million dollar shortfall. Should Planned Parenthood of Wisconsin lose all of its Title X funding, it would face a shortfall of $3.5 million and thousands of Wisconsinites would likely have nowhere else to go for this essential care. The effects of this proposed policy will likely be similar in other states, too.
Second, the Department’s proposed “gag rule” allows health care providers to withhold medically accurate and necessary information regarding abortion from patients who request that information directly. This is not only unethical, but harmful to the provider-patient relationship, patient health, and the public health. All patients in Wisconsin, regardless of where they access care, deserve the fundamental right to be able trust their healthcare providers in order to receive accurate and comprehensive information that is necessary for these patients to make informed health care decisions.
Lastly, this rule would prohibit health care professionals from referring their patients for abortion care, even in cases where such care is necessary for the health of the patient or requested by the patient. These last two provisions rob women of the right to make informed health care decisions and can even endanger their personal health in cases where an abortion is necessary to protect the health of a pregnant woman.
Because of the negative affects this rule would have on the health of patients and the professional standards of a wide swath of health care provider fields, the medical community overwhelmingly opposes this proposal. WAWH strongly recommends that the Department pay close attention to the concerns raised by organizations and individuals that are dedicated to providing essential care to the individuals who rely on Title X funded services. The concerns raised by those in the medical community are premised on the longstanding principle that when patients access any type of health care, they should have access to the best care and information available. This proposed rule runs afoul of this basic tenet of medical ethics. As a result, the Department should heed the widespread opposition to this rule and withdraw this harmful proposal.
Thank you very much for your time and consideration regarding this important matter.
Wisconsin Alliance for Women’s Health
While national demographics are rapidly changing, racial and ethnic minority populations are expected to continue growing in the coming years, communities of color continue to face substantial cultural, social, and economic barriers to obtaining quality health care and achieving equitable health outcomes. Communities of color also experience poorer health statuses than their counterparts. Efforts to improve their health and the delivery of care have been limited by inadequate resources for funding, staffing,
stewardship, and accountability.
The Health Equity and Accountability Act (HEAA) is a comprehensive, broadly-supported federal legislation to eliminate racial and ethnic health disparities. HEAA is the only legislation that holistically addresses health inequalities, their intersections with immigration status, age, disability, sex, gender, sexual orientation, gender identity and expression, language, and socio-economic status, along with obstacles associated with historical and contemporary injustices.
Health care advocates across the country applauded the passage of the Affordable Care Act (ACA) as the most significant advancement in support of the health of communities of color in the last 40 years. The ACA improved and extended health insurance coverage to millions of Americans, ended pre-existing
condition exclusions, lifted lifetime caps on care, covered clinical preventive costs, and increased investments in public health and community-level prevention initiatives. Many policy initiatives in previous versions of HEAA, such as expanded Offices of Minority Health and health data collection
standards, were passed as part of the ACA.
Since the ACA, the Department of Health and Human Services (HHS) has developed Healthy People 2020, the National Stakeholder Strategy for Achieving Health Equity, National Partnership for Action to End Health Disparities, National Prevention Strategy, and National Quality Strategy as the nation’s coordinated roadmap to reduce health disparities. Additionally, the enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS) and National HIV/AIDS Strategy (NHAS) are additional initiatives by HHS to prioritize the elimination of racial and ethnic health disparities. HEAA builds on these important efforts.
While the ACA includes a number of provisions to reduce health disparities, additional investments must be made to fully achieve health equity. At a time when health care is under attack, we must continue to use our shared values to work toward a unified vision of fairness, justice, and equal opportunity. Through collaborative work, we can better achieve a sustainable, cost-effective health care system without barriers that prohibit communities of color and other individuals from obtaining quality care and achieving equitable health outcomes.
Much like the previous three legislative session, the 2017-2018 state legislative session was incredibly challenging for issues related to women’s health and economic security. While there were some promising individual initiatives that became law and some of the most egregious attacks on women’s health and economic security were defeated, there were still many pieces of troubling legislation that became law. Below is a detailed summary of some of the highlights and lowlights of the 2017-2018 legislative session from a women’s health and economic security perspective.
