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While this was a monumental victory of preventing the ACA from being repealed recently should not be overlooked, the time to support the ACA is just beginning.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.
Donald Trump and Republicans in Congress are determined to gut Medicaid and
undo the Affordable Care Act (ACA)’s major advances for women’s health in order to pass tax cuts for the very rich. The Senate’s version of Trumpcare is more bad news for women and our families.
A projected 22 million people—more than half of them women—would lose health insurance. 15 million people would lose their health insurance next year. The total would rise to 22 million by 2026. Millions more would lose it after 2026—all to give the wealthiest Americans a trillion dollar tax cut! That’s not a health care bill. It’s a tax cut bill.
Trumpcare would eliminate the Medicaid expansion and make drastic cuts to traditional Medicaid. The Senate bill would cut $772 billion from Medicaid, slashing its funding by more than a fourth and ending Medicaid’s long-standing guarantee of coverage for pregnant women, children, disabled people, seniors and more.
Drastic cuts to Medicaid would leave many older women and women with disabilities unable to afford long-term care. Because women live longer, we are more likely to need long-term care than men. But regular health insurance and Medicare do not cover long-term nursing home care, which can cost $82,000 per year, or in-home care. Today, Medicaid pays for half of all long-term care in the U.S. for both low-income and middle-income seniors. If Trumpcare’s Medicaid cuts become law, states will be forced to limit the care they pay for, drop people from coverage, or both.
Pap tests, contraception, STI screenings, and more would no longer be covered by Medicaid at Planned Parenthood. The Trumpcare bill would block Planned Parenthood from accepting Medicaid for one year, forcing clinics to close and reducing access to care for 1 million women and men.
Private coverage of abortion care could disappear. Trumpcare would ban the use of federal financial aid (premium tax credits) to buy private health plans that cover abortion. As a result, most plans would drop coverage. In states like NY and CA, which require abortion coverage, no one could use federal premium tax credits to buy private coverage.
Maternity coverage and other essential health benefits would cost much more for millions of women. The Senate’s Trumpcare bill would allow states to let insurance companies drop coverage of essential health benefits such as maternity care, hospitalization, prescription drugs and mental health services.
Women in a state that opts out could end up paying as much as $1,000 a month more in premiums to add maternity coverage. Although Senate GOP leaders claim protections for people with pre-existing conditions would be preserved in this bill, people with serious illness could have difficulty finding or affording health insurance that covers the care they need, in states that allow insurers to drop coverage for essential health benefits.
Older women would see skyrocketing prices for individual health insurance. The Senate’s Trumpcare bill would make people over 50 pay a LOT more. Many low and moderate income women would be unable to afford insurance. Under Trumpcare, the price of a basic health plan for a 64-year-old making $26,500 a year would quadruple from $1,700 to $6,500. A 64-year-old making $56,800 a year would face a premium of $20,500 a year. Who could afford to spend one-third of their income on health insurance?
People who lose insurance for more than two months following a job loss or change in relationship would face a six-month waiting period to get covered. This rule would do little to encourage healthy people to get covered but it would harshly punish anyone who loses coverage through no fault of her own. Six months could be the difference between life and death for a person with cancer waiting for treatment. It will be particularly cruel for women, who are less likely than men to have insurance in their own names.
Speak out against this proposal! Call Senators Baldwin and Johnson today!
In mid-May, WAWH was one of the many organizations that submitted comments to the Department of Health Services (DHS) in regards to the proposed changes to Wisconsin BadgerCare Program for Childless Adults in the form of a 1115 waiver. This waiver included proposed changes such as:
WAWH opposed their proposal as it overlooked women of childbearing age that do not have children, those with chronic conditions, and create an unhealthier Wisconsin as a whole.
DHS received a total of 1,050 comments in regards to the changes proposed by Governor Scott Walker. Only 5 out of 1,050 comments were in favor of these proposed changes. That means that 1,045 comments, or over 99.5% of those who shared their comments with DHS, were against the Governor’s plan.
DHS is still withholding the names of those that commented, but those that are known include religious leaders, non-profit organizations, doctors, students, and many other Wisconsinites. Of the 5 comments that positively regarded the proposed changes, the only two known supporters are government officials in Scott Walkers corner: Lieutenant Governor Rebecca Kleefisch and state Representative John Nygren. Kleefisch and Nygren currently co-chair the governor’s task force on opioid abuse.
