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Federal judge quickly rules in favor of Planned Parenthood in suit over Medicaid funding

A Planned Parenthood clinic in Salt Lake City, Utah, is pictured on Wednesday, July 31, 2024. (Photo by McKenzie Romero/Utah News Dispatch)

A Planned Parenthood clinic in Salt Lake City, Utah, is pictured on Wednesday, July 31, 2024. (Photo by McKenzie Romero/Utah News Dispatch)

WASHINGTON — The federal government cannot withhold Medicaid funding from Planned Parenthood for at least the next two weeks, after a district court judge issued a temporary restraining order the same day the organization filed a lawsuit.

Republicans included language in their “big, beautiful bill” that would block Medicaid payments from going to Planned Parenthood for the next year, a move that would effectively prevent enrollees in the state-federal health program for lower income people from visiting any of its clinics for routine health care.

The ban began when President Donald Trump signed the bill into law on Friday.

Congress already bars federal funding from going to abortion services with limited exceptions.

Planned Parenthood filed a lawsuit over the change in federal law Monday in U. S. District Court for the District of Massachusetts and quickly requested the temporary restraining order, which was issued later that day.

The suit alleges Planned Parenthood was singled out “in order to punish them for lawful activity, namely advocating for and providing legal abortion access wholly outside the Medicaid program and without using any federal funds.”

The filing also says more than 1 million Medicaid enrollees go to Planned Parenthood in a given year and that the organization received more than one-third of its total aggregate revenue from Medicaid reimbursement during fiscal year 2023. 

District Court Judge Indira Talwani’s brief two-page temporary restraining order called on the Trump administration to file a status update later this week. And she set an in-person hearing later this month to hear from Planned Parenthood and the Trump administration.

Talwani was nominated to the bench by former President Barack Obama.

The Trump administration has yet to file any documents in the case and the Department of Health and Human Services did not immediately respond to a request for comment from States Newsroom about the judge’s temporary restraining order. 

Attorney General Pam Bondi indicated during a Cabinet meeting Tuesday afternoon that the Department of Justice plans to challenge the temporary restraining order.

“Absolutely, yes. We’re on it,” Bondi said.  

Planned Parenthood Federation of America, Planned Parenthood League of Massachusetts and Planned Parenthood Association of Utah — the three groups that filed the lawsuit — wrote in a statement they were “grateful that the court acted swiftly to block this unconstitutional law attacking Planned Parenthood providers and patients.

“Already, in states across the country, providers and health center staff have been forced to turn away patients who use Medicaid to get basic sexual and reproductive health care because President Trump and his backers in Congress passed a law to block them from going to Planned Parenthood. There are no other providers who can fill the gap if the ‘defunding’ of Planned Parenthood is allowed to stand. The fight is just beginning, and we look forward to our day in court.”

Planned Parenthood sues Trump administration officials over ‘defunding’ provision in budget bill

Planned Parenthood has about 600 clinics in 48 states, and according to their calculations, more than 1.1 million patients could lose access to care because of a provision in the massive budget bill signed by President Donald Trump last week. (Photo by McKenzie Romero/Utah News Dispatch)

Planned Parenthood has about 600 clinics in 48 states, and according to their calculations, more than 1.1 million patients could lose access to care because of a provision in the massive budget bill signed by President Donald Trump last week. (Photo by McKenzie Romero/Utah News Dispatch)

Days after President Donald Trump signed a massive budget bill, attorneys for Planned Parenthood Federation of America and its state members in Massachusetts and Utah filed a lawsuit Monday challenging a provision they say will affect more than 1 million patients who use their clinics across the U.S.

Planned Parenthood says if the defund provision stands, those targeted will be patients who use Medicaid as their insurance at its centers for services including birth control and cancer screenings. The organization says it only uses federal Medicaid funding for abortion in the very narrow cases allowed, including rape, incest, and to save a pregnant person’s life.

The complaint, filed in U.S. District Court of Massachusetts against U.S. Health and Human Services Secretary Robert F. Kennedy Jr. and Medicaid and Medicare administrator Dr. Mehmet Oz, challenges a provision on page 597 of the reconciliation bill. It prohibits Medicaid funding from going to any sexual and reproductive health clinics that provide abortions and received more than $800,000 in federal and state Medicaid funding in fiscal year 2023. That prohibition will last one year from the date the bill was signed.

While there may be a few independent clinics with operating budgets that high, it effectively singles out Planned Parenthood clinics. The entire organization has about 600 clinics in 48 states, and according to their calculations, more than 1.1 million patients could lose access to care because of the change in the law.

“This case is about making sure that patients who use Medicaid as their insurance to get birth control, cancer screenings, and STI testing and treatment can continue to do so at their local Planned Parenthood health center, and we will make that clear in court,” said Planned Parenthood Federation of America president and CEO Alexis McGill Johnson in a public statement.

The organization identified 200 of its clinics in 24 states that are at risk of closure with the cuts, and said nearly all of those clinics — 90% — are in states where abortion is legal. In 12 states, approximately 75% of abortion-providing Planned Parenthood health centers could close. Because of that, some reproductive health advocates have called it a backdoor nationwide abortion ban.

The nonprofit also warned that eliminating Planned Parenthood centers from the Medicaid program would likely also impact patients who use other forms of insurance, if centers are forced to cut their services or close. 

Planned Parenthood argued this section of the bill is unconstitutional because it specifies and punishes them, saying it violates equal protection laws and qualifies as retaliation against free speech rights. 

“The Defund Provision is a naked attempt to leverage the government’s spending power to attack and penalize Planned Parenthood and impermissibly single it out for unfavorable treatment,” the complaint says. “It does so not only because of Planned Parenthood members’ long history of providing legal abortions to patients across the country, but also because of Planned Parenthood’s unique role in advocating for policies to protect and expand access to sexual and reproductive health care, including abortion.”

The complaint also details numerous instances when Trump said he was committed to defunding Planned Parenthood in 2016 and 2017, during his first presidential term, and it highlighted the provisions of Project 2025 that called for the defunding of Planned Parenthood. Project 2025 is the blueprint document drafted by the conservative Heritage Foundation, and the administration has followed many of its directives so far.

According to the lawsuit, Planned Parenthood members have “structural independence,” meaning no member “has control over the operations or decision-making processes of another.” It’s argued in the complaint that 10 members, including plaintiff Planned Parenthood Association of Utah, don’t meet the definition of prohibited entity under the new law, because they do not provide abortion services or did not receive over $800,000 in Medicaid funds during fiscal year 2023. They say these members are not “affiliates, subsidiaries, successors, or clinics” of any prohibited entity because they are separately incorporated and independently governed.

“But these Non-Qualifying Members can take no comfort in the plain text of the statute,” reads the lawsuit. “Defendants will willfully misinterpret the statute to disqualify them from receiving federal Medicaid funding, based solely on their association with PPFA and other Planned Parenthood Members.”

“As the Trump administration guts our public health care system, we know millions will suffer and struggle to get care. We will not tolerate these attacks,” said Shireen Ghorbani, interim president of Planned Parenthood Association of Utah, in a statement. “For over 55 years, we have proudly cared for generations of Utahns, and we will always find ways to meet the health care needs of our communities. Here in Utah, we are used to politicians trying to strip away our rights for political gain. We haven’t backed down before, and we won’t now.”

Defunding will harm general wellness, not abortion care, Arizona clinic owner says

Planned Parenthood also noted in its complaint that the harms could be especially devastating because “even where alternative providers are theoretically available, those providers, who are already stretched to capacity, often do not offer the same comprehensive sexual and reproductive health service options, have long wait times for patients, and cannot accommodate the huge influx of patients who would need to find a new provider of care.”

Some clinics that operate independently of Planned Parenthood will be affected by the law as well. George Hill, president and CEO of Maine Family Planning, said they receive nearly $2 million from Medicaid funds (MaineCare) on a yearly basis, and about half of their patients are enrolled in some form of Medicaid. Hill said they plan to sue as well, but the timing is uncertain at this point. Abortion care makes up about 15% of their overall services, while the rest is routine gynecological and preventative health care, he said.

In the meantime, Hill plans to solicit as much support as possible from individual donors to keep the doors to their 19 clinics open and serving Medicaid patients.

“Whether or how long we’ll be able to do that is another question,” Hill said.

In Arizona, Dr. DeShawn Taylor operates the independent clinic Desert Star Institute for Family Planning. About 75% of the services at Desert Star are abortion related, and while Medicaid (AHCCCS in Arizona) dollars can’t be used for the procedure, Taylor said they could often at least get the initial consultation appointment covered by Medicaid.

The cuts that are coming, Taylor said, will not stop people from obtaining an abortion somehow. But there will be other downstream effects.

“People are already economically depressed,” she said. “What we’re going to see is people are still going to do what’s necessary to get (abortion) care, but what’s going to fall off is their ability to get their preventative care, their contraception, their wellness exams, those types of things.”

Here are 6 claims about Donald Trump’s big bill — and the facts

U.S. flag in front of the White House.
Reading Time: 3 minutes

We’ve learned a bit about American society amid the rhetoric over President Donald Trump’s “big beautiful bill.” For example, unauthorized immigrants don’t get Medicaid, but millions of working-age adults have gone on it. We’ve also knocked down some false claims about the bill along the way.

As of July 3, the nearly 900-page measure, filled with tax breaks and spending cuts, had moved toward passage but was still being debated in Congress.

Wisconsin Watch fact briefs have cleared up misstatements about the bill itself and about programs it would cut, such as Medicaid and food stamps.

Note: Our fact briefs answer a factual question yes or no based on the facts available when the brief is published.

Here’s a look.

Would the ‘big beautiful bill’ provide the largest federal spending cut in US history?

No.

The largest-cut claim was made by Republican U.S. Rep. Scott Fitzgerald, who represents part of southeastern Wisconsin. His office cited a $1.7 trillion claim made by the Trump administration.

Even if the net cut were $1.7 trillion, it would be second to a 2011 law that decreased spending by $2 trillion and would be the third-largest cut as a percentage of gross domestic product, according to the Committee for a Responsible Federal Budget.

But when Fitzgerald made his statement, the bill’s net decreases were $1.2 trillion, after taking its spending increases into account, and $680 billion after additional interest payments on the debt.

Have millions of nondisabled, working-age adults been added to Medicaid?

Yes.

Millions of nondisabled working-age adults have enrolled in Medicaid since the Affordable Care Act expanded eligibility in 2014.

Medicaid is health insurance for low-income people.

The nonpartisan Congressional Budget Office estimated that in 2024, average monthly Medicaid enrollment included 34 million nonelderly, nondisabled adults — 15 million made eligible by Obamacare.

Republican U.S. Rep. Tom Tiffany, who represents most of northern Wisconsin, complained about “able-bodied” adults being added, saying they are “draining” Medicaid.

The nonpartisan health policy organization KFF said 44% of the working-age adults on Medicaid, some of whom are temporarily disabled, worked full time and 20% part time, many for small companies, and aren’t eligible for health insurance.

Are unauthorized immigrants eligible for federal Medicaid coverage?

No.

Unauthorized immigrants are not eligible for traditional, federally funded Medicaid and have never been eligible.

Fourteen states, excluding Wisconsin, use state Medicaid funds to cover unauthorized immigrants. 

Trump’s bill proposed reducing federal Medicaid funds to those states.

Opponents of the bill, including Democratic U.S. Rep. Mark Pocan, who represents the Madison area, said Trump administration officials claimed that unauthorized immigrants receive traditional Medicaid.

Do half the residents in one rural Wisconsin county receive food stamps?

Yes.

In April, 2,004 residents of Menominee County in northeast Wisconsin received benefits from the federal Supplemental Nutrition Assistance Program (SNAP).

That’s about 46% of the county’s 4,300 residents.

SNAP, formerly known as food stamps and called FoodShare in Wisconsin, provides food assistance for low-income people.

Menominee County’s rate was cited by U.S. Sen. Raphael Warnock, D-Ga., at the Wisconsin Democratic Party convention. He commented on the bill’s provision to remove an estimated 3.2 million people from SNAP, according to the nonpartisan Congressional Budget Office.

Is Donald Trump’s megabill projected to add more than $2 trillion to the national debt?

Yes.

Nonpartisan analysts estimate that the “big beautiful bill” would add at least $2 trillion to the national debt over 10 years.

The debt, which is the accumulation of annual spending that exceeds revenues, is $36 trillion.

U.S. Rep. Gwen Moore, D-Milwaukee, and U.S. Sen. Ron Johnson, R-Wis., claimed the bill would add trillions.

Among other things, the bill would make 2017 individual income tax cuts permanent, add work requirements for Medicaid and food assistance, and add funding for defense and more deportations.

After we published this brief, the Senate passed a version of the bill that would increase the debt by $3.3 trillion.

Would ‘the vast majority’ of Americans get a 65% tax increase if the GOP megabill doesn’t become law?

No.

Most Americans would not face a tax increase near 65% if Trump’s 2017 tax cuts are not extended under the bill.

The tax cuts are set to expire Dec. 31. 

