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      ‘One death is too many’: abortion bans usher in US maternal mortality crisis

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      In Louisiana, doctors will no longer be able to carry a lifesaving medication with them during pregnancy emergencies. In Texas, the infant mortality rate is soaring. In Idaho, pregnant people drive hours just to give birth. And in Oklahoma and Georgia, women are bleeding out in hospital parking lots and facing dangerous infections before they can find care – and sometimes, that care comes too late.The limitations and outright bans on abortion that have taken hold in half of the US in the wake of the Dobbs decision have wreaked enormous changes to the reproductive health landscape.The restrictions put a growing burden on the health and wellbeing of patients and providers, even as more Americans find it difficult to find and access care.“The United States is, and has been for quite some time, in the midst of a maternal and infant mortality crisis,” said Dr Jamila Perritt, a board-certified obstetrician and gynecologist and president of Physicians for Reproductive Health.Banning access to reproductive healthcare, including abortion care, is “directly causing an increase in morbidity and mortality in our community”, she said. “We have really robust evidence that shows us that when people have sought abortion care and are unable to obtain it, their psychological, social, physical and emotional health is harmed.”Maternal and infant mortality will probably increase because of the restrictions – especially if national limitations, like enforcement of the Comstock Act, are put into place.“I expect in the next few years, we’re going to start to see the infant mortality, pre-term birth, maternal mortality, and maternal morbidity numbers rise for everyone, and particularly for folks from racially marginalized and low-socioeconomic communities,” said Rachel Hardeman, professor of reproductive health and founding director of the Center for Antiracism Research for Health Equity at the University of Minnesota.Calculating mortality is often a complicated and controversial endeavor. When maternal mortality dropped in 2022, anti-abortion advocates credited the success to the Dobbs decision.But that’s not the case, according to new research in Jama Network Open.Maternal deaths surged during the first two years of the pandemic, when Covid, a deadly illness during pregnancy, accounted for one-quarter of all maternal deaths. But in 2022, that rate dropped to levels similar to pre-pandemic levels, from 32.9 deaths per 100,000 live births in 2021 to 22.3 in 2022.That rate is still higher than maternal mortality rates in peer nations, and research indicates it will increase if officials clamp down on abortion nationally – which, with the Comstock Act, would require no additional anti-abortion legislation or bans.Right now, “people can still travel to other states, but once there’s a federal ban, that won’t be an option any more,” says Amanda Jean Stevenson, co-author of the new Jama research and a sociologist at the University of Colorado Boulder. “And there could be this very different set of outcomes when people’s options are gone.”In the United States, more than 80% of pregnancy-related deaths and more than 60% of infant deaths in the first week are preventable – and those figures were estimated before the Dobbs decision.Because of abortion restrictions, there are already significant challenges to accessing reproductive healthcare – and it’s not just abortion care.In Louisiana, misoprostol – a drug used for medication abortion and other lifesaving purposes – will be labeled a controlled substance beginning on 1 October. One of its uses is keeping patients from bleeding out after childbirth, which is the No 1 cause of postpartum mortality.Yet physicians cannot keep controlled substances in their emergency carts, and they fear they won’t have enough time to fill prescriptions for patients when minutes and even seconds make the difference between life and death.In the year following Texas’s abortion ban, child mortality shot up by 12.9% – compared with a 1.8% increase in the rest of the country, according to a recent study. Congenital anomalies are the leading cause of infant death in the US – but while they went down by 3.1% in the rest of the country, they went up by 22.9% in Texas.“That study was chilling. That is a huge change,” Stevenson said.It echoed previous research finding that states with the most restrictive abortion laws saw 16% more infant deaths between 2014 and 2018.The trauma and costs of carrying to term pregnancies that are incompatible with life inflict an incalculable toll on families and providers.States are closing obstetric units and losing experienced providers who worry about not being able to offer lifesaving care as patients die on the table in front of them, and facing jail time if they provide care.More than two-thirds (68%) of obstetricians and gynecologists say the Dobbs decision has made it harder for them to respond to pregnancy-related emergencies, according to the non-partisan health research organization KFF. They also believe it has worsened mortality in pregnancy while increasing racial and ethnic inequities, and fewer doctors are now interested in entering the field.In 2022, soon after the Dobbs decision, medical residency applications dropped for states with bans.More than half of doctors surveyed in states with bans and limitations said they were very concerned about legal repercussions to providing the standard of care in pregnancy.