To truly help improve the health and lives of Wisconsin women and girls...

Expand & Strengthen BadgerCare

wawh_policy_rx_ma_expansion.pdf
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The Issue

As originally passed, the Affordable Care Act (ACA) required all state Medicaid (known as “BadgerCare” in Wisconsin) programs to provide health insurance coverage to all adults under age 65 who live in a household with income up to 138% of the federal poverty level. In order to help states afford Medicaid eligibility expansion, the ACA also provides enhanced federal matching funds for any newly eligible groups of people who did not previously qualify for a state Medicaid program. The federal matching rate paid for 100% of benefit costs in 2016 and eventually tapers down to 90% of costs in 2020 and all subsequent years. In Wisconsin, the federal government currently pays for 58% of most Medicaid benefit costs, so the enhanced federal rate would result in a significant increase in federal aid to the state.

The 2012 Supreme Court case NFIB v. Sebelius made Medicaid expansion optional for states. As a result, 19 states, including Wisconsin, still have not expanded their Medicaid programs under the ACA, which has unnecessarily increased the number of low-income people who are without health insurance. An estimated 83,000 Wisconsinites would gain access to health insurance coverage under BadgerCare if Wisconsin expanded the program. If Wisconsin continues to reject BadgerCare expansion, doing so will cost Wisconsin taxpayers approximately $392 million during the 2017-2019 budget period alone.

Importance to Women

  • Low-income, uninsured women are more likely to forego health care because of cost, are less likely to have a regular source of care, and utilize preventive services at lower rates than low-income women with health insurance.
  • In 2015, 8.7% of Wisconsin women age 18-64 were uninsured and 12.5% of Wisconsin women did not receive health care at some point because of cost.
  • States that have expanded Medicaid under the ACA have reduced racial disparities in their uninsured rates, which is particularly important in Wisconsin given the state’s significant racial health outcome and access to care disparities.
  • Low-income women who do not have access to BadgerCare coverage often have to rely on a patchwork of care programs in order to receive the health care they need. For example, many of these women may have to go to publicly-funded safety net clinics to receive reproductive health care services.

What Wisconsin Can Do

Wisconsin should expand BadgerCare as offered under the ACA to cover all adults who earn up to 138% of the Federal Poverty Level as soon as possible. Full BadgerCare expansion on January 1, 2017 would allow an additional 83,000 Wisconsinites to receive health care insurance under the program and would save Wisconsin approximately $834 million over the next six years. Legislation that would fully expand BadgerCare under the ACA was introduced during the 2015-2016 legislative session. The bill failed to pass, but will likely be reintroduced during the 2017-2018 legislative session.
 
In light of the potential repeal of the ACA and other changes currently being discussed regarding the federal funding structure for Medicaid, there are now additional issues to consider regarding BadgerCare expansion.  Those issues are discussed in more detail in the longer Medicaid issue brief found here.

How Can You Help ?

  • Call or email your legislator and urge them to support legislation that would fully expand BadgerCare.
  • Connect with organizations such as the Public Policy Institute or Kids Forward are already working to make BadgerCare expansion a reality in Wisconsin.

Support Comprehensive, Medically Accurate Reproductive Health Care

wawh_policy_rx_medically_accurate_reproductive_health_care.pdf
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The Issue

Ensuring that women have access to comprehensive reproductive health care services results in a wide range of direct medical benefits to women, including reduced unintended pregnancies, improved maternal health, more effective diagnosis and treatment of sexually transmitted infections, and increases in women’s economic security, educational attainment, and employment opportunities. Policies that promote access to reproductive health care provide enormous economic and social value, from reducing poverty to improving the societal status of women.

Despite these well documented benefits, there has been a tidal wave of state-level political assaults on access to reproductive health care that began after the 2010 elections. Unfortunately, Wisconsin has been at the forefront of this trend. Since 2011, Wisconsin has enacted a wide array of restrictions on access to reproductive health care, ranging from medically unnecessary abortion restrictions to attempts to defund family planning clinics.

These restrictions create real, sometimes insurmountable, barriers to accessing reproductive care for many women in Wisconsin. In addition to political restrictions, many women and health care professionals face harassment, and sometimes even violence, when they try to access or provide care from a small minority of extremist opponents of abortion. This legitimate fear of harassment and intimidation serves as a deterrent to professionals who would otherwise be willing to provide much-needed care and to women seeking care.

This unprecedented wave of political attacks on women’s access to reproductive health care has spurred advocacy organizations to begin formulating a positive, proactive vision of how states can begin to create a policy environment that ensures everyone has the right to make their own reproductive healthcare decisions free from harassment, intimidation, political interference, or false information.

Importance to Women

  • Access to comprehensive reproductive health care is an essential component to overall women’s health, which in turn impacts community health.
  • Medically unnecessary restrictions on access to reproductive care create substantial barriers to care for women seeking abortions, especially low-income women who cannot afford the costs of missing work, child care, travel, or lodging that are associated with mandatory waiting periods or clinic closures.
  • Meaningful access to contraception and family planning services greatly increases women’s ability to determine whether and when to have children, which has enormous consequences for the health and economic security of women.

