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Wisconsin Attorney General Josh Kaul and Gov. Tony Evers announced the state is among a group of Democratic attorneys general and governors from 23 states that is suing the Trump administration for abruptly cutting off about $11 billion in public health funding.
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ABC for Health, a public interest law firm, argues that a Dane County health assessment should have addressed the problem of medical debt. (Getty Images)
ABC for Health, the public interest law firm, has filed a complaint with the IRS, charging a team of hospitals led by UW Health of falling short of federal standards when they filed a Community Health Needs Assessment required of health nonprofits under federal law.
Late last year, the hospitals released their report on the health needs of Dane County.
Federal law requires nonprofit health care providers to file such a document every three years. The December report covered reproductive care, chronic illness, mental health and substance abuse, along with special sections about health concerns for children and youth as well as the elderly.
But in 63 pages, the report included no discussion of how the cost of care and medical debt have burdened people without money and hampered their access to the health care system.
Bobby Peterson, ABC for Health founder and executive director. (Wisconsin Examiner photo)
For Bobby Peterson, that was a glaring omission — and on Thursday, Peterson and ABC for Health, the firm he founded and directs, filed a complaint with the IRS, charging the report doesn’t live up to the federal law’s requirement for a Community Health Heeds Assessment (CHNA).
The organization’s complaint argues that failing to address that issue in the Dane County health needs document violates the collective responsibility of UW Health and the other three nonprofit hospital systems that produced it.
“Their insistence to exclude medical debt from consideration during the CHNA betrays many principles and requirements of non-profit hospitals,” the complaint states. “We maintain that UW Health’s intentional indifference towards the medical debt epidemic stems from a value for their own revenue at the expense of their community. That value is at odds with UW Health’s duty towards its community.”
Sara Benzel, media relations manager for UW Health, defended the report Thursday as well as the hospital system’s handling of medical debt.
“UW Health stands behind the priorities identified in the community health needs assessment process,” Benzel told the Wisconsin Examiner in an email message.
“Regarding the UW Health Financial Assistance Policy, we are proud of the work we do every day to make this support accessible, and the work we have done to simplify the process and lower barriers to accessing financial support.”
She said the hospital system’s financial assistance program isposted online in English and Spanish.
“The application has been simplified over the years using an equity lens, requires minimal supporting documents, and goes up to 600% of the federal poverty level, well above others in the state,” Benzel said.
Medical debt critic
ABC for Health has been a longstanding critic of hospitals’ handling of medical debt and has publishedseveral reports finding fault with how hospital systems address the problem of patients unable to pay their health care bills.
While hospitals have programs for financial help when a patient has no insurance and can’t afford to pay out of pocket, ABC has argued those programs are too often needlessly complex. The organization also contends that hospitals’ financial counselors don’t take actions that could circumvent a problem — such as helping patients enroll in Medicaid if they qualify.
The requirement for a Community Health Heeds Assessment is a little-noticed provision in the 2010 Affordable Care Act — the legislation nicknamed Obamacare that has helped drive down the numbers of uninsured Americans since its passage 15 years ago. Nonprofit health care systems must produce a CHNA report for their communities every three years.
“The IRS is regulating this because they are looking at their tax-exempt status,” Peterson said Thursday. “And to be a tax-exempt organization, to be able to step away from all the property tax requirements that many of us face, they have a responsibility then to give back.”
He sees a hospital’s approach to medical debt as a direct measure of how they give back.
“They have a community benefit that they need to provide, and part of that benefit is making sure that they’re providing enough charity care and services to the vulnerable in a community,” Peterson said.
The2025-2027 CHNA report, like severalprevious editions, was the work of Healthy Dane Collaborative, a coalition of the county’s four hospital systems: Unity Point-Meriter, SSM Health-St. Mary’s Hospital, Stoughton Health and UW Health. The report’s drafters conducted a survey, collected and analyzed data, met with a variety of community organizations and held focus groups
The final report included discussions of health care disparities by race, income and gender. It called attention to the health care needs of the LGBTQ and immigrant communities, including undocumented migrants.