“That can just exacerbate already pretty large gaps in the workforce,” said Usha Ranji, associate director for women’s health policy at KFF.In the past two years, more than 100 hospitals have closed their obstetric units entirely, according to a new March of Dimes report. More than one-third of US counties are now maternity care deserts, with no obstetricians or places to give birth. North Dakota, South Dakota, Alaska, Oklahoma and Nebraska have the least access to maternity care.The majority of rural hospitals (57%) no longer deliver babies, with more than 100 of the rural hospitals ending labor and delivery services in the past five years.“We’ve created policy and legislation to limit access to abortions and also have closed the exact places that people need to go to get care if they are pregnant,” Hardeman said. That puts pressure on neighboring states that still provide care, she said.“Where you live matters for your health. And I think that the Dobbs decision and the fall of Roe have demonstrated that in a very real and very obvious way, because there are literally places in this country where there is essentially no access to reproductive healthcare,” she said.“It started out in rural spaces, but more and more, there’s reports popping up of labor and delivery units closing in, like, urban Chicago.”In states with restrictions on abortion, women of color and pregnant people from low-income communities often suffer the most, said Hardeman. “Taking away access to reproductive healthcare is exacerbating those disparities.”Black women die because of pregnancy at twice the national rate, and three times more than white women, according to the US Centers for Disease Control and Prevention.“The fact that black women and birthing people are dying at three to four times greater risk than white women is shameful – and it’s preventable,” Perritt said.It’s important to shore up protections for reproductive health for all Americans before health complications and mortality rise even more, she said. “One death is too much. One is too many.” More

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      Kamala Harris should launch a national campaign to end the US diabetes epidemic | Neil Barsky

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      Before addressing the political opportunity in front of the vice-president, let us first confront the sacred cow in the room.Contrary to recent claims by Donald Trump, JD Vance and Ted Cruz, Kamala Harris loves a good cheeseburger; she positively does not want to take our red meat away. She has cited sugars and sodas as major culprits in our poor health. Moreover, the Biden-Harris administration has demonstrated that it is unafraid to challenge the stranglehold the pharmaceutical industry has over insulin prices, and the cost that industry charges Medicare patients for drugs.Next, let’s dispense with the false narrative that Trump and his acolyte Robert F Kennedy Jr, have the capacity to “make America healthy again.” As part of RFK Jr’s recent endorsement, Trump vowed to appoint “a panel of top experts, working with Bobby, to investigate what is causing the decades-long increase in chronic health problems …” Kennedy, whose anti-vaccine work is more likely to make America have measles again, has recently become the darling of many metabolic health advocates for his series of half-truths about America’s obesity epidemic.Let’s not be fooled. To paraphrase Harris, these are not serious people, and the consequences of putting America’s healthcare in their hands would be deadly.I happen to live with type 2 diabetes, and have spent the past year chronicling the ways one of the country’s most lethal, expensive and ubiquitous diseases is actually reversible through a diet low in carbohydrates – the macronutrient that diabetics like me cannot safely metabolize without the help of drug therapies. Nutrition in America has become quite politically polarizing, as shaky science often collides with ideology, leaving us at a loss to know why we get fat, why we get sick, and even whether red meat causes diabetes (it doesn’t). Our healthcare budget is $4tn a year, yet our life expectancy is only 48th in the world, and we seem to be getting heavier and sicker. Something is terribly wrong.In this abyss lies a golden opportunity for presidential candidate Harris to present a healthcare agenda that would save thousands of lives, billions of dollars, as well as her appeal to voters in conservative