Some anti-abortion state lawmakers are pushing to revise the definition of “abortion” so abortion bans don’t apply to cases in which the death of an “unborn child” is the result of medical care provided to the pregnant woman.

In the four years since the U.S. Supreme Court allowed states to ban abortion, stories continue to emerge of women with doomed pregnancies who developed life-threatening infections, had to travel to another state, or even died because doctors were afraid to provide what was once considered standard pregnancy-loss care.

Thirteen states have abortion bans, and all of them include a medical exception that allows abortions to protect the life of the pregnant woman. Some, but not all, of the bans also have exceptions to protect the health of the woman.

But patients and providers have argued in lawsuits challenging the bans that such exceptions are too ill defined to give doctors and hospitals the confidence to provide timely care. As a result, they say, providers end up denying care until the woman’s condition deteriorates to a point where the exceptions definitely apply, jeopardizing her health and future fertility.

Last year, states including Texas, Kentucky and Tennessee enacted laws designed to provide additional clarity. Confusion persists in those states and others, however, and research has linked abortion restrictions to higher rates of maternal death and injury.

The latest measures, crafted and promoted by national anti-abortion groups, would redefine “abortion” as the intentional ending of the life of the “unborn child.” Supporters say they would clear the way for doctors to manage miscarriages, ectopic pregnancies and other pregnancy-related emergencies.

“No one wants a physician to hesitate or pause and further endanger the life of the mother,” said Ingrid Duran, director of state legislation for the National Right to Life Committee, which has advocated for all of the measures, in a written statement. “This is why providing clearer language in defining terms can be beneficial.”

But reproductive rights advocates and many OB-GYNs say the real purpose of the bills is to fortify abortion bans that are broadly unpopular, even in states with full bans, and under legal challenge in multiple states. They argue the new measures are still too vague because they hang on the intentions of individual physicians, and many of the same procedures and medicines used in abortions are used to treat miscarriages.

They also say the language in the bills could grant embryos legal rights, thereby making some fertility treatments illegal.

“If you’re trying to define what is and is not an abortion, and you’re creating really specific, narrow guidelines, it could really unintentionally classify some pregnancy-related procedures as abortion care, and therefore within the law not medically necessary,” said Elias Schmidt, state legislative counsel for the Center for Reproductive Rights, an advocacy group.

South Dakota is first

In March, South Dakota became the first state to enact such a law. Its measure states that the state’s abortion ban only applies to “the intentional termination of the life of a human being in the uterus,” and not to medical treatment that results in “the accidental or unintentional death of the unborn child,” treatment to resolve a miscarriage or ectopic pregnancy, “the removal from the uterus of a deceased unborn child,” or a medical procedure that aims to save the fetus.

To the concern of fertility-treatment advocates, the law also defines “human being” as “an individual living member of the species of Homo sapiens, including the unborn human being during the entire embryonic and fetal ages from fertilization to full gestation.”

A similar bill introduced in Missouri defines abortion as “the act of using or prescribing any instrument, device, medicine, drug, or any other means or substance with the intent to destroy the life of an embryo or fetus in his or her mother’s womb.” It explicitly exempts miscarriage management and treatment for ectopic pregnancies from the definition.

And a bill in Utah, where abortion is still legal up to 18 weeks’ gestation, would regulate how an abortion procedure is recorded in a patient’s chart, distinguishing between an elective abortion and a medically indicated abortion. It defines the latter as an abortion “to remove a deceased fetus,” resolve an ectopic pregnancy, or to avert the death or “serious physical risk of substantial impairment of a major bodily function of a woman.”

Wisconsin’s legislature recently voted not to advance a similar bill this past legislative session.

Blame for the confusion

Anti-abortion groups blame doctors and abortion-rights advocates for creating the confusion around the medical exceptions in abortion bans, insisting it is clear what is a medically indicated abortion and what is purely elective.

“The fact that we’re in a place now that states actually have to define (abortion) is a result of my field, particularly (the American College of Obstetricians and Gynecologists) not clarifying it,” said Dr. Susan Bane, vice chair of the board of the American Association of Pro-Life Obstetricians and Gynecologists, which is made up of about 7,500 physicians and other medical professionals who oppose abortion.

The organization has launched a medical education and messaging campaign arguing that abortion bans do not prevent necessary health care.

According to Bane, the main difference between an induced abortion and medically indicated termination is that in the first case, “you want a dead baby at the end of whatever you do.”

The author of the South Dakota law, Republican state Rep. Leslie Heinemann, said he sponsored the measure to quell some of the criticism that the medical exceptions in his state’s ban were ill defined. He admitted he underestimated how difficult it would be to codify in law when care for a miscarriage is necessary.

“Even the medical community had trouble with helping define some of the issues,” he said.

The version of the bill that became law names only a few conditions and leaves the rest up to the discretion of physicians, who must exercise “appropriate and reasonable medical judgment that performance of an abortion is necessary to preserve the life of the pregnant female” to avoid felony charges.

Heinemann insisted his measure would not restrict fertility treatments or birth control. But reproductive health and legal experts say that by defining the beginning of human life as “the entire embryonic and fetal ages from fertilization to full gestation,” it could have that effect.

“Embedding personhood language into state laws does really bring up concern around contraceptive access and IVF access,” said Kimya Forouzan, principal state policy adviser for the Guttmacher Institute, a think tank that supports abortion rights.

“As personhood provisions grow in the state code, it brings up the question: At what point are we granting the legal rights of a person and placing those rights above the individual themselves?”

Dr. Amy Kelley, an OB-GYN in Sioux Falls, South Dakota, who was the chair of the South Dakota chapter of the American College of Obstetricians and Gynecologists from 2023 to 2025, said lawmakers ignored her and other doctors’ concerns that the amended abortion ban is still too vague.

“The whole point of medicine is to prevent people from becoming on the brink of death, right? So are they expecting us to wait until that?” Kelley said. “It’s still not very clear, and the definition for miscarriage and ectopic is also not the one we wanted. It’s just not helpful.”

Kelley said that since her state enacted an abortion ban, she often waits longer to terminate a pregnancy for medical reasons, and will sometimes send patients out of state for care. She noted that the new law doesn’t explain what level of risk to the pregnant woman justifies terminating a pregnancy.

“They want to say elective abortions are not allowed. But what do they consider elective?” she said. “Let’s say they have a heart condition and their risk of dying in pregnancy is 40%. Is that an elective abortion because their risk is not 100%?”

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org

In the eight states that expanded Medicaid after 2018, the number of people receiving prescriptions for the opioid addiction treatment medication buprenorphine increased dramatically, according to a paper that researchers will present next month.

The states that expanded Medicaid before that period also saw gains, but they were generally smaller. That’s because other changes, aside from Medicaid expansion, made buprenorphine easier to get after 2018.

The researchers found that among all patients — those covered by Medicaid, other insurers and the uninsured — the number of buprenorphine prescriptions increased in the eight most recent Medicaid expansion states (Idaho, Maine, Missouri, North Carolina, Oklahoma, South Dakota, Utah and Virginia) by more than 21% between 2019 and 2023. Maine, Oklahoma and Virginia saw the most dramatic increases.

Among the states that expanded Medicaid in 2018 or before, Kentucky, Vermont and West Virginia experienced the largest boosts. The study, published in February in JAMA Network Open, was conducted by researchers from Rutgers University and Indiana University, based on pharmacy claims data from retailers across the country.

Stephen Crystal, director of the Center for Health Services Research at Rutgers University and one of the authors, explained that buprenorphine became more accessible after 2018 as the federal government loosened various prescribing rules, including allowing prescribing via telehealth.

“Longer-term tracking shows that expansion, whether early or later, provides essential financial access and supports the growth of a provider network that improves population-level treatment rates,” Crystal told Stateline.

Experts warn that looming Medicaid cuts could cut off buprenorphine access to thousands of patients. The broad tax and spending law President Donald Trump signed last summer is projected to cut federal Medicaid spending by an estimated $886.8 billion over the next decade, largely because new work requirements will push people off the rolls, according to estimates by the Congressional Budget Office. CBO estimates that it could increase the number of people without health insurance by 7.5 million in 2034.

Opioid overdose deaths in the U.S. peaked during the COVID-19 pandemic, reaching a high of 81,806 deaths in 2022. They’ve fallen sharply since then, to 79,358 in 2023 and 54,045 in 2024.

Medicaid is  the largest payer of opioid use disorder treatment, and in 2023 it covered nearly half of all non-elderly adults in the U.S. with opioid use disorder in 2023, said Robin Rudowitz, a senior vice president at KFF, a health policy research group.

“Having health insurance is the main way for people to have consistent access to health care services, and also particularly for Medicaid, as most people are low income, and it provides protections against financial burdens,” Rudowitz said.

“And for (opioid use disorder) specifically, research shows that when people discontinue treatment, mortality risk increases. And for discontinuation of Medicaid, specifically, when coverage lapses, mortality rate increases.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

Under a bill signed Wednesday by Gov. Tony Evers, Wisconsin will seek health care coverage from the federal government for certain services for incarcerated people. 

A statement from Evers’ office said that AB 604 — now Wisconsin Act 233 — aims to improve health outcomes and reduce disruptions in care and rates of people committing new crimes. 

As people with substance use disorders return to the community from jail or prison, they are especially vulnerable to dying from an overdose. Supporters of the new law hope it will aid them.

A federal “inmate exclusion policy” limits incarcerated people’s ability to use Medicaid, but under the new law the state will apply for a waiver, taking advantage of an exception outlined by the federal government. 

The Wisconsin Department of Health Services will submit a request for a waiver to conduct a demonstration project to provide incarcerated people with health care coverage for certain services for up to 90 days before release. 

The department will request coverage for case management services, medication-assisted treatment for all types of substance use disorders and a 30-day supply of prescription medications. If the waiver is approved, incarcerated people would have to be otherwise eligible for coverage under the Medical Assistance program in order to qualify. 

As of Nov. 21, 19 states have approved waivers and nine states including Washington D.C. have pending waivers. 

The Wisconsin Department of Health Services must submit the waiver request by Jan. 1, 2027. The department told the Examiner in November that it needed the authority that the bill would provide before it starts work on putting together the details of the waiver. 

‘The care they need to live’

Rep. Shelia Stubbs (D-Madison), one of the lawmakers who introduced AB 604, said in a statement Wednesday that the bill gives incarcerated people “a greater chance of maintaining sobriety, preventing overdose, and remaining healthy after they rejoin the community.” 

The criminal justice advocacy organization WISDOM was among groups that expressed support for the bill. Tom Denk, the co-president of one of WISDOM’s affiliates, said in an emailed statement that this law is very personal to him and called it “a step forward.”

Denk, who was released from prison to extended supervision in 2022, said he’s had friends in and out of facilities and had too many die because of a lack of services. 

He said that “my own struggles, the trauma, and the deaths of some of my best friends are what motivated me to get involved in advocating for a better system.”

“Medications, and access to medical care, will literally save lives,” Denk said. “Too many people don’t have either, when they’ve left facilities.” 

Denk also emailed the Examiner a statement signed by Bev Kelley-Miller, who wrote that she lost her 22-year-old daughter, Megan Kelley, to a preventable heroin overdose. Kelley-Miller wrote that her daughter had an ankle bracelet “but that didn’t stop her from using.” 

Kelley-Miller, who expressed support for AB 604, wrote that substance use disorder is a medical condition and that using substances is not a choice once you are addicted. 

“I wish Megan was still here,” Kelley-Miller wrote. “Since she’s not, I advocate for others to receive the care they need to live.”

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Democrats seeking the party’s nomination for governor talk about many of the same goals when it comes to Wisconsin’s health care system: expanding access, reducing costs and ensuring quality.

Some of their proposals to those ends are almost identical. But key details vary. 

“If there’s one thing that’s a certainty, the context will change between now and when one of us takes office and has a Legislature that hopefully is going to work with us,” said Joel Brennan, former secretary of the Department of Administration, at a forum Wednesday conducted by Wisconsin Health News. “That context will change in the next nine to 10 months and we better be ready to change with it too.”

Brennan said his campaign’s health care policy will rest on four principles: broadening access to health care, particularly in rural areas; reducing costs; fostering a pathway to increase the health care workforce; and ensuring that mental health is “a basic part of health care.”

Other candidates have issued more detailed plans.

Former Wisconsin Economic Development Corp. CEO Missy Hughes announced a list of 10 proposals Wednesday.

“I’m really wanting to make sure that we’re addressing a very, very complicated problem in every different way,” Hughes said at the Wednesday forum.

Expanding Medicaid

Almost all of the seven major Democratic hopefuls have endorsed expanding Medicaid under the Affordable Care Act — opening up the health insurance plan for low-income Americans to people with incomes up to 138% of the federal poverty guideline.  When the ACA was enacted the federal government paid states that accepted expansion 90% of the additional cost.

Democratic Gov. Tony Evers made repeated attempts to enact expansion after he took office in 2019, but couldn’t do it without the support of the Republican majority in the state Legislature because of a law passed the month before Evers was sworn in.

Former Lt. Gov. Mandela Barnes has made Medicaid expansion the central focus of his health care policy pitch. He has promised to veto the state budget if it doesn’t include Medicaid expansion.

“The fact that so many folks aren’t covered right now is a problem for everybody,” Barnes said at a forum Monday, because health care providers pass the cost of uncompensated care on to other patients or their insurance companies. The Monday forum was conducted by ABC for Health, a nonprofit law firm that assists low-income Wisconsinites trying to navigate health care coverage and medical debt.

Hughes also lists expanding Medicaid — referred to as BadgerCare in Wisconsin — among her 10 proposals. She would connect BadgerCare expansion to the creation of a public option health insurance plan that Wisconsinites could purchase through the ACA marketplace, HealthCare.gov.

Milwaukee County Executive David Crowley also favors combining expanded Medicaid with a public option for people to buy into the plan. “We already have the BadgerCare infrastructure that is already in place,” Crowley said at the Wednesday forum. “So I think it’s our responsibility to expand the people’s ability to actually pay into a BadgerCare public option.”

Lt. Gov. Sara Rodriguez favors BadgerCare expansion as well as a public option health plan. Rather than combining them, however, she lists them as two of three health care initiatives she would pursue as governor. The third initiative is to institute a stabilization fund program to support struggling rural providers.  

