Volunteers from No Limits Outreach Ministries in Hyattsville, Maryland, and the Capital Area Food Bank prepare for distribution on Oct. 28, 2025 to furloughed federal workers affected by the government shutdown. People with government employment ID began lining up hours ahead of time. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — By Saturday, millions of Americans are expected to face a drastic spike in health care premium costs during open enrollment, though a hunger crisis may have been temporarily averted, both tied to the ongoing government shutdown.

A federal judge in Massachusetts Friday afternoon found that the U.S. Department of Agriculture acted unlawfully in deciding to withhold billions in emergency funding for 42 million people who rely on the Supplemental Nutrition Assistance Program, or SNAP, amid a government shutdown.

But while the ruling does not order USDA to immediately tap into its roughly $6 billion contingency fund, a separate ruling from a federal judge in Rhode Island ordered the agency to continue the payments after a coalition of religious and advocacy groups sued.

Prior to both rulings, Agriculture Secretary Brooke Rollins defended USDA’s decision to not use the contingency fund during a Friday press conference at the U.S. Capitol with House Speaker Mike Johnson on day 31 of the government shutdown. 

“We are here today because SNAP benefits run dry tomorrow, so the truth has finally revealed itself, hasn’t it?” Rollins said. “Democrats’ support for programs like SNAP is now reduced to cynical control over people’s lives.”

It was not yet clear midday Friday how the two court rulings would be carried out by the administration.

The move to cut off SNAP would leave millions hungry, nearly 40% of them children, and is an effort by the Trump administration to put pressure on Senate Democrats to accept the House-passed GOP stopgap spending bill to fund the government until Nov. 21. 

Senate Democrats have held out demanding action on tax credits that will expire at the end of the year for people who buy their health insurance through the Affordable Care Act marketplace, hugely driving up costs. 

They have tried to spark negotiations, but Republicans have maintained that talks on health care subsidies will only begin after the government is funded. 

Flight delays, filibuster fate 

As the government shutdown continues, millions of federal workers are furloughed, or have continued to work without pay, including air traffic controllers. 

Flight delays and cancellations are starting to mount, with 3,739 delays within, into or out of the United States and 364 cancellations within the United States by midday Friday, according to the FlightAware delays tracker.

Another shutdown complication emerged when President Donald Trump, who has spent most of the week abroad in Asia meeting with foreign leaders over trade and tariff talks, Thursday night urged Republicans to eliminate the Senate filibuster, which requires a 60-vote threshold. 

“Get rid of the Filibuster, and get rid of it, NOW!” Trump wrote on his social media platform. Senate Republicans have been lukewarm on the idea, since Democrats then could do the same if they regain control of the chamber now held by the GOP with 53 seats.

Lacking 60 votes, the Senate has failed 13 times to pass the House-passed stopgap spending measure and left Capitol Hill Thursday night. Democrat Sen. Jacky Rosen from Nevada tried to keep the Senate in session, but was overruled by Republicans. 

Another critical deadline approaching Friday was pay for active duty military members. Vice President JD Vance said the Trump administration would shuffle funds to ensure pay, but did not detail those plans. According to Axios, the Defense Department pulled billions from several accounts to ensure the troops could be paid. 

Rollins defends USDA refusal to pay benefits

Congress failed to fund SNAP and nearly every other discretionary federal program for the 2026 fiscal year that began Oct. 1.

In order to receive SNAP benefits, a household’s gross monthly income must be at or below 130% of the federal poverty guidelines. A family of four would receive a SNAP maximum monthly allotment of $994, according to USDA.

Rollins sought to justify her agency’s refusal to shuffle the contingency funds to pay for SNAP, saying that money “is only allowed to flow if the underlying program is funded,” and “by law, a contingency fund can only flow when the underlying fund is flowing.” 

The Agriculture secretary said that “even if it could flow, it doesn’t even cover half of the month of November.” 

USDA said in a memo earlier in October that it would not tap into the contingency fund to keep the program afloat in November, despite its since-deleted Sept. 30 shutdown plan saying it would tap into this reserve. 

The memo said the contingency fund “is a source of funds for contingencies, such as the Disaster SNAP program, which provides food purchasing benefits for individuals in disaster areas, including natural disasters like hurricanes, tornadoes, and floods, that can come on quickly and without notice.” 

Democrats have objected. Friday’s decision from a federal judge in Boston stems from a lawsuit brought by 25 states and the District of Columbia against the Trump administration to force USDA to use the contingency fund. 

USDA secretary recounts conversation with waiter

At the Capitol press conference, Rollins also recalled a recent encounter she had at a Louisiana restaurant with a “wonderful” waiter named Joe, who she said took on that job after being furloughed as a federal government employee due to the shutdown. 

“He didn’t know who I was. And I said, ‘Well, Joe, I can appreciate that. You know, I’m sort of in that world as well.’ And I said, ‘Where do you work?’ And he said, ‘Well, I work for the U.S. Department of Agriculture in their New Orleans office as part of the financial team.'”

Rollins said that encounter “just really brought home for me … to echo what Mike (Johnson) said, just thanking so many thousands of federal workers who are showing up, who are still doing their job, who aren’t getting paid, those that are now concerned about putting food on the table and making their mortgages and paying their rent.” 

Rollins, along with the rest of the president’s Cabinet, is still getting paid.

Health premiums skyrocket

As open enrollment begins Saturday, those enrollees in the Affordable Care Act marketplace who currently receive a tax credit are likely to see their monthly premium payments more than double to about 114% on average, according to an analysis by KFF. 

For the last month, Democrats have warned of this, as the tax credits that help pay for individual health insurance are set to expire at the end of the year. 

The top Democrat on the House Energy and Commerce Committee, Rep. Frank Pallone of New Jersey, said in a statement that many families will see an increase in their premiums on Nov. 1.

“The sticker shock many families will face when they shop for health coverage is unacceptable, and it’s why Congress must act,” Pallone said.

The nonpartisan Congressional Budget Office estimated that if Congress does not extend the tax credits, insurers expect healthy, younger people to drop their marketplace coverage plans, which will lead to increased premium costs. 

Anxiety over WIC program

Meanwhile, USDA’s Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC, a program separate from SNAP, got a $300 million infusion from the agency, using tariff revenue, to keep the program running through October. 

The program provides nearly 7 million women, infants and children with healthy foods, breastfeeding support, nutrition education and other resources. 

Advocates are calling on the administration to supply additional emergency funds for WIC. 

Led by the National WIC Association, more than three dozen national organizations signed on to an Oct. 24 letter to the White House urging the administration to provide an additional $300 million in emergency funding. 

Head Start affected

The consequences of the shutdown are also hitting Head Start — a federal program that provides early childhood education, nutritious meals, health screenings and other support services to low-income families and served more than 790,000 children in the 2023-2024 program year. 

The National Head Start Association estimates that 140 programs across 41 states and Puerto Rico serving more than 65,000 children will not receive their operational funding if the shutdown continues past Nov. 1 — a reality that appears certain.

Six of those programs serving more than 6,500 children did not receive this funding on Oct. 1 and have had to look to outside resources and local funds to keep their programs afloat. 

SNAP, WIC and Native communities 

American Indian and Alaska Native communities are also scrambling to fill the anticipated gaps in food security and assistance due to funding uncertainties for SNAP and WIC. 

Advocates and U.S. senators across the aisle say these funding uncertainties for the key federal nutrition programs are putting particular pressure on Native communities. 

At an Oct. 29 Senate Indian Affairs Committee hearing on the shutdown’s impacts on tribal communities, Minnesota Democratic Sen. Tina Smith said she is hearing from tribal nations in her state about people switching from SNAP to the Food Distribution Program on Indian Reservations, or FDPIR, a separate USDA initiative.

FDPIR is an alternative to SNAP and, per USDA, provides foods “to income-eligible households living on Indian reservations, and to American Indian households residing in approved areas near reservations and in Oklahoma.” 

American Family Children's Hospital in Madison. An annual report from the Wisconsin Hospital Association says hospitals in the state are doing better financially, but face uncertainty. (Photo by Erik Gunn/Wisconsin Examiner)

Uncompensated health care at Wisconsin hospitals rose more then 30% in 2024 from the year before, according to a new report from the Wisconsin Hospital Association.

People without health insurance or regular health providers are using emergency rooms more, the report also finds.

The association annually assesses the state of Wisconsin hospitals, including their finances, utilization and staffing. The 2024 report was released Thursday.

“We are seeing a modest improvement in hospital financials across the state,” said Kyle O’Brien, president of the Wisconsin Hospital Association, in an interview. Nevertheless, he added, “there’s a lot of uncertainty in the health care market right now.”

While the state’s hospitals were doing better in 2024 than in the previous two years, 40 hospitals had a negative operating margin, O’Brien said, and many hospitals across the state where margins were positive, but narrow.

Uncompensated care includes charity care — provided by the hospital with the full knowledge that the cost won’t be covered — as well as bad debt: care for which the hospital expected to be paid but wasn’t.

In 2024, uncompensated care in both categories added up to $1.77 billion — a 30.5% increase over the 1.36 billion in uncompensated care in 2023.

O’Brien said several factors are responsible for that increase. One of those is generally higher deductibles on health insurance plans, requiring patients to spend more out of pocket before their insurance coverage kicks in.

“If that patient can’t pay for that higher out-of-pocket [expense], hospitals are the ones that either have to try to collect those dollars, or they are the ones that provide relief through charity care, bad debt policies, or things like that,” O’Brien said.

For hospitals, another top concern is how much Medicaid pays to cover the cost of care.

State budgets over the last decade have been increasing Medicaid hospital payments, O’Brien said, with the 2025-27 budget having the largest increases to date. Even so, he said, hospital Medicaid reimbursements fall short of fully covering the cost of the care that Medicaid is supposed to cover.

Decisions by health insurance to deny coverage are a source of “general consternation” for hospitals, O’Brien said — both with group health insurance policies but also for Medicare Advantage policies. Medicare Advantage policies are sold to people eligible for the federal Medicare program but are instead provided by private insurance companies.

O’Brien said the hospital association is also concerned about projected increases in people without health insurance as a result of higher premiums paid by people who buy their own insurance at the federal marketplace, HealthCare.gov, created under the Affordable Care Act.

Enhanced subsidies for HealthCare.gov policies enacted in 2021 will expire at the end of this year unless they are renewed. The subsidies are provided in the form of federal income tax credits for consumers who purchase insurance through HealthCare.gov

This week the state Office of the Commissioner of Insurance released projected rates for 2026 that reflected the loss of those enhanced subsidies.

Those higher costs have prompted widespread predictions that, after years in which enrollment in the marketplace plans has set new records, enrollment will drop off and more people with go without health insurance instead.

“We are certainly concerned anytime there’s a potential that somebody might lose coverage,” O’Brien said. Federal law requires hospitals to treat patients whether or not they are able to pay.

“We have been advocating with the congressional delegation to reauthorize those enhanced premium tax credits,” O’Brien said. He said members of Congress have been focused on “issues that are playing out right now [that] may be even bigger than hospital-related issues, but I think that they understand our concerns.”

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Idaho resident Lynlee Lord said she used nutrition assistance programs that helped ease some of the stress she was dealing with while pregnant in the aftermath of her partner’s death. Food insecurity can bring heightened risks of preeclampsia, preterm birth and NICU admission, research shows. (Courtesy of Lynlee Lord)

Millions nationwide could be cut off from access to government food assistance Saturday due to the shutdown, including those who are pregnant or have babies and young children.

That possibility brings back a lot of difficult memories for Lynlee Lord, a mom of three in rural Idaho. In 2014, when Lord was 24, her partner died by suicide. She was 11 weeks pregnant with his daughter and already had a 2-year-old son.

“I went from building my life with my best friend to not having anything, and having to move into income-based apartments,” Lord said.

She was also going to cosmetology school full-time in Boise, Idaho, nearly an hour away from where she lived, spending more than 12 hours away from home each day. She worked on her dad’s ranch and cleaned houses to earn gas money. She tried to keep her stress levels down, but the one thing she didn’t worry about was food, because she had benefits from the U.S. Department of Agriculture’s Supplemental Nutrition Assistance Program, or SNAP.

“It took a lot of pressure off of me,” she said.

Many studies have shown adequate nutrition is essential for a developing fetus, and a January study published in the Journal of the American Medical Association found food insecurity in pregnancy is associated with medical complications. The researchers defined food insecurity as being worried about running out of food before there’s money for more. Risks include preeclampsia, preterm birth and NICU admission. 

Those who did not have access to food assistance had the highest risk of complications, according to the January study. The increased rate was alleviated by food assistance. 

It’s unclear how many pregnant people use SNAP benefits on average, but the program helped feed 42 million Americans in 22 million households in the 2025 fiscal year, according to the USDA. A separate supplemental nutrition program for Women, Infants and Children — known as WIC — is often used simultaneously by participants. The federal government temporarily shored up WIC through October and promised more money, but whether the funding will last through November remains uncertain as the shutdown wears on.

The Trump administration has so far declined to use emergency funds to keep SNAP solvent while the government shutdown continues. Republican Senate Majority Leader John Thune said he won’t consider a Democrat-led standalone funding bill to keep the program going during the shutdown.

Though officials in some states are making moves to boost food assistance temporarily, others — including in Indiana and Tennessee — have refused to step in.

Lord doesn’t need food assistance anymore, but about 130,000 Idahoans still do and are set to lose their benefits starting on Saturday, Nov. 1. The Women, Infants and Children program, which helps families afford formula and other supplemental foods, could also soon run out of funds in certain states, including Idaho, the Idaho Capital Sun reported.

Instability and hard choices

Gestational diabetes — one of the more severe complications that can result from food insecurity — affects up to 10% of all pregnancies on average. The condition occurs when the placenta produces hormones that decrease insulin sensitivity, creating unstable blood sugars that necessitate a more strictly controlled diet and potentially the use of insulin or other medication to keep glucose levels in a normal range. Most cases are diagnosed in the third trimester, when the amount of insulin needed to keep blood sugars normal is at its peak.

Blood sugar can also be affected by stress, poor sleep, irregular meals and other physiological factors. If left untreated, or if glucose remains unstable through the last trimester of pregnancy, it can cause the fetus to grow too quickly, increasing the risk of stillbirth and other complications, like high blood pressure and low blood sugars in the baby after delivery.

Dr. Chloe Zera, chair of the Health Policy and Advocacy Committee for the Society of Maternal-Fetal Medicine, specializes in gestational diabetes and said she saw a patient on Tuesday who was worried about losing her SNAP benefits.

“Adding that on top of what is already a stressful diagnosis is incredibly challenging for people,” Zera said. “There’s so much guilt and shame and blame that goes along with gestational diabetes and diabetes in general in pregnancy.”

