Unemployment benefits application (photo by Getty Images)

This report has been updated.

In a unanimous decision, the U.S. Supreme Court ruled Thursday that a Catholic Charities organization in Wisconsin doesn’t have to take part in the Wisconsin unemployment insurance (UI) system.

The ruling rejected a Wisconsin Supreme Court opinion that said the agency’s purpose was essentially secular and didn’t qualify for a religious exemption in state unemployment law.

Advocates who supported Catholic Charities cheered the ruling as a blow for religious liberty and against attempts to define whether or not an organization’s motives are sufficiently rooted in faith.

“We have maintained throughout the process and in an amicus brief that Catholic Charities is in fact a religious institution and is eligible for the unemployment insurance tax exemption offered by the state law,” said David Earleywine, associate director for education and religious liberty at the Wisconsin Catholic Conference.

Organizations that represent workers, however, have raised questions about the decision’s broader implications for employees of other institutions connected to churches, including the large networks of Catholic hospitals across the U.S.

“It is crucial that employees, especially low-wage workers, have the protections of unemployment insurance, regardless of the identity of their employer,” said Larry Dupuis,  director of litigation and advocacy at Legal Action of Wisconsin. The law firm joined with groups including the Economic Policy Institute, the Century Foundation and the National Employment Law Project on a friend of the court brief supporting the Wisconsin Supreme Court ruling.

“Unemployment payments help the laid off worker, and the economy as a whole, during a downturn by supporting consumer demand,” Dupuis said.

Thursday’s ruling overturns a 4-3 Wisconsin Supreme Court decision issued in March 2024 that declared the work of Catholic Charities Bureau Inc. of the Superior Diocese of the Catholic Church doesn’t get a pass from Wisconsin’s UI law on religious grounds.

The Wisconsin ruling, written by Justice Anne Walsh Bradley, declared that the Catholic Charities work is “secular in nature” and that the agency and its subsidiary organizations that took part in the case “are not operated primarily for religious purposes” as defined in the UI law’s religious exemption.

Justice Sonia Sotomayor wrote Thursday for the U.S. Supreme Court that the Wisconsin high court majority’s arguments amounted to giving preference to one religious denomination over another.

The Wisconsin ruling held that the agencies’ work was not religious in nature because they didn’t attempt to preach the Catholic faith to participants and did not serve only Catholics.

“Petitioners’ Catholic faith, however, bars them from satisfying those criteria,” Sotomayor wrote. The ruling quoted from the dissent by Justice Rebecca Bradley in the Wisconsin decision.

“Wisconsin’s exemption,” Sotomayor wrote, “as interpreted by its Supreme Court, thus grants a denominational preference by explicitly differentiating between religions based on theological practices. Indeed, petitioners’ eligibility for the exemption ultimately turns on inherently religious choices (namely, whether to proselytize or serve only co-religionists).”

Earleywine said the decision reflected the position of Catholic Charities and its supporters. 

“For Catholic Charities in particular, serving the poor is part of our Catholic mission — that is something that we are called to do,” he said.

Sotomayor’s ruling noted that the church offers its own unemployment compensation program for laid-off workers and dismissed the suggestion that the organizations were “more likely to leave their employees without unemployment benefits.”

Earleywine underscored the ruling’s reference to the Catholic unemployment compensation program as  “essentially equivalent” to the state UI program. 

The employment lawyers’ amicus brief disputed that comparison, however, and also noted that there’s no guarantee other religious employers made exempt would have any kind of substitute benefits program. The brief also argued that in the event an individual diocesesan employer can’t afford to pay benefits for a laid-off employee, the overall program has renounced any obligation to pick up the tab. 

Earleywine said the ruling enables Catholic Charities organizations to sign up with the church system, which is available to employees of Catholic dioceses, including church parishes and schools. Other Catholic-related organizations without a diocesan connection — such as Catholic hospital systems or universities — are not eligible under current rules.  

Justice Clarence Thomas, while joining in the unanimous opinion, wrote a separate concurrence stating that because the Wisconsin ruling did not defer to the Bishop of Superior’s assertion that Catholic Charities and its affiliates are “an arm of the Diocese, the Wisconsin Supreme Court violated the church autonomy doctrine.”

While Thursday’s ruling was emphatic, it also appeared to suggest how Wisconsin’s UI religious exemption might be rewritten to produce a different outcome.

The Wisconsin UI law exempts all churches, church conventions or church associations “without differentiating between employees actually involved in religious works” and those who are not, Sotomayor wrote.

Dupuis of Legal Action Wisconsin pointed to another concurrence, by Justice Ketanji Brown Jackson, who wrote that state UI laws could cover nonprofit employees of religiously associated organizations by focusing on the work involved rather than its underlying motivations to determine who is and who is not exempt.

“As Justice Jackson’s concurrence shows, this ruling still gives states the ability to limit the scope of the religious exemption so large employers that provide services that are not inherently religious, like hospitals, must still cover their employees,” Dupuis said.

When the federal law was revised in 1970 to include nonprofit employees in state UI programs, Congress exempted certain church-affiliated employees. The goal, Jackson wrote, was to avoid the state getting involved in a dispute “over the sufficiency of a fired employee’s prayers or the accuracy of their scriptural teaching.”

The intent of Congress was to exempt “a narrow category of church-affiliated entities” that could produce such an entanglement “precisely because their work involves preparing individuals for religious life,” Jackson wrote.

She concluded: “It is perfectly consistent with the opinion the Court hands down today for States to align their [federally-based] religious-purposes exemptions with Congress’s true focus.”

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Children at Mariposa Learning Center in Fitchburg. (2023 file photo by Erik Gunn/Wisconsin Examiner)

While providers, their supporters and Democratic lawmakers are pressing for a substantial continuing direct state investment in Wisconsin’s child care sector, Republicans in the Legislature are pursuing another route: expanding a child care tax credit for employers.

So far, child care providers and some small business owners aren’t interested.

The legislation circulated in draft form in early May. On Friday, May 30, it was formally introduced in the Assembly (AB 283) and the state Senate (SB 291).

“We really think it’s an important opportunity to reward employers for getting involved in child care,” Neil Kline, who says he encouraged GOP lawmakers to draft the tax credit legislation, told the Examiner.

Kline is executive director of Family Friendly Workplaces, a nonprofit based in Woodville that works with businesses in Burnett, Pierce, Polk and St. Croix counties. The organization certifies employers as family-friendly “to support their recruitment and retention efforts,” Kline said. To that end, one of its missions is focusing on workforce-related problems such as housing and child care access.

In early May Sen. Howard Marklein (R-Spring Green) and Rep. Karen Hurd (R-Withee) circulated the proposed bill seeking cosponsors.

The legislation was written “to encourage more businesses to invest in child care in their communities,” Marklein and Hurd wrote in their May 12 cosponsor memo. “These changes will increase the number of available child care slots and provide more options for families.”

Demanding direct support

The legislation has been introduced while child care providers and Democrats are continuing their campaigns to revive direct support for the child care sector.

During the COVID-19 pandemic the Evers administration used federal pandemic relief funds to pay child care providers monthly stipends through the Child Care Counts program. The $20 million a month that the state doled out helped providers stabilize child care, increasing workers’ pay while keeping care more affordable for families.

When Evers tried to use $360 million from the 2023-25 budget to continue Child Care Counts with state money, none of the Legislature’s Republican majority got behind the measure. The governor was later able to reallocate other federal dollars to fund Child Care Counts through June 2025, but at half the original amount: $10 million a month.

With lawmakers now writing the 2025-27 budget, Evers, child care providers and their advocates have been campaigning for $480 million to continue the program for the next two years. A survey commissioned by the state and conducted by the University of Wisconsin Institute for Research on Poverty forecast closures and tuition hikes if the state payments end.  

At their very first budget vote, however, Republicans on the Legislature’s Joint Finance Committee removed the proposal along with more than 600 other items Evers had included in his budget draft. The GOP outnumbers the Democrats 3 to 1 on the committee.

Democratic lawmakers responded by circulating a draft stand-alone bill to reinstate the Evers proposal.

“Child care providers are facing increasing cost to operate while still making poverty-level wages,” said Sen. Sarah Keyeski (D-Lodi) at a May 22 press conference to announce the Democrats’ bill. “This has made it extremely difficult to hire and retain quality staff. [Meanwhile] providers desperately want to avoid rising costs and rates on families already struggling to afford child care.”

Child care as business investment

As yet no Republican lawmakers have gotten behind the Child Care Counts proposal.

Instead, the bills that Marklein and Hurd have introduced would make changes to the Business Development Tax Credit, which is provided through the Wisconsin Economic Development Corporation (WEDC).

That tax credit is granted to reward a variety of business investments and reduces the state income tax that a business pays by the amount of the credit.

Currently, a business that spends money on starting a child care program for its employees can get up to 15% of that cost taken off its tax bill. The credit applies only to capital investments, however — building or remodeling the child care facility.

“Unfortunately, we have heard that the current program parameters limit the incentive for businesses to invest in child care programs,” Marklein and Hurd wrote in their co-sponsor memo. “While many businesses may want to provide child care as a benefit to employees, the current credit limitations reduce the incentive for this investment.”

In addition to capital expenditures, the draft bill would extend the tax credit to cover 15% of several other costs:

• An employer’s spending on child care program operations;
• Spending to reimburse employees for their child care expenses;
• Spending to buy or reserve openings for its employees at a child care center;
• Contributions an employer makes to an employee’s flexible spending account for dependent care.

The draft bill also allows the tax credit for “any other cost or expense incurred due to a benefit provided by an employer to facilitate the provision or utilization by employees of child care services.”

The tax credit would be refundable: Even if the credit totals more than the employer pays in taxes, the company would get its full value back from the Wisconsin Department of Revenue. 

It also would give a refund to nonprofit employers, which don’t pay taxes.

“While not a silver bullet, these changes are another step in the right direction to address the child care issue in Wisconsin,” Marklein and Hurd wrote in their memo.

Kline, the Family Friendly Workplaces director, said the proposal would help engage employers more directly in addressing child care shortages.

“We really think it lays the groundwork for ongoing, self-sustaining support of child care in Wisconsin,” he said. “The primary goal is to help introduce new money into the child care — really, the child care ecosystem — by rewarding employers to support the ongoing expenses of child care, because the reality is that the sector needs additional money in it.”

Kline said he understands that “the ongoing operational economics” is a central problem for the child care sector. “That’s why we are so focused on helping employers find avenues and be rewarded for helping defray the expenses that are related to child care and helping support that ongoing operational side of child care.”

Chilly reception

To date the existing child care employer tax credit hasn’t had any takers, according to the WEDC. In January, as part of an overall evaluation of the state’s business development tax credit, an outside consultant told WEDC that “due to the high operational costs of childcare centers, affordability would likely be better achieved through subsidy as opposed to a tax incentive.”