The public option plan, to be sold on the ACA marketplace, “would be able to put downward pressure on costs across Wisconsin and have some price transparency within that,” Rodriguez said at the Monday forum. She pointed to examples in other states, including Colorado, where a public option health plan is also required to reduce its premium costs by 5% each year.

“Secondly, I do think that we should expand Medicaid in the state of Wisconsin,” Rodriguez said, noting Wisconsin is one of just 10 states that have not done so.

Rodriguez also observed that the 2025 “big, beautiful” tax and spending bill enacted by the Republican majority in Congress and signed by President Donald Trump on July 4, 2025, “makes it a little harder” for the state to expand Medicaid.

State Rep. Francesca Hong also included BadgerCare expansion and “a robust public option” health plan in a longer list of priorities during the Monday forum. Along with those, she called for lowering prescription drug costs, acting to “crack down on private insurers,” among other goals.

A Medicaid expansion dissent

An exception on Medicaid expansion is Sen. Kelda Roys. Although she has advocated Medicaid expansion going back to her years in the Assembly a decade ago, she argues now that it’s no longer practical.

An August 28 memo from the Wisconsin Department of Health Services declares that the 2025 tax and spending law includes “several traps making it cost and policy prohibitive for Wisconsin to expand Medicaid.”

The law requires Medicaid participants to prove they’re eligible every six months instead of annually as now — which advocates argue will lead more qualified recipients to be kicked out of the program. In addition, a $1.3 billion boost that Wisconsin would get for expanding Medicaid will end Dec. 31.

Expansion “is not feasible given the changes that the Trump administration has made right now,” Roys said Wednesday.

Instead, she has proposed allowing the general public to buy into the state health insurance plan that covers state employees. Wisconsin employers could buy into the plan to cover their workers, or individual Wisconsin residents could buy into it as an alternative to other private health insurance plans.

“We can lower costs, reduce uncompensated care, expand access to coverage, especially for small businesses,” Roys said.

Brennan has also proposed opening the state plan to the public, because it has broad participation as well as higher reimbursement rates for health providers, he said Wednesday. 

But he added that he thinks details on the public option should wait until the next governor takes office, so that experts in the state as well as from other states that have instituted a public option “can be part of that conversation.”

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Doula services aren’t covered by Wisconsin Medicaid – known as BadgerCare – as of April 2026.

Doulas provide emotional support and education around childbirth. Unlike midwives (which are covered), they don’t perform medical tasks.

A Wisconsin Department of Health Services spokesperson confirmed doulas aren’t covered as a stand-alone benefit for Medicaid recipients. 

State law requires the health department to get legislative approval before making changes to Medicaid. Doula coverage has been proposed by Gov. Tony Evers and Democratic lawmakers but has not come to pass.

According to the National Health Law Program, 26 states and Washington, D.C., are actively reimbursing for Medicaid coverage of doula care. Seven more are in the process of doing so.

A 2024 study from the American Journal of Public Health found Medicaid recipients with doulas had a 47% lower risk of cesarean delivery and a 29% lower risk of preterm birth than those without.

This fact brief is responsive to conversations such as this one.

Sources

• DONA International: What is a doula?
• Harvard Medical School: What does a doula do?
• Wisconsin Department of Health Services: Email with Elizabeth Goodsitt, communications specialist
• Wisconsin Legislature: 2017 Wisconsin Act 370
• Department of Administration: State of Wisconsin Executive Budget, February 2025
• Wisconsin Legislature: 2025 Assembly Bill 1085
• National Health Law Program: Doula Medicaid Project
• American Journal of Public Health: Role of Doulas in Improving Maternal Health and Health Equity Among Medicaid Enrollees, 2014‒2023

Are doula services covered under Wisconsin Medicaid? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

MIAMI — Midwife Sheila Simms Watson leaned to gently press on the pregnant woman’s belly. Me’Asia Taylor lay on a bed fitted with tie-dyed purple printed sheets in the corner of the RV.

Far from a typical camper, this RV houses a mobile midwifery clinic for prenatal, postpartum and women’s general health care.

“Roll when you’re getting up, and we can help you. You can sit there for a moment, all right, so you’re not lightheaded, not dizzy,” said Watson, whom patients and doulas call “Mama Sheila.”

Calm and slow, led by Watson’s soothing and attentive demeanor, the appointments are unrushed.

Run by the Southern Birth Justice Network, the mobile midwifery clinic brings care to majority-Black and Latino neighborhoods across Miami-Dade County several times a month. The clinic aims to offer a more relaxed setting, where women are comfortable and heard, their cultures are integrated, and they can connect with doulas from diverse backgrounds.

On the half-moon bench inside the RV, Watson, a doula and a midwife in training sit with patients. They take blood pressures and draw blood. They ask the women about their lives: How is their mental health and sleep? Do they have support at home? Do they want to give birth at a hospital or birth center with a midwife?

Taylor said pre-eclampsia, a dangerous pregnancy condition, runs in her family. She wanted to make sure she had space and time to express her concerns about her first pregnancy.

Taylor said she wants a midwife for her delivery. Many women of color have reported feeling marginalized or dismissed in medical settings. “I’ve just seen too many people have bad experiences,” Taylor told Watson.

The U.S. has markedly higher maternal mortality and infant mortality rates compared with other high-income countries, and women and babies of color fare the worst. Black women’s maternal death rates are three times higher than those of white women, and American Indian and Alaska Native women’s rates are twice that of white women. Researchers point to implicit bias, less regular access to prenatal care and higher rates of poverty.

OB-GYN shortages and labor and delivery units closing continue to make getting care harder. Last year, more than two dozen hospital labor and delivery units across the nation closed, including some in South Florida. And pregnant patients living miles away, or feeling uneasy about going to the doctor, may even forgo care.

Midwives can help fill gaps, maternal health equity advocates say, and mobile clinics can meet patients where they are.

“It really helps to disrupt this idea that patients must navigate these complex systems to receive care — and instead, (mobile midwifery) reimagines care as something that should be responsive to the needs of patients and should be community-centered,” said Tufts University professor and maternal health scholar Ndidiamaka Amutah-Onukagha.

But mobile units are not as common for midwifery as they are for other areas of care, such as dentistry or family medicine, the American College of Nurse-Midwives told Stateline. Other prenatal mobile outreach efforts in the state include an OB-GYN-run mobile unit by the University of Florida that serves areas around north-central Alachua County and an operation called The Midwife Bus in Central Florida.

To increase access to care, maternal health advocates are also pushing states to change regulations that restrict midwifery. The American College of Nurse-Midwives recently filed a lawsuit against Mississippi for requiring nurse-midwives to have agreements with physicians in order to practice. This week, Jamarah Amani, a midwife and the executive director of the Southern Birth Justice Network, joined other plaintiffs in filing a lawsuit against Georgia over its restrictions. But supporters of the rules say they are meant to protect patients and foster communication between clinicians.

Offering culturally centered prenatal care that women are more inclined to use can help address inequities in maternal health, Amani said. The group trains doulas, offers telehealth, provides referrals such as to mental health therapists, and advocates for equitable policies across the South.

Most of the mobile clinic’s clients — about 70% — are on Medicaid or uninsured, and the clinic is funded through federal and university grants, as well as donations.

“(Midwifery) presents like a luxury concierge-type of service,” Amani said. “Our goal is to really change that and to bring it back to the community in a very grassroots way.”

Preserving tradition

The Southern Birth Justice Network keeps a small drum on a table at a nearby booth. It represents the heartbeat, and ancestral reverence, Amani said. Drums are a universal language, and the instrument is meant to symbolize culture.

For doulas and many midwives like Amani and Watson, bringing their profession to communities today is the continuation of a significant part of Black American heritage.

Throughout history, Black midwives were venerated in their communities. Many practices were rooted in West African traditions. These midwives were the keepers of Black ancestral records, and delivered many white women’s babies. Enslaved women who were midwives traveled for deliveries. Some routes, long and traversed by foot, were dangerous in the deep rural South. During the Jim Crow era, Black Americans were denied care at hospitals or given inferior care.

“They only had protection if someone would send a carriage for them if they were going to deliver a white woman’s baby. But to care for the Black families, they often had to go in the middle of the night, alone,” Amani said. “We talk about the legacy of Black midwives as health care providers, but also as social pillars, as community leaders, as resistors of oppression.”

In the 20th century, medical institutions began to oppose midwifery, sometimes using racist and sexist campaigns to target the practice. They argued it was unhygienic and lobbied across states to dismantle midwifery. At the same time, while developing the field of obstetrics, doctors conducted gynecological experiments on Black women. The American College of Obstetricians and Gynecologists has acknowledged this history and said it’s committed to fighting racism and inequities.

Dr. Jamila Perritt, an OB-GYN and president and CEO of Physicians for Reproductive Health, said that in order to address structural barriers and close gaps, policies have to prioritize access to care, such as allowing midwives to expand their practices. Throughout the South especially, states still restrict midwives from practicing independently, despite widespread maternal health care deserts. She also pointed to research showing midwifery is associated with fewer C-sections, less preterm labor and better patient satisfaction.

“Expanding access to midwifery care, and expanding collaborations between physicians and midwives, only improves outcomes,” Perritt said.

Cultivating trust

On a recent breezy and brisk Saturday morning, the Southern Birth Justice Network’s midwives and doulas were stationed in the parking lot of the Freedom Lab, a local community center that hosts food and clothing distribution and a free urgent care center.

At the booth by the mobile clinic, under the shade of a royal-purple awning, meditation music, low-key and mellow, reverberated from a small speaker. There was a cooler filled with oranges, water and other snacks for the clinic’s pregnant patients.

“I’m going to keep giving you food. You need to eat enough,” one doula told a patient, handing her an orange and a liter of spring water.

Staff had surveys to help assess a new patient’s needs, and Florida-specific pamphlets on pregnant patients’ rights. The group is working on other state-specific guides for Louisiana, Massachusetts, Tennessee and Texas.

The table also held a portrait of the late midwife Ada “Becky” Sprouse, who started the mobile midwife clinic around 2008. She’d drive it to the city of Homestead, an agricultural hub in Miami-Dade County. There, she offered free midwifery care to migrant farmworkers, many of whom couldn’t afford care throughout their pregnancies.

Sprouse passed the clinic on to Amani, who relaunched the mobile unit and broadened the scope of the Southern Birth Justice Network.

Patients told Stateline trust was one of the main reasons they sought out the clinic. One patient said she spent 2 1/2 hours on public transit that day so that she could see the team.

For now, deliveries take place at hospitals or neighboring birth centers, where some of the group’s midwives also work. But the organization recently bought a building to open its own freestanding birth center, aiming for next year, along with a larger RV.

One patient, Isis Daaga, turned to Amani to deliver her other children after her first birth at a hospital. Despite the pressure she felt and her need to push during labor, Daaga recalled, hospital staff prevented her from delivering.

“They literally held my knees together,” Daaga said. “They were like, ‘the doctor’s not here yet,’ and the nurses were scared to deliver the baby.” In many hospitals, protocol is to wait for the doctor in case an emergency occurs.

By the time the doctor came, Daaga had a severe perineal tear, and she delivered the baby in one push. She had been in labor for 15 hours.

“I was in pain, I was upset,” said Daaga, a mental health therapist who is 35 weeks pregnant.

At the mobile clinic and with the midwives, Daaga said she feels supported.

“They make me feel the way I try to make my clients feel, like, it’s a safe space. You’re not judged here. I have a lot going on,” she said. “If I’m MIA or something, most of them will call and text me and (say), ‘Girl, you need to come in.’”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

CINCINNATI — For four years, Kimberly Dudley has worked on the front line of the Affordable Care Act as a navigator, helping Ohioans solve the puzzle of buying private insurance on the federal HealthCare.gov marketplace.

But the job is harder now, the answers scarcer. In one of its first acts, the second Trump administration cut annual funding for navigators by 90%, from $100 million to $10 million, arguing the program was wasteful. Under the ACA, better known as Obamacare, navigators help educate and enroll people — especially those living in hard-to-reach communities. They were paid through a user fee on monthly premiums.

In January 2025, 50 navigators served Ohio’s 88 counties, toting their laptops to meet Ohioans at rural libraries and suburban food courts to help them search for a health care plan on the marketplace. But by the Nov. 1 start of open enrollment, the busiest time of year, only five navigators remained. Dudley, of Cincinnati, is one of them.

Married with a child, she was hired in 2022 at Cincinnati’s Freestore Foodbank and found “such a joy from helping people, although it’s been hard this year.” The hotline, for example, is in Dudley’s hands now. The other navigators who worked calls were laid off.

The administration did not respond to requests last week to discuss the navigator program cut. But in announcing the cuts last year, an administration statement said: “Navigators are not enrolling nearly enough people to justify the substantial amount of federal dollars previously spent on the program. This reduction will ensure funding is focused on meeting the statutory goals of the program more efficiently and effectively.”

Dudley’s task got even tougher at the end of last year, when the Trump administration and Congress allowed certain pandemic-era subsidies to expire, and policy premiums rose sharply, often to more than many Ohioans can pay.

She hears the stories every day on her own phone, which doubles as Ohio’s ACA hotline. People call when they are ruled ineligible for Medicaid, usually because their incomes are too high. In early March, Dudley heard from Tonya Horn, 59, of Cleveland Heights, who needed help.

All her working life, said Horn, she felt lucky to have employer-paid health benefits up to her most recent job, working remotely for Empower, a Colorado financial services company, as a talent acquisition diversity program manager. But last year, her job at Empower felt less secure. Her pink slip came in January.

Helping Horn, Dudley spotted a plan on HealthCare.gov that with an income-based subsidy would cost $450 a month with no deductible. But then Dudley discovered that Horn’s doctor does not accept that insurance plan.

“I don’t know if this works for you,” Dudley said, “but getting insurance could involve switching doctors.”

Horn sighed. “Can we keep looking?”

Drop in enrollment

This year, Ohio’s enrollment in the HealthCare.gov marketplace fell by 20%, the second-largest decline among the 50 states. The overall national enrollment slid 5%.

Experts in Ohio said a few factors depressed enrollment. Some people aged into Medicare. Others found jobs with health benefits. But one certain force was the Dec. 31 expiration of the pandemic-era subsidies on most marketplace plans.

The ACA does provide premium subsidies based on income, but the federal government began offering additional help in 2021 as temporary pandemic relief. The “enhanced” subsidies cut many people’s monthly premiums by hundreds of dollars.

