The legal group that demanded Wisconsin rescind a professional standard for therapists that bars attempts to change sexual orientation or gender identity is now suing Gov. Tony Evers and the counselors’ professional board to kill the standard.

The Wisconsin Institute for Law & Liberty filed the lawsuit Tuesday in federal court in Milwaukee on behalf of two licensed therapists, charging that the standard is unconstitutional because it prescribes “what views [the therapists] may express.”

In April 2024 the examining board for licensed counselors and therapists added to its definitions of unprofessional conduct “sexual orientation change efforts,” commonly referred to as conversion therapy.

Conversion therapy has included electric shock, physical violence and “personal degradation and humiliation,” according to a 2015 statement opposing  the practice from the American Academy of Nursing.

The Wisconsin board standard barring conversion therapy includes “any intervention or method that has the purpose of attempting to change a person’s sexual orientation or gender identity, including attempting to change behaviors or expressions of self or to reduce sexual or romantic attractions or feelings toward individuals of the same gender.”

The board’s guidance document calls such practices “harmful, ineffective, non-evidence based, and not in line with current standards of professional practice.”

In March, the U.S. Supreme Court sent a lawsuit against a Colorado law banning conversion therapy back to lower courts. The high court said that applying the Colorado law to talk therapy required “strict scrutiny” for impinging on the First Amendment right of free speech.

Two weeks later, WILL and Wisconsin Family Action wrote to Gov. Tony Evers, demanding that the state repeal the professional standard barring conversion therapy.

The demand letter asserted that the court “struck down the law,” a claim WILL has repeated in publicizing its lawsuit.

Evers rejected the demand and stated in his letter to WILL that the organizations were “misreading” the U.S. Supreme Court ruling in the Colorado case. Rather than striking down the Colorado law, the high court sent a lawsuit back to lower courts, directing them to apply “strict scrutiny” on First Amendment grounds to how the law is applied to talk therapy.

The lawsuit WILL filed against Wisconsin’s standard names as defendants Evers; Dan Hereth, secretary of the state Department of Safety and Professional Services, which administers the licensing boards for a wide range of professional disciplines; and all the members of the Wisconsin Marriage and Family Therapy, Professional Counseling, and Social Work Examining Board.

WILL argues that the therapists it represents practice only talk therapy, conducting their counseling practice as “an exercise of their faith,” and that clients have voluntarily sought their “faith-based counseling, including obtaining advice on issues of sexual orientation and gender identity.”

The professional standard “prevents Plaintiffs from providing verbal advice in accordance with their sincerely-held religious beliefs in helping these patients specifically seeking to align their gender identity with their biological sex or to make changes relating to their sexual orientation or expression,” the lawsuit states.

A DSPS spokesperson said the agency doesn’t comment on pending litigation. A spokesperson for Evers referred to the letter Evers wrote rejecting WILL’s demand.

“I do not believe this lawsuit will succeed,” said Marc Herstand, executive director for the National Association of Social Workers Wisconsin chapter. “Wisconsin law clearly gives professions the authority to set their own Conduct Codes.”

The conversion therapy ban’s adoption in 2024 marked the third attempt by the professional board to bar the practice. Previous efforts were blocked by the Legislature’s Joint Committee for the Review of Administrative Rules. In 2025, the state Supreme Court ruled that state statutes giving the committee the power to block rules indefinitely were unconstitutional.

WILL since its founding has pursued legal actions against measures and policies respecting LGBTQ+ people, programs aimed at redressing systemic racial discrimination, and local election administration practices intended to increase voter access to the ballot box.

The organization has sued to block public health measures that were taken during the COVID-19 pandemic; argued that government efforts to encourage diversity, equity and inclusion in the workplace are unconstitutional; and defended laws such as Wisconsin’s 2011 Act 10, which stripped most public employees of most union rights.

Wisconsin Family Action has opposed LGBTQ+ rights and has lobbied against the inclusion of gender identity in civil rights protections under Wisconsin law.

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The U.S. Supreme Court decided Thursday to preserve telehealth access to the abortion drug mifepristone until after the U.S. 5th Circuit Court of Appeals has ruled on the merits of the high-stakes federal lawsuit Louisiana v. Food and Drug Administration.

Justices Samuel Alito and Clarence Thomas issued dissenting opinions.

In his dissent, Thomas said the rule violates the Comstock Act, a long unenforced 1873 law that bans the mailing of “obscene” material. During the 2024 presidential campaign, President Donald Trump said he didn’t support using the Comstock Act to stop mail delivery of abortion pills, saying he thought the federal government should have nothing to do with the issue.

Mifepristone’s manufacturer “makes a passing reference to the possibility of lost sales,” Alito wrote in his dissent. “But lost sales in states where abortifacients are generally illegal are not ‘irreparable injuries’ that can justify granting a stay.”

Abortion-rights advocates around the country called the decision a relief after two weeks of uncertainty.

On May 1, the appellate court sided with Louisiana, where state officials sued the FDA in October, arguing that a rule allowing telehealth access to mifepristone, one of two drugs used to terminate a pregnancy in the first trimester or to treat miscarriage, undermines the state’s abortion ban. Danco Laboratories and GenBioPro, two manufacturers of mifepristone, filed emergency appeals, leading the Supreme Court to issue a 10-day stay on May 4, extended until today.

“Though today’s decision means that mifepristone remains available through telehealth for now, this fight is not over,” said Dr. Camille A. Clare, president of the American College of Obstetricians & Gynecologists, in an emailed statement. “The chaos and confusion wrought by competing decisions and the revocation and restoration of access on an almost daily basis do real harm to patients and to the clinicians who care for them.”

Abortion opponents decried Thursday’s decision.

“Women deserve better than dangerous abortion drugs sent through the mail without physician oversight or in-person support,” said Jor-El Godsey, president of Heartbeat International, a major network of anti-abortion crisis pregnancy centers. “A state like Louisiana that values life in its laws should be able to protect its smallest residents as well as their moms.”

The FDA’s approved two-drug regimen via telemedicine is an increasingly common abortion method, especially for people living in parts of the country where abortion is banned or difficult to access.

Last month, a federal district court paused the lawsuit at the request of the FDA until after the completion of a safety review on mifepristone. That review was prompted by non-peer reviewed, anti-abortion research and in spite of the drug’s record of safety and efficacy since 2000. The state appealed to the 5th Circuit.

Due to multiple ongoing efforts to restrict or block mifepristone, abortion providers have told Stateline they are ready to eventually switch to a misoprostol-only method, which researchers have found to be as safe as the two-drug regimen but typically involves more symptoms and is slightly less effective.

National groups have tried to pressure the Trump administration to drop the Biden-era rule allowing telehealth abortion and called for the head of FDA Commissioner Marty Makary for reportedly slow-walking a safety review of the drug until after the midterm elections. Makary resigned on Tuesday, and anti-abortion groups wasted no time in getting Acting Commissioner Kyle Diamantas on the phone.

Live Action founder and president Lila Rose, in a written statement, said she talked to the acting commissioner on Wednesday and that he said he was morally opposed to abortion. “Diamantas told me that reviewing the abortion pill is a top priority for him and the administration,” Rose posted on X.

Students for Life of America President Kristan Hawkins wrote a similar message to supporters in an email on Thursday, saying Diamantas will be the “most pro-life FDA commissioner in American history.”

But many doctors around the country say curbing access to telehealth abortion is likely to cause harm to people in states with bans who may face more barriers to obtaining an abortion without that option.

“Women will be forced to travel long distances — at times hundreds of miles — to access safe, essential health care at a doctor’s office, no longer having the option to receive mifepristone via telemedicine,” wrote Rob Davidson, an emergency physician in Michigan and executive director of the Committee to Protect Health Care, in a letter asking the Supreme Court to maintain access to telehealth abortion. The letter was cosigned by more than 2,200 physicians.

Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.  Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org. 

WASHINGTON — Officials from the Centers for Disease Control and Prevention said Wednesday the risk of a member of the general public contracting hantavirus remains low despite several passengers on a cruise ship becoming infected with the disease. 

Dr. Brendan Jackson, an epidemiologist and the agency’s team lead in Nebraska, said Americans who were on the MV Hondius cruise ship after others were diagnosed with the illness were flown to the National Quarantine Center at the University of Nebraska Medical Center.

Healthcare providers at the site have been talking with each passenger about whether they may have been exposed to any of the people with confirmed cases. They’re also monitoring the Americans for fevers or other symptoms. 

“This particular virus has a long incubation period, so the monitoring period is 42 days,” Jackson said. “And the 42 days started with the departure of the ship, so May 11 was day one.” 

Any cruise ship passengers who traveled on commercial flights, leading to possible exposures for others on those planes, left the ship before the infections were diagnosed, he said.  

“The passengers that are being monitored who were on shared flights were separate from the passengers who were on the ship at the time the outbreak was detected. So they had actually left the ship before the outbreak was detected,” Jackson said. 

“All the passengers that were on the ship after that detection phase were transported just several days ago on a private plane directly from the Canary Islands to here in Omaha, Nebraska,” he added. 

CDC officials are working with local and state public health officials to ensure anyone who may have been exposed outside of the cruise ship isolates at home and monitors themselves for symptoms. 

The officials on the call declined to say how many people are being monitored for possible exposure or where they are located in the country, citing privacy concerns.

They also declined to talk about the two cruise ship passengers taken to Emory University Hospital’s Serious Communicable Diseases Unit in Georgia. 

Dr. David Fitter, incident manager for the agency’s hantavirus response, said that unlike the coronavirus pandemic that spread around the world in 2020, hantavirus is not new to public health officials. 

“At this moment I want to emphasize that the risk to the general public is low,” he said. 

In addition to monitoring Americans who were on the cruise ship and anyone they may have come into contact with, CDC officials have been talking frequently with lawmakers.

“We’ve held two Hill briefings and have just completed a call with the governors from the states of repatriated Americans,” Fitter said. “We’ve also held daily calls with state health officials. 

“Our role now is to continue our conversations with each passenger about their potential exposure and work with partners to ensure appropriate monitoring.”

CDC officials have encouraged the people at the Nebraska facility to stay there throughout the quarantine period but there are not currently any state or federal quarantine orders in place.