The proposal to expand the tax credit isn’t gaining traction with providers or small business owners.

Main Street Alliance, which organizes small business owners to advocate for state and national legislation, has already announced objections to the bill.

“These kinds of programs and tax credits are often advantageous for employers who can afford compliance and the procedural costs and have economies of scale,” said Shawn Phetteplace, MSA’s national campaign director. That leaves out the typical small business, said Phetteplace, who sent lawmakers a memo calling the proposal “deeply unserious.”

Evan Dannells, a chef and owner of two Madison restaurants, questioned how a relatively small business like his would benefit from the tax credit.

Of his eight full-time employees, one has two children. Most of the others are graduate students. Directly paying for the one employee’s child care, even if receiving a tax credit, doesn’t feel fair to the others who don’t have that expense, Dannells said.

“If you put the onus of taking care of child care on the employer, the employer won’t hire people with children,” he said.

Dannells considers the cost of child care a legitimate use of his tax dollars. “This is why government should be doing this,” he said. He observed that children are required to go to school when they reach the age of first grade. “Why can’t we take care of them from age 1 to 5?”

While the tax credit may make it easier for a particular company’s employees to afford child care thanks to the employer’s support, skeptics of the proposal say that assistance only helps some people — not the system as a whole.

“That doesn’t help keep the doors open,” said Heather Murray, who operates a child care center in Waunakee. “We’re hitting crisis mode and centers are shutting down now, and a quarter of them will be gone if [Child Care Counts] isn’t renewed. We need the investment to go directly to providers to make sure that the doors stay open.”

Child care as a public good

National child care analyst Eliot Haspel is also skeptical. Haspel is a fellow at Capita, a think tank that works in the area of family policy. In February 2024, the think tank New America published his report raising questions about the impact of various employer-sponsored child care benefits.

Haspel views child care as a public good that benefits society broadly. For that reason, he contends, it should serve families regardless of whether they work for an employer able to fund a child care benefit.

“Small business will never be able to offer a really robust child care workplace benefit,” Haspel says. That puts small businesses and small business employees at a disadvantage if supporting child care is primarily an employer’s responsibility, he argues.

The large number of low-wage workers and “gig workers” “also raises the specter of increasing inequalities,” he writes in the New America report.

Haspel says that tying child care to a job also locks people into a job — or strands them from needed care if they lose their job. It also disrupts children’s early education at a time when they need consistent and reliable connections with their caregivers, advocates say.

“It’s really bad for workers and it’s really bad for kids for your child care to be tied to your employment,” Sen. Kelda Roys said at the Democrats’ May 22 press conference.

Tying health insurance to employment has been “a disaster,” Roys said. Health care is “rationed based on the job that you have or the wealth that you have,” she added, “and we do not want to exacerbate the current problems in our child care system by tying it to people’s employment.”

In his New America report and in an interview, Haspel says the problem isn’t providing child care at the workplace.

“I’m not against the idea of onsite child care — that can make all the sense in the world,” he says. “You can have an onsite center as part of a publicly funded system” — one to which employers contribute as taxpayers.

Focusing on the employer, however, carries with it “an opportunity cost,” Haspel says. “The more we say child care should be solved primarily through employers, the harder it is to say we need a fully public system that is universal and reaches everyone.”

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Carol Lemke, a member of the nurses union bargaining team at Meriter hospital in Madison, addresses nurses before they return to work Sunday morning after ratifying a new labor contract. (Photo by Erik Gunn/Wisconsin Examiner)

Nurses at Meriter hospital in Madison returned to work Sunday with a new contract at the end of a five-day strike, the first in the hospital’s history.

The agreement, reached Saturday and ratified by union members late Saturday night, for the first time gives nurses direct input on staffing concerns at the hospital, said Pat Raes, president of Service Employees International Union (SEIU) Wisconsin and also a nurse at the hospital. Raes spoke at a short return-to-work rally Sunday morning outside the hospital.

While it falls short of establishing guaranteed ratios of patients to nurses, Raes said the new two-year contract  establishes a precedent by including  language about staffing concerns.

Wages will go up by 10% over two years, Raes said. She said the wage gain offered “meaningful raises” including 8% across the board and the other 2% for “step increases recognizing our experience and attracting new talent.” 

Raes said the contract also contains  “enforceable language” addressing the safety of health care staff and patients, including a commitment to install a metal detector by the end of the summer.

Staffing concerns and a push for the hospital to guarantee specific ratios of patients to nurses on duty were among the issues that the union stressed in contract negotiations and during the five-day walkout.

In public statements during the contract talks and strike, UnityPoint Health-Meriter officials said they shared the union’s concerns for safe staffing levels but opposed dictating ratios, claiming it would hinder  flexibility to respond to changing conditions.

Raes said the agreement builds on an existing system of committees in which nurses are in charge. “We really felt that was the format for having the staffing discussions and noting where those issues were,” she said Sunday.

The contract also commits the hospital to an annual discussion with the union on staffing concerns and issues, Raes said.

“This was a long and difficult negotiation,” Raes said. “We acknowledge Meriter’s management for ultimately coming to the table and reaching an agreement that prioritizes the needs of our patients and our dedicated professionals. Today, we turn the page.”

The final negotiating sessions were conducted with the aid of a mediator from the Wisconsin Employment Relations Commission (WERC).

“We did not want to walk,” said bargaining committee member Carol Lemke, “but we felt it was the only thing we could do” to get staffing-related language in the contract.

In a statement distributed by UnityPoint Health-Meriter Saturday night after the agreement was announced, Sherry Casali, the hospital’s chief nursing officer, said, “We are grateful for the dedication and hard work of everyone involved in the negotiations. This tentative agreement represents meaningful progress toward a contract that recognizes the important contributions of our nurses.”

Raes said the union is now turning its attention to state legislation lawmakers have reported they are drafting that would establish a state mandate for the ratios of health care workers to patients in health care institutions. 

After five days of large throngs of picketing nurses, the crowd outside the hospital Sunday morning was smaller. The scene was cheerful and celebratory, accompanied by a sense of relief.

Madison Mayor Satya Rhodes-Conway turned out for the 6:30 a.m. return-to-work rally.

“I want to thank you for your courage because I know this wasn’t easy,” she told the nurses.

While she said she was grateful “mostly to the nurses,” Rhodes-Conway also said she was “grateful to management for coming to the table and finally understanding that we are stronger when we collaborate.”

The contract was ratified Saturday night by “a supermajority” of nurses, Raes said. Although the union didn’t release the official vote count, Raes said, “We had more people vote for this contract than we have ever had vote in the past.”

The union pushed to ensure the votes were cast and counted before midnight because the pay increases take effect with the start of the next pay period, Sunday morning.

The timing was also important for another reason. Meriter management told the union and employees that nurses on strike would be removed from the list of active employees effective Sunday, which would end their health insurance coverage.

The union wanted to complete the ratification process Saturday night “so there would not be any issues — there would not be any threat,” Raes said.

“We have nurses that are being treated for long-term health issues that cannot afford to lose their insurance who were out striking, and we have had other ones that felt they had to cross the picket line to not risk their health insurance,” Raes said.

She said she doesn’t expect divisions among members because of those choices, however. “Everybody, all the nurses, will continue to work together and have each other’s back on the floors,” Raes said, “because that is how we have to work.”

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Participants hold candles at a vigil for striking nurses outside Meriter hospital in Madison Thursday evening. (Photo by Erik Gunn/Wisconsin Examiner)

Roughly 150 nurses and their allies gathered at dusk Thursday for a vigil to show support for the strike underway at Meriter hospital in Madison.

The crowd was smaller than the throngs that have gathered outside the hospital during daily picketing and rallies, but the feelings they conveyed were no less intense.

“We’re holding this vigil because beneath the charts, beneath the chants, beneath the signs and beneath the daily strength that it takes to strike is something deeply serious,” said emergency room nurse Shelby Davis. “We’re not just here for better contracts. We’re here for safety, for dignity, for the basic right to care for our patients without risking their lives or our own.”

With the vigil, organized with the involvement of two church pastors, the nurses and their union sought to cast the issues that led to the five-day walkout as a matter of moral principle.

“You are doing holy work,” said Pastor Justin Dittrich of Lake Edge Lutheran Church, opening the vigil at Brittingham Park on Madison’s near South Side, a block from the hospital grounds.

“The strike is not the end, but the beginning of a more just health care system for all people, workers and participants,”  Dittrich added. “We stand with the nurses of Meriter because they are healers, truth tellers, and agents of faith and justice.”

UnityPoint Health-Meriter and Service Employees International Union (SEIU) Wisconsin are in the midst of negotiations for a new labor agreement for about 1,000 nurses who work at the hospital. The nurses union began a five-day strike Tuesday after a bargaining session May 19 ended without a new agreement, and after the union’s bargaining team said management negotiators were not responding adequately to their concerns about staffing levels, hospital security and compensation.

Negotiations resumed Thursday, during which union bargaining team members reported some progress, and continued on Friday.

Among the union’s primary issues in negotiations has been a demand for specific ratios of nurses to patients.

“Even though I work in the ER and not on the floor, I see how staffing levels affect every part of the hospital,” said Davis. “I’ll never forget the one moment during my nurse residency, a new grad was recognized for taking care of seven patients on their own. Seven. That wasn’t a badge of honor, that was a red flag.”

The hospital management has said dictating ratios would interfere with its need for flexibility to respond to changing conditions.

Speakers said the demand is not just in the interest of nurses, but a matter of concern for patients as well.

“Ratios are for us — yeah, absolutely,” said nurse Dara Pierce. “But they’re also for everybody else and I think sometimes that goes unnoticed.”

The fear of violence in the workplace has driven nurses to demand a stronger role in formulating security policy, speakers said, along with measures such as metal detectors.

“We’ve had violent or unpredictable situations come through our doors with just one security guard assigned to ER and no metal detectors,” said Davis. “No one should have to feel unsafe when they’re coming to a hospital and no nurse should be expected to risk their life just to do their job.”

The lingering impact of the COVID-19 pandemic, which began five years ago, continues to weigh on health care workers, nurse Annette Bernas told vigil participants.

“We were considered essential, but let’s be honest, we were expendable,” she said. “We didn’t complain. We showed up. We held hands when family members couldn’t.”

As the pandemic laid bare the importance of health care and health care workers, “we were hopeful that everything we gave would open the eyes of the world to the importance of nurses and support staff,” Bernas said. “But here we find ourselves in a deeper crisis. The burnout is real. Nurses are leaving in waves. PTSD from those years is something we still carry, and yet we’re being asked to do more with less.”

After the speeches the crowd walked behind a large yellow banner, carrying flickering candles from the park to the hospital entrance on Brooks Street.

There Pastor Raymond Monk of Milwaukee offered a benediction. 

