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.
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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:

• AB 128, which prohibits the state from purchasing health insurance plans that provide coverage for state and other public employees that would cover the costs for abortion services, with very limited exceptions.  This bill was signed into law earlier this week.
• AB 206, which would have prohibited employees of the University of Wisconsin System or the University of Wisconsin Hospitals and Clinics Authority (UWHCA) from performing or assisting with abortions within the scope of their employment.  The bill also would have prohibited those employees from providing services within the scope of their employment at a private entity, other than a hospital, where abortions are performed.  This bill failed to pass.
• Several pieces of somewhat competing legislation were also introduced that would have created new regulations and prohibitions regarding the use of fetal tissue for the purpose of scientific research and created new requirements for how health care facilities conduct the disposition of remains from a stillbirth or miscarriage.  All of these bills failed to pass.

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.

Conclusion
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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:

• The plan will do little to make up for the repeated acts of sabotage directed towards the ACA at both the state and federal level.
• The same day that Governor Walker signed a bill to provide reinsurance funding for the ACA, he authorized the Attorney General to join a lawsuit challenging the ACA, once again placing coverage at risk for hundreds of thousands of Wisconsinites.
• The plan does not require that insurance company savings be passed on to consumers buying plans.
• The plan does not address costs of deductibles and other health costs.
• According to the Governor’s own analysis, the plan could decrease premiums for effected enrollees by 10% and increase enrollment by less than 1%.
• The plan will largely benefit higher-income individuals and families who make too much to qualify for premium tax credits - about $100,000 per year for a family of four.
• $30 million per year will come from Wisconsin’s Medicaid program, which supports people with disabilities, seniors, and low-income children and adults. State funding for reinsurance should not come at the expense of our Medicaid program.
• What little savings this will provide would likely be undone by federal and state efforts to expand the use of skimpier health insurance that’s not required to cover essential health benefits. This will siphon healthier people away from the ACA Marketplace resulting in yet more expensive coverage and fewer options.
• If the Governor really wanted to stabilize health care he could expand BadgerCare, which would cover nearly 80,000 more people and saving the state $190 million per year. He could use those savings to fund his reinsurance plan, increase provider reimbursement rates, or fund more sensible plans to reduce health care costs for Wisconsinites.

​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.