What Wisconsin Can Do

Despite its troubling legislative track record since 2011, Wisconsin has also been at the national forefront of proactive reproductive health policy activism. Wisconsin introduced first-of-its-kind legislation in 2015 to protect a patient’s right to medically accurate, comprehensive reproductive health care in a setting free of harassment and intimidation. The “Patients Reproductive Health (PRH) Act” provides a roadmap for what states can do to ensure reproductive health care decisions are made by patients in consultation with their health care professionals without undue interference from politicians. Key provisions include:
  • Create robust legal protections for a patient’s right to receive medically accurate care and a health care professional’s right to provide medically accurate care.
  • Repeal reproductive health care laws and regulations that restrict access to care and are not grounded in medical science or accepted standards of care.
  • Enact protections for patients and health care professionals against threats of force and physical obstruction of facilities that are consistent with First Amendment rights, such as a state version of the Freedom of Access to Clinic Entrances Act.
Despite failing to pass during the 2015-2016 legislative session, many provisions of the bill will be reintroduced during the 2017-2018 legislative session.

How Can You Help?

Protect the Confidentiality of Insured Dependents

wawh_policy_rx_confidentiality_for_insured_dependents.pdf
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The Issue

The passage of the Affordable Care Act (ACA) allowed children to be covered as dependents under their parents’ health insurance until age 26. The ACA also increased health coverage opportunities for other dependents. However, concerns remain regarding the disclosure of sensitive health records to other family members or partners with whom dependents share insurance. Current state and federal laws combined with private sector insurance billing and notification practices create significant barriers to protecting the privacy and confidentiality of insured dependents.

For example, when insurance companies send an Explanation of Benefits (EOBs) to an insurance policyholder that provides notice about medical care received by an insured dependent, this can represent a significant breach of privacy for the insured dependent who sought medical care, especially in cases where the dependent has accessed more sensitive health care services such as mental or reproductive health care.

These privacy concerns represent very real barriers to care. For instance, adolescents and young adults on their parents’ policies are less likely to access needed care if they know that such care will not be confidential.  Protecting confidentiality is also a concern in abusive households or relationships, as insured dependents who access care could be subject to threats or further abuse in the event that the nature of the medical services that they accessed were revealed.

Importance to Women

What Wisconsin Can Do

Several states have passed or introduced legislation to protect privacy for insured dependents, including Maryland, California, and Massachusetts. These proposals include provisions that limit when a summary of payments or an Explanation of Benefits (EOB) can be sent out to policyholders and prohibit summary of payments forms from being sent out if the insured has no remaining financial obligation for the services received.

Wisconsin should follow the lead of other states and pass legislation that would help to protect insured dependents’ privacy to the fullest extent possible. Wisconsin should adopt legislation that would do the following:
  • mandate that patients are offered forms to request an alternate address for insurance communications that must be honored by insurance companies;
  • mandate that no EOB form be sent out to insurance policyholders detailing the nature of services that their dependent received if there is no remaining financial obligation unless requested by the insured dependent;
  • notify each dependent of services available that are not subject to cost-sharing;
  • and implement a training program to educate insurers and health care professionals on the requirements proposed by the bill

How Can You Help?

Make Workplaces Friendlier to Breastfeeding Moms

wawh_policy_rx_breastfeeding.pdf
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The Issue

The American Academy of Pediatrics, the Institute of Medicine, and the World Health Organization all recommend exclusive breastfeeding for approximately 6 months, with continuation of breastfeeding for 1 year or longer as mutually desired by the mother and infant. However, according to the Centers for Disease Control and Prevention (CDC), many women who are not medically prevented from breastfeeding have difficulty achieving these recommended guidelines. In 2011, about 79% of U.S. newborn infants started to breastfeed, but only 49% were breastfeeding at 6 months and 27% at 12 months.

Inadequate workplace breastfeeding policies and laws serve as major obstacles that prevent many new mothers from starting or continuing breastfeeding. Women now make up approximately half of the U.S. workforce, and two-thirds of working women return to work within three months of giving birth. Many workplaces and many of our labor laws have not adequately evolved to accommodate breastfeeding moms’ needs for break time and private space in order to express milk when they return to work.

The Affordable Care Act (ACA) began to address these issues by providing new workplace protections for many breastfeeding moms. Under the ACA, employers must provide breastfeeding moms who are hourly wage earners a reasonable break time and a private, non-bathroom location to express milk for one year after a child's birth. However, a significant percentage of women workers are not covered by the law, as employees who work for businesses with 50 or fewer employees that can demonstrate compliance would constitute an undue business hardship and women who have “salaried” positions are exempted.

Importance to Women

  • Mothers who breastfeed experience short- and long-term health benefits, including reduced likelihood of postpartum depression, cardiovascular disease, and certain types of cancer.
  • Babies who are breastfed exclusively are less likely to experience illnesses such as ear infections, diarrhea, and pneumonia. In addition, children who were breastfed are less likely to become obese later in life.

What Wisconsin Can Do

In addition to the workplace protections provided by the ACA, 28 states and the District of Columbia have passed workplace breastfeeding accommodation laws that vary greatly in scope. Wisconsin has yet to pass a state breastfeeding accommodation law. However, the bipartisan “Healthy Babies, Working Mothers Act” was introduced during the 2015-2016 legislative session. If passed, the bill would:
  • Enshrine the ACA’s workplace breastfeeding protections into Wisconsin law;
  • Require an employer to provide access to an electrical outlet, running water, and a refrigerator for the storage of breast milk;
  • Employers with less than 50 employees would be exempt from the first two provisions if the employer could demonstrate that complying with these provisions would create an undue business hardship;
  • Require that if an employee receives employer-sponsored health care benefits that are dependent on the number of hours worked by the employee, the employer must treat any unpaid break time taken by the employee to express breast milk as paid work time for purposes of determining that eligibility.
The bill received a committee hearing, but did not pass before the end of the legislative session. The legislation will most likely be reintroduced during the 2017-2018 session.

How Can You Help?