An increasing number of conservative states are mandating that state and local social service providers verify and report the immigration status of the people they serve — in some cases threatening stiff penalties for public employees who fail to comply.

Under federal law, immigrants who are in the United States illegally are generally barred from receiving public benefits such as nonemergency health care, food aid and housing help, though a handful of left-leaning states use their own money to provide such benefits.

Supporters of the new verification and reporting laws say they will help curb illegal immigration by making it more difficult for people who aren’t eligible for public aid to receive it.

Government-funded health care, housing aid and the right to have a driver’s license are a “pull factor that encourages illegal immigration,” said Cooper Smith, director of homeland security and immigration at the America First Policy Institute, a conservative think tank that has worked on policy development with the current Trump administration.

Government benefits, Smith said, are “an incentive for (immigrants) to come here and cross the border and make this their home, and we don’t want to see that.”

In Tennessee, legislators this week sent a bill to Republican Gov. Bill Lee that would require all state and local agencies to verify the immigration status of people who apply for federal, state or local government benefits, and to report those who are here illegally to the legislature and the state’s new immigration enforcement agency.

The measure, which the governor is expected to sign, authorizes the state attorney general to investigate possible violations, and threatens jail time or a loss of state funding for workers or agencies that fail to comply.

The potential penalties in Tennessee’s law are especially strict, but this year Indiana, Utah, and Wyoming also enacted laws requiring state and local agencies to verify the immigration status of people applying for certain benefits. In Indiana and Wyoming, agencies also must report immigrants who are here illegally to federal authorities. Louisiana enacted a similar verification and reporting law last year.

The Indiana and Wyoming laws go beyond the specific individuals applying for aid.

In considering an application for the Supplemental Nutrition Assistance Program (SNAP), the Indiana law requires agencies to notify federal authorities if they cannot verify the immigration status of any member of an applicant’s household. Similarly, the Wyoming law requires the state health department and the state department of family services to notify federal immigration authorities if they determine that anyone applying for public benefits resides in a household that includes a person who is here illegally.

Critics say the new state laws will dissuade many people who are eligible for benefits — especially those with family members who are here illegally — from getting help they are entitled to, and force state and local officials to perform an immigration enforcement role for which they are ill equipped.

“They have to do this verification process for everybody that walks in the door. This is something that slows down services for every Tennessean in the name of collecting data and trying to make assessments that folks are not trained to make,” Democratic state Sen. Jeff Yarbro said last month during the floor debate on the bill.

“There’s probably no one who understands enough of the rules to make that determination,” he said. “But we are forcing that decision upon every single government office in the state of Tennessee — it’s just a little bit insane.”

Tanya Broder, an attorney at the National Immigration Law Center, which advocates for immigrants, said the new laws represent an escalation of state anti-immigration efforts. She said the measures demonstrate that conservative states are moving in lockstep with the Trump administration.

“There are many, many states that impose restrictions on access to public to state and local public benefits, but some of these reporting requirements that states are proposing now likely do violate the law,” Broder said. “I think they are sowing a campaign of fear and misinformation.”

Broder added that the fear of penalties might prompt agency workers in Tennessee to overreport and potentially engage in racial profiling.

The Tennessee bill is part of a sweeping package of immigration enforcement measures the state legislature approved this year. Tennessee’s broad immigration agenda was crafted in coordination with the White House, specifically with Deputy Chief of Staff Stephen Miller, the architect of the Trump administration’s crackdown on illegal immigration.

Earlier this month, Lee signed a measure that requires state judges to cooperate with federal immigration authorities. And last month, the governor signed a bill that makes it a crime under Tennessee law for an adult to refuse or fail to leave the state within 90 days of a final order of removal. The law also makes it a crime for immigrants to try to enter the state if they have an outstanding deportation order.

Other bills that would require local sheriffs to cooperate with federal immigration agents and make it illegal for people who are living in the U.S. illegally to operate a commercial vehicle or truck in the state are on Lee’s desk awaiting his signature.

Smith, of the America First Policy Institute, said Tennessee is “serving as a model for other states to follow.”

Republicans struggled this year to secure funding for the Department of Homeland Security, Smith noted, “so they know that their ability to get meaningful legal immigration reform, through both houses of Congress and signed by the president, is very, very unlikely,” he said. “So the next step is to do as much as you can at the state level.”

Julia Gelatt, an associate director at the Migration Policy Institute, a Washington-based think tank, agreed with Smith’s assessment of the political situation.

“There are things that the federal government can’t control, or that may be harder to achieve at the federal level, particularly with a Congress that isn’t passing bills,” Gelatt said.

“We know that Stephen Miller advised Tennessee on their immigration bills, and I think that his philosophy is that the federal government and state governments should make life in the United States so hard for people who don’t have legal status that they decide to go home.”

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

A growing number of states are reexamining how the criminal legal system treats pregnant and postpartum women behind bars.

This year, legislators in at least five states, including Kentucky, Ohio, South Carolina, Utah and Virginia, have considered legislation that would reshape how pregnant people are treated in jails and prisons. The measures vary, but some seek to expand eligibility for alternatives to incarceration during pregnancy, restrict or prohibit restraints during labor and delivery, and strengthen data and reporting requirements.

The Utah and Virginia bills were signed into law in March and April, respectively. In Utah, the new law restricts the shackling of pregnant and postpartum women, and requires state prisons and jails to track the number of pregnant people in their custody, as well as incarcerated mothers of children under 18.

In Virginia, one of the new laws requires correctional facilities to adopt lactation policies for pregnant and postpartum incarcerated people by December 2028. A separate new law allows courts to consider home or electronic incarceration programs for pregnant or postpartum women, with certain exceptions.

The Kentucky legislature adjourned for the year without passing a similar measure there, but the bills in Ohio and South Carolina are still under consideration. Ohio’s legislative session runs through the end of the year, while South Carolina’s continues until mid-May.

The latest legislative activity comes amid growing scrutiny of conditions faced by pregnant people in prisons and jails, as well as increased interest in nursery and community-based programs for mothers.

At least nine states have prison nursery programs, and about a handful of others are considering or developing similar programs.

In Wisconsin, the state Department of Corrections said in early April that the agency is still working to develop a program for incarcerated mothers and their newborns, but has faced challenges due to funding and facility capacity limits. 

The Justice-Involved Women and Children Collaborative at the University of Minnesota this spring launched what the group describes as the first comprehensive national database tracking state policies affecting pregnant people in custody.

The interactive tool documents more than 460 active policies across the country, including statutes on the use of restraints, access to abortion and access to menstrual products. 

The database fills a longstanding gap in information about how state systems regulate pregnancy in correctional settings. Policies vary widely not only from state to state, but sometimes among facilities within the same state. Federal data also is limited. The most recent national statistics on pregnant incarcerated people, which were released last year, reflect prison populations from 2023.

Stateline reporter Amanda Watford can be reached at awatford@stateline.org.

The U.S. Supreme Court on Monday extended a highly anticipated stay blocking an appellate court’s pause on telehealth abortion access until May 14.

The U.S. Food and Drug Administration’s approved medication-abortion regimen remains available via telehealth until then, following a week of uncertainty among abortion patients and providers.

“With this critical temporary administrative stay extended, we hope that some of the chaos and confusion inflicted on patients and providers last weekend will be abated,” said Evan Masingill, CEO of abortion-pill manufacturer GenBioPro, one of the defendants in the case, in a statement.

On May 4, the Supreme Court temporarily stayed the 5th Circuit Court of Appeals’ ruling to reinstate the FDA’s in-person dispensing requirement for mifepristone that the Biden administration officially lifted in 2023. Over the past week, several doctors groups submitted friend-of-the-court briefs arguing that cutting off access to mifepristone could harm many women seeking abortions and miscarriage management. Republican attorneys general from 23 states, meanwhile, urged the Supreme Court not to allow providers to send mifepristone through the mail. 

People in states with abortion bans or diminished abortion access continue to depend on abortion providers prescribing FDA’s approved mifepristone-misoprostol regimen through telemedicine and sending it to patients by mail.

According to new preliminary findings from the Society of Family Planning, telehealth abortion comprised 28% of all abortions at the end of 2025, an increase from 25% at the end of 2024.

Attorneys representing Louisiana have argued that in addition to undermining a state abortion ban, the federal rulemaking process allowing telehealth prescriptions of medication abortion was flawed.  

University of Michigan law professor Samuel Bagenstos, who served as general counsel of the U.S. Department of Health and Human Services at the time the Biden-era rule was implemented, said the policy was well considered and based on evidence. 

“The 2023 update was the result of an incredibly careful, deliberate, time-consuming, painstaking process to make sure that they were following what the evidence was,” Bagenstos said. If, the plaintiffs were to prevail, he added, ending telehealth access to mifepristone nationwide would have “really harmful effects on women across the country, as well as really destabilizing effects on the drug approval system.” 

Louisiana’s lawsuit against mifepristone has nationwide implications and could threaten residents in states with abortion access and so-called abortion shield laws, such as Maryland. 

Regardless of what happens in this case, abortion providers told Stateline they are determined to continue providing telehealth abortions, though potentially without mifepristone. Dr. Angel Foster, a telehealth provider in Massachusetts, a shield law state, said in the past week, about 100 patients have requested pills for future use, compared with 34 in the entire month of April. She said constantly changing rules around abortion access followed by sensational news headlines continue to create confusion for people seeking termination or miscarriage management.

“I live and breathe abortion at this point, and I find it can be hard to keep up with the ever-changing legal environment and the way that things are getting framed and phrased,” Foster said. “When you’re a patient and what you see are just the headlines, and you’ve got to figure out what it means for you, it’s really complicated.”

Editor’s note: This story has been updated to correct the number of Republican attorneys general who asked the Supreme Court to keep mifepristone from being prescribed via telehealth visits. It should be 23. 

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

Advocates and opponents of abortion access say they’re wondering what happens next in a critical telehealth medication case that created chaos and confusion over the past week after an appeals court blocked nationwide access to the drug and, days later, U.S. Supreme Court Justice Samuel Alito issued a temporary stay.

Alito’s stay preserves telehealth access until May 11. But it’s unclear what happens next for patients and providers.

