Some older patients with diabetes are now getting easier access to insulin. But there is concern many younger ones are still navigating a difficult path in managing their situation, including an outspoken Wisconsin health care worker.

The average cost of insulin nearly tripled between 2002 and 2013, according to The American Diabetes Association. It prompted outrage following stories of patients being forced to ration their supply of the drug. Last year's federal Inflation Reduction Act capped monthly copays at $35 for Medicare recipients.

Saskia Hale, a registered nurse in Stevens Point, said she is relieved those individuals are less likely to need hospitalization for diabetes complications.

"Some of these complications include having limbs amputated, having sores, having chronic kidney problems, going into kidney failure," Hale said.

She said those often stem from patients not being able to cover out-of-pocket insulin costs. A new federal Health and Human Services report suggests the cap will save seniors $500 a year. But Hale, who is a diabetic herself, said non-Medicare patients still have insurance barriers, along with added expenses for supplies like needles and glucose monitors.

Hale said falling off a management plan because of skyrocketing insulin costs can result in being labeled "noncompliant" by your insurance coverage provider.

"When they're labeled that way, it makes it seem as though they are doing this simply because they don't want to take their insulin and that is usually not the case," she said. "It's usually because they cannot afford the medication."

She added being labeled noncompliant, even if it's not the patient's fault, can lead to the insurer dropping insulin coverage from the individual's plan. President Joe Biden recently called on Congress to extend the $35 cap to all Americans with diabetes. But political analysts predict it is unlikely, with a divided power structure right now. There is some bipartisan support, but some Republicans say it would be a mandate, hindering competition.

A coalition of Wisconsin groups is asking Gov. Tony Evers to reject bills it contends would make it harder for people struggling to get by to bounce back with the help of certain public assistance programs.

More than two dozen organizations from around the state want the governor to veto a bill requiring BadgerCare recipients to renew their health coverage twice as often. They also want to see him veto a measure limiting unemployment benefits.

William Parke-Sutherland, senior health policy analyst for the group Kids Forward, argued the plans unfairly target people who need some type of public assistance. He added seven of 10 Medicaid recipients are already employed.

"And so, if state policymakers want to support workers, they need to address the real factors that make it difficult and sometimes impossible for workers to take more hours, and to get and keep better jobs," Parke-Sutherland urged.

For example, he noted expanding child care access would be a big help. Business groups supporting some of the bills said they would be more effective in addressing worker shortages. And GOP legislators point to a nonbinding referendum from the April election showing Wisconsin voters agree with the idea of work requirements for certain public benefits.

But skeptics like Parke-Sutherland pointed out there are already checks and balances built into many public assistance programs. He feels it is an attempt to avoid empowering low-income workers who are not getting the necessary benefits from their employers.

"They don't want to pay their workers fair wages, and offer lifesaving benefits like health insurance," Parke-Sutherland contended.

He added most people enrolled in Wisconsin's public assistance programs are white, but restrictions disproportionately affect people of color. In the last legislative session, similar bills were advanced by the Republican-led Legislature and were subsequently vetoed by Evers.


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Groups working to fight poverty in Alabama are urging state senators to approve a bill aimed at lowering food costs for families.

House Bill 479 proposes a gradual reduction in the state sales-and-use tax on grocery items from 4% to 2%, starting Sept. 1.

Carol Gundlach, senior policy analyst for the group Alabama Arise, emphasized the way Alabama taxes food products puts a disproportionate burden on lower- and middle-income working families.

She pointed out recent months of high inflation have made it an even more urgent issue.

"We estimate that people, just on the state sales tax alone, could buy an extra two weeks' worth of groceries if they were not paying the state sales tax for the groceries they do buy.," Gundlach reported.

Alabama, Mississippi and South Dakota are the only states still charging their full state sales tax rate on groceries, according to the Center on Budget and Policy Priorities.

Rep. Danny Garrett, R-Trussville, sponsored the bill, which has passed in the House and awaits a Senate vote.

Gundlach stressed although the measure would not entirely eliminate taxes on groceries, lowering them would be a positive step.

She acknowledged the challenge of completely eliminating taxes on food, since they're currently used to cover state education expenses. However, Gundlach's group thinks the bill presents an opportunity for Alabama lawmakers to responsibly reduce food taxes and explore alternative options for funding schools.

"So, we would like to either get rid of or reduce the federal income-tax deduction in such a way that if anybody gets that tax break, it's going to be the people who are kind-of middle income and need it the most," Gundlach explained.

Alabama is the only state allowing a full deduction for federal income taxes, which reduces taxes for the state's wealthiest population. Gundlach suggested eliminating the deduction could raise millions of dollars for public schools and replace the revenue from the current food tax, without imposing any additional tax burden on low- or middle-income residents.

Rural Nebraska could lose on two fronts if two of Gov. Jim Pillen's budget vetoes are allowed to stand.

Pillen struck down a second year of increases in Medicaid reimbursement rates and millions of dollars for Rural Workforce Housing.

Dr. Jed Hansen, executive director of the Nebraska Rural Health Association, called the veto a "gut punch." He said all of Nebraska's hospitals and nursing homes will feel the effects, but especially those in rural communities, where more than 60% of hospitals operated at a deficit last year.

"So, the narrative the governor had used -- that hospitals were 'better off financially coming out of the pandemic' -- just wasn't true," Hansen asserted. "And especially wasn't true for our rural hospitals."

The Legislature had approved $20 million for rural housing development over the next two years, which the governor also nixed.

Johnathan Hladik, policy director for the Center for Rural Affairs, said a lack of housing is the "number one workforce issue" in the state, noting it is a major reason jobs remain unfilled in Nebraska's smaller towns. He pointed out the higher cost of building in rural areas makes it unlikely developers would start such projects on their own.

"We're talking about standard houses for the workforce to relocate to a community," Hladik explained. "To become employed, contributing members of that community."

With his veto, the governor cited the investments the state has made in affordable housing over the last few years, but Hladik countered it came after years of no support for housing. He maintained the state is still "playing catch-up," with the housing problem far from solved.

Hladik added the program would fund grants to nonprofit development corporations to partially cover the costs of building moderately-priced, owner-occupied houses and rental housing units.

"When you talk about how we populate our rural areas, how we attract people to rural areas, how we fill the open jobs that are in rural areas, this is a narrowly targeted program that has the ability to do that," Hladik contended. "I think it's important that it has our support."

Hansen stressed it is also important to raise the Medicaid reimbursement rate, noting maternal care and behavioral health tend to be heavily Medicaid-dependent, so the services are at particular risk in Nebraska's rural hospitals.

"We feel that those have been areas -- mental health, maternal care, family care -- that have been important to him," Hansen pointed out. "He's expressed that those are values that are important to him. And this veto, we just feel, doesn't line up with that."

A decision about overriding both vetoes is expected on Wednesday.