A member of the Capitol Police uses tear gas on rioters at the U.S. Capitol on Jan. 6, 2021. A group supporting law enforcement officers who defended the building has published ads ahead of Monday's inauguration urging members of Congress to oppose presidential pardons of the Capitol rioters. (Photo by Alex Kent/for Tennessee Lookout)

For Aquilino Gonell the inauguration Monday of Donald Trump to a second term as U.S. president will carry bitter ironies.

Before and after winning the election in  November, Trump said he would pardon those convicted in the Jan. 6, 2021, attack on the U.S. Capitol by a mob that sought to overturn his 2020 reelection loss.

Gonell was a sergeant with the U.S. Capitol Police, one of hundreds of police officers on the scene who sought to protect the building, members of Congress and their staffs during the attack that delayed the vote by hours to certify Joe Biden’s election as president.

“I was assaulted multiple times,” Gonell told the Wisconsin Examiner in an interview. “Not because we instigated anything, but because I was defending my colleagues and myself and the Capitol, along with the elected officials” — some of whom, he added, were trying to set aside the result of the 2020 election that Trump lost.

“Both my hands were bleeding on that day, and my left shoulder required surgery,” Gonell recalled.

He and his fellow police in the building were the targets of violence by the Trump-supporting rioters.

“These are the same people that claim that they support the police, that they respect the rule of law, that they believe in law and order,” Gonell said. “And with their actions, they showed otherwise.”

Last week, the Courage for America campaign took out newspaper ads urging members of Congress to publicly oppose the pardons. Courage for America formed in the aftermath of the Jan. 6 riot to spotlight the violence and call attention to members of Congress who they believe have papered over the violence with misinformation and propaganda. The group describes its mission as opposing “an extreme MAGA agenda that puts money and power over the rights and freedoms of the American people.”

In Wisconsin the group published ads in Wisconsin Rapids and Stevens Point newspapers, both in the district of U.S. Rep. Derrick Van Orden, a Republican and Trump supporter. 

“We must call January 6th what it was, a domestic terrorist attack of the highest level,” said Courage for America’s spokesperson, Danny Turkel. “Americans must unite and remind our elected officials that violent criminals who assaulted the United States Capitol and threatened our democracy pose major public safety risks to our communities. Every member of Congress, including MAGA Republicans, have a duty to loudly and publicly oppose the pardoning of the January 6th rioters.”

The full-page ad tells readers to “Exercise Caution” and warns of “violent criminals” who “may soon be present in your community.” It urges people to call Van Orden “and demand he oppose the pardoning of any January 6th insurrectionists.”

Van Orden was first elected to Wisconsin’s 3rd Congressional District in 2022 and was reelected this fall. On Jan. 6, 2021, however, he was at the Capitol, taking part in the rally that preceded the attack.

Gonell spoke to the Wisconsin Examiner in conjunction with the newspaper ad.

He reserves his most pointed criticism for members of Congress who were in the building on the day of the riot and who, he says, feared for their lives at the time but have since downplayed or ignored the violence that took place.

“People who organized and orchestrated the attack, and the people who we protected,  they tend to tell others and the public that it was not as severe, as grave, as we say,” Gonell said.

On Jan. 6, however, “the only reason why they made it out was because we saved their asses — and yet, they have contorted themselves to tell the public and tell themselves that it was peaceful.”

He scoffed at Trump’s description  of  the riot as a “day full of love.”

“If that was a day full of love, they almost loved me to death,” Gonell said sardonically.

A native of the Dominican Republic, Gonell said he came to the U.S. legally and enlisted in the military, fighting in Iraq during the Gulf War then pursuing a law enforcement career with the Capitol police, where he served for 17 years.

Because of his injuries, he received a medical pension. The benefit is less than his income before he was hurt,  “but is enough for me to be able to sustain myself and pay my bills,” he said.

Legislation was enacted in 2022 to expand benefits for public safety officers or their survivors after suicide or disability as a result of post-traumatic stress disorder, but Gonell said law enforcement personnel involved in defending the Capitol on Jan. 6 have yet to receive any assistance from the program.

He believes his outspokenness about his experience cost him the support of department brass. He’s written a book, “American Shield,” and has a website that tells his story.

Gonell testified before the Congressional committee that investigated the Capitol attack. He believes that the stories he and others in law enforcement who defended the Capitol have told failed to resonate with the voting public because many more officers who were also injured or traumatized that day haven’t come forward.

“They saw how the few of us who spoke out were being treated and they probably said to themselves, ‘Why should I put myself out there? Look how they treat you,’” he said.

The U.S. Supreme Court ruling this past summer that presidents have immunity for acts committed in their official capacity — a decision that delayed the federal felony case against Trump on charges of election interference in 2020 — “is a betrayal,” Gonell said. “Because of that decision, this person is about to return to power.”

He expects that Trump will go through with pardoning at least some of the Jan. 6 convicts. Reports that members of  Congress have invited Jan. 6 riot participants as inauguration guests infuriate him. “They are returning these people to the crime scene,” Gonell said.

He’s already heard about comments by the president-elect that the rioters deserve an apology. “But he will never apologize to the officers who were defending the Capitol,” Gonell said.

This report has been updated to correct the spelling of Aquilino Gonell’s last name. 

 

A courtroom and a judge's gavel. (Getty Images creative)

The Wisconsin Supreme Court on Friday denied a request for records of voters identified as ineligible due to incompetence, overturning an appeals court opinion that had opened the door to releasing the list.

The lower court ruling, issued in December 2023, contradicted an appeals court opinion from another district holding that the records sought were confidential.

The Supreme Court returned the case to the appeals court on procedural grounds, ordering the judges to follow instructions laid down previously for conflicting appeals court rulings.

The Supreme Court acted in a case brought by the Wisconsin Voter Alliance. WVA’s president, Ron Heuer, has promoted unfounded claims about fraud in the state’s electronic voting system.

WVA had sought records from Walworth County identifying recipients of a Notice of Voting Eligibility from the county. The notice is issued when a court has found a person incompetent to vote or has restored a person’s right to register or vote. The Wisconsin Elections Commission sends the names of disqualified voters to local elections officers.

WVA has aired claims that people found incompetent might remain on voting  rolls. It has made the same request for Notice of Voting Eligibility recipients in 13 Wisconsin counties.

In a November 2023 opinion, the 4th District Court of Appeals upheld a lower court ruling that denied WVA’s request to Juneau County. That appeals court upheld a circuit court ruling finding that the records are confidential and not subject to public disclosure.

A request to Walworth County was denied by a Walworth County circuit judge, who ruled that voting eligibility forms were confidential under the state law that declares records relating to incompetency proceedings to be closed. The association lacked a legal right to the information, the judge ruled.

In the 2nd District 2-1 ruling, lead author Judge Maria Lazar, a conservative, wrote that the confidentiality requirement is “expressly outweighed by the Legislature’s mandate that voting ineligibility determinations are to be publicly communicated to the local officials or agencies” through the elections commission. She was joined by Judge Shelley Grogan, also a conservative. 

In dissent, Judge Lisa Neubauer pointed to the 4th District ruling from seven weeks earlier and wrote that the eligibility forms are exempt from disclosure and not subject to the 2nd District majority’s balancing test.  

Friday’s 5-2 Supreme Court opinion was authored by Justice Janet Protasiewicz. Asked to decide whether the 4th District ruling was binding on the 2nd District judges, the majority demurred. Instead, they ruled that the 2nd District judges had failed to follow a procedure that an earlier Supreme Court ruling laid down for appeals courts rulings that contradict previous opinions.

“When the court of appeals disagrees with a prior published court of appeals opinion, it has two and only two options,” Protasiewicz wrote. “It may certify the appeal to this court and explain why it believes the prior opinion is wrong. Or it may decide the appeal, adhering to the prior opinion, and explain why it believes the prior opinion is wrong.”

The 2nd District judges failed to follow that procedure, instead “drawing fine distinctions between arguments and assuming additional or different facts” — an effort “to skirt” the established procedure, Protasiewicz wrote.

Justice Rebecca Bradley and Chief Justice Annette Ziegler dissented, criticizing the majority for taking briefs and holding oral arguments, then issuing a ruling that didn’t address the merits of the appeal. They argued that given the procedural basis for the ruling, it should have been issued summarily.

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The Joint Committee for the Review of Administrative Rules, photographed at a Jan. 12, 2023, meeting when the body voted to block an examining board's ban on conversion therapy. On Thursday the Wisconsin Supreme Court heard arguments in a lawsuit brought by Gov. Tony Evers charging that the commitee's powers violate the state constitution. (Baylor Spears/Wisconsin Examiner)

For an hour and a half Thursday, lawyers argued before the Wisconsin Supreme Court about how much power should be conferred on executive agencies and on a single committee of the Legislature when it comes to enacting regulations.

The oral arguments were part of a lawsuit Gov. Tony Evers filed attacking the Legislature’s Republican leaders’ “legislative vetoes” that have hamstrung the Democratic governor. The focus was the Legislature’s Joint Committee for the Review of Administrative Rules (JCRAR), which holds broad power to block rules enacted by the executive branch under its regulatory authority.

The Evers lawsuit, filed in October 2023, cited two instances in which the committee thwarted rulemaking.

One was JCRAR’s vote to block a new ethics code for therapists and social workers that declared that the practice of conversion therapy to change the sexual orientation or gender identity of LGBTQ people was unprofessional conduct.

The other was a vote to block an update to the state commercial building code that had been years in the making.

State laws give the executive branch agencies, such as the Department of Safety and Professional Services and the Department of Natural Resources, the authority to establish administrative rules in order to carry out the laws for which they’re responsible.

A series of Wisconsin Supreme Court decisions as well as laws passed by the state Legislature have strengthened the power of the Legislature’s Joint Committee for Administrative Rules (JCRAR) to intervene when rules are enacted. JCRAR can object to a rule after it’s promulgated, either temporarily or indefinitely.

If lawmakers introduce legislation that codifies their objection to a rule, the rule stays blocked for the rest of that two-year legislative session until the bill is vetoed by the governor. In the last several years, lawmakers have avoided a veto that would restore a rule they’re blocking by introducing the legislation and sending it to committee, where it remains dormant for the remainder of the term.

The governor’s case

A recurring phrase in Thursday’s argument was “bicameralism and presentment.” Bicameralism refers to the requirement in the Wisconsin Constitution that to change the law, both houses of the Legislature must pass a bill. Presentment refers to the requirement that the bill, once passed, must go to the governor to be signed or vetoed.

The ability of state agencies to write administrative rules is “executive power” in the service of carrying out laws that have been enacted, said Charlotte Gibson, an assistant state attorney general arguing the governor’s case.

When the JCRAR acts to block a rule, “they change the law,” Gibson said. “They change those rights and duties” of the state agency that have already been granted under state law. But, she argued, “bicameralism and presentment is the very method through which the Legislature has to act when it wants to amend the law.”

In addition, Gibson argued, rulemaking is “a core executive power,” and the way lawmakers have intervened in the process violates the doctrine that legislative, executive and judicial powers are separate from each other.

“The Legislature has to act through its legislative constitutional role in making law, procedurally and substantively,” Gibson said. “It can’t have the power to override the [executive] branch’s exercise of its own constitutional role.”