The Supreme Court on Monday temporarily blocked the 5th U.S. Circuit Court of Appeals’ Friday ruling to suspend a federal rule allowing telehealth prescriptions of the drug mifepristone while the lawsuit Louisiana v. U.S. Food and Drug Administration unfolds. Abortion providers are determined to continue providing the service, though potentially without mifepristone, the drug at the center for the case, which has had a high record of safety and efficacy since 2000.

Anti-abortion advocates have pushed to reverse the 2023 policy, enacted under former Democratic President Joe Biden, that allowed the FDA to drop its requirement that a patient see a provider in person before the medication can be prescribed. One similar national case already failed unanimously before the Supreme Court, but anti-abortion advocates are hoping this time around, with a more tailored approach, they will be successful.

Abortion-rights advocates say they’re prepared for whatever might happen in the courts, with contingency plans and a message that abortion will still be available even if the particular medication — mifepristone — is not.

Has the abortion pill been banned?

No. Mifepristone is still a legally approved FDA drug commonly used to terminate a pregnancy before 10 weeks’ gestation and is used off-label to treat miscarriages.

Is telehealth abortion still legal?

Yes, for now. Under the U.S. Supreme Court’s administrative stay that expires on May 11, it is still legal to obtain abortion medication through telemedicine under the FDA’s regulations. Mifepristone is commonly used with a second drug, misoprostol, in medication abortions. The case doesn’t include misoprostol.

Who would be affected if telehealth access is struck down?

According to the Society of Family Planning’s #WeCount report, 27% of all abortions in the first six months of 2025 were obtained through telehealth, adding up to more than 162,000 cases.

Mifepristone is also used for patients experiencing a miscarriage; those patients also would have to visit a provider in person.

The ruling would apply nationwide, meaning that health providers couldn’t prescribe mifepristone without an in-person visit with the patient, even in states with abortion access.

What are the arguments on each side in Louisiana v. FDA?

Louisiana says the Biden-era policy undermines a state law banning abortion, and that the federal rulemaking process allowing telehealth prescriptions was flawed.

The Food and Drug Administration says the state doesn’t have standing to sue, but also notes that it’s taking more time to review the drug’s safety.

Two mifepristone drugmakers, meanwhile, have intervened on the FDA’s side.

What could happen next?

The Supreme Court has many options available moving forward, but a few options are most likely, said Katie Keith, founding director of the Center for Health Policy and the Law at the Georgetown University Law Center. The justices could extend the stay when it expires May 11, or the court could make a longer-term ruling.

That could mean sending it back to the 5th U.S. Circuit Court of Appeals, with or without upholding the initial ruling blocking the 2023 provision while the appeals case proceeds. Or justices could decide to take up the case and bypass the rest of the 5th Circuit appeal.

If it did that, the manufacturer defendants Danco Laboratories and GenBioPro have asked for an expedited process with a decision by June. That seems unlikely, Keith said, but the court has conducted expedited cases related to abortion before, such as the Moyle v. United States case in 2024 related to the federal Emergency Medical Treatment and Labor Act.

What will providers do if they can’t use the combination of mifepristone and misoprostol?

Brittany Fonteno, president and CEO of the National Abortion Federation, said providers have been preparing since 2023 for the possibility of losing access to mifepristone. There have long been plans to switch to a misoprostol-only protocol, which is the main method of pregnancy termination across much of the world, she said.

“A lot of providers had created these policies and just needed to dust them off,” Fonteno said.

Dr. Angel Foster, co-founder of the Massachusetts Medication Abortion Access Project, which provides telehealth abortions to patients in all 50 states, said she and her team spent the weekend scrambling to contact patients waiting on medication abortion pills they had ordered before the ruling, and implementing a contingency plan that many abortion providers have been planning for since the lawsuits against mifepristone began in 2023.

That contingency involves pivoting from the FDA-approved mifepristone-misoprostol regimen to a misoprostol-only regimen.

Early Monday, Foster said her team was getting ready to ship misoprostol-only packages to patients at 2 p.m., but after the Supreme Court stayed the appeals court’s ruling on Monday morning, she said they were able to switch back to the mifepristone-misoprostol regimen.

Foster also said her organization was inundated with requests for pills that people could stockpile — people who didn’t need an abortion but were worried about losing access to the pills. Normally that’s a small fraction of the requests they receive, she said, but on Tuesday, they sent out more than had been sent in the entire month of April.

“Over the last two days, we’ve had a huge increase in the number of people from Louisiana requesting pills, especially pills for future use,” Foster said.

What are the pros and cons of the misoprostol-only regimen?

Dr. Maya Bass, a family physician in New Jersey who also provides abortions in Delaware, said misoprostol-only regimens are still safe and highly effective, but that the regimen has a lower efficacy rate than the combination of the two drugs and comes with potentially more side effects and risks.

Misoprostol-only regimens vary between 85% and 90% effective, while the combination is between 93% and 99% effective. The effective rates are lower as the gestational age increases.

The combination works well, Bass said, because mifepristone stops the hormone that allows the pregnancy to continue and signals to the body that the pregnancy is over. The misoprostol then helps soften the cervix and prompts the uterus to contract and expel the pregnancy tissue.

Without that hormonal signal, Bass said, a higher dose of misoprostol is needed to empty the uterus. The usual side effects of nausea, diarrhea, chills and sometimes fevers can be more severe because of the higher dosage. And it may lead to more people needing to seek in-person follow-up care to fully remove all of the pregnancy tissue, which can cause infection if it stays in the uterus.

“A lot of the people who are using telehealth for their medication abortion are not necessarily in places where they can safely access that care,” Bass said. “So it is concerning that we might be relying more on a regimen that means that many more people needing to seek care.”

What are the details of the legal arguments?

Louisiana officials, including Republican Attorney General Liz Murrill, argue that the state is harmed by the 2023 telehealth policy because it undermines a state law banning abortion at all stages of pregnancy, with few exceptions that don’t include rape or incest. The state also challenged the Food and Drug Administration’s process in deciding to eliminate the in-person dispensing requirement, saying it was based on flawed or nonexistent data.

The state also said the rule has resulted in $92,000 in Medicaid bills from two women who went to the emergency room because of complications related to mifepristone in 2025. And the state says the rule harmed the other plaintiff in the case, Louisiana resident Rosalie Markezich, who said her ex-boyfriend ordered the medication online and pressured her into taking it. That wouldn’t have been possible if the medication had to be dispensed through an in-person visit, the state argues.

“The priority of safety supersedes the priority of access, and that is what ultimately, I believe, needs to be looked at directly,” Sarah Zagorski, senior director of public relations at Americans United for Life, told Stateline on Wednesday. The anti-abortion organization submitted a brief supporting Louisiana’s case to the U.S. Supreme Court this week.

The FDA’s response has been to try to dismiss the claims in part on the grounds that Louisiana doesn’t have standing to sue, but agency officials have also said they are in the middle of conducting a safety review of mifepristone and need more time.

GenBioPro and Danco Laboratories, two of the manufacturers of mifepristone, intervened as defendants in the case, which can happen when the party that is sued may not be willing to fully defend the case for various reasons.

The two companies argue that Louisiana does not have proper standing to sue because the state does not prescribe or use mifepristone and is an “unregulated party” as it relates to the 2023 telehealth provision. They also noted that the FDA reviewed 15 studies evaluating medication abortion outcomes for more than 55,000 patients before approving the rule, “all of which supported the safety and effectiveness of dispensing mifepristone by mail, courier, or through pharmacies.”

How does this compare to the 2023 case Alliance for Hippocratic Medicine v. FDA?

Both lawsuits were designed to restrict access to mifepristone. The plaintiffs in the Alliance for Hippocratic Medicine case included a group of anti-abortion doctors who said they would be harmed by having to care for people who took mifepristone. They also argued that the FDA’s approval of the drug was improper.

The 5th U.S. Circuit Court of Appeals was involved in that case as well, and determined that the FDA should roll back its decision to ease restrictions on the drug, including the 2023 telehealth rule. But the U.S. Supreme Court unanimously decided in June 2024 that the Alliance plaintiffs didn’t have proper standing and sent it back to the lower court.

After that ruling, the attorneys general of Missouri, Idaho and Kansas stepped in as plaintiffs, and the case was transferred to Missouri’s U.S. district court, where it’s still pending.

The Louisiana case is more limited because it would strike down one provision of mifepristone regulation, noted Jenna Hudson, senior counsel at the Center for Reproductive Rights. The Alliance plaintiffs sought to revoke the drug’s approval altogether.

Stateline reporters Kelcie Moseley-Morris can be reached at kmoseley@stateline.org and Sofia Resnick can be reached at sresnick@stateline.org.  

A new report forecasts that changes to Medicaid enacted in 2025 will cut $7 billion from the program in Wisconsin alone over the next 10 years, according to the advocacy group Protect Our Care.

Calculations last year from KFF, a nonprofit, nonpartisan healthcare policy and news organization, indicate that at least 57,000 more people in Wisconsin will become uninsured by 2034.

“Wisconsinites and people everywhere have either lost coverage or they’re living with the ongoing fear of not knowing whether or not they’ll have health coverage in the next month,” said state Rep. Deb Andraca (D-Whitefish Bay) in a media call conducted Thursday by Protect Our Care.

The organization has issued a new report on the impact on Medicaid across the country from the 2025 tax cut and spending bill that passed with only Republican votes and was signed by President Donald Trump July 4. The legislation’s tax cuts primarily went to the wealthiest Americans, said Protect Our Care’s Joe Zepecki.

“Every single state in the United States is going to see these cuts and it’s going to have all kinds of consequences,” said U.S. Rep. Gwen Moore (D-Milwaukee), who also took part in the call Thursday.

The legislation included new requirements for some Medicaid recipients to prove they are working or are exempt from a work requirement. It also included requirements that those recipients submit paperwork showing they qualify for Medicaid twice a year instead of once a year.

Those requirements will take effect in 2027. The work-reporting requirements, however, have been broadly criticized by healthcare experts.

“We have also consistently seen in our research and everybody’s research that work requirement policies often do not meaningfully increase employment or access to inclusive, competitive employment,” said Dr. Kiley McLean, a social work professor, researcher and advocate for people with disabilities.