Access to Comprehensive Reproductive Health Care
Compared to previous sessions, the Legislature spent far less time debating measures to restrict women’s access comprehensive reproductive health care. One likely explanation for this shift is that the Legislature had already passed so many restrictions on access to family planning services and abortion care from 2011-2016 that there are simply not that many state-level policy restrictions to care that have yet to be passed in Wisconsin that could even arguably be consistent with existing federal law or federal constitutional interpretations that currently protect women’s access to reproductive health care.
That said, there were several pieces of legislation introduced, which proposed further abortion restrictions in Wisconsin. These proposals included:
In addition to these harmful pieces of legislation, WAWH and a broad coalition of allies worked to promote a positive vision of comprehensive reproductive health care policies in Wisconsin in the form of the Respect Women Act. While none of these bill were passed into law, the wide range of organizational support and positive media attention given to this initiative make us hopeful that this vision will someday become a reality in our state.
For more information regarding these proposals and other bills that would affect women’s reproductive health, see our reproductive health policy watch page.
Health Care Programs and Access to Care
Compared to previous sessions, the state budget contained far fewer major policy and funding changes to state health care programs and policies. For a good rundown of how the 2017-2019 state budget impacted health care policy and funding, see this post from our friends at the Wisconsin Budget Project.
Many of the most important health care policy debates took place outside the context of the state budget. In January, Governor Walker introduced an election year package of health care proposals that stood in stark contrast to many of his previous policy positions and public statements regarding the Affordable Care Act (ACA) and other important health care issues. The package included a reinsurance program that supporters claimed would help stabilize the ACA insurance marketplace for individuals and families who are not eligible for subsidies. Critics of the bill claimed that it will do very little to actually benefit consumers. Also included in the Governor’s package was a proposal to protect people with pre-existing conditions from being denied insurance coverage should the ACA be repealed and a requirement that the state Department of Health Services (DHS) submit a waiver request to the federal government to permanently approve the state SeniorCare prescription drug program instead of requiring periodic federal approval.
The reinsurance proposal passed with bipartisan support. The preexisting condition legislation failed to pass. According to reporting by the Wisconsin State Journal, health policy experts do not believe that the federal government has the authority to permanently approve the SeniorCare program, but the fate of that proposal is still unknown.
Of course, all of these state-level debates regarding health care policy took place in the backdrop of efforts at the federal level to repeal and sabotage the ACA and fundamentally undermine the funding structure for Medicaid. For more information regarding federal health care policy, see the Wisconsin Health Matters website.
Finally, as discussed in the next section, the Legislature and Governor also approved sweeping changes to state social safety net programs as part of their special session on “welfare reform,” and some of these changes affected the state Medicaid program. The next section will go into these changes in more detail.
Undermining the Social Safety Net
As the session drew to a close, Governor Walker and his legislative allies rushed through a series of “welfare reform” bills, almost all of which were aimed at creating barriers for vulnerable populations to access important public programs that help provide low-income people with access to nutrition, health care, and affordable housing under the guise of providing program participants with an incentive to work. Instead of empowering the people and families who rely on these programs for essential life needs, these proposals created stricter eligibility criteria and increased the administrative hurdles for program participation. This is an especially misguided approach to increase workforce participation, as most of the participants in these vital programs already work or face existing obstacles to work (such as a disability, caregiving responsibilities for a family member with a disability, or caregiving for an older family member). As a result, there is very little evidence that these proposals will empower people to achieve meaningful employment.
Unfortunately, almost all of these harmful proposals were passed into law as introduced. Hopefully the Governor and Legislature will eventually shift their focus to proactive proposals that will empower vulnerable individuals and families to achieve economic security. Our friends at Kids Forward have some helpful suggestions for policymakers who are interested in taking a more positive, empowering approach to these issues.