Early on, the text of the report emphasized concern for health equity — “ensuring fair distribution of health resources, outcomes, and opportunities across different communities.”
Seeking a voice
At an ABC for Health symposium Thursday on Medicaid and health care access, Peterson said the report’s priorities were “good things” and were all important.
“But what we wanted to see was access to health care coverage,” Peterson said, along with a discussion about improving financial assistance policies and better coordination among providers. “It wasn’t there. That’s not part of what they wanted to give out to the community.”
Peterson said ABC started reaching out more than a year and a half ago to offer input for the CHNA report.
“We wanted to make sure that the people that are in the planning process understand what the access to health care coverage needs are, what the barriers in the financial assistance process are, and how can we make it better. What can we do to improve that process?” Peterson said.
“We thought this is a real opportunity for us to make sure that all these issues that we see every day can be put up in this Community Health Needs Assessment process,” he added. “We wanted our voice and the voice of our clients to be heard.”
The IRS complaint includes email messages ABC Health sent various people about the assessment process starting in mid-2023.
In a message Aug. 13, 2024, Peterson told Adrian Jones, UW Health Director of Community Health Improvement, “ABC remains eager to engage in Dane County’s 2024 CHNA process.”
The message asked for updates on the CHNA “process and timeline” and mentioned that ABC for Health was “preparing a report with recommendations to provide input, from the perspective of our clients, to inform Dane County’s CHNA process.”
In her Aug. 14 reply, Jones invited Peterson to “share your report with us.” She wrote that “we have also held our own community input sessions and survey and have analyzed a lot of quantitative and qualitative data.”
Peterson followed up with an email Aug. 16 that included a half-dozen questions about the data being collected, when and where community meetings had been conducted, whether more community meetings were planned and the timeline for completing the assessment document.
“ABC for Health is eager to continue engagement with the Dane County CHNA process,” Peterson wrote. “Please keep us posted about future community input sessions and meetings.”
Correspondence ends
There was no further response, and “the Dane County hospitals quietly released the CHNA report in late 2024, without ABC’s input that we maintain failed to take into account the perspective of the many communities we represent,” the complaint to the IRS states.
“Unsurprisingly, this report ignored access to health care coverage issues. The report lacks any recommendations to improve financial assistance policies, practices, and processes to equitably serve populations negatively affected by health disparities. It fails to address the impact of medical debt on Dane County patients,” the complaint states.
“It lacks broad community input and instead reflects a hospital-driven marketing piece that ignores and sidesteps Affordable Care Act requirements. ABC was largely shunned despite our multiple efforts over the past 2 years to provide client-based input.”
ABC for Health releasedits report shortly after Peterson learned that the CNHA report was published. Its critique was unsparing.
“Dane County hospitals must do more to justify extensive tax breaks and better serve patients impacted by health disparities,” the report states. “In 2023, Dane County hospitals spent an average of only 0.7% of their gross patient revenues on charity care. The national average is 2.3%.”
ABC for Health bases its calculations for Dane County charity care on Wisconsin Hospital Association data, and the national average on a 2022 Wall Street Journalreport.
Peterson sent a letter reiterating ABC for Health’s concerns and the organization’s complaint about its lack of input in the CNHA report to UW Health’s CEO, Alan Kaplan, in January. He said there was no response.
ABC for Health also invited Kaplan and other hospital leaders to the ABC for Health event Thursday. The invitations were ignored or declined, Peterson said.
Stroud held a town hall in Superior this week, discussing among other issues a dearth of health care services in the district. Before the town hall, she joined WPR’s Robin Washington on “Morning Edition” to talk about those concerns.