The Tax Foundation estimates that if the cuts expire, 62% of taxpayers would see a tax increase in 2026. The average taxpayer’s increase would be 19.4% ($2,955).

GOP U.S. Rep. Derrick Van Orden, who represents western Wisconsin, made the 65% claim

Do you have questions about this bill and how it affects Wisconsin? Submit them here, through our Ask Wisconsin Watch project.

Wisconsin Watch is a nonprofit, nonpartisan newsroom. Subscribe to our newsletters for original stories and our Friday news roundup.

Here are 6 claims about Donald Trump’s big bill — and the facts is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Have millions of nondisabled, working-age adults been added to Medicaid?

Reading Time: < 1 minute

Wisconsin Watch partners with Gigafact to produce fact briefs — bite-sized fact checks of trending claims. Read our methodology to learn how we check claims.

Yes.

Millions of nondisabled working-age adults have enrolled in Medicaid since the Affordable Care Act expanded eligibility in 2014.

Medicaid is health insurance for low-income people.

The nonpartisan Congressional Budget Office estimated that in 2024, average monthly Medicaid enrollment included 34 million nonelderly, nondisabled adults – 15 million made eligible by Obamacare.

Two smaller estimates used U.S. Census survey data.

The White House Council of Economic Advisers said there were 27 million nondisabled working-age (age 19-64) Medicaid recipients in 2024.

That’s similar to the 26 million for 2023 estimated by the nonpartisan health policy organization KFF. That figure includes people who are disabled.

KFF said 44% worked full time and 20% part time, many for small companies, and aren’t eligible for health insurance.

Medicaid costs nearly $900 billion annually, two-thirds from the federal government, one-third from the states.

Forty states, excluding Wisconsin, adopted the Obamacare Medicaid expansion.
Congress is considering President Donald Trump’s proposal adding work requirements for Medicaid.

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

Sources

Think you know the facts? Put your knowledge to the test. Take the Fact Brief quiz

Have millions of nondisabled, working-age adults been added to Medicaid? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Trump urges voters to press for US Senate GOP mega-bill after setback on Medicaid cuts

U.S. Senate Majority Leader John Thune, R-S.D., left, listens as Sen. Mike Crapo, R-Idaho, speaks to reporters outside of the West Wing of the White House on June 4, 2025 in Washington, D.C.  after a meeting with President Donald Trump. (Photo by Anna Moneymaker/Getty Images)

U.S. Senate Majority Leader John Thune, R-S.D., left, listens as Sen. Mike Crapo, R-Idaho, speaks to reporters outside of the West Wing of the White House on June 4, 2025 in Washington, D.C.  after a meeting with President Donald Trump. (Photo by Anna Moneymaker/Getty Images)

This report has been updated.

WASHINGTON — President Donald Trump on Thursday told his supporters to call members of Congress and lobby them to support the “big, beautiful bill,” a crucial push with just days to go before a self-imposed Fourth of July deadline.

Trump’s plea follows several tumultuous days on Capitol Hill as GOP leaders struggled to find consensus on multiple policy disagreements, especially after the parliamentarian ruled core elements of the package don’t meet the complex rules for moving a budget reconciliation bill.

Trump during an event in the White House’s East Room that was attended by several GOP lawmakers also cautioned Republicans against voting down the tax and spending cut package.

“We don’t want to have grandstanders,” Trump said. “Not good people. They know who I’m talking about. I call them out. But we don’t need grandstanders. We have to get our country back and bring it back strong.”

Some Republican senators remain optimistic they can work through the weekend and that the House votes will come together next week, despite growing opposition from members in that chamber.

Sen. Eric Schmitt said he doesn’t think the parliamentarian’s rulings will delay the votes “outside the weekend window, which has been the goal all the time.”

“We’re probably voting into the weekend, though. That’s probably my guess — Saturday and I suppose even Sunday — but, that’s the goal, I don’t think that materially changes too much,” the Missouri Republican said.

Senate Majority Leader John Thune, R-S.D., however, appeared a bit less definite, telling reporters in the afternoon that he didn’t know when the chamber would take the procedural vote that kicks off floor consideration.

“I’ll get back to you on that,” he said.

Medicaid provisions tossed

Earlier Thursday, Senate Republicans suffered a significant setback when the parliamentarian ruled several changes to Medicaid in the bill don’t comply with the rules, which means billions of dollars in savings are no longer available for the GOP to offset the cost of tax cuts.

Finance Committee Chairman Mike Crapo. R-Idaho, must rework or completely eliminate nine changes the committee proposed to the health care programs, though more of the panel’s proposals are still under review.

Republicans can no longer reduce the amount of federal matching funds for state governments that use their own tax dollars to provide Medicaid coverage for immigrants in the country without proper documentation.

The GOP bill cannot bar gender-affirming care for Medicaid patients.

And Republicans need to change or scrap a proposal to reduce states’ Medicaid provider tax credits, an issue that is relatively in the weeds of health care policy but has sharply divided the GOP and drawn fierce opposition from states.

The changes or eliminations will have a major impact on how much in savings the GOP tax and spending cut bill will generate during the next decade and will likely make the overall package’s deficit impact higher than before. The legislation is intended to extend the 2017 tax cuts and make spending reductions.

The ruling might make it more difficult for Trump and GOP leaders in Congress to get the votes needed to pass the bill at all, let alone before their self-imposed Fourth of July timeline. Senate GOP leaders had said they wanted to begin procedural votes as soon as Friday.

The measure already had been stuck on Wednesday amid growing disputes over how Medicaid changes will impact rural hospitals and far more.

Democrats to continue scrutinizing bill

Senate Budget Committee ranking member Jeff Merkley, D-Ore., who released the parliamentarian’s rulings, wrote in a statement that Democrats will continue to advocate for removing dozens of proposals from the bill that they believe don’t meet reconciliation rules.

“Republicans are scrambling to rewrite parts of this bill to continue advancing their families lose, and billionaires win agenda, but Democrats stand ready to fully scrutinize any changes and ensure the Byrd Rule is enforced,” Merkley wrote.

A staffer, who was granted anonymity to discuss the chairman’s plans, said the Finance Committee will “rework certain provisions to address the Byrd guidance and be compliant with reconciliation.”

The Byrd rule, named for former West Virginia Sen. Robert Byrd, includes several guardrails for reconciliation bills.

Finance Committee ranking member Ron Wyden, D-Ore., wrote in a statement that the parliamentarian’s ruling will lead to “more than $250 billion in health care cuts removed from the Republicans’ big bad bill.

“Democrats fought and won, striking health care cuts from this bill that would hurt Americans’ walking on an economic tightrope. This bill is rotten to its core, and I’ll keep fighting the cuts in this morally bankrupt bill until the end.”

The parliamentarian is still deciding whether several health provisions meet reconciliation rules, including language that would block all Medicaid funding from going to Planned Parenthood, effectively blocking Medicaid patients from visiting the organization for routine health services.

Federal law already bars funding for abortions with exceptions for rape, incest, or the life of the pregnant patient.

The parliamentarian will also decide later whether Republicans’ bill can block the Department of Health and Human Services from implementing a Biden-era rule that would require nursing homes to have a nurse working 24 hours a day, seven days a week.

Higher ed provisions axed

The parliamentarian also struck down several attempts from congressional Republicans to overhaul the higher education system.

GOP lawmakers cannot streamline student loan repayment options for current borrowers to just a standard repayment plan or an income-driven repayment plan, making such restrictions apply to only new borrowers.

Republicans have to nix a proposal that opened up the Pell Grant — a government subsidy that helps low-income students pay for college — to institutions that are for-profit and not accredited.

The parliamentarian scrapped a proposal that would have barred payments made by students enrolled in a medical or dental internship or residency program from counting toward Public Service Loan Forgiveness.

The federal program eliminates remaining debt for borrowers when meeting certain requirements, including working for a qualified employer within the government or nonprofit sector.

The parliamentarian rejected GOP lawmakers’ proposal to end federal student aid eligibility for certain immigrants who are not U.S. citizens.

‘Too many Medicaid cuts’

Missouri Republican Sen. Josh Hawley said the parliamentarian’s ruling on the Medicaid provider tax rate will give lawmakers “a chance to get it right.”

“This is a chance for the Senate to fix a problem that they created and not defund rural hospitals,” Hawley said, later adding he supports the House language that would freeze the rate at 6% instead of decreasing it to 3.5% over several years. 

Hawley said hours before Trump’s event that he expects the president to get more involved in negotiations now that he’s back from a NATO conference in Europe and said Trump was in a “terrific mood” during a recent phone call.

“I think he wants this done. But he wants it done well. And he does not want this to be a Medicaid cuts bill,” Hawley said. “He made that very clear to me. He said this is a tax cut bill, it’s not a Medicaid cuts bill. I think he’s tired of hearing about all these Medicaid cuts, you know. As am I. It’s because there are too many Medicaid cuts.”

Louisiana Republican Sen. Bill Cassidy early Thursday night called on leaders to put the House’s language regarding Medicaid back into the bill, wiping out changes made by the Finance Committee.

“My position is that cuts, and especially drastic cuts, to Medicaid have to be avoided. The Senate bill cuts Medicaid too much,” the influential chairman of the Health, Education, Labor and Pensions Committee wrote in a social media post. “I agree with President Trump, the House version is better.”

SNAP cuts

The Agriculture Committee also is reworking parts of its bill, some being closely watched by states, to meet the rules that govern reconciliation.

Committee Chairman John Boozman, R-Ark., said he expects to hear from the parliamentarian before the end of Thursday about whether a revised state cost share provision for the Supplemental Nutrition Assistance Program that’s based on error rate payments will be in the final bill.

“It was thrown out the first time, so we actually gave her revised text. If she rules the revised text is fine, then we’ll release it,” Boozman said.

The committee released a statement later in the day announcing the parliamentarian had cleared the revised state cost share for SNAP that’s based on a state’s error payment rate.

States that have SNAP error payment rates higher than 6% will have to contribute some of the cost of the program. The updated proposal will give states the option of choosing between fiscal 2025 and fiscal 2026 to determine their match, which will begin during fiscal 2028. After that, a state’s match will be determined by its error payment rate for the last three fiscal years. 

State and local tax, ‘revenge tax’

Senate Republicans also remained stuck on finding a deduction level for state and local tax, or SALT, that passes muster with House Republicans who represent high-tax blue states.

The House version would allow taxpayers making under $500,000 to deduct up to $40,000 in SALT from their federal tax bill. Both the $40,000 cap and the $500,000 income threshold will increase annually at 1% until hitting a ceiling of $44,000 and $552,000. The deduction cap phases down for higher earners.

Senate Republicans and the White House sought to lower the income threshold but were shot down Thursday by House Republicans, according to multiple reports.

Sen. Markwayne Mullin of Oklahoma, the lead negotiator on SALT for Senate Republicans, said he remained optimistic.

“We’re gonna be in a good spot. We’re gonna find a landing spot,” Mullin said.

A Senate Finance Committee spokesperson declined to comment on current negotiations, including any proposed income level changes.

Treasury Secretary Scott Bessent also weighed in on another tax provision: the so-called “revenge tax” on investments from countries whose trade policies the president views as unfair to U.S. businesses.

Bessent asked lawmakers to remove the up to 20% tax from the mega-bill following an agreement made with G7 partners, he wrote on social media.

“This understanding with our G7 partners provides greater certainty and stability for the global economy and will enhance growth and investment in the United States and beyond,” Bessent said.

The retaliation tax would have raised roughly $116 billion over 10 years, according to the Committee for a Responsible Federal Budget.

Timing on votes

Republican lawmakers don’t have much time left to rework all of the ineligible provisions, clear them with the parliamentarian, read through final bill text, slog through a marathon amendment voting session in the Senate and then move the bill through the House before their self-imposed deadline.

White House press secretary Karoline Leavitt said during a briefing before Trump’s event that the president is “adamant” Congress must pass the “big, beautiful bill” within the next week, despite the latest ruling.  

“We expect that bill to be on the president’s desk for signature by July Fourth. I know there was a ruling by the Senate parliamentarian this morning,” Leavitt said. “Look, this is part of the process, this is part of the inner workings of the United States Senate. But the president is adamant about seeing this bill on his desk here at the White House by Independence Day.” 

GOP mega-bill stuck in US Senate as disputes grow over hospitals and more

U.S. Senate Majority Leader John Thune, R-S.D., speaks to reporters at the Capitol as lawmakers work on the "One Big Beautiful Bill Act" on June 25, 2025 in Washington, D.C.  (Photo by Joe Raedle/Getty Images)

U.S. Senate Majority Leader John Thune, R-S.D., speaks to reporters at the Capitol as lawmakers work on the "One Big Beautiful Bill Act" on June 25, 2025 in Washington, D.C.  (Photo by Joe Raedle/Getty Images)

WASHINGTON — U.S. Senate Republicans appeared deeply divided Wednesday over how to establish a fund for rural hospitals to offset the budget impacts of Medicaid cuts in the “big, beautiful bill.”

The hospitals, which are generally already hurting financially, rely heavily on Medicaid, a state-federal partnership that provides health insurance for low-income households and for some people with disabilities.