“This new course has caused many of you all to make a decision to make sure that your voices are heard and the voices of those who are hurting, their voices are heard also,” said Monk. “I want to encourage you at this pivotal moment in history to continue to defy the norms and to make known to the world that things must change and that things must change right now.”

Faith upholds their cause, he suggested, adding that God “is always on the side of the oppressed.”

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State Sen. LaTonya Johnson (D-Milwaukee) argues Thursday in the Legislature's Joint Finance Committee for including the full budget request from the state Department of Safety and Professional Services in the 2025-27 Wisconsin state budget. (Screenshot/WisEye)

Republicans on the Legislature’s budget committee rejected a proposal Thursday to add permanent staff to the state agency responsible for ensuring that a range of professionals have licenses they need to do their jobs.

Instead, the Joint Finance Committee voted along party lines to extend five contract positions for three more years as well as add a handful of other positions.

The 2025-27 state budget marks the fourth one in which Gov. Tony Evers has been rebuffed after urging lawmakers to increase staffing at the Department of Safety and Professional Services (DSPS) to speed up the agency’s license and permit administration.

There was no debate during the 45-minute meeting Thursday.

All four Democrats on the committee spoke up, either to advocate for their proposal for the agency or to criticize the GOP proposal as inadequate. None of the Republicans, however, made arguments for their plan for DSPS or against the Democrats’ alternative.

In addition to issuing professional licenses in health care, personal services, professions such as accounting or architecture and for skilled tradespeople such as plumbers and electricians, DSPS also oversees a variety of building and other public safety licenses and permits.

Starting more than three years ago, Republican lawmakers raised criticism of the agency amid heavy backlogs in the licensing process for a wide range of professionals.  

Democratic lawmakers — as well as some outside groups representing licensed professionals — have charged the backlog was a result of the Legislature’s failure to authorize more positions at the department.

The department is almost entirely self-funded through the fees it collects from license applications, but the size of its staff requires the approval of the Legislature.  

In the 2023-25 draft state budget, Evers requested 74 new positions at DSPS, but the final spending plan drafted largely by the Republican majority on the finance committee added 17.75 positions.

Evers redirected pandemic relief funds to DSPS to hire more contract workers to help manage the licensing process. In the last couple of years, the backlog has been reduced so that on average a license is issued in two weeks, according to state Rep. Deb Andraca (D-Whitefish Bay), a finance committee member.

In his 2025-27 budget draft, Evers requested 30 new positions at the agency. On Thursday, Democrats on the finance committee proposed adding 31 positions, including 14 to staff the department’s call center serving license applicants and nine additional employees to process license applications.

Authorizing fewer people than DSPS has requested “has a tremendous risk of causing significant delays or or even just making it a little bit harder for people to be able to get their license,” said Rep. Tip McGuire (D-Kenosha). “We want people to be able to get the licenses that they need so they can go to work. We want people to get the renewals that they need so they can continue working.”

State law requires about 10% of the fee revenue from professional licenses in health and business professions to be transferred to the state budget’s general fund.

“We have been pulling funds out of an agency that’s almost basically self-sufficient and dumping the money into the general fund, all while the demand for licenses is exploding,” said Sen. LaTonya Johnson (D-Milwaukee).

Johnson warned the committee that if the licensing process gets bogged down again, shortages in fields such as health care in particular are likely to worsen.

Falling short of funding the department’s full request “impacts every single person in the state, whether you’re a licensee or not,” said Sen. Kelda Roys (D-Madison). “What we are doing is starving that system and making it harder for every single one of us to access needed professional services.”

The Democratic proposal failed on a 4-12 vote, with all the Republicans on the 16-member committee voting against it. 

The Republican measure passed 12-4, with only Republicans’ support.

It extends five contract call center positions that expire Sept. 30 for another three years.

The GOP motion omits three lawyers and three paralegals the department had requested for professional regulation compliance and for the state’s Prescription Drug Monitoring Program.

The motion also transfers $5 million from DSPS revenues to the state budget’s general fund, in addition to the annual 10% from license fees. 

The Republican measure authorizes a consultant for pharmacy inspections that was part of the original budget draft. It also includes funding to continue a youth firefighter training grant that was in the original request and the Democratic proposal.

The committee’s co-chairs, Sen. Howard Marklein (R-Spring Green) and Rep. Mark Born (R-Beaver Dam), released a joint statement later Thursday declaring that “Joint Finance Republicans voted to invest in important government services while holding the line on spending.”

The statement cited funding for DSPS call center staff “to help credential holders and the public navigate licensure platforms” and said the funding “ensures the department can operate effectively and provide these critical services to professionals.”

Immediately after the final vote, however, Andraca told her colleagues that the outcome was a missed opportunity.

“We could be sitting here claiming a bipartisan success story, because today the median time to get a license is only 15 days,” Andraca said. “We should be continuing the success story and taking a victory lap, and instead we’re chipping away the progress that we’ve made — and that’s very disappointing.”

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Flanked by state Sen. Mark Spreitzer (D-Beloit) and state Rep. Lee Snodgrass (D-Appleton), Rep. Christian Phelps (D-Eau Claire) outlines a joint resolution for Pride Month, (Screenshot/WisEye)

Wisconsin Democratic lawmakers are circulating four draft bills and two joint resolutions to address issues of discrimination against members of the lesbian, gay, trans and queer community.

The package was announced just before  Pride Month begins on June 1.

“We celebrate the history of the LGBTQ+ movement and the future of our population, and I can’t think of a more important time to do that,” said Rep. Christian Phelps (D-Eau Claire), at a Capitol press conference Thursday. “Meanwhile in Washington the Trump administration and Republicans here in Wisconsin are engaging in rhetoric and political activity that seeks to erase LGBTQ+ people and target us …  the goal in that rhetoric and in that movement is to make us feel alone.”

Embracing diversity and joining with  allies give the community strength, Phelps said.

“Everybody who is not themselves a member of the LGBTQ+ community knows and loves at least one person in the community. And I think when they shut out all the noise and look inside, they know that they want the best for that person or those people,” Phelps said.

In addition to a joint resolution embracing Pride Month, the Equality Agenda legislation includes measures to:

• Update various Wisconsin laws pertaining to married couples, including laws on adoption and on in vitro fertilization, to ensure they apply to same-sex couples.
• Prohibit “conversion therapy” aimed at changing a minor’s sexual orientation or gender identity and subjecting licensed professionals who practice it to professional discipline.
• Bar the use of a “gay or trans panic” as a defense by persons accused of crimes.
• Provide grants for training school counselors and social workers on LGBTQ+ rights.

Also part of the package is a proposed amendment to the Wisconsin Constitution that would repeal the 2006 amendment declaring marriage to be only between one man and one woman.

The amendment preventing the state from legally recognizing same-sex marriages remains on the books although it was overridden by the 2015 U.S. Supreme Court ruling legalizing same-sex marriage across the country.

“With the 20th anniversary of Wisconsin’s constitutional amendment that banned marriage equality coming up next year,” said Sen. Mark Spreitzer (D-Beloit), chair of the Legislature’s LGBTQ+ Caucus. “It is long past time to give voters the chance to remove that discriminatory language from our constitution.”

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Striking nurses picket outside UnityPoint-Health Meriter hospital Wednesday. (Photo by Erik Gunn/Wisconsin Examiner)

Nurses at Meriter hospital in Madison and the hospital’s management team are returning to the bargaining table Thursday, the third day of a five-day strike over a new labor agreement covering nearly 1,000 union-represented nurses.

The nurses, represented by Service Employees International Union (SEIU) Wisconsin, went on strike Tuesday after their last negotiating session with UnityPoint Health-Meriter on May 19 ended without an agreement.

As nurses rallied and picketed in front of the hospital Wednesday, the issue of staffing requirements was at the forefront of arguments offered by both the nurses and the hospital’s management.

“Let me be very clear, it is not unreasonable to want safe staffing guaranteed in our contracts,” said Carly Dickmann, a Meriter obstetrics, labor and delivery nurse.

“It is not unreasonable to want to feel safe at work and to have a voice in the procedures that impact us and our patients,” Dickmann continued. “It is not unreasonable to want fair compensation for our labor. It’s long past time for management to take us seriously. It’s time that Meriter listen to nurses and come to the table ready to make real, tangible changes to improve the hospital we love so dearly.”

A management position paper distributed Wednesday by the hospital’s communications department asserted that the hospital and the union both “agree that staffing levels are a critical component to safe patient care.”

The paper stated that the hospital’s approach to staffing assignments needed “to remain flexible” so it could move personnel in response to “patient needs and census changes.” It said the hospital would review “the staffing matrix” in four units the union identified as having problems, and that nurses and support staff in the affected units would be included in the process.

At the union’s picket line rally on Tuesday, bargaining team member Amber Anderson said the management proposal fell short.

“Meriter management refuses to put staffing solutions in our contract,” Anderson said, calling the management proposal “a vague promise to review staffing with no timelines, no accountability and no enforceable standards. That is not enough.”

The union has also focused on security and on wages. Union proposals have sought  increases particularly for nurses with the longest tenure, as well as metal detectors in certain areas.

The management paper said average wages would go up by $4.67 an hour over the life of the agreement under the hospital’s proposal, and that Meriter had plans to install weapons screening equipment in its emergency department this summer.

At Wednesday’s picket line rally, striking nurses heard messages of support from Milwaukee Mayor Cavalier Johnson, Milwaukee County Executive David Crowley and U.S. Rep. Mark Pocan (D-Black Earth).

Pocan recalled his visit to Meriter for three clogged arteries seven and a half years ago.

“And I got time to spend in the ICU and other rooms here at Meritor, and I received excellent health care,” Pocan said. “Not because of the comfort of the bed or the colors of the wall, not because of the profitability of the hospital, but because of the staff and the nurses at Meriter.”

Johnson came to Madison because he sees issues in the strike as important “not just for nurses in Madison, but really for nurses all across the state of Wisconsin,” he said in an interview. “When you stand with labor, it’s not just a sometime thing, it’s an all the time thing.”

Strikers also got support from union activists organizing at other area health care employers.

“The people who own the health care industry are running a race to the bottom, where executives try to lower quality of care, increase ratios as much as they possibly can get away with,” said Colin Gillis, who has been active in the effort begun more than five years ago to win union representation for nurses at the University of Wisconsin Hospitals and Clinics in Madison.

“And when they do it here, at the hospital next door, they look at their nurses and they say, ‘Hey, they take six patients at night, so can you,” Gillis said. “Well, you and your nurses are here to say, ‘Heck, No!’”

Dr. Ira Segal, who has been among the employees at Group Health Cooperative in Madison organizing a union, said his coworkers see the Meriter nurses as allies.

“Together, we will persevere and we will shape a future where workers and patients come before profit, and where every voice is heard,” Segal said.

