December 10, 2018
The Wisconsin Alliance for Women’s Health (WAWH) appreciates the opportunity to comment on the Department of Homeland Security’s (DHS’) Inadmissibility on Public Charge Grounds proposed rule. WAWH is a state-based organization that advocates for public policies to promote the health, economic security, and safety of Wisconsin women and girls.
We strongly oppose the proposed rule because it would erect insurmountable barriers to the ability of immigrants and citizens to access and use Medicaid and other public benefit programs for which they are lawfully eligible. The proposed rule would drastically change the definition of what it means to be a “public charge” by considering immigrants’ use of public benefits beyond those used for subsistence. It would improperly penalize immigrants who use public benefits to augment their standard of living and ultimately achieve self-sufficiency. The proposed rule would also create a widespread chilling effect whereby both immigrants and citizens, especially women and citizen children, disenroll from or forego enrollment in public benefits. The resulting effects would needlessly harm individuals’ and families’ health and well-being, the greater public health, the U.S.
economy, and the public budget.
Further, the proposed rule would undo decades of policy work that improved benefits administration and eligibility processes for such programs. Streamlined enrollment and access to public benefits such as Medicaid have had a positive impact on public health. In particular, Medicaid and health related public benefits programs improve both individual quality of life and population health of the U.S. No person should have to question whether accessing the health care they need will adversely impact their immigration status or ability to remain in the U.S.
Given the proposed rule’s significant detrimental effects, its contravention of established law and practice, and its lack of supporting evidence, DHS should immediately withdraw its proposed rule.
View our full comments here:
Wisconsin Republicans Rush Through Bills to Undermine Incoming Administration and Efforts to Improve Health Care Access
The contents of the bills were so extensive and the passage happened so quickly that we still don't have a full analysis of the consequences of the legislation. But we do know that these bills will have significant ramifications for many policies that are important to women’s health. For example the bills as passed will significantly limit the extent to which Governor-Elect Evers will have discretion over Wisconsin’s Medicaid program and prevents Attorney General-Elect Kaul from withdrawing Wisconsin from a federal lawsuit that is trying to strike down the Affordable Care Act (ACA). This damaging and unprecedented move by the GOP will prevent state agencies from taking action to effectively implement and meet the full promise of the ACA in Wisconsin.
In total, three separate pieces of legislation were passed. Two pieces of legislation focused on limiting the powers of Governor-Elect Evers and Attorney General-Elect Kaul and reducing the time period for early voting. Both bills passed the Senate and Assembly on largely party line votes, with the exceptions of Republican Senator Rob Cowles and Republican Representative Todd Novak, who joined Democrats in opposing both measures. We encourage you to use the links to your own legislators to find their phone numbers and to call them to express your gratitude or outrage over their vote depending on how they weighed in. Link here if you need help finding out who represents you. You can always use the State Legislative Hotline number too: 1-800-362-9472
Coverage of the lame-duck session:
GOP lawmakers vote in wee hours to pass lame-duck bill curtailing powers of governor, attorney general
In Lame-Duck Coup, Wisconsin GOP Strips Democrats of Power and Makes It Harder to Vote
Governor-Elect Tony Evers hasn’t even been inaugurated, and Republicans are already trying to weaken his ability to govern and override the results of November’s election. The lame-duck Session involves five sweeping pieces of legislation that propose to strip away constitutional powers from the Governor and Attorney General, limit early voting, and change a spring election date to favor a conservative State Supreme Court candidate.
The contents of the bills are so extensive that it is impossible to provide a full analysis of them in this post. However, if passed, these bills will have significant ramifications for many policies that are important to women’s health, including whether Governor-Elect Evers will have discretion over Wisconsin’s Medicaid program, whether Attorney General-Elect Kaul will be allowed to withdraw Wisconsin from a federal lawsuit that is trying to strike down the Affordable Care Act (ACA), and remove discretion from state agencies that would allow them to more effectively implement the ACA.
To learn more about these proposals, see the following articles:
A proposed change in U.S. immigration rules (known as “public charge”) has caused many immigrant families to worry whether it is safe to enroll in health insurance through healthcare.gov. It’s important for immigrants to get the facts and make the best decision for you and your family. Here are the top three things you need to know:
Here are the answers to some of the questions that you might have
about “public charge:
What is a “public charge?”
Immigration offices in the U.S. use the term “public charge” to refer to someone who is likely to depend on the U.S. government to pay for things like food, housing or care. Immigrants who are determined to be a public charge can be denied a visa or change in status.
How does the government decide if someone is a “public charge?”