Women’s Economic Security
There were many other proposals introduced in the Legislature that would impact women’s economic security, but we want to focus on two of them. The first bill would have undermined some of the protections provided by the Wisconsin Family Medical Leave Act (FMLA). In addition to the Wisconsin FMLA, there is also a federal FMLA. Both FMLA’s provide certain workers with the right to take unpaid time off of work if they become ill, have a child, or need to care for a sick family member.
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.
SB 490 would have “federalized” some portions of the state FMLA that are more generous than the federal FMLA, thus reducing some employees' access to family and medical leave and the quality of leave for which they are eligible. A large coalition of over 40 organizations opposed this legislation and thankfully it failed to pass.
Unfortunately, another attack on women’s economic security was approved by the Legislature. AB 748 prohibits local governments from enacting or enforcing many different types of labor and employment regulations that are important to reduce the gender wage gap, increase wages, and improve working conditions in many occupational fields that often disproportionately employ women. One of the worst provisions of the bill, which would have eliminated the ability of local governments from passing and enforcing more expansive anti-discrimination policies, was removed. This provision was particularly problematic because it would have eliminated existing local anti-discrimination laws, such as the City of Madison’s Equal Opportunity Ordinance, that have been used to combat employment discrimination in communities around the state. However, other than this small but important victory, all of the other harmful provisions of the bill remained intact and will become law once the legislation is signed by the Governor.
For more details regarding these bills and other legislation what affect women’s economic security, please see our policy watch page on the issue.
This summary certainly isn’t meant to be a comprehensive discussion of the 2017-2018 legislative session. Many other important policy issues were debated throughout the session. We will make sure to continue providing any relevant state policy updates on this blog and we will continue to closely monitor events on the federal level, which will continue to engage in important policy debates in Congress and administrative agencies through the rest of 2018.
Following years of sabotage and hostility directed towards the Affordable Care Act (ACA), Governor Walker and the legislature pivoted to pass a $200 million reinsurance program, which is expected to slightly lower premiums for those relatively few people who earn too much to qualify for premium tax credits that help defray the costs of purchasing a health insurance plan on the federal ACA Marketplace.
Reinsurance is a concept where insurance companies are reimbursed for paying the health care costs of people who require very expensive care. By helping to insulate insurance companies against the financial risk of having to cover very expensive care, they can offer lower rates for everyone. However, the plan does not require savings to be passed on to consumers, does not address soaring costs of deductibles, or address other health care costs borne by patients and their families. This new law is anticipated to provide a little help in the form of small cost reductions to some consumers, but will not undo the damage caused by Republicans’ efforts to sabotage the Affordable Care Act, which has led to increases in premiums and fewer choices for the people insured through the ACA.
What Wisconsinites need to know about Walker’s $200 million Reinsurance Plan:
Please comment and tell Governor Walker to include consumer protections to his healthcare stability plans by mandating that savings are passed on to consumers and funding for his plan shouldn’t come from our state’s Medicaid budget. Comments are due by April 14, 2018 and can be submitted electronically to OCI1332WaiverComments@wisconsin.gov.
Assembly and Senate Committees Advance “Safe Harbor Legislation” to Protect Victims of Child Sexual Exploitation
Now for some much needed good news on the state policy front!
Last week, the Senate Committee on Judiciary and Public Safety passed important legislation that would ensure that a person under the age of 18 could not be prosecuted for committing an act of prostitution. This is an important step to improving Wisconsin’s approach to child sexual exploitation and human trafficking, as it reflects the widely held belief that criminally charging minors exploited by sex trafficking and child prostitution is not only immoral, but also does nothing to address the dynamics that make such children vulnerable to further victimization.
The bill, SB 344/AB 186, would help bring Wisconsin law in line with the federal Trafficking Victims Protection Act, which treats prostituted minors as victims of sexual exploitation instead of as juvenile delinquents, and would also align Wisconsin with the wide consensus of advocacy groups that believe exploited children should always be treated as victims. Laws similar to SB 344/AB 186 have been enacted in a majority of states, including Illinois, Minnesota, and California. These state laws are heralded as model legislation that many organizations with expertise on child sexual exploitation prevention believe Wisconsin should emulate.