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The Wisconsin Department of Health Services (DHS) website for enrolling in Medicaid and other state benefits programs. (Screenshot)

Among changes to Medicaid tucked in the federal reconciliation bill that passed the U.S. House last week is one that requires participants in the state-federal health plan for the poor to prove they’re eligible every six months.

Wisconsin advocates said Tuesday the provision is likely to reduce Medicaid enrollment — not because people don’t qualify but because of administrative errors and confusion.

Under current state and federal law, people covered by Medicaid must have their eligibility confirmed every year. Eligibility depends on various factors, chief among them household income. People whose Medicaid services are tied to a disability undergo an annual evaluation to determine whether their disability still qualifies them.

“We already do a really good job about making sure that everybody who’s in Medicaid is already eligible to be there,” Tamara Jackson, policy analyst and legislative liaison for the Wisconsin Board for People with Developmental Disabilities, said in an interview.

Checking eligibility more frequently isn’t likely to uncover more people who are enrolled in Medicaid and don’t qualify, Jackson said: “It will lead to a different result because people who are eligible for the program are losing coverage because they didn’t get the paperwork in on time.”

“It’s going to probably result in kicking people off the program — some of it through error and some of it just benign neglect,” said Bobby Peterson, executive director of ABC for Health. The nonprofit is a public interest law firm that assists people navigating the health care system get coverage and address problems such as medical debt.

“It’s part of a blizzard of paperwork to keep people off the program,” Peterson said of the twice-yearly Medicaid eligibility test. “And it’s not necessarily going to be very effective in maintaining program integrity.”

He said Medicaid participants are already required to report changes in their income that could change whether they’re eligible.  

“It’s calculated to deter people from staying with the [Medicaid] program,” Peterson said. “It’ll leave more people out and less people covered, more people uninsured.”

With fewer people covered by health insurance, that could lead to “higher rates of medical debt, higher rates of uncompensated care, and then the socialization and redistribution of all that medical debt onto everybody else’s [health care] bill,” Peterson said. “So, it’s a lose-lose proposition.”

The House Republican majority drafted the reconciliation legislation in order to extend tax cuts enacted in 2017 during President Donald Trump’s first term.

The bill’s tax cuts largely benefit higher-income households, according to the Congressional Budget Office. The bill’s spending cuts to Medicaid and other programs, including federal nutrition aid, were included to reduce the tax cuts’ impact on the federal deficit.

In Wisconsin, about 1.3 million people are covered by Medicaid, according to the state Department of Health Services (DHS). About 900,000 are enrolled in BadgerCare Plus, which provides primary health care for families and single adults with incomes below the federal poverty guidelines. Another 250,000 are in one of several Medicaid programs for long-term care for people with disabilities or the elderly, and the rest are in other specialized programs.  

The change in how often Medicaid recipients must qualify for the program is just one of many changes in the program under the House reconciliation bill.

In a report produced in late April before the bill’s passage, the state Department of Health Services (DHS) calculated that its proposed Medicaid changes could cost Wisconsin up to $16.8 billion over the next date.

Current federal Medicaid regulations forbid states from determining a person’s eligibility more often than once a year. The House reconciliation bill would effectively override that rule.

A requirement to check every Medicaid recipient’s eligibility twice a year was part of state legislation that Wisconsin Republican lawmakers introduced earlier this year. That bill was met with sweeping criticism at a public hearing in April and has not advanced in the state Legislature.

Supporters of the change have argued that more should be done to reduce fraud in  the Medicaid program. But health care experts contend that the Medicaid cuts in the House bill are unlikely to address genuine fraud.

During the COVID-19 pandemic, the federal government temporarily suspended the annual Medicaid renewal requirement to ensure that people had health coverage and would seek medical help if they felt sick.

“Obviously if there’s a public health emergency, you want to maintain connections and access to health care and coverage,” Peterson said. Some people may have been still covered under Medicaid after they were no longer eligible, he added, and some “didn’t even know they had Medicaid or BadgerCare Plus in addition to some private insurance at various times.”

Nevertheless, “it wasn’t like there was wide-scale fraud” in the Medicaid program, Peterson said. “There’s very little evidence of a lot of consumer-related fraud in the program.”

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Striking nurses and supporters circle the UnityPoint Health-Meriter hospital in Madison on the first day of a five-day walkout Tuesday. (Photo by Erik Gunn/Wisconsin Examiner)

With a spirited rally, a picket line march around the building and a small brass band, nurses at UnityPoint Health-Meriter hospital in Madison launched a five-day walkout Tuesday, reiterating their demands for changes in safety practices, minimum ratios of nurses to patients and improved pay.

The strike — the first ever by nurses at Meriter hospital — is scheduled to run through Saturday. It follows the end of bargaining on Monday, May 19, when the nurses’ union bargaining team turned down the hospital management’s latest proposal.

Services Employees International Union (SEIU) Wisconsin and UnityPoint Health-Meriter have been in negotiations since earlier this year on a new contract covering about 950 nurses. The nurses’ most recent two-year agreement expired in late March and they have since been working without a contract.

The nurses’ contract demands include establishing required ratios of nurses to patients, improved safety for hospital employees and pay increases — particularly for senior nurses, according to union officials.

“Time and time again, Meriter’s management refused to meet us halfway,” said nurse Lindsey Miller, one of three bargaining team members who spoke at the strike’s opening-day rally Tuesday morning. “At our last bargaining session, it was management, not nurses, who walked away from the bargaining table.”

Miller said the most recent management officer included “an unacceptable raise that doesn’t cover the cost of living” and made “no progress” towards the nurses’ union’s demands for staffing commitments or security improvements.

“I am striking because I love working here,” said Madison Vander Hill, a birthing center nurse and one of six union speakers at the rally. “I love getting to walk alongside and care for families as they go through one of the most transformative experiences of their lives.”

Vander Hill said she and other nurses were striking “because we must see tangible change from management in order to ensure that safety and security are prioritized and the things we love about the work that we do are protected.”

Her coworker, Audrey Willems Van Dijk, said the nurses’ concerns extended to concerns for the hospital’s patients.

“We are fighting for every single person who walks through Meriter’s doors,” she said. “Yes, we deserve adequate compensation, but more than that, we deserve safety and security for ourselves and our community. We deserve respect.”

Dane County Executive Melissa Agard declared her support for the nurses and connected their dispute with former Gov. Scott Walker’s signature legislation after he took office in 2011 — Act 10, stripping most public workers of most union rights.

“It was his mission to crack the foundation of union rights in the state of Wisconsin. And that crack has continued not only in Wisconsin but across our nation, and you guys are here to say, ‘No more,’” Agard said.

As the strike got underway this week, Meriter told nurses that health benefits — including health insurance — would be cut off as of June 1 for nurses who do not report for their first scheduled shift during the strike this week.

A union spokesperson said the effect of the order would be to cut off benefits for strikers for the month of June if the two sides don’t reach a tentative agreement on Thursday, when their next bargaining session is scheduled.

Meriter spokesperson Nicole Aimone confirmed in an email message Tuesday that nurses who do not report for their first shift during the strike will be put on “inactive status” through Sunday, June 1, with their benefits ending as of that date.

Nurses whose benefits are cut off would have to use the federal law known as COBRA to maintain their coverage, paying for their insurance out of pocket. The law, enacted in the 1980s, enables fired or laid-off workers to maintain their employer’s health insurance temporarily at their own cost.

“They will have the ability to re-enroll once they are placed back into active employee status,” Aimone said.

The union has filed an unfair labor practice charge with the National Labor Relations Board over the hospital’s action.

“It is outrageous and it is disgusting,” said Ben Wikler, the outgoing chair of the Democratic Party of Wisconsin, addressing the rally. Wikler went on to lead hundreds of sign-carrying nurses and supporters in chanting, “Union busting is disgusting!”

“When management says you’ll lose your health insurance if you insist that there [should be] enough nurses on the floor to make sure that everyone is taken care of — it is disgusting,” Wikler said.

He described the dispute in the larger context of President Donald Trump’s return to the White House.

“They think that the Trump administration and the National Labor Relations Board that this administration has gotten is going to turn its back on working people,” Wikler said.

“They will still have to come back to the negotiating table and they will have to do what’s right, because you are building the power to make them do what’s right,” he added.

The hospital is continuing to operate during the strike. Aimone said that the hospital has contracted with an outside agency for replacement “travel nurses” to support ongoing patient care.

She said she did not have information on the cost for the contract nurses who are filling in during the walkout.

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In a 5-2 ruling the Wisconsin Supreme Court kept alive a woman's lawsuit against a doctor who had recommended surgery to another doctor that was performed on the woman without her knowledge. (Photo by Henry Redman/Wisconsin Examiner)

A patient whose ovaries were removed without her knowledge during colon surgery can sue the doctor who she says recommended the procedure, the Wisconsin Supreme Court ruled Friday.

In the opinion, five of the Court’s seven justices agreed that lower courts were correct when they refused to dismiss the patient’s lawsuit. With the ruling, the case is sent back to Rock County Circuit Court.

The patient, Melissa Hubbard, was being treated for endometriosis in 2018 by an obstetrician/gynecologist, Dr. Carol Neuman. During the time, Hubbard also was referred for surgery to remove a section of her colon.

The surgery was performed by Dr. Michael McGauley. During the procedure, Hubbard’s ovaries were removed, but she wasn’t told beforehand that would be part of the operation.

Hubbard initially sued McGauley, but that lawsuit was dismissed. She subsequently sued Neuman, charging that — without telling her — the OB/GYN had suggested to McGauley that he remove Hubbard’s ovaries during the colon surgery.

The lawsuit charges that when Neuman made the recommendation to McGauley, she violated Hubbard’s right to informed consent under Wisconsin law.

Neuman’s lawyers filed a motion in Rock County circuit court to dismiss the lawsuit on saying that, in the context of the surgery, Neuman was not Hubbard’s “treating physician” under the informed consent law.

Neuman’s lawyer argued that because the state law’s informed consent requirement applies to the “treating physician,” Hubbard had no case against Neuman since she did not perform the surgery and she never gave a formal order to the surgeon to remove Hubbard’s ovaries.

The circuit court judge denied the dismissal motion, and the state 4th District Court of Appeals agreed.

With Friday’s opinion, the Wisconsin Supreme Court also denied the motion to dismiss the case.

“We disagree with Dr. Neuman,” Chief Justice Anne Walsh Bradley wrote on behalf of the majority. “The essence of the inquiry is whether Hubbard’s complaint sufficiently alleges that Dr. Neuman was a ‘physician who treat[ed]’ Hubbard, even though she did not actually remove Hubbard’s ovaries herself. We conclude that it does.” 

Bradley was joined in the majority by Justices Rebecca Dallet, Brian Hagedorn, Jill Karofsky and Janet Protasiewicz.