Gibson said that, on constitutional grounds, the Court should overturn a 1992 decision and five state statutes that together have cemented the committee’s power.

Defending the JCRAR’s power

Representing the Legislature’s Republican leaders, Misha Tseytlin conceded one of the arguments that the governor has made.

In their brief on the governor’s behalf, Evers’ lawyers highlighted that JCRAR blocked the therapy rule twice, suspending it for a total of about three and a half years, and that the committee blocked the building code with an “indefinite” objection.

Tseytlin said that the argument against allowing JCRAR to permanently suspend a rule without further action by the Legislature “has some strength” and could be addressed by limiting a suspension’s duration. He suggested that putting a “grace period” limiting suspension to six months, after which a rule would take effect unless the Legislature was able to pass a bill blocking it, would address that objection.

But he defended the rules committee’s power otherwise. By permitting agencies to write administrative rules, the Legislature “is giving away its power to the executive agencies,” Tseytlin said “So that if it enacts a law, that says that in giving away that power to you, we are interposing one of our committees, there is nothing offensive in the separation of powers.”

Tseytlin suggested that under “the original public meaning of the Constitution,” administrative rulemaking was out of bounds entirely, although he added that returning to that original idea  is now beyond reach.

“And I’m not standing here, Your Honors, saying that this Court should throw out the entire administrative state — that is water under the bridge,” he said. “But I think it is quite unfair” to question the legitimacy of the Legislature’s efforts to push back on rules.

Rulemaking as lawmaking?

The idea that rulemaking is a delegation of the Legislature’s power to enact laws, however, was sharply contested.

Early in the arguments, Justice Rebecca Bradley described rulemaking that way, while rejecting its constitutionality.

“You think that rulemaking is an executive function, but the lawmaking power, the lawmaking authority, was given by the people to the Legislature,” Bradley told Gibson. “There’s nothing in the Constitution giving that to the executive.”

Gibson disputed that framing. “When the Legislature passes a statute, they can dream up any public policy they want and make up a law that tries to address that public policy,” she said. “But when the executive branch promulgates a rule, all they’re trying to do is effectuate the statute that the Legislature has charged them to carry out.”

For Justice Rebecca Dallet, however, the constitutional affront was allowing JCRAR to block rulemaking by an agency authorized to do so  under the law, even temporarily. “This structure is a few people who get all the power to make a decision about what happens, to what an agency does with their rulemaking,” she said.

The rules themselves

For most of Thursday’s session, which ran about 30 minutes over the official time limits that had been announced at the start, the lawyers’ arguments and the justices’ challenges stuck to the broad subject of the committee’s powers.

One exception came early, when Gibson pointed out how JCRAR stepped in and blocked the building code.

Gibson said Evers’ lawsuit doesn’t challenge the state’s lengthy legal process for enacting rules — including hearings, public comment and formal approval by a designated body. The building code, for example, went through those steps and was approved by a council of experts empowered under state law for the purpose.

“So all of that is fine,” Gibson said. “What’s not fine is when the Legislature comes in at the end, through a committee, and says, ‘No, actually, the rule’s no good. We’re vetoing it.’”

The second exception came more than an hour in, when Justice Jill Karofsky brought up the specifics of the conversion therapy rule while Tseytlin was arguing for the Legislature’s right to block a rule.

Karofsky quoted from a brief on behalf of the National Association of Social Workers. The association had initiated work on the rule banning conversion therapy, including it in a new ethics code drawn up by the state board that licenses therapists, counselors and social workers.

Although delayed for more than a year, the board reinstated the new ethics code with the conversion therapy ban in 2024 after the Legislature ended its session for the year. Gibson told justices that JCRAR could block it again, however.

The brief describes conversion therapy “as torture,” Karofsky said, “And I think with good reason.” Conversion therapy seeks to lead LGBTQ people “to abandon that identity and adopt and/or exhibit a heterosexual sexual orientation and gender identity consistent with the one assigned to them at birth.”

She recited from a list of tactics included in the brief, including exorcism and “corrective rape.”

“I was a sexual assault prosecutor for decades. I had to look up what ‘corrective rape’ was,” Karofsky said. “It is rape perpetuated by a straight man against lesbians in order to correct or cure their homosexuality. It is basically a punishment for being gay and violating traditional gender presentation.”

“So under your interpretation of the statutes,” she said, addressing Tseytlin, “less than a handful of unchecked legislators . . .  can shelve a rule that stops therapists from subjecting children to horrors like ‘corrective rape’ and exorcism. Do I have that right? Because I can’t even begin to wrap my head around that.”

Tseytlin replied first with a hypothetical alternative of a rule mandating “those horrible things,” then returned to his earlier suggestion of simply a temporary waiting period for rules.

Rebecca Bradley took a different approach to the question, however.

“What is left of the rule of law if this Court makes its decisions not on the constitution, not on the law, but on our visceral, personal emotional responses to what policies the Legislature may be attempting to enact or resist?” she said.

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The NorthLakes Community Clinic health center in Washburn is one of a group of community health centers across northern Wisconsin. A new report finds that rural residents are at least as likely to rely on Medicaid for health coverage as people in other communities. (Photo courtesy of NorthLakes Community Clinic)

Residents of rural areas and small towns are more likely to rely on Medicaid for health coverage than city dwellers, a new report issued Wednesday finds.

Authors of the report said the findings highlight the potential harm that could particularly affect rural residents if Congress imposes drastic cuts to Medicaid as is reportedly being considered.

The analysis was released by the Georgetown University Center for Children and Families less than a week after a published report that U.S. House Republicans are contemplating cutting Medicaid by up to $2.3 trillion as part of their plan to renew tax cuts enacted in the first Trump administration.

“That equates to almost one-third of federal Medicaid spending,” said Joan Alker, executive director of the center and a research professor at Georgetown’s McCourt School of Public Policy, during an online press briefing Wednesday. “Rural communities are at grave risk if substantial Federal cuts are enacted.”

Medicaid provides health care coverage for about 80 million low-income Americans. Closely related, the Children’s Health Insurance Program (CHIP) extends coverage for children in families with incomes too high to qualify for Medicaid but too low to afford private health insurance coverage. Both programs are funded jointly by states and the federal government and are managed by states under federal rules.

 “Medicaid is the backbone of many aspects of our health care system, including paying for the majority of nursing home residents, covering 40 to 50% of children and births nationwide, depending on where you live, covering people with disabilities and many other low income people,” Alker said.

Medicaid’s rural footprint

The report looks at 2023 federal census data to estimate the share of urban as well as rural and small town residents covered by Medicaid and CHIP. The data source, the American Community Survey, is useful for comparisons among states but may undercount Medicaid enrollment, Alker said, making the report’s estimates conservative.

In 40 out of 48 states, the report finds, Medicaid enrollment in rural counties was similar to or higher than in urban counties. (The report defines a rural county as one with no urban communities of 50,000 people or more. New Jersey, Rhode Island and the District of Columbia have no designated rural counties.)

Medicaid and CHIP covered more than half of all children living in rural areas and small towns in six states: New Mexico, Louisiana, Arizona, Florida, South Carolina and Arkansas.

Ten states had the largest difference between rural and urban children in the programs. Arizona headed that list, with 55.9% of rural or small town children enrolled in Medicaid or CHIP compared with 34.9% of children in metro areas.

Among all states, Texas had the largest number of children — 239,100 — enrolled in Medicaid or CHIP, followed by North Carolina, with 237,800; Georgia, with 205,200; and Kentucky, with 199,200.

Higher rural Medicaid enrollment also showed up among adults. In 15 states at least 20% of rural or small-town adults ages 18 to 65 were covered by Medicaid. Arizona again headed the list, with 35.9% of rural non-elderly adults enrolled in the program compared with 16.8% of urban adults.

“Medicaid is protecting families and people from exposure to high medical costs, and Medicaid is very good at that,” Alker said. “Cuts to Medicaid, which is already a very lean payor in our health care system, will result in transferring costs, shifting costs to families and providers cutting services and in rural communities,” Alker said.

Wisconsin patterns

Overall, Medicaid coverage is highest in urban Milwaukee County (27.4%) and rural Menominee County (29.9%). On average, Medicaid covers about 15% of Wisconsin adults under 65, rural and urban alike, and Medicaid or CHIP cover about one-third of children on average, whether they live in urban or rural communities.

In 27 rural counties across northern and central Wisconsin, however, the share of children on Medicaid is higher than the state average.

“Nearly 1.5 million Wisconsin residents live in rural areas and small towns, and Medicaid plays a critical role in ensuring access to health care for these communities,” said William Parke-Sutherland of Kids Forward. “Congress is considering enormous funding cuts to Medicaid in the year ahead, and this new report confirms how disastrous this would be for our rural communities and small towns.”

Rural patients and providers alike count on Medicaid to support the health care infrastructure and provide health care services, providing preventive care, dental care and behavioral health services, according to Ana Tochterman, CEO of NorthLakes Community Clinic, a federally supported health clinic with facilities across northern Wisconsin.

“Medicaid is an absolutely essential program that provides insurance for the majority of patients served at our rural Community Health Center,” Tochterman said. “Rural patients face unique challenges like transportation barriers and limited access to resources found in larger communities, and Medicaid is an important tool that enables rural patients to thrive.”

Rural health and resources

The report identifies several health care challenges for rural areas. Those include a greater scarcity of providers, limited internet connectivity and longer distances between people and their health care providers, exacerbated by a lack of public transportation.

Medicaid cuts could threaten already-shrinking rural health care networks, the report warns. “Health care systems are already under enormous pressure and can ill afford any loss of resources,” Alker said.

Care for mothers and newborns is especially likely to suffer, said Katy B. Kozhimannil, a health policy researcher at the University of Minnesota who has studied hospital and delivery room closures.

In 2010, more than 43% of rural hospitals and almost 30% of urban hospitals didn’t offer obstetric care, she said. By 2022, that was true of more than 52% of rural hospitals and more than 35% of urban hospitals.

“More than a decade into a maternal health crisis in the United States, fewer U.S. hospitals provide obstetrics every year, with rural hospitals experiencing the greatest losses,” Kozhimannil said.

The high cost of specialized facilities and staff to deliver babies have to be covered by revenues that vary depending on how many children are born each year and how much the hospital gets paid for each birth, she explained. Those factors put a bigger burden on smaller hospitals and on hospitals with more Medicaid patients, because Medicaid usually pays less than private health insurance.

Beside care at and before birth, she added, Medicaid can make it possible for families to get health care for children growing up with special health needs, mental health care or substance abuse treatment for teens, or long-term care for the elderly.

“These are all areas of deep need in our rural communities that are disproportionately financed through Medicaid programs,” Kozhimannil said.

‘A crucial backstop’

Hutchinson Regional Medical Center in central Kansas serves a population of about 100,000 people, but its service area extends into Western Kansas. 

“Our health system, which cares for that region, is sustained largely, or in part, by Medicaid,” Benjamin Anderson, the medical center’s CEO, said during the Georgetown press briefing.

He mentioned a baby born earlier this week at the hospital whose mother never had access to prenatal care. The infant will now spend months in the facility’s neonatal intensive care unit, incurring health care expenses likely to top $1 million.

