Voting is a cornerstone of American democracy and gives citizens a voice in choosing the elected officials whose decisions impact us, not only personally, but often professionally for those who work in highly regulated industries. With that in mind, take a few minutes to educate yourself on what you need to know to cast your vote on Election Day – Tuesday, November 8^th.

• Wisconsin allows both traditional absentee voting, as well as early in-person voting, which starts today, Tuesday, October 25th. 
• Anyone can request an absentee ballot in Wisconsin. Click here to make the request electronically.
• Click here to find out additional information on how to cast an absentee ballot in-person between now and the Sunday before election day.
• Your election day polling place can be found here. 
• If you still need to register to vote, it’s not too late, you can register to vote in-person on election day.  Click here to find out what is required to register.
• Enter your home address here to find out which candidates will be on your ballot

The latest Marquette University Law School Poll, which was conducted October 3-9 and released on October 12 shows incumbent Tony Evers (D) and Tim Michels (R) in an extremely close race for governor. It also shows incumbent Sen. Ron Johnson (R) leading Democratic challenger and current Wisconsin Lt. Governor Mandela Barnes in the contest for U.S. Senate. Please find below highlights of the poll:

Wisconsin Governor’s Race:

·        Wisconsin Voters’ Preference for Governor (among likely voters):

• Governor Tony Evers (Democrat) – 47%
• Tim Michels (Republicans) – 46%
• Joan Beglinger (Independent) – 4% (Beglinger has dropped out of the race but will remain on the ballot)
• Other – 3%

In the September poll, Evers received 47%, Michels 44%, and Beglinger 5%.

·        Evers Favorability:

·        Michels Favorability:

Wisconsin U.S. Senate Race:

·        Wisconsin Voters’ Preference for U.S. Senate (among likely voters):

In the September poll, Johnson received 49% and Barnes 48%

·        Barnes Favorability:

·        Johnson Favorability:

CLICK HERE to read the complete results from the latest Marquette University Poll.

Last week, US Department of Health & Human Services (HHS) Secretary Xavier Becerra announced the renewal of the public health emergency (PHE) due to the ongoing COVID-19 pandemic. The PHE was originally declared on January 31, 2020 and has been renewed continuously since then. Renewal of the PHE keeps a number of important waivers and flexibilities active. The current PHE declaration will last 90 days from its effective date of October 13, 2022.

Concerned that a recent change to the Veteran’ Health Administration’s Community Care Program guidelines lowers the standard of eye care for the nation’s veterans, a group of U.S. House of Representatives members and a senator has sent a letter to the agency demanding answers.

The letter was led by Rep. Mariannette Miller-Meeks, MD, R-Iowa, an ophthalmologist and a veteran, and signed by four other physician members of Congress. It was delivered to the VA Under Secretary for Health Shereef Elnahal, MD, MBA, on Oct. 18, 2022.

Their action comes after the VA’s action to remove language from the Community Care “Standardized Episode of Care: Eye Care Comprehensive” guideline that has historically provided that “only ophthalmologists can perform invasive procedures, including injections, lasers and eye surgery.”

The Academy shares lawmakers’ concern that “by removing this standard, even if the VA intends to defer to state licensure and scope of practice law, the VA is creating confusion by implying that someone other than an ophthalmologist — e.g., an optometrist — can perform invasive eye surgery.”

In their letter, the members of Congress are asking the VA for answers to specific questions so the lawmakers can “better understand the steps the VA is taking to prevent poor outcomes for veterans.”

Dr. Miller-Meeks was joined on the letter by Sen. Roger Marshall, MD, R-Kan., and Reps. Larry Bucshon, MD, R-Ind., Andy Harris, MD, R-Md., and Greg Murphy, MD, R-N.C.

The Academy shares their concerns. By removing the clause limiting surgery to ophthalmologists, the VA is implicitly authorizing optometrists to perform ophthalmic surgery on veterans that are referred under this program, where permitted by state licensure laws. We are concerned about the implications the community care policy change could have for the national standards that the VA is developing for optometry

The legislation would have dangerously reduced requirements to perform eye surgery

After a handful of states passed legislation into law this year to expand the optometry scope of practice and authorize optometrists to perform certain surgical procedures, there is good news coming out of California. Governor Gavin Newsome recently vetoed legislation that would have allowed optometrists in the Golden State to perform laser and scalpel eye surgeries. Newsome vetoed the bill on Sept. 29, 2022

The legislation would have reduced the medical education, clinical, and surgical training requirements to become licensed in California to perform eye surgery. More specifically, the bill would have authorized optometrists who treat glaucoma to perform advanced procedures, including excision and drainage of small lesions, administering injections in the eyelid, and using therapeutic lasers.

