The bill passed 87-10 with only Republican lawmakers voting against. (Photo by Baylor Spears/Wisconsin Examiner)

The Wisconsin State Assembly, in a departure from prior floor debates this session, passed several widely bipartisan bills related to health care, including one to exempt direct primary care services from insurance laws and another to allow pharmacist to prescribe birth control.

AB 43 would allow pharmacists to prescribe certain birth control, including the pill and contraceptive patches, to patients 18 and older as a way of making it easier to access. Currently, Wisconsin patients have to make an appointment with a doctor or advanced practice nurse and answer a mandatory list of questions regarding their health before a doctor could prescribe birth control. Once a physician determines it safe, patients can take a prescription to a pharmacy to be filled. 

Under the bill, pharmacists would have to give patients a self-assessment questionnaire and do blood pressure screening. If there are any “red flags,” then a pharmacist would need to refer  patients to see a physician.

Rep. Joel Kitchens (R-Sturgeon Bay) said during a press conference ahead of the session that the process included in the bill is “much more rigorous” than when women get birth control online. He said it would also help women with family planning, noting that about half of pregnancies in Wisconsin are unplanned each year.

“These women are unlikely to finish school, and it will severely affect their potential earnings throughout their lives…” Kitchens said. “Birth control is 99.9% effective when it’s used according to directions and regularly. The lack of access is the biggest reason that it sometimes fails. Women will leave home for a couple of days and forget about it, or they can’t make an appointment with their doctor, and this bill is going to help with all of that.” 

This is the fourth time the Assembly has passed a similar bill. Last session, it passed a Senate committee but it never came for a floor vote. 

Kitchens said he thinks there is a “good chance the Senate will pass it this time.” 

Rep. Jessie Rodriguez (R-Oak Creek) said in a statement that the policy “will increase access to contraceptives, particularly for women who live in rural areas, where many Wisconsinites live closer to their pharmacy than they do to their doctor’s office,” and urged her Senate colleagues to take up the bill. 

“This is a good bill that will make for greater access to contraception. I have voted for this proposal four sessions in a row. I urge the Senate to follow our lead,” Rodriguez said. 

The bill passed 87-10 with only Republican lawmakers voting against. 

Primary care insurance exemption

SB 4 would exempt direct primary care, which is a health care model where patients pay a monthly or annual fee to a physician or practice for access to primary care services, from insurance laws. Advocates have said that clarifying that insurance law doesn’t apply to direct primary care doctors would encourage more providers to opt in to this model.

Bill author Rep. Cindi Duchow (R-Town of Delafield) said at a press conference that direct primary care “is not insurance.” 

“It’s a private contract you have with the doctor, then you have insurance for something catastrophic — if you need to have surgery or you have a heart attack, you have insurance to cover that — but this is just for your everyday needs, and it’s more one-on-one, and you have more personal experiences with the doctors,” Duchow said. 

Rep. Robyn Vining  (D-Wauwatosa) expressed concerns about the bill, noting that it is missing nondiscrimination language and that she would be voting against it.

“[This] is getting us nowhere helpful,” Vining said. 

The nondiscrimination language, Vining referenced, was in relation to prohibiting discrimination on the basis of “gender identity.” Conservative organizations had lobbied against the bill last session due to the inclusion of that language and it never received a vote in the Senate.

Vining expressed concerns that Evers might veto the bill without the nondiscrimination language. 

Rep. Lisa Subeck (D-Madison) said she had similar concerns but would be voting for it. 

“I think it is a good bill, and it does something that is important, but I do it knowing that I wish the bill could be stronger,” Subeck said. 

The Assembly concurred in SB 4 in a voice vote. The Senate passed the bill in March, and it will now head to Evers’ desk.

Lawmakers also concurred in SB 14, a bill to require written informed consent from a patient when a hospital performs a pelvic examination for educational purposes on a patient while the patient is under general anesthesia or otherwise unconscious. The bill was advocated for by Sarah Wright, a teacher who was subjected to a nonconsensual pelvic exam while she was undergoing abdominal surgery in Madison in 2009. 

Subeck said it is a “horrifying” story that Wright has shared every legislative session. 

“[Wright] was unconscious. There was no medical need for a pelvic exam and medical students were brought in to do public exams in order to learn the procedure because it’s easy as to learn on an unconscious individual,” Subeck said. “This is tantamount to sexual assault. This is not giving consent. This is assuming consent from somebody who is unconscious.” 

Subeck noted in a statement that lawmakers have been working on the legislation for over a decade. 

“It has taken far too long, but we are finally honoring her bravery by putting an end to this disturbing and unethical practice,” Subeck said in a statement. “Patients entrust medical professionals with their care at their most vulnerable moments. That trust must never be violated. Performing a medically unnecessary and invasive exam without consent is not only a breach of ethics — it is a violation that can feel indistinguishable from sexual assault.”

Rep. Joy Goeben (R-Hobart) noted that one study found that over 80% of medical students at major training hospitals reported performing pelvic exams on anaesthetized patients, but only 17% said that the patients were informed, while nearly half reported that the patients were rarely or never explicitly told so. 

“I am really thankful for the bipartisan support,” Goeben said. 

Assembly Minority Leader Greta Neubauer (D-Racine) said in a statement ahead of the session that the bills were a sign that lawmakers could work across partisan lines, but said they could do more. 

“It is possible to come together to pass good, bipartisan bills that will move our state forward — but we know that there is so much work left to be done,” Neubauer said. “Just last week, Republicans on the Joint Finance Committee cut proposals by [Evers] that would have lowered costs for working families and cut taxes for the majority of Wisconsinites. Removing these critical proposals from consideration and preventing future discussion is ridiculous, and on top of this, the GOP has refused to have public hearings, let alone votes, on popular and bipartisan legislation that would move our state forward.”

Ahead of the floor session, Assembly Speaker Robin Vos (R-Rochester) told reporters that work on the budget is on hold until legislative leaders meet in person with Evers. Republican lawmakers are seeking a tax cut in the budget. 

“Our preferred option [is] to be able to get an agreed upon tax cut so that we know we have X dollars to invest in schools and health care and all the other things that are important,” Vos said. “It’s pretty hard for us to move forward… I think we’re kind of on pause until we hear back from Gov. Evers.”

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