“Much of that would have been preventable with adequate prenatal care,” Anderson said.

Maternal and child health is a major part of the facility’s mission, “but older adults, too, are also cared for by moms and they are also particularly vulnerable,” he added. “Cuts to Medicaid mean fewer providers, and just speaking very plainly, fewer providers are able to sustain receiving patients that have Medicaid. Fewer poor people will be able to access care at a health system like ours that takes all payers — and those who can’t pay — and is currently operating at break even.”

The COVID-19 pandemic put health care systems into a metaphorical intensive care unit and “we’re still recovering,” Anderson said — striving to address needs ranging from maternity care to seniors who need long-term care, perhaps at home in the face of nursing home bed shortages.

“Medicaid is a crucial backstop for that to happen, and it’s so important that we sustain it, that we prop it up,” Anderson said. “We have an opportunity to rebuild a system right now, and there are many in this country that are doing that following the pandemic. And significant cuts, as are identified in this report, would cripple those efforts to recover.”

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President Joe Biden speaks in Milwaukee Oct. 8, 2024, to highlight his administration's investment in removing lead pipes and announcing a new rule requiring their replacement across the U.S. by 2037. (Screenshot | White House livestream)

Ahead of President Joe Biden’s planned farewell address Wednesday evening, the Democratic Party is calling attention to the impact his policies have had during his four-year term.

“With an unemployment rate under 3% and infrastructure investments of over $20 billion into Wisconsin, including fixing the Blatnik Bridge, President Biden and Vice President [Kamala] Harris have delivered for Wisconsinites,” outgoing Democratic National Committee Chair Jaime Harrison said Tuesday. “The investment and commitment the Biden Administration made into Wisconsin will benefit the state for decades to come.”

The DNC is crediting Biden with a list of accomplishments, economic and otherwise, and has customized them for the Badger State.

• Unemployment in the state was 4.7% in January, 2021, when Biden took the oath of office and has since fallen to 2.9% in November, the St. Louis Federal Reserve reports.
• The U.S. Bureau of Labor Statistics counts 186,800 jobs added in the last four years. The state lost 83,500 jobs in Donald Trump’s first term as president, reflecting the job crash that came starting in early 2020 with the onset of the COVID-19 pandemic.
• The White House takes credit for an estimated $8 billion investment that private companies have announced for clean energy and manufacturing in Wisconsin.  The U.S. Department of Energy is projecting that the 2022 Inflation Reduction Act is responsible for $4 billion in new, large-scale clean power projects in the state by 2030.
• The administration has pegged the value of federal infrastructure investments in Wisconsin at $9.2 billion, with $1 billion of that going to upgrade and repair the Blatnik Bridge connecting Superior, Wisconsin, with its twin city of Duluth, Minnesota.
• Federal investment in health care navigator services and the Inflation Reduction Act’s extension of enhanced subsidies for health insurance premiums purchased through the health care marketplace Healthcare.gov under the Affordable Care Act have contributed to a record enrollment of 306,000 people to date — an increase of more than one-third from the 2020 enrollment of 195,000.
•  According to the Department of Health and Human Services, capping insulin prices at $35 a month for Medicare recipients, a new $2,000 cap on yearly out-of-pocket Medicare prescription costs and Medicare’s new ability to negotiate the prices for certain high-priced prescription drugs will benefit more than 1 million Wisconsin seniors. For some 300,000 Wisconsin Medicare recipients, prescription drug cost savings will average $475 a year, HHS projects. All of those provisions were included in the Inflation Reduction Act.
• The American Rescue Plan, enacted in the first three months of Biden’s term has most recently enabled Wisconsin to extend Medicaid postpartum coverage to 12 months from two months previously, according to KFF, a nonpartisan health policy news and analysis organization.
•  As a result of the administration’s student debt relief efforts, the federal Department of Education has projected that 62,000 Wisconsinites have had over $2.4 billion in student debt canceled.

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Justice Rebecca Bradley poses questions during oral arguments in the Wisconsin Supreme Court on Tuesday. (Screenshot/WisEye)

When does a doctor’s recommendation to a colleague become something their mutual patient should know about?

That was the question that lawyers for an obstetrician/gynecologist and one of her patients discussed before the Wisconsin Supreme Court Tuesday. The recommendation, which the ob/gyn doctor made to a surgeon who operated on the patient, led to the woman having her ovaries removed without her knowledge or consent.

Dr. Carol Neuman made the recommendation to a surgeon, Dr. Michael McGauley, who was to remove a section of Melissa Hubbard’s colon. Neuman was treating Hubbard for endometriosis and suggested to McGauley that he could take out her ovaries during the same procedure.

He did so, but Hubbard didn’t learn about that step — or that Neuman had recommended it — until afterward.

Hubbard sued Neuman, claiming that the doctor should have told her about the recommendation. Neuman’s lawyers told the Rock County circuit judge hearing the case that it should be dismissed because one doctor’s recommendation to another doctor didn’t violate any duty under Wisconsin law.

The judge denied the dismissal motion, and it was that decision that was at the center of Tuesday’s arguments in the Supreme Court.

David Pliner, Neuman’s lawyer, told the justices that if Neuman had issued a medical order or a prescription, or if the surgeon had been a direct employee, it might have fallen under Wisconsin’s informed consent law.

“Dr. Neuman had nothing more than, at most, a conversation with Dr. McGauley, saying, ‘Here’s what I recommend you do,’” Pliner said. It was not a prescription or an order, however, he said.

There are “no allegations that she had the authority to require him to do it, order him to do it,” Pliner said.

At one point, according to court documents that the justices referred to Tuesday,  Neuman and McGauley had contemplated doing the surgery together. In the end, the ob/gyn observed the procedure but didn’t perform any part of it.

When it was his turn to present Hubbard’s case, her lawyer, Guy Fish, argued that it should be straightforward.

“Dr. Neuman was a treating physician up to and through the surgery, where she attended,” Fish said. “And she failed to disclose to Melissa Hubbard the recommendation that Dr. McGauley perform ovarian surgery upon her. Simply put, if Melissa had learned that recommendation before the surgery, she would have declined the surgery.”

Fish dismissed the distinction Pliner made between an order or prescription and a recommendation as “an argument of semantics.”

“I think that’s a misplaced analysis,” Fish said. “If the two doctors are discussing and [agree to a] recommendation or an order that a type of surgery is to be performed, I submit respectfully, the patient needs to be informed of that recommendation or prescription or order, so they can make the best, informed, fullest and timely decision on the care they’re going to receive.”

Justice Rebecca Bradley described the underlying allegations of the case as egregious, but questioned whether informed consent law was the appropriate instrument.

“This woman’s real complaint is the allegation that her ovaries were removed and no one told her they were going to remove her ovaries,” Bradley said.

She questioned the lower courts’ framing of the matter as a matter of informed consent.  “So we’re talking about and I am trying to figure out how we got to this point. It appears that the circuit court decided to interpret the complaint as one stating a claim for informed consent,” Bradley said.

“But the complaint is not that she wasn’t advised of alternative modes of treatment and the risks and benefits of different modes of treatment,” Bradley said. “We go back to older common laws. It’s kind of a battery. If a doctor removes somebody’s body part without telling them that that is what they’re planning to do, that is a terrible invasion.”

Bradley also briefly raised the question of whether McGauley had been sued as well. Pliner said that the surgeon had been sued before Neuman was. That case was dismissed, but the reason for the dismissal was never explained or discussed in Tuesday’s Court session.

Bradley and other justices seemed wary of the implications of the appeals court decision. 

Pliner argued that if it was affirmed, that could make Neuman’s recommendation, or other casual exchanges among medical professionals, subject to the informed consent law, to the detriment of medical care.

“What happens when physicians consult with each other?” Chief Justice Annette Ziegler asked Fish. “I mean, there may be a specialist who’s going to conduct a surgery and may want to consult with your GP over, you know, what else you may have going on. Would your GP have to have a separate meeting with the patient to disclose that the GP is going to give their opinion to the other surgeon?”

Fish said the specific facts of such conversations should govern whether informed consent is required. Doctor-to-doctor dialogue about the color of suture to use or whether to hold an operation in the morning or the afternoon would not rise to that level, he suggested.

“But this specific medical mode of a surgical removal of an ovary, I think, is mandated that that be disclosed to my client,” Fish said.

“The facts you’ve alleged for your client are egregious, right?” Rebecca Bradley said to Fish later in the arguments.

“Dr. McGauley is alleged to have removed her ovaries and not told her he was going to do that. That’s the big problem,” she said. “So setting aside the facts of your case, we have to be very careful about the pronouncement of law we make.”

The appeals court decision, Bradley said, has language “imposing a duty on all physicians, under all circumstances, to inform a patient about all reasonable alternative medical modes of treatment and the benefits and risks of treatment beyond the unique facts of your case, and that’s where we have to be very careful.”

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The Wisconsin Supreme Court chambers. (Henry Redman/Wisconsin Examiner)

In February 2018 Melissa Hubbard underwent surgery to remove part of her colon. What she didn’t know until afterward was that her ovaries were removed as well.

Removing Hubbard’s ovaries had been recommended to Hubbard’s surgeon by her gynecologist to treat another painful condition that Hubbard was dealing with. But while the gynecologist had previously discussed the ovary surgery with her, Hubbard wasn’t ready to go forward with that procedure. She was unaware that the gynecologist had suggested it to the surgeon who was operating on her colon.

On Tuesday, the Wisconsin Supreme Court will hear oral arguments in a lawsuit that Hubbard has filed against the gynecologist, Dr. Carol Neuman. The lawsuit argues that Neuman’s recommendation to the surgeon without Hubbard’s knowledge was an act of medical negligence.

The lawsuit Hubbard filed against Neuman hasn’t gone to trial yet. The Ob/Gyn doctor, through her attorneys, argues that the lawsuit should be dismissed for failing to state a claim.

The lawsuit — and the doctor’s argument to throw it out — revolve around Wisconsin’s law that requires informed consent from patients for medical treatment.

Neuman’s lawyers argue that the doctor had no legal responsibility for Hubbard’s surgery under that law and no duty to tell Hubbard about what was merely Neuman’s recommendation to the surgeon, since Neuman didn’t perform the surgery herself.

A Rock County circuit judge disagreed with the doctor’s lawyers and rejected the summary judgment motion. The 4th District Wisconsin Court of Appeals upheld the circuit court’s refusal to dismiss the case. Now Neuman’s lawyers have asked the state Supreme Court to reverse those decisions.

Writing for a three-judge District 4 appeals court panel in March 2024, Judge Chris Taylor found that “the duty to inform a patient about ‘the availability of reasonable alternative medical modes of treatment and about the benefits and risks of these treatments’ applies to any physician who treats a patient, regardless of whether that physician actually performs the disclosed treatment options.”

According to the appeals court’s summary of the case, in 2018 Hubbard was in Neuman’s care for treatment of endometriosis — a condition in which the same sort of tissue that lines the inside of the uterus also grows outside the uterus. Endometriosis can cause pain as well as infertility, according to the Mayo Clinic.

In a medical note quoted in the original lawsuit, Neuman wrote that she told Hubbard she should consider having at least her left uterus tube and ovary removed, or both tubes and ovaries.