Thankfully, Newsome recognized the bill threatened patient safety and quality medical eye care. In his veto message, he said, “I am not convinced that the education and training required is sufficient to prepare optometrists to perform the surgical procedures identified. This bill would allow optometrists to perform advanced surgical procedures with less than one year of training. In comparison, physicians who perform these procedures must complete at least a three-year residency program. For this reason, I cannot sign this bill.”

While the ophthalmologist/optometrist scope battle in California ultimately ended on a positive note, it won’t be the last scope battle fought across the country in the coming month and years – and even quite possibly in Wisconsin.

Consistent and focused advocacy is critical to the long-term viability of ophthalmology and the delivery of quality medical eye care in Wisconsin. And the WAO is an active force in Madison working on issues of importance to WAO members that impact the practice ophthalmology. Our comprehensive advocacy program aims to:

1.      Strengthen the image of the practice of ophthalmology and educate policymakers on the importance of medical eye care; and

2.      Provide public policy leadership to enhance the practice of ophthalmology and ensure high standards for medical eye care are maintained in Wisconsin.

Of course, our most effective advocacy efforts actively engage WAO members in their strategy and execution – aiming to capitalize on the expertise of our physician members.

Member participation in WAO’s advocacy programs is increasingly important, as we are likely to face two highly concerning legislative battles in the 2023-24 legislative session. Nursing special interests will almost certainly reintroduce their “APRN bill” – a proposal to create a new advanced practice nurse practitioner (APRN) license and authorize APRNs to prescribe medication and generally practice an expanded scope of care without direct physician supervision. A similar proposal introduced last session ignored the need for critical title protection for physicians. 

In addition, we anticipate Wisconsin optometrists will pursue legislation to expand their permissible scope of services, as they have in several other states. In fact, there are now ten states – with Virginia and Colorado being the latest—that have expanded their optometric scope of practice laws to specifically include certain office-based laser procedures for glaucoma and post-cataract care. Again, it would not be surprising if an optometrist scope of practice battle hits the Badger State as early as the 2023-24 legislative session.

Thankfully, WAO is well-positioned act on these issues. In addition to our direct lobbying efforts thorough our professional lobbying form (HZW), we have several advocacy programs in place – that draw on the collective grassroots voice of WAO members – to influence public policy at every level of government. If are not already involved, WAO encourages you to participate in the following three programs to strengthen our influence in the Wisconsin Legislature and ultimately help us meet our legislative/regulatory goals:

·       Sign-up for WAO’s Legislative Key Contact Program

WAO’s Legislative Key Contact Program can be a highly effective grassroots advocacy tool to help build and nurture strong on-going relationships between WAO members and lawmakers in Wisconsin. Ultimately, the program can help us help shape new policies important to our members.

The program is live on the WAO website and members can easily and quickly sign-up as a Key Contact. With the campaign season winding down, and the 2023-24 legislative session right around the corner, it’s more important than ever for WAO to have a robust Key Contact Program. It is essential to raising our profile in the State Capitol and beyond.

As a Key Contact, you can help influence the legislative process by cultivating relationships with elected officials. By taking advantage of existing relationships and making new contact with members of the Wisconsin Legislature (as well as the Wisconsin Congressional  Delegation), you can help us educate lawmakers on the practice of ophthalmology and ultimately influence legislation.

But the program will not succeed without strong member participation, so please take a few moments to read more about it – and learn how simple it is to “enlist” and participate as a Key Contact. The time commitment is minimal and your responsibility as a key contact depends on your level of comfort and willingness to engage.

Remember, lawmakers are often eager to hear input from their constituents, and as an expert in the home health care field, you can make a real difference in the policy process as a Key Contact. CLICK HERE to sign-up by filling out and submitting a brief online survey.

·       Participate in the WAO Capitol Connection Program

In WAO’s ongoing effort to raise the profile of ophthalmology and our organization in the State Capitol, we have established our Capitol Connection program to encourage WAO members to invite their local legislators to visit their clinics and facilities.

The program is designed to help WAO members build and strengthen working relationships with legislators and offers a unique face-to-face opportunity to educate them about the importance of ophthalmology and medical eye care. Through the Capitol Connection program, lawmakers can learn firsthand what is important to the ophthalmology community. In many cases, just a single meeting or contact can have a significant impact on a legislator's view or position on a legislative issue.