People with gestational diabetes who already have children and who are food insecure will also most often feed their children before themselves, Zera added.

“They’re going to make really hard choices that mean they have even less control over their nutrition,” she said.

Dr. Andrea Shields, an OB-GYN and maternal-fetal medicine specialist at the University of Connecticut, said uncontrolled gestational diabetes can cause low blood sugar in babies after delivery, which has been linked to neurodevelopmental issues later in life. If the SNAP benefits stop, she said, more people will have to get creative about finding ways to help pregnant patients without assistance from the federal government.

“This is a perfect example of why we pay taxes and why we want to help society in general, because we don’t need to create generational issues, which this will, because it impacts the unborn fetus,” Shields said.

Lord said if she was in the same situation today that she was 10 years ago, she might have had to consider an option that never crossed her mind at the time — an abortion. Even though it was her partner’s only child, and abortion is now banned in Idaho, Lord said she may have needed to find a way to end the pregnancy out of necessity, especially considering the costs of rent, child care, food and other expenses today.

“I would’ve probably picked my child that was living,” she said. “It was really scary for me back then, and I can’t even imagine in today’s world if that happened.”

UPDATE: This story was updated to include more information about WIC on Friday, Oct. 31. 

Democratic U.S. Sen. Chuck Schumer of New York, accompanied by Democratic U.S. Sen. Cory Booker of New Jersey, points to a poster depicting rising medical costs if Congress allows the Affordable Care Act tax credits to expire. (Photo by Andrew Harnik/Getty Images)

States are preparing for the possibility of a rapid shift in the cost of Obamacare health plans, depending on whether Congress extends the subsidies that are at the center of the federal government shutdown.

No matter what Congress does, the amount insurers charge for coverage sold on the marketplaces created by the Affordable Care Act will increase by an average of 26% in 2026, according to KFF, a health research nonprofit. In the 30 states that use the federal Healthcare.gov, premiums will rise by an average of 30%. In the states that run their own marketplaces, the average increase will be about 17%.

But 22 million of the 24 million people who are enrolled in marketplace plans receive a tax credit. If Congress extends the credits, the amount subsidized enrollees pay each month won’t significantly change, even as insurers charge more.

If Congress doesn’t act, people with incomes below 400% of the federal poverty level will receive less financial help, while people making more than that amount will not get any help at all. As a result, according to KFF, monthly premium payments for all enrollees will increase by an average of about 114%,

For a month, Republicans and Democrats have been in a stalemate over whether to extend these subsidies, leading to a government shutdown. The situation has created ambiguity for the states that run their own marketplaces, as many of them move this weekend into the open enrollment period for people to purchase health plans.

Some states, such as Maryland, are preparing for a scenario in which they would either extend state-funded subsidies to enrollees to help them keep their plans, or rapidly apply federal subsidies if Congress extends them.

“It’s going to vary state by state based on their technological abilities and if they need to do anything with their rates,” Michele Eberle, executive director of the Maryland Health Benefit Exchange, said in a phone interview.

Eberle said Maryland created a state subsidy program to make up for some of the federal subsidies that are in limbo. She said that if Congress extends the subsidies, enacting changes for the state’s 240,000 marketplace enrollees could take around three weeks.

Maryland would have to ask health insurers to resubmit their rates. The state also might have to send notices to enrollees to give them the opportunity to change their choice of plan, according to Eberle.

“We would change [enrollees’] premiums. We would have to back out the state subsidy [that we] put in, if there’s a new rate, put the new rates in, recalculate the new premium tax credit and apply that,” Eberle said.

In California, where two million people are enrolled in Covered California, residents are already reeling from sticker shock after seeing next year’s premiums on the state’s website.

“People are very stressed about what to do and what their options are with these cost changes,” Jessica Altman, executive director of California’s marketplace, said in an interview. “At the same time, we are very much ready, and we’ll move any mountain that we can possibly move if Congress does act.”

Altman said the state will automatically recalculate what enrollees would pay for their plans if Congress extends the credits, and is prepared for people to want to change their plans if federal lawmakers act.

“We’re also very much going to want to inform our consumers and give them the opportunity to make a different choice,” she said.

Altman said notifying enrollees’ of changes should take a few weeks, but changing information in the state’s system should only take about a week.

“Even when the enhanced tax credits passed the first time, it was in the middle of the year, in the spring,” Altman said.

“All the state exchanges had to build that, and it was done in a matter of weeks, right? So, that’s who we are, and that’s how we’re thinking about this challenge.”

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

Medications are stored on shelves at a pharmacy in Los Angeles. States have gotten creative in trying to lower patients’ prescription drug copays by targeting different parts of the drug supply chain. (Photo by Eric Thayer/Getty Images)

In the absence of much federal action, states have enacted dozens of laws this year to lower prescription drug costs for their residents — and many more are considering following suit.

States cannot lower drug prices directly, but they can go after different parts of the drug supply chain to try to lower patients’ out-of-pocket costs and reduce excessive spending in state-run health plans.

Nearly two-thirds of the new state laws are aimed at pharmacy benefit managers — the drug middlemen who negotiate deals among the manufacturers that make the drugs, the insurers that allow the drugs to be prescribed, and the pharmacies that sell them.

Several states are considering drug affordability review boards. Others have passed laws to hold manufacturers and PBMs to higher transparency standards.

“So a lot of states went into looking at drug costs — trying to understand and follow the dollar,” said Maureen Hensley-Quinn, a senior program director at the National Academy for State Health Policy, a nonpartisan group that works on health policy issues. “Is it the price that manufacturers are setting? Is it the supply chain where there are different entities?”

Advocates of these laws say it’s up to states to take the lead as the federal government lags in compelling drug companies and insurers to lower prices for patients. But critics say some state interventions could lead to local pharmacies shuttering and may stifle innovation in the pharmaceutical industry, leading to fewer new drugs.

Laws targeting PBMs are wide-ranging in scope, requiring PBMs to pass discounts on to consumers or to be more transparent in their drug purchasing activities. Some states have created drug affordability review boards to assess manufacturers’ prices. Some laws aim to place copay caps on critical medications like insulin.

So far this year, at least 31 states have enacted nearly 70 laws designed to lower drug costs, according to a state drug affordability law tracker from the National Academy for State Health Policy.

“States have no leverage, really, to put pressure on manufacturers to lower their prices, and that’s why I think most of the legislation at the state level has been on the intermediaries, the supply chain,” said Geoffrey Joyce, chair of the Department of Pharmaceutical and Health Economics at the University of Southern California.

Those interventions can go a long way in trying to reduce patients’ expenses, he said.

“The concern [is] about, well, ‘States really can’t lower drug prices, per se,’ but they can,” Joyce said. “I think there’s been evidence.”

California Democratic Gov. Gavin Newsom in October signed legislation to cap the cost of insulin for people covered by state-regulated health plans, including the state’s Affordable Care Act marketplace, private health plans and its Medicaid program. The state also plans to start offering its own generic version of insulin, costing just $11 a pen, in January.

Colorado’s drug affordability review board capped the cost of a widely used rheumatoid arthritis medication.

And Maryland Democratic Gov. Wes Moore signed a law in May to expand the authority of the state’s drug affordability review board to lower prescription drug prices for all residents, not just state employees.

Pointing fingers

The federal government has taken some steps to lower prescription drug prices. The Inflation Reduction Act under the Biden administration created annual caps on out-of-pocket drug costs and capped the cost of insulin at $35 a month for patients with Medicare, the health care program that primarily serves people over 65. The law also gave the federal government more power to negotiate drug prices for Medicare patients.

President Donald Trump has promised to slash drug prices by percentages that some experts say are mathematically impossible. He threatened tariffs on manufacturers that import their drugs if they didn’t lower their prices, which led to a deal with biopharmaceutical company Pfizer. And in May, he signed an executive order designed to ensure the U.S. government can secure drugs at prices on par with other nations.

Kush Desai, a spokesperson for the White House, said in a statement that the Trump administration’s website, TrumpRx, which hasn’t yet launched, will lower drug costs by allowing people to purchase drugs directly from the manufacturer.

But some states are going further.

In October, Colorado became the first state to cap the price of a prescription drug for all consumers. Starting in 2027, new insurers and patients will pay no more than $31,000 a year for Enbrel, a drug that treats rheumatoid arthritis and other autoimmune diseases — a sharp decrease from the average insurance payment of $53,049 in 2023. Nearly 2,600 Coloradans used Enbrel in 2022, according to state research.

Colorado Democratic state Sen. Julie Gonzales, who sponsored the bill creating the state’s drug oversight board, said states have to deal with a lot of competing interests in the drug supply chain. When it comes to establishing who is setting high drug prices, she said, “everyone is pointing the finger at everyone else.”

It took four years from the law’s passage to set up the board and approve its first payment limit because there were so many special interests involved, she said. “We had to overcome a tremendous amount of angst and fear.”

Maine, Maryland, Minnesota, Oregon and Washington also have prescription drug affordability boards. New Hampshire created a board but dissolved it in July because of budget cuts.

In California, Newsom signed a bill this year to cap the consumer copay of insulin at $35 per month for all state-regulated health plans, after vetoing similar legislation in 2023. More than two dozen other states had already opted to cap insulin for state health plans. He also signed a PBM regulation bill that, among other provisions, requires pharmacy benefit managers to pass drug discounts on to payers and patients.

California Democratic state Sen. Scott Wiener, who sponsored the PBM and insulin bills, said states have the power to lower patients’ out-of-pocket expenses, even if they can’t force manufacturers to lower drug prices.

“The federal government right now is a disaster zone when it comes to health care,” Wiener said. “That’s why it’s more important for the states to step up.”

Other states such as Illinois, Iowa and Louisiana enacted similar PBM laws this year, according to the National Academy for State Health Policy.

A complicated system

The system for developing, selling and distributing prescription drugs is complex.

Pharmaceutical companies determine the initial costs of drugs, but are often accused of setting prices too high. Pharmacy benefit managers say they exist to negotiate lower drug prices, but are often accused of pocketing discounts or engaging in predatory practices. Meanwhile, health insurers pay for the drugs and decide what copays patients may end up with, and are often accused of not reimbursing enough.

Experts note that three pharmacy benefit management companies — CVS Health, Cigna and United Health Group — dominate the PBM industry, which adds to concerns about their market power.

“There’s also some truth to the fact that this industry is very concentrated, and there’s not a lot of transparency around how much money they’re making and how they make their money, and if that’s being shared back with plans and with consumers,” said Pragya Kakani, a health economist specializing in drug policy at the Weill Cornell Medical College.

The pharmaceutical industry typically opposes drug affordability boards.

In Colorado, Amgen Inc., the manufacturer of Enbrel, sued the state in 2024 over its drug affordability review board, alleging that a price cap would cause economic harm to the company. A federal district court dismissed the challenge in March.

“Instead of fixing the root causes of patient affordability concerns, the board has rushed into a reckless experiment,” Reid Porter, senior director of state public affairs for PhRMA, a group that represents pharmaceutical companies, wrote in an email statement in regard to the board’s upper payment limit. “Colorado is risking patient access and jeopardizing the development of new medicines.”

Porter argued that PBMs and health insurers, not drugmakers, drive high costs.

But PBMs say their negotiations lower costs.

“Big Pharma sets the price — and the price is the problem when it comes to Americans facing difficulty affording their prescription drugs,” Mike Baldyga, a spokesperson for the Pharmaceutical Care Management Association, which represents pharmacy benefit managers, wrote in an email statement. “PBMs are the only entity in the drug supply chain that lower prescription drug costs on behalf of patients, and there is no correlation between the rebates they negotiate and list prices.”

Hensley-Quinn, of the National Academy for State Health Policy, noted the challenge of making drugs affordable and accessible.

“There is no silver bullet for lowering drug costs,” Hensley-Quinn said. “You have to balance being able to innovate and making sure that drugs are affordable so that what you have just created, which is life-changing, actually gets to the people that need it.”

But this challenge is in some ways expected and more evidence that states must take action, said Priya Telang, communications manager at the nonprofit advocacy group Colorado Consumer Health Initiative.

“Manufacturers point the finger at PBMs, and PBMs point the finger at insurers. And so it’s really hard to get a sense of who the actual bad players are all at the same time,” she said.

“And so that’s why it’s critical for affordability boards to exist, because they get to see the data, they get to see behind closed doors what the root causes are and really work to bring affordability to consumers.”

Drug affordability boards

When Mary Fowler Simmons, 54, was diagnosed with an advanced cancer three years ago, she had to give up her steady job as a state government worker in Virginia to go through months of expensive and painful treatment. Fowler Simmons survived and is cancer-free today, but is still reeling financially.

Fowler Simmons told Stateline that after being saddled with a hospital bill totaling over $323,000 and depleting her savings, she and her husband continue to pay around $300 a month — after insurance — for prescription medications to maintain her health.

Fowler Simmons, who also has Type 2 diabetes, says she wants her state and federal lawmakers to recognize that some Americans are having to choose between paying for their next meal or their necessary prescription drugs.

“They need to have more compassion for people. We’re not in the position that we are making millions, that we can afford this. We’re working-class people,” Fowler Simmons said. “I need them to actually consider what they are doing to the American people and just have affordable prescription drugs available.”

Otto Wachsmann, a Republican in the Virginia House of Delegates and a pharmacist, said that he doesn’t think there’s enough evidence yet that prescription drug affordability review boards work.

He said if states set upper payment limits on drugs, that doesn’t mean a pharmaceutical company would necessarily lower the cost. Rather, he says, pharmacies may just get reimbursed even less than the cost of the drug. This year Virginia lawmakers tried to create a drug affordability review board.

“There’s nothing to prevent the board from saying we’re only going to reimburse $100 for this prescription, although those pharmacies may have to pay $120 for the drug,” Wachsmann said in an interview.

He added that if review boards target expensive and rare drugs for which to set upper payment limits, they could stifle innovation.

“If those manufacturers think that those are the type of drugs that are going to get hit by these boards and they realize they’ll never get their investment back, they’re not going to develop those drugs anymore,” Wachsmann said.

Virginia Republican Gov. Glenn Youngkin vetoed a bill this year that would have created a drug affordability board in the state, saying in a statement, “This approach could limit access to treatments and hinder medical innovation, especially for life-threatening or rare diseases.”

Wachsmann had voted against the board. Instead, he says it’s better to target PBMs, because he said they are engaging in predatory practices that freeze out small pharmacies and leave consumers with nowhere to go.

Neighboring Maryland created the nation’s first drug affordability board in 2019; it got a boost of resources and revved up activities in 2023.

“It will not hurt pharmacists. It will help everybody except Big Pharma,” said Vincent DeMarco, president of health care advocacy group Maryland Health Care for All, in speaking about the state’s drug affordability review board.