They also helped boost the number of people buying health coverage from the insurance marketplaces, from 11.4 million people in 2020 to 24.3 million last year.

Americans who had the enhanced subsidies got warnings from their insurers about the Dec. 31 expiration. As of March 26, the number of Americans with marketplace coverage dropped by about 1.2 million compared with 2025, according to the Centers for Medicare & Medicaid Services.

Last week, a spokesperson for U.S. Sen. Jon Husted, an Ohio Republican, said that Husted proposed to extend the subsidies two more years, with new restrictions to prevent fraud in marketplace plans. Democrats rejected the idea, said Joshua Eck, Husted’s deputy chief of staff. “But had they supported the bill, or been willing to discuss it, it’s likely this problem would have been solved in December.”

In Ohio, the Columbus nonprofit research group Health Policy Institute of Ohio found that of the more than 580,000 Ohioans with 2025 HealthCare.gov plans, nearly 90% used the temporary subsidies.

California and at least nine other states that run their own health insurance marketplaces have used state money to help residents absorb the expiration price shock, though only New Mexico is completely filling the gap. Ohio could not dip into its budget that way because it uses the federal marketplace.

In January, the Health Policy Institute of Ohio estimated that 2026 premiums for Ohio marketplace plans would surge by 114% on average. Said institute analyst Brian O’Rourke: “It’s reasonable to expect that (the enrollment drop is) because of the expiration of the subsidies.”

On the statewide ACA hotline call with Horn, Kimberly Dudley said her own mother got a notice from her insurance company that her $40-a-month premium would increase to $400. “I was able to help her figure out a plan, but her premium still went up some,” Dudley said. “We’re going to find a way forward for you.”

“I hope so,” Horn said.

Ohio expands the ACA

Ohio’s industrial base collapsed in the 1990s, and hundreds of thousands of workers lost employer-paid coverage. Young people left Ohio for work, and the insurance pool shrank as it rapidly aged. Numerous studies found Ohio’s health declining, in no small part because nearly 1.5 million Ohioans, more than 10% of the population, had zero health insurance.

The ACA also allowed states to expand Medicaid to adults with incomes up to 138% of the poverty level, although some Republican-led states have refused the expansion. In Ohio, GOP Gov. John Kasich pushed the Republican-led state legislature to approve the expansion in 2013; 40 states and the District of Columbia have expanded their programs. Ohio’s participation in the federal marketplace grew until 2025, when enrollment hit a record high.

The speed of the retreat in Ohio of the ACA brought swift consequences. The Columbus nonprofit group UHCAN Ohio “has been helping people since the law’s inception,” said Executive Director Charlotte Rudolph. Then last fall, “If we saw five people, maybe one enrolled. They’re making that tough decision to say, ‘I hope I don’t get sick.’”

“We are now going through our archives, asking ourselves, how did we help people back in the day when they didn’t have coverage?”

Further complicating Ohio’s health care horizon are Trump administration cuts to Medicaid. More than 3 million Ohioans use the health program for low-income residents. But under the broad tax and spending measure President Donald Trump signed last summer, as many as 1 in 10 of those Ohioans could be found ineligible through new work requirements and other hurdles.

Horn, on the hotline phone call, said her weekly $624 unemployment payments had put her over the Medicaid threshold. Dudley nodded as she tapped on her keyboard. “I hear that a lot,” she said.

What the future holds

While the immediate problems are stressing the system, experts say they are anxious for what is to come in Ohio’s health care.

Uninsured people often use emergency departments for primary care, straining hospitals still under pandemic duress and understaffed. Many Ohioans on Medicaid live in its rural spaces, where the safety net has long been fraying. The trade group the Ohio Hospital Association told the state legislature last year that more than 70% of the state’s rural hospitals have been running in the red for years.

“My fears,” said Grace Wagner of the Ohio Association of Foodbanks, “are that as these changes continue to come, decision-makers aren’t aware or prepared to respond.”

Dudley and Horn spent another 30 minutes on the ACA hotline, but none of the HealthCare.gov options clicked. Finally, Horn said she would call back.

“Sure, it’s a lot to think about,” Dudley said, and ended the call. Then she sat looking at her laptop screen full of HealthCare.gov. She doesn’t like to leave a puzzle unsolved for someone who came to her for help.

“I love what I do. Being able to do this work is fantastic, even in the midst of all this stuff happening,” she said. “But there are times when I feel a little overwhelmed.”

States are paying contractors such as Deloitte, Accenture, and Optum millions of dollars to help them comply with the One Big Beautiful Bill Act — a law that will strip safety-net health and food benefits from millions.

State governments rely on such companies to design and operate computer systems that assess whether low-income people qualify for Medicaid or food aid through the Supplemental Nutrition Assistance Program, commonly referred to as food stamps. Those state systems have a history of errors that can cut off benefits to eligible people, a KFF Health News investigation showed.

These benefits, provided to the poorest Americans, can mean the difference between someone obtaining medical care and having enough to eat — or going without.

States are now racing to update their eligibility systems to adhere to President Donald Trump’s sweeping tax and domestic spending law. The changes will add red tape and restrictions. They are coming at a steep price — both in the cost to taxpayers and coverage losses — according to state documents obtained by KFF Health News and interviews.

The documents show government agencies will spend millions to save considerably more by removing people from health benefits. While states sign eligibility system contracts with companies and work with them to manage updates, the federal government foots most of the bill.

The law’s Medicaid policies will cause 7.5 million people to become uninsured by 2034, according to the nonpartisan Congressional Budget Office. Roughly 2.4 million people will lose access to monthly cash assistance for food, including those with children.

In five states alone, company estimates developed for state officials and reviewed by KFF Health News show that changes will cost at least $45.6 million combined.

“This is a pretty big payday,” said Adrianna McIntyre, an assistant professor of health policy and politics at Harvard’s T.H. Chan School of Public Health.

The law, which grants tax breaks to the nation’s wealthiest people, requires most states to tie Medicaid coverage for some adults to having a job, and imposes other restrictions that will make it harder for people with low incomes to stay enrolled. SNAP restrictions began to take effect in 2025. Major Medicaid provisions begin later this year.

Documents prepared by consulting company Deloitte estimate that a pair of computer system changes for Medicaid work requirements in Wisconsin will cost nearly $6 million. Two other changes related to the state’s SNAP program will cost an additional $4.2 million, according to the documents, which Deloitte drafted for the Wisconsin Department of Health Services.

In Iowa, changes to its Medicaid system are expected to cost at least $20 million, according to an estimate prepared by Accenture, a consulting company that operates the state’s eligibility system.

Optum — which operates the platform Vermont residents use for Medicaid and marketplace health plans under the Affordable Care Act — estimated that it could cost roughly $1.8 million to evaluate and incorporate new health coverage restrictions.

Initial changes in Kentucky, which has had a contract with Deloitte since 2012, have cost the state $1.6 million. And in Illinois, Deloitte estimated modifications will cost at least $12 million.

A historic mandate

For six decades after President Lyndon Johnson created the government insurance program in 1965, Congress had never mandated that Medicaid enrollees have a job, volunteer, or go to school.

That will change next year. The tax and spending law enacted by Trump and congressional Republicans requires millions of Medicaid enrollees in 42 states and the District of Columbia to prove they’re working or participating in a similar activity for 80 hours a month, unless they qualify for an exemption. The CBO projected, based on an early version of the bill, that 18.5 million adults would be subject to the new rules — nearly half of those enrolled.

Vermont Medicaid officials expect it will cost $5 million in fiscal 2027 to implement changes in response to the federal law, said Adaline Strumolo, deputy commissioner of the Department of Vermont Health Access. About $1.8 million is for Optum to make eligibility system adjustments. Optum is a subsidiary of UnitedHealth Group.

The One Big Beautiful Bill Act will subject nearly 55,000 Vermont Medicaid recipients to work requirements — about a third of the state’s enrollees.

The law forced the state “to essentially drop everything else we were doing,” Strumolo said in an interview. “This is a big, big lift.”

Optum’s contract with the state was worth $125.6 million as of October.

Nearly two-thirds of adult Medicaid enrollees nationally are already working, according to KFF. Advocacy groups for Medicaid recipients say work requirements will nonetheless cause significant coverage losses. Enrollees will face added red tape to prove they’re complying. And eligibility systems already prone to error will have to account for employment, job-related activities, and any exemptions.

An estimated 5.3 million enrollees will become uninsured by 2034 due to work requirements, the CBO reported.

In Wisconsin, state officials estimate roughly 63,000 adults could lose coverage after work requirements take effect. Not covering those people would save $532.6 million in Medicaid spending for one year.

Wisconsin’s eligibility system for Medicaid and SNAP — known as CARES — was implemented statewide in 1994, and initially was a transfer system from Florida, according to a 2016 state document.

Deloitte submitted its cost estimates for Medicaid and SNAP changes to the state in September and December. Elizabeth Goodsitt, a spokesperson for the Wisconsin Department of Health Services, declined to answer questions about whether additional changes will be needed, how much it will cost to make all eligibility system changes to comply with the new federal law, and whether the state negotiated prices with Deloitte.

Bobby Peterson, executive director of the public interest law firm ABC for Health, said Wisconsin has invested “very little” to help people navigate the Medicaid eligibility process, which soon will become more difficult.

“But they’re very willing to throw $6 million to their contractors to create the bells and whistles,” Peterson said. “That’s where I feel a sense of frustration.”

New hurdles for vets and homeless people

Medicaid work requirements are only one change required by Trump’s tax law that will make it harder to obtain safety-net benefits.

Starting in October, the law prohibits several immigrant populations from accessing Medicaid and ACA coverage, including people who have been granted asylum, refugees, and certain survivors of domestic violence or human trafficking. Beginning Dec. 31, states must verify eligibility twice a year for millions of adults — doubling state officials’ workload. And the law restricts SNAP benefits by requiring more adult recipients to work and by removing work exemptions for veterans, homeless people, and former foster youth.

Days after Trump signed the bill in July, Kentucky health officials raced to make changes to the state’s integrated eligibility system, which verifies eligibility for Medicaid, SNAP, and other programs. Deloitte operates the system under a five-year contract worth more than $157 million. According to documents obtained by KFF Health News, initial changes costing $1.6 million were labeled a “high priority” and approved on an “emergency” basis, with some of the changes to the nation’s largest food aid program going into effect almost immediately.

Officials with Kentucky’s Cabinet for Health and Family Services declined to answer a detailed list of questions, including how much it will cost to make all the modifications needed.

Deloitte spokesperson Karen Walsh said the company is working with states to implement new requirements but declined to answer questions about cost estimates in several states. “We are delivering the value and investments we committed to,” Walsh said.

In most states, government agencies rely on contractors to build and run the systems that determine eligibility for Medicaid. Many of those states also use such computer systems for SNAP. But the federal government — that is, taxpayers — covers 90% of state costs to develop and implement state Medicaid eligibility systems and pays 75% of ongoing maintenance and operations expenses, according to federal regulations.

“Five, 10 years ago, I’m not sure if you would hear much mention of SNAP from a Medicaid director,” Melisa Byrd, Washington, D.C.’s Medicaid director, said in November at an annual conference of Medicaid officials. “And particularly for those with integrated eligibility systems — as D.C. is —­ I’m learning more about SNAP than I ever thought.”

The federal law was the topic du jour at last year’s gathering in Maryland, held at the Gaylord National Resort and Convention Center, the largest hotel between New Jersey and Florida.

Consulting companies had taken notice. Gainwell, an eligibility contractor and one of the conference’s corporate sponsors, emblazoned its logo on hotel escalators. Companies set up booths with materials promoting how they could help states and handed out snacks and swag.

“Conduent helps agencies work smarter by simplifying operations, cutting costs and driving better outcomes through intelligent automation, analytics, and innovation in fraud prevention,” read one such handout from another contractor. “Together, we can better serve residents at every step of their health journeys.” Conduent holds Medicaid eligibility and enrollment contracts in Mississippi and New Jersey, their Medicaid agencies confirmed to KFF Health News.

In handouts, Deloitte touted its role in “building a new era in state health care” and as “a national leader in Medicaid program and technology transformation, building a strong track record across the federal, state, and commercial health care ecosystem.” KFF Health News found that Deloitte, a global consultancy that generated $70.5 billion in revenue in fiscal 2025, dominates this slice of government business.

“With Medicaid Community Engagement (CE) requirements, states are tasked with adding a new condition of Medicaid eligibility to support state and federal objectives,” added another brochure. “Deloitte offers strategic outreach and responsive support to help states engage communities, lower barriers, and address access to coverage.”

A $20.3 million bill in Iowa

Before Trump signed the One Big Beautiful Bill Act, Iowa lawmakers wanted to impose their own version of work requirements. They would have applied to 183,000 people before any exemptions. The new law would necessitate a change to Iowa’s Medicaid eligibility system, according to documents prepared by Accenture, which operates Iowa’s system through a contract worth more than $60 million.

Adding the ability to verify work status would cost up to $7 million, an Accenture estimate from March 2025 showed. By July, the cost to implement the One Big Beautiful Bill Act’s work requirements and other Medicaid provisions skyrocketed to roughly $20.3 million. Accenture’s analysis said the federal law necessitated additional changes to Iowa’s system. Making employment a condition of Medicaid benefits could cause an estimated 32,000 Iowans to lose coverage, according to a 2025 state document.

Cutting 32,000 people from coverage could save $183 million in one year, a fraction of the $8.9 billion Iowa and the federal government spend on Medicaid in a given year.

In Cedar Rapids, most of Eastern Iowa Health Center’s patients rely on Medicaid, CEO Joe Lock said. He questioned the government’s logic of spending tens of millions of dollars on a policy to remove Iowans from Medicaid.

Most of the health center’s patients live at or below the federal poverty level — currently $33,000 for a family of four.

“There is no benefit to this population,” Lock said.

Danielle Sample, a spokesperson for Iowa’s Department of Health and Human Services, did not answer questions about how much it will cost to implement changes to the state’s separate SNAP eligibility system.

In Illinois, the state’s work this year is largely focused on meeting major provisions of the One Big Beautiful Bill Act. The state estimates that as many as 360,000 residents could lose Medicaid, largely due to the work requirements, said Melissa Kula, a spokesperson for the Illinois Department of Healthcare and Family Services.

Kula confirmed that most of the work detailed in one of Deloitte’s estimates — priced at $12 million — is related to Trump’s law. The estimate also mentions other work. Kula said Deloitte is charging the state a $2 million fixed fee related to work requirements.