With potential scope of practice legislative battles on the horizon, it’s more important than ever for WAO members to connect with their state lawmakers to discuss the critical role of ophthalmology, as well as the level of education, training, and knowledge required of ophthalmologists.

To date, we have held multiple successful legislative tours and have several more being planned for the near future. Hosting a legislator at your site is easy, enjoyable, and can make a significant advocacy impact, so we would encourage all WAO members to participate in this highly effective advocacy program.

If you would like to host a legislative tour at your site, please contact the WAO office at wao@badgerbay.co. We will work with you and your legislators to coordinate the meetings and will provide participating members with full support, including legislator bios, advocacy tips, issue briefings, and supporting documents. 

·       Contribute to the WAO Political Action Committee

The Wisconsin Academy of Ophthalmology is committed to offering a wide collection of member services and programing. That includes a comprehensive government affairs program that provides direct lobbying services and grassroots advocacy strategies to increase WAO’s presence in the State Capitol and help shape policy decisions that preserve and enhance the practice of ophthalmology in Wisconsin.

One of the most effective advocacy tools the WAO has as its disposal is the Ophthalmologists for Better Government Political Action Committee (PAC). The PAC allows WAO to collect contributions from members into a single account to support candidates for state legislative office who understand and support issues important to ophthalmologists, the practice of ophthalmology, and Wisconsin’s House of Medicine.

Contributing to our PAC is more important than ever, as optometrists have been successful in expanding their permissible scope of services in several other states – and the debate is heating up in other parts of the country. Wisconsin could very likely be next… and an optometrist scope of practice battle may hit the Badger State as early as the 2023-24 legislative session.

The best way we can win these legislative battles is to significantly enhance our legislative advocacy outreach, and having a robust, well-funded PAC is critical to our efforts. With strong member participation in the Ophthalmologists for Better Government PAC, we will be well positioned to preserve the Ophthalmology scope of practice in Wisconsin.

As mentioned above, the WAO PAC is funded through contributions from ophthalmologists across the state and is only effective as a political tool if members participate in the program. With that in mind, please take a few moments and contribute online TODAY to the Ophthalmologists for Better Government PAC. Every dollar helps, as the risk of non-involvement in the political process is getting too high to ignore.

On Thursday, September 8, 2022, the legislature’s Joint Finance Committee (JFC) on Thursday voted 16-0 to modify a plan to spend $31 million in funds from an opioid lawsuit settlement.  DHS initially submitted a spending proposal to JFC in July 2022, but an anonymous JFC member objected, resulting in the September 8 committee meeting and vote. 

The committee’s changes to the DHS plan include:

• Providing $3 million for law enforcement agencies, with $1 million reserved for those in counties or municipalities with 70,000 or fewer people.
• Adding $1 million more to the plan for medication-assisted treatment, bring the total to $2 million.
• Providing $1 million to expand the state's “hub and spoke” pilot model for Medicaid recipients with substance use disorders and other medical conditions that pose barriers to their recovery. 
• Providing $750,000 for prevention efforts by the Boys & Girls Club of Wisconsin.
• Reducing the plan’s $11 million for capital projects to $10 million, requiring DHS to support a capital project expanding beds for inpatient treatment of pregnant and postpartum women like the expansion of Meta House in Milwaukee, and mandating the state agency to distribute at least 30 percent of the remaining funds for projects in counties with fewer than 500,000 residents. 
• Cutting $2 million from the plan to pilot family support centers that would have helped family members and friends of people who are actively using drugs, have experienced an overdose or died from an overdose. 
• Reducing the plan’s amount for school-based substance use prevention curriculums and programs from $2 million to $250,000.
• Cutting $1 million from the plan for local public health departments and community organizations to address the root causes behind substance use.
• Requiring DHS to report to the committee by the end of the year and on a quarterly basis on their progress in awarding funds and how much recipients have spent.

• The Improving Seniors’ Timely Access to Care Act, a top legislative priority for the American Academy of Ophthalmology (AAO) that would reform prior authorization in Medicare Advantage plans, was unanimously passed the U.S. House of Representative earlier this month and is now under further consideration by the Senate.
  
  Providing much-needed oversight and transparency while protecting beneficiaries from unnecessary care delays and denials, the bill would require Medicare Advantage plans to:
• • Establish an electronic prior authorization program.
  • Standardize and streamline the prior authorization process for routinely approved services, including establishing a list of services eligible for real-time prior authorization decisions.
  • Ensure prior authorization requests are reviewed by qualified medical personnel.
  • Increase transparency around Medicare Advantage prior authorization requirements and their use.
    