states. She can do what no president has ever had the courage to do before: launch a national campaign to reverse America’s diabetes epidemic and, in the process, improve our metabolic health. She might even declare the destructive disease a national emergency.This initiative would be both good policy and good politics, and it is not as quixotic as it might first sound. Type 2 diabetes is a condition where the hormone insulin does not naturally function properly, leading to high blood sugars, and leaving its victims at risk of cardiovascular, kidney, eye and other disease. Currently, 38 million American adults have diabetes, while another nearly 100 million more have pre-diabetes – or more than a third of adult Americans. At $420bn per year, it is one of America’s costliest diseases, accounting for over 10% of the country’s $4tn annual healthcare budget. It kills over 100,000 Americans annually, more than die of opiate overdoses.And while it is true that people of color are more likely to get diabetes than white people, it is also the case that, like the opiate crisis, diabetes is a color-blind disease that has disproportionately ravaged red state America. In fact, 14 of the 15 states with the highest diabetes mortality rates voted Republican in 2020. And 14 of the 15 states with the lowest mortality rates voted Democratic in 2020.What form should a Harris initiative take? Here are my personal recommendations, based on my own experience with the disease, and a year’s worth of interviewing well over 100 researchers, clinicians, advocates and patients. Frankly, it is baffling that this disease – which is killing us widely, breaking our budget and reversible through diet – is not yet a matter of national urgency.1. First, she should announce her intention to appoint a diabetes czar whose job, among other things, would be to solve this puzzle – over the past quarter-century, America’s pharmaceutical and medical technology industry have made extraordinary strides developing various forms of insulin and other drugs, continuous glucose monitors and test strips. So why have seven times more Americans been diagnosed with diabetes than in 1980? Eventually commonsense solutions would emerge, such as restricting cereal companies’ ability to market their sugary treats to children.Not only would the czar be empowered to confront things like the scandalous $1bn-plus in sugar subsidies provided by US taxpayers, she would explore common-sense treatments for treating diabetes that are diet and lifestyle-focused. (A good place to start would be the excellent 2024 book Turn Around Diabetes, written by endocrinologist Roshani Sanghani.)2. We must defund, disqualify and otherwise delegitimize the American Diabetes Association (ADA). As I have written, the ADA has become a virtual branch of big pharma and big food. Yet it sets standards of care for clinicians and de-emphasizes mountains of evidence that the low-carbohydrate diet is a powerful tool in reversing the disease. Frankly, it is mind-boggling that the world’s most powerful diabetes-fighting organization (2023 revenue: $145m) has so utterly failed to stem the disease, but still sets standards of care, controls research dollars and dictates the diabetes narrative in this country.Late last year, the ADA was sued by its former director of nutrition. She claimed she was fired for refusing to include the artificial sweetener Splenda, whose parent company donated $1m to the ADA, in the ADA’s list of approved recipes. It is one of American healthcare’s great tragedies that the ADA and the plaintiff, Elizabeth Hanna, settled before the facts of the inner workings of the ADA were brought to light in a trial. In any case, the complaint is a stinging indictment of the organization and should be read by every clinician interested in learning how corporate donations have corrupted the organization’s nutrition guidance.3. Perhaps most urgently, the federal government, including the National Institutes of Health, should expand its research budget to include researchers treating patients with low-carbohydrate and ketogenic diets. Over the past two decades, there has been an explosion of courageous clinicians who prescribe the low-carbohydrate diet to their patients, as well as at least two startups – Virta Health and OwnaHealth – with promising results treating diabetes and obesity with low-carbohydrate diets.But because their research does not include the search for the next blockbuster drug, researchers often cannot access ADA, NIH and big pharma research dollars. They don’t get prominent spots in pharma-funded conferences. This is an enormous impediment to the low-carbohydrate diet becoming part of the medical mainstream and in my opinion is responsible for the persistence of the diabetes plague.4. We should give platforms to people who actually have diabetes, especially those who have reversed their condition by taking control of their diet. Of all the misconceptions I uncovered in my reporting on diabetes, the most common was that the low-carb diet was