The original bill creating the board only authorized the board to create upper payment limits for drugs purchased by states and local governments in Maryland. But this year, Moore signed a law to expand the authority of the board to create upper payment limits for everyone, except patients on health plans regulated by the federal government.

DeMarco said he’s hoping the board will move to create limits on two popular drugs prescribed for Type 2 diabetes, Jardiance and Farxiga.

“In addition to individuals who can’t afford their drugs, all of us pay the price in higher health insurance premiums, because a big part of our health insurance premiums is high-cost drugs,” DeMarco said.

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

Engineer and TV host Emily Calandrelli came to Capitol Hill Wednesday, Oct. 29, as part of an effort to require the U.S. Transportation Security Administration to enforce a policy that allows parents to bring breast milk, formula and supplies on planes. She is among many moms who say they have faced scrutiny traveling with breast milk and ice packs. (Photo by Sofia Resnick/States Newsroom)

Brinda Sen Gupta was traveling by plane for work last month without her infant but with gel packs she would need to keep her breast milk cool on the return flight. Knowing how hard it can be to get through airport security with breastmilk and infant-feeding supplies, Sen Gupta arrived extra early and prepared.

Sure enough, a U.S. Transportation Security Administration agent objected to Sen Gupta’s gel packs, she said. She took out her phone and showed a screenshot of TSA’s current policy. It stems from a 2016 law and states that breast milk, formula and toddler drinks are considered “medically necessary liquids” and are allowed in carry-on baggage in quantities greater than 3.4 ounces. The policy expressly allows breast milk and formula cooling accessories like ice and gel packs, and states a child does not have to be present for a parent to carry these supplies.

Despite the law, women continue to report issues with TSA security in airports across the country, saying many workers are not trained on their own policy.

“The TSA agent had to ask their supervisor to come,” Sen Gupta said. The supervisor reviewed the policy and allowed the gel packs through, she said, “but it was annoying to me, because I had to add extra time before I went to make sure that I could have this conversation with them.”

Sen Gupta was among several D.C. chapter leaders of the national nonprofit Chamber of Mothers who gathered in Washington, D.C., on Wednesday, Oct. 29, to advocate for the passage of the Bottles and Breastfeeding Equipment Screening (BABES) Enhancement Act. Introduced in the House by Democratic Rep. Eric Swalwell of California, the bill would require an audit by the inspector general of the Department of Homeland Security within one year of enactment to ensure the policy is being enforced and workers are being trained on how to inspect infant-feeding supplies in a way that is sanitary. 

The bill has been introduced in Congress three years in a row but failed to pass despite bipartisan support. In May for the first time the bill cleared the Senate, where it was cosponsored by Democratic Sens. Tammy Duckworth of Illinois and Mazie Hirono of Hawaii, and Republican Sens. Steve Daines of Montana and Ted Cruz of Texas. It has advanced in the House, where it has 26 cosponsors, including five Republicans.

“We don’t actually need to change the policies. We need to enforce them, to have some oversight for when the policy isn’t adhered to and how they’re held accountable for those missteps,” said Emily Calandrelli, an engineer and science TV host, who brought attention to the issue after her story of being escorted out of an airport security line because of her ice packs went viral.  

Calandrelli said she is unaware of major pushback to the bill in the U.S. House, but she is not certain there will be enough support to move the legislation anytime soon, especially as the federal government shutdown is about to enter its second month.

She said she is hopeful that Rep. Maria Elvira Salazar of Florida, one of the first Republicans to sign on, will recruit more members of her party. 

“At this point, we need Republicans to really lead the charge to help get to the finish line,” Calandrelli said.

In the meantime, moms who relayed their recent TSA experiences at the Chamber of Mothers event said parents traveling with infant-feeding supplies should prepare themselves for traveling — have TSA’s policy ready on their phones and arrive well ahead of time.

Travel security lines may be even slower or flights may be delayed during the shutdown, too, as federal workers like air traffic controllers and TSA agents work without pay.  

Bri Adams, another Chamber of Mothers D.C. chapter leader, said she has been dealing with the headache of nursing while frequently traveling for work for the past few years. A breast milk overproducer who had to pump frequently to maintain her supply, she said agents would handle her milk or supplies in ways that were not sanitary. Over time, she learned to advocate for herself. 

“I literally had it up on my phone, the regulations on the TSA website, ready to go, and I pretty much just acted a lot more confident,” Adams said. “This is what I’m doing, and I’m taking breast milk that’s thawed and frozen at the same time, and you’re going to let me on because you can.”

TSA has not yet responded to requests for comment. 

‘What would make motherhood easier for you?’

A driver parked the Chamber of Mothers’ black and red bus across the street from the U.S. Department of Labor, which ordinarily would have meant lots of foot traffic. But on the 29th day of the shutdown, the sidewalks and streets were largely empty of the typical tourists and federal workers, many who were either furloughed without pay or working without pay. 

The bus has stopped in nine cities over the last couple of months. Lexie Wooten said she has been to every stop, where the group’s been asking moms, “What would make motherhood easier for you?” Overwhelmingly, responses have been about economic support and paid family leave, she said. 

Wooten said she could feel the economic anxiety as Americans brace for cuts to health and food assistance programs for people with low incomes, exacerbated by the shutdown. As States Newsroom has reported, temporarily losing food assistance like the Supplemental Nutrition Assistance Program could lead to more pregnancy complications.

“People are broke, and it makes everything harder,” Wooten said.

Chamber of Mothers CEO Erin Erenberg said the organization now has 43 local chapters in 30 states and about 100,000 members nationwide, and focuses on policies meant to improve access to maternal health care, paid parental leave and affordable child care. Erenberg, who is also an intellectual property attorney, cofounded the nonprofit in 2021 with a group of fellow working moms after paid family leave was cut from former President Joe Biden’s Build Back Better plan. One of the state bills they’ve worked on since is Arizona’s HB 2332, a maternal mental health bill, which Gov. Katie Hobbs signed in May. 

Erenberg said the Trump administration, through the office of the vice president and the U.S. Department of Health and Human Services, has reached out to her organization to collaborate. But before the group would work with the White House, she said there are some nonnegotiable terms, which include preserving and expanding access to affordable health care, Medicaid and SNAP — all impacted by recent federal spending policies.

“So far, this administration hasn’t shown that they’re fully behind what we advocate for,” Erenberg said. “With pronatalism, we have repeatedly said, great, you want people to have more babies? … We need paid leave, we need affordable child care, and we need you to invest in what actually would make us healthy … and survive childbirth.”

An emergency room nurse tends to a patient at Houston Methodist The Woodlands Hospital in Texas. States, counties and nonprofits are striving to continue their work to close racial health disparity gaps but are struggling amid a loss of federal dollars. (Photo by Brandon Bell/Getty Images)

Racial health disparities may widen as states, universities and nonprofits grapple with federal funding cuts to programs that were aimed at filling gaps in care, public health experts say.

As part of its federal restructuring and crackdown on diversity, equity and inclusion (DEI) programs, the Trump administration has been shuttering federal offices and rescinding grants dedicated to addressing worse health care access and outcomes for racial minorities.

The shake-up has caused some state agencies and nonprofits to pause programs and some groups and universities to apply for foundation grants instead.

Hundreds of grants have been terminated for state, local and territorial health departments as well as nonprofits and universities, many of which addressed health equity across rural, low-income and communities of color.

The nation’s racial health disparities were laid bare during the COVID-19 pandemic, when the virus killed Black, Hispanic and Indigenous people at higher rates than white people. The police murder of George Floyd in May 2020 also fueled a racial reckoning across the nation, prompting efforts by states, universities, health systems and the federal government to address racial health disparities.

Those approaches ranged from targeted vaccine campaigns and efforts to enroll more people of color in clinical trials to corrections of diagnostic tests that relied on inaccurate information about race and biology.

Communities of color have long had less access to health care, increased exposure to environmental pollutants and higher rates of certain chronic illnesses and cancer deaths. They also have more diabetes-related amputations because of a lack of access to care. And specific genetic diseases, such as sickle cell disease, disproportionately affect Black people.

“COVID revealed the impact of health disparities to individual health — as well as how not addressing these disparities undermines the health system for everyone,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

Now, many of the programs trying to address health disparities are being rolled back.

As a result, health policy experts, clinicians and researchers fear those disparities will widen as states, universities and nonprofits grapple with lost federal dollars while the administration continues to limit federal funding for DEI programs. In July, the U.S. Department of Justice released guidance saying such initiatives should not receive federal funding, alleging they are “discriminatory.”

Entities that receive federal funds “must ensure that their programs and activities comply with federal law and do not discriminate on the basis of race, color, national origin, sex, religion, or other protected characteristics—no matter the program’s labels, objectives, or intentions,” the news release said.

Several state and local health officials were reluctant to speak with Stateline on the record about how the federal administration’s DEI crackdown has left them in a bind, fearing retaliation or targeting by the federal government. The White House did not respond to Stateline’s request for comment.

“My concern about what the administration is doing is that they are, in effect, making these disparities worse,” Benjamin said. “Everybody’s health is not the same. … It’s important to know that the disparities are really profound.”

Benjamin added that the cumulative effect of disparities means more late-stage disease — costing both patients and health systems more.

“There’s a trope or misunderstanding out there that DEI is a ‘woke’-related agenda. DEI is not a ‘woke’ agenda. DEI is an American agenda, because it’s really one that is the same thing as ‘rising tides lift all boats,’” said Brandon Wilson, senior director of Health Innovation and Public Health at Community Catalyst, a health equity advocacy organization. “When you cut [resources] off, you’re actually disproportionately impacting those who are already impacted.”

‘Increasing need’

The administration canceled billions of dollars in grants from the National Institutes of Health (NIH), the Centers for Disease Control and Prevention, the Environmental Protection Agency and the Department of Health and Human Services.

Many of the grants helped recipients create solutions tailored to their communities’ needs and strengths.

At least three dozen state, local and territorial health departments have had pandemic-era grants that addressed health equity terminated. While originally focused on COVID-19, agencies have since used that grant money for other public health efforts: testing and contact tracing for a wide range of diseases, better data reporting, and community partnerships that address social and environmental effects on health.

The money was part of a $2.2 billion national health equity initiative that aimed to address vulnerabilities and protect those communities ahead of the next outbreak.

The Department of Health and Human Services told media such cancellations were due to the pandemic emergency ending in 2023.

At NIH, the administration terminated more than 5,400 NIH research grants, although about 2,800 were reinstated. Canceled grants included research toward illnesses like HIV and AIDS, which disproportionately affect Black and Hispanic people as well as gay and transgender people.

The Trump administration has also gutted federal offices dedicated to fighting disparities, including the Offices of Minority Health under the Centers for Medicare & Medicaid Services and the Department of Health and Human Services.

At the state level, the Arkansas Department of Health recently shut down its own minority health-focused office. Ashley Whitlow, a spokesperson for the department, said in a statement that it “relies on federal grant funding to support a variety of public health programs.”

“The recent reduction in program staff reflects the Arkansas Department of Health’s ongoing efforts to operate more efficiently with the resources available. Despite these changes, ADH remains fully committed to serving communities across the state,” the statement said.

Meanwhile, Maryland’s Department of Health said its minority health office is funded through state general funds and not directly impacted by the federal cuts.

The nation has seen a spike in congenital syphilis cases, which disproportionately occur among Black and Indigenous families.

“Regardless of whether you’re at the highest risk, any outbreak that’s not controlled can spread widely and broadly, and you can see that that’s what’s happening with measles,” said Dr. Julie Morita, former executive vice president of the Robert Wood Johnson Foundation and former health commissioner Chicago Department of Public Health.

But states likely can’t replace all the lost federal dollars.

“You’ve got declining capacity, and increasing need — which is a formula for problems,” said Richard Frank, director of the Brookings Institution Center on Health Policy.

“It’s impossible to make all that up with state and local dollars,” he continued. “You’re going to see programs that serve real people getting pulled back.”

Frank and Wilson also expressed concern about the Medicaid changes included in the broad tax and spending law President Donald Trump signed in July. The law is projected to cut federal Medicaid spending by an estimated $911 billion over the next decade, largely because new work requirements will push people off the rolls. Data shows the majority of Medicaid enrollees already work, and experts say many will be kicked off the rolls due to difficulties in states’ reporting processes. Black and Hispanic people are disproportionately represented on the Medicaid rolls.

OB-GYN Dr. Versha Pleasant, a clinical assistant professor at the University of Michigan, directs the Cancer Genetics and Breast Health Clinic at Von Voigtlander Women’s Hospital. She treats patients at high risk for breast and ovarian cancers. Black women have an almost 40% higher risk of death from breast cancer than white women.

“That, to me, is unacceptable,” she said, adding that such disparities speak to the need for ongoing programs to “provide everyone with a fair chance at leading a long and healthy life.”

“If we don’t make a special effort to save the most vulnerable lives … where does that leave us?” she continued. “The changes that we’re seeing are only going to magnify preexisting challenges.”

Data and dollars

Dr. Sarah Rudman, acting public health officer at the Santa Clara County Public Health Department in California, and others have told Stateline that federal officials are informing health agencies that race and ethnicity data are no longer required to be reported.

“We are being asked to change the way we collect our own data here and report it,” Rudman said, adding that her county is going to continue collecting data to “understand who is here, who’s experiencing what health outcome and what they need.”

Many families, in the shadow of the county’s Silicon Valley, still struggle with poverty — more than 27,000 children suffer food insecurity, United Way Bay Area says.

“It is sometimes surprising and striking to people to understand how much poverty and other types of vulnerability are hidden among the more visible wealth of Silicon Valley, and that’s where we’ve dedicated our resources,” Rudman said.

“It’s hard to even imagine what my colleagues in smaller areas of California or in other parts of the country are experiencing,” she added about lower-income counties. “We are feeling extremely strained and already in our second round of layoffs, knowing that many more are likely. So I think that the hits are going to be that much more significant in areas who have less resources than we do.”

Federal officials also canceled the county’s $5.7 million grant to address COVID-19-related disparities, used to shore up vulnerable communities ahead of the next disease outbreak, natural disaster or heat wave, Rudman said. The money helped the county conduct basic laboratory testing and vaccine outreach for a wide range of diseases, not just COVID-19.

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

Reading Time: < 1 minute

Affordable Care Act premiums, expected to skyrocket in 2026 unless enhanced subsidies are extended, have increased about 118% since coverage for individuals began in 2014.

That’s three times higher than inflation (39%).

U.S. Sen. Ron Johnson, R-Wis., made the three-times claim Oct. 21, as the federal government shutdown continued. 

To end the shutdown, Democrats want to extend the enhanced Obamacare subsidies, which made more people eligible. They expire Dec. 31. 

Without enhanced subsidies, Wisconsinites could see 2026 premium increases of up to 800%, according to the state. 

The average monthly premium for a benchmark Obamacare plan was $273 in 2014; it is expected to be at least $596 in 2026.