“Instead, they create paperwork barriers that cause eligible people to lose coverage, not because they are ineligible because but because the system becomes too difficult for them to navigate,” McLean said.

McLean said she has heard from people with disabilities and their families who are concerned that they could lose access to Medicaid for healthcare and personal care in their homes and communities.

“For decades, disability advocates like myself have fought to move away from unnecessary institutionalization and toward community living and inclusion,” she said. “Medicaid is what made that possible.”

States can apply waivers to cover those home and community based services — referred to as HCBS for short. But while federal law requires Medicaid coverage for people in institutions, it’s optional for home and community-based care, McLean said.

“That means when states face budget pressure or major Medicaid cuts, community services, HCBS services are among the first at risk,” McLean said.

Another call participant, Dr. Chris Ford, said he has seen the consequences on the job as an emergency room specialist in Milwaukee.

“When access to primary care disappears, when those clinics close, and when people lose that insurance, the emergency department becomes a safety net for an entire — albeit collapsing — system,” Ford said. “We are already seeing the warning signs happening now.”

Ford said he’s seen longer wait times in the emergency room, more patients who, lacking insurance, are “delaying care until they’re critically ill.”

“These cuts disproportionately hurt the very people  who already face the greatest barriers to care to begin with,” Ford said. “This is not something that is a potential. This is something that is happening already.”

This report has been updated.

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Three weeks after two right-wing groups demanded the repeal of a professional licensing board’s ban on conversion therapy for LGBTQ+ clients of social workers and other therapists, Gov. Tony Evers sent a sharply worded reply.

In a Tuesday letter to the Wisconsin Institute for Law & Liberty and Wisconsin Family Action, Evers declared, “my administration has no intention of repealing Wisconsin’s conversion therapy ban.”

Evers asserted that the April 14 demand letter from the two groups was based on “a significant misreading” of a U.S. Supreme Court ruling earlier this year that threw parts of a Colorado ban on conversion therapy into question. 

Evers wrote that it was “disappointing” that the organizations support “a long-disavowed and outdated practice” that extensive research has shown to be ineffective and responsible for harms including depression, suicide, substance misuse, posttraumatic stress and anxiety.

“On the other hand, this should come as no surprise,” Evers wrote. “After all, bullying LGBTQ kids and Wisconsinites seems to be an important goal for Wisconsin Institute for Law & Liberty and Wisconsin Family Action.”

Purported to dissuade people from same-sex attractions and from gender dysphoria — which the American Psychiatric Association has defined as  “psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity” — conversion therapy, also known as reparative therapy, has been widely discredited.

Conversion therapy is not limited to talk therapy. “Aversive techniques used in reparative therapies have included electric shock, physical violence, administration of emetics, and personal degradation and humiliation,” the American Academy of Nursing wrote in a 2015 statement opposing the practice.

The Wisconsin Marriage and Family Therapy, Professional Counseling, and Social Work Examining Board published an updated professional code in April 2024 that declared “any intervention or method” used or promoted to change a person’s sexual orientation or gender identity to be “unprofessional conduct” that could subject a practitioner to professional discipline.

The U.S. Supreme Court, in a March 31 ruling, sent a lawsuit challenging a Colorado law against conversion therapy back to lower federal courts. The ruling instructed the lower courts to apply “strict scrutiny” on First Amendment grounds to the Colorado law because it seeks to “regulate speech based on viewpoint.”

In their demand letter, WILL and Wisconsin Family Action called on the Evers administration to repeal the ban in the Wisconsin therapists’ code. The letter declared that it was similar to the Colorado law and claimed that “the Supreme Court held that Colorado’s substantively identical statute was unconstitutional.”

Evers wrote that the demand “relies on a significant misreading of the U.S. Supreme Court’s recent decision” and had “erroneously” characterized its findings. 

“First, the Court intentionally — and specifically — stopped short of striking down any applications of Colorado’s law,” Evers wrote. The high court instead remanded the case to the lower court to apply a “more searching scrutiny” to the law, he added. “Repeal before that occurs would be premature.”

Evers also wrote that the ruling “expressly held that heightened scrutiny applies only to certain applications of Colorado’s law, not the entire provision. Specifically, the case concerned only Colorado’s conversion therapy prohibition as it applied to talk therapy — not to other treatment, such as physical or medication interventions.”

Quoting the Court’s ruling, Evers wrote that the Colorado plaintiff, therapist Kaley Chiles, stated that “the statute has many valid applications. Indeed, [she] did not take issue with Colorado’s effort to ban what she herself calls ‘long-abandoned, aversive’ physical interventions. Instead, Ms. Chiles objected to Colorado’s law only as it applies to her talk therapy, therapy that involves no physical interventions or medications, only the spoken word.”

Wisconsin’s professional rule also covers more than talk therapy, Evers wrote, and the therapy, counseling and social work board “will maintain the rule and continue to enforce its valid applications, in order to protect Wisconsinites from harmful and offensive practices by Board licensees.”

WILL’s initial response Thursday to a request for comment was a two-word email message from WILL Deputy Counsel Rebecca Furdek: “Lawsuit incoming.”

In a follow up statement, Furdek said that Evers was “resorting to personal, baseless attacks on WILL and its mission.” Contrary to the distinctions Evers made about the U.S. Supreme Court ruling, the statement reiterated WILL’s characterization that the Court found Colorado’s “substantively identical law amounted to unconstitutional viewpoint discrimination.”

Making no reference to other conversion therapy tactics, the statement concluded: “Government shouldn’t be deciding which viewpoints are ‘acceptable’ for Christian counselors to express when providing talk therapy to the individuals who voluntarily seek out faith-based counseling.”

In his letter, Evers wrote that because the Colorado case remains active in lower federal courts, the Department of Safety and Professional Services will attach a note to the conversion therapy rule stating that “certain instances of the unprofessional conduct” it refers to “are the subject of ongoing litigation.”

Wisconsin’s conversion therapy ban was enacted after several previous attempts were blocked by the Legislature’s Joint Committee for the Review of Administrative Rules. A Wisconsin Supreme Court ruling in July 2025 found that state laws the committee’s Republican majority used to review and suspend administrative rules were unconstitutional and encroached on the examining board’s legal authority.

Marc Herstand, executive director of the National Association of Social Workers Wisconsin chapter, praised Evers’ letter Thursday. The association was among the groups that urged the counseling board to add conversion therapy to practices considered unprofessional conduct. 

Wisconsin state law “clearly gives professions the authority to establish their own Conduct Code as the social work profession, along with the marriage and family therapy and professional counseling professions,  have done in classifying Conversion Therapy as unprofessional conduct,” Herstand said in an email message. 

“I applaud Governor Evers for his recognition of the severe harm that Conversion Therapy inflicts on LGBTQ children and his commitment to retain the ban on Conversion Therapy [in the professional code] to the maximum extent possible.”

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Charlotte Cravins’ son Landry turned 2 in January. He’s a smiley little boy who loves singing “Itsy Bitsy Spider” and recently got his first pair of glasses.

Landry was born with Down syndrome and has impaired vision. He receives publicly funded therapies that have helped him learn to crawl, to pull himself up to stand, and to use American Sign Language.

Landry lives with his parents and sister in Baton Rouge, Louisiana, one of the eight states whose attorney general has chosen to remain in a lawsuit challenging a federal rule that protects accommodations for people with disabilities. States are asking a federal court in Texas to declare unconstitutional a part of federal law that requires states to provide services to disabled people in their communities, rather than in institutions, when appropriate.

Cravins, an attorney, has followed the case with increasing concern. If the states succeed, that could strip disabled people like her son of the right to publicly funded services that allow them to live in their own homes and neighborhoods, and instead push them into institutions such as state hospitals and nursing homes.

“Landry is a part of our family, a part of the community,” she said, “and to present his involvement in our family and in our community as a burden is unconscionable.”

The lawsuit is unusual. It began in 2024 with 17 Republican-led states suing the Biden administration over its inclusion of gender dysphoria as a protected disability under a portion of federal law known as Section 504. The states also challenged the constitutionality of Section 504 itself.

But the suit has since morphed into something different.

After President Donald Trump was reelected and his administration made clear it would not enforce the Biden rule protecting gender dysphoria, eight states pulled out of the lawsuit. Their attorneys general scrambled to distance themselves from it, amid a swift backlash from the disability community that warned the suit imperiled federal protections for all people with disabilities.

But in a surprising move, nine states chose to stick with the lawsuit anyway, and in January amended their complaint.

They’re now asking the court to strike down a part of Section 504 that requires states to provide disabled people with services in their communities whenever possible, rather than in institutions such as state hospitals and nursing homes.

It’s a maneuver that has shocked many in the disability rights community. Those who spoke with Stateline said they have not received answers from public officials about why the states are still pursuing the lawsuit after the Trump administration removed federal protections for gender dysphoria.

The Republican attorneys general from the states involved either did not respond to Stateline’s requests for comment or referred Stateline to Texas Attorney General Ken Paxton, who is leading the lawsuit. Paxton did not respond to Stateline’s request for comment.

Last week, a few days after Stateline reached out, Indiana dropped out of the lawsuit, leaving eight states remaining.

Indiana Attorney General Todd Rokita, a Republican, said he remains concerned about “federal overreach into traditional state matters” but felt that Trump’s move in December to officially exclude gender dysphoria from Section 504 protections meant the lawsuit’s core objective had been reached.

“Our goal in this lawsuit was to remove President Biden’s ridiculous addition of gender dysphoria as a disability, which risked jeopardizing services for those who truly need them most,” Rokita said in a statement. He noted he has a child with a disability; his son has Angelman syndrome, which causes developmental delays.

But eight other states are pushing forward with the lawsuit: Alaska, Florida, Kansas, Louisiana, Missouri, Montana, South Dakota and Texas.

Cravins, Landry’s mom, said she feels misled by Louisiana Republican Attorney General Liz Murrill, because Murrill initially framed the case as being about the inclusion of gender dysphoria and has not responded to questions about why her state remains involved after that’s no longer an issue.

“Other states left the lawsuit. Louisiana didn’t. Why?” Cravins asked. She said she’s written an open letter to Murrill about the case, with no response. “At this point, it seems that her issue is people with disabilities living in the community.”

