Entrance to Senate Chambers in the Wisconsin State Capitol. (Photo by Baylor Spears/Wisconsin Examiner)

The state Senate Health Committee cleared three bills Thursday, two of them on bipartisan votes, advancing them to the full Senate for consideration.

SB 4 allows direct primary care doctors, who charge patients on a monthly subscription, to practice without being regulated as part of the insurance industry. 

The bill passed 3-2, with the Senate committee’s two Democrats, Sens. Jeff Smith and Dora Drake, voting against recommending it for passage.

Drake said she voted against the measure because it lacked non-discrimination language that had been included in a previous version of the bill.

The bill from the 2023-24 legislative session included a non-discrimination section listing a series of civil-rights protections for patients. One of those items, forbidding discrimination on the basis of “gender identity,” led two organizations, Wisconsin Family Action and the Wisconsin Catholic Conference, to oppose the legislation.

Although the legislation passed the Assembly on a voice vote in 2024 and was unanimously endorsed by both the Assembly and Senate health committees, it died after the state Senate failed to take it up.

The current bill states that direct primary care providers “may not decline to enter into or terminate a direct primary care agreement with a patient solely because of the patient’s health status.”

It has replaced language enumerating specific civil rights protections with a more general stipulation that it “shall not be construed to limit the application” of Wisconsin’s civil rights statute to a health care provider’s practice. The civil rights law bars discrimination based on race, sex and sexual orientation, but is silent on gender identity.

“As Chair of the Legislative Black Caucus, I refuse to support a new version of a bill that doesn’t provide protections for Wisconsinites that prevents discrimination from healthcare providers,” Drake told the Wisconsin Examiner via email.

The committee voted unanimously Thursday to recommend the other two bills.

SB 23 would make it possible for women who are covered by Medicaid in childbirth to maintain that coverage for a full year after the child is born. The postpartum Medicaid legislation has broad bipartisan support, but Assembly Speaker Robin Vos (R-Rochester) has opposed extending the coverage, claiming it would expand “welfare.”

SB 14 requires health care providers to obtain a patient’s consent when they teach medical students how to do pelvic exams by having them practice on women under anesthesia. Authors of the bill and advocates have reported that some providers have a history of training students on the procedure with unconscious patients who have not been informed or given consent.

The committee also added a requirement that hospitals institute written policies for informed consent relating to pelvic exams under anesthesia. The amendment replaces language requiring an administrative rule implementing the requirement.

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Sen. Jesse James is the coauthor on the postpartum Medicaid expansion bill. Screenshot via WisEye.

Members of the Wisconsin Senate Health Committee expressed support on Wednesday for a bill that would extend Medicaid coverage for postpartum mothers to a year after the birth of a child.

Typically, people in Wisconsin are only eligible for Medicaid coverage if they make up to 100% of the federal poverty level, but pregnant women can receive Medicaid coverage in Wisconsin if they have an annual income of up to 306% of the federal poverty level. While a newborn whose mother is a Medicaid recipient receives a year of coverage, mothers risk losing their coverage after 60 days if they don’t otherwise qualify for Medicaid.

The bill — SB 23 — seeks to change this by extending Medicaid coverage for postpartum mothers from 60 days to a full year after childbirth. 

“This bill does not change that income threshold so no new women would qualify for Medicaid,”  bill coauthor Sen. Jesse James (R-Thorp) said at the hearing. “It would just allow for those women, who are already being covered, to be covered for longer to help address potential health issues that arise during the postpartum period.”

“My goal as a legislator… is to make sure we keep moving Wisconsin forward and fight for the future of our youth. We, as a state, are unfortunately behind on this issue,” James said. “We have a chance to do better for our moms, our kiddos and our families as a whole.”

The federal government gave states the permanent option to extend coverage to a year postpartum in 2022 in the American Rescue Plan Act.

Gov. Tony Evers has been proposing covering mothers for a year in each of his budget proposals since 2019, but the Republican-led Legislature has rejected it each time. A Republican bill passed the Senate last session with only one opposing vote and also gained the support of a majority of Assembly lawmakers, but it never came to a vote. Assembly Speaker Robin Vos (R-Rochester) has been a staunch opponent of the policy, saying that he doesn’t support expanding “welfare,” and has so far blocked its passage. 