    The AAO is actively advocating in Congress for swift passage of the bill.
• The Supporting Medicare Providers Act of 2022 was recently introduced in Congress to counteract pending  budget neutrality cuts to the Medicare Physician Fee Schedule. More specifically, the legislation would prevent a 4.5% cut to Medicare physician payments set to go into effect next year. The bipartisan legislation – introduced by physician Congressmen Ami Bera, M.D., (D-CA) and Larry Bucshon, M.D. (R-IN) – would also encourage the implementation of a longer-term solution to promote and reward value-based payments and advance health equity.

The latest Marquette University Law Poll, which was conducted earlier this month and released on September14, shows incumbent Gov. Tony Evers (D) and Tim Michels (R) remain in a very tight race for governor, and incumbent U.S. Sen. Ron Johnson (R) and current Lt. Governor Mandela Barnes in a statistical dead heat for U.S. Senate. In the August Marquette Poll, Barnes was up 7-ponts over Johnson. Please find below highlights of the poll:

Wisconsin Governor’s Race:

Wisconsin Voters’ Preference for Governor:

• Governor Tony Evers (Democrat):  47%
• Tim Michels (Republicans):  44%
• Joan Beglinger (Independent):  5%
• NOTE:  Joan Beglinger ended her gubernatorial campaign on September 6, 2022 and endorsed Republican candidate Tim Michels.  However, her name will remain on the November general election ballot.

• Evers Favorability:
• Favorable:  45%
• Unfavorable:  45%
• Haven’t heard enough:  7%
• Don’t know:  3%

• Michels Favorability:
• Favorable:  34%
• Unfavorable:  39%
• Haven’t heard enough:  19%
• Don’t know:  8%

U.S. Senate Race:

• Wisconsin Voters’ Preference for U.S. Senate:

o   U.S. Senator Ron Johnson (Republican):  49%

o   Lt. Governor Mandela Barnes (Democrat):  48%

• Johnson Favorability:
• Favorable:  39%
• Unfavorable:  47%
• Haven’t heard enough:  11%
• Don’t know:  3%

• Barnes Favorability:
• Favorable:  33%
• Unfavorable:  32%
• Haven’t heard enough:  25%
• Don’t know:  9%

Earlier this month State Representative Adam Neylon (R-Pewaukee) toured the Medical College of Wisconsin (MCW) Eye Institute as part of the WAO’s Capitol Connection program. This WAO grassroots advocacy program aims to connect WAO  physician members with their local state legislators to show them firsthand the importance of ophthalmology and medical eye care.

Neylon, who was joined on the tour by Senate President Chris Kapenga’s (R-Delafield) top policy staff member, had an opportunity to interact with numerous MCW ophthalmologists, discuss cutting-edge medical eye care research and procedures, and tour nearly every aspect of the Eye Institute, including scientific research spaces and surgery facilities. In addition, WAO members, including WAO Board Member Dr. Baseer Ahmad and Dr. Deborah Costakos, briefed the legislative guests on the mission of the Eye Institute and the stark difference between ophthalmologists and optometrists as it relates to an ophthalmologist’s  education and training and the types of procedures and services they provide.

According to the WAO Government Affairs Team, the tour “provided a great opportunity to host Rep. Neylon and legislative staff to showcase the MCW Eye Institute and illustrate how ophthalmologists  deliver critical medical eye care to patients in Wisconsin and beyond. Dr. Ahmad and Dr. Costakos did a tremendous job facilitating the tour, which appeared to have a significant impact on the legislative visitors.”

Neylon, who was first elected to the Wisconsin Assembly in an April 2013 special election, represents the 98th Assembly District, which includes a large portion of Waukesha County, including the village of Pewaukee and a part of the City of Waukesha. Neylon currently serves as the Co-Chair of the Legislature’s Joint Committee for Review of Administrative Rules, which is tasked with reviewing proposed and existing state agency rules to determine if they conform with state law.

As the MCW Eye Institute tour illustrated, hosting a legislator at your site is easy, enjoyable, and can make a significant advocacy impact.  If you would like to host a legislative tour at your site, please contact the WAO office at wao@badgerbay.co. We will work with you and your legislators to coordinate the meetings and will provide participating members with full support, including legislator bios, advocacy tips, issue briefings, and supporting documents.