Congress provided billions of dollars to help communities remove lead pipes under the 2021 bipartisan infrastructure law. The funding will help water systems pay for those projects. Almost all of them can apply for forgivable loans. But Superior’s water utility is barred from doing so.
Scientists at UW–Madison said they are struggling to advance study of a potential new epilepsy treatment after the Trump administration's pause on grant review meetings by the National Institutes of Health.
"MPS allowed children back into the work areas at Fernwood to attend class on March 11, 2025, while paint chip dust and debris from the previous night’s work was present," the letter states.
Vivent Health conducts tests for HIV and other sexually transmitted infections. Federal funds that cover the cost of those tests and other HIV prevention services are being considered for drastic reductions. (Photo courtesy of Vivent Health)
Wisconsin stands to lose at least $1.2 million a year to help prevent the spread of HIV if the federal government follows through on reported plans to drastically cut HIV prevention.
The Wall Street Journalreported this week that the administration of President Donald Trump was planning sharp reductions at the U.S. Centers for Disease Control and Prevention (CDC) and the Division of HIV Prevention housed there.
The U.S. spends about $1.3 billion annually on HIV prevention. That includes just over $1.2 million that goes to the Wisconsin division of Vivent Health, a multistate nonprofit specializing in care for people who have HIV or are at risk of being infected.
Vivent Health’s federal HIV prevention grant comes through the Wisconsin Department of Health Services. A department spokesperson said the agency could not provide the total it receives each year in federal HIV prevention funds by the end of the day Thursday.
Bill Keeton, vice president and chief advocacy officer for Vivent Health (Photo courtesy of Vivent Health)
At Vivent, the money has helped reach tens of thousands of people across the state to help them avoid infection with the human immunodeficiency virus, said Bill Keeton, Vivent’s vice president and chief advocacy officer.
The funds are used for outreach to people who are vulnerable for HIV, he said. They cover the costs of testing for HIV and other sexually transmitted infections. They also cover services to help people who are candidates for medication that can prevent HIV infection as well as medication after being exposed to the virus.
“We do thousands of tests a year throughout the state,” said Keeton. Vivent has 10 clinics around in Wisconsin and additional mobile clinics for outreach to people who use drugs. Drug use can heighten the risk of transmitting HIV, he said.
In addition, HIV prevention funds cover condom distribution and other methods of harm reduction, Keeton said, along with education to help people learn how to use condoms properly and other ways to protect themselves from HIV infection.
“These are services and programs that are designed to reach out and provide education, testing and resources designed to prevent HIV from occurring,” Keeton said. “These dollars that we get from the federal government comprise the lion’s share of the resources we get to do this work.”
In 2024, Vivent in Wisconsin provided 2,200 HIV tests, about half that number for Hepatitis C and nearly 1,900 for other primary sexually transmitted infections. The organization distributed 300,000 condoms and 2.7 million clean syringes for drug users.
American taxpayers and health care consumers will bear the brunt of these shortsighted policy changes.
– Bill Keeton, vice president and chief advocacy officer at Vivent Health
Vivent assisted 369 people with navigating the decision to use pre-exposure prophylaxis, or PrEP, daily medication to ward off the HIV virus in a person who is not already infected. Vivent has 678 patients in Wisconsin using PrEP.
The CDC has reported HIV infections have fallen by 12% nationally, from 36,300 in 2018 to 31,800 in 2022. Cutting off prevention funds could reverse that trend, Keeton said, and would be a setback to efforts to end HIV — an objective that has been embraced by the last three presidential administrations, including Trump’s in his first term.
“New diagnoses will increase,” Keeton said. “New transmissions will occur — unfortunately, that means people will take on $500,000 in lifetime health care costs managing their HIV.”
People will get sick, deaths will increase along with the difficulty of managing chronic illness that would otherwise be avoidable, he said, along with increasing health costs.
“American taxpayers and health care consumers will bear the brunt of these shortsighted policy changes,” Keeton said.