Those procedures would leave Hubbard unable to conceive a child, but Neuman wrote in her clinical note, “I believe her endometriosis is so severe she may need reproductive specialists to help her. She does not want to see them because her insurance does not cover this option.”

Hubbard did not agree to the removal of her reproductive organs, according to the lawsuit.

Neuman also referred Hubbard to a surgeon for a separate procedure: the removal of part of her colon due to a concern about cancer, according to Hubbard’s lawyer, Guy Fish of Milton.

Before the colon surgery, the doctor made a recommendation to the surgeon that he could remove Hubbard’s ovaries at the same time.

“Hubbard, prior to her surgery on February 13, 2018, at no time advised Neuman that she opted to have an ovary or ovaries be surgically removed” during the operation, however, according to Hubbard’s lawsuit.

Neuman and the surgeon, Dr. Michael McGauley, “engaged in pre-surgery discussions and planning … without including or briefing Hubbard,” the lawsuit states. At one point in their discussions, the plan was for Neuman to remove Hubbard’s tubes, ovaries and uterus, with McGauley performing the colon surgery in the same procedure.

Hubbard was not informed of those conversations, the lawsuit states. On the day that the surgery took place, McGauley performed the colon surgery and also removed Hubbard’s ovaries himself.

“Had Hubbard been apprised of Neuman’s pre-surgery recommendations to McGauley . . . Hubbard would have immediately cancelled the scheduled surgery for February 13, 2018 in order to consider all her options,” the lawsuit states.

Defending the motion to dismiss the case, Neuman’s lawyers have argued that a doctor’s recommendation to another doctor shouldn’t be subject to the state’s informed consent law.

“A recommendation is not an order or a prescription,” wrote Neuman’s legal team, from the Corneille Law Group in Madison, in a Supreme Court brief. The lawyers argued that not disclosing to Hubbard the recommendation Neuman made to the surgeon should not be treated as a violation of the state’s informed consent law.

“Treating physicians who discuss the patients’ care must be able to freely exchange their thoughts, opinions, advice and counsel without concern that they may each be liable for failing to disclose the content of those communications to the patient,” the brief for Neuman argues.

The brief asks the Supreme Court to send the case back to the Rock County circuit court with an order to dismiss the lawsuit.

But Hubbard’s lawyer argues that it’s in the interest of patients to encourage disclosure, including of communications among doctors.

“Doesn’t a treating physician more fully fulfill his/her duty by disclosing more pertinent medical information to the patient?” Fish asked in a brief to the high court. 

The lower court also rejected the assertion that holding the gynecologist responsible for providing informed consent for her recommendation to the surgeon would squelch doctors from freely consulting one another.

In making their ruling, the appeals court judges focused on whether the state law would not apply to Neuman even assuming all of the factual allegations in the lawsuit were true.

The effect of Neuman’s recommendation — the loss of Hubbard’s ovaries without her knowledge ahead of time — was instrumental enough to consider Neuman a “treating physician,” even though she didn’t perform the surgery, the lower court judges wrote.

In making the recommendation to the surgeon, they wrote, Neuman arguably had a responsibility to disclose to the patient the risks of the procedure, the probabilities of success and any alternative treatments that might be available.

In short, they ruled, Neuman failed to make the case for dismissing the case outright.

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A doctor takes a blood pressure reading for a pregnant woman. Wednesday is the deadline for signing up for individual health insurance under the Affordable Care Act. (Getty Images)

Wednesday is the final deadline this year for people who want to sign up for health insurance through the Affordable Care Act.

Wisconsin has already set a new record for enrollment, according to preliminary information from the federal Centers for Medicare & Medicaid Services (CMS), part of the Department of Health and Human Services.

The health care marketplace, https://healthcare.gov, was established as part of the Affordable Care Act for consumers who don’t have affordable health insurance through work or through government programs such as Medicaid. Individuals and families can purchase health insurance policies at Healthcare.gov.

The most recent federal data from CMS shows sign-ups through Jan. 4. On Friday, Gov. Tony Evers announced that in Wisconsin, 306,470 residents had signed up as of that date — an all-time high for the state.

Through 2025, plans purchased through the marketplace are also supported by enhanced federal subsidies, lowering their monthly insurance premium cost depending on a family’s income.

The future of the subsidies beyond this year is uncertain. Advocates are trying to pressure Republicans in Congress to maintain them as they negotiate other tax changes in the coming months.

Sens. Tammy Baldwin (D-Wis.) and Jeanne Shaheen (D-N.H.) have introduced legislation to extend the enhanced subsidies and make them permanent.

The ACA advocacy group Protect Our Care cheered the legislation when it was introduced last week. “If Republicans succeed in taking away these tax credits, health care costs will increase by an average of $2,400 for working families, and five million people will lose their health care altogether,” said Leslie Dach, the group’s chair.

For people seeking guidance in how to choose coverage, Covering Wisconsin, at https://coveringwi.org/, is a federally funded navigator to help people to assess their health insurance options, including through the federal health insurance marketplace.  

The Wisconsin Office of the Commissioner of Insurance (OCI) and the Department of Health Services (DHS) also outline options through WisCovered, a joint website. OCI also has a website that consumers can visit to find which ACA-approved insurers are operating in their region of the state: https://oci.wi.gov/Pages/Consumers/FindHealthInsurer.aspx.

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Artist's rendering of the planned new UW-Madison College of Engineering building. (Continuum SmithGroup rendering/UW-Madison)

A plan to redirect $70 million in Universities of Wisconsin system funds that includes $29 million for the UW-Madison’s new engineering building moved forward Friday, three weeks after Republicans on the State Building Commission blocked the measure the week before Christmas.

The money comes from a series of projects at the UW-Eau Claire that came in under budget.

On Dec. 19, the commission, with membership consisting of four Republican lawmakers and four Democrats — Gov. Tony Evers, two lawmakers and a citizen appointed by the Evers administration — deadlocked on approving the transfer, which put it on hold.

The commission met again Friday and approved reallocating the money.

“While it’s unfortunate that these reallocations to help support UW campuses across our state were unnecessarily delayed, I’m glad they were finally approved today to ensure these critical projects can move forward,” Evers said in a statement Friday.

The $29 million directed to the planned new UW-Madison engineering building will help expand enrollment and infrastructure for the school, enabling it to increase enrollment, according to the university. The $197 million project had earlier been stalled in a pitched partisan battle that was supposed to have been resolved in early 2024.

Redirected funds will also go to projects at UW-Whitewater ($10.5 million), UW-Stout ($5.4 million) and assorted university repair and maintenance projects ($25 million).

In December, Sen. Andre Jacque (R-DePere) and Rep. Robert Wittke (R-Racine) said they had voted against the transfer because they hadn’t been consulted about it. Jacque questioned why the original estimate for the Eau Claire projects had exceeded the costs based on the final bids.

Neither responded to an inquiry Friday about their decision to change their votes.

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Rainbow LGBTQ heart on hands, Getty Images

Since 2018, Marc Herstand has been on the forefront of a campaign to ban mental health professionals in Wisconsin from counseling clients with the goal of changing their sexual orientation or gender identity.

“Conversion therapy” has been denounced by mainstream professional organizations for doctors, psychiatrists, social workers and counselors. “People likened it to child abuse and torture,” says Herstand, executive director of the National Association of Social Workers Wisconsin chapter. “LGBT kids who are not accepted have a much, much higher rate of suicidality and mental health issues.”

Twenty states — and several local communities in Wisconsin — have banned the practice. And since late April 2024, the state professional licensing board for therapists, counselors and social workers has labeled conversion therapy as unprofessional conduct.

“It has no place whatsoever in the mental health professions, frankly, in our society,” Herstand says.

The provision banning the practice is precarious, however. Twice it’s been blocked by one of the Wisconsin Legislature’s most powerful committees. And advocates for the LGBTQ community fear it could be blocked again.

“Undoing this rule would overturn the work of the state’s mental health experts and expose young people and their families to unnecessary and lasting harms,” says Casey Pick, director of law and policy at the national LGBTQ advocy group The Trevor Project.

Next week, the Wisconsin Supreme Court will hear arguments in a lawsuit that could determine whether the conversion therapy ban survives — and whether that legislative body has been overstepping its bounds in overriding state regulations that address everything from environmental quality to public health.

The Legislature’s Joint Committee for the Review of Administrative Rules (JCRAR) has been a thorn in the side of  the administration of Democratic Gov. Tony Evers since he took office in January 2019. The committee’s power under Wisconsin law to stymie regulations enacted by the executive branch was one of three issues that Evers identified in a lawsuit the governor filed in October 2023 charging that Republican leaders of the Wisconsin Legislature were exercising an unconstitutional “legislative veto” to thwart his administration from carrying out its duties.

The lawsuit went straight to the Supreme Court. This past July the Court ruled 6-1 in Evers’ favor on the first of those three issues, throwing out state laws that had allowed the Legislature’s Joint Finance Committee to block how the Wisconsin Department of Natural Resources spends money budgeted for the Knowles-Nelson stewardship fund.

In October, the Court dismissed the lawsuit’s second issue, an objection to actions by Assembly Speaker Robin Vos (R-Rochester) that had held up raises for University of Wisconsin system employees to pressure the UW into eliminating its diversity, equity and inclusion (DEI) programs. A deal between Vos and the UW Board of Regents ended the delay in December 2023.

The Court also said it would take up the third issue: the power that JCRAR has exercised to block regulations, sometimes repeatedly.  Over the last six years, the 10-member committee’s six Republican lawmakers have voted to block or rewrite rules drawn up by state agencies on matters including environmental regulations, vaccine requirements and public health protections.

Two rules blocked

The Evers lawsuit identifies two JCRAR actions. One was the committee’s vote in January 2023 blocking the conversion therapy ban. The second was a committee vote blocking a state building code update. Both measures were produced under the umbrella of the Department of Safety and Professional Services (DSPS).

The building code revision was developed over three years in a series of meetings and hearings following national and international model documents under the direction of a statewide professional building code body. Brian Flannery, a veteran building inspector who was part of the code revision process, told the Wisconsin Examiner in a 2023 interview that at two hearings, there were no objections to the code change brought to the group.  

In August 2023, however, a Senate committee voted along party lines against approving the new building code following a hearing in which objections were raised by business lobbyists. JCRAR held a vote Sept. 29, 2023, approving an “indefinite objection” — blocking DSPS from reintroducing the code update unless the Legislature passes a bill authorizing it.

The JCRAR vote was 6-4 on party lines, with only Republicans supporting the motion, and was conducted by paper ballot, without a hearing and without the committee meeting in person.

Therapists’ ethics rules

The rule opposing conversion therapy for LGBTQ persons was part of an ethics revision by the Wisconsin Marriage and Family Therapy, Professional Counseling, and Social Work Examining Board.

Herstand of the National Association of Social Workers said he first appealed to the examining board in 2018 to ban conversion therapy. Later that year the board began the process of revising the state professional code and added to the list of actions considered “unprofessional conduct” a provision that began, “Employing or promoting any intervention or method that has the purpose of attempting to change a person’s sexual orientation or gender identity…”

“When I talk to survivors of conversion therapy, I hear their struggles with loss of trust — trust for family members, trust for licensed medical professionals and the entire health care system,” Abigail Swetz, executive director of Fair Wisconsin, an LGBTQ advocacy group, tells the Wisconsin Examiner. “Conversion therapy really erodes that ability to trust, and that makes interacting with the health care system in the future more difficult.”