DHS released a “Summary of Public Comments and Wisconsin DHS Response” that listed the “changes” that were made due to the comments made, but also gave a brief summary of the comments in general. Misleading statements such as, “Additionally, there were a number of other comments that were either wholly in opposition or approval of the proposed waiver amendment.” It is a tough pill to swallow that DHS would make a statement that creates the illusion that this was a 50-50 issue. It required an open records request to see the sheer number of negative comments in relation to the five positive ones.
It is clear that this plan did not take into account the view of the 1,045 comments made, because the changes that were made were essentially irrelevant to the concerns of every group that WAWH worked with and are as follows:
It is clear that the comments of the Wisconsin people were not taken seriously as the overwhelming majority of commenters’ opposed the changes that are being proposed. While DHS made changes based on these comments, those changes do not take into account any of the negative effects that WAWH and numerous other organizations see as the harm to Wisconsin. The waiver purports to increase enrollment in BadgerCare and create a healthier Wisconsin, when in reality it does the opposite. These concerns have been completely ignored by DHS.
Link here to view the final version of the waiver application submitted to CMS on June 7th.
In May WAWH submitted comments to the Wisconsin Department of Health Services (DHS) regarding the Department’s proposed changes to the BadgerCare program for low-income, “childless adults” who earn an income at or below the federal poverty level. DHS is currently seeking a waiver from the federal government that would allow the Department to implement changes the program that would otherwise be prohibited by federal law that governs the Medicaid program.
The proposed changes include:
If implemented, the Department’s proposed waivers would harm low-income adults currently participating in BadgerCare. These changes will actually undermine the Department’s stated goals of reducing the uninsured rate and increasing workforce participation, as many BadgerCare participants who rely on the program to access the health care they need to maintain employment will be thrown off the program as a result of these changes. This plan will simply shift costs onto low-income people, which will lead to further cost-shifting in the form of uncompensated hospital care that will result from former BadgerCare enrollees having to turn to emergency rooms to treat conditions that could have been prevented with access to preventive care. Finally, the Department’s approach will waste state funds that could be used to implement far more effective strategies for expanding the Wisconsin workforce and providing adequate resources for substance use disorder treatment.
Many other organizations that advocate for greater access to health care and on behalf of health care professionals have expressed similar concerns regarding the Department’s proposed waiver. The widespread opposition to the proposed waiver is largely based on experiences in other states that have adopted similar policies and significant research that indicates such changes will reduce access to health care for many of the particularly vulnerable populations that would be affected by this proposal and likely have no other means through which they can access health insurance.
A copy of our waiver comments can be found here.
In 2010, the Department of Health Services (DHS) created the Healthiest Wisconsin 2020 plan with the input of over 1,500 people including staff of the Wisconsin Alliance for Women's Health. The plan set out to create a healthier Wisconsin by addressing health, social, economic, educational, and environmental issues that contribute to health problems in Wisconsin. This plan differed from previous plan because it not only focused on risk factors for death, but broadened the plan to include factors that contribute to quality of life.
The newly released Wisconsin Health Improvement Plan (WI-HIPP) supplements the Healthiest Wisconsin 2020 plan with a narrowing of the focus of the DHS to five main factors. These new priority factors are alcohol, nutrition and physical activity, opioids, suicide, and tobacco. While we recognize that these are all important factors in keeping Wisconsin healthy, there are some key components missing from this Health “Improvement” Plan - components that matter greatly to the health and wellbeing of Wisconsin women and girls.
The WI-HIPP reverts back to the problem of only focusing on factors that lead to death by failing to include the following relevant health topics:
These are just examples of health concerns left out of the new plan.
Reproductive and sexual health deals with unintended pregnancies, teen births, sexually transmitted diseases, adolescents, and HIV/AIDS. While these factors may not all lead to death, the physical, emotional, mental, and social well-being to a persons’ life under these circumstances are monumental. Issues such as unintended pregnancies can also create bad birth outcomes while perpetuating disparity in Wisconsin.
Excluding injury and violence is another concern. Specifically, violence against women and children such as sexual assault needs to be a higher priority. It is estimated that 14% of Wisconsin women over the age of 18 has been raped in their lifetime. This is an act that disproportionately affects women in Wisconsin, and it is also noted that two-thirds of victims of assaults are under the age of 15, so female children are who is being harmed by this issue not receiving priority status.