too difficult for patients, particularly low-income patients, to maintain. Of course, resisting bread, sweets, rice and starches is not easy, but it is made far more difficult by the utter lack of a national consensus that these are the foods responsible for diabetes and obesity. Stopping smoking is hard too, but once it became a national imperative, usage plummeted. In my experience, when patients are told the truth (“Stop eating carbs or your disease will progress and you may die”), they can change their behavior. And they feel empowered.Take the case of Jemia Keshwani, a 40-year-old LaGrange, Georgia, woman who has had diabetes for 25 years, and who narrowly escaped amputation of her right foot after her doctor prescribed a low-carbohydrate diet. She has lost 120lb (54kg) and no longer shoots insulin into her belly four times a day. “I didn’t understand you could change things around if you eat the right foods,” she said. “You know how sometimes you feel helpless? Now I don’t feel that way.”Or the case of Ajala Efem, a 47-year old Bronx woman, who, according to a recent article in Medscape, lost nearly 30lbs and got off 15 medications after her Bronx-based healthcare provider, OwnaHealth, prescribed a low-carb diet.“I went from being sick to feeling so great,” she told her endocrinologist. “My feet aren’t hurting; I’m not in pain; I’m eating as much as I want, and I really enjoy my food so much.”This past March, Harris asked an audience in Las Vegas how many people had family members living with diabetes. “A sea of hands went up,” she wrote on her Facebook page.Harris clearly understands the diabetes scourge and needs only a gentle push to make it a priority. So here is one final word of affectionate advice. The next time she attends a state fair, she might consider having one of those cheeseburgers she loves. It’s delicious, nutritious and will make a great photo op.Just lose the ketchup and bun.

      Neil Barsky, a former Wall Street Journal reporter and investment manager, is the founder of the Marshall Project More

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      Black voters in Georgia want affordable access to healthcare. Will Kamala Harris win them over?

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      Around 4am last Christmas Eve, Kuanita Murphy’s father suddenly became short of breath and briefly passed out. Without a medical facility nearby, Murphy had to drive him 45 miles east to Albany, Georgia, to the Phoebe Putney memorial hospital. The only hospital in their small town of Cuthbert, Georgia – Southwest Georgia regional medical center – had closed down three years earlier due to financial strain from failing infrastructure and an increase in uninsured patients.After waiting for several hours, Murphy’s dad was finally admitted at noon into a hospital room for internal bleeding and a restricted heart valve. While he eventually underwent lifesaving surgery, Murphy said that he would have received treatment faster had Cuthbert still had a hospital.“He had some pain dealing with his chest and the anxiety of not knowing exactly what was going on with him,” Murphy, the editor of Rural Leader magazine, said. “That made it worse off than it probably was, not knowing and having to wait.”Hospital closures are top of mind for Black voters throughout Georgia, since it’s one of 10 states to reject Medicaid expansion. On Wednesday, Kamala Harris launched a two-day bus tour through south Georgia that will culminate with a rally in Savannah on Thursday afternoon. “Campaigning in this part of the Peach state is critical as it represents a diverse coalition of voters, including rural, suburban and urban Georgians – with a large proportion of Black voters and working-class families,” the campaign said in a statement.Since 2013, 12 hospitals have closed down in rural and urban areas throughout the state, according to the Georgia Hospital Association. In 2022, two Wellstar Atlanta medical centers closed in the Atlanta metro area, where more than two-thirds of the 4,281 emergency room patients were Black, according to 2019 data from the private, non-profit Wellstar Health System cited by the Atlanta Journal-Constitution.In Murphy’s eyes, the shuttered medical facility where she was born 49 years ago has served as a rallying cry before the upcoming presidential election. The city’s residents, she said, want to “back a candidate that is going to support Medicaid expansion, or affordable access to healthcare”.Murphy, like most residents in majority-Black Cuthbert, has long voted Democrat. Although Joe Biden won Georgia in 2020, the first Democratic presidential candidate to do so since 1992, the Republican-led state legislature has rejected expanding Medicaid coverage to more lower-income adults. The Biden-Harris administration has long urged all states to expand Medicaid – a legacy that health policy experts predict Democratic nominee Harris will continue if she becomes president.Throughout her vice-presidency, Harris has discussed the need to expand Medicaid