With continued support, however, those outcomes can be avoided. “We have the tools, we have the science, we have the interventions that can work to end HIV,” he said. “What we lack is the resources.”
Keeton told the Wisconsin Examiner that Vivent and other providers of HIV-related care started getting word earlier this week that the HIV prevention division was “getting a lot of attention” in the White House.
He acknowledged that replacing the federal money would be a challenge given the $1 billion price tag it would carry nationally. Other organizations involved in HIV health care and advocacy are looking at mounting a court challenge if the Trump administration follows through on the proposal to cut the prevention programs.
For now, however, Vivent’s focus is on heading off the potential cuts. Keeton said the organization is advocating with members of Congress and encouraging them to “weigh in with the administration” to keep prevention programs funded.
Little Chute High School in Outagamie County and Mound View Elementary in Dunn County received the inaugural Program of Excellence Award. The state award recognizes school counseling programs using data-driven solutions to meet the needs of students.
A woman receives a flu vaccination at a recent clinic in Cambridge, Mass., conducted by health care providers from the Cambridge Health Alliance. Flu-related deaths are at a seven-year high as vaccination levels fall, according to a Stateline analysis. (Courtesy of the City of Cambridge)
As vaccine skepticism gains a greater foothold in the Trump administration and some statehouses, some Americans may already be paying the price, with deaths from influenza on the rise.
Flu-related deaths hit a seven-year high in January and February, the two months that usually account for the height of flu season, according to a Stateline analysis of preliminary federal statistics. There were about 9,800 deaths across the country, up from 5,000 in the same period last year and the most since 2018, when there were about 10,800.
Despite that, the U.S. Department of Health and Human Services has canceled or postponed meetings to prepare for next fall’s flu vaccine, when experts talk about what influenza strains they expect they’ll be battling.
The cancellations raised protests from medical professionals and state and federal officials. U.S. Sen. Kirsten Gillibrand, a New York Democrat, said in a statement that her state is having its worst flu season in at least 15 years, with more deaths from flu and other causes as the state’s health care system struggles under the strain of flu patients.
Some experts say putting off vaccine planning will only feed false narratives that discourage lifesaving vaccinations.
“These delays not only weaken pandemic preparedness but also undermine public confidence in vaccination efforts,” said Dr. Akram Khan, an Oregon pulmonologist and associate professor at Oregon Health & Science University who has studied attitudes toward vaccines.
U.S. Health and Human Services Secretary Robert Kennedy Jr. has expressed doubt about the need for vaccines, including flu vaccines, despite evidence that they reduce deaths and hospitalizations.
Deaths fluctuate naturally from year to year depending on the severity of current flu strains and the effectiveness of that year’s vaccines. But some see a hesitancy to use any vaccine, fed by misinformation and political mistrust of government, already taking a toll on lives.
“It’s been a bad winter for viral respiratory infections, not just in the United States but across the Northern Hemisphere,” said Mark Doherty, a vaccine scholar and former manager for GlaxoSmithKline Biologicals, a vaccine manufacturer.
“The U.S. does appear to be hit a bit harder, and it’s possible lower vaccination coverage is contributing to that,” Doherty said.
Flu vaccine distribution in the United States has been declining in recent years, and as of the first week of 2025 was down 16% from 2022, according to federal statistics.
The flu was a factor in 9,800 deaths in January and February, according to the analysis, using provisional data collected by states and compiled by the federal Centers for Disease Control and Prevention.
The highest death rates were in Oklahoma, Minnesota, Pennsylvania, South Dakota and Kentucky, all at about four deaths per 100,000 population so far this year. Some counties in Florida, New Jersey and Pennsylvania, as well as Oklahoma and Kentucky, were even higher — at about six deaths per 100,000.
The highest rates have been among older people. Statistics show the deaths hit white people and American Indians especially hard.