The Assembly Committee on Children and Families already unanimously approved AB 186 in December. As a result, both SB 344 and AB 186 are available to be scheduled for floor votes in both the Senate and Assembly. With the legislative session quickly racing to an end, we hope that this important legislation receives the votes it deserves so that it can become law.
The Assembly Committee on Local Government has scheduled a committee vote for this Tuesday on AB 748, which would prohibit local governments from enacting or enforcing a wide range of important labor and employment policies that are important for increasing wages and improving the working conditions of employees. The Senate Committee on Labor and Government Reform already passed the Senate version (SB 634) of the bill on a party line vote. Many of these policies, such as living wage ordinances and efforts to promote collective bargaining rights, are particularly important for lower- and moderate-income professions in which women are often disproportionately employed.
It does appear that one of the more odious provisions of the bill, which would have removed the ability of local governments from enacting or enforcing local anti-discrimination policies (such as the City of Madison’s longstanding equal opportunities ordinance), is likely to be removed from the bill via an amendment from the Assembly author due to the significant negative attention that provision has received. However, it also appears that the other six provisions of the bill will remain intact for now, all of which are incredibly problematic, as they will greatly reduce the ability of local governments to increase wages, fight the gender wage gap, and improve working conditions for people in their communities.
If the bill is approved by the Assembly Committee, it will then be available to be scheduled for a vote before the full Assembly. We are concerned that such a vote will be scheduled as early as this week.
For more information on this troubling legislation, please see our policy page on economic security issues. Finally, if you haven’t done so already, please take a moment to contact your state legislators and tell them to oppose this bill. This legislation is making quick progress through the legislative process and it is essential that anyone who cares about stopping it take the time to share their opinions with their legislators as soon as possible.
Wisconsin Alliance for Women’s Health Statement on Gov. Walker’s State of the State Address
Sara Finger, Executive Director of the Wisconsin Alliance for Women’s Health (WAWH), made the following statement in response to Governor Walker’s State of the State Address:
Governor Walker and his political allies have spent the past seven years trying to undermine, sabotage, and repeal the Affordable Care Act, much to the detriment of the health and wellbeing of Wisconsin women and girls. As a result, it is hard to take seriously his newfound interest in making healthcare more accessible to Wisconsinites.
Furthermore, his proposals to address health insurance affordability omits the policy solution that would provide the most Wisconsinites with access to healthcare and save the state the most money: accepting federal Medicaid expansion money that was made available to states that are willing to expand eligibility for their state Medicaid program. In addition, accepting federal Medicaid expansion money will likely reduce private health insurance premiums by providing Medicaid coverage to people with health conditions that currently have to purchase private insurance.
WAWH calls on Governor Walker focus his efforts to address health care affordability on solutions, such as Medicaid expansion, that are proven to improve the health of women and families in Wisconsin.
The United States Senate Committee on the Judiciary has scheduled a confirmation hearing for Judge Michael Brennan, one of President Trump’s nominees to the U.S. Court of Appeals for the Seventh Circuit.
Before discussing Judge Brennan’s nomination, here is a quick history of the judicial vacancy for which he is nominated. All the way back in 2010, then President Obama nominated Victoria Nourse to fill the vacancy, which was created by a judicial retirement. The Senate did not convene hearings on Nourse before the end of 111th Congress, and President Obama re-nominated her again in 2011. However, Senator Ron Johnson had replaced Russ Feingold in the Senate, and Sen. Johnson refused to turn in his “blue slip” on Nourse, which effectively held up her nomination despite Nourse’s extensive vetting and approval by the bipartisan Wisconsin Federal Nominating Commission.
Nourse’s nomination was eventually withdrawn due to Sen. Johnson’s opposition. After lengthy negotiations between Sen. Johnson and Sen. Tammy Baldwin to reach an agreement regarding the process by which future federal judicial nominations from Wisconsin would be handled, the bipartisan nominating commission unanimously recommended Donald Schott for the vacancy, who was then nominated by President Obama in January of 2016. The U.S. Senate never held a floor vote on Schott’s nomination.