The Trump administration has acknowledged that the work is coming at a cost. In January, top officials for the Centers for Medicare & Medicaid Services said government contractors, including Deloitte, Accenture, and Optum, have promised to offer discounts and reduced rates through 2028 to help states incorporate system changes.

“The companies were extremely excited to do this,” said Daniel Brillman, the top CMS Medicaid official. “Everyone’s really focused on getting to work.”

CMS spokesperson Catherine Howden declined to answer questions about the discounts.

Goodsitt, the Wisconsin Medicaid spokesperson, declined to answer questions about whether Deloitte has discounted its rates. Officials with Kentucky’s Cabinet for Health and Family Services did not answer a detailed list of questions, including whether Deloitte extended discounts to make these changes.

It’s unclear what discounts, if any, Deloitte and Accenture have offered to individual states. Walsh, the Deloitte spokesperson, declined to answer detailed questions about the discounts the Trump administration announced this year. Accenture did not respond to repeated requests for comment.

Strumolo, the Vermont health official, said state officials discussed the announcement with Optum “in detail.”

Optum pledged to offer discounts for a specific module related to Medicaid work requirements. That product is unworkable for Vermont because it would mean “moving to a new system when we don’t have to.” When asked about whether the company offered discounts, Strumolo said “not explicitly.”

In a statement, UnitedHealth Group spokesperson Tyler Mason said Optum supports state implementation of new federal requirements “with a range of options to meet their unique cost and policy needs.”

He declined to specify whether Optum discounted Vermont’s rates and how it calculated the costs of doing its work. “Optum is helping mitigate upfront implementation expenses so states can focus on approaches that reduce duplication, accelerate implementation, and manage costs over time — supporting better outcomes for individuals covered by Medicaid,” Mason said.

Strumolo said Optum’s initial changes in Vermont cover items that take effect this year and in 2027 — Medicaid work requirements, checking eligibility every six months, and prohibiting certain immigrants from qualifying for health programs.

“There’s a lot more that could come,” she said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License. 

When an Alabama clinic’s only OB-GYN left the state to provide abortion care in Colorado, the head of operations thought the facility would have to close.

But Robin Marty, executive director at WAWC Healthcare in Tuscaloosa, hired a doctor in August who she called a “unicorn” — someone who’s from Alabama and, after training outside of the state, returned home to practice medicine.

Marty said Alabama’s near-total abortion ban could cause physicians to practice elsewhere after they finish their residencies.

“Doctors don’t want to worry about surveillance, potential arrests and other legal issues,” she said.

A study published in March found that applications to medical residency programs in states with abortion restrictions have declined compared to states where abortion remained mostly legal. The findings are an “early signal” that the U.S. Supreme Court’s decision nearly four years ago overturning federal abortion rights protections may exacerbate health care shortages, said lead author Dr. Anisha Ganguly.

A majority of doctors end up practicing medicine in states where they trained. Obstetrician and gynecology training programs typically take four years to complete, so the full scope of how abortion restrictions affect where physicians work after they complete their residencies remains to be seen.

Still, experts said the findings could spell trouble for the future of the reproductive health care workforce in states with abortion restrictions, some of which are already plagued with maternity care deserts.

Doctors say bans limit training, standards of care

OB-GYNs affiliated with Physicians for Reproductive Health who either trained or work in states with abortion bans told States Newsroom that restrictions after the Supreme Court decision hamstrung their ability to offer reproductive care and affected the education of medical residents.

Dr. Neha Ali grew up in Texas and trained there, too. But by the end of her OB-GYN residency’s second year, the state enacted SB 8, a six-week abortion ban that allowed residents in the state to sue providers or anyone who helped someone terminate a pregnancy. After the Dobbs decision in June 2022, a near-total abortion ban took effect in Texas.

“I knew I wanted to be an abortion provider before I started OB-GYN residency, and I chose to be in Texas for my residency training because I wanted to experience what that’s like in a state with barriers. But ultimately, the barriers became too large,” Ali said.

After she finished residency in 2024, Ali moved to Colorado, a state with strong abortion-rights protections, where she practices complex family planning.

Ali said she talks to medical students about her experience training in Texas, where she was not able to perform any dilation and evacuations — a second-trimester abortion procedure — during residency.

“I do think it’s very valuable to see what it’s like to be in a restrictive state and understand what that is like to be a provider there, but that doesn’t sell people on a residency for four years,” she said.

OB-GYN Dr. Louis Monnig trained in Kentucky before the state banned abortion.

“Making it difficult or putting up barriers to that training just limits the abilities of any doctor who provides reproductive care to have opportunities to get exposure and experience, and just get better at what they’re doing,” he said.

Monnig completed his residency in June 2023 and moved back to his home state of Louisiana because of his connections to the region and its health care disparities. “It felt like it was worth it to come back,” he said.

In October 2024, a Louisiana law classifying mifepristone and misoprostol as controlled dangerous substances took effect.

“It made me lose faith that lawmakers were doing any of these things to actually protect patients or patient safety,” he said.

The medications are used not only for abortions, but miscarriages and other conditions, too. The law has sowed confusion among health care providers and led some to practice emergency drills to access the drugs during obstetric emergencies, Louisiana Illuminator reported. Monnig said the law has “changed some of the day-to-day operational workflow for patient care,” especially for situations where misoprostol is used, such as labor induction and postpartum hemorrhaging.

Patients have faced issues when trying to get prescriptions filled: Pharmacists have called Monnig’s office to make sure a patient wasn’t having an abortion after he prescribed misoprostol for conditions such as cervical stenosis — when it’s difficult to insert a medical instrument in the cervical canal.

Drop in applications to ban states’ residency programs

Out of more than 22 million applications to 4,315 residency programs across the U.S., 67% were submitted to programs in states without abortion restrictions between 2018 and 2023, the new research showed. Thirty-three percent went to programs in states with restrictions.

Fewer women than men applied to train in states with abortion restrictions before the Supreme Court’s landmark abortion ruling, according to the study, and that disparity widened after more than a dozen states enacted abortion bans. The number of men applying to residency programs in states with abortion restrictions — mostly in the South and the Midwest — also decreased significantly.

“When there’s a decreased level of interest in these states, it suggests to us that there’s an evolving health care workforce shortage in these states,” said Ganguly, an internal medicine physician and an assistant professor at University of North Carolina’s Division of General Medicine and Epidemiology.

Many states with abortion bans — Idaho, Iowa and Georgia, for example — are also facing labor and delivery unit closures, particularly in rural areas where hospitals struggle with provider recruitment. Health officials in these states listed improvements to maternal health as a priority in their applications to the federal Rural Health Care Transformation Program, but solutions will take years to implement.

Shortages affect more than one specialty. Ganguly said OB-GYNs have historically offered the bulk of abortion-related care in the U.S., but it’s increasingly important in emergency medicine, family medicine and internal medicine. Primary care providers and emergency medicine doctors often diagnose pregnancy complications such as miscarriages, and internists help women who have chronic disease manage and plan for pregnancy.

Dr. Hector Chapa, an OB-GYN who teaches obstetrics and gynecology at Texas A&M University and is a member of the American Association of Pro–Life Obstetricians and Gynecologists, took issue with the study’s approach.

“It’s essential to understand that this study is not specific to OB‑GYN residency programs, and by grouping OB‑GYN with family medicine, internal medicine and emergency medicine, the study assumes that all specialties are affected equally, despite their very different levels of involvement in abortion. This broad grouping risks introducing bias into the results,” he said in a statement.

Ganguly said her team did examine applications to OB-GYN residency programs in isolation to affirm findings of a decline among applicants in abortion-restricted states. Looking at other specialties, too, was meant to provide clarity about how bans affect the health care workforce more broadly.

OB-GYN education and the maternal health care workforce

The latest study adds to a body of research examining how the Supreme Court’s decision on abortion in 2022 affected training after medical school, particularly for those specializing in reproductive health care.

In the 2023-2024 application cycle, the number of applicants to training programs in states with abortion bans decreased by 4.2% compared to the previous cycle, while there was less than a 1% decrease in applications to residency programs in states where abortion is legal, according to the American Association of Medical Colleges.

In some states, abortion bans have definitively led to an exodus of OB-GYNs and maternal fetal medicine specialists. Idaho lost 35% of its doctors who provide obstetrics between August 2022 and December 2024, according to a study published in July.

Having reproductive health providers flee states with abortion bans is “devastating,” according to Pamela Merritt, the executive director of Medical Students for Choice.

“It’s a public health disaster that we’re going to see the consequences of decades to come,” she said.

Merritt’s organization has chapters at several medical schools in states with abortion bans. She said students are not getting adequate training, and some are even discouraged from discussing abortion.

In February, Texas Tech University Health Sciences Center canceled a Medical Students for Choice chapter’s talk with an OB-GYN who wrote a book about providing abortion care later in pregnancy. School officials told The Texas Tribune hosting the event on campus was not in the university’s best interests.

“Everybody who graduates from medical school in Texas should know that there’s this thing called third-trimester abortion, that when the life of the mother is at risk, you legally can provide this care,” Merritt said.

Republican Gov. Greg Abbott signed legislation last year clarifying that doctors can offer pregnant women abortions during medical emergencies. The Texas Medical Board released guidelines for the abortion law this year, nearly half a decade after the state banned most abortions and at least four Texans died after being denied prompt abortion care, ProPublica reported.

Program helps residents in restrictive states get abortion care training

“Every single physician, nurse and health care provider needs to be educated about abortion care,” said Dr. Jody Steinauer, an OB-GYN and the director of the Bixby Center for Global Reproductive Health at the University of California in San Francisco. “This is a huge crisis in OB-GYN specifically: All OB-GYNs must have the competence and the skill to safely empty the uterus. Even if the individual is personally uncomfortable providing abortion care, they have to be able to empty the uterus to save someone’s life in an emergency.”

Steinauer leads the Ryan Residency Training Program, which works with OB-GYN residencies across the country to ensure comprehensive abortion and family planning rotations. Nearly a dozen states lack Ryan programs, and most of them have near-total abortion bans.

She said residencies in states with abortion bans are struggling to make sure their students have the skills to provide abortion: “We’re at risk of having a whole generation of OB-GYN graduates who are not skilled to provide the care they need to provide.”

To remedy this issue, the Ryan Program has helped to establish 20 partnerships with schools in abortion-restrictive states to train OB-GYN medical residents in states with reproductive rights protections.

Steinauer said the rotations are between two to four weeks and complicated to plan, but they help doctors learn procedural skills, how to manage medication abortions and counseling.

The rotations also help OB-GYNs navigate pain management during obstetric procedures, communicate effectively with abortion patients and familiarize themselves with ultrasounds, she said. These skills are important for providing the full spectrum of reproductive health care, from inserting IUDs to treating miscarriages, the doctor said.

“It’s such a refreshing experience for them to be working in a state without a ban, and they get to see abortion as normal health care,” she said.

Stateline reporter Elisha Brown can be reached at ebrown@stateline.org.

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For many families across the Midwest, discussing end-of-life planning is about as comfortable as a January blizzard on Highway 175. However, proactive planning is a final act of care that prevents legal headaches and ensures a legacy stays within the family. In Wisconsin, specific statutes — ranging from marital property laws to unique transfer-on-death rules — make it essential to use the right tools. Whether you are a young parent or assisting aging parents, these are the legal and financial cornerstones for a solid plan.

Write a will and consider a living trust

A last will and testament is the traditional bedrock of any plan. In Wisconsin, a will allows you to name an executor (the person who will manage your estate) and a guardian for minor children. Without a will, a state judge — not your family — decides who raises your kids and how your assets are split.

For many Wisconsin families, a revocable living trust is a powerful alternative or supplement.

Benefit: Unlike a will, which must go through the public, often costly probate court process, a trust allows assets to pass privately and immediately to heirs.

Midwest reality: If you own property in multiple states (like a cabin in Michigan’s Upper Peninsula or a farm in Iowa), a trust can prevent your family from having to open probate cases in every state where you own land.

Assign power of attorney: health care and finances

Control is often lost not at death, but during a period of incapacity. Wisconsin law recognizes two distinct roles:

• Financial power of attorney: This grants a “trusted agent” the authority to pay your mortgage, manage your taxes and handle your bank accounts. Under Wisconsin Chapter 244, these are “durable” by default, meaning they remain valid even if you lose mental capacity.
• Health care power of attorney: This allows someone to make medical decisions if you cannot. In Wisconsin, your spouse is not automatically authorized to make all medical decisions for you without this document. It requires two witnesses who are not related to you or responsible for your health care costs.

Create an advance directive (living will)

While a health care power of attorney names who makes decisions, an advance directive (often called a “declaration to physicians” in Wisconsin) tells them what those decisions should be. This document outlines your wishes regarding life-sustaining treatments, such as ventilators or feeding tubes, specifically if you are in a terminal condition or a persistent vegetative state.

For Wisconsin residents, the Department of Health Services provides standard forms that are legally recognized across all state health systems.

Name beneficiaries for accounts and insurance

One of the most common mistakes is assuming a will covers everything. In reality, beneficiary designations on life insurance policies, 401(k)s and IRAs “trump” what is written in a will. If your will says your estate goes to your children, but your 20-year-old life insurance policy still lists an ex-spouse, that money will likely go to the ex-spouse.

To keep things simple, many Wisconsin banks offer payable-on-death (POD) options for checking and savings accounts, which keeps that cash out of the probate court’s hands.

Transfer-on-death deeds

Wisconsin is one of the states that allow a transfer-on-death (TOD) deed for real estate. This is a game changer for the “family home.”

How it works: You file a TOD deed with your local register of deeds (such as the one in Juneau for Dodge County). It names who inherits your home, but it has no effect while you are alive. You can still sell the house or change your mind at any time.

The catch: Because Wisconsin is a marital property state, if you are married, your spouse generally must sign the TOD deed even if the spouse’s name isn’t on the original title.

Note: For small estates, Wisconsin offers a “transfer by affidavit” process for estates valued under $50,000. This allows heirs to collect assets without a full court proceeding, provided they follow strict notification rules for the state’s Medicaid Estate Recovery Program.

This story is published in collaboration with Multi-Media Channels. It originally appeared in Multi-Media Channels’ print “Dignity in Care” publication.