According to the opinion, the complaint depicts “Neuman’s intimate involvement with the removal of Hubbard’s ovaries” — first, diagnosing Hubbard with a severe case of endometriosis and then advising her to consider removing her left fallopian tube and ovary.

“Second, after Hubbard agreed to undergo colon surgery, Dr. Neuman allegedly helped plan the surgery with Dr. McGauley,” Walsh Bradley wrote. “The physicians’ pre-surgery discussions and plans included Dr. Neuman’s plan to attend and participate in Hubbard’s surgery and to remove Hubbard’s ovaries herself. Hubbard also alleges that Dr. Neuman recommended to Dr. McGauley that he remove Hubbard’s ovaries.”

Those allegations in the lawsuit are enough to consider Neuman a treating physician in the case, Walsh Bradley wrote.

Justice Annette Ziegler, joined by Justice Rebecca Bradley, disagreed. 

“To be a treating physician under [the informed consent statute], the physician needs to either provide the treatment at issue himself or formally order the treatment at issue,” Ziegler wrote, citing the text and history of the law along with “the decisions of courts across the country that have addressed who qualifies as a treating physician.”

While Hubbard never told Neuman she wanted her ovaries removed and never consented to their removal in the surgery, Ziegler wrote, “the complaint never expressly alleges, nor reasonably implies, that Dr. Neuman performed or participated in the surgery or attended the surgery.” 

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State Sen. Kelda Roys, holding her toddler, speaks about legislation Democrats are proposing to provide ongoing funding for child care providers. (Photo by Erik Gunn/Wisconsin Examiner)

Democratic lawmakers are circulating a draft bill to extend the soon-to-end state child care support program and fund it with $480 million that was stripped from the 2025-27 state budget.

The proposed legislation follows action earlier this month by Republican lawmakers to remove child care support and more than 600 other items that Gov. Tony Evers included in his draft budget.

Both Evers’ proposal and the Democrats’ bill aim to continue support that child care providers have been receiving since 2020 as part of federal pandemic relief.

“This funding has been essential in continuing successful programs that support our early educators, child care providers, parents, and most importantly, our kids,” said state Rep. Alex Joers (D-Middleton) at a Capitol news conference Thursday announcing the legislation.

The $20 million that Wisconsin paid out each month to providers through mid-2023 “kept our early educators in the workforce, held tuition down for parents and provided a direct investment in our children during the most crucial years of their childhood development,” Joers said.

Payments were cut to $10 million a month in June 2023, and the last of those funds will be paid out by early July.

“But with this impending deadline, child care providers and early educators are faced with the impossible decision to either raise rates or have to close altogether,” Joers said. “Without assurance of this funding lifeline, many have already made that decision and have devastatingly shut their doors forever.”

Citing recent reports, Joers said that there are 48,000 children on waiting lists for child care in Wisconsin. In a survey of providers, 78% said they would have to raise fees for infant care — the most expensive age group in most child care programs.

“Altogether, if nothing changes, parents are looking at having to find an additional up to $2,600 in their yearly budget,” Joers said.

First-term Sen. Sarah Keyeski (D-Lodi), the lead state Senate author on the legislation, said that when she was running for office last year, voters repeatedly shared their concerns about the cost and scarcity of child care.

“We have historically undervalued and underpaid child care and early education professionals,” Keyeski said. “This is no longer tenable.”

She described the plight of one constituent who had to change providers three times after the first and then the second provider went out of business because of financial difficulties or other constraints. The mother told her that her current provider — the third — had rates that are “at the top” of what the family could afford.

Keyeski said the provider has told the woman that unless the state can continue with its support, the center’s rates will go up $40 a week, or $160 a month. For the couple, “this increase is unsustainable,” she said. “Her family is left wondering, what to do next?”

Wisconsin’s rural communities have been especially hard hit, she added: In 70% of them, there are three or more children for every child care opening.

“In my district alone, over 34,000 children need care, but there are only about 26,000 available slots,” Keyeski said.

Child care should be viewed as essential infrastructure, said state Rep. Renuka Mayadev (D-Madison).

“And as a state, we support infrastructure. We maintain roads, we maintain bridges. Why is funding childcare such a fight?” Mayadev said.

Wages of less than $14 an hour are driving child care workers out of the field, she added. “There is no other industry where such high value work is being done at such dismal low wages.”

Sen. Kelda Roys (D-Madison) — accompanied by her toddler son before she took him to his child care provider near the Capitol — said the legislation calls for $480 million in state funds over the next two years.

“But I think the real question is what it will cost the state if we don’t do it,” Roys said. She forecast “continued massive closures” of child care centers.

“Already over 60% of child care providers have classrooms sitting empty or slots that can’t be filled because they don’t have the teachers to fill them,” she added.

Roys said child care was a critical need in order for the state to address persistent shortages of people to fill jobs.

“In critical areas like public safety, in K-12 education, in health care — what is it going to mean if the parents of even more kids can’t get child care?” Roys said. “We can’t afford that. We have to make this investment.”

Changes a U.S. House bill makes to the federal program known as FoodShare in Wisconsin would increase costs for the state, the state Department of Health Services (DHS) reports. (Getty Images Creative)

Food and nutrition cuts in the reconciliation bill that passed the U.S. House early Thursday would cost Wisconsin taxpayers at least $314 million if they are signed into law, a state health official said Thursday.

A requirement for the state to pick up some of the costs of the federal Supplemental Nutrition Assistance Program benefits, a provision penalizing the state for errors in distributing benefits, expanded work requirements for recipients and the elimination of a nutrition education program will all contribute to that cost, said Bill Hanna, Medicaid director at the Department of Health Services (DHS) in a briefing for reporters Thursday afternoon.

The SNAP program is known as FoodShare in Wisconsin and administered by DHS.

SNAP currently includes a work requirement for adults ages 18 to 54 without children to receive benefits. The legislation would raise the upper age to 65 and add the requirement to adults with children who are 7 or older.

Wisconsin has an employment and training program to help FoodShare recipients meet the existing work requirement. With the increase in people who would have to meet the requirement, “We estimate that would cost another $44 million a year,” Hanna said.

Currently the federal government funds 100% of the food benefits under SNAP. The new bill requires states to pick up a portion of the cost, which is tied to a state’s error rate, Hanna said. Errors include the payment of more benefits than a person qualifies for or the payment of fewer benefits than they qualify for.

“When errors are identified, we correct them, meaning if there was an overpayment to a member, that is recouped on future benefits, or if there’s an underpayment, we fix that and back pay those payments,” Hanna said.

Wisconsin’s error rate is low enough to require the state to submit only a 5% match for SNAP funds under the House Republican proposal, he said. But another change — which would allow zero tolerance even for errors that in the past have not counted against state programs — would boost the state’s required match to 15%.

DHS estimates based on the proposed new requirements the state would have to pay about $207 million a year in benefit costs, he said. If the state is able to reduce its error rate to qualify for the 5% match, it would still need to pay $69 million a year.

A higher state share of administrative costs in the bill would add $51 million to the state’s costs for SNAP, Hanna said.

The state would also lose the $12 million it receives for SNAP-Ed, a program that provides education to SNAP participants on healthier food choices.

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From left, parents Jessica Seawright and Brooke Wampole talk with Sen. Tammy Baldwin about their concerns over the impact of Medicaid cuts on families with children such as theirs who have disabilities. (Screenshot/Zoom)

As members of Congress continue to debate the Republican budget reconciliation bill that includes hundreds of billions of dollars in cuts to Medicaid, Jessica Seawright ponders what that could mean for her young son.

Seawright is a social worker in Southeast Wisconsin. She’s also the mother of a 9-year-old boy with complex medical needs resulting from a genetic condition.

She and her husband — a college professor — have medical coverage through work, but with her son’s condition, which includes cerebral palsy, their health plans could never cover the degree of care he requires.

Medicaid has made the difference, Seawright said Wednesday. It’s helped through the Katie Beckett  program, which enables children with disabilities to have Medicaid coverage while living at home instead of being in an institution; the Medicaid children’s long-term support coverage; and Medicaid support that public schools receive to cover certain services that students with disabilities require.

Her son has been able to thrive living with her and her husband, Seawright said — but worry clouds the future.

“We look toward his adulthood, knowing that disability and aging programs that would support him staying in the community — where we, our family and our community, know he belongs — are being dismantled and defunded,” Seawright said. “Forcing us and others like us into medical bankruptcy is not a solution.”

Seawright was one of two parents who said Wednesday that their lives and their children’s lives could be profoundly upended by the Medicaid reductions that are included in the budget reconciliation proposal.

They spoke during a webinar conducted by Sen. Tammy Baldwin (D-Wisconsin), who has been an outspoken critic of the budget bill’s Medicaid cuts.

“Our neighbors, our friends and our colleagues at work who rely on Medicaid and are scared, really scared,” Baldwin said. She cited estimates produced by Democrats on the Joint Economic Committee that with cuts to Medicaid as well as to the Affordable Care Act, the legislation could reduce health care for nearly  14 million Americans, including almost 230,000 Wisconsin residents.

The money saved, she added, would be used to extend and expand tax cuts enacted in 2017, during the first Trump administration. The Center on Budget and Policy Priorities has said the tax cuts primarily favor the wealthy and corporations.

“It’s giveaways for their wealthy friends at the cost of Americans’ health and lives,” Baldwin said. “That’s the deal.”

Baldwin said the choice that U.S. House Republicans made to advance the bill in committee in the early hours of Wednesday morning was a sign that “Republicans know what they’re doing is deeply unpopular.”

She dismissed claims that the objective of the bill’s authors was to address waste, fraud or abuse in Medicaid and other safety net programs.

“I would be happy to come to the table to write a bill that truly gets at fraud and abuse,” Baldwin said. “We want that out of Medicaid. We want that out of Medicare. But that is not what this bill does. This bill terminates health care for Wisconsin families.”

Besides being a mother of a child who has been helped by Medicaid’s programs, Seawright has experienced Medicaid through two other lenses.

When she and her sister were growing up, their mother was relying on Medicaid for the family’s health care. That helped give the family stability so that her mom could go to community college, become a medical assistant and get full-time work in health care with insurance through her employer, Seawright said.

In her own job as a social worker, she added, some of the clients she works with have Medicaid.

Both her childhood experience and her role as a mental health provider have made her critical of proposals to cut Medicaid, Seawright said — especially one to add work requirements as a condition for adults considered “able-bodied” to enroll in Medicaid.  

“Creating more barriers for people to access the care they need … individuals losing their primary care providers and their specialists, from my perspective, is just a cruel response that is steeped in distrust of those of us who are doing the work day to day,” Seawright said.

Also on the webinar was Brooke Wampole, who lives in northern Wisconsin. She and her husband have a 4-year-old son who was found to have long delays in his development.