Premiums, initially so low that insurers lost money, jumped in 2017, stayed stable since 2018 but are expected to rise more than 18% in 2026, KFF Obamacare program director Cynthia Cox said.

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

Sources

• U.S. Bureau of Labor Statistics: CPI Inflation Calculator
• The Journalist's Resource: The battle over Affordable Care Act insurance subsidies: What to know as open enrollment looms
• Wisconsin Gov. Tony Evers: Healthcare Premiums for Wisconsinites to Skyrocket in 2026 if Republicans Fail to Extend Affordable Care Act Tax Credits
• KFF: Marketplace Average Benchmark Premiums
• Peterson-KFF: How much and why ACA Marketplace premiums are going up in 2026

Have Obamacare premiums increased three times the rate of inflation? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

A Planned Parenthood Clinic in downtown Milwaukee. (Photo | Isiah Holmes)

Planned Parenthood of Wisconsin is restarting abortion services after a nearly month-long pause due to a federal budget and tax law that threatens to withhold Medicaid funding from organizations that provide abortion services.

The organization paused services on Oct. 1, due to a provision in the federal megabill signed by President Donald Trump that bars Medicaid payments for one year to organizations that received more than $800,000 in Medicaid reimbursements in fiscal year 2023 and primarily engage in family planning services and reproductive health and provide abortions. Planned Parenthood of Wisconsin had said the pause was temporary as they explored options for being able to resume. 

The federal Hyde Amendment has prohibited federal funds from being used to pay for most abortion care for nearly five decades, but the new provision, which expires in July 2026, expands that prohibition to cover all Medicaid-covered services at clinics that also provide non-covered abortions. 

“Providing compassionate, high-quality care to our patients has always been our mission — and it always will be,” President and CEO Tanya Atkinson said in a statement. “At a time when politicians are working to take away health care from women and families, we are fighting back with everything we have. We’ve been here before. We’ve stood up to relentless attacks on reproductive health for decades — and we are not backing down now. Our patients deserve nothing less.”

Planned Parenthood of Wisconsin said that it decided to relinquish its “Essential Community Provider” designation, so it won’t meet the definition of a “prohibited entity” under federal law and won’t be barred from receiving Medicaid funds even while it provides abortion services. 

According to KFF, Essential Community Providers are “safety net clinics and hospitals” that serve predominantly low-income, medically underserved patients. The federal Affordable Care Act requires that Qualified Health Plans available through the federal or state insurance Marketplaces include a “sufficient number and geographic distribution of ECPs, where available, to ensure reasonable and timely access to a broad range of such providers for low-income, medically underserved individuals in the plan’s service area.”

A Sept. 29 court filing from attorneys on behalf of Health and Human Services stated that organizations could continue billing Medicaid by ceasing abortion, or by relinquishing their tax-exempt status, or relinquishing their Essential Community Provider status.

Atkinson told the Milwaukee Journal Sentinel that it was unclear what the implications of giving up the ECP status might be, including whether it will affect its financial situation. 

“What we do know is that the vast majority of our patients really rely on BadgerCare as their form of insurance, and our focus is on providing as much care as we possibly can to as many people as we can across the entire state,” Atkinson said.

Planned Parenthood of Wisconsin  — the largest provider for abortion services in the state — offers abortion services at its clinics in Madison, Milwaukee and Sheboygan.

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Gov. Tony Evers, shown here in a press gaggle in March, said Monday that health insurance rates on the ACA market are set to skyrocket in Wisconsin. (Photo by Baylor Spears/Wisconsin Examiner)

Last updated 10/28/2025, 1:51 p.m. 

The cost for health care coverage purchased on HealthCare.gov in Wisconsin will rise for some insurance policies by anywhere from 45% to 800% for 2026, depending on where a person lives, Gov. Tony Evers announced Monday.

The increased rates will be made worse with the end of enhanced federal subsidies, provided in the form of tax credits, that have lowered insurance costs through the marketplace since 2021, Evers and Sen. Tammy Baldwin (D-Wisconsin) said during a virtual press conference Monday morning. The enhanced subsidies expire at the end of December.

“In 2025, 88% of Wisconsinites [who] enrolled in coverage on HealthCare.gov qualify for tax credits, saving an average of $664 a month,” Evers said. “And without these enhanced tax credits, health care premiums for Wisconsinites are going to skyrocket, period. Many Wisconsinites will see their premiums double, and some of them will see staggering increases.”

HealthCare.gov is the federal insurance marketplace, created under the 2010 Affordable Care Act (ACA) to improve health insurance access for people without health coverage from an employer or from government programs.

More than 310,000 Wisconsinites purchased health insurance through the marketplace for 2025, according to the Wisconsin Office of the Commissioner of Insurance (OCI). HealthCare.gov open enrollment for 2026 starts Nov. 1.  

OCI released a list Monday with examples of rate increases for patients of various ages and under selected scenarios based on age, family size and incomes. The examples compared rate increases across eight counties.

Evers said a statewide average increase wasn’t available “because it’s going to impact lots of people in a lot of different ways.”

The comparisons made by OCI all reflected health plans in the Silver category on HealthCare.gov. Silver plans have a “moderate” deductible and require patients to pay 30% of the cost of care (see sidebar, HealthCare.gov insurance plan categories).

In a few scenarios and locations, rate increases will be lower than 10%. Those are exceptions, however. Most scenarios and locations showed premium increases ranging from more than 30% on up. Some increases were well over 100%, and one example showed an increase of more than 800% in one county.

The comparisons reflect the premium cost after any subsidies are applied. 

The ACA included subsidies on the cost of insurance from the beginning for people with incomes up to 400% of the federal poverty guideline.

The enhancements that were put in place in 2021 and expire at the end of December included increases in the subsidies for the original group. They also extended subsidies to people with incomes above 400% of the poverty guideline, to avoid an “eligibility cliff” at those higher incomes. 

In the comparisons, the 2025 premiums include the effect of the enhanced subsidies, while the 2026 premiums reflect the return to the original subsidy formula.

According to OCI’s report 2026 premiums will increase:

• Between 39% in Waukesha County and 85% in Barron County for a 26-year-old with an income of $48,000 (subsidy continues, but reduced).
• Between 16% in Marathon County and 43% in Barron County for a 26-year-old with an income of $65,000 (subsidy ended).
• Between 18% in Brown County and 84% in Barron County for a 40-year-old with an income of $65,000  (subsidy ended).
• Between 132% in Waukesha County and 391% in Barron County for a 60-year-old with an income of $63,383  (subsidy ended).
• Between 221% in Waukesha County and 812% in Barron County for a 60-year-old couple with an income of $85,658  (subsidy ended).
• Between 2% in Waukesha County and 57% in Barron County for a family  of four with a household income of $128,000 (subsidy continues, but reduced).
• Between 102% in both Waukesha and Dane counties and 312% in Barron County for a family of four with a household income of $130,000  (subsidy ended).

In both family examples, the parents are ages 48 and 47 and children ages 8 and 12.

Nationwide, some 22 million Americans will see their premiums double on average, Baldwin said. She cited projections that 4 million Americans “will look at that price tag and decide to drop their insurance altogether because it’s simply too expensive. It’s more than they can afford.”

KFF, a nonpartisan, nonprofit health policy news and analysis organization, reported Oct. 3 that seven out of 10 people nationally who buy health coverage through the federal marketplace said they would not be able to afford insurance without the enhanced subsidies.

Democrats in Congress have named extending the subsidies as one of their conditions for Democratic support of the Republican majority’s legislation to end the current federal shutdown.

In response, GOP leaders in Congress have called on Democratic lawmakers to sign on to their spending bill to restart the government and then negotiate to extend the subsidies.

Baldwin said Democrats won’t accept “a wink and a nod” that the tax credit talks should come after the government reopens. She said she’s heard privately from Republicans in the Senate who agree that Congress should extend the subsidies.

With 78% of Americans, according to one poll, “who believe we need to address this, and many of my Republican colleagues want to do so, then we need to have an agreement to extend the tax credits as we reopen the government,” Baldwin said.

Later Monday in Milwaukee, Evers held a round table with business owners, advocates and lawmakers to discuss the HealthCare.gov rate increases.

“If you’re seeing these jumps in 26-year-olds, across the board, I don’t know how we afford this,” said Dan Jacobs, owner of the Milwaukee restaurant DanDan. Jacobs said about two-thirds of his employees have health insurance, most of them probably purchasing it through the marketplace.

His business subsidized the insurance premiums that full-time employees and managers bought through HealthCare.gov for 2025, he said, but with the premium increases, reported Monday, “we’re not going to be able to afford to do that,” Jacobs told Evers.

Kara Pitt-D’Andrea, who operates a nonprofit child care facility in Milwaukee with about 25 employees, told Evers,  “100% of us are on the ACA or Medicaid.” 

She called health coverage a moral imperative rather than an act of charity. “To say to people, ‘We refuse to come to the table to create a sustainable option for you’ is the equivalent of saying, ‘You are unimportant in the game of business that we are playing,’” Pitt-D’Andrea said.

 

A child receives a standard immunization at a Coral Gables, Fla., doctor’s office in September. Since the government shutdown began Oct. 1, the federal Centers for Disease Control and Prevention has stopped providing health surveillance data that helps state and local governments track disease trends. (Photo by Joe Raedle/Getty Images)

As the federal shutdown continues, states have been forced to fall back on their own resources to spot disease outbreaks — just as respiratory illness season begins.

The shutdown has halted dashboards and expert analysis from the federal Centers for Disease Control and Prevention, which monitors indicators such as wastewater to provide early warnings of the spread of COVID-19, influenza, RSV (respiratory syncytial virus) and other infectious diseases.

The pause leaves states with less early warning on disease outbreaks, potentially endangering lives even as child vaccination rates drop amid increased exemptions and hesitancy fed by misinformation. State and local officials can combat outbreaks with targeted advice to get vaccinated and stay home when sick, but they need to know where to do that first. And residents won’t know to take precautions if they’re unaware when many in their community are falling ill.

Wastewater is particularly crucial to finding outbreaks before people start seeking treatment, said Dr. John T. Brooks, a former chief medical officer for CDC’s Emergency COVID-19 Response who retired last year.

“This is one more piece of information to each American citizen to inform their decision, like, ‘Do I want to get vaccinated, and is now the time?’” Brooks said. “It really helps protect Americans by identifying communities where you may need to ramp up, raise awareness, remind people about hygiene.”

Ericka McGowan, senior director for emerging infectious disease at the Association of State and Territorial Health Officials, said the absence of CDC involvement “could be a problem if there’s some major issue [states] miss.” Generally, states and localities gather their own health information, but many rely on the CDC for analysis and public display.

The CDC would normally display Washington state’s wastewater surveillance information along with national and regional insights, McGowan said.  Now, the information is only available on the state’s own dashboards.

Caitlin Rivers, an associate professor at Johns Hopkins University who studies infectious disease outbreaks, checked all 50 states for shutdown-related data issues. In a Substack post, Rivers said the result of the shutdown is “DIY surveillance.”

Georgia had to pause its influenza report, which would normally start this month, because of missing CDC data. However, health officials are working on a version using only state information, said Nancy Nydam, a spokesperson for the Georgia Department of Public Health. Some hospitals report cases to the state and some directly to the CDC, so there will be some information gaps during the shutdown, she said.

In the meantime, Georgia has its own data on emergency room visits showing cases of suspected COVID-19, flu and RSV declining between August and early October.

Georgia also has its own wastewater surveillance program, which provides early warning of diseases spreading in the population before confirmed cases show up in hospitals. But some states rely on CDC wastewater surveillance.

Michael Hoerger, an associate professor at Tulane University, had to pause his state-by-state wastewater reports on COVID-19 because of the lack of CDC wastewater data and an unrelated pause in data from a private wastewater reporting collective called Biobot, he said. Biobot did not respond to a request for comment.

“The pause means that we won’t have a good sense of which states are dealing with elevated transmission [of COVID-19] until the data come back online,” Hoerger said. “I can still post useful national estimates and forecasts, but that doesn’t really help with states that are outliers from what’s happening nationally.”

Hoerger’s Pandemic Mitigation Collaborative released a report in August on COVID-19 hot spots in California, and the highest state rates for COVID-19 in late September were in Connecticut, Delaware, Nevada and Utah.

For the time being, all Hoerger can do is rely on past forecasts predicting about 499,000 new COVID-19 infections a day as of Oct. 13, the first time it’s been under 500,000 since July.

“We’re in a bit of a blackout at the moment in terms of real-time rigorous data,” Hoerger said. “Fortunately, at least nationally, we’re in a relative lull in transmission.”

Like Georgia, many states can monitor wastewater on their own to track COVID-19, flu, RSV and other diseases, according to a list compiled by Hoerger’s Pandemic Mitigation Collaborative.

Texas, for example, has not had trouble updating its data during the shutdown, health department spokesperson Chris Van Deusen said. “We do our own surveillance for most metrics,” he said. However, the state no longer gets information on new COVID-19 and RSV deaths from the federal government, he said.

North Carolina also gathers its own wastewater data and interprets it with help from the University of North Carolina and local health departments. Normally, the CDC would weigh in with its own guidance and post results on a national dashboard — actions that are paused in the shutdown, said Hannah Jones, a spokesperson for the state health department.

But even if they have their own wastewater data, other state and local health departments may rely on the CDC for analysis and guidance, said McGowan, of the state health officials group.

“Even if you collect the data, you still have to have someone who is an expert to analyze that data to give you some kind of result,” McGowan said. “A lot of localities don’t have that kind of expertise in house and they rely on the CDC for that type of technical expertise and guidance. So there’s a gap there.”

Rivers, the Johns Hopkins associate professor, wrote in her post that she sees “clouds on the horizon” in some states. There are more young children, who are most susceptible to RSV, visiting emergency rooms in Louisiana, South Carolina, Texas and Virginia, she wrote, and also more hospitalizations in Texas.

Editor’s note: This story has been updated to clarify that Washington state has its own public dashboard with updated wastewater information during the shutdown. Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

Advocates gather outside the Hippodrome Theater in Richmond, Virginia, this summer to protest Medicaid cuts. Medicaid covers nearly two-thirds of Black babies’ births in the U.S., federal data shows, and congressional cuts to the program are already limiting reproductive health care in Black and low-income communities. (Photo by Bert Shepherd/Courtesy of Protect Our Care PAC)

At least 90% of Black people surveyed for a new poll said Medicaid is important to them or their families, and more than half either have public insurance or a family member who relies on the program. 

“Medicaid is critical for so many things with regards to making sure that we’re healthy and addressing health disparities. By losing it or weakening it, it is just going to disproportionately harm our communities,” said Regina Davis Moss, the president and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda. 