Immigration offices look at more than just whether someone receives government benefits like food stamps (SNAP) or housing assistance. A person’s entire circumstances, such as their income, age and use of benefits, are currently considered to determine their likelihood of becoming a public charge.
What would change if the new proposed “public charge” rule
goes into effect?
The proposed public charge rule would add to the current list of public benefits that can be considered in a public charge determination. Two types of health insurance would be included: full, non-emergency Medicaid ([known as BadgerCare in Wisconsin) and the Medicare Part D Low Income Subsidy, which helps people over age 65 who are enrolled in Medicare pay for prescription drugs.
The proposed rule says that if you receive regular non-emergency Medicaid for more than 12 months in a three year period, it will be considered in a public charge determination. So, even if the rule does go into effect, receiving Medicaid for less than 12 months in a three year period will NOT count against you. Also, Emergency Medicaid, which pays for medical costs if you have a sudden, life-threatening emergency, will NOT be considered in a public charge determination.
Could benefits my family members get cause me to be considered a public charge?
Your immigration status will only be affected by other family members receiving benefits if you apply for a change in immigration status together. If you apply individually, benefits your family members receive will NOT be counted against you.
What should I do if I have more questions?
If you have any other questions about health insurance and the public charge rule, please contact an immigration attorney.
Please Note: This fact sheet contains general information and is not legal advice.
If you have questions, you should speak with an immigration attorney
who can assess your unique situation.
As Breast Cancer Awareness Month comes to a close, we share concerns and frustration that persist around changes made to the Wisconsin Well Woman Program (WWWP) in 2015.
In August of this year, our staff along with elected leaders and leaders from the Wisconsin Breast Cancer Coalition met with Wisconsin Department Health Services staff to address the fact that the number of women served by the WWWP program has dramatically fallen and the concerning feedback provided by the Local Coordinators (see below).
After making strong recommendations and requests to ensure Wisconsin women who need life-saving cancer screenings have access at that August meeting with DHS officials, three months later, we still await the data and response from administrative leaders.
As as another month of breast cancer prevention awareness and advocacy ends, we remain infuriated that many Wisconsin women may be falling through the cracks of care and services because of this unnecessary change to a successful program made in 2015.
From a 10/19/17 Press Release from the Wisconsin Breast Cancer Coalition:
Wisconsin Breast Cancer Coalition Completes WWWP Survey:
Staff at the Wisconsin Breast Cancer Coalition completed a survey of all 14 Wisconsin Well Women Program Coordinators in Wisconsin. In a letter to the Department of Health Services, the WBCC outlined the survey results, which point to ongoing problems with the WWWP. The WBCC also reached out to partners in advocacy in order to give them the opportunity to express their shared concerns for the women served by this program.
Our organization’s aim is to make sure that women throughout our state have access to the potentially lifesaving screenings that the WWWP is tasked with providing. The WBCC and others have made repeated attempts to get up-to-date information regarding the status of the WWWP, in order to ensure that all women in Wisconsin are getting the access to the care they need.
Data from this survey was collected by surveying all 14 WWWP coordinators in Wisconsin.
All 14 WWWP Coordinators participated in the surveys conducted by the WBCC. Percentages were calculated by the number of respondents who answered “Yes” divided by the total number of coordinators. The only exception is the data regarding coordinators serving a county without a provider, in order to account for the fact that Milwaukee County is served by two coordinators.
Overview taken from a 10/13/18 email from the Center for Reproductive Rights
What is Public Charge?
“Public charge” is a longstanding test under federal immigration law designed to identify people who may depend on the government as their main source of support. If the government determines that a person is likely to become a “public charge,” it may deny a person entry to the U.S. or permanent residence (or “green card” status).
What is the Trump Administration doing?
On October 10, 2018, the Trump Administration proposed a change that would broadly expand what forms of public assistance make someone a “public charge.” In short, it would force immigrant women and children to make an impossible decision between meeting basic needs, including health care, and keeping their families together in this country. The impact would be particularly harsh on pregnant and postpartum women and children who may decline to enroll in Medicaid and other services, resulting in poorer maternal and child health, education, and financial outcomes.
How Public Charge could change
If the rule is finalized in its proposed form, this would mark a significant and harmful departure from the current policy. For over a hundred years, the government has recognized that basic and necessary services, such as health care and housing help families thrive and remain productive. And decades ago, the government clarified that immigrant families can seek health and nutrition benefits without fearing that doing so will harm their immigration case.
Rejecting this long-standing approach to public charge, the proposed rule targets the following key programs essential to immigrant women and children’s well-being:
What can you do?