Tragedies are happening across the country to people of all ages and races, however. A 43-year-old Indiana father died after a brief bout of the flu, according to family members. After two 10-year-olds died in Prince George’s County, Maryland, area schools drew crowds to vaccine clinics.
Doug Sides, a pastor at Yulee Baptist Church in northern Florida, has held funerals for three congregation members who died from flu — all within one month, all of them over 70 years old. That compares with only one victim of COVID-19 from his congregation during the pandemic, he said.
“Flu death is a reality,” Sides told Stateline on a phone call from a Jacksonville hospital, where he was visiting another 84-year-old congregation member who was rescued from her home with severe pneumonia from an unknown cause.
“I encourage my church members to keep their hands clean, use hand sanitizer and to stay home if they’re feeling sick,” he said. He said he hasn’t personally gotten a flu vaccine recently because he gets conflicting advice about it — some doctors tell him to avoid them because he and some family members have cancer, while another “rides me all the time about getting a flu shot.”
“We’re all getting conflicting advice. We’re living in strange-o times,” he said. (The American Cancer Society says vaccination for people with cancer may or may not be recommended depending on individual circumstances.)
Many states are relaxing vaccine requirements as public skepticism rises. But many are taking action to warn residents and reassure them that vaccinations are safe and can help prevent deaths, despite misinformation to the contrary.
Burlington County, New Jersey, has had the highest flu-associated death rate of any county this year, according to the analysis, with 31 deaths among fewer than 500,000 people. The county held 30 free vaccine clinics from September to January, then extended them into February because of the severity of the flu season, said Dave Levinsky, a spokesperson for the county health department.
In Oklahoma, death rates are highest in the eastern part of the state where the Cherokee Nation is centered. A state publicity campaign stresses that flu shots are safe, effective and free at many community health centers. However, vaccination rates in the state are low compared with other states as of December, according to federal statistics: Only about 16% of Oklahoma residents had gotten flu vaccinations by then. Rates were even lower in Louisiana (just under 16%), Mississippi (12%) and Texas (10%).
States with the highest flu vaccination rates by December were Maine (37%), Connecticut and Vermont (33%), and Wisconsin and Minnesota (31%). But even those were down since 2022.
People have become less likely to get vaccinated in recent years, a phenomenon researchers call “vaccine hesitancy.”
Unfortunately, vaccine hesitancy is deeply entangled with misinformation, political rhetoric and public distrust.
– Dr. Akram Khan, pulmonologist
A report published last year in the medical journal Cureus found three-quarters of patients in a rural New York state community refused flu vaccine with comments such as “I do not trust vaccines” or “I do not believe in vaccines.” The most common reasons cited were that earlier vaccinations made them feel sick, that they got the flu anyway, or that they thought they shouldn’t need a new shot every year. (Doctors recommend flu vaccinations annually and note that even vaccinated patients who get the flu usually face less severe forms.)
And in a paper published in February in the journal Vaccine, researchers found that people refuse flu vaccinations for many of the same reasons they refused COVID-19 shots: a feeling of “social vulnerability” that leads to distrust of government and medical guidance. One hopeful sign, the report noted, is that vaccine recommendations from trusted health care professionals can turn around such attitudes.
“Unfortunately, vaccine hesitancy is deeply entangled with misinformation, political rhetoric and public distrust,” said Khan, the Oregon pulmonologist and the study’s author. “Scientific data alone may not be enough to shift public perceptions, as many vaccine decisions are driven by gut feelings and external influences rather than evidence.”
Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.
At a "Hands Off Medicaid" event Monday with U.S. Sen. Tammy Baldwin, one Wisconsin woman said she'd be unable to work without support from the program.
Three more schools in Milwaukee are closing after staff with the city health department identified "significant lead hazards" when inspecting the properties this week.
The Trump administration announced more than two dozen rollbacks of environmental regulations Wednesday that may affect efforts to limit pollution in Wisconsin from fossil fuel plants, vehicles and neighboring states.
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