States say in their revised complaint that updates to Section 504 unfairly restrict how they’re able to spend money and prevent them from deciding how best to care for their own residents. They say their budgets, strained by rising costs and workforce shortages, can’t always accommodate expensive service changes required by the law, and that with smaller Medicaid budgets they’re having to make hard choices. Removing the law’s “integration mandate” would give them more flexibility.

Disability rights advocates respond that if the court strikes down the integration rule, it will be harder for people with disabilities to get services in their communities. States won’t be required to provide those as a condition of receiving federal money.

And they worry the states’ efforts signal a return to darker times, when disabled people were hidden away, warehoused in institutions and far from family and friends.

“The reality is, the world was not built with us in mind, and there are people who would rather us not be here,” said Kaleigh Brendle, an advocate and college student who launched a nonprofit to push back against efforts to defang Section 504. “Us existing in the world makes people uncomfortable, with our braces, our canes, our wheelchairs, our differences.”

Nonpartisan, until recently

For decades, disability issues were largely nonpartisan. The two most consequential landmark federal disability rights laws were signed by Republican presidents: Richard Nixon signed the Rehabilitation Act — which includes Section 504 — in 1973; George H.W. Bush signed the Americans with Disabilities Act in 1990.

The requirement that states provide services for disabled people in their communities comes from the landmark 1999 Olmstead v. L.C. ruling by the U.S. Supreme Court. Advocates hailed that decision as a civil rights victory that has helped shift disability care from institutional “warehousing” to integrating disabled people into the fabric of their communities.

“Now the states’ lawsuit seeks to upend all of that,” said M. Geron Gadd, a senior attorney with the National Health Law Program who focuses on disability rights cases.

Gadd said that as a litigator, she’s seen states shift how they fight disability-related cases: Instead of disputing how laws apply in specific situations, states are increasingly challenging the thrust of the laws themselves.

“States seem to be much more offended by having to conform their programs and services to basic requirements of disability law,” said Gadd. And, she added, “it seems to have become politicized in ways that it had not been for decades.”

State efforts have echoed those at the federal level.

The Trump administration has been pushing a rule change that would penalize disabled adults who live with their families and deduct the value of their bedroom from the amount they receive in federal benefits. Last year, Trump administration officials abandoned a proposal to cut disability benefits for older workers after news reports and public outcry. The efforts have been made in the name of government efficiency and reducing red tape, particularly in safety-net programs.

And in April, the U.S. Department of Justice delayed a Biden-era deadline — based on the Americans with Disabilities Act — for state and local governments to update their web content to make it accessible for people with disabilities.

Disability rights advocates say the conservative-led states and the U.S. Department of Health and Human Services they are suing feel like two sides of the same coin, with disabled people and their families caught in the middle of the case, without a champion.

‘Something to fight back’

When Kaleigh Brendle was 17, she joined four other vision-impaired high school students in challenging a decision by the College Board — which administers Advanced Placement tests — to replace hard-copy Braille exams with a digital format during the COVID-19 pandemic.

They were successful. Brendle’s experience then, as well as her experiences pushing to get the accommodations she needed in school, drove her to advocate for disability rights nationally.

She named her new advocacy nonprofit Judy’s League, for Judy Heumann, a legendary disability rights activist known as the “Mother of the Disability Rights Movement.” Brendle likes to quote Heumann, who often said that disability can happen to anyone at any time.

Families and students with disabilities also worry the Republican states’ lawsuit could erode Section 504 protections for students if states were no longer required to provide services in public schools and could instead direct students to institutions.

As a student, Brendle received services locally that helped her learn to use a cane, to read Braille and to use accessible technology needed to complete school coursework.

At times she had to push for the accommodations she needed.

“But at least 504 gives you a leg to stand on,” she said. “It gives you something to fight back with.”

Similarly, Cravins worries her son Landry could have a hard time receiving services at his local school when he’s old enough to attend, even though he would be able to go to school with his peers with the right supports.

National disability rights groups — including the National Federation of the Blind, the National Down Syndrome Society and the Disability Rights Education and Defense Fund — have continued urging the public to speak out about the possible loss of rights.

“It feels like it’s up to us as individuals to try and convince these people in these positions of power to stop attacking us,” Brendle said.

Cascading effects

On Monday, the states asked the judge to decide the lawsuit without a trial. Over the next few months, the states and feds will file briefs with the court. Disability community groups and allies will have the chance to file briefs as well.

If the states prevail, it’s hard to say what the cascading legal impacts could be. A win could trigger further litigation. Other courts might interpret the law differently.

A number of state laws, programs and other efforts have been built on the integration mandate and could be affected as well, said Mike Oxford, a retired director of an independent living center in Topeka, Kansas, who has been a longtime disability rights advocate.

“I’ve seen people with significant disabilities become great lawyers, academics, corporate leaders, on and on,” he said. “That would not have happened” without the integration mandate.

Oxford said he has not gotten a response from Kansas Republican Attorney General Kris Kobach when he asked about the case. He doesn’t think that the attorneys general remaining in the case believe it’s still about gender dysphoria.

“It’s just totally ridiculous,” he said. “They’re lawyers. They signed the new complaint. They know what it does and doesn’t say.”

If the court strikes down the integration mandate, that doesn’t mean the entire law is invalidated or in-community services automatically cease.

But it does mean that if a family were denied services outside of an institution, they’d likely have to pursue litigation each time to fight the decision, Cravins said.

“I think it’s important for the average citizen to realize that laws only work when there is enforcement behind them,” she said.

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

A Milwaukee provider of personal care services has been charged with bilking Wisconsin’s Medicaid program of almost $2.2 million, the state Department of Justice announced Wednesday.

Debbie Long, 44, was charged with billing Medicaid for services that didn’t take place, according to the criminal complaint filed Tuesday.

The complaint also charges Long inflated the size of the payroll and workforce at her home health business to obtain a $219,072 loan under the Paycheck Protection Program enacted to help businesses that had to temporarily shut down early in the COVID-19 pandemic.

In addition, the complaint alleges she purchased businesses and a luxury car with proceeds, using a series of shell companies to conceal where some of the funds came from.

Long’s business, Pinnacle Home Health Care LLC, submitted reimbursement claims for services purportedly provided to Medicaid members between March 2017 and August 2022, according to the complaint. DOJ investigators reviewing those submissions found at least $2.1 million in Medicaid reimbursements to Pinnacle for services that weren’t performed, the complaint charges.

The complaint says the allegedly fraudulent billings included “impossible or improbable hours of service,” such as a personal care worker who reportedly worked more than 12 hours on a single day for one Medicaid member.

There were also reimbursements for services that were never provided, according to the complaint, for services that were more than workers provided, for services in which the Medicaid member’s need was “misrepresented,” and for services when the Medicaid member was in the hospital or incarcerated — situations in which members weren’t eligible for Medicaid reimbursement.

The investigation included interviews with Medicaid recipients as well as personal care workers employed by the business who helped investigators uncover some of the allegedly false information provided, according to the complaint.

Long is charged with five felony counts: theft by false representation greater than $10,000, fraud against a financial institution greater than $100,000, wire fraud against a financial institution, and two counts of money laundering greater than $100,000.

Court records reviewed Wednesday did not list an attorney for Long.

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WASHINGTON — Voters, including those within the Make America Healthy Again movement, say the rising cost of healthcare is a significant concern that will have an impact on whom they support in November’s midterm elections, according to a poll released Wednesday by KFF. 

Sixty-one percent of respondents to the survey, which asked how important several health-related issues were, said the price of healthcare will have a major impact on which party they support as control of Congress hangs in the balance.

Among MAHA voters, who are predominantly Republicans but also include independents and some Democrats, 42% said cost is their top issue heading into the elections. 

“While the issue of health costs is more salient for Democratic voters than for Republicans, larger shares across partisans say health costs will have a major impact on their voting decisions than say the same about vaccine policy or food safety,” the survey said. 

Seventy-two percent of Democrats, 63% of independents and 47% of Republicans said the cost of healthcare will have a major impact on which party’s candidate they vote for. 

Vaccine policy came in next, with 57% of Democrats, 46% of independents and 32% of Republicans surveyed saying it will have a major impact on their choice. 

Issues related to food safety came in third after 43% of Democrats, 40% of independents and 38% of Republicans responded that it will have a major impact on their choice of candidate.  

MAHA issues 

For MAHA voters, twice as many listed health costs as their first priority than the next issue: restricting the use of certain chemical additives in food, which was a key concern for 21%.

Ten percent were interested in politicians who will reevaluate vaccine approvals, 8% want lawmakers to limit corporate interest in food and 8% want Congress to limit the use of pesticides in agriculture. Eleven percent said none of those or had no answer. 

The survey showed that a significant majority of Americans across the political spectrum believe the government hasn’t done enough to address chemical additives in food or pesticide use in agriculture, two core demands of MAHA supporters.  

“The public perception that there is not enough regulation may be rooted in broader skepticism toward the industries themselves,” the survey said. “Most U.S. adults do not trust pharmaceutical companies, food and beverage companies, or agricultural companies to act in the public’s best interest.”

Doctors and healthcare providers were the most trusted source of information at 70%, followed by agriculture companies at 40%, food and beverage companies at 25% and pharmaceutical companies at 21%. 

Seventy-five percent of those polled said the government hasn’t done enough to regulate chemicals in food, while 65% said it should do more to regulate pesticides in agriculture. 

The poll of 1,343 U.S. adults took place from April 14 to April 19. It has a margin of error of 3 percentage points for the full sample and 6 percentage points for MAHA supporters.

The U.S. Supreme Court issued a temporary stay on an appeals court ruling from Friday that was blocking remote access to an abortion drug, restoring access until at least May 11.

The administrative stay, issued by Justice Samuel Alito, pauses Friday’s decision by the 5th Circuit Court of Appeals. That ruling blocked a 2023 rule adopted by the U.S. Food and Drug Administration allowing mifepristone, one of two drugs used to terminate a pregnancy before 10 weeks and to treat miscarriages, to be prescribed without an in-person visit with a health care provider and also allowed it to be mailed to recipients in states with abortion bans.