There are currently 23 Senate cosponsors and 67 Assembly cosponsors on the bill. 

DHS Legislative Director Arielle Exner told lawmakers that from 2020 to 2022, there were 63 pregnancy-related deaths in the state of Wisconsin with one-third of pregnancy-related deaths occurring after that 60-day postpartum period; 76% of those who died had Medicaid at the time of their delivery. In 2023, Medicaid covered 35% of births in Wisconsin and 41% of births nationwide.

“Wisconsin moms are losing health care coverage when they need it the most,” Exner said. 

Exner said the agency projects that an additional 5,020 women would have coverage per month under the bill, and that according to a fiscal estimate by the Department of Health Services, the policy would cost $18.5 million in all funds with $7.3 million in general purpose revenue.

If Wisconsin accepted full Medicaid expansion, which would expand Medicaid coverage to nearly all adults with incomes up to 138% of the federal poverty level, the cost for the postpartum coverage would be reduced to $15.1 million in all funds with $5.2 million in general purpose revenue — a total lower cost to Wisconsin.

DHS chief medical officer Jasmine Zapata, who is also co-chair of the Wisconsin Maternal Mortality Review Team and a newborn nursery hospitalist, called attention to the fact that the numbers and statistics are representative of people’s lives. She noted that the team reviews medical records, police records, hospital records, family interviews and more when looking at the deaths. 

“The way they were found deceased in their homes after a suicide or overdose… striking stories and heartbreaking stories… their children were there when they were found, brain matter splattered on the floor after a gunshot wound to the head, these are serious situations that are happening,” Zapata said. “For every statistic that we see, we have to remember that there are real lives and real stories behind them.” 

Zapata said that providing access to health care is one of the biggest recommendations that the review committee has. 

Arkansas is the only other state besides Wisconsin that has  not implemented the extension, a fact that was brought up repeatedly during the hearing. That state has also recently been working on maternal health legislation, though a recent bill still excludes the 12-month Medicaid coverage.

“Are they going to beat us and we [will] become the last in the union that does not have this coverage?” bill coauthor Rep. Patrick Snyder (R-Weston) asked. “It is my sincere hope that Wisconsin does not become the last… If we can’t get something like this done, then I don’t know what I’m doing in the Legislature.” 

“Can you believe it?” Snyder commented after a question. “Arkansas.” 

Jackie Powell, an OB-GYN who is completing her training in maternal fetal medicine, represented the American College of Obstetricians and Gynecologists at the hearing. She said she often cares for the highest risk patients, who may have chronic medical conditions. 

“During pregnancy, we have the opportunity to gain control of these conditions, but for these people who lose their insurance and lose their health care postpartum, we are essentially erasing all progress that we have made throughout their pregnancy,” Powell said.

Powell said that through her work she sometimes diagnoses a major medical condition, including heart failure, cancer and kidney failure, during pregnancy that “alters someone’s life course.”  

“Many of these patients need life-saving surgery and intervention postpartum to save their lives. Oftentimes, we need to deliver patients very preterm so that they can receive this care that they need,” Powell said. 

“Imagine being told that you need to have major surgery for a life-threatening medical condition within the first few weeks after delivering your baby, and possibly preterm baby, and then losing your insurance. Imagine the complications that you could still experience without the appropriate follow-up care when in the last year, you underwent all of this. Imagine walking into the neonatal intensive care unit to see your baby that you delivered prematurely in a hospital where you can no longer be treated,” Powell said. “This is a failure of our medical system.” 

Former Rep. Donna Rozar, who was the lead author on the bill last session and is a nurse, also testified on the bill.

“I could not get, even, a public hearing in the state Assembly, which made me really mad, and so I’m hoping that this year, some things will be different,” Rozar told lawmakers. 

Rozar said that she has heard objections to the bill that people could seek coverage through the Affordable Care Act rather than Medicaid once the coverage is lost after 60 days. 

“If you have a two-month-old, the last thing you want to do is change insurance programs. At 60 [days], you’re caring for a two-month-old and shouldn’t have to worry about health care coverage,” Rozar said.