Outside of the context of what issues received priority focus, the WI-HIPP purports to explore these issues from the perspective of older adults, racial and ethnic minorities, poor, and the geographically diverse, but says nothing about other underrepresented populations such as women or those of a different sexual orientation or identification.
While moving towards a more healthy Wisconsin is always a positive goal, we must be careful about how we go about reaching that goal. Disparity is one of the biggest issues in Wisconsin, and focusing on the same physical factors that have always been a priority will only perpetuate a cycle in which disparity in Wisconsin continues to grow.
Key missing components from the Emphasis of WI HIPP:
Press Release from WAWH:
Madison, WI - As an organization that advocates for the health, safety, and economic security of women and families in our state, the Wisconsin Alliance for Women’s Health (WAWH) is horrified by the Trump’s budget proposal that would deny health care, food and other essential supports to struggling households with children, most of which are headed by women.
“This budget adds insult to injury for already underfunded programs that critically impact women’s health and financial security and it is a blatant assault against working families by the Trump administration,” said Sara Finger, WAWH Executive Director. “Trump’s proposal would shred safety net programs, defund Planned Parenthood and will cause deep, lasting harm to Wisconsin women and their families.”
This historically harsh proposal includes an additional $610 billion in cuts to Medicaid on top of the already proposed $880 billion in cuts from the American Health Care Act, culminating in a proposed reduction of 47% to Medicaid over 10 years. These cuts would be devastating to women’s health and are unprecedented in modern politics.
Because women bear a disproportionate share of family caretaking responsibilities, they are exceptionally impacted by these proposed cuts to programs that effect children. Several safety net programs such as Medicaid, food stamps, and income support are relied upon by mothers to keep children healthy. The budget includes a $191 billion dollar cut to SNAP (Supplemental Nutrition Assistance Program), which is a last resort for families to not starve because of poverty. The cutting of these programs will affect families, but to an even greater extent, will hinder the ability of single mothers to keep themselves and their children healthy.
In addition to cutting safety net programs that countless women rely on, it also launches an attack against the reproductive rights of women. For the first time in history, the Trump budget would bar Planned Parenthood from participating in any U.S. Department of Health and Human Services program. In addition to defunding Planned Parenthood health centers from the Medicaid program, denying millions access to essential health care, these health centers would be excluded from a range of programs including Zika and cancer prevention and from Title X, the nation’s family planning program.
While the Trump budget proposal has not been enacted, and needs to be passed by both houses of Congress in order to become law, the proposal lays out the Trump administration’s dangerous priorities for our country. WAWH calls on all women’s health supporters to speak out to their national leaders to warn of the devastating impacts this budget will have on women and girls.
Wisconsin Alliance for Women's Health (WAWH) Executive Director, Sara Finger, released the following statement regarding today's ruling by U.S. District Court Judge James Peterson that found 1997 Wisconsin Act 292, sometimes referred to as the "Cocaine Mom Law," unconstitutional:
"WAWH is excited and relieved by today's decision to strike down this punitive law that permits the state to deprive pregnant women of basic rights and take action that is known to undermine maternal, fetal, and child health.
We are especially proud of the brave plaintiff in this case, Tammy Loertscher, who was willing to relive the trauma she endured as a result of this law in order to challenge its constitutionality. As a result of admitting to drug use before she was pregnant, Ms. Loertscher was denied her most basic constitutional rights and was incarcerated in a local jail for 18 days, which included time in solitary confinement. While in the jail she did not even have access to prenatal care or medication she needed to treat a thyroid condition.
This punitive approach to potential maternal drug use is almost uniformly opposed by the established medical community. The American College of Obstetricians and Gynecologists, American Society of Addiction Medicine, and American Public Health Association all filed an amicus brief opposing the law. A link to the WI ACOG statement can be found here.
WAWH hopes that Judge Peterson's ruling is upheld so that no other Wisconsin women must endure what Ms. Loertscher, along with hundreds of other women in the state since the law's enactment, have experienced under this ill-conceived law. WAWH would also like to thank attorneys from National Advocates for Pregnant Women and the law firm Perkins Coie for their invaluable work on this case."