About two years ago he was screened and qualified for services and therapies covered by Medicaid programs for children with disabilities, and over time, his clinicians helped him first to “exist, to self-regulate, to see the world around him and not find it to be a threat,” Wampole said.

The family’s regular health insurance “could never cover the cost” those treatments required. “ Medicaid programs “have been absolutely instrumental in our lives.”

In the last year, her son has begun speaking one-syllable words. “My favorites or Mommy and Dada,” Wampole said, then added with a smile, “however, he is pretty partial to talking about trapezoids. And raisins.”

The thought of losing Medicaid coverage “is terrifying,” Wampole said — both because of the loss of services for her son, but also because of its impact on other families.

“I worry what our world looks like without Medicaid,” Wampole said. “Other families, they could be way worse off … and cutting Medicaid could hurt them even more than my family. I don’t want to be part of a system that contributes to that.”

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SEIU Wisconsin and UnityPoint Health-Meriter hospital will meet May 29 to resume contract talks covering 950 nurses. But the hospital management and the union have given conflicting accounts about plans for earlier negotiations. (Wisconsin Examiner photo)

SEIU Wisconsin and Meriter hospital management confirmed Wednesday plans to meet on Thursday, May 29 to resume negotiation on a new contract covering about 950 nurses.

Talks ended Monday without an agreement, and the union said it would go forward on Tuesday, May 27, with a five-day strike.

On Wednesday, however, the two parties gave contradictory accounts of the conclusion of their talks and the prospect of further negotiations before the walkout begins.

In Meriter’s initial statement on Tuesday after the strike was announced, the hospital reported that a bargaining session was scheduled for Monday, May 26.

In a statement Wednesday, however, the union bargaining committee said they had never scheduled talks for that day.

UnityPoint Health-Meriter issued an updated statement Wednesday asserting that “SEIU Wisconsin notified Meriter on Tuesday that they are no longer available to meet on May 26 and are now offering May 29 as their first available date to resume negotiations.”

The management statement quoted Meriter’s vice president of human resources Shana Wuebben: “SEIU Wisconsin has declined the bargaining session previously set for Monday, May 26 and has rescheduled bargaining sessions to Thursday, May 29 near the end of the 5-day strike period,” Wuebben said.

The bargaining committee flatly disputed the characterization that the Monday date had been agreed to.

“There was no agreement between the parties to meet on Monday May 26,” the committee’s statement said.

In the hospital’s statement, Wuebben said, “Meriter is listening. We have made great strides in our proposals and tentative agreements to date.  And we are ready to continue bargaining.”  

The union, however, charged that management — not the union — was responsible for ending the talks Monday.

“At our last bargaining session on Monday May 19, the union bargaining committee offered to stay as late as needed to reach an agreement,” the bargaining committee statement said.

“The union was clear that management needed to make movement on our core priorities — priorities we have been crystal clear about since Day 1 — in order to avoid a strike,” the committee said. “Instead of engaging in discussions about our priority issues, management chose to end the bargaining session.”

Wuebben reiterated that Meriter’s management negotiators are “ready to return to the bargaining table at any time.” 

The union statement said bargaining team members are also ready to return to the table, but said they would need to see evidence that management was willing to move on their issues relating to staffing ratios, stronger hospital security and compensation.

“The union bargaining team has consistently made themselves available to meet with Meriter management, and we will continue to do so,” the union statement said. “If Meriter management would commit to make meaningful movement on our priority issues before the strike, we would consider scheduling a meeting with them before Tuesday May 27.”

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Pat Raes, a Meriter hospital nurse and president of SEIU Wisconsin, addresses union nurses and their supporters at a rally April 8, 2025. On Tuesday the union announced it would strike starting May 27. (Photo by Erik Gunn/Wisconsin Examiner)

Nurses at Madison’s Meriter hospital plan to walk off the job for five days starting Tuesday, May 27, after negotiations on a new union contract ended Monday night without an agreement.

The hospital management and Service Employees International Union (SEIU) Wisconsin, which represents about 950 nurses at the hospital, are divided over pay, security provisions and whether the hospital should commit to specific ratios of how many patients are under a nurse’s care.

If the strike goes forward, it is scheduled to last for five days, with union members returning on Sunday, June 1.

Update: In a statement Tuesday, Meriter said there was a bargaining session scheduled for Monday, May 26, the day before the strike is scheduled to start. An SEIU Wisconsin spokesperson said Wednesday that the union never agreed to that session, and that a bargaining date has been scheduled for Thursday, May 29.

In order to allow hospitals to secure temporary replacement staff or move patients, federal law requires hospital workers to give at least 10 days notice before striking, which SEIU Wisconsin gave May 9. The union also opted for a fixed duration for the walkout.

“We don’t take going on strike lightly, but we truly feel in order to make the changes that are necessary we’re willing to fight to make things safe for our patients,” said Pat Raes, a long-time Meriter nurse and also president of SEIU Wisconsin, in an interview May 14.

“We’ve called a five-day strike because our goal isn’t to walk away from the table — it’s to make UnityPoint Meriter finally hear the voices of nurses,” Raes said Tuesday. “This timeline reflects the urgency of our demands while giving the hospital every opportunity to return to negotiations in good faith.”

She said the five-day window was chosen to match the standard five-day contract used by health care staffing agencies, such as would be called to cover the striking nurses, “to send a strong, clear message without unnecessary disruption to patient care. We hope Meriter uses these five days to come back with real solutions.”

The hospital, UnityPoint Health-Meriter, is one of 17 regional hospitals in the large, Iowa-centered nonprofit health care chain, UnityPoint Health.   

“We’ve been in a union environment for decades and know that a strike could happen. We always work very, very hard to avoid that,” said Sherry Casali, market chief nursing officer for the hospital, in a statement released to the press Tuesday. “I think both parties would prefer not to have a strike.”

The hospital statement said Meriter’s management was disappointed there were not more talks prior to Monday. “Meriter leadership will remain available throughout this week to return to the table and we encourage SEIU to do the same,” the statement said.

In past years, the union and the hospital have worked with federal mediators during contract talks. This year federal mediation wasn’t available after President Donald Trump issued an executive order in March gutting the Federal Mediation and Conciliation Service (FMCS), nursesan independent federal agency.

Although that order was blocked by a federal judge May 6, the union and hospital turned instead to the Wisconsin Employment Relations Commission.

Defined patient-nurse ratios have been a longtime goal for union nurses. California and Massachusetts both have state laws setting certain minimum ratios, according to  NurseJournal.org. A limited number of other states require hospitals to publish their nurse-to-staff ratios.

“The more patients you take care of once you get above that ratio puts every patient that you’re taking care of at higher risk for complications and higher risk for mortality,” Raes said.

The statement the hospital issued Tuesday acknowledged that “both parties agree on the importance of safe and effective staffing,” but said that mandated ratios “limit flexibility” and could make it more difficult “to adjust to patient needs and staff availability in real time.”

The hospital statement said the facility relies on its charge nurses, who “are key to staffing and have clear avenues to discuss any patient care needs throughout each shift.”

There are limits to flexibility, however, according to the members of the nursing staff. Flexibility “sometimes works and sometimes doesn’t,” said Amanda Husk, a postpartum nurse. “We just know there’s always a base need for nurses to make sure patients are safe.”

Husk said ensuring that the ratio of nurses is always sufficient “also prevents burnout and turnover of nurses. That’s a big deal.”

Raes said nurses also wanted stronger security measures — including metal detectors — in light of violent incidents at hospitals across the country that have led to injuries or deaths of health care workers.

The hospital’s statement said its security staff regularly updates security measures and plans additional unspecified changes this summer.

On pay, Raes said that while nurses in their first 12 years have had significant raises, those at the upper end of the scale for pay and longevity don’t see their pay keeping up.

The shift to a 401(k) retirement plan from a standard pension has diminished the incentive for more experienced nurses to stick around, said Raes, while the original pension plan encouraged longevity on the job.

Meriter’s statement said the hospital’s most recent pay offer would keep its nurses “some of the best-paid nurses in Wisconsin” as well as in Madison. 

This report was updated Wednesday with new information about when upcoming bargaining is to take place. 

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Randy Bryce in a still from the video for his 2026 Congressional campaign. (Bryce campaign photo)

Randy Bryce, the former iron worker who ran unsuccessfully for Congress in Wisconsin’s First District in 2018, is taking another shot at the seat, focusing again on a pitch for voters to send an everyday worker to Washington.

Bryce announced Tuesday he would seek the Democratic nomination to run against Republican incumbent Bryan Steil in 2026.

Bryce said he expects the top issues in the race to be preserving Social Security and other safety net programs, resisting  President Donald Trump’s steep tariffs and attacks on immigrants and pushing back against the general climate of fear as Republicans enact the Trump agenda. 

“I cannot sit and just watch this happen,” Bryce said in an interview Monday. “And with Trump it’s even worse now, with people literally being afraid.”

Bryce’s first 2026 campaign video, launched Tuesday morning, hearkens back to the 2018 campaign, when “one man stood up to Washington,” in the words of the opening narration. “He’s not a politician or a billionaire. He’s something much more rare in Congress, someone who actually works for a living.”

The video puts Trump and his policies front and center, and it depicts the 2026 campaign as finishing a job that Bryce began in his first run for the seat.

When the president’s image first appears, the narrator says, “as old enemies come out of the shadows…” A follow-up shot shows a welder — Bryce — in a darkened workshop, and the narrator says, “we need him one more time.”

“I’ve never left the job unfinished,” Bryce tells the camera. “For 20 years, I’ve helped build Wisconsin with these hands while they shipped our jobs overseas. I stayed right here fighting for working families. Trump promised to bring manufacturing back. Eight years later, we’re still waiting.”

Bryce made national headlines with the 2018 race — a  campaign he launched the year before with the intention of running against the district’s 20-year incumbent, then-U.S. Rep. Paul Ryan.

Ryan, who by then was U.S. House Speaker, unexpectedly declined to run for an 11th term however. Since then Bryce has claimed credit for having “chased Paul Ryan out.”

Steil, a corporate lawyer who was once a Ryan congressional aide, ran in Ryan’s place after handily overcoming five primary election challengers.

Bryce’s campaign was widely seen as energetic and novel for the district, which has been in Republican hands since the 1994 election. With the exception of Rob Zerban in 2012, Ryan’s Democratic challengers since 2004 garnered only about a third of voters, ranging from 30% to 37%. In 2018, Bryce finished with 42%. Since that election, Democrats have cleared from 40% to 45% in the 1st CD.

Since that campaign Bryce has headlined a fundraising operation raising money for progressive political candidates, many of them with working-class backgrounds akin to his.