Don’t leave a mess: What Wisconsin families should know about wills, trusts and end-of-life planning is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

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Hi, Wisconsin! Health reporter Addie Costello here. 

I spent last Saturday with around 80 attendees of a senior breakfast in Merrill, and it was one of my best-spent weekends so far in 2026. 

Northwoods residents packed a banquet hall to eat, talk with neighbors and list the biggest issues they face as older adults. 

The Senior Empowerment Project, an organizing group focused on issues impacting older people in rural areas and small towns, organized the event and asked me to give a short presentation about my reporting on long-term care issues. The most exciting part? Once I finished talking, a microphone was passed from table to table as older adults shared the questions and issues they think about the most. 

Where can they get transportation on the weekends? How can older adults afford to stay in their homes as property taxes increase? Where can they get nutritious food? 

I left the event with a long list of questions I plan to answer in a new project. We’re calling it Q&Aging, a series of short stories where I interview experts to answer your questions about getting older in Wisconsin — whether about health care, housing or what comes next.

If you’re a diligent reader of Wisconsin Watch newsletters, you may remember us asking people last year to share their experiences with hospice. Or last month, when I asked for questions about long-term care. 

We’re now getting back to you with answers. Here’s a look at our first installments of Q&Aging: 

Can you tour long-term care facilities without an appointment? 

A reader’s email inspired this story. The short answer is yes. Read on for more specific tips from experts.  

What to know about hospice and palliative care in Wisconsin

I reported this as part of our collaboration with several Multi-Media Channels, which cover swaths of northeast and central Wisconsin. Find the full Dignity in Care project here.

Don’t leave a mess: What Wisconsin families should know about wills, trusts and end-of-life planning

Here, Multi-Media Channels Editor Taylor Hale reports on the important paperwork we all need to stop avoiding — for the benefit of our loved ones.

If you have a question or a suggestion for the series, fill out this form or contact me directly at acostello@wisconsinwatch.org or 608-616-5239.

Q&Aging tackles your questions about aging in Wisconsin is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

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Choosing a long-term care provider is an important, expensive decision. Like test-driving a car, unannounced visits can provide helpful insight. 

So what should someone do before a “walk-in” visit?

Wisconsin Watch asked two experts to weigh in:

• Devon Christianson, director of the Aging and Disability Resource Center of Brown County. 
• Mike Pochowski, president and CEO of the Wisconsin Assisted Living Association. 

Here’s what they recommend: 

Start with a scheduled tour. The person giving tours likely has important information about a facility’s care and costs. The state health department provides a guide for comparing assisted living providers, and the federal government has a similar guide for nursing homes. ADRCs can also help people prepare for tours. 

Ask about “walk-in” visits. Facility staff might list certain times that are not ideal or explain security concerns, especially in a facility that offers memory care. But if the answer is an absolute no, that is something to consider when comparing providers.

Be transparent. The goal of drop-in visits is not to catch a provider doing something bad. Prospective residents or their family members should tell staff who they are and go through the normal guest registration process. 

Be respectful. Nursing and assisted living facilities are people’s homes. Visit at a reasonable time and stay in common areas. 

Ask residents and their families if they would be open to talking, Christianson said. Don’t base your decision around one resident’s experience. Use these conversations as a tool to help inform your decision. 

This article was inspired by a reader sharing an experience touring facilities for a loved one. Do you have something to share? Please reach out.

Can you tour long-term care facilities without an appointment? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

A coalition of 22 states told a federal court that the Trump administration appears to have violated a court order that limited the types of health data that could be shared with U.S. Immigration and Customs Enforcement for deportation proceedings.

Back in December, a court allowed ICE to pull some basic information from Medicaid, the state-federal health insurance program that primarily covers people with low incomes, to help the agency find people who are in the country illegally.

That ruling was a partial win for the administration in a lawsuit in which the 22 states and the District of Columbia had sued to block information sharing between ICE and Medicaid.

But the court also placed restrictions on ICE, saying it could only pull basic data such as addresses, phone numbers, birth dates and citizenship or immigration status. And the ruling barred ICE from collecting information on lawful permanent residents or citizens.

Advocates warned that even the sharing of that partial information would prompt immigrants, including those in the country legally, to forgo health coverage for fear that enrolling in Medicaid could make them or their family members easier for ICE to find.

Now, in a new filing, the states say the Trump administration appears to have ignored the court’s order limiting what information ICE is allowed to have. They claim the U.S. Department of Health and Human Services, which oversees Medicaid, has admitted to sharing with ICE “a large and complex” set of data on Medicaid recipients, even though the court said the data of citizens and lawful permanent residents is off limits.

The states claim the federal government hasn’t clarified how it determines who is “lawfully present,” nor has it confirmed whether it’s filtering out protected individuals from the data it gives to ICE.

The states are asking the court to formally bar the sharing of protected health care information for people lawfully residing in the United States. They’re also asking the court to confirm that “lawfully residing” includes noncitizens who have legal status, such as refugees and asylees. And they want the court to allow the states to examine the data that’s been shared with ICE so far, and how it has been used.

The Trump administration has not yet responded. The plaintiff states are scheduled to appear in a San Francisco federal court on April 30 for a hearing.

The states involved in the suit are those with Democratic attorneys general: Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, Wisconsin.

The court’s orders preventing Medicaid data sharing won’t apply to states not involved in the lawsuit.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

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People cannot avoid death, but they often avoid talking about it. That’s why many people don’t receive as much — or any — hospice care they qualify for, experts say. 

“There’s a real taboo in society that hospice equals death,” said Alisa Gerke, the board chair of Wisconsin Hospice and Palliative Care Collaborative and executive director at Unity Hospice and Palliative Care, a nonprofit provider that serves 14 northeast Wisconsin counties.

The goal of hospice isn’t to speed up the dying process; it’s to make people more comfortable — treating the symptoms of an illness instead of trying to cure it. 

Once families enroll in hospice, Gerke said, they often ask: “How come nobody told us about this sooner?”

When to talk about hospice

Don’t wait for your provider to bring up hospice.

Patients and providers often wait for the other person to bring hospice up, said Angela Novas, an advanced certified hospice and palliative care nurse and consultant at the nonprofit Hospice Foundation of America. Let providers know that’s something you might be interested in. 

Patients or their loved ones can also reach out to hospice providers directly and ask for an eligibility assessment, Novas said.

The basic requirements for adults to receive hospice care under Medicare include:

• Verification from two physicians that a patient has a life expectancy of six months or less. 
• A patient’s willingness to pursue treatments to provide comfort instead of treatments aimed at extending life expectancy. 

Clearing up misunderstandings about hospice

Some people may have misperceptions about hospice. Here is what it is not: 

• A place. Instead, it’s a model of care, Gerke said. While some providers may run facilities, hospice care can be provided at home and in nursing homes, assisted living facilities, hospitals and other settings.
• Constant nursing care. Hospice is meant to supplement care from family or facility caregivers, Novas said. But providers should be readily accessible for questions and concerns.
• Stopped if someone lives longer than six months. Instead, providers work to re-certify that someone is still likely to die within the next six months, Gerke said. Patients are no longer eligible for hospice if their life expectancy unexpectedly improves.
• Permanent. Patients can decide to stop hospice and try curative treatment. If their outlook doesn’t improve, they can return to hospice, Gerke said. They can also freely switch providers.

So what’s palliative care?

Palliative care is a philosophy and medical speciality focused on alleviating suffering, according to Dr. Sara Johnson, a palliative care physician and University of Wisconsin School of Medicine and Public Health professor.

Hospice is a form of palliative care for people at the end of life. But people with a serious illness can access palliative care earlier in their diagnosis and while receiving curative treatments.

Palliative care services are becoming more accessible, Johnson said. 

Palliative care specialists add a layer of support for patients and their families, Johnson said.

There is no harm in asking a provider about palliative care options, Johnson said. “If you’re thinking about it, just ask.”

How to find the right provider

Ask local providers for hospice care recommendations, Novas said. But don’t be afraid to shop around. Experts recommend asking these questions before choosing a provider:

1. How long have you served this area, and where are your staff located? 
   
   “Having staff that know that community, live in that community, are a part of that community is huge,” Gerke said.
   
   
2. What is your response time?
   
   A patient’s condition can quickly change, making it important to know how quickly staff will answer calls or arrive in those cases.
   
   
3. What is your relationship with nearby providers?
   
   If you know you want to use a particular nursing home, hospital or physician, it helps to know whether hospice providers have relationships and contracts with them.

4. What grief support do you offer?
   
   Medicare requires hospice companies to provide families with bereavement services. But the level of those services can range widely.
   
   
5. What is your Medicare rating?
   
   Medicare.gov offers a hospice look-up tool with quality care ratings. The federal agency provides comparative ratings based on family surveys and metrics like nursing visits in patients’ last days before death.

6. Are you for-profit or nonprofit?
   
   Private equity and publicly traded companies are increasingly taking hold of the hospice industry. Those providers have been associated with lower quality of care, according to a Cornell University study.
   
   For-profits face expectations around financial performance and typically have obligations to shareholders, Gerke said.
   
   But a nonprofit status does not guarantee better care, Novas said. People should prioritize whether a provider fits their specific needs.

7. What services do your volunteers provide?
   
   Medicare requires hospice providers to have a volunteer program. Do volunteers play games with patients? Provide pet therapy? Read to people? Some volunteer programs are more robust than others, Novas said.

8. What medications do you not cover?
   
   Not all medications and supplies are covered under the Medicare hospice benefit, Novas said. It’s important to know what you might have to pay for out-of-pocket or with other health coverage.

More resources on what to ask providers and know about hospice can be found through the Hospice Foundation of America’s website.

What to know about hospice and palliative care in Wisconsin is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Connection, compassion and hope — those are the three key elements members of the Milwaukee Overdose Response Initiative (MORI) say helped lower overdose deaths to levels unseen in Milwaukee County since 2016. “It’s MORI in conjunction with this whole community,” Jonathan Belott, a lieutenant with the Milwaukee Fire Department, told the Wisconsin Examiner. 

“We don’t live in a silo,” said Belott, who’s led the overdose response initiative since its inception in 2019. “We have so many of our different partners that we have come to rely on to get people the help that they need throughout this community.” 

Last year there were 383 fatal overdoses in Milwaukee, the lowest number in a decade, according to the county’s overdose dashboard. That marked a significant reversal of the recent overdose epidemic that peaked in 2022, with 674 fatal overdoses in Milwaukee, fueled by widespread contamination of cocaine, heroin, prescription pills, and other substances with the powerful synthetic opioid fentanyl.

As the crisis accelerated in 2019, Belott was assigned to head a new strategy. “I didn’t even know what I was getting into in that moment,” he told the Examiner, sitting beside fellow firefighter and team supervisor Robert Rehberger and peer support specialist Amy Molinski — both members of the overdose response initiative — at the team’s homebase fire station on Fiebrantz Avenue. 

“I didn’t understand even the full impact of what it was,” said Belott. “I was kind of just told, ‘Hey, you’re going to be this guy.’ But the more you get into it, the more you see how it has been impacting people’s lives over these years…We watched those numbers go up and up…Just a crazy amount of people.”  

Between 2017 and 2025, 4,582 people died across Milwaukee County. Nationwide, overdose deaths became more common than those caused by homicide, car accidents or suicide. The people who died were brothers and sisters, fathers and mothers. Some were children younger than 5, others were elders in their 70s. Most were people between 20 and 60 years old. They were unhoused, working class and wealthy people from numerous ethnic and racial backgrounds. Even in Milwaukee — one of America’s most segregated cities — addiction and death have never discriminated.

Every year seemed worse than the last as record-breaking numbers of Milwaukeeans died. “And then we saw just a little decline,” said Belott. Overdose deaths fell by more than 30% in 2024, followed by a sharp drop in 2025. “You’re talking 50% less people dying over the course of the three years,” Rehberger said of the most recent numbers.  

“I’ll say it’s bittersweet,” said Molinski. “And I’ll say that because the number of deaths that we have are still too many. It’s unfortunate that it had to get as high as it did before people were willing to do anything about it.”

Milwaukee’s sharp decrease in overdose deaths mirrors a nationwide trend, tied to stepped-up treatment and harm reduction efforts as well as a shrinking fentanyl supply.

Building a program from scratch

Belott credited Michael Murphy, who served on the common council, with helping steer the first $100,000 to the fire department to start an overdose reduction program. “To his credit, he recognized that we had to do something different than what we were doing,” Belott told the Examiner. 

Although it was just enough money to get a program off the ground, there were questions about what such a program would actually look like. “We had to make the program from absolutely nothing,” said Belott. “Like this didn’t exist anywhere that we knew. …We didn’t base it off anything.” The team itself started off very small. “It was like three hours a day for Monday through Friday,” said Rehberger. “And now we got four teams going out every day doing this work. And it’s just proud to see like,  something come from it.”

The Milwaukee Overdose Response Initiative started by using the fire department’s access to 911 call data to identify people who had survived an overdose within the last 24-48 hours. From there, team members would go out to find those people, and see whether there was any help they could provide. “Help” doesn’t have to mean pressuring someone to go into rehab — although the Milwaukee overdose team also regularly works to get people into treatment programs. With time, the team realized that “help” can also mean getting someone clothes, food, providing them with narcan and other harm reduction supplies, and offering compassionate and non-judgmental support.

Molinski recalled one girl who called the overdose response team because she needed a ride to her psych appointment. “It’s cold, she didn’t want to walk,” Molinski recalled. “So we picked her up and we took her there. We stopped at the food pantry along the way so that she could get some food.”

“Help” can also mean checking in on family members who recently lost a loved one to the overdose crisis, and ensuring they have access to the resources they’ll need to process their loss. Belott said that acts like these are about providing “basic humanity for the people that we work with.” Molinski echoed the sentiment. “It’s helping to eliminate some of the struggle,” she told the Examiner. “We all want to quit when it’s hard.”

The Milwaukee overdose team also had to focus on how it would grow to meet those needs. Like Belott, Rehberger didn’t know what to expect when he joined the team. “I volunteered but I didn’t really know exactly what I was volunteering for at the time,” he told the Examiner. When the team decided to add addiction peer support specialists, Molinski, who is employed by Community Medical Services, a medication-assisted treatment clinic, was brought on. The team’s vehicles, modestly marked with the fire department’s logo and “community paramedics” on the trunk, usually carry two firefighters and one peer supporter.