A study from the Trevor Project also shows “a significant increase in suicide attempts, and not only that, but also a significant increase in multiple suicide attempts,” Swetz adds.

After hearings and the board’s unanimous vote to advance the rule change, however, JCRAR voted 6-4 to put the change on a temporary hold until the end of the 2021-22 legislative session.  

At the end of November 2022, the examining board republished the new ethics code, effective Dec. 1 of that year. Six weeks later, JCRAR convened again, holding a public hearing.

Mental health professionals and LGBTQ advocates urged the committee to allow the new code to stand. Herstand was among them, describing conversion therapy as “Child abuse. Torture. Major mental health and suicidal risk. Unprofessional conduct. Fake therapy.”

Testifying in favor of throwing out the rule, Julaine Appling, executive director of the conservative Wisconsin Family Council, said the ban violated professionals’  freedom of speech and religion.

JCRAR again voted 6-4 to suspend the rule for the rest of the 2023-24 legislative session. The committee co-chair, Rep. Adam Neylon (R-Pewaukee) said that “the merits of any conversion therapy or any other type of therapy” was “a question for the Legislature as it is public policy and deals with speech issues.”

Nine months later, Evers filed his lawsuit, calling both of the committee actions examples of an unconstitutional legislative veto that hampered the executive branch from doing its job.

In April, with the Legislature wrapped up for the rest of 2024, the examining board reinstated the code banning conversion therapy. 

Sending rules to limbo

Under Wisconsin law, JCRAR can object to a rule after it is promulgated, either temporarily — for the balance of a legislative session — or indefinitely. State law also holds that if lawmakers introduce legislation that codifies a rule objection, the rule stays blocked until the legislation is vetoed by the governor.

Instead, however, lawmakers have introduced such legislation and referred it to committee, where it has remained dormant for the rest of the legislative session in order to avoid a veto that would restore the blocked rule.

The Evers administration argues that by blocking regulations, JCRAR is taking over the power that the Wisconsin Constitution confers on the governor to carry out the laws.

“In other words, when JCRAR vetoes a proposed rule, it effectively amends the statute under which the executive agency proposed that rule,” a brief filed on behalf of Evers argues.

“By proposing the conversion therapy rule, the [therapy licensing board] exercised that statutory authority. By objecting to that rule, JCRAR effectively withdrew a share of the statutory authority the Legislature had granted to the Board” — in essence, the brief argues, unilaterally rewriting the state law that authorizes the licensing board to set the profession’s ethical standards.

“JCRAR does not have that power—only the full Legislature does,” the brief states.

The committee’s action — and the state laws that empower it — undercut the legal right of the profession to set its standards, Herstand tells the Wisconsin Examiner.

“It’s an issue of the ability of professions, which is delineated in the law, in statute, to set their own ethical standards, when some in the Legislature are trying to prevent that,” he says. “To me, that’s a violation of statute.”

A brief filed on behalf of the Legislature’s Republican leaders argues otherwise. A 1992 state Supreme Court ruling upheld the right of the committee and the Legislature to suspend rules as part of its oversight of the executive branch. While the Evers administration argues that the earlier decision was wrong and should be overturned, the legislators’ brief contends it should be honored as legal precedent.

In defense of JCRAR’s powers, the legislators’ brief describes regulations as the product of power “delegated” by the lawmakers — an argument that lawyers for the governor reject.

A friend of the court brief by a group of legal scholars, including Miriam Seifter and Bryna Godar of the University of Wisconsin Law School, sides with the administration. The power that Wisconsin law grants to JCRAR is unlike that found in other states and unconstitutional, the brief argues.

“Wisconsin’s anomalous statutory scheme allows a handful of legislators to determine whether administrative rules are lawful; to suspend otherwise final rules forever or rescind them once in force; and to act without deadlines or judicial review,” the brief states. “The Constitution readily permits other forms of agency oversight, but it precludes these committee overreaches into the domains of the executive branch, the judiciary, and the people.”

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Sign for the Wisconsin Elections Comission. (Wisconsin Examiner photo)

The Wisconsin Elections Commission voted Thursday to investigate how nearly 200 absentee ballots cast in Madison were overlooked and not counted on Election Night.

“This was such a serious oversight that I didn’t want to wait for a complaint,” the commission chair, Ann Jacobs, said at a special meeting the commission held Thursday.

The investigation findings will be summarized to commissioners, who will “provide further direction” at a future meeting.  

The uncounted ballots didn’t affect the outcome of any state or local elections, according to the elections commission staff.

Madison Mayor Satya Rhodes-Conway said Thursday that the city welcomed the investigation.

“I fully support this independent review, and look forward to WEC’s findings and recommendations, which will inform any changes we make to prevent a similar situation from occurring in the future,” Rhodes-Conway said in a statement.

The Madison City Clerk’s office told the elections commission in a memo Dec. 20 about the overlooked Nov. 5 ballots in two Madison wards. A bag containing 68 unprocessed absentee ballots from two wards was found Nov. 12 in a tabulator bin, the memo stated. During reconciliation of ballots on Dec. 3, clerk employees found two sealed envelopes contained a total of 125 unprocessed absentee ballots from another ward.  

The mayor’s office announced the unprocessed ballots Dec. 26. In a public statement the same day, the clerk’s office said that in future elections, “every polling location will receive a list of absentee envelope seal numbers that will be verified as counted on Election Day.”

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The infection of a farm worker in Wisconsin with avian flu has been confirmed by the Centers for Disease Control and Prevention (CDC). (Stephen Ausmus | Agricultural Research Service, USDA)

A Barron County farm worker has been confirmed to have been infected with avian influenza, the state health department reported Friday. The confirmation was made by the federal Centers for Disease Control and Prevention (CDC).

With the CDC analysis in hand, “the case will now be reported as a confirmed human case” of the highly pathogenic avian influenza H5N1, the Wisconsin Department of Health Services (DHS) announced. It is the first reported case of the virus in a human in Wisconsin. 

The presumed infection was first reported Wednesday in a farm worker who was one of 19 people exposed to a poultry flock in Barron County where the avian flu virus was detected. The flock has been destroyed to prevent the spread of the virus. 

The individual has been treated with antiviral drugs and is recovering, according to DHS. 

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Gov. Tony Evers signs legislation in March 2024 funding a new UW-Madison engineering building. On Wednesday, the State Building Commission divided on party lines, blocking a plan to transfer unspent money for other projects, including the engineering building. (Screenshot via @GovEvers Twitter page)

The on-again, off-again plan for a new engineering building at the University of Wisconsin-Madison has hit a new roadblock, with Republican lawmakers questioning how the state was constructing its building project bids and Democratic Gov. Tony Evers accusing  them of last-minute political gamesmanship.

The four Republicans on the eight-member commission voted against a proposal Wednesday that would have provided $29 million for the UW-Madison engineering building from unspent funds.

The engineering building has been a political football over the last two years since Republican lawmakers sought to use the project as leverage to force the UW system to reduce or eliminate diversity, equity and inclusion initiatives.

After the Republican majority excluded the engineering building funding from the 2023-25 state budget, Assembly Speaker Robin Vos pressured the University of Wisconsin Regents to accept an agreement that reframed diversity initiatives. In return, the Legislature passed and Evers signed in March legislation transferring $423 million to the state’s capital improvement fund for UW projects, including $197 million for the engineering building.

At Wednesday’s State Building Commission meeting, the Evers administration proposed taking $70 million from projects at the UW Eau Claire for which bids came in under budget. The proposal called for redirecting the unspent funds to other projects already approved by the building commission.

In addition to the $29 million for the engineering building, the redirected funds were proposed to go to projects at UW-Whitewater ($10.5 million), UW-Stout ($5.4 million) and assorted university repair and maintenance projects ($25 million).

While blocking the transfer, the commission approved $81 million in projects across the state.

In a statement issued after the commission votes, Evers called the approved projects “critical to our communities” and condemned the vote blocking the transfer, calling it “partisan obstruction” to the UW.

“I am deeply disappointed that Republican lawmakers are once again pulling the rug out from under UW in the eleventh hour and putting politics ahead of doing what’s best for our kids, our workforce and economy, and our state,” Evers said.

In statements released after they voted against the transfer, GOP lawmakers on the commission complained that, among other things, the engineering building project’s design had been expanded beyond what had been previously proposed.

“I have advocated for the Engineering Building, it is important to UW-Madison but the scope of this project has drastically changed and we were not made aware all the changes until it was time for the vote,” said state Rep. Robert Wittke (R-Racine).

Sen. Andre Jacque (R-DePere) cited a news report that the UW-Madison planned to add an additional floor to proposed engineering building and criticized the university for not consulting the Legislature or the building commission about the change. Jacque also questioned why the original estimate for the Eau Claire projects had exceeded the costs based on the final bids.

The commission’s next regularly scheduled meeting is in February, but Evers said his administration will bring the transfer proposal back to the body in January.

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Bird flu was found in a Kenosha flock of chickens and ducks, which will be destroyed to prevent the spread of the highly contagious virus. (Photo by Stephen Ausmus | Animal Research Services, USDA)

A farm worker in Barron County has tested positive for avian influenza after being exposed to a poultry flock infected with the virus, Wisconsin health officials said Wednesday. The woman is the first person identified with the infection in Wisconsin.

At the other end of the state, a case of the highly contagious disease has turned up in a Kenosha County poultry flock, according to the state agriculture department. The flock has been isolated and will be destroyed.

The risk of illness for the general public remains low, according to the Wisconsin Department of Health Services (DHS), while people working with infected animals or who might be otherwise exposed to them are at higher risk.

Also Wednesday, the federal government reported the first severe case of bird flu in a patient in Louisiana. That was believed to be associated with wild birds, not domestic poultry. 

The infected woman in Barron County was identified through a test at the Wisconsin State Lab of Hygiene. The diagnosis is pending confirmation at federal Centers for Disease Control and Prevention (CDC).

She was exposed to the Barron County poultry flock where the state Department of Agriculture, Trade and Consumer Protection (DATCP) identified an infection with highly pathogenic avian influenza (HPAI H5N1) last week. The flock was destroyed.

After the infected flock was identified, DHS and Barron County Health and Human Services began monitoring farm workers who may have been exposed to the birds, said Thomas Haupt, a DHS research scientist and epidemiologist, in an online news conference Wednesday.

The woman who tested positive was one of two people tested. 

“She had relatively mild symptoms but symptoms that would be consistent with influenza, including sore throat, slight fever, some fatigue, some eye discharge,” said Haupt. He said she was improving after being treated with an antiviral medication and was expected to make a full recovery.

Public health officials are monitoring another 17 people who were exposed.

State public health veterinarian Dr. Angie Maxted said when people are infected with a communicable disease, public health agencies contact family and other household members to test them for the illness and inform them about preventive measures.

The Kenosha flock where an H5N1 infection was reported Wednesday is a “backyard flock” — one that is raised for a family’s own use, with limited, local sales of eggs or other products, said Dr. Darlene Konkle, DATCP state veterinarian. The flock consisted of 88 chickens and five ducks.