GOP senators haven’t yet reached agreement on how to structure the fund, or on dozens of other unresolved provisions in the sweeping package, even though leaders hope to begin voting as soon as Friday. Still up in the air were agreements on major provisions of the measure involving the U.S. Department of Agriculture’s food aid program for low-income people and a proposed selloff of certain public lands.

Republican leaders continued to project optimism. “We’re well on our way to getting this bill passed this week,” Senate Majority Leader John Thune, R-S.D., said during a floor speech, continuing to press ahead toward a self-imposed Fourth of July deadline. 

Others saw it differently. Wisconsin Republican Sen. Ron Johnson cast doubt on the short timeframe leaders have set to reach final agreement and move the bill through both chambers.

“We’re still discussing some pretty fundamental issues,” Johnson said. “I’m just laying out the reality of the situation. We’ve got a lot of work to do.”

‘The only person up here that’s ever ran a rural hospital’

Dueling plans to establish the rural hospital fund to ease the threat of Medicaid cuts circulated among senators working to finalize the massive tax and spending cut measure, but an agreement had not surfaced by late afternoon.

Unofficial details showed Senate Republicans eyeing the inclusion of a $15 billion fund — $3 billion a year between fiscal 2027 and fiscal 2031 — to help rural hospitals, according to multiple reports.

But Sen. Roger Marshall, who sits on the Senate Committee on Finance, said he wants to increase that fund to $5 billion annually, with “half of that going to rural hospitals, and half of it going to primary care and prescription drugs and throw in physical therapy and occupational therapy, all the others as well.”

The Kansas Republican and physician said “we should probably only do it for four or five years and then regroup and see where we are.”

“I’m the only person up here that’s ever ran a rural hospital — I actually know something about them,” he added.

While Marshall said he loves “90%” of the broader bill, he said not nearly enough is being cut.

“But I can’t get the votes to do that, so it’d still be the largest cut in spending in my lifetime anyway,” he said, noting that “it’s going to be hard for the House to vote against it.”

Fund size criticized

On a midday call with reporters, Traci Gleason with the Missouri Budget Project said the stabilization fund being batted around by lawmakers “would fall well short of addressing these problems.”

“Forty-three percent of Missouri’s rural hospitals are at risk of closing, and 17% are considered to be at immediate risk,” said Gleason, who spoke during a virtual press briefing organized by the left-leaning Center for Budget and Policy Priorities.

“Those figures don’t account for all of the other health care providers in rural communities, like federally qualified health centers and others that operate on these incredibly thin margins. So the massive cuts to Medicaid are what is creating the problem and the only real way to address it is for Congress to not make these massive cuts,” she said.

‘Problematic’ Medicaid cuts

Sen. Susan Collins was advocating for a much bigger rural hospital stabilization fund, at $100 billion.

“I don’t think that solves the entire problem,” the Maine Republican and chair of the Senate Appropriations Committee said.

“The Senate cuts in Medicaid are far deeper than the House cuts, and I think that’s problematic as well.”

Sen. Jim Justice of West Virginia said that the $15 billion “is better than zero.”

“You know, naturally, I’d want it to be as high as it possibly can,” he said, adding that rural hospitals are the “lifeblood” of his state.

Sen. Josh Hawley of Missouri, a loud voice against Medicaid benefit cuts, said a stabilization fund is a “good idea but we’re still going to have to address the longer term effects of this.”

When asked for a dollar figure, Hawley said “it depends on the structure of it.”

Texas Republican Sen. John Cornyn said he keeps hearing the Senate will take a procedural vote on Friday, though that isn’t set in stone. 

“Should be a fun weekend for all of us,” Cornyn said. “Can’t wait.”

Once the Senate votes on what is called a motion to proceed, there’s a maximum of 20 hours of floor debate before the chamber must begin its marathon amendment voting session and eventually a passage vote.

SNAP provisions

Senate Agriculture Chairman John Boozman, an Arkansas Republican, said a revised version of his committee’s bill had not yet been reviewed by the parliamentarian.

The updated text alters a section restructuring the cost-share of the Supplemental Nutrition Assistance Program, or SNAP, a key food assistance program for low-income people.

The provision would require states for the first time to shoulder some of the cost of the program’s benefits. The amount a state owes would be determined by its error payment rate, with greater error rates requiring a higher state share.

Complex rules govern what can and can’t be included in the measure. The Senate parliamentarian ruled the language in the initial proposal did not comply with the chamber’s reconciliation rules.

The updated proposal would allow states more flexibility during the policy’s phase-in in fiscal 2028, allowing them to choose either the error rate in fiscal 2025 or fiscal 2026.

Boozman told reporters that change sought to respond to the parliamentarian’s ruling.

The parliamentarian “asked us to allow them (states) to use a different time frame — essentially gave them more time to understand what their error rate would be and to plan for it,” Boozman said. “And so we adjusted for that and I think we satisfied it.”

Lee and public lands

Senate Energy and Natural Resources Chairman Mike Lee of Utah reportedly narrowed a provision that would mandate the sale of Bureau of Land Management lands. He has not publicly said where it stands with the parliamentarian.

A committee spokesman did not return messages seeking clarification Tuesday and Wednesday, but a version of the changes obtained by news media shows changes consistent with what Lee proposed Monday.

Those changes include limiting the mandated sales to only the BLM — and not U.S. Forest Service lands, as Lee had initially proposed — and lowering the percentage of the agency’s lands that must be sold to between .25% and .5%. The initial proposal required between .5% and .75%.

The updated provision would also only require lands located within 5 miles of a population center to be sold and exempts lands that are currently used for grazing or another “valid existing right that is incompatible with the development of housing,” according to a copy of the changes obtained by hunting and angling publication Outdoor Life.

The provision has sparked opposition from Western lawmakers, including a handful of conservatives.

But it also has its share of supporters. Alaska Republican Dan Sullivan told reporters he had not seen the updated text but remained supportive of the idea.

“I’ve been supportive of what Sen. Lee is trying to do,” he said. “We have a lot of public lands in Alaska that the federal government abuses. But we’re in a good discussion on that, so I need to see the update.”

 

US Senate panel grills Trump CDC nominee on vaccines

Susan Monarez, President Donald Trump’s nominee to be the director of the Centers for Disease Control and Prevention, testifies during her confirmation hearing before the U.S. Senate Committee on Health, Education, Labor, and Pensions on June 25, 2025. (Photo by Kayla Bartkowski/Getty Images)

Susan Monarez, President Donald Trump’s nominee to be the director of the Centers for Disease Control and Prevention, testifies during her confirmation hearing before the U.S. Senate Committee on Health, Education, Labor, and Pensions on June 25, 2025. (Photo by Kayla Bartkowski/Getty Images)

WASHINGTON — Members of the U.S. Senate Committee on Health, Education, Labor and Pensions pressed President Donald Trump’s nominee to lead the Centers for Disease Control and Prevention about vaccine recommendations Wednesday after the Health and Human Services secretary fired members of a critical vaccine panel this month.

Trump’s pick, former acting CDC Director Susan Monarez, said that she trusted vaccines while defending HHS Secretary Robert F. Kennedy Jr.’s decision this month — widely seen as part of a vaccine-skeptical agenda — to fire all 17 members of the Advisory Committee on Immunization Practices, or ACIP, and recommend eight new members.

“Part of the secretary’s vision in restoring public trust is making sure that the American people can be confident in the way the evidence and science is driving decision-making,” she told senators.

The panel’s seven members — one dropped out this week — will meet Wednesday and Thursday to review data and vote on new vaccine recommendations. The recommendations carry significant weight as insurance providers and federal health programs like Medicaid use them to determine if shots are covered and schools rely on them for immunization mandates.

Cassidy questions

Louisiana Sen. Bill Cassidy, who chairs the committee, said he was concerned about ACIP, especially as a non-CDC staff member is scheduled to give a presentation to the committee about thimerosal, a mercury-based preservative. The panel is expected to vote on approving flu shots that contain the compound.

Lyn Redwood, the former head of Children’s Health Defense, the anti-vaccine group that Kennedy founded, is giving the presentation arguing that thimerosal causes autism. The CDC’s own research shows that thimerosal does not cause autism. 

Cassidy said that while Monarez had no part in this week’s ACIP meeting, or the agenda, he said that “if the ACIP hearing today is being used to sow distrust, I would ask that going forward, that you would make sure that there really was a balanced perspective.”

“Yes, someone can speak as a critic, but there should be someone who is reviewing the overwhelming evidence of the safety of vaccines,” Cassidy, who is a physician, said.

Monarez, who was the agency’s acting director from January to March, said that she trusted vaccines and that immunization was important to save lives.

If Monarez is confirmed by the Senate, she would be the first director of the CDC without a medical degree in nearly 70 years. She has a Ph.D. in microbiology and immunology.

More concerns about vaccine panel

Cassidy was not the only Republican on the panel concerned about the firing of all the members of ACIP.

Alaska Republican Sen. Lisa Murkowski said she was concerned about the backgrounds of the seven new panelists.

“I would hope that one of the things that you would all be looking into is to make sure that these individuals are going to be looking at the science in front of them, (and) leave their political bias at home,” Murkowski said.

Democratic Sens. Patty Murray of Washington state and Angela Alsobrooks of Maryland also pressed Monarez about Kennedy’s actions to fire everyone on the panel.

Murray asked Monarez if the new members of the panel voted to not recommend vaccines, if she would listen to that recommendation.

Monarez sidestepped the question and said the roles at ACIP were difficult to fill and that members needed to pass an ethics process.

“If they have not gone through an ethics approval process they shouldn’t be participating in the meetings,” she said.

Alsobrooks asked Monarez if she believed the 17 members fired from ACIP lacked qualifications.

Monarez did not answer the question, but said Kennedy’s reasoning for “resetting the ACIP to a new cohort was going to be on the path of restoring public trust.”

Grant funding and layoffs

Senators also raised concerns about grants that had been canceled, even though Congress already approved the funds.

Maine GOP Sen. Susan Collins, who is the chairwoman of the Senate Committee on Appropriations, said that her state is suffering from a high level of Lyme disease and as a result a vaccine was in the works at a research institute in Maine.

“This vaccine is very promising and I want to make sure that it is allowed to continue to its conclusion,” Collins said.

Monarez agreed and said if she is confirmed, she will specifically work to make sure funding for that vaccine continues.

“It’s ironic that our dogs can get a vaccine to protect them against tick-borne illnesses like Lyme disease but we humans can’t and I hope we can remedy that,” Collins said.

Sen. Tim Kaine, Democrat of Virginia, pressed Monarez about the elimination of the Office on Smoking and Health at the CDC. He asked if she was involved in laying off all the staff in April, the month after her brief stint as acting director ended.

“I had no participation in (the layoffs) after I left,” she said.

Fluoride in water

Alsobrooks pressed Monarez about Kennedy’s push to have the CDC stop recommending that low levels of fluoride be placed in public drinking water.

Fluoride is added in drinking water to help prevent cavities, tooth decay and other dental health issues.

Alsobrooks asked Monarez, who is her constituent, if the public water supply that contains fluoride in Potomac, Maryland, where Monarez lives, was safe to drink.

“I believe the water in Potomac, Maryland, is safe,” Monarez said. 

Are unauthorized immigrants eligible for federal Medicaid coverage?

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No.

Unauthorized immigrants are not eligible for traditional, federally funded Medicaid, which helps cover medical costs for low-income people.

They have never been eligible. A 1996 welfare reform law signed by Democratic President Bill Clinton also requires most authorized immigrants to wait five years for eligiblity.

Fourteen states, excluding Wisconsin, use state Medicaid funds to cover unauthorized immigrants. 

President Donald Trump has proposed reducing federal Medicaid funds to those states. That would cause 1.4 million people to lose coverage, the nonpartisan Congressional Budget Office estimated

Medicaid costs nearly $900 billion annually, two-thirds from the federal government and one-third from the states.

In Wisconsin, Medicaid serves 1.28 million people, more than a third of them children. Among adults, 45% work full time, 28% part time. The annual cost is $12.1 billion, $4.2 billion of it in state spending.

While unauthorized immigrants can’t get Medicaid in Wisconsin, they can apply to receive emergency care covered by state Medicaid.

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

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Both parties prep for mega-bill marathon in U.S. Senate vote-a-rama

U.S. Senate Minority Leader Chuck Schumer, D-N.Y., speaks during a press conference inside the Capitol building on Wednesday, June 18, 2025. Oregon Democratic Sen. Ron Wyden is at right. (Photo by Jennifer Shutt/States Newsroom)

U.S. Senate Minority Leader Chuck Schumer, D-N.Y., speaks during a press conference inside the Capitol building on Wednesday, June 18, 2025. Oregon Democratic Sen. Ron Wyden is at right. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — The next hurdle for Republican leaders in the U.S. Senate and the “big, beautiful bill”: Democrats — and possibly a few of their own members — in a marathon voting session will make last-ditch attempts to change the tax and spending cut measure.