This process brings us where we are today with the Trump Administration’s decision to nominate Judge Brennan to what is now the longest federal appeals court vacancy in the country. Despite their previous zeal to obstruct and delay President Obama’s two nominees to the position, it appears that many of Judge Brennan’s supporters no longer think such a rigorous and lengthy nomination process is necessary. In fact, the Trump Administration did not even consult with Sen. Baldwin regarding the Brennan nomination and Judge Brennan did not receive the requisite five votes from the nominating commission that Senators Baldwin and Johnson had agreed were necessary for a judicial nomination to move forward (Brennan received four votes).
Perhaps more importantly than this flawed nomination process, Judge Brennan has also expressed viewpoints that are troubling from the standpoint of women’s health and economic security. According to a report from the Alliance for Justice, Brennan has expressed dismissive attitudes regarding the very real challenges women continue to face in the workplace, many of which contribute to a gender wage gap that has improved very little since 2001.
Brennan shared some of his insights on the matter in an article he authored on “personal responsibility,” in which he cautioned readers to guard themselves against arguments that some individuals or groups of people are denied advancement by a “glass ceiling” or because the rules were “rigged” against them. Brennan hints that these concepts are more a rhetorical “sleight-of-hand” than a genuine problem grounded in gendered societal expectations of women, the lack of affordable child care, outright discrimination, and a whole host of other societal factors that an abundance of research has clearly demonstrated have a negative impact on the career advancement and earnings of women.
The Alliance for Justice report also mentions some other troubling viewpoints held by Judge Brennan, such as his applauding of a U.S. Supreme Court decision that struck down part of the Violence Against Women Act that provided a federal civil rights remedy to victims of gender-motivated violence.
Judge Brennan also played a prominent role in Governor Walker’s appointment of two Wisconsin Supreme Court justices, Rebecca Bradley and Daniel Kelly, both of whom have a record of troubling comments regarding a range of issues. Bradley’s comments regarding people living with HIV/AIDS, members of the LGBT community, the women’s rights movement, and violence against women earned her infamy after her appointment to the state Supreme Court in 2015. Kelly’s comments regarding affirmative action and same-sex marriage also drew substantial attention at the time of his appointment.
At a minimum, the process leading to Judge Brennan’s nomination, his record on issues that are important to women’s rights, and his judgement about who is fit to serve on Wisconsin’s highest court should give members of the Senate Judiciary Committee significant pause when determining whether to confirm his appointment.
Appointments to a federal court of appeals are for life and these judges are entrusted to make some of the most important decisions that shape our rights as citizens and the communities in which we live. With the stakes so high, it makes no sense to abandon the rigorous selection process that has served our state so well in the past. Sen. Johnson should join Sen. Baldwin and demand that a nominee be put forward who can gain the necessary support of the Wisconsin Nominating Commission before this vacancy is filled.
The Wisconsin Senate Committee on Labor and Regulatory Reform held a hearing yesterday on SB 634, which would prohibit (or “preempt”) local governments from creating or enforcing many different types of employment and labor protections. State law already prohibits local communities from passing living wage or paid leave ordinances. If passed, SB 634 would add the following labor and employment protections to this list of what local government cannot do:
Many of these types of labor and employment protections are essential for raising the wages and improving the working conditions of working women. Many of them, such as anti-discrimination laws, prohibitions against employers soliciting the salary histories of prospective employees, and laws that protect union organizing rights are critical to reduce the gender wage gap.
The Wisconsin Alliance for Women’s Health testified against the bill, as did several other organizations that advocate for issues to promote women’s economic security, labor unions, and local governments.
The Committee has not yet voted on the bill, nor has the Assembly Committee to where the Assembly version of the bill was referred held a hearing on the legislation. We will continue to provide any relevant updates regarding the fate of this legislation.
If you would like to contact your legislators and urge them to oppose this legislation that would undermine the economic security of many working women and their families in Wisconsin, click here.
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.