Haupt said the Kenosha County residents who might have been exposed are being tested for the virus. There are no concerns that members of the general public were at risk, however. Maxted said that it appears only the flock’s owners were exposed to the birds.

According to DATCP, the birds from the flock where the infection was reported will not enter the food supply.

In addition, poultry within a 10 kilometer (6.2 mile) area of the Kenosha flock will be restricted from being moved on or off any premises, said DATCP, which establishes a control area around any premises where an infection is found.  

DATCP has a mapping tool that poultry producers and owners can consult to learn whether their poultry are in an active control area or surveillance zone.

Concern about the virus has been heightened for the last three years, with reports of infections in both wild and domestic birds in North America since December 2021.

Konkle said DATCP has been sending information to dairy, poultry and other livestock producers all year, encouraging them to improve biosecurity measures to prevent the spread of disease and protect their birds and animals.

The H5N1 HPAI virus is highly contagious and can be fatal to domestic poultry. The severity of the illness varies depending on its strain and on which species of animal it affects, according to DATCP.

The virus spreads by contact with infected birds, commingling with wild birds or their droppings, and through clothing or equipment used by people working with infected birds or animals.

DHS has a web page with guidance for Protective Actions for People. The department can provide a limited amount of surplus personal protective equipment for farm workers, businesses and processors from the department’s medical stockpile through its Office of Preparedness and Emergency Health Care.  

State law requires all Wisconsin livestock owners to register where their animals are kept, which helps health officials alert flock and herd owners.

Avian flu in domestic birds tends to increase late in the year, likely due to weather conditions and the flow of migrating birds through Wisconsin. “There’s more opportunity, when it’s circulating in these wild birds” for the virus to spread, Konkle said.

People who have contact with livestock and animals are at higher risk for exposure to the H5N1 avian flu virus and should avoid contact with sick or ill animals, said Maxted.

When they must be in contact, people should follow “common sense” precautions, washing their hands frequently and wearing protective clothing including gloves, respiratory protection and eye protection, she said, and clothing exposed to animals should be cleaned and disinfected.

Haupt said the DHS bureau of environmental and occupational health has been working with farmers and farm workers to inform them about the risks of avian influenza and precautions to protect themselves from the virus. The agency urges people who do get sick to take time off.

“If someone is sick, if you don’t have to work — don’t work,” Haupt said. “Stay home, give yourself time to heal.”

This report has been updated to correct the number of people in Barron County being monitored after avian flu exposure.

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Several hundred people gathered on the Capitol Square in Madison Tuesday evening for a vigil following a school shooting Monday that left three dead and injured six other people. (Erik Gunn | Wisconsin Examiner)

A day after a student killed two people, injured six others and took her own life at a Madison private school, public officials and community members mourned and processed their own trauma from the devastating violence.

“It is OK to ask for what you need to take care of your own mental health,” said Madison Mayor Satya Rhodes-Conway at a vigil on Madison’s Capitol Square Tuesday evening. “Please. Please. Let us be a community where it is okay to ask for help. Let us be a community where, when we see someone who needs help, that we are the first to extend our hands and to offer resources where they are needed. Let us be a community that takes care of each other. That is where our focus is right now — on caring for everyone who has been impacted by this gun violence.”

The vigil was organized by the Boys & Girls Club of Dane County. “We come together to begin the healing journey for our children and to support one another in this face of another school shooting that has hit our community,” said Michael Johnson, the organization’s president. “Let us remind each other that we are loved, that we are valued and we are not alone in this difficult time.”

“Violence in our community is preventable,” said state Rep. Sheila Stubbs (D-Madison). “We must not stand silent, but instead be moved to action.” She quoted Rev. Jesse Jackson, the civil rights activist: “At the end of the day, we must go forward with hope and not backwards by fear and division.”

Elected officials have united in expressing grief at the shooting. Following through on his announcement Monday, Gov. Tony Evers signed an executive order Tuesday morning calling for the U.S. and Wisconsin flags to be flown at half staff on all state buildings through Sunday, Dec. 22, as well as on the date of each victim’s funeral.

In the well of the U.S. House Tuesday, U.S. Rep. Mark Pocan, flanked by a bipartisan group of six of Wisconsin’s eight House members, led a moment of silence in recognition of those affected by the shooting. 

“These were innocent lives, innocent victims of senseless violence, and we mourn their loss with their families and loved ones and the entire Abundant Life Community,” Pocan said. He thanked law enforcement, first responders and health care workers who went to the scene or treated the victims. He emphasized as well that not just the dead and wounded, but the school community, its students, staff and parents, are all victims.

Pocan, like many Democratic lawmakers, has long been an outspoken advocate for tougher gun laws aimed at curbing gun violence. He alluded to that cause in his House speech, saying, “We must do better and we must turn these moments of silence into moments of action.”

But Pocan demurred from discussing specific policy talking points.

At a WisPolitics panel, Assembly Democratic leader Rep. Greta Neubauer cited direct policy changes that Democrats in the Legislature have tried in vain to pass over the last several years, only to be blocked by large Republican majorities: red flag laws that enable authorities to take guns from people perceived to be dangerous and universal background checks on all gun purchases. With a narrower GOP majority in both houses, she said, she hopes measures such as those could advance in the session starting in January.

Meanwhile, on the same panel, incoming Republican Senate President Mary Felzkowski highlighted concerns ranging from violent entertainment to social media — rather than firearms — as potential targets for regulation to reduce gun violence. 

In a television interview, Wisconsin Senate Majority Leader Devin LeMahieu (R-Oostburg) told Emilee Fannon of TV station CBS 58 that he would support a request by Wisconsin Attorney General Josh Kaul for $2.3 million in the state’s 2025-27 budget to continue permanent funding for the Office of School Safety in the Wisconsin Department of Justice. The office provides K-12 schools with resources to improve security measures and trains school staff on handling traumatic events and crisis prevention and response. It also runs a round-the-clock tip line.

The office became a partisan flashpoint in the Legislature’s 2023-25 budget deliberations after Republicans rejected funding and Democratic lawmakers attacked their decision. The state DOJ subsequently extended its operation by redirecting $1.3 million in federal pandemic relief funds.  

In the hours after the shooting, elected officials were unanimous in their expressions of grief while dividing along party lines in their policy responses.

 “Today’s tragedy is shocking, senseless and heartbreaking,” Assembly Speaker Robin Vos (R-Rochester) said Monday. 

“My thoughts and prayers are with the students, parents and faculty who will have to live with the trauma and grief of this day for the rest of their lives,” he said. “There are no words to adequately express condolences to those who have lost loved ones or to express gratitude for the first responders who were on scene for this violence.”

The statement made no reference either for or against legislation to address gun violence. 

Democratic lawmakers weren’t so reticent. 

“Right now, it’s hard to think of a greater moral failing as a nation and society than our inaction and unwillingness to keep our children safe from gun violence,” said Sen. Kelda Roys (D-Madison). “We do not have to accept this as an ordinary part of life. No other country does. Indeed – guns are the number one cause of death for American children, and that is a policy choice.”

At a news conference hours after the shooting Monday, Rhodes-Conway largely kept her focus on trauma and healing. “I am on record that I think we need to do better in our country and our community to prevent gun violence,” she said, adding that solutions should be the work of the whole community. A little later, she added: “But first and foremost, what needs to be a priority for all of us is supporting our young people, and that is where our community’s attention needs to turn at this point in time.”

And at Tuesday night’s vigil, she kept the attention on those who had immediately responded to the crisis. “Our community showed up in a big way, and is still continuing to show up,” Rhodes-Conway said. “Ultimately, that’s what gives me hope.”

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From left, former Gov. Tommy Thompson and Republican Party of Wisconsin Chair Brian Schimming speak to reporters after casting their Electoral College votes for President-elect Donald Trump on Tuesday. (Erik Gunn | Wisconsin Examiner)

Wisconsin’s 10 Republican presidential electors — meeting officially Tuesday for the first time since 2016 — cast their votes shortly after 12 noon for President-elect Donald Trump and Vice President-elect J.D. Vance.

Afterward, state GOP Chair Brian Schimming and former Gov. Tommy Thompson cheerfully asserted their party was on a roll and declared that the Democratic Party of Wisconsin was in for a period of soul-searching after having been “completely captured by the left” and taken over by “elitists.”

“I don’t know if everybody realizes this as much as I do, but there’s been a complete transformation of the political parties — in the state of Wisconsin, across this country,” Thompson told a swarm of reporters who gathered in the Legislature’s Joint Finance Committee meeting room on fourth floor of the state Capitol.

“The Republican Party is the party of the working man and woman,” Thompson said. “The Republican Party is the party of the downtrodden and the individuals that need help. The Democrat Party has become a party of elitists, and their policies show that. The Republican Party has been out there asking, what are the problems? What are the questions? Inflation, taxes, regulation. They’re also talking about how you can improve schools, education, and Republicans are there, front and center with ideas and answers, and the Democrats have been vacant. They’ve been vacuous in the last four years.”

The press gaggle followed a formal procedure in which each of the 10 electors signed six copies of the papers documenting Wisconsin’s Electoral College votes for Trump and Vance in 2024. The documents will be forwarded to Washington as part of the Congressional procedure in early January certifying the election results.  

In 2020, 10 Republicans also met in the Capitol and signed forms asserting that Trump, then the incumbent president, had  won Wisconsin’s electoral votes in that year’s presidential race. In fact, President Joe Biden had defeated Trump in Wisconsin by about 20,600 votes, and the state’s official electors were Democrats led by Gov. Tony Evers.

Legal ramifications of the Republicans’ 2020 false electors scheme are still playing out. In June, Wisconsin Attorney General Josh Kaul filed felony forgery charges against three people accused of developing the 2020 plan to have false slates of electors vote for Trump. The defendants had their first court appearance Dec. 12.

Asked his reaction to those latest charges, Thompson said Tuesday  prosecutors and the country should move on.

“Isn’t it about time to turn the page?” Thompson said. “I mean, we can fight over the election of 2020 for the next four years. What does it get us? Isn’t about time to say, you know, we’ve had, we’ve had a lot of differences. This is time to start trying to mend ways in solving America’s problems, Wisconsin’s problems.”

“No one is above the law — not lawyers for former presidents or elected officials themselves,” said Democratic Party of Wisconsin Executive Director Sarah Abel in a statement responding to the GOP press conference. “We can’t move forward unless we learn from the mistakes of the past, and that includes holding accountable those who undermined our democracy and tried to overturn a free and fair election because they didn’t like the outcome.”

Schimming described the Republicans’ victories this year , in which they captured the White House, the U.S. House and the U.S. Senate, as evidence that the party connected with voters  outside as well as inside the GOP. And, he added, those voters remain enthusiastic supporters and volunteers who will power the party forward.

“As I travel across the state, the folks that we identified as Trump voters — not just Republicans, but a lot of people who were concerned about the direction of the country — are extremely motivated,” Schimming said.

“Donald Trump is the face of the Republican Party right now,” Thompson said. “We have control of the Congress and the presidency — we got to deliver to the American people,” he added. “It’s up to us now to show America that we’re going to be able to do it, and I’m confident we’re going to be able to do that without any doubt whatsoever.”