Tell the Trump administration that we will not stand by while it attempts to punish parents and their children for feeding themselves or going to the doctor. Because this is just a proposed rule at this point, the Trump administration must open the proposal up for comments by the public, and review and consider every comment that is submitted. By December 10th, 2018, submit an official comment with the government telling them you object to the rule change and stand with immigrant families.
Much of the national media’s coverage of Judge Brett Kavanaugh’s confirmation hearings to become the next member of the U.S. Supreme Court has rightfully focused on what his confirmation would mean for the future of abortion rights in our country. If the Senate confirms Judge Kavanaugh’s nomination, the Court will almost certainly be ruled by a majority of justices who are hostile to reproductive rights and will likely act to roll back abortion rights or even entirely reverse the landmark decision of Roe v. Wade, which currently protects the right to have an abortion.
While the repeal or reversal of Roe would have incredibly negative consequences for women across the country who need to access comprehensive reproductive health care, the ramifications would be particularly dire in Wisconsin. The reason why the stakes are so high in Wisconsin is that we currently have a law on the books that makes it a felony to provide an abortion. This law dates back to 1849 and was never repealed, even though it has been unenforceable since Roe.
Even by the standards of many other existing political barriers to abortion, Wisconsin’s criminal abortion ban law is incredibly harsh. It does not have exceptions for rape, incest, or the health of the mother. In fact, the only way a woman could legally have an abortion under this law would be if she was about to die as a result of her pregnancy. Should Judge Kavanaugh be confirmed and Roe be repealed, there is a very real possibility that Wisconsin’s criminal abortion ban will be enforceable, which means that a physician or anyone else who helps a pregnant woman obtain an abortion could face up to 6 years in prison and a $10,000 fine (the law doesn't criminalize a woman for having an abortion).
Such a legal regime would mean that a woman would have no feasible option to access an abortion from a licensed medical provider in Wisconsin, unless she can prove that she needs to terminate a pregnancy to save her life. This scenario would turn the clock in Wisconsin 45 years back to a time when women were simply not allowed to make their own health care decisions.
An outright repeal of Roe is not the only concerning possibility of a Kavanuagh confirmation. The Court may choose to slowly erode Roe one case at a time without ever explicitly reversing the decision. In this scenario, the Court would reverse a recent Court decision that encouragingly held that state abortion regulations have to benefit patient health more than they burden their access. As a result, the Court would likely refuse to strike down state regulations on abortion, regardless of how extreme of a burden the restriction placed on abortion access or how little evidence there is that the restriction would promote patient health.
Under this approach, meaningful access to abortion will largely be regulated out of existence in states that are hostile to abortion rights. In fact, we’ve already had a glimpse of what this scenario looks like: there are currently six states that have only one abortion provider. Sadly, Wisconsin has been moving down this troubling path for the last eight years, as the state has only four facilities that provide abortions while our elected officials continue to pass an ever more restrictive set of anti-abortion laws.
The good news is that Wisconsinites and our elected officials have the power to stop these threats to reproductive health care. First, we can urge our U.S. Senators, Tammy Baldwin and Ron Johnson, to oppose Kavaunaugh’s nomination. Whether he is confirmed will likely come down to a single vote. Second, we can demand that our state legislature and Governor start using their powers to stand between a hostile Supreme Court and the women of Wisconsin and take concrete actions to protect access to abortion and reproductive healthcare by repealing our archaic 1849 criminal law and passing new laws that protect our health and rights.
For more information on what’s at stake with abortion access in Wisconsin, visit: http://www.supportwomenshealth.org/scotus.html.
MADISON – Statement from Sara Finger, Executive Director of the Wisconsin Alliance for Women’s Health (WAWH):
“The nomination of Judge Brett Kavanaugh to the U.S. Supreme Court is a direct threat to the right of women in this country to make their own health care decisions. If Judge Kavanaugh is confirmed, the Supreme Court will almost certainly explicitly overrule Roe v. Wade or silently undermine the remaining protections of Roe by allowing states hostile to women’s reproductive health to effectively regulate access to abortion out of existence. As a result, the stakes could not be higher for states like Wisconsin, which currently has a law on the books that will make abortion a crime should the Court overrule or refuse to enforce Roe.”
“Millions of Americans have advocated and fought for the right of women to make their own health care decisions in this country. It would be a travesty to turn back the clock on this progress. The research is clear from other countries that criminalizing abortion endangers women’s health and safety, all while doing virtually nothing to actually reduce abortion rates.”
“Because his nomination represents such a dire threat to the health and wellbeing of Wisconsin women, WAWH strongly urges both Senators Baldwin and Johnson to oppose Judge Kavanaugh’s nomination.”
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.
Mike Murray, Policy Director