Davis Moss’ organization commissioned the 10-state poll, which includes views from California, Florida, Georgia, Michigan, North Carolina, New Jersey, Nevada, Ohio, Pennsylvania and Virginia. Nonpartisan research firm PerryUndem conducted the survey between May and June and interviewed 500 Black adults in each state. 

The findings, shared exclusively with States Newsroom, show a significant number of Black people who want children are not yet planning to have them due to cost and health care concerns. 

Results were released just as several Planned Parenthood clinics that served Black patients with low incomes closed after a law took effect blocking certain reproductive health clinics affiliated with abortion providers from receiving Medicaid reimbursements until July 2026.

Louisiana’s Planned Parenthood clinics, which never offered abortions in their decades of service, closed on Sept. 30. Sixty percent of the Baton Rouge and New Orleans patients were Black and most have Medicaid insurance, States Newsroom reported. One of two Planned Parenthood locations in Memphis, where more than 60% of the population is Black, temporarily closed its doors during the first week of October due to Medicaid cuts, Tennessee Lookout reported. 

“Proximity is important, and the fact that these clinics have to close means that individuals needing their services will go without,” said Danielle Atkinson, executive director of Mothering Justice, a national advocacy group based in Michigan. 

Four Planned Parenthood clinics closed in her state this spring after the Trump administration cut millions of Title X family-planning funding, Michigan Advance reported.  

“They’ll go without STI testing. They’ll go without cancer screening. They’ll go without counseling,” Atkinson said. 

The ban on Medicaid for some reproductive health providers was part of a larger reconciliation package that is also set to slash nearly $1 trillion from Medicaid more broadly over the next decade. 

“Medicaid is a lifeline for Black women, girls and gender-expansive people,” Davis Moss said. The state and federal program covers nearly two-thirds of Black births, according to the U.S. Centers for Disease Control and Prevention, and almost half of all births nationwide. 

Maternal health advocates are bracing for the impact of Medicaid cuts on labor and delivery units, which have already been closing at a rapid pace over the last 10 years, especially in rural communities. A maternity ward in northeast Georgia, one of the states included in the poll, will close at the end of the month partially due to Medicaid cuts, Georgia Recorder reported in September. 

Findings from the In Our Own Voice poll also show that Black people of reproductive age — 18 to 44 in this case — want children but are not planning to have them, citing high costs of living. 

California had the biggest disparity of 28 percentage points: 56% want children but only 28% plan to have them. 

“I believe some of the reasons they said are not new issues that we are grappling with, but it’s deeply concerning because they are being exacerbated in this current administration,” Davis Moss said. 

At least 69% of Black people polled in each of the 10 states said they worry about being able to take care of children or more children than they already have, while at least 67% cited housing costs and 57% pointed to child care expenses. 

“In a lot of these states, the cost of child care is more expensive than a year of tuition, which is such a barrier for people to be able to: one, go into the workforce, two, have that early intervention and early education that really sets their children up for success, and three, give individuals and families the opportunity to go and explore careers and learning opportunities,” Atkinson said. 

Abortion restrictions played a factor in family planning, too, though in smaller numbers. At least 45% said they don’t want children because they or their loved one could die from pregnancy, while 43% worry about miscarriage care and 30% said abortion bans are stopping them from growing their families. 

Three of the states included in the poll — Florida, Georgia and North Carolina — have abortion bans stricter than 20 weeks. Voters in California, Michigan and Ohio approved reproductive rights amendments in recent years that secured the right to an abortion up to fetal viability, while Nevada and Virginia may have similar safeguards in place after the midterms. 

A majority of voters in each of the 10 states say abortion should be legal in all or most cases and at least 78% say Black women should make the decisions about pregnancy that’s best for them. 

Overall, at least half of Black adults polled are struggling with economic security. Black women of reproductive age were more likely to expect less safety and security throughout the rest of Republican President Donald Trump’s second term than Black men. 

“We’re getting ready to celebrate our 250 years, and all the things that we have fought for and all these things that we have gained in terms of civil rights and human rights, they are under threat like never before,” Davis Moss said. 

Halle Berry calls for Wisconsin lawmakers to advance a bill related to menopause education as Rep. Robyn Vining and Sen. Dianne Hesselbein watch. (Photo courtesy of Vining's office)

Senate Minority Leader Dianne Hesselbein (D-Middleton) and Rep. Robyn Vining (D-Wauwatosa) brought in a big name — award-winning actress Halle Berry — this week to help them call for better education on perimenopause and menopause. 

Berry, who wasn’t able to be at the hearing in real time, has become an advocate nationally for raising awareness of menopause and advocating for changes. She joined the Wisconsin bill authors at a virtual press conference on Tuesday afternoon, and her testimony was played at a Senate Health Committee public hearing Wednesday. The committee also took testimony Wednesday on bills to help with falls prevention among older Wisconsinites and on medical marijuana. 

“This is not a political issue — I promise you, it’s not. It is a human rights issue,” Berry said. 

Menopause is the period of time usually in middle age when a woman has not had her period for 12 consecutive months. Perimenopause is the period of time when hormone levels fluctuate and decline and a woman begins transitioning into menopause. It typically lasts between 4 years and 10 or more years.

Women can reach menopause at different ages, but often women reach it between 45 and 55. Symptoms typically begin during perimenopause. 

During the hearing, Vining listed part of a long list of symptoms that women can experience when they hit perimenopause and menopause.

“Wisconsin women deserve to know what is happening to their bodies. Wisconsin women deserve to access to information that can help explain symptoms like increased anxiety and depression, brain fog, frozen shoulder, concerns about increases in cholesterol, decreases in bone density, sleeplessness, night sweats, increased sensitivity and pain in joints, vertigo, gut issues, loss of libido, the unusual exhaustion, confusing dryness, hot flashes, and more,” Vining said. “Many women say, ‘I don’t feel like myself’ and they deserve to know why that is and what they can do about it.”

Berry said her experience started with “excruciating” pain in her vagina and her OB-GYN telling her that it was herpes “and probably one of the worst cases” he had seen. 

“I had just started dating a new guy, one year into a wonderful new relationship, and [my doctor] said, ‘Well, go have a talk with this guy [because] you have herpes.’”

Berry said she and her partner both got tested and found that neither of them had herpes. She said that when she went back to her doctor, he said that he didn’t know what was wrong with her. She saw another doctor, when she started experiencing dry mouth, who suggested she might have had an autoimmune disorder. She saw the first doctor again when she started experiencing dry eyes. 

It was then that he reluctantly told her she was experiencing menopause. 

“Why couldn’t you just say that to me? You’re my health care provider. You’re my doctor,” Berry said she asked her OB-GYN. “He said, ‘because my patients don’t want to hear they’re in menopause. It scares them. They think they’re getting old.’” 

“I have real life examples of how more education would have saved me almost four years of self-exploration and self-diagnoses,” Berry said.  “I would have loved to have gotten this information from my health care providers.”

Lack of education about menopause is connected to stigma, she said.

Hesselbein and Vining are lead authors on a bill meant to help women in Wisconsin get the information that they need. 

SB 356 would require the Department of Health Services to partner with health care providers, including obstetricians and gynecologists, community health centers and hospitals, to educate women on symptoms and other issues surrounding perimenopause and menopause. The bill is bipartisan with Sen. Rachael Cabral-Guevera (R-Appleton) as a cosponsor. 

Under the bill, DHS would also be required to create digital and physical informational materials to be distributed to women who are or are soon to experience perimenopause and menopause. 

The authors said it was discussions with their friends and shared experiences that led them to introduce the bill. 

“We’re all talking about the same thing right now,” Hesselbein said. “[Halle Berry is] having this problem with all the resources she has, and as a state employee with my health insurance, I also ran into some obstacles where people weren’t giving me the correct information. …How many other women in the state of Wisconsin are going through this?” 

Hesselbein said a big moment for her was when she was dealing with “frozen shoulder” — a condition that causes pain, stiffness and limited range of motion in the shoulder joint and is common during perimenopause. 

“I didn’t know what it was, and I thought it’s not related to menopause,” Hesselbein said. “They gave me a cortisone shot, which was really great because it released the frozen shoulder, and I had [physical therapy] after that… I talked to friends about it, they’re like, ‘oh, yeah, I’ve had that too.’”

Hesselbein said the bill is based on a similar model adopted in Pennsylvania. 

“It is my hope that we can pass this bill so that we can get Wisconsin women the help they deserve and in the process of doing so that we can destigmatize honest and forthright conversations and discussions about menopause and perimenopause,” Vining said.

Falls prevention awareness

Rep. Rick Gundrum (R-Slinger) and Sen. Andre Jacque (R-New Franken) are seeking to cut down on the number of falls that Wisconsin residents are experiencing through a state grant to raise awareness for prevention. 

“If passed, the impact that this bill would have on Wisconsin’s older population is significant,” Gundrum said during the public hearing. “Falls are the leading cause of injury-related death and hospitalization for seniors. According to the CDC, Wisconsin has the highest fall death rate among older adults in the country.”

According to a recent Department of Health Services report, emergency medical services responded to 35,564 more falls-related calls in 2024 when compared to 2019 — an increase of nearly 10,000 a year or 7.4% a year since 2019. 

Speculation on why the state’s high fall death rate includes Wisconsin’s cold weather, the amount of alcohol that is consumed in the state and that the state may be better at reporting death-related falls.

SB 410 would provide $900,000 across 2025-26 and 2026-27 to the Wisconsin Institute for Healthy Aging, a nonprofit that oversees the Falls Free Wisconsin Coalition. The coalition is responsible for a statewide initiative to reduce older adult falls and works to raise awareness; curate and share best practices in falls prevention; gather and report falls data; and address policy and systems changes. The state funds provided under the bill would be used by the organization to support falls prevention awareness and initiatives. 

A legislative council staffer told lawmakers in response to a question that the bill in its current form is  “really a broad charge to the Institute for Healthy Aging for how they’d want to spend the money in the category of falls.” 

“I think it would kind of remain to be seen exactly how, what initiatives they’ve spent the money on,” the staffer said. “The bill gives the Institute broad latitude to figure out how to use the money.” 

Jill Renken, executive director of the Wisconsin Institute for Healthy Aging, told the committee that she has seen the benefits of programs through her own mother, who had started falling in her home after she retired. She said that she encouraged her mother to take a class at the local aging and disability resource center, which she said can reduce falls by 31%. 

“I noticed that she was applying what she learned… She was doing her exercises. She talked with her pharmacist about her medications. My dad made some home safety modifications in the home,” Renken said. “I’m so excited that she has not fallen. It’s been over two years.” 

Renken said the organization for the last decade has worked to diversify funding, but there isn’t enough to sustain their activity.

“State investment is critical in order to maintain the stability of the programs, to maintain the services that we offer and also to grow the program so we can make a much more significant impact in our communities,” Renken said. “We want more older adults to be able to have access to these programs and services. We want to increase awareness so that people know what these services exist.”

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A view of medical marijuana products at a New York medical marijuana cultivation facility. Wisconsin Assembly Republicans have proposed a bill to legalize medical cannabis in the state under strict conditions. (Drew Angerer | Getty Images)

“Illness does not discriminate,” said Sen. Patrick Testin (R-Stevens Point) during a hearing of the Senate Committee on Health on Wednesday. “It affects people from all walks of life. There is no doubt that each and every one of us knows someone that has suffered through an illness and struggles to find ways to make it through each day.” 

Testin was speaking in favor of SB 534, a bill introduced by Republicans to legalize medical cannabis in Wisconsin. If passed, the bill would allow registered patients to have cannabis in a non-smokeable form such as a concentrate, oil, tincture, edible, pill, cream or vapor. The bill would also create an Office of Medical Cannabis Regulation attached to the state health department and tasked with overseeing the budding program. 

Testin shared a story about his grandfather, whom he described as his role model and as “the reason I decided to take a life of public service.” Back in the 1990s, Testin’s grandfather was diagnosed with lung cancer, which then metastasized to bone cancer. 

The senator recalled watching his grandfather undergo chemotherapy. The man “was a big guy,” Testin said, “and we watched him wither away.” At that moment, over 25 years ago, “my family made the very difficult decision to go outside the law to get him marijuana,” Testin said. “It gave him his appetite back, and it gave him time that we probably otherwise would not have had.”

Testin said his story was not unique. Although other medications exist, he said that many “come with side effects that can make living a normal life much more difficult.” He noted that 40 states, including Wisconsin’s neighbors Michigan, Illinois and Minnesota, give patients access to medical cannabis when recommended by doctors. Texas is the most recent state to legalize medical cannabis, he noted

“So both red and blue states alike have been able to come together and recognize that this is a viable option,” Testin said. “Medicine is never a one size fits all, and it’s time for Wisconsin to join the majority of the country and add another option which may help patients find relief they need.”

Legislation’s provisions

Under the proposed bill, medical cannabis sales would be tracked through the state’s prescription drug monitoring program. Pharmacists would also be required to be on-site at dispensaries. The legislation would only cover certain conditions: cancer, seizures or epilepsy, glaucoma, severe chronic pain, severe muscle spasms, severe chronic nausea, Parkinson’s disease, multiple sclerosis, inflammatory bowel disease, and any terminal illness, including patients with a life expectancy of less than a year. 

Patients must be at least 18 years old. Minors could have access if there is  written consent “from all” of their parents or guardians. Patients would be given registration cards and would be charged $20 a year to remain on the registry. 

The bill also prohibits dispensaries or their staff “from claiming that medical cannabis may cure, mitigate, treat, or prevent any disease or medical condition.” Dispensaries would also be prohibited from “advertising their services to the general public, with certain exceptions.” 

The bill includes a provision preventing courts from considering  lawful use or possession of cannabis, or being registered as a patient, when determining  custody or placement of a child, except where the child has access to the cannabis. Unlawful possession or use could still be used against parents in court, however. The bill also protects people who lawfully possess cannabis against housing discrimination, and prevents local governments from regulating legal medical cannabis programs or using zoning laws to restrict the location or operation of a legal cannabis operation. 

Support and opposition

Earlier this year, two-thirds of registered voters polled by Marquette Law School said that cannabis should be legalized in Wisconsin. The Wisconsin Wellness Coalition has registered with the Wisconsin Ethics Commission in support of the legislation and the Wisconsin Medical Society against it, The Alzheimer’s Association, Outdoor Advertising Association, and Pharmacy Society have all registered their positions as “other.” 

People from a variety of backgrounds also spoke during the public hearing. Many supported legalizing cannabis, but had concerns about restrictions in the bill. 

“This should not be a partisan issue,” said Testin. “It is clear that we as a state need to begin having a real discussion about medical cannabis legalization, and it is our hope that this bill will be the first step. It’s time for Wisconsin to provide our citizens with another option in their health care.” 