The vote-a-rama, as it’s known, is expected to begin sometime during the last full week of June as Congress heads toward the Fourth of July recess. It will likely begin in the afternoon and  last overnight into the next morning. Senators will debate and vote on dozens of amendments attempting to revise the massive legislation that could have an effect on nearly every American.

Democrats, who have 47 votes in the Senate compared to 53 for Republicans, plan to zero in on Medicaid, taxes, corruption, policies that could raise energy costs and proposals that would increase the deficit, according to Senate Minority Leader Chuck Schumer.

Senate Majority Leader John Thune, R-S.D., and the committee chairs tasked with drafting pieces of the package have spent weeks combing through the House-passed bill to figure out what needs to be altered to avoid divisive floor votes. 

They’ve rewritten numerous policy proposals to comply with the strict rules that go along with the complex reconciliation process and are now trying to work out disagreements among GOP senators that could doom or complicate a final deal.

The goal is to avoid a protracted debate over core GOP provisions in full public view once the vote-a-rama begins, though some senators are already predicting votes on GOP amendments.

‘A potentially messy process’

Missouri Republican Sen. Josh Hawley, who has raised concerns about the bill’s impact on rural hospitals, said he hopes GOP leaders reach a consensus before vote-a-rama but didn’t rule out offering his own amendments if they don’t settle their disputes.

“Amending it on the floor, that’s a potentially messy process,” Hawley said. “I would hope that we could get to a good place before that. But we have to fix the rural hospital issue.”

Alabama Republican Sen. Tommy Tuberville said he will likely propose amendments during floor debate, though he declined to say what specific policies he’d seek to change or eliminate from the package.

“Yeah, we’ll have some,” Tuberville said. “And we’ve got them all, we just haven’t turned them in yet.”

Thune said he and other negotiators are making “headway” toward consensus on the more significant provisions in the package, which in many respects is far from its final form.

“The meetings right now are on the major provisions in tax and health. We have sort of pre-litigated a lot of that,” Thune said. “But there are a lot of the other provisions in the bill, chapters in the bill that are still subject to going through the Byrd bath, and we’re in the process of doing that. But hopefully that’ll be done by early next week.”

U.S. Senate Majority Leader Sen. John Thune, R-S.D., left, listens as Sen. Mike Crapo, R-Idaho, speaks to reporters outside of the West Wing of the White House on June 4, 2025 in Washington, D.C. (Photo by Anna Moneymaker/Getty Images)
U.S. Senate Majority Leader Sen. John Thune, R-S.D., left, listens as Sen. Mike Crapo, R-Idaho, speaks to reporters outside of the West Wing of the White House on June 4, 2025 in Washington, D.C. (Photo by Anna Moneymaker/Getty Images)

Republicans are using the reconciliation process to pass their sweeping tax and spending cuts package through the Senate with just a simple majority vote, requiring them to comply with the Byrd rules.

That includes the Byrd bath — going before the Senate parliamentarian to explain how each provision has an impact on federal revenue or spending that is not “merely incidental.” Democrats then usually debate before the parliamentarian the various changes that don’t meet that threshold. The process is named after the late Sen. Robert Byrd, a West Virginia Democrat.

Once the parliamentarian rules what elements comply and which need to be removed, the bill can go to the floor and senators can trudge through vote-a-rama. Eventually, all 100 lawmakers will vote to approve or disapprove of the legislation.

GOP senators passing their version of the package would send it back to the House, which passed its version on a slim 215-214 vote earlier this year — and could make yet more changes in the Senate bill.

Democrats develop strategy

Democrats are hoping to highlight policy divisions among Republicans during the vote-a-rama. And even if they don’t succeed in getting any of their amendments adopted, several votes could serve as fodder for campaign ads during next year’s midterm elections.

Schumer said Wednesday during a press conference it would be “difficult” for Democrats to peel off at least four GOP senators from the rest of the party in order to get an amendment adopted, but said he’s hopeful Republicans will “vote with us on some things they’ve all said they’ve agreed with.”

Democratic senators, he said, have created a task force to reach out to Republicans on major issues in the package, including how it would impact rural hospitals.

“Many of these hospital administrators and employees are Republican,” Schumer, a New York Democrat, said. “In many of the rural hospitals, they are the largest employer in the county, and in most they’re the only supplier of health care. It infuriates the rural counties, and they tend to be Republican.”

‘It’s just a show, it’s a charade’

West Virginia Republican Sen. Shelley Moore Capito said she’s not concerned about having to vote on dozens of amendments. 

“We’re here to vote,” Capito said. “As a creature of the House, we voted all the time on everything, so this doesn’t bother me. And, you know, just let the body work its will. If some changes are made, those will have to be dealt with. But I’m not worried about that.”

Arkansas Republican Sen. John Boozman said he expects the vote-a-rama will be “a very late night” and that he’s not planning to offer any of his own amendments.

As chairman of the Agriculture, Nutrition and Forestry Committee, Boozman expects to spend a considerable amount of time during vote-a-rama arguing against amendments seeking to change those provisions — including controversial cuts in the Supplemental Nutrition Assistance Program, which provides food aid for lower-income families.

Wisconsin Republican Sen. Ron Johnson said he plans to spend much of the vote-a-rama “going back and forth from my hideaway,” the ceremonial office that every senator holds in the Capitol building.

But Johnson cast doubt on actually being able to amend the package during that process, saying changes to the various bills that Senate committees have released need to be agreed to before then.

“You’ve got to get this before it ever goes to the floor. I mean, you’re not going to change things substantially or significantly with amendments. I know people have some idealized version that happens. It doesn’t,” Johnson said. “You’ve got to get these things in the base bill. Amendments; it’s just a show, it’s a charade.”

Vote-a-rama after vote-a-rama

The Senate has held two vote-a-ramas so far this year, and both demonstrated how difficult it is to change a piece of legislation.

The first all-nighter in February went along with Senate debate on its budget resolution and included votes on 25 amendments, with lawmakers adopting just two — one from Alaska Republican Sen. Dan Sullivan and one from Utah Republican Sen. Mike Lee.

The second vote-a-rama took place in April just before the Senate voted to approve the budget resolution that ultimately cleared the way for Congress to use the budget reconciliation process to advance the “big, beautiful bill.” Senators debated 28 amendments, voting to adopt one change from Sullivan.

Oregon Democratic Sen. Ron Wyden, ranking member on the Finance Committee, said he and staff on the panel will continue to parse through details of the panel’s bill, which Republicans just released Monday.

Wyden said he plans to hold several town hall meetings in GOP areas of his state over the weekend to gauge how residents there view the policy revisions Republican senators have put forward.

“We’ve had this bill for basically 36 hours. The first time I had it, I stayed up all night, so last night I got a little sleep,” Wyden said on Wednesday. “But on the plane, I’ll be working through it. And I expect to be working through it all through the next few days, except when I’m having these town hall meetings where I’ll have a number of questions.”

Medicaid cutbacks will affect unpaid family caregivers, experts warn

By: Erik Gunn

Tami Jackson of the Wisconsin Board for People with Developmental Disabilities describes how unpaid family caregivers could be affected by proposed Medicaid cuts in the Republican budget reconciliation package in Washington, D.C. Janet Zander of the Greater Wisconsin Agency on Aging Resources, seated at right, also spoke. (Photo by Erik Gunn/Wisconsin Examiner)

Among the many people whose health care could be in jeopardy from possible Medicaid cuts, one group may be even less visible than the rest.

Federal fallout

As federal funding and systems dwindle, states are left to decide how and
whether to make up the difference.
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For elderly residents as well as children and adults with disabilities whose health care is covered by Medicaid, family members who help with their care will also be affected by the proposals coming from Republican members of Congress.

“Medicaid is the primary thing that supports family caregivers,” said Tami Jackson, policy analyst for the Wisconsin Board for People with Development Disabilities (BPDD), in a presentation to social workers Thursday in Dodgeville. 

The person under the caregiver’s care could be living at home, but will probably still require long-term support of some kind — support covered by Medicaid, Jackson said. Medicare provides coverage only for a limited time, such as when a person has come home after being hospitalized.

Private long-term care insurance plans “are unaffordable and they have not been workable for many years,” she added. “So Medicaid is it — and we happen to have a lot of people who need long-term care.”

Jackson and Janet Zander of the Greater Wisconsin Agency on Aging Resources met with Iowa County social workers in Dodgeville Thursday to explain the likely effect of Medicaid cuts that are part of the budget reconciliation bill that has passed the U.S. House and is now in the Senate.

The GOP majorities of both houses want to pass the legislation so they can extend tax cuts enacted in 2017, when President Donald Trump was in his first term. Those tax cuts have been found to heavily benefit wealthy Americans. Without action they will expire at the end of 2025.

Cutting Medicaid, hiking other costs

Medicaid is the single largest source of federal funds in the state budget — about $9 billion a year.

Under the U.S. House version of the budget reconciliation bill, the Wisconsin Department of Health Services (DHS) has projected between 71,000 and 111,000 Wisconsinites would lose Medicaid coverage, including more than 3,800 people with disabilities and 2,400 older adults. The state’s federal Medicaid revenues would be cut by $501 million to $663 million.

The Medicaid cuts on the scale of those in current iterations of the bill “are too large to not cause states to have to cut many things in their state budget,” Jackson said.

The bill’s Medicaid cuts as well as changes it would make to the Affordable Care Act’s health insurance marketplace — including ending subsidies that have made marketplace plans more affordable for lower-income people — would increase the number of uninsured Americans by 16 million in the next decade, according to the Congressional Budget Office.

“Whether you’re a caregiver, whether you’re on Medicaid, whether you’re working for somebody who’s on Medicaid,” everyone will be affected by 16 million more uninsured people, Zander said.

With more uncompensated care for hospitals and providers, she predicted that the cost for other payers will increase.

“We’re going to see premiums for any kind of [health] insurance skyrocket — the employer’s portion, the employee’s portion,” Zander said.

Reduced Medicaid care, more unpaid care

Family caregivers feel Medicaid’s impact in several ways. For many people who are elderly or have disabilities it enables them to get paid, professional care at home. If that care is cut back, that means more work for the unpaid family member.

“Those paid caregivers — they’re paid for by Medicaid dollars and there aren’t enough of them. There haven’t been enough of them for years,” Jackson said.

 If Medicaid cutbacks reduce the pay for those caregivers, the workforce that is already underpaid is likely to be even harder to find — making access to paid care even more difficult, she added, to the point where “it’s either the unpaid caregiver or nothing.”

Family caregivers who take on more unpaid care responsibilities may have to cut back on their own paid jobs.

“The amount of people who are reducing, limiting [work hours or] leaving the workforce because there isn’t a stable, paid caregiving workforce to provide what they need is huge,” Jackson said.

A BPDD survey found that for unpaid family caregivers in Wisconsin providing or coordinating care or filling in for missing care workers took 80% of their time. Two-thirds said caregiving had a negative impact on their family finances and 50% said they left jobs or reduced hours to provide care because there were no care workers to hire.

Unpaid caregivers who leave the workforce not only lose income but reduce the earnings that contribute to their Social Security retirement, Jackson said.

Kristin Voss, a former public school teacher, gave up her job because of her responsibilities as the guardian and family caregiver for her adult daughter. (Photo by Erik Gunn/Wisconsin Examiner)

Kristin Voss, a Madison public school teacher for 24 years, had to retire to help manage and care for her 23-year-old daughter. Her daughter has epilepsy, autism and an intellectual disability and “functions at about anywhere from 6 to 12 years old,” Voss said in a panel discussion that was part of Thursday’s presentation.

Until her daughter was 21, she was entitled to public education, where she got “tons of support” including in her transition period that started when she was 18, Voss said. At 21, those supports were no longer available, however.

Her daughter enrolled in the state’s self-directed long-term care program called IRIS. The program includes a caseworker, but Voss also has responsibility as her daughter’s family caregiver, helping to manage day-to-day changes in her daughter’s placement and activities.

“I don’t mind doing these things, but there’s things that I don’t always know about and I’m not always prepared for,” Voss said. “And so, no, I couldn’t do this and be a public school teacher.”

Instead, she has put together a collection of part-time positions that give her flexibility that she needs — although none of them have health insurance, Voss said.

Unpaid caregivers ‘untangling the mess’

Some unpaid caregivers who leave the workforce may also turn to Medicaid for their health coverage because they can’t afford health insurance or work at a job that doesn’t provide insurance.

“About 4 million people nationally are unpaid caregivers who are in Medicaid themselves,” Jackson said.

Among the changes proposed for Medicaid is a requirement for participants in the program to prove every six months that they are still eligible for the program, instead of once a year, the current standard. Another change proposed is to add a work requirement for certain Medicaid participants.

Both of those changes will mean more paperwork. “Unpaid caregivers are the folks that are keeping people who are in Medicaid programs already,” Jackson said — by filling out the forms that are required to prove the person is still eligible.  

“Often these processes are so complex,” Jackson said. And when something goes wrong, because of an error in an eligibility form or a billing mistake, family caregivers “are the people who are untangling the mess.”

The current version of the bill in the Senate gives caregivers an exemption from the work requirement — but Jackson said the definition has raised concerns.