Abel pointed to the divided results in Wisconsin, in which Democratic Sen. Tammy Baldwin won reelection even as Trump was elected by a slim margin and Democrats picked up seats in the state Legislature, to reject the Republicans’ depiction of the outcome. 

“Let’s not pretend that the Republican Party has a monopoly over Wisconsin,” Abel said. “Neither party swept the state in 2024, and the GOP is grasping at straws as they see their grip on power here fading away. Wisconsin Democrats are built to last. We have a progressive identity that exists separately from the leader of our party — and Republicans can’t say the same.”

Thompson, who headed the U.S. Department of Health and Human Services under President George W. Bush, also stood by his previous endorsement of Robert F. Kennedy Jr., Trump’s choice to head the agency.

Kennedy has been widely criticized for anti-vaccine positions. On Dec. 9, dozens of Nobel laureates released a letter opposing Kennedy’s nomination because of his opposition to vaccines as well as to other public health measures.

Thompson said the suggestion that Kennedy harbored hostility toward vaccines is “misreading what he said,” adding, “I’m hoping what he said is not correct.” Kennedy’s past criticisms of vaccines included the “implied” question, “is that based upon science?” Thompson argued. “I think everything has got to be based on science.”

Thompson said he supported Kennedy because the nominee’s stated goals include improving Americans’ health, ensuring foods are healthier, “trying to make sure that all medicines are based upon science — who’s against that?” and that he favors speeding up the process of approving new drugs. “I’m in favor of all of those,” Thompson said, “and that’s why I support him.”

Asked about Democratic Party of Wisconsin Chair Ben Wikler’s campaign to head the national party, Thompson joked, “I’m going to contribute to it,” then later said Wikler “is a very good politician” whom he wished well.

Schimming called Wikler “obviously a talented guy,” but asserted that the party needed more dramatic change. “The Democratic Party has been completely captured by the left, and they can’t seem to figure out that that’s part of their problem,” he said. “And if they continue not figuring it out, that’s fine.”

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The Healthcare.gov website, where people can sign up for health insurance coverage under the Affordable Care Act (ACA). Sunday, Dec. 15, is the deadline to enroll for people who want coverage to start Jan. 1. (Screenshot | Healthcare.gov website)

People who want to sign up for health insurance coverage under the Affordable Care Act in 2025 must do so by the end of the day Sunday, Dec. 15, if they want coverage to start on New Year’s Day.

“For accidents or injuries or when illness strikes, the last thing that anyone should have to worry about is how they’re going to pay for that, or whether they’re going to fall into some sort of medical debt,” said Milwaukee County Executive David Crowley during an online press conference Friday to draw attention to the Sunday deadline.

The Affordable Care Act (ACA) imposed new consumer protection provisions for health insurance plans, among them a requirement that people cannot be denied coverage or charged higher premiums because of their personal health history.

The act also led to the creation of a federal health care marketplace Healthcare.gov, where people can purchase individual health insurance plans if they don’t have health coverage through an employer or some other group source, including Medicaid or Medicare. Healthcare.gov provides information about the plans available in a person’s geographic area.

The ACA open enrollment period for individual plans started Nov. 1. Whether people are enrolling for the first time — because they’ve lost their coverage through work, for example — or renewing their insurance after enrolling previously in 2023 or before, “you should take advantage of this time right now,” said Joe Zepecki of Protect Our Care, a national campaign to support and strengthen the ACA. Protect Our Care organized Friday’s news conference.

People who sign up for a plan at Healthcare.gov must do so by Sunday, Dec. 15, to get coverage that starts Jan. 1.  For people who enroll after Sunday, 2025 coverage won’t start until Feb. 1. The final deadline for enrolling is Jan. 15.

People can get guidance in assessing their choices of plans through the statewide health insurance navigator, Covering Wisconsin (coveringwi.org).  In addition to the website, Wisconsin residents can call 414-400-9489 in the Milwaukee area or 608-261-1455 in the Madison area to reach a navigator with the organization. Both telephone numbers are available to residents anywhere in the state.

As of Dec. 1, 88,189 Wisconsin residents have enrolled in coverage during the current open enrollment period, according to the federal Centers for Medicare & Medicaid Services (CMS). That’s slightly short of the pace at the same time last year, when 99,950 people enrolled by Dec. 2, the Wisconsin Office of the Commissioner of Insurance reported.

Almost 250,000 Wisconsin residents — a record number — have been covered in 2024 under plans provided through the ACA website, Zepecki said Friday.

Expanded federal tax credit subsidies tied to the income of an applicant have reduced the cost of plans purchased through the ACA dramatically. Those subsidies have reduced the cost for about 61,000 Wisconsin residents, Zepecki said, and will remain in effect through 2025, making health plans much more affordable for people.

The enhanced insurance premium tax credit subsidies were first instituted with the enactment in 2021 of the American Rescue Plan Act (ARPA) in the first year of President Joe Biden’s term, and they were extended in the 2022 Inflation Reduction Act.

Zepecki said that for a 45-year-old Wisconsinite making $60,000 a year, the enhanced subsidy would save about $1,442 a year. For a 60-year-old couple with a combined income of $82,000 a year, “the difference in having the premium tax credits and losing them is more than $18,000 a year,” he added. And for a family of four with a household income of 125,000 a year, the premium tax credits would save more than $8,200.

“This helps almost everybody who’s in the [federal health insurance] marketplace,” Zepecki said.

Sen. Tammy Baldwin (D-Wis.) said making the subsidies permanent “will be at the top of my list as something that helps working families across Wisconsin and across the United States” in the 2025 Congress. She said they will be part of “a very robust debate” about the tax code as Republican lawmakers seek to extend tax cuts enacted in 2017 during Donald Trump’s first term as president.

“I know we have some folks who are more focused, sadly, on tax breaks for the wealthy and big corporations,” Baldwin said. “I’m going to be fighting for working Wisconsinites.”

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Photo by Getty Images

For employees of small businesses, health benefits cost more and cover less than they do for employees of large companies, according to a new report released Tuesday.

“Small-firm employees are paying more for their health insurance coverage but getting less financial protection in return,” according to the report, produced by The Commonwealth Fund.

Wisconsin is right in line with the national trend. In 2023, insurance premiums for family coverage cost Wisconsin small business employees just over $1,300 more each year compared with the cost for employees of large businesses, according to the report.

Wisconsin small business employees also absorbed higher health costs up front, paying nearly $1,400 more a year on their health insurance deductibles in 2023 than their big business counterparts.

Those are close to the national average, with a smaller disparity than some states have. According to the report, small-firm employees in some states pay as much as $10,000 more toward their annual health insurance premiums than their large-firm counterparts.

Most large employers provide health coverage, and smaller employers competing with them for workers are motivated to provide coverage as well, but find it a lot more difficult, the report finds.

“Small firm employers have generally been in a tough place because they have so much less leverage than a large firm,” Sara Collins, a coauthor of the report, told the Wisconsin Examiner in an interview. “They have higher administrative costs per employee, and it’s a much more onerous benefit to provide.”

Because of those challenges, the Affordable Care Act (ACA), enacted in 2010, includes requirements for businesses with 50 or more employees to provide health coverage, but exempts smaller employers.

“While all firms face growing premiums, small employers may have less capacity to absorb these rising costs and may pass on greater portions of these costs to their employees,” the report states. “Half of participating small-business owners in a 2024 survey reported raising employee contributions in response to rising health care costs.”

For TJ Semanchin, who owns Wonderstate Coffee, the report’s analysis rings true.

Wonderstate operates a coffee roastery in Viroqua, Wisconsin, as well as three cafes: in Viroqua, Bayfield and Madison. The roastery employs about 30 people, and the three cafés about 20 people each.

“Our current health system is a major competitive disadvantage for small business,” said Semanchin. 

He would like to see a universal, single-payer health care plan. But since that’s not the current reality, “We want to be providing as best we can for our staff as a responsible employer, and we’re also competing for talent.”

The roastery and the cafés are structured as separate corporations and have different health plans.

On the café side, Wonderstate offers a supplemental policy for employees who don’t have health insurance or whose insurance has a high deductible; the policy covers needs such as emergency room visits and a telehealth service.

The business encourages employees to sign up for comprehensive coverage at Healthcare.gov under the Affordable Care Act, where they’re likely to qualify for enhanced tax-credit subsidies that have lowered the premium costs for people whose incomes qualify.

On the roastery side of the business, Wonderstate recently made a major switch after facing the prospect of an 18% increase in premium costs for employees.

“That is on top of years of double-digit increases,” Semanchin said. “That’s not sustainable at all.”

In response, Wonderstate switched to a level-funded plan for roastery division employees — similar to a self-funded plan, in which an employer covers health care costs directly from its revenues.

Wonderstate will pay a fixed amount each month from which the company managing the plan will pay for medical care as it’s needed. There’s company-wide catastrophic coverage if health care costs exceed the budget for the year.

Nationwide, according to the Commonwealth Fund report, about 40% of small-firm employees with health benefits are covered by self-funded or level-funded plans. Those plans are exempt from state insurance regulations and from protections provided by the Affordable Care Act, which prevents insurers from denying coverage or increasing premiums based on a person’s health history.

Semanchin said the provider reviewed the staff medical history before approving the business for the plan.  Wonderstate pays 80% of the premium for individual coverage and 50% of the family coverage premium.

“It’s allowed us to hold costs [down] for the first time in many years,” Semanchin said of the new plan. “If our staff has a bad year for medical bills, we might get kicked off” in future years.

That is not unusual, and the result can have “a very destabilizing effect on the small group market,” Collins said. “The markets function a lot better when everybody plays by the same rules.”

The report lists a number of policy options to help bolster the ability of small employers to provide health coverage for employees.

States that have expanded Medicaid under the ACA to cover people with incomes up to 138% of the federal poverty guideline could require employers to inform workers who would qualify for Medicaid about the option — which has low or no premiums and limited cost-sharing requirements — if it would be more affordable than the employer’s plan.

For states that haven’t expanded Medicaid — including Wisconsin — the report suggests that Congress could create a federal fallback plan covering the same group of people expansion would cover. “This would enable lower-income people with unaffordable employer plans to enroll in Medicaid in those states,” the report states.

Another option the report suggests would be to make enhanced subsidies for low-income purchasers of insurance at Healthcare.gov permanent. The subsidies are now scheduled to end next year. The report also suggests making it easier for workers at small firms with unaffordable or low-quality health plans to become eligible for the subsidies.

Extending the subsidies is already shaping up to be a significant subject of debate in Congress next year. “People are going to see really big increases in their premiums if they aren’t extended,” Collins said. “That will be a real cost shock to families,” leading more people to return to the ranks of the uninsured.

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State Rep. Ryan Clancy (D-Milwaukee) takes a selfie at the 2024 conference of the American Legislative Exchange Council (ALEC) in Washington, D.C. (Photo courtesy of Ryan Clancy)

Milwaukee State Rep. Ryan Clancy readily admits he was the odd one out last week at a Washington, D.C., meeting of the American Legislative Exchange Council (ALEC).