Sen. Mary Felzkowski (R-Tomahawk), who has proposed  medical cannabis legislation for years, echoed that sentiment. 

“Wisconsin is on an island surrounded by neighboring states that allow the use of medical cannabis products,” Felzkowski said during the Wednesday hearing. “Someone who suffers from a serious health condition should not have to make the choice to travel to another state or break the law so that they can try an alternative medicine for relief.”

Felzkowski recounted her battles with breast cancer, first when she was 40 years old, which resulted in a double mastectomy, and then a stage 4 diagnosis a decade later. She described the side effects of opioids that doctors prescribed to control her pain as “something nobody should have to live through.” 

She said her oncologist called medical cannabis  “another tool in the toolbox, and it could help a lot of people.” 

 “Here we are sitting in our Ivory Tower, denying that for people that really need it, and it’s wrong that we’re doing that,” Felzkowski said.

Legislators are divided

Lawmakers hope to get more colleagues behind the bill. Yet, despite lagging behind many other states, Wisconsin’s Legislature still struggles with just talking about cannabis. “We are not going to be talking about overall legalization for cannabis products,” said Sen. Rachael Cabral-Guevera (R-Appleton), as she chaired a meeting of the Senate Committee on Health on Wednesday. “So, if you’re here to testify on how this should be 100% legal, this is not the spot for you today.” 

The Legislature held its first public hearing on legalizing cannabis in 2022 in the Senate. Rep. Patrick Snyder (R-Weston), who also spoke during Wednesday’s hearing, said in an interview with the Wisconsin Examiner that he’s optimistic that the new bill will survive the Senate. “My goal this time,” Snyder told Wisconsin Examiner, “is something we haven’t done yet since I’ve been here and that is to have a hearing in the Assembly, where people I talk to can come down and explain their situations.”

Snyder said he hears from constituents who want the state to legalize medical cannabis. When he talks to Republicans who oppose the bill, he said, “I try to tell them first of all, this is something that helps a person. This is something that is going to be focused on folks that really need it.” 

Snyder stressed that “these are people not looking for shortcuts to get marijuana, I mean they could do that without [legalized medical cannabis].” Rather, his constituents are people who often don’t want to travel so far north or south to get their medicine, or who would prefer going to a local farmer or dispensary instead.

The bill’s critics include Republicans who feel medical cannabis would only lead to legalizing recreational use, which they don’t want, as well as Democrats who criticize the bill’s restrictive framework and want Wisconsin to legalize recreational use of cannabis. 

Even with the Republican bill’s restrictions on the form in which cannabis can be used and its system of rigorous licensing, testing and enforcement, Snyder said there are “far right” Republicans in the Assembly who need to be won over. 

Felzkowski said of the 24 states that allow recreational marijuana, 15 did so through ballot measures, which aren’t available in Wisconsin. “So that’s never going to happen in the state,” she said. 

Nine states that have legalized recreational  marijuana after legalizing medical cannabis “are solid blue states like Illinois, New York, and Connecticut,” she said. “Wisconsin is not a solid blue state.”  

Another 16 states have only legalized medical cannabis. Hawaii, the first state to pass a comprehensive medical cannabis program in 2000, still does not allow recreational cannabis, she said.  

“Fortunately, Wisconsin is able to learn from the experience of other states,” said Felzkowski. “We can create an effective program with safeguards, so patients and small businesses can benefit from medical cannabis products, while preventing abuse, or those without medical need from gaining access.”

Miraya Gran and her husband took out a second mortgage and had a family fundraiser to be able to conceive their first child through in vitro fertilization in 2021. She still does not have insurance coverage for IVF, and despite having two embryos waiting to be implanted, she cannot afford the cost on her own to give her daughter a sibling. (Courtesy of Miraya Gran)

Miraya Gran is the kind of person who Republican President Donald Trump and his administration say they are going to help with new policies on in vitro fertilization.

It took a second mortgage on her Minnesota house and a family fundraiser to afford the IVF treatment she needed to have her first child in 2021. Gran’s husband has male-factor infertility, and she has a genetic blood disorder, making it extremely difficult for them to conceive on their own. But unless the cost of IVF goes down a lot, Gran can’t afford to give her daughter a sibling.

“I’ve got two embryos waiting for me, and I’m not accessing them due to lack of insurance coverage,” she said.

But Gran doesn’t have much hope left that IVF costs will drop enough after Trump’s announcement at the White House on Thursday, Oct. 16. The president said his administration negotiated steep discounts on a key fertility drug, as well as a new regulation allowing employers to offer IVF coverage as a standalone policy like dental or vision. EMD Serono, a major pharmaceutical brand, will offer the medication at an 84% discount via direct sales on a government webpage called TrumpRX, according to a company representative who spoke at the White House event.

Gran said that isn’t good enough. The drug prices are only a portion of what makes treatment expensive. One IVF cycle ranges between $12,000 and $25,000 on average but can cost more depending on medical needs. Many people require more than one round of IVF to get pregnant. 

Plus, the new policy only clears the way for employers to offer coverage options — it’s not required by the government.

“They have the ability to put the onus on insurance companies,” Gran said. “There really isn’t a solution for our community until we have insurance coverage.”  

Trump campaigned on a promise to make IVF treatment free for all, either through federal funding or insurance, but has so far not fulfilled that promise.

Dr. Eve Feinberg is an OB-GYN professor at Northwestern University, and a reproductive endocrinologist and fertility specialist who treats IVF patients every day. She said lowering the cost of the drugs is a positive step, but that’s only about one-third of the cost of a typical IVF cycle — less in some cases.

“For some patients, the medications can go as high as half the cost,” Feinberg said. “If you have a good reserve of eggs, you require less medication. If you have a lower reserve, you’ll need more. So for some, it’s $3,000 … and for some, it’s $10,000.”

‘Restorative reproductive medicine’ not a replacement for IVF, doctor says 

Trump’s promise to make IVF free is a difficult one to fulfill not only because of the overall cost but because of divisions among conservative groups about the ethics of the treatment. IVF requires the collection of as many eggs as possible that are then fertilized. Some are later destroyed because they would not make it after implantation in the uterus due to abnormalities or other medical factors.

The Alabama Supreme Court ruled in 2024 that embryos have the same legal rights as children, which threw the medical community into chaos and caused some Alabama IVF clinics to close. Later that year, the Southern Baptist Convention adopted an anti-IVF resolution stating the church’s opposition to the practice.

The ruling happened just as Latorya Beasley was waiting on a transfer date for the embryo she hoped would be her second child. Her clinic temporarily canceled appointments but eventually reopened, and she was able to have a second child. Beasley had IVF insurance through her employer, which only about 25% of companies with more than 200 employees offer nationwide, according to KFF. But there were still out-of-pocket costs.

“There was a point where we ran out of medicine for like one day, and we paid $1,000 out of pocket for that,” Beasley said. “And that was with insurance coverage.”

Feinberg said she was also worried about the aspects of the announcement that talked about “restorative reproductive medicine,” which is a newer field of medicine not recognized by the same medical boards guiding reproductive endocrinology. The practice has been promoted by the Heritage Foundation — a conservative advocacy organization that authored Project 2025 — as the “new frontier” of reproductive medicine.

“There were certain things said in the briefing that made me think the idea of fertility coverage, especially for companies whose beliefs and ideas are religiously focused and religiously based, that may mean offering restorative reproductive medicine and not offering IVF,” she said.

The restorative practice focuses on cycle tracking to conceive, as well as weight loss and nutrition. Feinberg said she had a patient who had been using those methods for four years with no success, and she was 43 by the time a reproductive specialist told her that her husband had such a low sperm count, there was no way they could conceive without medical intervention.

“He had a genetic mutation that the restorative reproductive medicine person was not trained to ever diagnose,” she said. “They could have and should have done IVF.”

Gran and Beasley said if the Trump administration put forward plans that made a real difference for families in need of IVF, they would be the first to celebrate it. But until then, the lack of action is frustrating.

“It just feels like I’m being sold a complete line from a traveling salesman, because until there’s actual substantiated change, I have no faith in what they say,” Gran said.

An Oakland, Calif., grocery store displays a sign notifying shoppers that it accepts electronic benefit transfer cards used by state welfare departments to issue food assistance benefits. States are just beginning to implement changes to work requirements for the national food stamp program approved by Congress and President Donald Trump this summer. (Photo by Justin Sullivan/Getty Images)

States are rushing to inform some residents who rely on food stamps that they will soon be forced to meet work requirements or lose their food assistance.

Recent federal legislation ended exemptions to work requirements for older adults, homeless people, veterans and some rural residents, among others. A rapid timeline to put the changes into effect has sparked chaos in state agencies that must cut off access if residents don’t meet certain work, education or volunteer reporting requirements.

States are implementing these permanent changes to the Supplemental Nutrition Assistance Program — commonly called food stamps — amid the uncertainty of the federal government shutdown. The budget impasse could result in millions of Americans not getting their SNAP benefits next month if money runs out. But even before the shutdown, states were assessing the new work rules for food stamps — the first in a wave of cutbacks to the nation’s largest food assistance program required under President Donald Trump’s major tax and spending law enacted in July.

Known as the One Big Beautiful Bill Act, the law mandates cuts to social service programs, including Medicaid and food stamps. In the coming years, the law will require states to pay a greater share of administering SNAP and could cause millions of Americans to lose benefits.

But states are currently confronting the end of exceptions to work requirements for older adults, homeless people, veterans and those recently living in foster care. Those could threaten benefits even for people who are working but who may struggle with the paperwork to prove they’re meeting the requirements, advocates say.

Under the new law, states have also lost funding for nutrition education programs, must end eligibility for noncitizens such as refugees and asylees, and will lose work requirement waivers for those living in areas with limited employment opportunities.

And the federal government wants those changes made quickly.

“They’ve given us a virtually nonexistent window — I’ll just describe it that way — in which to implement the changes, so we are working on them very quickly,” Andrea Barton Reeves, commissioner of the Connecticut Department of Social Services, told lawmakers last week.

She said changing work requirements could threaten the benefits of tens of thousands of people in Connecticut.

“We do believe that if we cannot in some way either move them into another exemption category or they don’t meet the requirements, we have about 36,000 people in these new categories that are at risk of losing their SNAP benefit,” Barton Reeves told lawmakers.

The federal government issued guidance to states earlier this month saying several key changes to food stamps would need to be implemented by early November.

The Food Research & Action Center, a nonprofit working to address poverty-related hunger, characterized that deadline as an “unreasonable” timeline for states.

In California, for example, the state previously had been approved for a waiver to work requirements through January 2026. But this month, USDA told states they had 30 days to terminate waivers issued under the previous guidelines. In California, the end of that waiver could affect benefits for an estimated 359,000 people.

Gina Plata-Nino, interim SNAP director at the Food Research & Action Center, said states must quickly train their social services workers on eligibility changes, communicate those changes to the public and deal with an onslaught of calls from people relying on the program.

“It’s incredibly complex,” she said.

Plata-Nino said implementation will be uneven: Some states are already in compliance with the changes, while others will phase them in as households go through regular eligibility reviews.

USDA and the White House did not respond to Stateline’s questions about the changes.

Republicans, including House Speaker Mike Johnson of Louisiana, have said the cuts would eliminate waste in the food assistance program. In a June news release, he characterized SNAP as a “bloated, inefficient program,” but said Americans who needed food assistance would still receive it.

“Democrats will scream ‘cuts,’ but what they’re really defending is a wasteful program that discourages work, mismanages billions, and traps people in dependency. Republicans are proud to defend commonsense welfare reform, fiscal sanity, and the dignity of work,” Johnson said in the release.

Rural residents

Changes to work requirements will prove especially burdensome for rural residents, who already disproportionately rely on SNAP. Job opportunities and transportation are often limited in rural areas, making work requirements especially difficult, according to Plata-Nino.

“None of these bills came with a job offer,” Plata-Nino said. “None of them came with additional funding to address the lack of transportation. Remote and rural areas don’t have public transportation — they don’t even have taxis or Ubers.”

With waivers, states previously could show USDA evidence that certain areas had limited job opportunities, thus exempting people from work requirements.

“Because it doesn’t make sense to punish SNAP participants for not being able to find a job when there are no jobs available, right?” said Lauren Bauer, a fellow in economic studies at the left-leaning Brookings Institution and the associate director of The Hamilton Project, an economic policy initiative.

The legislation changed the criteria for proving weak labor markets to what Bauer characterized as an “utterly insane standard,” of showing unemployment rates above 10%. (The national unemployment rate was 4.3% in August, according to the most recently released figures by the Bureau of Labor Statistics.)

“The national economy during the Great Recession hit 10% in one month,” Bauer said. “Ten percent unemployment is a very, very high level. So they set this standard basically to end the waiver process.”

That change will not only affect recipients now but also will drastically impair the program’s ability to respond to recessions: Traditionally, SNAP has quickly helped people who lose their jobs. But the new law requires states to cover more costs, meaning they will be stretched even thinner during economic downturns when demand increases.

“Not only are these changes difficult to implement — and certainly at the speed that the administration is asking for — they could be devastating to the program, to residents who are in need in their states, and eventually SNAP may no longer be a national program because states will not be able to afford to participate,” Bauer said.

‘Widespread confusion’

Since July, Pennsylvania officials have been working to not only inform the public about the federal changes, but also to update information technology systems — a process that generally takes a minimum of 12 months.

“Strictly speaking from an IT perspective, we’re talking about massive systems that generate terabytes of data and are working with records for hundreds of thousands — and in the case of Pennsylvania, 2 million people,” said Hoa Pham, deputy secretary of the Office of Income Maintenance for the Pennsylvania Department of Human Services.

Pham said the timing of the federal legislation and lagging guidance from USDA was “simply not ideal.” But the state is doing its best to train thousands of employees on the changes and help affected recipients get into compliance by finding work, education or volunteer opportunities that meet federal guidelines.

The end of geographic waivers put the benefits of about 132,000 SNAP recipients at risk in Pennsylvania.

“It is difficult, it requires time, it requires planning, it requires money,” she told Stateline. “And I want to be super clear that H.R. 1 [the new law] delivered a ton of unfunded mandates to state agencies.”

Pennsylvania created a detailed webpage outlining the changes and will notify individuals if their eligibility is jeopardized in the coming months. Pham said those who depend on SNAP should make sure their contact information is up to date with both the department and the post office.

“As a state agency, we’re working very hard to make sure that people have accurate, factual information when it is most immediately necessary for them to know it,” she said.

States are implementing the SNAP changes even as the ongoing federal government shutdown might temporarily cost recipients their benefits.

New Hampshire leaders say they are days away from running out of food stamp funds. No new applications will be approved in Minnesota until the government is reopened, officials announced last week.

And the changes hit agencies already strained from staffing shortages and outdated software, said Brittany Christenson, the CEO of AidKit, a vendor that helps states administer SNAP and other public benefits.