“The administrative stay is temporary, and I am confident life and law will win in the end,” said Louisiana Republican Attorney General Liz Murrill in a statement. 

Thirteen states have near-total abortion bans, including Louisiana. Murrill sued the FDA in October, saying the rule undermines the state’s laws and causes financial harm because the state paid $92,000 in Medicaid bills for two women who needed emergency care in 2025 from complications related to mifepristone. 

In the years since the 2022 U.S. Supreme Court decision allowing states to regulate abortion access, telehealth prescriptions of abortion medication have become increasingly popular, with more than 27% of all abortions provided that way in 2025, according to data from the Society of Family Planning.

“While this is a positive short-term development, no one can rest easy when our ability to get this safe, effective medication for abortion and miscarriage care still hangs in the balance,” said Julia Kaye, senior staff attorney for the Reproductive Freedom Project at the American Civil Liberties Union, in a statement. “The Supreme Court needs to put an end to this baseless attack on our reproductive freedom, once and for all.”

The case could follow a similar pattern to one that played out in 2023, after U.S. District Court Judge Matthew Kacsmaryk of Texas issued a ruling that would have revoked access to the abortion drug mifepristone altogether. 

The U.S. Supreme Court intervened shortly after that ruling and kept mifepristone available while the case proceeded in the 5th Circuit appeals court, which eventually decided that more restrictions were warranted, but not pulling the drug’s approval. The Supreme Court officially took the case several months later, and unanimously ruled in June 2024 that the plaintiffs suing the FDA did not have standing, keeping access to mifepristone intact.

Responses from the attorneys in the latest case are expected to be filed with the Supreme Court by Thursday, according to Alito’s order.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

In the contest for the Democratic nomination for governor, “affordability” might be the most frequently used campaign watchword. Side-by-side with it is another word: Healthcare.

Healthcare “is one of the most broken systems in the whole of government,” says former Lt. Gov. Mandela Barnes. It’s “working as it was designed to,” says state Rep. Francesca Hong — in what is decidedly not a compliment to the system.

Among voters, it is “a top issue if not the top issue,” says Milwaukee County Executive David Crowley. Former Wisconsin Economic Development Corp. CEO Missy Hughes calls healthcare one of the “foundational pieces of our economy” — but one that is under strain and not working well.

For Lt. Gov. Sara Rodriguez, it’s “a complicated system” in which she made a career as an  emergency room nurse, a CDC infectious disease officer and finally a health system executive — “which means that I know the levers that we can pull to try to reduce costs across the state of Wisconsin.”

Former Department of Administration Secretary Joel Brennan considers healthcare a leading Wisconsin asset, innovator and employer, but one that’s been hobbled by “the healthcare management that we are allowing to go on in this county — and it’s not helping.”

State Sen. Kelda Roys describes the healthcare system  as imbued with “the worst aspects of capitalism in that we’ve injected profits before patients at every step, but none of the benefits of capitalism — there’s no free market, there’s no real competition.”

Those remarks come from three forums in April at which the seven leading Democratic hopefuls fielded questions about their healthcare policies and priorities.

Four of them — Rodriguez, Barnes, Roys and Hong — took part in a forum hosted by HealthWatch Wisconsin that focused entirely on healthcare issues. (All seven were invited, according to HealthWatch, which is affiliated with the nonprofit public interest law firm ABC for Health).

All seven joined a Wisconsin Health News event focused entirely on healthcare as well as a Wisconsin Citizen Action online forum, where healthcare led off a discussion that covered a cross-section of other issues as well.

Many of the Democratic Party rivals’ policies and priorities overlap. They all agree that healthcare costs and access are among the most important priorities for the state.

All of them say they favor a public option for health insurance — a plan that would be available for people to purchase health coverage on the Affordable Care Act health insurance marketplace if they don’t have coverage through work and their incomes are too high to qualify them for Medicaid.

All but one of the seven propose to expand Medicaid, referred to as BadgerCare in Wisconsin, under the Affordable Care Act. Expansion would open the health insurance plan for low-income Wisconsinites with incomes above the current limit (100% of the federal poverty guideline) up to 138% of the guideline.

Roys is the exception, arguing that Medicaid expansion is no longer feasible in Wisconsin because of federal changes enacted after President Donald Trump took office.

Instead, Roys proposes a public option that would allow the public to buy into the state health insurance plan for public employees. Brennan also proposes using the public employees’ plan as a public option, but he favors Medicaid expansion as well.

Four of the other five Democrats would tie the public option to Medicaid expansion, making it possible for people whose incomes don’t qualify them for BadgerCare to pay a monthly health insurance premium for BadgerCare coverage. Rodriguez proposes a public option plan called “BadgerChoice,” which would be a state-based insurance plan but would not be connected to BadgerCare, according to her campaign. 

Four years after the U.S. Supreme Court overturned a national right to abortion, all seven Democrats have vowed to protect reproductive healthcare and to firmly back abortion rights in Wisconsin.

All of them speak of the importance of ensuring that mental health is treated on a par with physical health. And all of them at least nod to the need to improve healthcare access in rural Wisconsin.

At the same time, each candidate’s proposals differ, sometimes in fine details, sometimes in broad priorities, and sometimes mostly rhetorically.

Federal relations

Another point of general agreement is on the need for stronger support for public health measures. All of the Democratic candidates have criticized the Trump administration and Health and Human Services Secretary Robert F. Kennedy Jr. for undermining longstanding support for vaccination against communicable diseases.

But they take different directions in their expectations for federal-state relations in healthcare. Roys, for example, writes off federal assistance during the current administration, which is why she considers expanding Medicaid a dead issue for now. Crowley’s Medicaid expansion proposal explicitly refers to federal matching funds to cover some of the costs.

None have laid out the level of detail that will be required for turning their ideas into legislation or incorporating them into the next state budget.

This report has been updated to clarify that the “BadgerChoice” proposal from Sara Rodriguez is not connected with Medicaid Expansion. 

In the gallery below, click on the caption of each candidate’s picture to read a summary of what that candidate has said and published about their approach to healthcare policy and links to relevant pages on the candidate’s campaign website. 

Massachusetts and Rhode Island are considering dropping GLP-1 drugs for obesity treatment from their Medicaid programs, continuing a trend of states that have stopped coverage of these expensive medications. 

Thirteen state Medicaid programs are covering GLP-1 drugs for the treatment of obesity this year, down from 16 last year. 

Medicaid programs in California, New Hampshire, Pennsylvania and South Carolina have eliminated coverage of the drugs for weight loss, because the expense strained state budgets. 

In Massachusetts, the governor’s proposed fiscal 2028 budget would not fund the state’s Medicaid program, MassHealth, to cover GLP-1 medications for weight loss alone, though the state would continue covering the drugs for diabetes and other conditions. The legislature is still debating the state budget. 

Rhode Island’s governor also has proposed removing GLP-1 coverage from the state’s Medicaid program for weight loss treatment. 

North Carolina reinstated such coverage in mid-December after having dropped it in October. 

Medicaid programs in Delaware, Kansas, Michigan, Minnesota, Mississippi, Missouri, Tennessee, Utah, Virginia and Wisconsin also cover the drugs for obesity treatment, according to KFF, a health policy research group. 

But some states, such as Michigan, have restricted eligibility for these medications to morbidly obesity patients rather than those who are overweight or obese. The move is expected to save the state an estimated $240 million. 

Meanwhile, lawmakers in Louisiana are debating whether to allow Medicaid to cover GLP-1s for obesity treatment if enrollees have another chronic condition, or comorbidity, such as prediabetes, hypertension or cardiovascular disease.  

The medications generally have been too expensive for people without insurance. In February, one of the largest producers of these drugs, Novo Nordisk, announced it would reduce their list prices to $675 per month in 2027. 

Gross spending on Medicaid prescriptions for GLP-1s — for diabetes as well as for weight loss — has increased from around $1 billion in 2019 to almost $9 billion in 2024 as demand for these drugs has risen, according to KFF. 

At the same time almost 40% of adults and a quarter of children with Medicaid have obesity and may benefit from having access to the drugs, according to KFF. 

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

One of the main methods of obtaining abortion medication for those living in states with bans is now blocked nationwide, after a federal appeals court decision issued Friday afternoon.

The 5th Circuit Court of Appeals blocked a U.S. Food and Drug Administration rule from 2023 that allowed mifepristone, one of two drugs used to terminate a pregnancy before 10 weeks and to treat miscarriages, to be dispensed without an in-person visit with a health provider. 

In the years since, states with abortion access have increased their telemedicine offerings to prescribe the medication remotely and send it through the mail. Many of those states also enacted shield laws to prevent officials from states with abortion bans from prosecuting or investigating their providers — meaning many patients have been able to receive the medication across state lines.

Louisiana judge preserves telehealth abortion access provision for now, puts case on hold

The block will remain in effect as the lower court case proceeds, but the FDA could file an emergency appeal to the U.S. Supreme Court in the coming weeks.

More than 27% of all abortions were provided through telehealth appointments in the first six months of 2025, according to the Society of Family Planning, a research and advocacy group that publishes a report called #WeCount. Nearly 15,000 abortions per month were provided under shield laws during that same time frame, according to the report.

Louisiana Republican Attorney General Liz Murrill sued the FDA in October, seeking to strike down the 2023 provision, and the lower court declined to do so in early April. U.S. District Judge David C. Joseph said then that the stay was premature while the FDA completed a safety review of mifepristone, but allowed state officials the opportunity to re-file the motion after that review was complete. The state appealed that decision to the 5th Circuit.

“Every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is human being from the moment of conception and is, therefore, a legal person,’” Friday’s decision said.

There were no dissenting opinions among Judge Leslie Southwick, an appointee of former Republican President George H.W. Bush, and Judges Stuart Kyle Duncan and Kurt D. Engelhardt, both appointees of Republican President Donald Trump.

Without access to telemedicine and the opportunity to receive the medication through the mail, people in 13 states with near-total abortion bans may have to travel to another state to get an abortion.

There is a misoprostol-only abortion pill protocol that some providers can use, but it is slightly less effective and requires a higher dosage, which can increase side effects.