ALEC, a nonprofit that brings together  state lawmakers and corporations and drafts model legislation, describes its point of view as “dedicated to the principles of limited government, free markets and federalism.” It has produced state policies  embraced almost solely by Republicans — drafted with input from  corporate members of the  organization.

Clancy is neither a Republican politician nor a corporate official. “To the best of my knowledge, I would be the only Democrat — and almost certainly the only socialist” at the States & Nation Policy Summit ALEC held Tuesday through Thursday, Clancy said in an interview. But as a state legislator, he was technically welcome at the event.

On the last day, however, Clancy was summarily kicked out and told his registration would be withdrawn and the fee refunded. While declining to explain how, an ALEC spokesman said Clancy was being “disruptive” — something Clancy categorically denies.

Attending an ALEC event was important to him, said Clancy, who is just wrapping up his first term in the Assembly after being elected in 2022. He wanted to see the process by which ALEC drafts model legislation and distributes bill proposals through its member lawmakers to statehouses around the country.

Clancy said that in his first term in Madison he has seen a lot of legislation circulate that originated in ALEC proposals. Those included more than a dozen bills putting restrictions on trans and nonbinary people, such as preventing gender affirming medical care for people under 18, he said.

“My oldest child is trans,” Clancy said in an interview. “It was just horrific to have to bring together the community to push back on those. But it was also good to know about them in advance.”

Clancy said the anti-trans legislation points to priorities that he believes ALEC has beyond the talking points it makes about individual liberty, free markets and limited government.

“Even more economic-seeming policy discussions were often peppered with anti-trans and anti-DEI comments behind the scenes,” Clancy said. 

While his attendance was cut short, he said, his time at the session offered a preview of ALEC-inspired legislation that he expects to see in the coming session of the state Legislature, and an opportunity for his fellow Democratic lawmakers to “figure out how we can push back on that.”

Democratic tradition

When Clancy joined ALEC and signed up to attend last week’s policy summit, he was following a tradition among Wisconsin Democrats in the state Legislature, who have long viewed the organization with suspicion. 

The first Democrat to decide to attend ALEC sessions was then-state Rep. Mark Pocan, who began attending the meetings two decades ago, before he became a member of Congress. He was succeeded by Democratic Rep. Chris Taylor, who has since left the Legislature when Gov. Tony Evers appointed her to Dane County circuit court, before her election to the Wisconsin Court of Appeals. 

Most recently in 2023, Reps. Kristina Shelton (D-Green Bay) and Francesca Hong (D-Madison) attended an ALEC annual meeting in Florida.

ALEC has its lawmaker members join two task forces, and Clancy, a former Milwaukee Public Schools teacher, chose education and the environment.

In the education task force, Clancy caught a discussion about legislation that would give families who home-school their children or enroll them in private schools a tax credit to offset the taxes they pay to support public schools.

“They were looking at it as fairness because [those families] shouldn’t have to pay for public schools and also pay for homeschooling or a private school as well,” he said.

As proposed, the tax credit would be non-refundable — meaning that a taxpayer would only collect up to the amount of their tax liability.

“What that means is if you are fairly well off, like middle class or rich, and you have a big tax liability at the end of the year, you’d get that back,” Clancy said. A lower-income family with a lower tax liability wouldn’t get as much, even if their school expenses were just as high.

He said another lawmaker suggested that in the name of fairness, the tax credit should be made refundable — paying the balance of the credit amount in cash to someone whose tax liability was less than the credit’s full value.

The lawmaker presenting the proposal rejected the suggestion, saying that “it was not supposed to be, quote, a wealth redistribution program,” Clancy said. The lawmaker called that “a bright line and she absolutely would never support that.”

Recycling — conservative or ‘woke’?

At the environmental task force session he attended, the principal topic was recycling — a subject that provoked conflicting opinions.

One participant advocating incentives for recycling disposable cans and bottles instead of sending them to landfills declared, “Conservation is conservative,” according to Clancy. “And then you have other people very angry about this saying no … recycling is ‘woke.’”

Still others countered in defense of recycling aluminum in particular, making the argument that “communist China is going to continue to get a leg up because we import aluminum from communist China all the time,” Clancy said.

Those arguments revolved around a model bill that  would establish a deposit-based recycling system operated by the beverage industry rather than the state, with the deposit funds that consumers don’t collect staying with the industry, offsetting the costs for recycling initiatives and for marketing the system to consumers. “This would be a handout to corporations,” Clancy said.

Clancy said that throughout the meetings he kept his own reactions to the proposals to himself and listened to other lawmakers as they discussed the issues. He took notes and photographed information slides with his phone, something that he said he saw many other participants doing.

But he said he never spoke up during any of the presentations, raised questions or publicly engaged presenters or other participants.

“The extent of my behavior in both the task forces and the workshops was sitting there taking notes, holding up the [phone] camera and getting pictures of what was going on, just like all of the other participants who were not told to leave for that same behavior,” Clancy said.

Kicked out of the meeting

In the midst of the last session he attended on Thursday, however, a hotel security staff member came to him and escorted him from the room. Outside he was told that his registration had been withdrawn.

Clancy, who recorded the exchange with the security staff member, asked why he was being thrown out. The security staffer deferred the answer to ALEC officials, but Clancy said he’s never been told what violations he was accused of.

When registering, Clancy said he was directed to a code of conduct that ALEC has posted directed to media covering the event, but that he has seen no other such list of rules for participants. In any event, he said, he took pains to not draw attention to himself.

“I have recordings of all the things that I was in, and you can hear me not asking questions,” Clancy said. “That’s really difficult for me,” he added. “I mean, to be in those spaces, to hear them saying those things, and not to say what the hell is wrong with you people was an act of will on my part, and I succeeded. I managed not to say any of the things that a reasonable person would say in that situation, because I didn’t want to be, you know, accused of disrupting or anything else.”

Clancy questioned an unnamed ALEC representative whether he was being thrown out because he’d been identified as a Democrat or a socialist. He suggested that in doing so the organization would be running afoul of its 501(c)(3) tax-exemption and IRS rules under which “they can’t give undue influence to inside members of their group and exclude people based on partisan things.”

In response to the Wisconsin Examiner’s inquiry, ALEC’s communications director, Lars Dalseide, replied in an email message.

“All are welcome at ALEC events, where all attendees are asked to abide by our long-standing code of conduct. One that ensures a welcoming and productive experience for everyone in attendance. Sadly, the individual in question failed to adhere to these guidelines. On the final day of the conference, after several complaints, he was asked to leave,” Dalseide said.

In a subsequent email, Dalseide declined to clarify what actions of Clancy’s constituted conduct violations.

“We don’t release those kinds of details to the press,” he said. “If we did, then every speaker, member, and guest wouldn’t feel comfortable speaking freely at our events.”

While Dalseide said that attendees were reminded of the code of conduct at each session, Clancy denied that. 

“They did not ever make reminders of any code of conduct at the beginning of any session, nor did I ever make a single comment or ask a question within any of them,” Clancy said. “I still don’t know what rules they’re accusing me of violating, or why speakers wouldn’t feel comfortable speaking if they knew the rules for attendees.”

Dalseide also relayed an additional statement from Leah Vukmir, a former Wisconsin state senator and former ALEC National Chair:

“The Wisconsin Socialist Party has been sending people to disrupt ALEC meetings for years, so it’s no surprise that the newest member of the Wisconsin Socialist Party would try to cause trouble at this year’s event. As a former National Chairman, I can attest to the fact that ALEC has always welcomed all views as long as individuals conduct themselves in a mature, professional manner.”

Clancy said he is a Democratic Party member and that, while he also identifies politically as a socialist, he is not a member of any Wisconsin Socialist Party, nor had he  heard of any past actions by socialist-aligned groups to disrupt ALEC events.

Rep. Pocan was reached through his Congressional office and asked if during his years of attending ALEC he recalled any socialist groups attending or engaging in disruptive behavior.

“Nope,” Pocan replied in a text message. 

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A 2011 photo shows an exhibit at the Franklin D. Roosevelt Presidential Library & Museum that commemorated the 75th anniversary of the signing of the Social Security Act in August 2010. (FDR Presidential Library & Museum | via Flickr)

The chairman and CEO of Milwaukee-based FiServ said Thursday that he looks “forward to applying my experience to transform our social security system” as Commissioner of the Social Security Administration under President-elect Donald Trump.

Frank Bisignano made the statement in a press release from FiServ confirming his appointment to the post, which is subject to Senate confirmation. Trump first disclosed the Bisignano’s nomination on his social media platform Wednesday evening, The New York Times reported.

FiServ, founded in 1984 as a financial services data processing company, expanded into electronic billing and payments, providing mobile banking services for financial institutions and related technology based services for the financial industry.

Bisignano, who has spent most of his career in investment banking, has held the top spot at FiServ since 2020 after engineering the 2019 merger of the company he headed at the time, First Data Corp., with FiServ.

The Milwaukee Business Journal listed Bisignano as the highest-paid Wisconsin public company executive in the most recent fiscal year, with compensation totaling more than $27.9 million, 83% of that in stock awards.

At First Data, where he led the company in 2015 in a $2.6 billion initial public offering, he ranked as the second-highest paid U.S. executive in 2017, according to the Times — $102 million, 97% of that in stock awards. His total compensation that year was 2,000 times that of the average First Data employee, the Times reported.

In announcing his nomination, Trump listed Bisignano’s prior investment banking posts at Morgan Stanley, CitiGroup and JPMorgan Chase & Co. “He has a long career leading financial services institutions through great transformation,” the president-elect wrote.

Bisignano has contributed to both Democrats and Republicans over the course of the last two decades, according to Federal Elections Commissions records assembled by OpenSecrets.org, a nonprofit, nonpartisan group that tracks political spending. Those include contributions to Trump.

In the last election cycle, however, his largest individual contributions include $15,000 to a PAC backing former New Jersey Gov. Chris Christie, who mounted an early primary challenge to Trump’s 2024 bid, and $50,000 to Florida Gov. Ron DeSantis, who also ran against the former president for the GOP nomination. 

Nancy Altman, president of the advocacy group Social Security Works, was skeptical Thursday about Bisignano’s qualifications to operate the program, however.

“I don’t know that he has any background in Social Security or with a large government agency, or a program that sends benefits to 70 million Americans every month,” Altman said.

She suggested that the absence of evidence that he’s proposed drastic changes to Social Security makes it likely he can be confirmed. “But it’s a question who will come in with him who maybe won’t [need to be] confirmed, but will maybe be  calling the shots,” she added.

Social Security is designed so that payroll taxes from the current generation of workers fund the benefits of the previous, now retired, generation. Altman said that it should be viewed not as a kind of savings account but as a form of insurance.

Within the next decade, forecasters have predicted that Social Security’s revenue from payroll taxes will not be enough to fully fund recipients’ benefits, requiring changes to the program.

While that’s led some people — especially younger members of the workforce — to fear the program won’t be around for them when they retire, Altman said those fears have been stoked by opponents hoping to do away with Social Security entirely.

Altman said she’s confident that Congress will reach a solution, but that her organization and other advocates will watch closely and oppose a deal that cuts benefits, raises the retirement age or privatizes the system. Instead, Social Security Works is campaigning for an approach that includes raising the income levels subject to the payroll tax. 

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