Working on the overdose response team, Molinski grew to understand just how much people respected the Milwaukee Fire Department. “These guys [firefighters] got rolled into it, and I don’t think that there’s any way that you can’t say that that helped impact the success that we see today,” Molinski, who got into the peer support field after enduring her own battles with addiction, said. When overdose survivors “get greeted by someone in a uniform that doesn’t judge them, tries to take the shame out of what they’re doing and say ‘your life is worth saving, like not just on the street last night but moving forward,’ that means a lot,” she said.

As the overdose response effort evolved, so did team members’ understanding of the epidemic, themselves, and each other. “There was a lot of humility in the beginning,” said Molinski. “There was a lot of us having to look at one another and sometimes kindly, sometimes very directly, [saying] like, ‘Hey, what you just did wasn’t right.’” 

Molinski admitted that “I’m a little rough around the edges” and “I’ve kind of always done things my own way.” She grew to appreciate what representing the fire department meant. “So you can be you, just tone down just a little bit,” she said. “And I needed to hear that. …We learned from one another.” The firefighters learned how to loosen up and Molinski learned how to tighten up, she said, “and we were kind of able to share that with everybody as they came.” 

A conversation, not an interrogation

Firefighters who joined the team also often had to rethink how they approach people struggling with addiction. As emergency responders, Belott and Rehberger were trained to stabilize people, patch them up, and transport them to a hospital in the middle of a crisis. In order to succeed, however, the overdose response effort demanded a completely different modus operandi.

“For us, we’re not there in the crisis moment,” Belott explained. “We’re there following the crisis moment. So we have time…we sit down and we have a conversation, not an interrogation, which is what I used to do at the beginning.” 

“If you have a conversation with somebody, you learn about them…Because a conversation flows,” Molinski said. Rehberger called it “asking a question in a different way, and listening.”

This allowed team members, especially those with no personal experience with addiction, to see a whole new side of the epidemic and what it meant for people fighting to stay alive. The conversations they had affected them deeply, allowing them to experience the gratitude the people they tried to help felt  for anyone willing to treat them with dignity. “Before I came here, one of the things that I wasn’t expecting was how much relationship you grow with the people that we’re meeting,” said Rehberger. “I feel like I was just thinking that it was going to be mostly like a 911 call, you know? Like you’re helping the person in that moment.” Rehberger wasn’t used to people being so grateful on calls that they gave him giant hugs. “Never did I think that I was going to be hugging someone while on the fire department. Ever.” 

Molinski recalled her first month with the overdose response team. “It was in the middle of the summer, it was hot, they didn’t have air conditioning,” Molinski recounted. “He was wearing no shirt, he was smoking cigarettes in his apartment, and it was a lot. And as we left, I hugged him goodbye.” Belott was taken aback, quipping that Molinski was “all in.” The peer support specialist explained that it may have been a very long time since that man had felt “a caring human touch.” 

What winning looks like

Even for Molinski, who’d experienced her own addiction to heroin and other drugs, the conditions people survived day-to-day were startling. “Our stories of addiction while we were in active addiction are insane,” Molinski told the Examiner. People living with an active addiction may or may not have stable housing, regular access to food, hygiene products, transportation, work, or even trustworthy people. Sometimes, the overdose response team would find people only to lose track of them again for over a year.

“They probably lost three phones in those 18 months,” said Molinski. Yet, out of the blue, the same person who couldn’t hold onto a phone might call the overdose response team for help because they had managed to keep a team member’s business card. “I mean, think about that for a second,” said Molinski, “how hard it is to keep track of your property when you’re in active addiction, but somehow a business card was still there to call.” 

Other times, team members learned firsthand just how hard it is for people to stop using drugs. “People are trying,” said Molinski. “… not everybody is just choosing to stay in their addiction. Some of them don’t see a way out. They’ve tried and they can’t get out. And when you see that, it’s easier to treat people with a little bit more compassion. Give somebody a little bit of grace as to why they’re still in that situation.”

Rehberger remembered checking on a woman, who contacted the team saying that she didn’t have any clothes. “I didn’t know what that meant, honestly,” said Rehberger. When team members met the woman they realized that she literally didn’t have clothes to wear. So they got her clothes, then food, and then they returned to see if she’d go into treatment. When they did, the woman told them, “Honestly, I would never have gone in for treatment the next day had you not gotten me the food first,” Rehberger recounted. 

Belott said that simply getting through the door to have a conversation was a success. “If they’re willing to sit down and talk with some strangers in uniform, that’s an amazing thing,” he said. “And we show up and they know, OK, somebody’s following up, somebody gives a crap about me.” 

Team members have dropped off birthday cupcakes to people living in homeless encampments, and celebrated “clean days,” marking milestones for people who’ve quit drugs. Molinski recalled one unhoused man the team had been trying to locate for a long time. After connecting with his grandparents, the team was able to arrange for him to get into detox before going off to a residential facility. It turned out the man was living near an alley. He conveyed to the team that he didn’t want members to park too close to the site.  So they stood near a pizza sign, yelled his name, and he came out accompanied by a friend. “My buddy needs help, too,” he said. 

The overdose response team’s efforts were the subject of intense debate in the community. Team members often found themselves fighting the stigma and shame attached to addiction. Some people were confused about why the team tried so hard, even questioning whether the city would be better off just letting people die. With patience and much labor, however, some people’s minds changed. Belott wondered, “How many 10-minute conversations have we had over the years? And how many minds [were] changed by doing that?” 

Success can be measured in concrete results like the lower number of fatal overdoses. But not every achievement can be recorded on a spreadsheet, and not every good deed results in a life saved.

About eight months into the program, team members were working with a young woman they had come to know well.  “We actually got told that we weren’t allowed to see her anymore,” said Molinski. “We were too invested…She saw us a lot. She was not in good shape. This girl was struggling. And we just kept going to see her. And we didn’t know how we were going to help her, if we could help her. We had no idea what to do.” First they tried reaching her parents, who were exhausted by their daughter’s  addiction. The mother hadn’t seen her in over 200 days, and the father didn’t want her back home because she was prone to stealing. 

Team members eventually found out that she was sustaining herself as a sex worker on Milwaukee’s North Side. Besides her addiction, she also suffered from the condition endocarditis which causes inflammation of the heart. Team members accompanied her to the hospital so that she could get a Peripherally Inserted Central Catheter (PICC) line, a procedure which frightened her.

Then one day the team got a call from a man she was staying with, saying that she was lying in the bathroom and couldn’t get up. She was rushed to the emergency room. She asked team members to bring some of her favorite treats, a Sprite and Reese’s Peanut Butter Cups, when they visited. 

It was her thirtieth birthday when the team visited the hospital and brought her a blanket and a book to read. “She was completely unconscious, unable to speak in any way,” said Molinski. “And then the day after that, her family called [Belott] and I and said, ‘We’ve made the decision to take her off of life support. And we would like to invite you guys to come and say goodbye if you would like.’” 

Molinski said that she and Belott “were too invested…We were all f-ing in…And we went, and we cried over her bed, and we said goodbye to her, and her family took her off life support, and that sucked.” Yet, Molinski also had texts that the young lady sent her saying that she loved them, and that knowing them was the first time in years that she felt that anyone cared about her. “And she died,” Molinski said, shedding tears, “but she died feeling loved.” Her parents saw that love, too. “I don’t care what anybody says…The numbers say that was a fail,” said Molinski. “They weren’t there. It wasn’t a fail. …We made that girl feel like she was worth something before she left the world. We met her too late, we couldn’t help her. But she felt loved when she left.”

Despite the loss, the team knew that they’d done something good that day. “I think about her all the time,” said Molinski. Belott, the team leader who was sitting near her and Rehberger, wiped tears from his eyes. 

“I still have a list of the books that she wanted me to bring her when she was in the hospital. I can’t delete it off my phone,” said Molinski. “She made an impact on me. And we were told to stop. And we didn’t stop.” 

What Milwaukee needs to keep overdose deaths down

Since the Milwaukee Overdose Response Initiative began its work in 2019, Milwaukee County has made great strides against the overdose and addiction epidemics. Narcan — the crucial spray-medication used to revive an overdose victim — can be found in bars, grocery stores, hospitals, restaurants, and free-to-use vending machines. Not only is Narcan carried by firefighters and other emergency responders, but ordinary people can be trained to use it. “Keep that Narcan flowing out there,” Belott stressed. 

Several Milwaukee County communities have adopted their own kinds of overdose response teams. The West Allis fire department, which recently integrated with Wauwatosa’s, has launched one such effort. The state of Wisconsin also legalized testing strips both for fentanyl and xylazine — a potent tranquilizer — allowing people to check drugs for dangerous substances before using them. New treatment centers have opened in parts of the county. Even within local jails, people are able to access medication-assisted treatment and take the first steps towards recovery.

Many of those resources are also distributed by the Milwaukee Overdose Response Initiative  for free in the form of “Hope Kits.” Similar to a small plastic purse, with the word “Hope” printed on it in bright red lettering, the kits are stocked with Narcan, testing strips and contact information for treatment centers, therapy, and groups like Narcotics Anonymous and Alcoholics Anonymous. All frontline firefighters are deployed with Hope Kits.

The Milwaukee overdose response team’s work is funded by opioid settlement funds, paid out by the pharmaceutical companies that helped spark the opioid epidemic. With those funds, and additional grants, the team is able to keep the lights on and grow its coterie of firefighters, peer support specialists, vehicles, and harm reduction resources. “We’re proud of MORI,” Belott told the Examiner. 

Treatment is still in short supply. Often, the team is forced to look for residential treatment beds outside of Milwaukee County. Sometimes that’s a good idea for people who need to sever their old connections. But for those facing transportation challenges, it can be difficult. Molinski, Belott and Rehberger also said no residential treatment centers in Milwaukee have proper accommodations for people with disabilities.

“There is none. Zero,” said Molinski. “Not a single place where someone can get help in a wheelchair. Or somebody that simply hurt themselves while using and is on crutches, they also can’t go.” 

Ultimately, the greatest resource the overdose response team can provide is hope. Regardless of what they’ve done, or experienced, people’s lives are worth saving, team members said. In Molinski’s case, it was disconnection and feeling empty that led her into drug use, and it was connection and hope that pulled her out of it.  

“My life was worth saving,” said Molinski. “It would’ve been really hard to convince someone of that back in 2006, 2007…That would’ve been a tough sell. My parents were starting to wonder if it was worth it for them to keep fighting. But it was worth it!” Today, she is raising a teenage daughter, and works in a field where she can help people who struggle like she did. But to get there, Molinski had to keep trying. “I never dreamt that this was waiting for me,” she said.

This article has been edited to reflect that Ald. Michael Murphy helped steer funds to get the overdose team started, not Ashanti Hamilton.

All 41 states that expanded Medicaid eligibility under the Affordable Care Act will see fewer people covered due to new federal work requirements and more frequent eligibility checks. But the percentage of recipients who lose coverage will vary greatly from state to state, depending on how state officials implement the new rules, according to a new report.

The report, released this week by the Urban Institute with support from the Robert Wood Johnson Foundation, projects that in 2028, between 4.9 million and 10.1 million people will lose coverage as a result of the federal policy changes included in the broad tax and spending measure President Donald Trump signed last summer. That prediction is roughly in line with estimates by the Congressional Budget Office, which projected last fall that the changes would increase the number of people without health insurance by 7.5 million in 2034.

Whether the actual number ends up at the low end or the high end of that estimate will depend on state policy, according to the researchers. States that automatically check eligibility using data-matching, impose the minimum work requirements allowed under federal law and broadly define certain exemptions, such as those for “medical frailty,” will minimize the number of people who lose coverage.

On the other end of the spectrum, states that require stricter documentation of work hours and implement narrower exemptions will see more people dropped from the rolls.

With stricter state policies, the report projected that eight states — Connecticut, Massachusetts, Maryland, Minnesota, Missouri, New York, Vermont and Wisconsin — would see a decline in enrollment of 60% or more. (Wisconsin hasn’t expanded Medicaid under the ACA, but it was included in the study because it received a federal waiver that makes some of its Medicaid enrollees subject to work requirements.)

Arkansas, Idaho, Montana, North Dakota, Nebraska, New Mexico, Oklahoma and Oregon would have the smallest declines under strict policies, but would still see losses ranging from 37% to 46%.

With the least stringent policies, North Dakota and South Dakota would have the smallest declines — 18% and 19%, respectively. Even under lax rules, six states — Connecticut, Massachusetts, Maryland, New York, Virginia, Vermont —- would see declines of 30% or more.

Nationwide, between 19% and 37% of people who already work will lose Medicaid coverage, according to the analysis, due to challenges such as fulfilling the documentation requirements to prove that they work.

States have to enforce work requirements by next January. They may enforce them earlier via a waiver or state plan amendment, but so far only one state, Nebraska, has announced a plan to implement the requirements earlier, in May.

Some groups are exempt from the work requirements, including American Indian and Alaska Natives, people deemed “medically frail,” households receiving benefits through the Supplemental Nutrition Assistance Program, caretakers for children under age 13 or for those with disabilities, foster care youth and former foster care youth under age 26, among others.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

When an Alabama clinic’s only OB-GYN left the state to provide abortion care in Colorado, the head of operations thought the facility would have to close. 

But Robin Marty, executive director at WAWC Healthcare in Tuscaloosa, hired a doctor in August who she called a “unicorn” — someone who’s from Alabama and, after training outside of the state, returned home to practice medicine. 

Marty said Alabama’s near-total abortion ban could cause physicians to practice elsewhere after they finish their residencies. 

“Doctors don’t want to worry about surveillance, potential arrests and other legal issues,” she said. 

A study published this month found that applications to medical residency programs in states with abortion restrictions have declined compared to states where abortion remained mostly legal. The findings are an “early signal” that the U.S. Supreme Court’s decision nearly four years ago overturning federal abortion rights protections may exacerbate health care shortages, said lead author Dr. Anisha Ganguly.

A majority of doctors end up practicing medicine in states where they trained. Obstetrician and gynecology training programs typically take four years to complete, so the full scope of how abortion restrictions affect where physicians work after they complete their residencies remains to be seen. 

Still, experts said the findings could spell trouble for the future of the reproductive health care workforce in states with abortion restrictions, some of which are already plagued with maternity care deserts. 

Doctors say bans limit training, standards of care

OB-GYNs affiliated with Physicians for Reproductive Health who either trained or work in states with abortion bans told States Newsroom that restrictions after the Supreme Court decision hamstrung their ability to offer reproductive care and affected the education of medical residents. 