“The result is widespread confusion among both administrators and beneficiaries, as states are tasked with integrating new compliance requirements while maintaining service continuity.

“The changes not only increase workloads for states, but they can lead to more errors and longer wait time or applicants,” Christenson said.

“Beneficiaries face a heightened risk of losing aid not because they are unwilling to work, but because they cannot meet new documentation or compliance requirements on time,” she said.

Slow trickle of changes

In Maine, the new work requirement rules are in place, but recipients have some time to meet the altered guidelines, the Portland Press Herald reported. The state estimates changes to work requirements could affect more than 40,000 recipients as soon as this fall.

The state’s Department of Health and Human Services did not respond to Stateline requests for comment. But advocates said food banks are already struggling to keep up with increased demand and decreased supply because of the high cost of food.

“They’re seeing huge increases in families and individuals showing up, needing groceries, needing food every month, some every week, and that’s before any of these cuts to SNAP have happened. So we’re really, we’re very worried,” said Anna Korsen, deputy director of Full Plates Full Potential, a nonprofit focused on ending childhood hunger in Maine.

More than 70% of Maine households receiving SNAP have at least one person working, Korsen said. While some recipients — including those who are caretakers for relatives — cannot work, many more who are employed will struggle to meet documentation requirements.

“They call them work requirements, but we’ve started calling them work reporting requirements, because we think that’s a more accurate way to portray what they are,” she said.

Alex Carter, policy advocate at the nonprofit legal aid organization Maine Equal Justice, said SNAP recipients will be affected on a rolling basis because of regular six-month eligibility reviews. For example, a 59-year-old who previously would have been exempt from the work requirement may not be notified until next month that their eligibility status is in jeopardy.

“So people are not going to be losing their benefits this month because of those changes, which I think is the thing that is hard to explain to people,” she said. “These things are happening, but we can’t tell people this will happen to you in October or this will happen to you in January. It’s different on a case-by-case basis.”

Carter said her organization is urging Mainers to ensure their contact information is correct with the state and to remain vigilant for official communications on SNAP.

While states are forced to implement the federal changes, Carter said they should emphasize they’re only the messengers. She said Congress and the president should be held responsible for the fallout when people begin losing benefits.

‘It’s very natural to think this is a state decision, or this is a departmental decision, and to direct your anger and your frustration there,” she said. “ … In this case, this is not a state decision. They are required by federal law to implement these work reporting changes.”

Stateline reporter Kevin Hardy can be reached at khardy@stateline.org. 

Protesters hold signs opposing the Supreme Courts draft ruling on Roe vs. Wade on May 14, 2022, at the Wisconsin State Capitol in Madison, Wis. (Angela Major / WPR)

This article originally appeared in Wisconsin Watch.

A new Republican bill that would exempt certain life-saving medical procedures from falling under the definition of “abortion” is drawing criticism from medical professionals despite being described by its authors as an attempt to protect reproductive health care.

Under the bill, introduced on Friday, medical procedures “designed or intended to prevent the death of a pregnant woman and not designed or intended to kill the unborn child” would not fall under Wisconsin’s abortion definition. They would also not be subject to state laws prohibiting funding for “abortion-related activities” and Wisconsin’s ban on abortion past 20 weeks.

The bill, authored by Rep. Joy Goeben, R-Hobart, and Sen. Romaine Quinn, R-Birchwood, specifically exempts early inductions or cesarean sections performed in cases of ectopic, anembryonic or molar pregnancies from being considered abortion so long as the physician conducting them makes “reasonable medical efforts” to save both parent and unborn child from harm.

Moreover, the bill would change the definition of “unborn child” in Wisconsin statute from “a human being from the time of conception until it is born alive” to “a human being from the time of fertilization until birth.”

OBGYN Carley Zeal, a representative for the Wisconsin Medical Society and fellow at Physicians for Reproductive Health, said “unborn child” is not a medically recognized term because doctors don’t confer personhood to a fertilized egg or fetus. Legal expert Howard Schweber told Wisconsin Watch he doesn’t expect changing the definition of “unborn child” to begin at fertilization will have a meaningful impact.

Abortion as a political issue hits deep in the heart of Wisconsin, where Marquette Law School polls since 2020 show 64% of all voters believe abortion should be legal in all or most cases. Democrats have campaigned in support of eliminating restrictions on abortion, while Republicans, who in 2015 passed the state’s current ban after 20 weeks of pregnancy, have sought to increase restrictions on, penalize or ban abortion completely.

The bill follows multiple successive changes to Wisconsin’s abortion law since 2022, when the U.S. Supreme Court struck down the landmark Roe v. Wade ruling and returned the issue of abortion to individual states — leaving Wisconsin scrambling to put together a consistent abortion policy.

The new GOP bill also seems to nod toward several high-profile national incidents of patients dying from being denied reproductive care in states with restrictive abortion bans, even when the bans include exceptions for abortion care if a patient’s life is in danger.

One  National Institutes of Health study found that after Texas’s abortion ban was passed, maternal morbidity during the gestational period doubled from the time before the law despite it having a medical emergency clause.

Goeben and Quinn stated in a memorandum that their bill seeks to “counter misinformation spread by bad actors” about doctors not performing needed medical care for fear of being criminalized under abortion statutes. Goeben told Wisconsin Watch she consulted with physicians about the bill and believes it will reassure them of their ability to provide this care.

“A doctor may at all times, no matter where the state is at on the abortion issue, feel very confident in providing the health care that women need in these very challenging situations that women face,” Goeben said.

Medical and legal experts weigh in

Both Zeal and Sheboygan OBGYN Leslie Abitz, a member of both the state medical society, the Committee to Protect Healthcare and the American College of Obstetricians and Gynecologists, said they oppose the bill.

They argue it is an attempt by the Wisconsin Legislature to use “emotionally charged, ideologically driven, non-medical terms” to “interfere with the patient-physician relationship” in medical care.

“The stated goal of the bill — to distinguish between medical procedures from abortion — is misleading because it suggests that abortion care is not an essential part of comprehensive health care,” Abitz said.

“A woman is putting her health and her life at risk every time she chooses to carry a pregnancy, and so she shouldn’t be mandated to put her life at risk.”

Schweber views the bill differently. While a clause in Wisconsin’s 20-week abortion ban statutes already exempts abortions performed for the “life or health of the mother,” he believes Goeben and Quinn’s bill could make hospitals and insurance companies more comfortable with authorizing lifesaving reproductive health care procedures.

“Insurance companies and hospitals or doctors, in order to err on the side of safety, will tell the doctors not to perform a procedure that is medically needed and, in fact, properly legal,” Schweber said. “(This) law is trying to prevent a chilling effect on legal medical procedures.”

Though the bill is not yet formally introduced, the Society of Family Planning, an international nonprofit composed of physicians, nurses and public health practitioners specializing in abortion and contraception science, opposes it.

“The narrative that exceptions to an abortion ban — or redefining what abortion care is — can mitigate the harm of restrictive policies is based in ideology, not evidence,” Executive Director Amanda Dennis said in a statement.

The American College of Obstetrics and Gynecology has not yet taken a position on the bill, but told Wisconsin Watch that state medical emergency clauses “do not offer adequate protection for the myriad (of) pregnancy complications people experience, resulting in substantial harm to patients” in the case of an abortion ban.

Political reaction to the bill

Prominent Democratic lawmakers, such as gubernatorial candidate Sen. Kelda Roys, D-Madison, have criticized the proposed bill as part of a series of moves by anti-abortion politicians to distance themselves from the “deadly” consequences of abortion bans.

“The way that you protect people from legal jeopardy is by not criminalizing health care,” Roys said. “Goeben’s bill just shows how deadly and dangerous criminalizing abortion bans are. It’s an acknowledgement of the truth, which is that abortion bans kill women.”

Goeben said she is surprised by the opposition because her bill on its own does not introduce any additional penalties to abortion.

“These are the issues that the other side of the aisle has talked about, saying, ‘oh, the poor women that can’t get health care!’” Goeben said. “So I thought honestly that this would be supported by everybody, if we are really concerned about the health care of women.”

She said she would also be open to discussing amendments to the bill, which would include exemptions for abortions performed because of other medical complications such as preeclampsia or maternal sepsis.

Anti-abortion organizations Wisconsin Right to Life, Pro-Life Wisconsin, Wisconsin Catholic Conference and Wisconsin Family Action have endorsed the proposal.

A similar bill by Quinn prior to the Wisconsin Supreme Court invalidating Wisconsin’s 1849 abortion ban in July died in the Senate last year. Even if the new bill is to pass through the Legislature, Gov. Tony Evers plans to veto it, spokesperson Britt Cudaback told the Milwaukee Journal Sentinel.

Looming gubernatorial, attorney general and legislative races in 2026 could decide the future of abortion laws and enforcement in the state. New legislative maps and a national midterm environment that historically has favored the party out of power in the White House gives Democrats their best chance to win control of the Legislature since 2010.

Republican U.S. Rep. Tom Tiffany, the GOP frontrunner for governor, previously supported a bill planning to ban abortion after six weeks, though he has rolled back that position in recent media appearances and deleted all mention of abortion from his website.

Schweber said Wisconsin’s newly liberal majority Supreme Court will decide the future of abortion in the state. The justices must answer the cases being brought to them on whether the  state constitution guarantees a right to an abortion.

“Just because the U.S. Constitution does not secure a right to abortion does not mean that Wisconsin or Ohio or Texas constitutionally doesn’t have that right,” he said. “Each state supreme court now has to decide this profound question.”

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

Community Medical Services (CMS) on Milwaukee's South Side. (Photo by Isiah Holmes/Wisconsin Examiner)

When patients struggling with opioid addiction walk into the newly opened Community Medical Services (CMS) clinic on Milwaukee’s South Side, “we want them to feel that this is a space for healing and growth,” said Amanda Maria De Leon, regional community impact manager for CMS. The clinic provides therapy and medication-assisted treatment for people working to stabilize their lives after addiction.

Medication-assisted treatment involves medications like Methadone to control opioid cravings and withdrawal symptoms. Together with therapy, medication-assisted treatment allows patients to begin to stabilize and repair their lives. Although studies have associated medication-assisted treatment with reductions in overdoses and other improved recovery outcomes, its use also carries stigma. Confronting that social disapproval, while also providing a comfortable environment for patients, is part of the mission of CMS. 

Walking into the clinic, patients are met with an open waiting room and ample seating. There is a small area with toys for young children in one corner, and across the room nurses sit at a desk waiting to check in patients. Hanging over the small play area is a plaque dedicated to a young girl who spoke at one of the city zoning hearings in favor of the clinic opening. De Leon explained that the girl, who was 8 years old at the time, had befriended a local unhoused man to whom she’d given food. “She knew he needed treatment,” De Leon told the Wisconsin Examiner, saying the girl told the zoning board, “I want them to open this clinic for my friend.” 

Around a corner from the lobby, behind a set of protective glass windows, nurses dispense liquid methadone into small cups for patients on a daily basis. Walls and therapy rooms throughout the facility are painted calming  blues and  greens, and feature art or motivational messages. Small, decorative coffee tables sit between two small couches large enough for one or two people to sit facing each other. 

“We create a space like this intentionally, because we don’t want a patient to feel like it’s a transaction,” De Leon told the Examiner. She said that the facility is designed to be therapeutic both to the patients and the staff, to mitigate burnout. 

Dr. Dan Lemieux, one of the medical doctors at CMS, said that he’s “used to the hustle and bustle” of a clinic. His background began in family medicine, where Lemieux was used to seeing 20-25 patients each day. Over time he also began working in Suboxone treatment programs. “I think about eight years ago I kind of pulled back on family medicine a little bit and did a little more time in addiction,” Lemieux told the Wisconsin Examiner. “I found it more gratifying, enjoyed helping people a little bit more.” Lemieux began working at methadone clinics after the COVID-19 pandemic and found his way to CMS, where he has worked for about two years. 

Lemieux has worked as the medical director of CMS clinics in West Allis, Madison, Fond du Lac, and now the Southside Milwaukee Clinic. Recalling the workload at West Allis, Lemieux told the the Examiner, “I think the counselors are really good at just keeping the flow going, and the front desk staff. So it never seemed overwhelming or busy, and the clients are always very appreciative.” Lemieux said he likes the highly focused sessions in recovery work, because “you can really spend your time kind of helping the client with those particular issues.” 

Overdose deaths driven by the synthetic opioid fentanyl began skyrocketing in Milwaukee County around 2016, claiming hundreds of lives annually. New records for overdose deaths were set and broken every year from 2018 to 2022, when the death toll peaked at 674 lives lost. Nearly 5,800 non-fatal overdoses occurred that same year, according to the county’s overdose dashboard. 

Recently, as new programs and services were established to stem the tide, overdoses began to decline. Last year there were 450 overdose deaths in Milwaukee, so far there have been fewer than half that number this year. CMS is  one of the many organizations on the frontlines of the crisis, both as a treatment clinic and as a harm-reduction advocacy organization. 

De Leon showcased a storage room full of boxes of hygiene kits, testing strips for both fentanyl and the tranquilizer xylazine (a more recent trend in the drug market), and Narcan (used to reverse an overdose), all of which are either used or distributed by the CMS outreach team. Sometimes staff visit homeless encampments and food pantries, other times they hold pop-up events in areas with high overdose rates. The team even organized a sober tailgate at American Family Field at a Milwaukee Brewers game and distributed over 1,200 tickets. 

“We just deliver a little hope,” said De Leon. “Hopefully when you’re feeling a little better you’ll walk into a door of a treatment center. We don’t care where you walk into.” CMS also works with numerous partner organizations including the Milwaukee Overdose Response Initiative (MORI), various fire departments, the West Allis overdose response team and other nodes along an evolving network. 

De Leon said the network has become bigger and more collaborative. At an open house CMS held at  the new clinic, dozens of people showed up, she said, including community members, firefighters and police officers from multiple departments, probation and parole representatives and treatment providers. “I was speechless,” said De Leon. “We had over 70 people show up to our open house…That would have never happened in a methadone treatment world 20 years ago.” 

“We’re breaking down silos, we’re educating people,” she added. Today, people have easier access to methadone treatment programs. In Milwaukee County, both the jail and the Community Reintegration Center (formerly known as the House of Corrections) have medication-assisted treatment programs. De Leon stressed that when people are taken to correctional facilities they should tell staff whether they need medication-assisted treatment in order to access those programs. 

The West Allis Fire Department became the first to carry Buprenorphine, which is given to people after reviving them from an overdose to stop sudden withdrawal symptoms. Bipartisan legislation at the state level legalized both fentanyl and xylazine testing strips.

