Nonpartisan Report on Opioid Prevention & Treatment Includes Important Policy Recommendations for Pregnant Women
Last summer, the Pew Charitable Trust released a comprehensive report that analyzed Wisconsin’s existing substance use disorder (SUD) treatment systems and public policy landscape. The report includes 25 policy recommendations, several of which pertain to providing SUD treatment to pregnant and postpartum women.
Most importantly, the report acknowledges the barriers to pregnant women seeking treatment in Wisconsin that are posed by Wisconsin’s Act 292, which was passed into law in over 20 years ago and is commonly referred to as the “Cocaine Mom” law. This law gives the state almost unprecedented power over pregnant women who use or have admitted to past use of any amount of alcohol or a controlled substance. There is widespread agreement among medical professionals and advocates that the law deprives pregnant women of basic rights and ultimately undermines maternal, fetal, and child health.
Before getting into the specifics of the Pew report, some details about the specific provisions of Act are needed to provide context for why the law serves as a barrier to pregnant women accessing the medical care they need. An excerpt from and article written by WAWH Executive Director, Sara Finger, outlines the most relevant provision:
Under this law, pregnant women who are thought to use alcohol or drugs may be subjected to forced treatment without any proof that it is safe or even helpful for the pregnant woman or her future child. It gets worse. If the woman refuses the forced treatment, a court can then hold her in contempt and incarcerate her in a county jail, where she is likely to be denied access to pretty much everything recommended for pregnant women including healthy foods, and access to prenatal and other health care. The state can also begin proceedings to terminate her parental rights before she even gives birth. And while the state appoints a lawyer to represent fetuses at all stages of such proceedings, the woman has no right to counsel at important preliminary hearings where her rights are at stake.
In 2017, a federal district court initially struck down Act 292 on constitutional grounds, but the case was eventually dismissed by a federal appellate court because the plaintiff eventually left the state.
While the Pew report does not explicitly call for the full repeal of Act 292, it does state that clinicians and patients “report that this policy serves as a barrier to SUD treatment for pregnant women by potentially discouraging individuals from seeking SUD treatment for fear of repercussions” and that “[t]his barrier potentially puts pregnant women and their child at greater risk of harm than they would be if this policy did not exist.”
Pew does generally suggest that the Legislature make changes to state law to make it easier for pregnant women to “seek and receive evidence-based treatment,” which can certainly be interpreted to mean making changes to Act 292. The report says that state agencies work to address misunderstandings about Act 292 among clinicians, social service agencies, and law enforcement. Finally, Pew recommends that the Department of Health Services issue guidelines for health care providers that receive any type of public funding to align with best practices regarding the education, screening, and treatment of childbearing age women regarding SUD’s.
In addition to recommendations regarding prevention and treatment for pregnant women, the report suggests several policy changes to improve SUD care for postpartum women, including:
If you’re interested in learning more about the background of Pew’s Substance Use Disorder Treatment Policy Recommendations for the State of Wisconsin, you can view the full report here.
Prior to the passage of the ACA, insurance companies were allowed to discriminate against women due to our unique health needs. Insurers could deny coverage to women if they had been pregnant, had fought and survived cancer, or even if they had suffered domestic violence. In many cases, health plans didn’t even cover maternity care.
If the ACA is overturned, then women could be denied coverage based on their medical history, their age, and their occupation, among other factors. As a result, women could be charged more, or priced out of the insurance market altogether. Insurance companies could also try to reinstate gender rating, a common pre-ACA practice in which insurance companies charged women higher premiums than they did men, even though other parts of the ACA protect women from discrimination in the health care system.
The gravity of what the loss of coverage for women and girls would look like, should ACA be repealed, makes it paramount that we speak out against our state legislature supporting anything that could lead to reduced coverage. That's why this week, we weighed in on a GOP authored bill - Assembly Bill 1 - that claims to addresses coverage of preexisting medical conditions in our state.
It's important to note that under the direction of former Governor Scott Walker, Wisconsin joined this multi-state lawsuit to overturn the ACA. In December, a Texas District Court judge held that the ACA is unconstitutional in Texas v. Azar. As this case makes its way through the appeals process, the ACA remains the law of the land.
Despite Wisconsin’s voters speaking out loud and clear in November by electing state-wide officials who campaigned on a promise to withdraw Wisconsin from the ACA lawsuit, the Republican-led Legislature rejected the outcome of the November elections and voted to force the state to remain as plaintiffs in Texas v. Azar, threatening coverage for many Wisconsinites.