The current proposal limits the exemption to people who are caring for a person under the age of 14. National advocates have said that “really narrows that caregiver exemption and doesn’t quite fit with the reality that most unpaid caregivers are providing care for people with disabilities and older adults,” Jackson said.

Including exemptions in the proposed work requirement provisions also doesn’t necessarily reduce the paperwork.

“You either have to prove you’re meeting the work requirements, or you have to prove that you’re exempt for those requirements,” Jackson said. “And if you’re a caregiver who’s in Medicaid, you have to do that for yourself and probably the person you’re supporting.”

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(STN Podcast E262) Assess & Fix: The NJ Transportation Director Managing 63 Contractors

School districts attempt to navigate the clean fuel struggle between the California Air Resources Board and the Trump administration. Chicago uses multimodal systems to provide student service.

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Planned Parenthood at risk of closing hundreds of clinics, drastically limiting abortion access

Planned Parenthood has identified 200 of its clinics in 24 states that are at risk of closure through federal cuts under the budget reconciliation package before the U.S. Senate. (Photo by Michael B. Thomas/Getty Images)

Planned Parenthood has identified 200 of its clinics in 24 states that are at risk of closure through federal cuts under the budget reconciliation package before the U.S. Senate. (Photo by Michael B. Thomas/Getty Images)

If the budget reconciliation package before the U.S. Senate becomes law in the coming weeks, reproductive health advocates say the provision that would cut federal funding to Planned Parenthood clinics could serve as a backdoor nationwide abortion ban, eliminating access to 1 in 4 abortion providers.

The Republican-led bill, which already passed the House by a slim margin, is more than 1,000 pages and includes sweeping tax cuts that mostly benefit the wealthy coupled with steep spending cuts to social services, including Medicaid.

On page 339 of the bill, Republicans included a provision prohibiting Medicaid funding from going to any sexual and reproductive health clinics that provide abortions and received more than $1 million in federal and state Medicaid funding in fiscal year 2024. While there may be a few independent clinics with operating budgets that high, it effectively singles out Planned Parenthood clinics.

Planned Parenthood clinics rely heavily on Medicaid funding, not to provide abortions, which is not permitted by federal law (except in cases of rape, incest or life-threatening health emergencies), but to provide standard reproductive health care at little to no cost, including treatment for sexually transmitted infections and cancer screenings, as well as contraception. Planned Parenthood provides services for about 2 million patients every year, and 64% of its clinics are in rural areas or places with health care provider shortages.

A Planned Parenthood spokesperson said people who use Medicaid make up half of the total patient volume nationwide for essential health care services provided by their clinics. Even though those patients aren’t seeking abortion care, funding cuts would affect the financial sustainability of those clinics, the spokesperson said.

The organization already identified that 200 of its clinics in 24 states are at risk of closure with the cuts but told States Newsroom on Thursday that further analysis revealed nearly all of those clinics — 90% — are in states where abortion is legal, and in 12 states, approximately 75% of abortion-providing Planned Parenthood health centers could close. The entire organization has about 600 clinics in 48 states.

The “One Big Beautiful Bill” would result in nearly 11 million people losing access to health insurance by 2034, according to the nonpartisan Congressional Budget Office, and add $2.4 trillion to the federal deficit over the next 10 years.

Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, told States Newsroom she and other advocates have been meeting with senators to lobby against the bill’s passage, emphasizing that it will have an outsized negative effect on rural clinics and hospitals.

“We are encouraging everyone to reach out to their representatives about this,” McGill Johnson said. “They know that they’re doing this under a watchful eye, and we want to make sure their constituents know about it.”

The defunding effort would be a win for several prominent anti-abortion organizations that have long lobbied for this change and nearly achieved it in 2017 with a similar budget bill. Americans United for Life sent a fundraising email to its supporters Thursday saying this is a “crossroads” for abortion in America. 

“So far in 2025 more than a dozen Planned Parenthood clinics have closed, their taxpayer funding is hanging by a thread, and the highest-ranking federal health officials are undertaking a ‘top-to-bottom review’ on the abortion pill,” the email attributed to CEO John Mize said. “It’s possible that very soon, mail-order abortion could be walked back, and more Planned Parenthood locations could be closing their doors for good.”

Susan B. Anthony Pro-Life America, another anti-abortion organization that helped draft the Heritage Foundation’s Project 2025 blueprint for the next Republican president, told States Newsroom in an emailed statement that the budget provision should be no surprise, and there are better uses for the funding, like community health centers.

“Republicans have identified budgetary concerns with funding Big Abortion since 2015, and the bill language to do so has remained substantially the same,” said SBA President Marjorie Dannenfelser.

Closures would affect already fragile health care system, Midwest doctor says

Planned Parenthood has already closed some clinics around the country, including eight clinics across Iowa and Minnesota at the end of May. Dr. Sarah Traxler, chief medical officer of Planned Parenthood North Central States, which includes Iowa and Minnesota, said the U.S. Health and Human Services’ decision to freeze Title X family planning funding to many reproductive health clinics at the beginning of May contributed to the decision to close those clinics. The North Central States affiliates serve more than 93,000 patients each year, about 20,000 of which use telehealth services.

About 30% of those patients use Medicaid to access care, she said.

“When Planned Parenthood isn’t able to provide services to patients as an essential safety net provider, it has ripple effects across the health care system at large,” Traxler said. “We are already sitting in a time in our country, and have for several decades, where we have patients who can’t access care.”

Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, told States Newsroom that 865 Title X clinics in 23 states are impacted by the federal freeze. She said there are no Title X services in eight states: California, Hawaii, Maine, Mississippi, Missouri, Montana, Tennessee and Utah. She said the funding freeze affects one-quarter of all Title X funding grantees, translating to about 842,000 patients who have lost access to care.

“In the two months since HHS withheld federal funding for nearly two dozen Title X family planning grants, affected grantees have been struggling with the unknown of whether they will ever receive the vital funds,” Coleman said in an email. “Some have had to close clinics, lay off staff, and reduce essential contraceptive and sexual health care services. … On top of the Title X funding freeze, proposed Medicaid cuts will be devastating for Title X grantees. Rates of unintended pregnancies and STIs will increase, cancer screenings and diagnoses will be delayed, and decades of public health progress will be reversed.”

After the Iowa Legislature axed Planned Parenthood from its family planning program, Traxler said, the rates of sexually transmitted infections increased considerably across the state — an outcome verified by a 2022 medical study. She expects similar effects from these cuts.

People already travel long distances for abortion care, she said, and that will only get worse if more cuts come to pass. But she also expects to see patients start traveling long distances for routine gynecological care.

‘Changes to Medicaid … only adds to the chaos’

Like many independent abortion clinics, the all-trimester Maryland abortion clinic Partners in Abortion Care does not receive Title X funding. But because Maryland is one of 17 states whose Medicaid program covers abortions, they do see a lot of patients who are on Medicaid, at a significant cost to the clinic. Certified nurse-midwife and Partners co-founder Morgan Nuzzo said the clinic did not receive more than $1 million in federal or state Medicaid dollars in fiscal year 2024, and in fact loses about $1 million annually for seeing Medicaid patients.

Nuzzo said Maryland’s Medicaid program reimburses first-trimester abortions at a “decent rate,” but at a very low rate for later abortion cases, which are more medically complex.

“After about 15 to 16 weeks [gestation], we’re losing money on these cases,” Nuzzo said. “We’ve been billing now for almost a year through the state. In second and third-trimester abortion care, we’re losing about 85% of what we would charge for a cash pay fee. So that comes out to about $250,000 a quarter that we are losing just by the under-reimbursement from Maryland Medicaid.”

For that reason, Nuzzo is hopeful about Maryland’s new $25 million Public Health Abortion Grant Programrecently approved by Gov. Wes Moore. The program will be open to clinics like Partners and abortion funds like the Baltimore Abortion Fund, but Nuzzo said it could be a while before that funding is available. Right now she is uncertain and concerned about how the federal reconciliation bill could potentially impact Maryland’s Medicaid program. 

Because Partners provides abortions for all trimesters, they see patients from all over the country, and even the world, and the vast majority need financial assistance, Nuzzo said.

“People are traveling further for their procedures, just like they were before,” she said. “The landscape is constantly changing, almost week to week, about where you can access abortion, which is confusing and chaotic to patients. Changes to Medicaid and insurance coverage of abortion only adds to the chaos.”

U.S. Senate GOP will try to drag Trump’s mega-bill across the finish line

U.S. Senate Majority Leader Sen. John Thune, R-S.D., left, listens as Sen. Mike Crapo, R-Idaho, center, speaks to reporters outside of the West Wing of the White House on June4, 2025 in Washington, D.C.  (Photo by Anna Moneymaker/Getty Images)

U.S. Senate Majority Leader Sen. John Thune, R-S.D., left, listens as Sen. Mike Crapo, R-Idaho, center, speaks to reporters outside of the West Wing of the White House on June4, 2025 in Washington, D.C.  (Photo by Anna Moneymaker/Getty Images)

WASHINGTON — U.S. Senate Republican Leader John Thune will spend a crucial next few weeks working behind the scenes with other top GOP senators to reshape the party’s “big beautiful bill” — a balancing test accompanied in recent days by incendiary exchanges between President Donald Trump and billionaire Elon Musk over whether the current proposals are so bad that Congress should just go back to the drawing board.

South Dakota’s Thune will need to gain support from deficit hawks, who want to see the mega-bill cut at least $2 trillion in spending, and moderates, who are closely monitoring how less federal funding for safety net programs like Medicaid and food assistance could harm their constituents and home-state institutions like rural hospitals.

Interviews by States Newsroom with Republican senators in early June showed many major elements of the package could change, including provisions that would put states on the hook for unanticipated costs. Arkansas Sen. John Boozman, for example, indicated the Senate may rewrite a proposal in the House-passed bill that would shift some of the cost of the Supplemental Nutrition Assistance Program, which provides food aid to low-income people, to state governments.

“We can do whatever we want to do,” the Agriculture, Nutrition and Forestry Committee chairman said when asked by States Newsroom about amending that policy.

The final deal — intended to extend the 2017 tax cuts — cannot lose more than three GOP senators and still make it back across the Capitol to the House for final approval, since all Democrats are expected to oppose the bill. Thune only needs a majority vote in the Senate for the special process being used by Republicans.

Internal debates about just how to rework the Trump-backed tax and spending cuts measure began in the first week of June during meetings on Capitol Hill and at the White House, as GOP senators began critiquing the House-passed package line-by-line to ensure it complies with their strict rules for the complex reconciliation process and their policy goals.

Republicans said during interviews that several provisions in the House version likely won’t comply with the chamber’s Byrd rule, which could force lawmakers to toss out some provisions.

Complicating all of it was the very public back-and-forth between not just Trump but GOP leaders and former White House adviser Musk over the bill, which Musk on social media labeled “a disgusting abomination” and a “big, ugly spending bill” for its effect on the deficit and debt limit. “KILL the BILL,” Musk said on X, the platform he owns. Senate leaders so far have dismissed Musk’s criticisms.

Fragile House coalition

The talks, and whatever the legislation looks like after a marathon amendment voting session expected in late June, have already raised deep concerns among House GOP lawmakers, who will have to vote on the bill again in order to send it to Trump.

The extremely narrow majorities mean House Republican leaders cannot lose more than four of their own members if all the lawmakers in that chamber vote on the party-line bill.

Any changes the Senate makes could unbalance the fragile coalition of votes Speaker Mike Johnson, R-La., cobbled together last month for a 215-214 vote. But GOP senators are adamant they will amend the legislation.

Complicating matters is a new report from the nonpartisan Congressional Budget Office that shows the proposed changes to tax law, Medicaid, the Supplemental Nutrition Assistance Program and higher education aid wouldn’t actually help to reduce deficits during the next decade but raise them by more than $2.4 trillion.

The numbers are the exact opposite for what Republicans hoped their sweeping tax and spending cuts package would accomplish.

Scrutiny begins

The first stop for the House-passed reconciliation package in the Senate appears to be the parliamentarian’s office, where staff have begun evaluating whether each provision in the current version of the bill complies with the upper chamber’s strict rules.

Boozman said staff on his panel have already begun meeting with the parliamentarian to go over the House provisions within its jurisdiction.

He expects that section of the package will have to change to comply with the strict rules that govern the reconciliation process in the Senate and to better fit that chamber’s policy goals.

“We can’t really decide exactly what we want to use in the House version until we know what’s eligible,” Boozman said. “We’ve got some other ideas too that we asked them about. But we need to know, of the ideas that we have, what would be viable options as far as being Byrd eligible.”

The Byrd rule, which is actually a law, requires reconciliation bills to address federal revenue, spending, or the debt limit. This generally bars lawmakers from using the special budget process to change policies that don’t have a significant impact on those three areas.

Alabama Sen. Tommy Tuberville, who is campaigning to become his home state’s next governor, said pushing some of the cost of the nutrition program to states may be problematic.

“We’re trying to send more costs to the states. Most states can’t afford that, so we want to take care of people, but we need people to go back to work,” Tuberville said. “It’s not a forever entitlement. It’s for part-time, you know, take care of yourself until you get a job, go back to work and let people that need it really, really get it.”