coverage for postpartum mothers from two to 12 months after giving birth. “We also must work together to call on Congress to advance other components of our Build Back agenda, to expand Medicaid in every state,” Harris said during a speech in 2021. “People live in every state, that’s the logic.”Floundering healthcare facilities might stay open if they have received Medicaid reimbursements for patients who otherwise couldn’t pay their bills, according to health policy experts. As they gear up for state and federal elections, healthcare advocates and community organizations say they want Georgians to vote for candidates who prioritize affordable and equitable access to healthcare.Bobby Jenkins, the Cuthbert mayor, believes that the state’s hospital closures could drive voter turnout there. “That’s a way of engaging people in the electoral process to get them to understand this is a direct impact of your vote, or it could be a consequence of your lack of voting,” he said. Case in point, Jenkins said, is that Biden-Harris’s 2025 fiscal year budget includes “Medicaid-like” coverage to people in states that haven’t expanded the program. Meanwhile, Donald Trump sought to repeal Medicaid expansion and supported work requirements for people to qualify for free government healthcare during his presidency.‘Our governor said no, which is crazy’According to surveys and canvassing sessions, access to healthcare has remained the most pressing concern only behind the economy for Black and brown communities over the past two years, said Kierra Stanford, the lead community health organizer for the non-profit New Georgia Project. At ice cream teach-ins and public meetings, Stanford tells residents that hospitals could stay open if state and federal leaders expanded Medicaid. While the group is nonpartisan, they encourage voters to research candidates’ stances on healthcare.Healthcare redlining, which Stanford defined as “the deliberate managing of healthcare resources in Black communities”, has led hospital systems to divest from historically marginalized areas. “It’s an ongoing trend,” Stanford said, that “has been exacerbated by not expanding Medicaid”.In May, Stanford held a public meeting with 30 attendees in East Point, Georgia, a majority-Black city south-west of Atlanta, to discuss the connection between hospital closures and the state’s refusal to expand Medicaid. A few days later, the New Georgia Project packed the public comment period of an East Point city council meeting to share their concerns about access to healthcare.On the state level, the New Georgia Project releases a voting guide to alert voters of pressing healthcare concerns before elections. Eventually, they plan to roll out a scorecard that shows the state politicians who didn’t vote to expand Medicaid. On the national level, Stanford explains to voters: “Georgia has literally been offered the funds, but our governor said no, which is crazy.”“I try to tell people that the money that’s being taken out of your check for federal taxes,” Stanford said, “you’re paying for healthcare for people in California, for people in these other states that have expanded Medicaid.”Hospital closures hit Black rural communities the hardest, said Sherrell Byrd, executive director of Sowega Rising, a Georgia-based non-profit focused on coalition-building and rural revitalization. “When a hospital closes in rural areas, it’s much more devastating than in urban areas, because it’s like a black hole,” Byrd said. “It takes out a whole subset of the economy side of the community.”It’s common for residents to drive up to an hour or to cross state lines to access hospitals. The organization encourages rural residents to speak to their legislators about their healthcare access concerns, but Byrd said that politicians have not shared any steps they have taken to solve the issue.“That’s where people start to be frustrated, because year after year, they still don’t have hospitals,” Byrd said. “And so that’s when people become disenfranchised.”Hospital closures are top of mind for Medlyne Zamor, a Rockdale county voter who was previously unconcerned about candidates’ healthcare platforms. She didn’t see the need to expand Medicaid and thought that the state would benefit from funding other institutions. However, after a spate of hospital visits due to fibroids in 2022, Zamor met other patients who had been personally affected by the closures. Some of them had needed to wait several months to see specialists. That opened her eyes to the issue, she said: “When I saw how the hospital closures … impacted them in the community, it definitely made me shift my vote to expansion.” Now she only votes for candidates in state and federal offices who support Medicaid expansion.As a result, Zamor began volunteering at the New Georgia Project, where she hosts events to inform Georgians about the lack of access to healthcare. She also addresses the issue by phone banking, sending out email blasts to residents and writing senators. “These hospital closures, not only does