Nevertheless, stigma associated with both addiction and medication-assisted treatment creates barriers to progress. Although CMS has clinics in the cities of West Allis and South Milwaukee, its new clinic is the first it has been able to open in the city of Milwaukee itself. The opening marked an end to years of contentious meetings with the city’s zoning board and local residents. Now, patients living near the South Side won’t need to travel far, and the new clinic could also lighten patient loads at other clinics. 

Ald. Marina Dimitrijevic, who represents the district where the new CMS clinic is located, said she supports the treatment center opening. “I strongly supported this facility opening in our community,” Dimitrijevic told the  Examiner. “Providing residents with nearby access to needed health care and harm reduction tools makes us all safer and healthier. I am proud to have led by example on this issue by welcoming CMS to our community and am grateful for their work serving our residents.” 

Another clinic is expected to open up on Milwaukee’s North Side in early 2026. But many people are not sold on medication-assisted treatment, fentanyl testing strips and overdose-reversing medications. In 2023, when the city of Milwaukee’s zoning board approved the North Side clinic, reactions from the community were split. Leadership from the fire departments of Milwaukee and West Allis spoke in favor of CMS opening a clinic, stressing the dire need for relief and treatment access across Milwaukee County. 

Others called treatment centers “predatory” and expressed concerns about the clinic’s   for-profit business model. 

At least one 2014 study, which analyzed self-reported services from disease testing to psychiatric care, found that for-profit providers “were significantly less likely than nonprofit and public programs to offer comprehensive services”. The study said that “interventions to increase the offering of comprehensive services are needed, particularly among for-profit programs.” 

Other objections to the new clinic came from neighbors who  argued that opening the clinic would hurt their property values and quality of life. A corporate representative and a real estate attorney from the Vin Baker Treatment Center, a facility named for a Milwaukee Bucks player that is located on N. 76th Street in Milwaukee, said that CMS would disrupt its business, jeopardizing a $3 million investment into the Vin Baker center. Ald. Lamont Westmoreland, who represents a North Side district, also opposed CMS,  referring to city planning documents which recommended against opening social service businesses in the area. “I support treatment facilities, just not at this particular location,” Westmoreland said before the center opened. 

John Koch, national director of community and public relations at CMS, explained that CMS is a for-profit entity with private equity backing. Koch said that the private equity investment, coupled with grants, has allowed the clinic to scale up to address the overdose crisis. opening new treatment centers, providing grants to extend clinic hours and embedding staff with local fire departments and homeless outreach programs for harm reduction. CMS bills Medicaid and other patient insurance to cover  patient care, “and 90% of our people are on Medicaid”, Koch told the Examiner. “We work very heavily with Medicaid. And then outside of that we receive grants to open new projects.” 

The private equity backing allows for “continuous investment back into the company to address the opioid epidemic as it’s needed,” said Koch. “If we were Ma and Popping it and just growing non-profit style, it’s so much slower and we would never be able to match the need.” CMS has opened seven clinics across Wisconsin, with over 70 clinics operating nationwide. “What we’ve been able to do is be innovative with our money, and meet people where they’re at,” said Koch. “So that’s our secret sauce, is using funds to just continue to provide more access to treatment. If we did not have private equity backing, we would never have been able to be this big, or be treating 30,000 people…That’s what’s allowed us to beat the opioid epidemic.”

Koch knows firsthand how treatment access can be the feather on the scale deciding life or death. In 2013, he was living on the streets of Chicago struggling with a heroin addiction. One night, not long after completing his second adult prison sentence, Koch encountered a police officer who saw that he needed help and gave him the number to a treatment center. Koch went the next day to begin recovery, which also included medication-assisted treatment. Today Koch is raising a family  and works to give people the second chance he got years ago. 

Despite such success stories, there is still public skepticism about medication-assisted treatment. De Leon recalled a conversation she had after making a presentation on harm reduction at a national conference. “This guy came up to me and said, ‘You know, you really changed my thinking,’” she said. He mentioned that in some cases people on probation or parole are expected to get off methadone in order to be fully released from supervision, despite the fact that he’s seen it significantly improve people’s lives. 

De Leon asked why people were being forced to get off methadone and the man replied, “Well, nobody should be on these medications for the rest of their life.” She countered that if someone is finally stable after decades of addiction then, “Why not?…Would you tell me to get off of my insulin?” The man said no. “Then why would you tell somebody to get off of lifesaving medication that has him the most stable he’s ever been?” People are free to work on tapering off if they choose, but the priority should be stabilizing and saving a life, she argued. 

Dr. Lemieux said that he’s also seen medication-assisted treatment make a difference. “It’s always a tough conversation to try and change minds,” Lemieux told the Examiner. “Just the data that comes out shows that people in recovery are getting jobs, they’re reuniting with family, they’re working more, crime goes down, and it’s just a win. They’re getting their lives back, and just being a part of that is very rewarding and amazing. I just hope that more people see this, realize this, and reducing deaths is just another huge point, too.”

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South Central Federation of Labor President Kevin Gundlach addresses a rally in support of Group Health workers seeking union representation on Monday, Oct. 13. (Photo by Erik Gunn/Wisconsin Examiner)

On Oct. 13, Group Health Cooperative held what appeared to be its largest membership meeting in at least a decade. Scores of GHC patients filed into the Alliant Energy Center’s Exhibition Hall, packing the meeting room until there were no seats left. They voted unanimously to direct their cooperative to change course and voluntarily recognize GHC workers’ chosen union. 

This win was a long time coming for GHC workers like me. We are unionizing for many reasons. Personally, I started working as a family medicine physician at GHC 22 years ago, and was excited about working for a primary care-based, member-owned cooperative that valued clinical staff voices. But GHC has changed. Through my union involvement I’ve come to see that many of my coworkers also face struggles with high turnover and understaffing, unfair pay and discipline and racial inequities. These struggles collectively hurt our ability to provide excellent patient care.

By supporting each other and working together through a union, we can better advocate for ourselves and improve our ability to provide the best patient care. Our input as employees is not only useful, but critical, to making GHC the best it can be.

But since we announced our intention to unionize in December, GHC has waged a relentless union-busting campaign. Following the legal counsel of antiunion law firm Husch Blackwell, administrators have engaged in surveillance and other intimidation tactics, and even used union activity as a factor in discipline. Their actions are under investigation by the National Labor Relations Board. GHC has also consistently parroted legal arguments straight from the Trump administration’s attacks on workers’ rights. 

GHC’s most fundamental attack, however, has been on our ability to choose for ourselves what our union looks like. We are creating a union of providers and nursing staff in primary and urgent care and closely related units – basically, the generalists you first see when you get care – since we all share issues in common and would benefit from bargaining together.

But GHC administrators are seeking to forcibly add on workers in specialty care units like optometry and radiology who haven’t even sought collective bargaining. Why? They hope to dilute our Yes votes and make it impossible for us to win a union election. They like to claim that the National Labor Relations Board sides with them, and that these specialty care workers must join with us – but don’t believe it. While the NLRB has said that the employer’s version of our union was feasible, they also said they weren’t offering an opinion on the appropriateness of a primary and urgent care union. GHC is still free to recognize the union we chose. 

GHC has also been confused, or is misleading, about what it is we’re asking for. Speaking with Wisconsin Examiner’s Erik Gunn, GHC representative Marty Anderson said “voluntary recognition” wasn’t likely, because they’d want “an NLRB sanctioned and overseen vote.” But voluntary recognition is an NLRB-sanctioned process: all GHC needs to do is tell the NLRB that they recognize our chosen union, either with or without an NLRB-sanctioned card check or secret-ballot demonstration of majority support. That’s voluntary recognition. It would save everyone further time and expense, not to mention cultivate a positive relationship between both parties going forward. We look forward to a collaborative relationship with GHC as we move forward as a union. 

Attending the meeting on Oct. 13 and seeing the support from our patients and community was truly heartwarming. It reinforced my decision to become active in our union movement – both for ourselves and for the care that we provide to our dedicated patients. Excellent patient care is at the heart of our union movement.

And GHC patients have made it clear, with a unanimous vote, that they stand shoulder to shoulder with their caregivers. As a cooperative where members stand “at the top of the leadership chart,” GHC’s Board should respect membership’s vote by voluntarily recognizing our union, effective immediately. To do anything else is unthinkable in any cooperative that claims to be democratically run.

To show your support, please send an email to the GHC Board telling them to respect the will of the membership and recognize our union: https://act.seiu.org/a/ghc-board-1.

Nisha Rajagopalan, MD is a family medicine physician at GHC’s Hatchery Hill Clinic.

South Central Federation of Labor President Kevin Gundlach addresses a rally in support of Group Health workers seeking union representation on Monday, Oct. 13. (Photo by Erik Gunn/Wisconsin Examiner)

A stalemate between Group Health Cooperative of South Central Wisconsin and employees who have been seeking union representation for the last 10 months shows little sign of breaking soon.

At a mass meeting Monday at the Alliant Center in Madison, members of Group Health, sometimes called GHC for short, passed a motion directing the co-op to voluntarily recognize the union as the employees originally petitioned in December — covering three departments and a series of health care professionals.

The motion set a deadline of Friday, Oct. 17. Marty Anderson, Group Health’s chief strategy and business development officer, said Thursday that action on all the motions would likely be deferred, probably until November.

“We communicated clearly ahead of the meeting that all motions are advisory in nature,” Anderson said. “Any deadlines that would be in any of the motions would also be advisory in nature.”

Monday’s mass meeting was the first of its kind for Group Health members to ask questions of the co-op administration and express their opinions about the union drive. About 172 people attended, according to a Group Health spokesperson. Group Health has more than 50,000 Class A and Founding members — the two groups that were considered eligible to attend, according to the co-op.

In the spring, a volunteer committee met with the board to argue in favor of recognizing the union. 

People attending the Monday meeting described the crowd as strongly supportive of the union, and the voice votes in favor of recognizing the union and other motions favored by union supporters were unanimous, according to Service Employees International Union (SEIU) Wisconsin. 

Growing dissatisfaction 

At a rally outside the Alliant Center before the meeting, South Central Labor Federation President Kevin Gundlach, a Group Health member, charged that the co-op “has lost its way” in its response to the union organizing drive.

“We want GHC to listen to the workers,” Gundlach said. “And these workers know, and it says on my shirt here” — he pointed to his chest — “it’s better in a union.”

Group Health has rejected charges that it’s trying to thwart the union drive, contending that it simply wants health care employees in all departments to take part in the union representation vote — not just those from departments and job classifications that were included in the original union petition.

Union supporters say that claim is disingenuous and a ploy to “dilute the vote,” in the words of several workers interviewed — racking up votes against the union from employees in departments that don’t have the same concerns.

Anderson denied the charge. “We don’t know” what the votes will be, he said.

According to workers involved in the union drive, the Group Health union campaign grew out of increasing dissatisfaction in specific co-op departments with working conditions and what they contend was a lack of input into the co-op’s practices.

“I feel like we can improve the patient care that we provide through unionization and through increased involvement in decision-making,” Dr. Nisha Rajagopalan, a family physician who has worked at Group Health for 22 years, said Thursday.

Pay practices, employee turnover and a voice at the table are all reasons employees have cited for supporting the union.

“GHC leadership stopped collaborating with us and despite our many patient care concerns and our many meeting requests,” said Julie Vander Werff, a physician assistant, the lead speaker at the Monday rally.

Who should be in the union?

Complicating the organizing campaign is the conflict over exactly who among Group Health’s workers should be included in the union.

Union supporters involved in the organizing drive originally proposed that the union represent a bargaining unit of about 220 people. They were doctors, physician assistants, nurse practitioners and nursing staff in three departments: primary care, urgent care and dermatology. Their petition also included physical therapists, occupational therapists and health educators.

The petition was filed Dec. 12, 2024. Group Health filed a brief asserting that the unit the employees sought “was an inappropriate unit,” said Anderson, the Group Health executive.

To resolve the differences, a National Labor Relations Board staffer held a meeting on Dec. 30 in Madison, where he moved between separate rooms, one housing Group Health executives and the co-op’s lawyer, the other housing SEIU Wisconsin staff and Group Health employees leading the union drive.

The NLRB staffer suggested to the union group that they narrow their petition to a single clinic, Group Health employees wrote in a letter to the Group Health board of directors Feb. 10, 2025. Hoping to get an agreement, they took the suggestion.

Group Health opposed the single-clinic unit, however. In subsequent hearings the co-op management’s lawyer argued the vote should include all direct care employees, including in departments that weren’t part of the union’s original petition.

After reviewing briefs from both sides, the NLRB regional director in Minneapolis who heard the case ruled that the single clinic unit that the union had proposed would not be an appropriate bargaining unit. The decision issued by Regional Director Jennifer Hadsall stated that the unit proposed by the employer, Group Health, was appropriate and set an election among all the co-op’s health care employees.

SEIU Wisconsin, however, moved to block the election. A raft of pending unfair labor practice charges against the employer could scare employees from voting for the union, SEIU charged. Hadsall agreed to block the vote until the charges are resolved.  

As a result, the vote is on hold. The NLRB investigation of the charges is on hold as well, because of the federal government shutdown.

Shared concerns, conflicting concerns

In her order, Hadsall also included a footnote that states she did not address the unit that the employees had originally asked for because it had not been formally litigated.

“We had always argued that we are a clinically integrated organization,” Anderson said. “Our staff floats between various parts of the organization and different clinics. And the bargaining unit was established [consisting of] all of our clinical sites and all of our direct care employees.”

But pro-union employees say there are concrete differences between employees who are in the groups that they had originally included in the union petition and the rest of the Group Health staff — including direct care providers.

“Initially our bargaining unit included employees who were in primary care and urgent care,” said Rajagopalan, the family doctor. “We practice similarly and we share the same concerns. There are other departments within GHC that don’t share the same concerns [and] practice very differently than we do. That’s why our initial bargaining unit is an appropriate unit.”

Pat Raes, president of SEIU Wisconsin and a nurse at UnityPoint-Meriter hospital in Madison, said that throughout her health care career she’s seen many workplaces where only some groups of workers are unionized.

“At the bedside or at the side of the patient, it doesn’t make a difference because the priority is patient care,” Raes said. “It’s not whether you’re unionized or not.”

Addressing the rally before Monday night’s meeting, Steve Rankin said it was “entirely normal” for workers in a single workplace to be represented by different unions or no union depending on their department or position.

“There is no reason that everyone at Group Health has to be in the same union,” said Rankin, who joined Group Health when it was founded in 1976 and has been active in marshalling Group Health patients to support the union effort. “We call on GHC to recognize the bargaining unit chosen by the workers themselves and to commit to bargaining in good faith toward the contract.”

While the board has yet to consider the motion that was passed at Monday night’s meeting, Anderson said Thursday that voluntary recognition was unlikely. 

“We want an NLRB sanctioned and overseen vote,” he said. “That’s always going to be our criteria.”

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