Rural hospitals on edge

Senate GOP leaders will have to navigate how best to reduce federal spending on Medicaid, the state-federal health program for lower-income people and some with disabilities, that is relied on by tens of millions of Americans, many of whom are loyal Republican voters.

The nonpartisan Congressional Budget Office projects that 7.8 million people would lose access to Medicaid during the next decade if the House’s policy changes are implemented as written.

There are also concerns among GOP lawmakers about how losing the revenue that comes with treating Medicaid patients would impact rural health care access and hospitals.

Missouri Sen. Josh Hawley said under no circumstances would he vote for a bill that cuts benefits to Medicaid recipients and is worried about how provisions in the House package would affect rural hospitals.

“They’re very concerned about it, rightly so,” Hawley said, referring to conversations he’s had with health care systems in his home state.

“This is something that we need to work on. I don’t know why we would penalize rural hospitals,” he added. “If you want to reduce health care spending, then cap the price of prescription drugs. I mean, that’s the way to do it. If you want to get major savings in the health care sector, don’t close rural hospitals, don’t take away benefits from working people. Cap the costs, cap the price that (the Centers for Medicare & Medicaid Services) is going to pay for prescription drugs.”

West Virginia Sen. Shelley Moore Capito said she’s not yet come to a decision about whether to keep, amend, or completely scrap some of the House changes to Medicaid.

“I talked to a lot of our hospitals when I was home to see what the impacts would be, because we have a very high Medicaid population,” Capito said. “I want to see it work and be preserved, but I want it to be there for future generations. And it’s just getting way out of control on the spend side. So right now, we’re looking at everything.”

Louisiana Sen. Bill Cassidy — chairman of the Health, Education, Labor and Pensions Committee — said he doesn’t expect all of the health care provisions in the House bill make it through the “Byrd bath” with the parliamentarian. But he declined to go into detail.

“Some of it is more regulatory, that’s all I can say,” Cassidy said.

West Virginia’s Sen. Jim Justice said he is in favor of requiring some Medicaid enrollees to work, participate in community service, or attend an educational program at least 80 hours a month to stay on the program, a sentiment shared by many of his GOP colleagues.

“I’m good with every bit of that,” he said. 

But Justice expects the Senate will make its own changes to the package and that it will be “proud of their own pond.”

“Any frog that’s not proud of your own pond’s not much of a frog,” Justice said.

He did not go into detail on what those changes would entail.

SALT shakers

The state and local tax deduction, or SALT, represents another tightrope  for Thune, who is no fan of the changes made in the House. But he has said repeatedly this week he understands altering that language too much could mean a Senate-amended version of the bill never makes it back through the House to actually become law.

Thune said outside the White House following a June 4 meeting with Trump and others that there will very likely be changes to SALT.

“There isn’t a single Republican senator who cares much about the SALT issue,” Thune said. “It’s just not an issue that plays.” States that are most affected generally don’t elect Republicans to the Senate.

The House tax-writing panel originally proposed raising the SALT cap from $10,000 to $30,000, but Johnson had to raise that to $40,000 in order to secure votes from House Republicans who represent higher tax states like California, New Jersey and New York. The revised cap would benefit more high-income taxpayers in their states.

“In 2017, that was one of the best reforms we had in the bill,” Thune said. “But we understand it’s about 51 and 218. So we will work with our House counterparts and with the White House to try to get that issue in a place where we can deliver the votes and get the bill across the finish line.”

Republicans hold 53 seats in the Senate, but can rely on Vice President J.D. Vance to break a tied vote if necessary.

At least 218 House lawmakers must vote to pass bills when all 435 seats are filled. But with three vacancies at the moment, legislation can move through that chamber with 216 votes. The GOP has 220 seats at the moment, meaning Johnson can afford four defections on party-line bills.

North Dakota Sen. John Hoeven told reporters this week that he’d like to see GOP senators rework the SALT section of the bill, even if that causes challenges for Speaker Johnson’s ability to pass a final version.

“Let’s talk about SALT, for example. The House has a very large SALT number. The Senate is probably going to take a look at that,” Hoeven said. “There’ll be a lot of areas we can look at. There’ll be other things we’re going to look at. We’d like to get to $2 trillion in savings.”

Ohio Sen. Bernie Moreno joined in putting his House colleagues on notice that they likely won’t get the agreement they struck with the speaker in the final version of the bill.

“I think we’re going to make common-sense changes. For example, the SALT cap, by the way, something that definitely helps very wealthy people in blue states,” Moreno said. “I think that cap, the 400% increase, is too much, so we’re going to work on tweaking that.”

Hawley, of Missouri, speaking more generally about the tax provisions, said he would like the Senate to make sure middle-class Americans benefit from the tax changes, just as much as companies.

“I want to be clear, I’m in favor of additional tax relief for working people. So my view is this corporate tax rate, which they lowered in 2017, they made that permanent back then. I know some workers that would like permanent tax relief,” Hawley said. “So I think it’s imperative that we do some addition to tax relief for workers. So I think that’s important.”

A new $4 trillion debt limit

Deficit hawks in the Senate have also voiced objections to raising the nation’s debt limit by $4 trillion, arguing that GOP leaders haven’t done enough to assuage their concerns about the nation’s fiscal trajectory.

Kentucky Sen. Rand Paul argued that the debt limit increase is more about next year’s midterm elections than good governance.

“​​This is really about avoiding having to talk about the debt during election times because people like to go home and talk to the Rotary or the Lions Club and tell them how they’re fiscally conservative and they’re against debt,” Paul said. “It’s embarrassing to them to have to vote to keep raising the debt. But they’re unwilling to have the courage to actually look at all spending.”

Paul suggested that House Republicans created problems by inflating some of the spending levels in their package, including to continue construction of a wall along the U.S.-Mexico border. Paul is chairman of the Homeland Security and Governmental Affairs Committee.

“The $46.5 billion for the wall is eight times higher than the current cost of the wall. If you’re going to do 1,000 miles, you can actually do it for $6.5 billion. They want $46.5 billion,” Paul said. “We can’t be fiscally conservative until it comes to the border, and then we’re no longer fiscally conservative.”

The border wall has been a constant focus for Trump, who made it a central part of his 2016 presidential campaign, when he said repeatedly that the United States would build it and Mexico would pay for it.

South Carolina’s Lindsey Graham, chairman of the Budget Committee, hinted during a brief interview that Congress can only cut so much spending without going near programs like Social Security, which accounted for $1.5 trillion in expenditures last year, or Medicare, which spent $865 billion. Both are normally considered untouchable.

“I think we’re going to make some changes to try to find more spending reductions. I think that’s a fair criticism of the bill, but you can’t do Social Security by law,” Graham said, referring to one of the many rules that govern the reconciliation process. “Nobody’s proposed anything in the Medicare area.”

Graham added that “trying to make the bill more fiscally responsible is a good thing, but we need to pass it.” 

We are choosing a bleak future for Wisconsin children

child care

Children at the Growing Tree child care in New Glarus. Wisconsin is one of only six states that doesn't put any money into early childhood education. (Photo by Kate Rindy)

Children are born into this world innocent. They did not choose their parents. They did not choose to be born into poverty. They do not get to choose if a parent is addicted to drugs or alcohol. Children do not get a choice to be born into an environment of neglect. Children do not choose to grow up in a home with violence. Children do not get a choice to be abused or assaulted. Children do not choose to be born with a disability. Children do not get to choose if they can access medical care. Children do not get a choice on whether they are even wanted or loved. 

Adults do have choices. In Wisconsin, we  have chosen to have a state where children are the largest demographic living in poverty. We have chosen to allow some children to live with constant hunger. We have chosen not to support children with disabilities. We are still choosing not  to create systems to support children who have experienced adversity like abuse and neglect. We made the choice to create an education system based on the income of the people living in the community. We choose to allow children to be uncared for. We as a community have made these choices deliberately and without shame. 

Consequently, we have chosen for those children to be  less likely to graduate from high school, more likely to fail at a job, have poor health (which is connected to stress in the early years) and to be statistically more likely to be placed in the prison system. 

We, as a state, have chosen to prioritize funding for  prisons and spend nothing on early care and education, one of only six states that don’t invest a penny in early childhood programs, even though we know that when children have access to quality early education that they are more likely to graduate high school, have higher incomes, be healthier, and are less likely to enter the prison system. We have chosen to remove health care options for children by not expanding Badgercare. We are soon to be the only state that does not provide postpartum Medicaid, risking the lives of new mothers and  increasing the likelihood that children will have to grow up without them. We have decided that children with disabilities will receive services not based on their actual needs, but based on the budget  for special education, which our state keeps at the barest minimum. 

We have chosen to make the word “welfare” into a bad word. Welfare by definition is the health, happiness and fortunes of a person or group. And we have chosen to deny the health, happiness and fortune of children in our state. Referring to a bipartisan push for Medicaid expansion to cover postpartum care, Assembly Speaker Robin Vos has said he  “cannot imagine supporting an expansion of welfare.” Why is providing welfare to support the health and wellbeing of children or anyone for that matter a negative concept? Why are we so afraid that if we support people in need  that it somehow takes away from us? For example, why would providing children with free lunches at school be a bad thing to do? Why would ensuring that children have access to medical care regardless of whether their parents can afford it or not be bad to do? Why would ensuring that children have access to quality care and education in their early years, regardless of their parents’ income, be a bad thing? Why would ensuring that children with disabilities have access to the services they need be bad? Why is it wrong  to have systems in our state that ensure we are doing everything we can to give all children the best opportunities to grow, thrive and become productive members of our communities? 

Rep. Vos and Joint Finance Committee co-chairs Sen.Howard Marklein (R-Spring Green), and Rep. Mark Born (R-Beaver Dam) all disagree with creating and funding policies that support our children. Time and time again, they have voted down policies that would have provided support to children. They have continued to forgo our future by not investing in our children. Instead,  they invest in the wealthiest in our state and invest in our punitive prison systems. They invest in large businesses with expensive lobbyists who demand tax breaks and deregulation. They invest in those most likely to donate to their campaigns. These grown-up white men cannot stand the idea of anyone, even a child, getting help from the state. If they had to pay for school lunch, they figure, so should  everyone else. If they had to pay for their child’s medical visit, then so should everyone else. If they had to pay for child care, then so should everyone else. They are incapable of seeing past their privileges. They cannot appreciate what it is like to be a child born into an environment that causes  harm and the trajectory that puts the child on. However, they will certainly be there when that child becomes an adult and enters the prison system. They are more than willing to pay for incarceration and punishment. 

That’s not just financially irresponsible — we spend about four times as much to keep someone in prison as we spend on education —  it’s inhumane, and it impoverishes our state and condemns children to unnecessary suffering and a bleak future.

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U.S. House tax cut bill would check Medicaid qualifications every 6 months

By: Erik Gunn

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.”


Federal fallout


As federal funding and systems dwindle, states are left to decide how and
whether to make up the difference.

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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Grassroots pressure on Gov. Evers reflects nationwide impatience with Dems

Robert Kraig of Citizen Action at the podium in the Senate parlor in the Wisconsin State Capitol on Tuesday, May 27 , surrounded by representatives of other grassroots groups | Ruth Conniff/Wisconsin Examiner

More than 100 citizens from an array of grassroots groups packed the Wisconsin state Senate parlor and marched on Gov. Tony Evers’ office Tuesday, their chants bouncing off the marble walls inside the Capitol. They were there to deliver a letter — which they urged others to sign online — demanding that Evers veto the state budget if it doesn’t include key elements of the governor’s own budget proposal.

“The whole Democratic grassroots is now demanding that national leaders stand and fight,” said Robert Kraig, executive director of Citizen Action of Wisconsin, who helped organize the effort, “and I think that spirit is now being translated down to the state level.” 

Public school advocates, child care providers, teachers’ unions and advocates for criminal justice reform and health care access came to demand that Evers take a stronger stand and threaten to use his significant veto power in negotiations with Republicans. 

“There has been a lot of talk over the last year about whether or not we can get this done as adults, or whether we have to be impolite,” Michael Jones, president of Madison Teachers, Inc., said of state budget negotiations. “Too much gets conceded about being polite,” he added. “Politeness without reciprocal respect is just being a sucker.”

In their letter, the advocates assured Evers that Wisconsinites were behind his original budget proposal — the one Republican legislative leaders threw in the trash. The advocates urged him to “hold the line” and reject any budget that doesn’t accept federal Medicaid expansion money, provide a 60% state reimbursement to schools for special education costs, close the Green Bay Correctional Institution, restore his proposed $480 million for child care and reject the snowballing growth of school vouchers.

Brooke Legler, a child care provider and co-founder of Wisconsin Early Childhood Action Needed (W.E.C.A.N.), has been leading a recent high-profile effort to sound the alarm about the loss of child care funds. “So many of us are going to be closing our doors because we cannot keep going and parents can’t afford to pay what they are paying,” she said during a press conference in the Senate parlor. Treating child care like any other business doesn’t work, she added. Instead, it needs to be seen as a public good. “Gov. Evers declared this the year of the kid,” Legler said, but “it’s not going to be” if Evers signs a budget that leaves out crucial funding for child care. 