“Reinstating in-person dispensing requirements would force people to travel farther, take more time off work, and absorb costs that are simply too high. For people living in states already hostile to abortion access, many of which are home to Black women and families, this is not health care,” said Regina Davis-Moss, CEO of advocacy group In Our Own Voice: National Black Women’s Reproductive Justice Agenda, in a statement. 

Murrill said in a statement on Friday that former Democratic President Joe Biden’s administration facilitated “illegal mail-order abortion pills.”

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“Today, that nightmare is over, thanks to the hard work of my office and our friends at Alliance Defending Freedom. I look forward to continuing to defend women and babies as this case continues,” Murrill said, crediting the advocacy legal organization that helped in the case.

The court also found Friday that the 2023 rule injures Louisiana by causing it to spend Medicaid funds for emergency care for women harmed by using the drug. The state identified $92,000 paid by Medicaid for two women who needed emergency care in 2025 from complications “caused by out-of-state mifepristone.”

Numerous studies have shown mifepristone is safe to use, with very low complication rates. A combined review of 10 years’ worth of studies between 2005 and 2015 found that severe outcomes requiring blood transfusion and hospitalization occurred in less than 1% of cases.

“We are alarmed by this court’s decision to ignore the FDA’s rigorous science and decades of safe use of mifepristone in a case pursued by extremist abortion opponents. We are reviewing the court’s order in detail,” said Evan Masingill, CEO of GenBioPro, one of the main manufacturers of mifepristone, in a statement. “We remain committed to taking any actions necessary to make mifepristone available and accessible to as many people as possible in the country, regardless of anti-abortion special interests trying to undermine patients’ access.”

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.

WASHINGTON — State officials say they need more information from the Trump administration before they can fully implement new requirements for Medicaid, according to a survey released Thursday by KFF and the Georgetown University Center for Children and Families.

Republicans’ “big, beautiful” law made several changes to the state-federal health program for lower income people and some people with disabilities, including that enrollees between the ages of 19 and 65 work, participate in community service, or attend an education program for at least 80 hours a month.

The survey of Medicaid program officials from 43 states showed the people tasked with implementing the law have questions about how exactly they should determine if someone meets the new requirements or is exempt. 

“In addition to how to define medical frailty, states wanted additional direction in many areas including what qualifies as community service, how to calculate half-time school attendance, and what is considered a ‘significant relationship’ to qualify for the caregiver exemption,” the report states. “They also indicated they need guidance about what sources can be used for verification, whether self-attestation will be allowed if other sources are not available, and how long verification of exemptions remain valid.”

The law includes several additional carve-outs, including for Medicaid enrollees who are pregnant, have dependent children, are tribal community members or are in the foster care system, and for individuals released from incarceration in the last 90 days, among others.

The vast majority of state officials surveyed said they would implement the new requirement for work, education, or community service at the start of next year.

There are, however, a few states moving forward earlier. 

Nebraska plans to begin May 1, Montana on July 1 and Iowa officials said they will begin this year, though they haven’t provided a date, KFF said. Arkansas has planned a “soft launch” for July but won’t actually remove anyone from Medicaid for not meeting the new requirements until next year, according to the report.

Hardship exemptions

The KFF-Georgetown survey says that nearly all states will allow hardship exemptions for people in counties with higher unemployment; those who recently experienced a natural disaster; those who have been admitted to a hospital or nursing facility; or those who need to travel outside their community for medical care.

Indiana and Iowa are the only two states so far that don’t intend to allow any hardship exceptions from the requirement that Medicaid enrollees work, attend community service, or enroll in an education program, the report said. 

“Oklahoma is not adopting the exceptions for residents of counties with high unemployment or with a declared natural disaster while Missouri is not adopting the exception for residents of counties with high unemployment,” the report says. “New York is not planning to adopt the exception for individuals traveling outside their community for medical care. Twelve states had not made a decision.”

Look-back periods vary

Thirty-six states will look back one month when someone applies for Medicaid to determine whether they’re working, participating in community service, or enrolled in an education program. Indiana and Idaho will look back at the last three months before the person applied to determine whether they meet the new requirement. 

Thirty-four states will look back one month during the renewal process, which must happen at least every six months under the law. 

“Indiana and New Hampshire will check quarterly and at renewal to verify that enrollees meet the requirements every month between renewals,” according to the report. “Arkansas will also look back three months at renewal but is not planning quarterly checks. States that had not made a decision at the time of the survey included five states for application, six states for renewal, and seven states for more frequent checks.”

Three years after a miscarriage that caused a severe, nearly septic infection because a Tennessee hospital denied her an abortion, Katy Dulong was looking forward to telling her story in a trial that was scheduled to begin Monday.

But this week, the state appealed to a higher court based on a new law passed by the legislature in March, and the court put the trial on hold indefinitely. It will now be months before the lower court can proceed.

Dulong had complications that led to a miscarriage in November 2022 at 16 weeks of pregnancy, long before fetal viability. Under the state’s abortion ban, which had only been in place for a few months, the hospital sent her home to miscarry on her own. When that didn’t happen, severe infection started to set in 10 days later, when she was able to get doctors to agree to help. The experience left her with post-traumatic stress disorder.

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The delay in the legal case feels like the state trying to silence her and the other plaintiffs, she said.

“It’s shocking to me that there’s anyone in this world that would have such opposing views to think that our voices don’t matter,” Dulong said in an interview. “How are they taking away our voice right now?”

In a motion to dismiss in February, the state argued it couldn’t be sued by the plaintiffs under a term called sovereign immunity, and in April, the Tennessee Legislature passed a law making it harder to sue the state on the constitutionality of a state or government action. Legislators passed another bill allowing the state to automatically appeal a decision related to sovereign immunity.

Nicolas Kabat, a staff attorney at the Center for Reproductive Rights who has been working on the case with the plaintiffs, said the state has tried to have the case dismissed four times without success, and said this is just the latest move to delay the trial. But he said the latest laws passed by the legislature allowing automatic appeals in the middle of a case, on the eve of a trial, make the situation unique.   

“There is nothing unusual about appealing an appealable order,” said Phil Buehler, press secretary for Tennessee Republican Attorney General Jonathan Skrmetti, in an email Thursday.

Similar lawsuits are ongoing or have already been resolved in several states with bans, including Texas and Idaho, where state residents have challenged the law based on their personal experiences. Plaintiffs in Idaho won their case in April 2025, when a judge said the near-total abortion ban does not mean a pregnant patient’s death has to be imminent or “assured” to perform an abortion. Complaints are also pending related to Texas hospitals allegedly not complying with federal law mandating emergency room treatment for a patient who needs an abortion as stabilizing care.

Women with serious pregnancy complications sue over state abortion bans

Allie Phillips, the lead plaintiff in Tennessee, joined several other women to sue the state in September 2023, alleging that the abortion ban put their health and lives in jeopardy when they were pregnant. They asked the state to clarify the law so that health is considered in an abortion decision, not just an immediate threat to a pregnant patient’s life. The way the law is written, attorneys argue, is too vague to allow for those exceptions.

Phillips and Nicole Blackmon, another plaintiff, had fetuses with anomalies related to the development of vital organs. Blackmon couldn’t afford to travel out of the state for an abortion, and eventually had to stop working because the pregnancy was affecting her health. She delivered a stillborn baby in her seventh month of pregnancy. Phillips raised enough money to seek an abortion in New York, only to find when she got there that the fetus had already died.

After the court granted a temporary block on the law as it relates to pregnancy complications, the state passed several laws that affected the case. The first bill, meant to clarify the state’s health exception for an abortion, was enacted in April 2025 but didn’t solve the issue, Kabat said. The language still wasn’t clear enough, and the court agreed and allowed the suit to continue.

Kabat said the legal team will continue its effort to clarify Tennessee’s laws so that stories like Dulong’s don’t happen to others.

“No matter how long this takes, we’re going to get the trial, we’re going to get these stories heard and we’re going to seek accountability from the state,” Kabat said.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org. 

This report was updated at 1:35 p.m. 4/23/2026.

Employees of two Wisconsin clinics operated by Rogers Behavioral Health voted by large majorities in favor of union representation Wednesday after more than two months in which the mental health nonprofit had campaigned heavily against the union.

In West Allis, employees voted 53-4 in favor of joining the National Union of Healthcare Workers. In Madison, the vote to join the union was 26-4. The votes were supervised by National Labor Relations Board officials at both clinics.

Employees at the two clinics “are ready to negotiate contracts that would provide better pay, protections to ensure safe staffing levels and more time to care for individual patients, as Rogers workers secured in California after joining NUHW,” the union stated in a press release Thursday.

The union represents Rogers employees at three facilities in California, where contracts have been negotiated, and one in Philadelphia, Pennsylvania, where contract negotiations are underway. “While contract negotiations are still ongoing in Philadelphia, the contracts Rogers agreed to for workers based in the Bay Area, Los Angeles and San Diego are among the best in the industry,”  the union statement said. “They include strong raises, limits on caseloads, and guarantees that no jobs will be lost to new technologies, including artificial intelligence.”

Rogers, based in Oconomowoc, said in a statement released Thursday, “We acknowledge the union election outcomes in Madison and West Allis Lincoln Center. We are evaluating our next steps in support of our system of care. We are committed to our patients, our people, and the integrated care that has made Rogers a trusted provider across Wisconsin since 1907.”

The union said in its press release that during the West Allis election Wednesday, Rogers management “prohibited NUHW’s representative from entering the facility and then suspended a worker who had agreed to serve as the union’s observer.”

Federal labor law procedures call for representatives from management as well as the union to observe the vote count. The absence of a union observer “could have resulted in the ballots being impounded and not immediately counted,” the union press release stated.

A second Rogers employee volunteered to serve as the union observer for the count “over the objections of Rogers’ representatives,” the NUHW stated, adding that Rogers did not attempt to stop ballots from being counted at the Madison clinic.

The workers involved were among three employees fired shortly after workers announced their petition for a union. The union has filed unfair labor practice charges over the terminations, claiming that the three were fired in retaliation for their support for unionization, which is illegal under federal law.

Rogers has declined to explain the firings, citing employment confidentiality, but said that it has not violated any laws.

Rogers Behavioral Health issued a follow-up statement Thursday about the voting conflict in West Allis. According to the statement, “individuals who are no longer employeed by Rogers had illegally entered the facility,” and Rogers contacted local police.