There are 37 groups — including American Civil Liberties Union of Wisconsin Inc, Medical College of Wisconsin, American Heart Association, Pro-Life Wisconsin — registered in support of the bill, according to the Wisconsin Lobbying website. No one is registered in opposition. 

“I think we’re all on board with this bill,” Sen. Rachael Cabral-Guevara (R-Appleton) commented to the room at one point.

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(Getty Images)

A majority of Wisconsin lawmakers support a bill to provide mothers on Medicaid who have just given birth with a year of coverage, but whether the bill becomes law hinges on persuading the Republican Assembly leader to let it through.

Pregnant patients in Wisconsin are currently eligible for Medicaid coverage for childbirth if they have an annual income of up to 306% of the federal poverty level. In Wisconsin, people are typically only eligible for Medicaid coverage if they make up to 100% of the federal poverty level.

Medicaid covers about 41% of births in the U.S. and 35% of births in Wisconsin, according to data compiled by KFF, an independent health policy research and news nonprofit. A newborn whose mother is a Medicaid recipient receives a year of coverage. But mothers whose income is above 100% of the poverty level risk losing their coverage after 60 days if they don’t otherwise qualify for Medicaid.

For the second time in two sessions, a bipartisan group of lawmakers are advocating for a bill to extend the mother’s postpartum coverage period to a year.

“I want to support the families,” said Rep. Patrick Snyder (R-Weston), a coauthor. “It’s just the right thing to do. It’s not political. It shouldn’t be.”

Gov. Tony Evers has been proposing covering mothers for a year in each of his budget proposals since 2019, but Republicans have removed the provision each time. In 2021, lawmakers passed a law to extend coverage to 90 days and the state applied for a federal waiver, but the federal government has never responded.

The federal government gave states the option to extend coverage to a year postpartum in 2022 in the American Rescue Plan Act, and since then, states have gradually opted in. 

In Wisconsin, the proposal gathered significant momentum in 2023 with a bill that passed the Senate with only one opposing vote. It also gained the support of a majority of Assembly lawmakers, but it never came to a vote. 

When Wisconsin considered extending coverage in 2023, Wisconsin was one of 12 states that hadn’t implemented the extension. Now, it’s one of two.

“It’s just us and Arkansas,” Snyder said. “Are you kidding? The only states that don’t do this.”

Despite widespread support, the bill will face a challenge in becoming law this session due to opposition from Assembly Speaker Robin Vos (R-Rochester). During a press conference in early January, he said it was “unlikely” that the proposal would become law this session.

“Our caucus has taken a position that expanding welfare is not a wise idea for anyone involved,” Vos said. 

Snyder said he’s heard “rumors” that Vos may assign the bill to the Assembly State Affairs Committee. “I hope he doesn’t because a lot of times that’s where bills go to die,” he said. 

Snyder, who chairs the Assembly Children and Family Committee, said his experience serving there has shown him the importance of the legislation.

“I just see the impact of families that are disrupted with something like this,” Snyder said. When mothers die as the result of a preventable issue, he noted that it results in “trauma” for the child and families.

A 2024 report from the Wisconsin Maternal Mortality Review Team found that from 2019 to 2020 there was a 30% increase in deaths of mothers within one year of the end of pregnancy, regardless of cause. In 2020, there were a total of 49 deaths.

According to the CDC, over 80% of U.S. deaths during pregnancy, delivery, or up to one year after pregnancy in 2020 were preventable. 

Snyder said Wisconsin’s continued holdout means “either we don’t understand the whole gravity of it or we’re just stubborn.”

Snyder told the Examiner that bipartisan support for the measure continues this session with the majority of Senators and around 65 Assembly representatives signing on to the bill as of Wednesday afternoon. 

Co-authors on the legislation alongside Snyder explained a number of ways a year of coverage would benefit Wisconsinites. 

Rep. Jessie Rodriguez (R-Oak Creek) called the legislation a “no-brainer,” noting the number of medical and other issues that can arise for mothers after giving birth. 

“Moms are most vulnerable after giving birth to a child. There's just a lot of issues that occur right after not to mention sleep deprivation and just being exhausted, tired,” Rodriguez said. 