Tanya Atkinson of Planned Parenthood Wisconsin spoke at the press conference about congressional Republicans’ effort to cancel Medicaid funding for patient care at Planned Parenthood.

In Wisconsin, 60% of Planned Parenthood’s patients have Medicaid as their form of insurance, she said. Most of them live in rural areas, are low-income, or are women of color who “continue to be further pushed out of our health care system,” Atkinson said. “And it doesn’t have to be that way. It is time for us to take the politics out of sexual reproductive health altogether.”

Atkinson and the other assembled advocates praised Evers’ budget proposal, including the part that would finally allow Wisconsin to join the 40 other states that have accepted the federal Medicaid expansion, making 90,000 more Wisconsinites eligible for Medicaid coverage and bringing about $1.5 billion into the state in the next budget cycle.

Shaniya Cooper, a college student from Milwaukee and a BadgerCare recipient who lives with lupus, talked about how scary it was to realize she could lose her Medicaid coverage under congressional Republicans’ budget plan. “To me, this is life or death,” she said. When she first learned about proposed Medicaid cuts, “I cried,” she said. “I felt fear and dread.”

She described having a flare-up of her lupus, with swelling and fluid around her heart, and then finding out she had to fill out paperwork to reapply for Medicaid, since it was unclear if her treatment would still be covered. 

“It isn’t just about the paperwork. It’s about waking up each day with the fear that the care I might need might be gone tomorrow,” she said, “It’s about knowing that people are quietly suffering mentally and emotionally from the stress and the anxiety that these policies are creating.” Her voice broke and people around her yelled encouragement. “You got this!” someone shouted. “What’s at stake here is humanity,” she continued, “and if we do nothing, we allow these cuts to happen, we are silently endorsing the neglect and slow death of those who cannot afford prime insurance. That is not a civil society. That is not justice.”

“We are here because we will not be pitted against each other to fight for crumbs in a time of plenty,” said Heather DuBois Bourenane of the Wisconsin Public Education Network. “We will not be divided on the issues that matter most where we live, because some people refuse to listen to us.”

DuBois Bourenane derided what she called a “cycle of disinvestment, first of all, but it’s also a cycle of disrespect,” by Republicans who dismissed Evers’ budget proposals despite  overwhelming public support. Increasing funding for schools, expanding Medicaid coverage and reforming the criminal justice system by closing prisons and reducing incarceration are popular measures. “Gov. Evers has the power, with his veto pen, to break [the cycle],” she said, “and we’re calling on him to use the full force, the full power of that pen, to say, enough is enough. It stops with me.”

“There’s a tremendous amount of Democratic leverage in this budget, if you consider both the number of Democratic members in the Senate and the veto,” Kraig said. 

“These are groups with large memberships calling on the governor to stand and fight,” he added.

Evers did not make an appearance or respond to the rowdy group at the Capitol. But it was clear they have no intention of going away quietly,

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Maybe we don’t need a tax cut

From Gov. Tony Evers' Facebook page: "Big day today in Wisconsin. Signing one of the largest tax cuts in state history and investing more than $100 million in new funds in Wisconsin's kids and schools calls for a twist cone!"

Gov. Tony Evers celebrates "historic" tax cuts in the last state budget. Schools are still facing austerity. Photo via Gov. Evers' Facebook page

As Republicans in Congress struggle to deliver President Donald Trump’s massive cuts to Medicaid, food assistance, education, health research and just about every other social good you can think of, in order to clear the way for trillions of dollars in tax cuts to the richest people in the U.S., here in Wisconsin Gov. Tony Evers and state lawmakers are working on the next state budget.

The one thing our Democratic governor and Republican legislative leaders seem to agree on is that we need a tax cut.

After throwing away more than 600 items in Evers’ budget proposal, GOP leggies now say they can’t move forward with their own budget plan until  Evers makes good on his promise to meet with them and negotiate the terms for the tax-cutting that both sides agree they want to do. Evers has expressed optimism that the budget will be done on time this summer, and said the tax cuts need to be part of the budget, not a separate, stand-alone bill. Evers wants a more progressive tax system, with cuts targeted to lower-income people. In the last budget, he opposed expanding the second-lowest tax bracket, which would have offered the same benefits to higher earners as the lower middle class.

But what if we don’t need a tax cut at all?

It has long been an article of faith in the Republican Party that tax cuts are a miracle cure for everything. Trickle-down economics is  a proven failure:  The wealthy and corporations tend to bank their tax cuts rather than injecting the extra money into the economy, as tax-cutters say they will. The benefits of the 2017 tax cuts that Congress is struggling to extend went exclusively to corporations and the very wealthy and failed to trickle down on the rest of us. 

 In the second Trump administration, we are in new territory when it comes to tax cutting. The administration and its enablers are hell-bent on destroying everything from the Department of Education to critical health research to food stamps and Medicaid in order to finance massive tax breaks for the very rich. 

If ever there were a good time to reexamine the tax-cutting reflex, it’s now.

Evers has said he is not willing to consider the Republicans’ stand-alone tax-cut legislation, and that, instead, tax cuts should be part of the state budget. That makes sense, since new projections show lower-than-expected tax revenue even without a cut, and state budget-writers have a lot to consider as we brace for the dire effects of federal budget cuts. The least our leaders can do is not blindly give away cash without even assessing future liabilities.

But beyond that, we need to reconsider the knee-jerk idea that we are burdened with excessive taxes and regulations, that our state would be better off if we cut investments in our schools and universities, our roads and bridges, our clean environment, museums, libraries and other shared spaces and stopped keeping a floor under poor kids by providing basic food and health care assistance. 

Wisconsin Republicans like to tout the list of states produced annually by the Tax Foundation promoting “business friendly” environments that reduce corporate taxes, including Wyoming, South Dakota, Alaska and Florida. They also like to bring up ALEC’s “Rich States, Poor States” report that gave top billing last year to Utah, Idaho and Arizona for low taxes and deregulation. 

What they don’t track when they lift up those states are pollution, low wages and bankrupt public school systems. 

I’m old enough to remember when it was headline news that whole families in the U.S. were living in their cars, when homelessness was a new term, coined during the administration of Ronald Reagan, the father of bogus trickle-down economics and massive cuts to services for the poor. 

Somehow, we got used to the idea that urban parts of the richest nation on Earth resemble the poorest developing countries, with human misery and massive wealth existing side by side in our live-and-let-die economy.

Wisconsin, thanks to its progressive history, managed to remain a less unequal state, with top public schools and a great university system, as well as a clean, beautiful environment and well-maintained infrastructure. But here, too, we have been getting used to our slide to the bottom of the list of states, thanks in large part to the damage done by former Republican Gov. Scott Walker. 

We now rank 44th in the nation for investment in our once-great universities, and the austerity that’s been imposed on higher education is taking a toll across the state. Our consistently highly rated public schools have suffered from a decade and a half of budget cuts that don’t allow districts to keep pace with inflation, and recent state budgets have not made up the gap

Now threats to Medicaid, Head Start, AmeriCorps, our excellent library system, UW-Madison research and environmental protections do not bode well for Wisconsin’s future.

In the face of brutal federal cuts, we need to recommit to our shared interest in investing in a decent society, and figure out how to preserve what’s great about our state.

Tax cuts do not make the top of the list of priorities.

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U.S. House GOP revamps giant budget bill in bid to appease hard right

U.S. House Freedom Caucus Chair Andy Harris, R-Md., center, speaks to reporters on Wednesday, May 21, 2025 at the U.S. Capitol. From left are Republicans Keith Self of Texas, Scott Perry of Pennsylvania and Chip Roy of Texas. (Photo by Jennifer Shutt/States Newsroom)

U.S. House Freedom Caucus Chair Andy Harris, R-Md., center, speaks to reporters on Wednesday, May 21, 2025 at the U.S. Capitol. From left are Republicans Keith Self of Texas, Scott Perry of Pennsylvania and Chip Roy of Texas. (Photo by Jennifer Shutt/States Newsroom)

This report has been updated.

WASHINGTON — U.S. House Republican leaders released changes to their “one big beautiful bill” late Wednesday after marathon negotiations with conservatives demanding deeper cuts to safety net programs, teeing up debate and a final vote likely sometime Thursday.

The alterations, which will have to be adopted later, moved up implementation of work requirements for Medicaid by at least a couple of years and tossed out plans to sell some public lands. The new language also tightened the timeline for clean energy tax breaks and raised the ceiling for taxpayers who deduct state and local taxes.

The package of adjustments — the manager’s amendment — was incorporated into the larger reconciliation bill, which was approved by the House Rules Committee just before 11 p.m. Eastern on an 8-4 party-line vote. Far-right holdout Rep. Chip Roy of Texas was absent.

Next, the package must pass a procedural vote on the House floor before lawmakers can debate and take a final vote.

With a razor-thin margin, House Speaker Mike Johnson can only lose a handful of members on each vote. Democrats are expected to uniformly vote “no” in the procedural and final votes.

Medicaid

Republicans moved up implementation of work requirements for Medicaid enrollees from taking effect after January 1, 2029 to no later than December 31, 2026. That could mean some states will make the changes before next year’s midterm elections.

The provision would require those who rely on the state-federal health program for lower-income Americans and some people with disabilities, who are between the ages of 19 and 65, to work, participate in community service, or attend an educational program at least 80 hours a month.

The language has numerous exceptions, including for pregnant people, parents of dependent children, people who have complex medical conditions, tribal community members, people in the foster system, people who were in the foster system who are below the age of 26 and people released from incarceration in the last 90 days, among others.

The GOP changes also would bar Medicaid from covering gender transition procedures for anyone in the program. The bill previously barred that type of treatment for anyone below the age of 18.

Clean energy tax credits

Republicans also tightened the timeline on the termination of clean energy tax credits enacted under President Joe Biden. Hardliners focused on reducing the deficit had demanded a quicker phase-out for the credits.

The new language would accelerate phase-outs for clean energy investment tax credits to 2028, up from 2031, with special carve-outs for nuclear facilities. Companies that break ground on new facilities 60 days after the bill is enacted, if passed, will not qualify for the tax credits. The same applies to any facility placed into service after 2028.

State and local taxes

A separate contingent of Republican holdouts reached a deal with Johnson to raise the SALT cap to $40,000, up from the $10,000 lid enacted under the 2017 tax law. The SALT cap  — the amount of state and local taxes constituents can deduct from federal taxable income — is a top issue for Republicans who represent districts in high-tax blue states, including California, New Jersey and New York.

The amount of SALT taxpayers can deduct decreases for those making more than $500,000 annually. The SALT cap and the income cut-off will increase by 1% each year from 2027 until 2033.

Public lands sale

The amendment removed language that would have allowed the sale of public lands in Nevada and Utah.

The National Wildlife Federation credited Montana Republican Rep. Ryan Zinke with removing the provision.

“Thank you to Rep. Ryan Zinke and his colleagues who listened to their constituents and worked with House leaders to eliminate the provision from the budget reconciliation bill,” NWF Associate Vice President for Public Lands David Wilms said in a statement. “We urge all members of Congress to refrain from similar attacks on America’s public lands.”

Jessica Turner, president of the Outdoor Recreation Roundtable, wrote in a statement that “Congress avoided setting a dangerous precedent that lands can be sold anytime the U.S. Treasury needs a budget ‘pay-for’ and threatening outdoor recreation businesses and rural communities alike that need certainty, access, and long-term infrastructure.”

The Center for Biological Diversity’s Great Basin Director Patrick Donnelly wrote in a separate statement that it was “appalling that GOP leaders tried to get away with auctioning off some of our country’s most beautiful landscapes to fund tax cuts for billionaires and make developers richer. This is Gilded Age-level stuff, and I hope people remember it the next time Republicans try to pretend they care about public lands.”

A separate provision in the amendment appeared to narrow the federal authorizations energy projects could bypass by paying a $10 million fee. The section had been attacked by environmental groups as a “pay-to-play” for energy companies.

White House meeting

The changes come after Johnson, a Louisiana Republican, and far-right holdouts huddled with President Donald Trump at the White House Wednesday afternoon.

Johnson, speaking to reporters at the Capitol following the meeting, said that lawmakers had “a good discussion” and that he believes the GOP is “in a very good place.”

“I think that all of our colleagues here will really like this final product, and I think we’re going to move forward,” Johnson said.

Johnson said members of the Freedom Caucus, who previously argued the legislation doesn’t go far enough to restructure Medicaid and reduce federal spending, may end up supporting the bill, in part because Trump plans to address their other concerns through unilateral actions.

“You will see how all this is resolved. But I think we can resolve their concerns and it’ll be probably some combination of work by the president in these areas as well as here in Congress,” Johnson said. “So there may be executive orders related to some of these issues in the near future.

“And, you know, this is a commitment the president has made. He wants to go after fraud, waste and abuse.”

White House press secretary Karoline Leavitt released a written statement saying the “meeting was productive and moved the ball in the right direction.