Dr. Neha Ali grew up in Texas and trained there, too. But by the end of her OB-GYN residency’s second year, the state enacted SB 8, a six-week abortion ban that allowed residents in the state to sue providers or anyone who helped someone terminate a pregnancy. After the Dobbs decision in June 2022, a near-total abortion ban took effect in Texas.

“I knew I wanted to be an abortion provider before I started OB-GYN residency, and I chose to be in Texas for my residency training because I wanted to experience what that’s like in a state with barriers. But ultimately, the barriers became too large,” Ali said. 

After she finished residency in 2024, Ali moved to Colorado, a state with strong abortion-rights protections, where she practices complex family planning.

Ali said she talks to medical students about her experience training in Texas, where she was not able to perform any dilation and evacuations — a second-trimester abortion procedure — during residency. 

“I do think it’s very valuable to see what it’s like to be in a restrictive state and understand what that is like to be a provider there, but that doesn’t sell people on a residency for four years,” she said.

OB-GYN Dr. Louis Monnig trained in Kentucky before the state banned abortion. 

“Making it difficult or putting up barriers to that training just limits the abilities of any doctor who provides reproductive care to have opportunities to get exposure and experience, and just get better at what they’re doing,” he said. 

Monnig completed his residency in June 2023 and moved back to his home state of Louisiana because of his connections to the region and its health care disparities. “It felt like it was worth it to come back,” he said. 

In October 2024, a Louisiana law classifying mifepristone and misoprostol as controlled dangerous substances took effect. 

“It made me lose faith that lawmakers were doing any of these things to actually protect patients or patient safety,” he said. 

The medications are used not only for abortions, but miscarriages and other conditions, too. The law has sowed confusion among health care providers and led some to practice emergency drills to access the drugs during obstetric emergencies, Louisiana Illuminator reported. Monnig said the law has “changed some of the day-to-day operational workflow for patient care,” especially for situations where misoprostol is used, such as labor induction and postpartum hemorrhaging. 

Patients have faced issues when trying to get prescriptions filled: Pharmacists have called Monnig’s office to make sure a patient wasn’t having an abortion after he prescribed misoprostol for conditions such as cervical stenosis — when it’s difficult to insert a medical instrument in the cervical canal.

Drop in applications to ban states’ residency programs

Out of more than 22 million applications to 4,315 residency programs across the U.S., 67% were submitted to programs in states without abortion restrictions between 2018 and 2023, the new research showed. Thirty-three percent went to programs in states with restrictions. 

Fewer women than men applied to train in states with abortion restrictions before the Supreme Court’s landmark abortion ruling, according to the study, and that disparity widened after more than a dozen states enacted abortion bans. The number of men applying to residency programs in states with abortion restrictions — mostly in the South and the Midwest — also decreased significantly. 

“When there’s a decreased level of interest in these states, it suggests to us that there’s an evolving health care workforce shortage in these states,” said Ganguly, an internal medicine physician and an assistant professor at University of North Carolina’s Division of General Medicine and Epidemiology. 

Many states with abortion bans — Idaho, Iowa and Georgia, for example — are also facing labor and delivery unit closures, particularly in rural areas where hospitals struggle with provider recruitment. Health officials in these states listed improvements to maternal health as a priority in their applications to the federal Rural Health Care Transformation Program, but solutions will take years to implement. 

Shortages affect more than one specialty. Ganguly said OB-GYNs have historically offered the bulk of abortion-related care in the U.S., but it’s increasingly important in emergency medicine, family medicine and internal medicine. Primary care providers and emergency medicine doctors often diagnose pregnancy complications such as miscarriages, and internists help women who have chronic disease manage and plan for pregnancy. 

Dr. Hector Chapa, an OB-GYN who teaches obstetrics and gynecology at Texas A&M University and is a member of the American Association of Pro–Life Obstetricians and Gynecologists, took issue with the study’s approach. 

“It’s essential to understand that this study is not specific to OB‑GYN residency programs, and by grouping OB‑GYN with family medicine, internal medicine and emergency medicine, the study assumes that all specialties are affected equally, despite their very different levels of involvement in abortion. This broad grouping risks introducing bias into the results,” he said in a statement. 

Ganguly said her team did examine applications to OB-GYN residency programs in isolation to affirm findings of a decline among applicants in abortion-restricted states. Looking at other specialties, too, was meant to provide clarity about how bans affect the health care workforce more broadly.

OB-GYN education and the maternal health care workforce 

The latest study adds to a body of research examining how the Supreme Court’s decision on abortion in 2022 affected training after medical school, particularly for those specializing in reproductive health care. 

In the 2023-2024 application cycle, the number of applicants to training programs in states with abortion bans decreased by 4.2% compared to the previous cycle, while there was less than a 1% decrease in applications to residency programs in states where abortion is legal, according to the American Association of Medical Colleges. 

In some states, abortion bans have definitively led to an exodus of OB-GYNs and maternal fetal medicine specialists. Idaho lost 35% of its doctors who provide obstetrics between August 2022 and December 2024, according to a study published in July. 

Having reproductive health providers flee states with abortion bans is “devastating,” according to Pamela Merritt, the executive director of Medical Students for Choice. 

“It’s a public health disaster that we’re going to see the consequences of decades to come,” she said. 

Merritt’s organization has chapters at several medical schools in states with abortion bans. She said students are not getting adequate training, and some are even discouraged from discussing abortion. 

In February, Texas Tech University Health Sciences Center canceled a Medical Students for Choice chapter’s talk with an OB-GYN who wrote a book about providing abortion care later in pregnancy. School officials told The Texas Tribune hosting the event on campus was not in the university’s best interests.   

“Everybody who graduates from medical school in Texas should know that there’s this thing called third-trimester abortion, that when the life of the mother is at risk, you legally can provide this care,” Merritt said. 

Republican Gov. Greg Abbott signed legislation last year clarifying that doctors can offer pregnant women abortions during medical emergencies. The Texas Medical Board released guidelines for the abortion law this year, nearly half a decade after the state banned most abortions and at least four Texans died after being denied prompt abortion care, ProPublica reported. 

Program helps residents in restrictive states get abortion care training 

“Every single physician, nurse and health care provider needs to be educated about abortion care,” said Dr. Jody Steinauer, an OB-GYN and the director of the Bixby Center for Global Reproductive Health at the University of California in San Francisco. “This is a huge crisis in OB-GYN specifically: All OB-GYNs must have the competence and the skill to safely empty the uterus. Even if the individual is personally uncomfortable providing abortion care, they have to be able to empty the uterus to save someone’s life in an emergency.”

Steinauer leads the Ryan Residency Training Program, which works with OB-GYN residencies across the country to ensure comprehensive abortion and family planning rotations. Nearly a dozen states lack Ryan programs, and most of them have near-total abortion bans. 

She said residencies in states with abortion bans are struggling to make sure their students have the skills to provide abortion: “We’re at risk of having a whole generation of OB-GYN graduates who are not skilled to provide the care they need to provide.” 

To remedy this issue, the Ryan Program has helped to establish 20 partnerships with schools in abortion-restrictive states to train OB-GYN medical residents in states with reproductive rights protections. 

Steinauer said the rotations are between two to four weeks and complicated to plan, but they help doctors learn procedural skills, how to manage medication abortions and counseling. 

The rotations also help OB-GYNs navigate pain management during obstetric procedures, communicate effectively with abortion patients and familiarize themselves with ultrasounds, she said. These skills are important for providing the full spectrum of reproductive health care, from inserting IUDs to treating miscarriages, the doctor said. 

“It’s such a refreshing experience for them to be working in a state without a ban, and they get to see abortion as normal health care,” she said. 

On this Sunday, March 29 — Palm Sunday on the Christian calendar — the Rev. Rachel Kirk will be among a procession of Christians gathering at the state Capitol building in Madison to assert their spiritual resistance to the actions of the administration of President Donald Trump.

Kirk, associate pastor for Community and Faith Formation at Middleton Community United Church of Christ, is one of the organizers for the Palm Sunday Path in Madison, an initiative promoted by the Wisconsin Council of Churches that will have variations across the state. 

It will take place the day after Saturday’s No Kings rallies across the country protesting Trump, and Kirk says the two events share similar objectives: “to challenge unjust power structures and the deterioration of democracy.” But she expects the Palm Sunday Path to offer a different experience — “a celebratory, but also a serious thing, more prayer than protest,” she says.

“The story of Palm Sunday is of Jesus processing into Jerusalem in what would become the final week of his life, and it’s a story told in all four of our gospels,” says Kirk. Some religious scholars have suggested that the Palm Sunday procession in the Bible purposefully echoed another parade: a triumphal march through the city by the Roman leaders whose army occupied the land of Israel.

In that light, for Christians such as Kirk, Jesus’ ride on a donkey has a pointed, anti-imperial meaning.

“Palm Sunday is his journey into that center of power to assert a different kind of power — one that doesn’t dominate and doesn’t exclude,” Kirk says. “We are trying to echo that original message of Palm Sunday — that it is Jesus’ legacy of confronting power that oppresses and excludes and is violent, and we’re trying to assert what we believe is the message of Christ, which is love and inclusion and belonging and peace.”

‘I cannot turn aside…’

The first year of Trump’s second administration has generated  recurring protests of increasing size, channeling public opposition to the administration’s sweeping attacks on immigrants, the reversal of policies that promote diversity and inclusion, the promotion of discrimination against LGBTQ and transgender people and cuts to health care and social supports for poor people. 

Among those resisting the Trump administration’s policies, faith groups and faith leaders have taken an increasingly high profile — across the country and in Wisconsin.

“My baptismal promises include following the works and words of Jesus and to resist evil. The ordination promises by which I became a minister echo that,” says the Rev. Kerri Parker, executive director of the Wisconsin Council of Churches, an ecumenical organization representing churches from more than 20 distinct Christian traditions.

“It means I cannot turn aside when I see evil being perpetrated, when I see vulnerable people being actively victimized by power, by what I would at this point call Capital E Empire,” adds Parker. “I have a duty to engage the tools of my faith, what platform I have, the skills I have been given, to say this is not right.”

At the height of the occupation in Minneapolis this winter by federal immigration agents, hundreds of faith leaders gathered in the city  to join the community’s resistance to the federal incursion. Among them was the Rev. Zayna Thomley, the lead pastor at the Middleton Community UCC church.

She attended a mass gathering of clergy in a large Minneapolis church and joined a protest in the lobby of the Target corporate headquarters the next day criticizing the store chain’s cooperation with Immigration and Customs Enforcement agents. 

“It felt really powerful to know that everybody who was in the room and who was on the street had the understanding to be a part of a bigger vision of what it means to be part of community, what it means to be held by God and what it means to show up for justice,” she says. “It was a deeply holy experience.

Religion and social justice

Religious groups have long taken part in social justice movements. The Rev. Martin Luther King Jr. was a Baptist minister who invoked his faith in his commitment to nonviolence as essential to the struggle for civil rights for Black Americans.

In Milwaukee, the interfaith organization MICAH — Milwaukee Inner-city Congregations Allied for Hope — has operated for nearly four decades, working to address the issues of justice in “a city afflicted with radicalized and concentrated poverty,” in the words of the organization’s website.

MICAH’s president, Rev. Richard Shaw, says he has seen more faith leaders and organizations getting involved in pushing back on federal policies in the current administration, as they are “looking at the families being broken up, looking at innocent people being arrested and put in detention without due process.”

He welcomes newcomers to the work. “I do believe that there’s power in numbers,” says Shaw, pastor of St. Matthew C.M.E. Church in Milwaukee. “If we truly follow the Jesus of scripture, to not get involved is to deny the earthly ministry of Christ.”

Christian groups are part of a broader coalition of faith groups standing up to the Trump administration. In January the Interfaith Conference of Greater Milwaukee, which represents 22 faith organizations — Jewish, Christian, Muslim, Buddhist, Sikh, Hindu and more — issued a statement in defense of immigrants and of peaceful protest after the fatal shooting of Renee Good in Minneapolis by a federal agent. 

“We consider the exploitation of human beings, the separation of families, and the use of violence and intimidation, to offend the human dignity not only of the oppressed but the oppressor,” the Interfaith Conference statement declared. “The rights of all people, including neighbors, immigrants and asylum-seekers, to humanitarian treatment is explicit in our national foundation, and our international treaty obligations.”

“There is a deep respect for human dignity in all of our religious traditions, and what has been happening on our streets is something that is observable to all people of faith who care about human rights and respect dignity,” says Ahmed J. Quereshi, the Interfaith Conference executive director.

At a vigil in Minneapolis for Renee Good after she was killed, Imam Mowlid Ali told Good’s neighbors, “Today is the day that we send a message to everyone in this nation. That we are united. We reject any dehumanization of any person in this city, in this state, or anywhere in our nation.”

“We Jews know from history what happens when people are kidnapped, deported, detained, and given no human dignity or rights,” Rabbi Sharon Kleinbaum said at a flash mob protest at a Minneapolis Target store. “We know what God demands of us. God demands that we be with the worker, with the vulnerable, with the immigrant … We are all created in God’s image, without exception.”

The morning after inauguration

Religious individuals, groups and leaders were among those who stood up to the policies and practices of the first Trump administration. Their role in response to Trump’s second term has been even more prominent.

“It arguably began the first day of Trump’s second term,” said Jack Jenkins, a Washington, D.C.-based reporter for Religion News Service, during an online round table discussion RNS conducted March 24.

At a prayer service the morning after Trump was inaugurated, Bishop Mariann Budde spoke directly to the president from the pulpit, urging him to “have mercy” on frightened gay, lesbian and transgender children as well as on “the vast majority” of immigrants, regardless of documentation, who are not criminals.

“That sermon that was given to him at the Washington National Cathedral by Bishop Mariann Budde, the Episcopal Bishop of Washington, made clear very quickly that there was going to be religious pushback to several parts of his agenda,” Jenkins said.

Trump was elected in 2024 with the support of more than 80% of white evangelical Protestant Christians, 60% of white Catholics and 57% of white non-evangelical Protestants, according to data compiled by the Public Religion Research Institute. And Trump has garnered favor among Christian groups that oppose abortion and LGBTQ+ rights.

But Christians cover a much broader spectrum of ideologies and perspectives on social issues.