The next step will be for the National Labor Relations Board to certify the results. But a federal lawsuit challenging the agency is still pending. In addition, Rogers said in public statements as well as in communications to the workers before the vote that the company would not begin bargaining with the union until all its appeals have been exhausted. 

The nonprofit campaigned actively against unionization, telling employees that a union would not have been in the interests of the staff, the patients or the organization. In a final letter distributed on Monday, Rogers urged employees to vote no and made statements that the organization had made mistakes and wanted to be given another chance to improve relationships with the staff without a union.

Union supporters welcomed the outcome of Wednesday’s votes.

“We are thrilled with the overwhelming victory,” said Stephani Lohman, a nurse practitioner who was among those active in the union organizing campaign and was one of the three fired employees. “Over the last few weeks Rogers has shown us exactly why we need a union by running an aggressive anti-worker campaign, trying everything in their toolbox to intimidate and demoralize us, but it failed spectacularly because it was so cruel and wicked that it drove everyone to support the union.”

According to union supporters, the union campaign began late last year after changes at Rogers that included clinicians being reclassified from salaried to hourly, which resulted in schedule changes that increased patient volumes for staff members and reduced individual patient care. The organization increased caseload caps, “forcing caregivers to be responsible for far more patients than previously,” the NUHW said in its statement.

This report has been updated with additional information and comments Thursday from both the National Union of Healthcare Workers and from Rogers Behavioral Health. 

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A federal judge in Milwaukee rejected a bid from Rogers Behavioral Health Tuesday to block a pair of union elections scheduled for Wednesday at Rogers mental health clinics in West Allis and Madison.

The decision sets the stage for votes to go forward at both clinics. About 35 employees at Rogers’ Madison clinic and about 68 at the West Allis clinic will vote Wednesday on whether to be represented by the National Union of Healthcare Workers.

Rogers, based in Oconomowoc, had argued that the union election should cover all 13 Rogers facilities in Wisconsin — not just the two where employees had actively organized. But in a direction of election issued April 14, the NLRB regional director whose jurisdiction includes Wisconsin said those two clinics alone were each appropriate bargaining units.

On Monday, Rogers lawyers filed a lawsuit to block both elections. U.S. District Judge Lynn Adelman denied the mental health nonprofit’s petition for a temporary restraining order Tuesday after an online hearing that ran a little more than 40 minutes.

“I don’t think that they’ve established unconstitutional irreparable harm,” Adelman said of Rogers’ lawyers.

The Rogers lawsuit echoed a recent line of legal challenges that have sought to unravel the National Labor Relations Board — the 91-year-old agency created under President Franklin Delano Roosevelt as part of his administration’s New Deal to secure rights for workers and help the U.S. recover from the Great Depression.

One of Rogers’ lawyers, Aron Karabel, argued that the members of the NLRB itself as well as the regional director who issued the union election order are unconstitutional because they aren’t subject to dismissal by the president, violating the separation of powers in the U.S. Constitution.

Similar arguments have been made by other businesses, including Amazon and SpaceX, but the U.S. Supreme Court has not endorsed the claim.

Karabel’s colleague, Hannah Fitzgerald, argued that under Wisconsin law, the NLRB regional director had engaged in “tortious interference” with existing employment contracts for some of the Rogers employees who would be included in the union election bargaining unit. For that reason as well as other reasons, the election could cause “irreparable harm” to Rogers, Fitzgerald asserted.

Representing the NLRB, lawyer Craig Ewasiuk said that a Supreme Court ruling 82 years ago established that individual contracts “may not be availed of or to defeat or delay the procedures prescribed by the National Labor Relations Act” to further collective bargaining.

“The Supreme Court has spoken unambiguously on this question, and you simply can’t bring tortious interference acts against the NLRB for running elections,” Ewasiuk said.

Karabel argued that Rogers’ case was not about collective bargaining — which would prevent the federal court from acting until after final action by the NLRB — and for that reason, the court was an immediately appropriate venue.

The NLRB lawyer rejected that argument. ‘’The employer is essentially trying to stop the board’s proceedings from resolving this underlying labor dispute,” Ewasiuk said.

Staunch resistance to the union

Rogers Behavioral Health has mental health clinics and hospitals in 10 states. Employees are already represented by the National Union of Healthcare Workers at four clinics — three in California and one in Philadelphia, Pa. — and at three of those, the union was recognized voluntarily.

But in its home state of Wisconsin, Rogers has taken a much different posture.

Three employees were fired shortly after the union campaigns went public, according to the union, and the NUHW has filed unfair labor practice charges claiming the firings were illegal retaliation for union support.

Rogers has declined to discuss the firings as confidential personnel decisions but has stated they were not in violation of any laws.

From when employees first notified Rogers management of their desire for union representation, however, Rogers has posted notices and issued statements declaring that the mental health nonprofit doesn’t want  union representation for the West Allis and Madison employees.

“Many of your colleagues, your leaders, and I strongly believe that this union is not in the best interests of you, your family or our patients,” said one notice, stating it was from clinic leaders but without a name attached, that was shared with the Wisconsin Examiner. “We believe you should vote no and allow our team the opportunity for positive and direct collaborations.”

In March, Rogers’ executive director of marketing and communications, Maureen Remmel, responded to a question from the Examiner about the difference between Rogers’ responses at its California and Pennsylvania clinics and its handling of the union campaigns in Wisconsin

“While we work in good faith with the NUHW in California and Pennsylvania, our integrated system in Wisconsin is different,” Remmel said in an email message  March 17. “A direct relationship with our Wisconsin team members best serves employees, patients, and the company.”

At an NLRB hearing in February to establish the appropriate bargaining units for the Wisconsin clinics, Rogers’ lawyer argued that flexibility across multiple facilities was important and necessitated allowing all 13 Wisconsin locations to vote on union membership.

A statement attributed to the organization as a whole that Remmel sent April 16, after the election order was issued, asserted, “A union is not right for Rogers Behavioral Health in Wisconsin because it jeopardizes our ability to work together to solve problems quickly and flexibly.”

Jennifer Hadsall, the NLRB regional director, wrote in her analysis that there was little evidence of “functional integration” across the system to overcome the presumption that the two facilities where employees had organized were by themselves appropriate bargaining units.

Hadsall also rejected Rogers’ argument that certain employees were supervisors and therefore not eligible to be part of their facility’s bargaining unit.

Professional consultants

Starting in early February, Rogers has hired consultants to assist in managing its response to the union campaigns, according to LaborLab, a nonprofit based in Helena, Montana. LaborLab monitors the industry of consultants who advise and assist employers in responding to union drives.

Under the federal Labor-Management Reporting and Disclosure Act, employers and the consultants they hire to persuade employees “directly or indirectly” about unionizing must regularly file reports with the federal government. Employers file LM-10 reports and consultants file LM-20 reports as well as LM-21 annual financial reports.

While advocates for greater disclosure complain that those reports are often late or incomplete, they offer some information about those businesses.

LaborLab has identified three consultants working for Rogers since early February, when pro-union employees in Madison and West Allis petitioned for voluntary recognition. Two were identified through their LM-20 reports and one was named by union supporters during a radio interview with WORT-FM, the listener-sponsored community radio station in Madison.

LaborLab has estimated the consultants’ fees total about $50,000 a week, or more than $325,000 through April 1. Those don’t include the cost of attorneys representing the business on legal matters connected with the union campaign or “internal costs” that LaborLab’s calculations impute to employees assigned to directly address the union organizing effort.

“It’s hard to be precise because there are a lot of variables in these campaigns,” said Teke Wiggin, LaborLab’s strategic coordinator. “But we think that workers should have some general sense of how much is being invested in these campaigns.”

Wiggin said in an interview that some consultants interact only with corporate managers and executives, while others hold meetings with employees themselves, an action that requires disclosure in federal reports.

“They take arguments that have been crafted by industrial psychologists to sow as much fear and doubt about the value of unionization as possible,” Wiggin said.

In a letter sent to Rogers Feb. 25, 20 local and state elected officials criticized the organization for having “hired union busters” and urged the organization’s CEO to “immediately stop wasting patient care dollars on union busters paid to try to intimidate workers from organizing.”

Rogers did not respond to a question from the Examiner about its use of consultants in the organizing campaign.

In a response to the elected officials that was signed by “Rogers Behavioral Health,” the organization said it has “retained consultants to better understand and address the concerns shared by our employees and to raise awareness about their rights and the election process.”

Messages to employees

In a media statement April 16 after the election was scheduled, Rogers reiterated the organization’s position that a union was not the right choice for its employees and its intention to appeal the regional director’s finding after the election.

The day before, Rogers management emailed employees with a similar message, stating, “We are disappointed and disagree with this decision and are appealing to the full NLRB in Washington, D.C.”

The final line of the message was, “Regardless of the election outcome, bargaining will not start with the union until all appeals have been exhausted.”

The Wisconsin Examiner was provided screenshots of the message.

Employees involved in the union campaigns said that shortly after it landed in their inboxes, that message was remotely deleted, possibly because it was recalled.

On Monday, Rogers distributed another letter at both the West Allis and Madison locations that took up about a page and a half.

“We want to be direct with you today: change is coming to Rogers,” states the letter, photos of which were shared with the Examiner. “You will see it. We are working on it. That is why we are asking you to vote no on Wednesday and allow leadership 12 months to demonstrate to you, your colleagues, patients and families our commitment to making Rogers better than ever.”

Under federal labor law, if a majority of employees vote against a union in a representation election, the employees must wait at least 12 months before seeking a union again.

The members of Rogers’ leadership team “have heard you,” the letter states. “We know that there are things we can do and must do better.”

The letter’s final paragraphs reiterated both the vow to improve relations and a plea to vote against the union.

“The leadership team is committed to doing better. Today we are asking you to please give us 12 months. Vote ‘no’ in the upcoming election and give us a chance to show our commitment in action. If we do not come through for you, the law gives you the right to hold another election. Rogers will honor your choice in that election.

“Please vote ‘no’ on April 22. Vote to hold Rogers leadership accountable.”

Federal court records show Rogers filed its lawsuit to block the vote the same day that employees received that letter.

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