Bryce is entering the 2026 campaign midway through the first year of a Trump term. Progressive and Democratic Party groups who asked if he would run again pointed out that his last campaign had roughly the same timing in Trump’s first term, Bryce told the Wisconsin Examiner, and the decision to run has “been gradually building.”

Cuts to the Veterans Administration is another issue that helped push him to run, said Bryce, a U.S. Army veteran. The agency is one of several that have been disrupted by the DOGE operation (the “Department of Government Efficiency,” although it is not an official U.S. government department) that until recently was run by billionaire and Trump supporter Elon Musk.

The campaign video plays up Bryce’s longtime social media nickname, “IronStache” — trading on the thick mustache he has sported for decades. While it shows flashes of Steil’s face and includes snippets of voters who are criticizing the incumbent, neither the narration nor Bryce mention the incumbent by name.

In the interview, Bryce said in addition to working with the union and grassroots progressive groups that rallied behind him in his first race, he would make an appeal to disaffected Trump voters who are being harmed by current federal policies.

“I want to go places where Democrats normally haven’t gone,” he said. “I want to bring more people together.”

Steil is “listening to his leadership [in Congress] and his donors, he’s not listening to the people that voted for him,” Bryce charged. “And he’s not doing anything to stand up to Trump. The Constitution was drawn up to stop somebody like Trump. But Congress isn’t doing their job. They’re helping enable whatever Trump wants to go on.”

Brynne Schieffer is a child care provider in Cameron, Wisconsin. She addressed a gathering outside the state Capitol on Friday, May 16, 2025. (Photo by Erik Gunn/Wisconsin Examiner)

After a week at the state Capitol to draw attention to their demand for a robust state fund for child care providers, advocates will spend the next couple of weeks back home to amplify their message.

Child care centers will reopen this week after closing their doors for all or part of the past week as providers sought to underscore the urgency of additional support for child care.

Providers will focus on raising more awareness in their local communities, said Corrine Hendrickson, co-founder of Wisconsin Early Childhood Action Needed (WECAN), a coalition of providers and parents. Federal pandemic relief money that has bolstered providers since 2021 will run out completely by early July.

This week, WECAN is encouraging providers to do “larger [local] community actions to help inform the community,” Hendrickson told the Wisconsin Examiner. “We’re also going to be calling other child care programs, making sure they even know this funding’s ending.”

WECAN organized the week of action in Madison, calling it “State Without Child Care.”

A small group of providers shut down for the week to dramatize the loss of child care that they contend will be inevitable without strong state support. Others closed for a day or two, and still others opted to stay open while also endorsing the funding demand.

Earlier this month leaders of the Legislature’s Joint Finance Committee removed a $480 million child care funding provision from Gov. Tony Evers’ proposed 2025-27 state budget, along with more than 600 other items.

On Friday, Hendrickson and WECAN cofounder Brooke Legler were joined by parents and other providers in front of the Capitol to reiterate their case for restoring the funds.

“My family still currently pays 25% of our monthly income towards child care, and honestly that’s just after-school care and then summer camps,” said Katy Dicks of Sun Prairie, who has a 10-year-old daughter and a 6-year-old son. When the children were younger, child care accounted for a third of the family’s income, she said — while “it has been suggested that 7% of a family’s income is what is affordable.”

Dicks leads the Wisconsin chapter of Mother Forward, a national advocacy group for child care, paid family leave and other policies to support families.

“We need policy that works for all families,” she said. “The quality of care for children approximately 3 months to 5 years should not be based on a child’s parents’ income.”

Also at the Capitol were Rochelle Navin and her husband. They have a 2-year-old daughter, and Navin is expecting twins. Their daughter is usually at Legler’s New Glarus child care center, The Growing Tree, while her parents work, but they juggled home care arrangements to support Legler’s decision to close the center for the week.

Navin told the Wisconsin Examiner it was disruptive to their routine, but the couple understood why Legler took that step.

“There’s two sides of it, right?” Navin said. “You fully understand why it’s gotten to this point, and why the extreme [response] needed to be taken, while at the same time being scared about what the future looks like.”

Evers’ proposal was to extend the Child Care Counts program, originally funded by federal pandemic relief money. The subsidy — originally $20 million a month, then cut back to $10 million a month in mid-2023 — enabled providers to raise wages without having to increase the fees parents pay for care.

A statewide survey conducted by the University of Wisconsin-Madison Institute for Research on Poverty found that 25% of providers said they might close if the revenue isn’t replaced.

Hendrickson said in the coming weeks she and other providers who have been active in campaigning for the support will reach out to operators with messaging guidance for talking to parents as well as to their local lawmakers.

“This week was definitely about coming together as a group in solidarity and really standing up for ourselves and for our children and our families and our communities,” Hendrickson said Friday.

Over the course of the week at the Capitol, “we visited almost every single office, dropped off information, talked to staffers and really helped them see who it is that they’re hurting,” she said.

The providers who engaged in those conversations also aimed to show legislators “that their constituents actually know what they’re talking about — we know what we’re talking about with our businesses, we can speak to it and the reason why we need the funding, and it’s not a handout,” Hendrickson added.

In the Institute for Research on Poverty study, up to 40% of rural providers said they might close if the additional funding stops. That’s  nearly twice the projected closure rate of urban providers.

Brynne Schieffer operates a child care program in the community of Cameron, near Rice Lake in Northwestern Wisconsin.

“I have spent the entirety of my adult life caring for not only my own children, but other people’s children, raising them, raising them to be kind human beings that will hopefully one day go out and be carers themselves,” Schieffer told the group gathered on the Capitol steps Friday.

“The funding runs out in July, and to avoid closure we have to raise our rates between $35 and $50 per child per week. Whose pocketbook can handle that?”

Hendrickson told the Wisconsin Examiner that if rural providers have to raise their rates, they’re more likely to lose families who can’t afford the increase, with no one to replace them. In cities, she said, moderate- and low-income families will be hurt by the loss of child care, but there are likely to be more high-income families able to keep up with rising costs, so fewer providers would have to close.

All but one of the providers who made the trip to Madison last week were from rural communities around the state, Hendrickson said.

“People drove four or five hours to get here,” she said. “It’s because they don’t feel listened to [back in their districts]. And that’s what they said — ‘I’ve had to come all the way down here to get them to listen to me.’”

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A solar power array. Advocates say projects that help speed the conversion to clean energy, such as solar power, could be stymied by a U.S. House proposal to repeal clean energy tax credits. (Photo by Evan Houk/Maine Morning Star)

The tax cut legislation that U.S. House of Representatives Republicans are putting together in Washington includes measures that will cost thousands of jobs in Wisconsin and undercut the state’s progress toward cleaner energy, according to environmental and labor advocates.

To help pay for the extension of tax cuts enacted in the first Trump administration, the GOP-led House Ways and Means Committee is proposing to repeal clean energy tax credits, Politico reported this week. The tax credits were among the measures enacted in the 2022 Inflation Reduction Act (IRA).

“These credits are not just numbers on a balance sheet out in Washington D.C,” said Emily Pritzkow, executive director of the Wisconsin Building Trades Council, in an online press conference Wednesday. “They are representing real jobs, real economic growth, and real progress towards Wisconsin’s sustainable energy infrastructure. Since the IRA was signed into law in 2022 we have seen an unprecedented boom in clean energy development in the trades.”

The press conference was hosted by Forward Together Wisconsin, a nonprofit established to inform people about the Biden administration’s infrastructure and climate investments and to defend them.

“We’ve been seeing this real opportunity to drive energy costs down, and I cannot for the life of me understand why people want to reverse that progress,” said former Lt. Gov. Mandela Barnes, president of Forward Together Wisconsin.

In addition to the tax credits that the U.S. House proposal would repeal, President Donald Trump in his second term has frozen federal clean energy grants that were part of the 2022 legislation. Those include grants to establish a network of electric vehicle charging stations — prompting a lawsuit by 15 states, including Wisconsin.

Solar energy investments that have boomed in the last three years are among those that are threatened by the House proposal, according to advocates.

“At a time when billions of dollars are being invested in states that overwhelmingly voted for President Trump, this proposed legislation will effectively dismantle the most successful industrial onshoring effort in U.S. history,” Abigail Ross Hopper, president and CEO of the Solar Energy Industries Association, said in a statement this week.

Since passage of the IRA, Wisconsin has seen $933 million in clean energy and transportation private-sector investments, along with just over $2 billion from federal grants and loans, according to Innovation Policy & Technology, a San Francisco climate change policy think tank. The organization tallied 61 new clean energy and transportation projects that got underway in the state, with 45 manufacturing American-made products.

“Lower investment and higher energy bills due to repealing these federal programs and tax incentives will cost nearly 5,200 Wisconsin jobs in 2030 and more than 6,400 jobs in 2035, compared to current policies,” Innovation Policy & Technology reported.

The advocacy group Climate Power has calculated that without the federal support $5.4 billion for 15 planned Wisconsin clean energy projects could be in jeopardy.

Of those projects, 12 — 80% — are in five congressional districts represented by Republicans, according to Climate Power. Three representatives of those districts — Bryan Steil in the 1st CD, Scott Fitzgerald in the 5th CD and Glenn Grothman in the 6th CD — voted against the IRA in 2022. The other two, Derrick Van Orden in the 3rd CD and Tony Wied in the 8th CD, weren’t in office at the time but publicly opposed the legislation.

John Jacobs, business manager of International Brotherhood of Electrical Workers Local 494 in Southeast Wisconsin, said the clean energy tax credits and related policies have spurred investment and employment for the union’s members.

“I see first-hand how the clean energy tax credits have delivered on their promise, creating good family-sustaining union jobs across Wisconsin,” Jacobs said. “Repealing these tax credits could be devastating to many, but would put thousands of jobs at risk and hurt a growing industry.”

The tax credits were “an investment in America,” he added. The jobs lost if the credits are repealed “translate to economic instability for families across our state.”

The IRA also included a provision that extends the value of the tax credits to nonprofit organizations and government agencies.

Thanks to that benefit, called direct support payment, the Menasha Joint School District in the Fox Valley has qualified for a $4 million reimbursement from the federal government for installing rooftop solar energy and geothermal energy systems in a school currently under construction, said Brian Adesso, the school district’s business services director.

Once the school is complete the district expects to save $159,000 a year on its electric bill, “which is cost savings to local taxpayers and money that can be invested back into the students and staff,” Adesso said at the Forward Wisconsin press conference.

Adesso said the tax credits gave the district “certainty” it needed to be willing to undertake the clean energy additions to the project. Killing the credits would make that choice harder for school districts and impose higher costs on local property taxpayers, he added.

“The bill making its way through Congress takes a sledgehammer to the tax credits,” Addesso said — ending some credits early and attaching “bureaucratic restrictions that could make many of the credits unusable.”

Barnes said Forward Wisconsin Together is calling on Congress to protect the clean energy initiatives. “The people of Wisconsin deserve better,” he said. “The country deserves better. Clean energy as we know is the future, and we have to continue to invest in it.”