And with recent actions and actions taken over the past eight years to sabotage the ACA while the GOP has held a super majority in our state, now the Republican controlled legislature is attempting to show interest in protecting coverage for Wisconsinites.
Unfortunately, their proposal, AB1, does not guarantee insurance for people with preexisting conditions in the same capacity as the ACA, nor does it address other very important issues of coverage -- including essential health benefit mandates such as maternal care. AB 1 does not address lifetime coverage limits, preventative care, consumer protections, or bar discrimination based on gender. During the Assembly Committee on Health’s January 15, 2019 hearing, the bill authors testimony made it clear that they were not interested in expanding the scope of AB1 to include expanded coverage. Without the broader protections and subsidies of the ACA, AB1 does not protect enough people—and could actually lead to harmful unintended consequences, including higher costs.
Northern District of Texas Judge Reed O'Connor's December ruling didn't just put protections for preexisting conditions at risk, it attempts to throw out the entire law, including the subsidies that help Wisconsinites afford coverage. AB1 would not close the gap in coverage that will open up should ACA be repealed through the courts.
Our state legislative leaders are in a unique position to work to ensure that Wisconsinites continue to be covered and protected in an affordable and comprehensive manner. Rather than enact this inferior talking-point bill, the Assembly should instead focus on withdrawing Wisconsin from the lawsuit and join the numerous attorney generals seeking to uphold the ACA's framework. Such action would allow the Assembly to proudly take ownership for protecting coverage for Wisconsinites and would have the full support of the Wisconsin Alliance for Women’s Health. AB1 is no substitute for the ACA.
Make 2019 the year you take charge of your health! Here are 5 Steps to get started:
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Trump-Pence Administration Issues Proposed Rule Designed to Eliminate Insurance Coverage of Abortion in the ACA Marketplaces
From the National Women's Law Center
All health insurance plans should cover all basic health services for women, including birth control, abortion, pre-natal care, childbirth and post-partum care. Yet, merely a day after voters made clear that health care is a top priority, the Department of Health and Human Services released a Proposed Rule designed to take abortion coverage away from individuals who get their insurance through the ACA marketplace.
The Proposed Rule is designed to eliminate coverage of abortion altogether.
The Trump-Pence Administration’s Proposed Rule is targeting states where abortion coverage is available in the marketplaces.
The Proposed Rule would endanger women’s health, economic security, and future wellbeing.
As we start 2019, the Affordable Care Act (ACA) remains the law! Recently, the federal judge in Texas who ruled last month that the law should be struck down declared that the ACA will remain in effect as his decision is appealed to higher courts by 17 state Attorneys General. U.S. District Court Judge Reed O’Connor stayed the effect of his own ruling, writing that otherwise, "many everyday Americans would otherwise face great uncertainty during the pendency of appeal.
That means millions of women, LGBTQ people and families are starting 2019 with health insurance they purchased through healthcare.gov and state-based marketplaces during the 2018 ACA open enrollment period. If you’re one of them, here are six insider tips from the pros at Raising Women’s Voices on how to get your money’s worth from your insurance.
1. Breathe a sigh of relief! You have quality insurance that complies with the ACA’s high standards. That means you’re covered for pre-existing conditions, hospitalizations, maternity care, prescription drugs and all the basics you’d expect a health plan to cover!
4. Find doctors you trust. The key to getting the most value out of your health plan is finding doctors and other health care providers you trust who take your insurance. A good way to start is by calling your health plan for help. Tell the representative what is important to you in a doctor, such as office location, languages spoken, gender, hospital affiliation or office hours. If you are looking for an LGBTQ-friendly doctor, try searching the glma directory. You can also ask friends, family or colleagues for recommendations. If you try a new doctor and you do not like him or her, you do not have to go back. You are entitled to try someone different next time.
Need more help getting started with your new health insurance? Raising Women’s Voices has created a website where you can learn much more. It’s called My Health, My Voice. There you can learn five important steps to getting started using your health plan, and understand the four types of costs you may pay to use your coverage (your monthly premium, co-pays, deductibles and co-insurance.) You can also download free copies of our publications: A Woman’s Step-by-Step Guide to Using Health Insurance and My Personal Health Journal.
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.
Cecely Castillo, Policy Director