“The loudest voice of Christianity in the United States is what we’re starting to really understand as white Christian nationalism,” says the Rev. Julia Burkey, senior pastor at Orchard Ridge United Church of Christ on the west side of Madison.

Burkey sees a religious revival emerging among Christian traditions that emphasize “the beloved community that we’re working towards, which includes all people,” regardless of gender, sexual orientation or other dividing categories.

When the immigrant advocacy group Voces de la Frontera and U.S. Rep. Mark Pocan (D-Black Earth) decided to hold a news conference in late January to announce their intentions for a peaceful but firm resistance to a possible federal immigration enforcement surge in Wisconsin, they chose the Orchard Ridge church for the event.

Burkey says engagement with social justice has been a core part of her ministry and faith since her seminary years in New York City.

“So it doesn’t feel new to me necessarily,” Burkey says — but, she adds, people may be noticing it more now.

“I just think it’s so important that we’re speaking up for human dignity and for just very basic things that are tenets of our religious faith, like loving one another,” Burkey says. “That golden rule of treating each other like we would like to be treated is a very deeply agreed upon value in the world and all faith traditions, and it’s being violated right now.”

Protests, lawsuits, immigrant support, nonviolence training

The faith-based resistance to the Trump administration has taken many forms.

During the Minneapolis gathering, nearly 100 faith leaders were arrested at the Minneapolis-St. Paul airport on Jan. 23 after going there to protest the ICE detention of workers and commuters as well as the involvement of airlines in transporting people taken into ICE custody.

After Trump reversed a 30-year policy that put schools and houses of worship largely off-limits for immigration raids, the Greater Milwaukee Synod of the Evangelical Lutheran Church in America joined the Religious Society of Friends (Quakers) and other church groups in a lawsuit to block the change.

A federal court ruling in February that granted the groups a preliminary injunction against the administration’s change is currently under appeal.

The Milwaukee synod joined the suit because church officials could see the impact of the administration’s aggressive stance towards immigrants on their congregations, says Bishop Paul Erickson.

“People were not coming to church because they’re afraid of ICE. People were not going to the food pantry at the church because they’re afraid of ICE,” Erickson says. “We felt a strong belief that the behavior of our federal government was interfering with the free expression of religion.”

At Christ Presbyterian Church in Madison, church members were among people in the community who years ago identified the need for an immigration legal aid service and helped raise the funds for it to operate, says the Rev. Will Massey, an associate pastor at the church. The church went on to host the service, the Community Immigration Law Center.

That relationship has gone back more than a decade. In the last year, however,  CILC has been ramping up its operations significantly in response to the Trump administration’s policies to remove immigrants. 

“Right now one of the church’s highest priorities is providing for the work of the law center — making sure that we are acting and we are managing our building in ways that allow their work to continue,” Massey says.

The Rev. Jennifer Nordstrom, senior minister at the First Unitarian Society in Milwaukee, helped lead a training in non-violent civil resistance for faith leaders in January.

“We have a long tradition as people of faith of being the moral voice in society against unjust laws and being willing to take a moral stand, a non-violent moral stand, against injustice in the world — even when it’s our government promoting that injustice, which is what we’re seeing today,” Nordstrom says.

“I see faith leaders who have always been siding with love, faith leaders who have always understood God and the Holy as a loving God that believes that all human beings are made in the image of God,” Nordstrom observes. “And in this moment, because the assault on human dignity is so pointed and aggressive, those folks are bringing that Imago Dei — the image of God, the holiness and sacredness of every human being — theology out into the community and even out into the streets.”

‘Loving our neighbor’

Other forms of support are less visible, but participants say, no less important. Some of it grows out of a longer history of assistance to refugees and immigrants in less fraught times.

“There’s been work that has happened quietly in an everyday manner that people have been proud of and comfortable participating in,” says Parker of the Wisconsin Council of Churches. “The everyday work of resettling refugees, feeding hungry people, helping folks learn the language of the place where they’re living now.”

In the current political climate, “folks who have been doing this quietly are being more direct and public about the need,” Parker adds. “And folks who may not have been engaged in it before are diving in.”

Much of that work now has also become much more discreet, to protect families and individuals who those involved fear could be targeted indiscriminately  by immigration authorities.

“I see so much organizing happening locally,” says the Rev. Kendra Grams, a Presbyterian pastor in Hudson. “It just doesn’t get as much visibility for various reasons. But it is happening and from my perspective that’s been wonderful to see.”

Erickson says friends, colleagues and family members in the Twin Cities, where he previously lived and worked for 13 years, have told him that protests and other public actions are only a fraction of the work people are undertaking to help the most vulnerable people in the community. 

“It’s the networking of providing mutual aid and food and money and support,” Erickson says. “Helping people get rides to the doctor’s office because they’re afraid to go out by themselves, and showing up in restaurants and committing to eat in the same restaurant every day and spend two hours there just in case ICE shows up in an immigrant-owned restaurant or a restaurant that employs significant numbers of migrants.”

Those are not “a centralized, coordinated, highly orchestrated effort,” Erickson says. “It’s simply baked into the fabric of how do I love my neighbor?”

That underlying tenet is found in “any religion that I’m aware of, whether it be Christian, Muslim, Buddhist, Jewish,” he says.  “And so I think that’s really what we’re trying to lean into and recognize, that the actions of the federal government are getting in the way of us loving our neighbor. And we’re not going to sit back quietly and let that continue.”

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Nine of Wisconsin’s 72 counties are “maternity care deserts”: no hospitals and birth centers offering obstetric care and no obstetric providers such as obstetricians.

The nine, according to the latest March of Dimes report (2024), are largely rural: 

Adams, Douglas, Forest, Kewaunee, Lafayette, Marquette, Oconto, Pepin and Rusk.

Maternal care deserts drive maternal mortality rates, which generally are higher for Black women and women in rural areas, according to a 2025 study by Brown University researchers.

Individuals in states with a high prevalence of maternity care deserts had 34.2% greater risk of maternal mortality and 18.3% greater risk of infant mortality, Yale University researchers found in 2025.

The Wisconsin Office of Rural Health at the University of Wisconsin-Madison recommended extending pregnant women’s Medicaid coverage to 12 months postpartum, from two months, to improve care and hospital finances.

Gov. Tony Evers recently signed legislation for that extension.

This fact brief is responsive to conversations such as this one.

Sources

• March of Dimes: Maternity Care Desert
• Journal of the American Board of Family Medicine: Maternity Care Deserts: Key Drivers of the National Maternal Health Crisis
• AJPM Focus: State-Level Prevalence of Maternity Care Deserts: Association With Healthcare Access, Utilization, and Outcomes Among Medicaid Recipients
• Wisconsin Office of Rural Health: Obstetric Delivery Services and Workforce in Rural Wisconsin Hospitals 2024
• Milwaukee Journal Sentinel: Lawmakers vote to extend postpartum Medicaid coverage to a full year
• The Commonwealth Fund: Positive Outliers: How Some Rural Communities Maintain Access to Labor and Delivery Services
• National Rural Health Association: Maternal health in rural America
• University of Wisconsin-Madison Collaborative for Reproductive Equity: New CORE brief explores Dobbs decision’s impact on the ob-gyn workforce in Wisconsin
• PBS Wisconsin: Maternal health care in Wisconsin and the future of Medicaid

Do some Wisconsin counties have no maternal health care providers? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

From 2021 to 2024, a new report reveals there was a dramatic increase in the number of incarcerated residents of Wisconsin’s jails and prisons accessing medications for opioid use disorder.

“Treatment Behind Bars: Medication for Opioid Use Disorder in Wisconsin’s Jails and Prisons” by the Wisconsin Policy Forum was released Wednesday at a press conference hosted by Vital Strategies Overdose Prevention Program, a global public health organization that has been working since 2018 to use “advanced evidence-based strategies on overdose prevention and to expand access to harm reduction and treatment, particularly for populations at highest risk,” said Giavana Margo, program manager.

The report notes that “medications for opioid use disorder are an important tool to help people manage symptoms of opioid withdrawal, as well as recover from symptoms of active opioid addiction. Research also shows that individuals who are newly released from prison are at elevated risk for overdose fatalities.”

The report said there are three factors that have “likely” resulted in the higher use of opioid use disorder medications  in carceral settings:

1. The high number of opioid deaths in the state that reached a peak in 2024
2. The availability of opioid lawsuit settlement dollars from pharmaceutical companies to address treatment.
3. Federal and professional agencies promoting the medications, and pressure from the U.S. Department of Justice to offer them to carceral residents under the Americans with Disabilities Act.

A fourth factor discussed during the press conference is the higher percentage of jail and prison facilities offering the medications, encouraging wider acceptability.

Jason Stein, president of the Wisconsin Policy Forum, said that even though the number of opioid deaths has dropped noticeably since 2024, the number of overdose deaths statewide is slightly higher than vehicle deaths, making overdoses a “significant public policy issue.”

He noted that of 71 jails in the state, 58 filled out a 42-question survey fully and seven answered partially, resulting in a 97% reporting rate for the jails, while the Department of Corrections (DOC) reported data via its central pharmacy that serves all the state prisons.

The primary two opioid use disorder medications used by facilities are methadone and buprenorphine.

“Both of those medications are associated with a decrease in overdose deaths as well as improvements in other important indicators such as recidivism,” he said.

The study also looked at the use of naltrexone, another medication that is not strictly for opioid use disorder, and it also looked at the prevalence of naloxone or Narcan, which is used to reverse opioid overdoses.

The report notes that only four residents in the DOC system took buprenorphine in 2021, but 148 were receiving it in 2024, and 44 took naltrexone in 2001 — a number  that increased to 154 in 2024.

Stein said a 2021 Department of Health Services (DHS) report showed that only one-third of prisons offered any medication for opioid addiction, but by 2025 all 36 prisons were offering at least one medication.

Currently, Stein said, most Wisconsin jails — 53 of 65 that responded or 81.5% — offer one form of opioid medication. That is more than double the 25 jails, or 41%, that reported at least one medication in 2021.

“It’s more common for jails in the central and southeastern parts of our state to have multiple forms available,” he said of opioid medication. “In northern Wisconsin, it’s typically one form … such as buprenorphine.”

The report notes that offering the medications to those in jails and prisons results in a reduction of overdose deaths after release, as well as a decreased risk of death for any cause and a lower risk of reincarceration.

“We want to note that there is increased availability of these medications in both county jails and prisons around the state, making it available to thousands of individuals in 2024 at a substantial increase from 2021, but at the same time, there are some gaps, meaning access at the county level,” Stein said. “We had eight counties that stated they did not currently provide any access to these medications. We had five more counties that did not answer the survey. There are now 24 counties that provide some access to methadone, but that is still a minority, and we have a number of jails that, while they may provide continuation of existing prescriptions, they do not initiate individuals on those medications.”

He added, “We do see some opportunity … despite the challenges that may exist, to increase access; we do see some tools that local counties can turn to. One, there are more counties and private providers that are offering this service around the state, so there’s the potential for partnership, and then, as well, the availability of opioid settlement funds also makes the possibility of funding this service more practical in some cases for counties.”

Joanna Hernandez of Milwaukee shared her experience of struggling with addiction while incarcerated and the importance of continuing medication.

She recounted being arrested in 2013 in Walworth County while possessing a valid prescription for Suboxone (a medication to treat opioid addiction).

“The jail verified my prescription, but even after confirming it, they refused to give me my medication,” she said. “I was there for five days and went through very severe withdrawal. I was extremely sick and eventually segregated to a single cell. I remember guards telling me, ‘You know, this isn’t a hospital.’ As soon as I was able to post bail and get out, I used immediately. If I had been able to continue my prescription while incarcerated, I could have focused on healing and making sure my mental health medications were the right fit for me. Mental health plays a huge role in withdrawal.”

She added, “Experiences like mine show why access to medications for opiate use disorder is so important. Withdrawal in jail does not treat addiction. It actually increases the risk of relapse and overdose when people are released. Jails and correctional facilities need to treat opiate use disorder like the medical condition it is. Access to medications for opiate use disorder is about dignity, medical care and saving lives.”

Kenosha County Sheriff David Zoerner said an important part of his jail’s intake is an initial screening, so the residents get the resources they need and they also have those resources when they leave.

He noted it was a grant that provided the dollars to do the initial screening, and also stressed the limiting factor on how much his office can do is money, mostly from tax levies.

Zoerner said the most efficient way to offer methadone would be at the jail but he fears methadone could be “diverted nefariously,” so instead those who need it are driven daily to a facility, but that is also costly because it requires a deputy to transport the residents.

“My hope, based on what we’re doing right now with the early screens, is being able to work with the affected population while they’re in our custody, getting them peer support and some need therapy,” he said.  “You understand that drug addiction, behavioral health issues, mental health, they all go hand in hand, so to facilitate that through and then with new legislation, hopefully we’re going to be able to get these folks prescriptions, a 30-day supply, before they leave.”

The new legislation Sheriff Zoerner referred to is AB 604, which passed the Legislature and is waiting for Gov. Tony Evers’ signature. It would allow the state to apply for Medicaid coverage for incarcerated people, including a 30-day supply of opioid medication prior to release.

At the press conference, Adriena Hust, state team leader of Vital Strategies, shared recommendations for expanding opioid use disorder medication access in Wisconsin jails and prisons.

“The first recommendation, incarceration is not treatment,” she said.  “More should be done to avoid reincarceration. Most admissions to prison in Wisconsin are due to supervision and technical violations, rather than a new crime. While reforms are in progress, Vital Strategies recommends that Wisconsin continue to minimize revocation and eliminate incarceration sanctions for drug use while on supervision, considering reoccurring drug use is a common part of substance use treatment. Although today’s study did not deal with the issue of revocations, we know they are costly, and the savings to minimize them can go toward medication and staffing.”

Another recommendation is to make methadone and buprenorphine standard treatments for opioid use disorder.

And she said counseling should be optional and not a condition to receive medication because it is the medication that saves lives.

 “As mentioned, people are at extreme risk of dying by overdose in the first few weeks after leaving carceral settings,” she said. “It is important that re-entry planning focus on seamless continuation of medication in the community, which greatly reduces this mortality risk.”

And she noted that those incarcerated who have a right to medication under the Americans with Disabilities Act should have “recourse against violations without fear of retaliation,” in demanding medication. Lastly, she said, the state and counties should prioritize opioid settlement dollars for “opioid use disorders in jails and prisons.”