“The President reiterated how critical it is for the country to pass the One Big Beautiful Bill as quickly as possible.”

Complex process

Republicans are using the complex reconciliation process to move the package through Congress with simple majority votes in each chamber, avoiding the Senate’s 60-vote legislative filibuster, which would otherwise require bipartisanship.

Reconciliation measures must address federal revenue, spending, or the debt limit in a way not deemed “merely incidental” by the Senate parliamentarian. That means the GOP proposals must carry some sort of price tag and cannot focus simply on changing federal policy.

Republicans are using the package to extend the 2017 tax law, increase spending on border security and defense by hundreds of billions of dollars, overhaul American energy production, restructure higher education aid and cut spending on Medicaid.

A new Congressional Budget Office analysis released late Tuesday projected the massive reconciliation package would decrease resources for low-income families over the next decade while increasing resources for top earners.

Freedom Caucus

Earlier Wednesday, members of the Freedom Caucus told reporters following a different meeting with Johnson that they believed negotiations were moving in the right direction, but were skeptical of trying to approve the entire package this week.

Maryland Republican Rep. Andy Harris, chairman of the group, said they wanted the legislation to go further in terms of addressing “waste, fraud and abuse” within Medicaid, though he declined to elaborate.

The Medicaid proposals in the version of the bill prior to the negotiated changes would cut $625 billion in federal spending during the next decade, under a CBO analysis. Democrats have warned the result would be millions of vulnerable people losing access to the health program for lower income people and some people with disabilities.

Texas Republican Rep. Chip Roy said during that same impromptu press conference that leadership and members of the Freedom Caucus had made “significant progress” toward a final agreement.

“We’re trying to deliver so that the people who are actually out there working hard can actually get the health care that they want to get, that they can get, and get it the best way possible,” Roy said. “That’s what this is all about; changing a broken system, making sure we’re saving taxpayer dollars and being able to provide a better environment for people to be able to thrive.”

Pennsylvania Republican Rep. Scott Perry, who used to chair the Freedom Caucus, said that holding a House vote before Memorial Day was a made-up timeline and that if negotiations needed to last longer, they should.

“This is a completely arbitrary deadline set by people here to force people into a corner to make bad decisions,” Perry said. “It’s more important to get this right, to get it correct, than to get it fast. We are sitting at the table to do that.”

Jacob Fischler contributed to this report.

‘She’ll fall through the cracks’: Parents of kids with disabilities brace for new reality

Illustration with images of girl in glasses says "SAVE MEDICAID" and "Improving Education Outcomes by Empowering Parents, States, and Commu…"
Reading Time: 8 minutes

This story was originally published by The 19th.

Jolene Baxter’s daughter, Marlee, has overcome immense challenges in her first eight years of life.

Marlee, who was born with a heart defect, has undergone four open-heart surgeries — suffering a stroke after the third. The stroke affected Marlee’s cognitive abilities — she’s in the second grade, but she cannot read yet. A mainstream class with neurotypical students felt overwhelming, so Marlee mostly attends classes with kids who also have disabilities. Her care includes physical, occupational and speech therapies.

For years, Baxter has relied on Medicaid to cover Marlee’s medical expenses while advocating for her daughter’s right to an equal education. Medicaid — which covers therapies, surgeries and medication for Marlee — and disability protections under the Department of Education have been a critical safety net for Baxter, a single mom in Oklahoma City. Now Baxter fears that proposed cuts to Medicaid and those already underway at the Department of Education, which President Donald Trump has effectively gutted, will have a disastrous impact on her daughter. 

As the Trump administration overhauls federal agencies with budget cuts, layoffs and inexperienced leadership, parents of children with complex medical needs and disabilities told The 19th they are navigating uncertainty over how the federal government plans to maintain key pillars of their kids’ lives.

Baxter, who fostered and, later, adopted Marlee, fought to give her life-saving medical treatment when the child was an infant. Since Marlee was both an abandoned child and is Kiowa, the officials overseeing her welfare weren’t invested in getting her the care she needed to survive, Baxter believes. Cuts to Medicaid would be yet another obstacle for the Baxters to overcome.  Just getting Marlee enrolled in local public schools that tried to turn her away was a battle, Baxter said. Now, the mom is gravely concerned that her daughter will be left behind due to the restructuring of the Department of Education.

“I’ll do everything I can at home, but she’ll just fall through all the cracks, and she won’t get the education that she deserves,” Baxter said.

In March, Trump signed an executive order to close the Department of Education. The Republican-controlled Congress is also considering massive funding cuts to Medicaid, the federal-state program that provides health insurance to millions of low-income Americans and is a key safety net for Americans with disabilities.

“It is 50 plus years of work to get these protections for people with disabilities that we could potentially see — maybe not fully diminished — but very deeply eroded, in a very short period of time,” said Robyn Linscott, director of education and family policy at The Arc, an organization that advocates for people with intellectual and developmental disabilities.

The Department of Education’s primary duty has been to ensure that all students have equal access to education, and it is equipped with an Office for Civil Rights to investigate schools accused of discrimination. In March, the Department of Education cut nearly half of its staff, with workers who enforce students’ civil rights hit particularly hard. Advocates worry how this could potentially impact students with disabilities, and a lawsuit filed in March began to paint a picture: newly closed regional offices, frozen investigations and new alleged politically based cases. 

The Trump administration claims that the nation’s most vulnerable will be spared from his plans for federal downsizing. 

The White House has tentative plans to assign oversight of special education to the Department of Health and Human Services. Conservative groups are calling for the Trump administration to refer civil rights complaints to the Department of Justice, an agency that has had an exodus of staff departures since Trump returned to office and changed its mission. 

Nicole Jorwic, chief program officer at Caring Across Generations, a national caregiver advocacy organization, said the Education Department’s Office for Civil Rights receives about 20,000 complaints annually. She worries about the impact of staffing cuts on handling these complaints on the families of children with disabilities.

“Some of those staff were the ones who were looking into those complaints,” she said.

Tow young girls embrace and smile at the camera.
Marlee Baxter (right) was born with a heart defect and suffered a stroke after an open-heart surgery, which affected her cognitive abilities. (Courtesy of Jolene Baxter)

It’s not just OCR complaints, she added. When she was a practicing special education attorney, Jorwic turned to reports and guidance issued by the agency. That helped local school districts, superintendents and special educators know how to implement different laws or changes.

“The lack of that federal agency to provide that clarity is also important, as well as something that we’re really worried about,” she said.

Parents and advocates are doubtful that students with disabilities won’t be impacted. Before the Department of Education was created in 1979, schools often denied these children a right to education with impunity. Dissolving it, families fear, could see a return to the period when states and schools failed to prioritize special education. 

Baxter’s daughter, Marlee, is guaranteed the right to free and appropriate schooling by the Individuals with Disabilities Education Act (IDEA) of 1975, which is enforced by the Department of Education. This federal law mandates that children like Marlee attend classes suited to their cognitive and physical abilities and that they get the services needed, such as speech, physical and occupational therapy, to attend school . Ninety-five percent of students with disabilities attend public schools, a higher share than the 90% of students overall who do — and that’s largely because of the services federal policy requires public schools to provide.

Kim Crawley, a mother to a teenager with medically complex needs, has a 25-year career as a special education teacher. As part of her training, she learned about the history of education, including how five decades ago, schools were not obligated to accommodate students’ special needs. The agency never took power away from the states, she said, but stepped in to ensure that they educated all students equitably. 

“We learn about this for a reason because we don’t want to repeat it,” Crawley said. “We don’t want to have to start over again. To think of losing everything we have gained through the Department of Education over these years is scaring not only parents but teachers. Teachers are scared because we don’t know where this is going to end up for those kids. And that’s why we go to work every day.”

Critics of closing the department and redirecting disabled children’s needs to other agencies say that it will create a bureaucratic nightmare for parents. Instead of one federal agency overseeing research on students with disabilities, state funding for special education or discrimination claims, multiple departments would be involved. Families might not know which agency to reach out to with questions and concerns.

As it is, families are sometimes unaware of the services legally available to them — a reality that has cost them time and energy in the past and could be even more complicated in the future.

Baxter, for one, pulled Marlee out of class for two years to homeschool her after the child’s kindergarten teacher retired and subsequent teachers did not know how to educate her properly, she said. It was not Baxter’s first choice to homeschool Marlee, an option unavailable to most working parents, but one she made after multiple public schools said they could not accommodate her child. 

“Our special needs are full,” Baxter said they told her. “We don’t have room for her.”

When an acquaintance told her that public schools could not lawfully refuse to enroll Marlee, Baxter finally got a local public school to admit her. But after her ordeal last year, she has no faith that the federal government will hold schools that discriminate against children with disabilities accountable if the education department is disbanded. 

“We have enough stuff to worry about (with) making sure that she gets taken care of as far as medical care,” Baxter said of parents like herself. “We don’t need to worry about what we’re going to do as far as their education.”


For some families, the potential Medicaid cuts could unravel both a child’s well-being and their family’s finances.

In Philadelphia, Meghann Luczkowski has three kids with varying levels of specialized health care needs, including a 10-year-old son who spent his first year of life in a hospital intensive care unit.

“His ability to grow and thrive and be part of our family and part of this community is dependent upon significant health care support at home,” said the former special education teacher, who now works in public health.

Luczkowski said her husband has robust health insurance for the family, but it does not cover a lot of her son’s home-based medical needs — a reality for many families whose children are on Medicaid for care related to a disability. Private insurance never paid for his ventilator to breathe, or home health nurses who allow family caregivers to sleep at night.

“It doesn’t pay for the nurse to go to school with him, to make sure that he can be at school, accessing his education with his peers,” she said. “That’s all been provided through Medicaid.”

In the first months of his second term, Trump has mostly indicated support for Medicaid when asked about his budgetary plans for other popular programs like Social Security and Medicare. But the president has also said he supports cutting fraud and waste — a description that health policy experts warn could be used to defend more expansive cuts. Congress is considering hundreds of billions of dollars in Medicaid cuts, a dollar figure that goes way beyond known cases of fraud.   

Among the considerations are work requirements and a cap on Medicaid enrollee spending. Such restrictions could have ripple effects on state education budgets and subsequent reductions in services for students with disabilities. Medicaid is one of the largest providers of funds to public school districts. It is the responsibility of school districts and states to find funding if Medicaid reimbursements are insufficient. Trump has not addressed general concerns about how such spending cuts could impact disabled children and adults.

“We know that before 1975 and the passage of IDEA, 50% of kids with disabilities were not educated at all. So we know that this is a crucial piece of legislation, and that mandate to find funding for these is really important,” said Linscott, who previously worked as a special education teacher in New York City. “But we also recognize that school districts and state budgets are so limited, which is why we want Medicaid to be able to provide as robust funding and reimbursement as they possibly can for students and for these services.”

Jorwic said federal funding for special education services is crucial, and local governments cannot make up for the lost funds. The federal government currently spends more than $15 billion annually on special education services, and Medicaid funding accounts for about $7.5 billion annually in school-based services.

Jorwic said Medicaid cuts could also translate into higher taxes on a local or state level. This month, the Democratic Kansas governor said she had asked the state’s congressional lawmakers not to cut Medicaid in large part because of the ramifications on services. 

“There’s no state, even the wealthiest states, that could afford cuts to those programs, either when it comes to education or when it comes to providing home and community-based services,” Jorwic said.

Rachael Brown is the mom of a medically complex second grader in Washington, D.C., who receives special education services and multiple therapies at his public school. 

Brown’s son, who has autism and cerebral palsy, has a rare vascular anomaly in his brain that has required multiple surgeries. He receives extensive support from Medicaid and IDEA, which are crucial for his care and education. Brown is concerned about how cuts to Medicaid would impact her son’s care and her family’s personal finances. She noted that pediatric hospitals are heavily reliant on Medicaid. If the rate of that reimbursement is cut, those hospitals’ operational costs would be on the line — impacting everything from how many doctors and other health care providers are hired to what therapies are covered for her son.

“There’s just a ripple effect for our whole community,” she said, adding: “We are relatively privileged. There’s a lot of families who aren’t. It would be much worse for families for whom Medicaid is their only insurance.” 

Brown said she lives in fear and worry about what happens next, and it’s exhausting. While she and other advocates have some experience fighting for health care rights given previous political battles, “this time, everything feels a little more cruel.”

Luczkowski planned to travel to D.C. — taking a day off from work and rearranging child care needs — to advocate for Medicaid as part of a multi-organization advocacy day. She said parents of kids with medically complex needs and disabilities often aren’t able to get out and advocate as much as they would like to, in part because of the needs of their families.

“Despite the fact that it’s an incredible hardship on my family for me to be in D.C. talking to legislators and being at rallies on the Capitol steps, that’s what me and a great number of families are doing — because our kids’ lives depend on it,” she said. “We’re hopeful that our voices will be valued, and our children will be valued.”

This story was originally reported by Barbara Rodriguez and Nadra Nittle of The 19th. Meet Barbara and Nadra and read more of their reporting on gender, politics and policy.

‘She’ll fall through the cracks’: Parents of kids with disabilities brace for new reality is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

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