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Terri Vandenhouten, a nurse practitioner in Brown County, testifies Tuesday in favor of a bill that would allow nurses with advanced credentials practice independently after a period of supervision. (Screenshot/WisEye)

Legislation to allow nurses with advanced training to practice independently has overcome objections that led the measure to be vetoed twice in the last four years, the Assembly’s health committee heard Tuesday.

AB 257 would create a new health care professional category of Advanced Practice Registered Nurse (APRN). APRNs would include certified nurse-midwives, certified registered nurse anesthetists, clinical nurse specialists and nurse practitioners.

Under the bill, an APRN would be permitted to practice on their own after working under the supervision of a medical doctor.

Currently, nurse practitioners in Wisconsin must have a continuing collaboration agreement with a practicing physician. Advocates for the legislation have said such agreements  shouldn’t be necessary for a fully trained APRN, and that some nurse practitioners have faced barriers in enlisting a collaborating doctor despite their own qualifications.

The legislation to end that requirement is a goal that organizations representing the nursing profession have been pursuing for more than a dozen years in Wisconsin. There are now 28 states that have a similar standard in place, advocates said.

At Tuesday’s public hearing on the bill before the Assembly Committee on Health, Aging and Long-term Care, advocates and one-time opponents of the measure alike appeared ready to see it finally enacted this year.

“Where health care providers are even more scarce, when the difference between a good outcome or a bad outcome is on the line, access to quality, dependable health care is everything,” said Rep. Tony Kurtz (R-Wonewoc), lead author of the Assembly bill, in his hearing testimony. “Recognizing APRNs will help ease the provider shortage we feel across our state and make Wisconsin a more attractive place for these professionals to practice.”

The bill “is important to meeting the demands for health care throughout Wisconsin and in particular our rural and at-risk populations,” said Terri Vandenhouten, a nurse practitioner in Brown County.  

Gov. Tony Evers vetoed a version of the APRN legislation in 2022 after it passed both houses of the Legislature, and he did so again in 2024.

This time around, Evers along with legislators from both parties spent time working through the objections that led to Evers’ previous vetoes.

“We had very good conversations with the governor’s office and came up with a compromise,” said Sen. Patrick Testin (R-Stevens Point), for whom the legislation has been a long-time goal. Testin said that “not everyone is 100% happy” with the bill in its current form — “which probably tells me we landed in a really good spot.”

As the last version of the bill was under debate, Evers laid down markers for three elements that he required before he would sign the measure: increasing the amount of training and supervision before an APRN can practice independently; requiring additional supervision for some APRN practitioners in the field of pain treatment; and ensuring that APRN practitioners didn’t use titles that might confuse patients about their credentials.

The new bill addresses all three points, said Testin.

Under the new bill, in order to be credentialed as an APRN, a nurse must have the equivalent of two years of practice under a doctor’s supervision. The new APRN must then work for another two years under a doctor’s collaborative supervision before going solo.

The bill added a requirement — sought by doctors in the field of pain medicine — requiring  APRN practitioners who treat pain syndrome and who use “invasive techniques” to work in collaboration with a pain medicine physician.

The bill also addresses the use of professional titles, which doctors have argued are sometimes improperly appropriated by providers without a physician’s credential. For an APRN to use a title, it must be one granted under Wisconsin’s nursing statutes, according to the bill.

An APRN with a doctorate may use the title of “Doctor,” but with identifying information about what field the degree is in, so patients don’t misinterpret the practitioner as being a physician.  

Representatives for the medical profession who have opposed previous versions of the bill told lawmakers Tuesday they now were officially neutral.

The Wisconsin chapter of the American College of Emergency Physicians hasn’t taken a position for or against the bill, said the group’s representative, Dr. Aurora Lybeck.

While she praised the “significant strides” in adding experience requirements, provider title protection and restrictions on pain practice, Lybeck said Wisconsin should institute specific requirements to staff emergency rooms with doctors.

Mark Grapentine, the Wisconsin Medical Society’s policy advocate, also testified that the doctors’ organization was now neutral on the measure after having opposed it. His remarks all but conceded that the arguments of the bill were now over.

“We are grateful that so many bipartisan members of the Legislature and that Gov. Evers listened to the concerns that physician groups brought forward and were able to include three of those important elements in the bill that you have before you,” he said.

Rep. Lisa Subeck (D-Madison), the health committee’s ranking Democrat, told the Wisconsin Examiner that years of working on the bill as well as Evers’ role in encouraging a resolution helped the legislation reach a point where its enactment now seems likely.

“This was a good example of a bill where there was both bipartisan support and bipartisan opposition,” Subeck said. “It felt like we were a long way from getting it done, and I think the governor has really helped to get this bill moving forward.”

Pinwheels posted at Tree Top child care center in Ashland represent the families on the waiting list for the program. (Photo courtesy of Theresa Fredericks)

Theresa Fredericks grew up in the world of child care.

Her mother founded a child care center in Ashland 52 years ago, when Fredericks was just 5 months old. Fredericks started her career in early education as a teacher there, then took over management and ownership of the program, Tree Top Child Development Center and Preschool.

Fredericks has been proud of the center’s reputation in the community. Tree Top currently is licensed for 33 children at a time. With schedules staggered for some children, there are a total of 39 currently enrolled.

The waiting list is nearly twice that size: 72 children. This week Fredericks put up one pinwheel for each waiting list occupant on the law in front of the center, along with some signs. “Child care wanted,” one sign said. “Quality child care should be a right” said another. “Not a luxury,” said a third.

On Tuesday Fredericks was 300 miles away, at the state Capitol in Madison. Tree Top was closed, and Fredericks says it will be closed again on Wednesday and the rest of this week.

It was a tough decision, she said — but one she and her staff felt was necessary to make a point to Wisconsin lawmakers.

“Without state investment the parents can’t afford to pay rising tuition and staff can’t afford to stay at low wages,” Fredericks told the Wisconsin Examiner. “With investment, we will see a rise in teachers going into the field, we will see an increase in available programs.”

That’s why she and her staff decided to join the statewide strike called by child care providers.

Balancing better wages, affordable fees

The strike is a response to action May 8 by the Republican majority on the Legislature’s Joint Finance Committee to strip $480 million from Tony Evers’ proposed budget. The money would provide child care centers with an ongoing monthly stipend, continuing support first provided through federal COVID-19 pandemic relief funds.

Child care providers have credited the money for enabling them to increase the wages of child care teachers while avoiding increases in the fees that parents pay.

“I know that there are many people who think that because we care for very young children that we don’t count as teachers,” said Tree Top teacher Betsy Westlund at a combination press conference and rally on the Capitol steps Tuesday. “But the work we do is highly skilled and deeply critical to our society, the economy, and our communities.”

She described a common suggestion that child care providers hear when they talk about funding shortfalls: increase tuition and expand enrollment.

“Never mind the tuition is already so high that so few can afford it, and never mind how difficult it is to find teachers willing to work for low wages with no benefits,” Westlund said.

“No one considers supporting the quality of child care by supporting skilled teachers because they assume anyone will do,” she added. “And that hurts. Man, does that hurt — because I know how much I have to put in to become educated in early childhood.”

Republicans favor expanding employer child care tax credit; providers skeptical

“We are not just babysitting — we are laying the foundation for lifelong learning,” said Amber Haas, a fellow Tree Top teacher.

The organizers of the strike are calling it “State Without Child Care.” They’re doing it “so that our elected representatives, especially on the Joint Finance Committee, can actually have an idea of what is going to happen this summer,” said Corrine Hendrickson, co-founder of Wisconsin Early Childhood Action Needed (WECAN) and the operator of a family child care center in New Glarus.

At the Assembly’s floor session Tuesday afternoon, child care providers sat in the overhead gallery. On the floor, Rep. Jodi Emerson (D-Eau Claire) introduced some by name, adding that they “are here in the Capitol to advocate for $480 million in the budget for living wages for teachers in early childhood education.”

While some providers are going all in with the strike, many say they cannot — but they are equally concerned about the issue.

Assessing the risk

Angela Norvold has grown her child care program in Hudson from a family day care  serving eight children to two centers, each licensed for 43 children. One is for younger kids and the other for older children, including 4-year-old kindergarten.

“We thought hard and as a team,” about closing for the strike, Norvold said in an interview. She and the center’s administrators decided to send a letter to parents asking for their input. “They agreed that we should stay open, and my fear was that if we closed we would lose those people for good,” she said.

There’s a child care shortage in Hudson, Norvold said. At the same time, she added, there are several providers in the area to choose from, but many have rooms that aren’t in use because they cannot find teachers.

“I don’t know that [closing] would be making a statement where we are,” Norvold said. At the same time, though, “we did have some parents volunteer to keep their children home so that we could come [to Madison] today and tomorrow.”

Norvold said that her centers were once more affordable than those in Minnesota, drawing families who moved across the border to make their home.

“They didn’t just come for lower prices, they came for quality care, educated staff that wanted to stay, and a community that values raising children well,” she said in a brief speech at the rally.  

The funding providers received during the pandemic “didn’t just help families, it helped providers,” Norvold said. “It helped us retain and educate staff, it helped us keep costs down without sacrificing quality. It helped us build futures.”

If the support doesn’t continue, “we’re looking at yet another tuition increase — at least $30 per child per week,” Norvold said. “That will push our infant care to a level that is not sustainable for most working families. It is not sustainable for us either.”

Families show support

Families of children enrolled at Tree Top in Ashland have gotten behind the center’s decision to join the child care strike .

“Our families support us,” Fredericks said. “They know that we have done everything. We’re contacting our legislators, they’re contacting our legislators —over and over again, telling them how important it is.”

Tony Singler is the father of three children who have gone through Tree Top’s program, from the age of 3 months though 4-year-old kindergarten. His youngest child is now nearing graduation from the 4-K program.

“Everything that Theresa does there is just more in-depth and more one-on-one,” Singler said in a telephone interview Tuesday. For his kids, he said, the center has been an ideal place to help their children through their first years.

“There’s a lot of research and support that the early years are very important to the children,” Singler said. “Our pediatrician supports that, and it’s a choice we make to give our children the best chance they have.”

Singler is a certified public accountant; his wife is a nurse. “We’re not teachers,” he said. “We don’t know how to teach kids at that young age.”

Now they are juggling schedules and turning to friends for help while hoping their child can return to Tree Top soon.

“It’s tough,” said Singler, but he says he understands the position that Fredericks and the center’s employees are in.

“It’s been a very good center,” he said. “And if they don’t have the funding, and they lose the teachers because the teachers have to go somewhere else, and they have to cut the enrollment and people get cut — then you don’t have the opportunity to put your child into the center like that, give them the best chance forward in their early development.”

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