Rodriguez noted that the legislation would ensure that mothers covered under Medicaid when they give birth are able to see doctors throughout the first year after birth and allow issues to be addressed early on.

Sen. Jesse James (R-Thorp) said his experience as a husband, father, grandfather, law enforcement officer and state legislator has shown him firsthand the importance of taking care of moms.

“In my opinion, there should not be a price tag on it. It shouldn't matter how much we invest because healthy mamas bring healthy babies, which bring healthy families to Wisconsin,” James said. “Our moms go through the wear and tear of pregnancy, carrying the baby for nine months, through all the body changes… Once that mom is done giving birth, the care just doesn't end there.”

In considering the actual cost to the state, however, James said he thought it would be worth it. 

A fiscal estimate by the state Department of Health Services of the 2023 bill found that the cost of the program would be about $21.4 million in all funds, including $8.4 million in state general purpose revenue. The estimate found that Medicaid would enroll an additional 5,290 people a month. 

“That's a very small investment," he said, suggesting that in return, mothers would get better health care and get it sooner, while also saving the system money in the long run. “Then that's a success. We're making them healthier.”

Sen. LaTonya Johnson (D-Milwaukee) spoke about the legislation at a roundtable hosted by Protect Our Care, a health care advocacy group, in Milwaukee on Wednesday — just after the Trump administration paused federal spending and Medicaid portals froze in states across the country. Postpartum expansion became a point of “optimism” during the conversation, which included U.S. Rep. Gwen Moore and patients who spoke about their varied experiences with Medicaid and fears about potentially losing Medicaid coverage. 

“When my daughter was born, I had a job. I was working. It didn't provide medical benefits. Not only did I give birth to a premature child, but two days after, I had to go back to work,” Johnson said. “What I know personally is that relying on Medicaid, it's considered a privilege that you have to fight too hard for.”

Securing coverage could have a significant impact for Black mothers and children, Johnson noted. 

Wisconsin has sharp racial disparities in maternal health. One DHS report found that from 2016 to 2023 Black women were at the highest risk for severe maternal morbidity — unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health. Another study found that between 2006 and 2010 the maternal death rate for Black women in Wisconsin was five times that of white women — outpacing the national disparity during that period.

“The only way to improve the odds is to make sure that we have the coverage that we need, to follow not only that baby for 12 months, but also that mom,” Johnson said. 

Johnson told the roundtable group that she thinks the bill is a priority for lawmakers, though there is a long way to go on it.

Snyder said he plans to have another conversation with Vos soon, and other lawmakers say they’ll continue to work to persuade the speaker to come around.

James said he is ready to provide his supportive colleagues with talking points and that he hopes to speak with Vos in the near future.

“I'm just hoping that he's willing to have a conversation,” James said. “I have no issue in hearing him out… they tried to do that 60 to 90 day waiver, and the federal government says they're not going to take anything less than one year, so I think as we progress through we just — we need to make things happen. We need to take care of our families.” 

Vos has told Wisconsin Watch that he wants to see the 90-day waiver resubmitted to the Trump administration. 

The proposed bill’s cosponsors said they would potentially be open to compromise, but that a year of coverage would be the easier and more impactful option. 

“If we could get his support in bringing it down to 90 days, that would be great, but we've already done. In order to do the 90 days, we have to ask for a waiver and the state never got a response back on that,” Rodriguez said. It'd be easier, she said, to pass legislation for the full year already authorized by the federal government.

“Most of the mortality occurs between five and nine months,” Snyder said. “Between five and nine months, there is anything from cardiac arrests, preeclampsia and even suicide, so 90 days isn't going to always help.”

Snyder said that he is hoping that Vos might change his mind. 

“Hopefully enough advocates will come to him and say ‘It's not really expanding welfare, it's extending from two months,” Snyder said.

Rodriguez acknowledged that Vos’ “philosophical beliefs” are part of his opposition to the legislation.

But if Vos doesn’t support the legislation, “Hopefully we can find a place where he can allow this to move forward,” Rodriguez said, “maybe not support it but at least allow this bill to get to the floor.”

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