it affect the nearby citizens,” Zamor said, “but also it affects the workers, and it affects the [remaining] hospitals, too.”State and federal politicians hold the power in slowing down the closures by extending healthcare coverage to lower-income adults, “relieving fragile hospitals from providing free care to uninsured patients”, said Laura Colbert, the executive director of the non-profit Georgians for a Healthy Future. “After that, state and federal leaders should work together to slow consolidation among hospitals and other investors, which can accelerate some rural hospital closures.”Congress members have stepped up to save Cuthbert’s healthcare system after its only hospital closed four years ago. The city plans to establish a new hospital after recently receiving nearly $12m in federal funding. The Randolph County Hospital Authority is currently working with an accounting firm on a feasibility study to ensure that the facility stays in the community for good. More

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      Biden and Harris celebrate landmark deal to lower medication prices

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      Joe Biden and Kamala Harris on Thursday cast themselves as the champions of American seniors in a David-and-Goliath fight against big pharmaceutical companies, at a joint event touting a landmark deal to lower the cost of prescription drugs.“We finally beat big pharma,” the US president declared, sharing the stage with his vice-president for the first time since he abandoned his re-election bid in late July and Harris replaced him as the Democratic nominee.The event, which came after a morning announcement about new lower drug prices for beneficiaries of Medicare, a government health insurance plan for seniors, was an opportunity to persuade voters that their administration has helped ease costs after years of high inflation. Healthcare, particularly the high cost of prescription drugs, is a top concern for US voters. Biden had held a slight lead over Donald Trump for his platform throughout the year before he dropped out of the race.Harris spoke first, calling Biden “our extraordinary president”, as the crowd, packed into the gymnasium at Prince George’s Community College, rose to its feet to applaud the president. “Thank you, Joe,” they chanted in appreciation of – according to several attendees – his record and his decision to step aside and pass the torch to Harris.Biden called Harris an “incredible partner” and said she would “make one hell of a president”.“We finally addressed the longstanding issue that for years was one of the biggest challenges on this subject, which was that Medicare was prohibited by law from negotiating lower drug prices, and those costs then got passed on to our seniors,” Harris said. “But not any more.”The 10 drugs subject to negotiations, among them widely used blood thinners and diabetes medications, are expected to save $6bn for Medicare, which is a major government health insurance program covering Americans older than 65, and those with certain disabilities, the administration said. Seniors should save $1.5bn directly in out-of-pocket costs.The negotiated prices, which take effect in 2026, were authorized by the Inflation Reduction Act, that Biden emphasized passed without a single Republican vote. The vice-president cast the tie-breaking vote in her role as president of the Senate.“We pay way too much for prescription drugs in America,” the health and human services secretary, Xavier Becerra, said.Before Biden and Harris spoke, administration officials and Maryland politicians celebrated the deal while thrilling the crowd with discreet references to Harris’s candidacy.“President’s a good title for her,” the retiring Maryland senator Ben Cardin winked in his remarks, crediting Harris for helping to pass the Democrats’ sweeping health and climate change bill.Biden, who simultaneously touted his record in office and played pass-the-torch, warned that if given a second term, Trump – who the president mocked as “the guy we’re running against, what’s his name? Donald Dump?” – would repeal Medicare’s authority to negotiate drug prices. He named the sweeping conservative policy agenda, Project 2025, that Trump has sought to distance himself from.“Let me tell you what our Project 2025 is: beat the hell out of them,” Biden said, drawing loud applause.Republican lawmakers have been highly critical of the Biden administration’s move, arguing that government-negotiated drug prices will stifle innovation and result in fewer lifesaving drugs being brought to market.In a joint statement, House Republicans accused Biden of “price-fixing”.“Make no mistake, price fixing has failed in every sector and in every country where it has ever been tried,” the statement by the House speaker, Mike Johnson, and the Republican leadership team said. “The Biden-Harris administration says it wants to lower prices for families, but their prescription drug price fixing scheme has accomplished just two things: driving up health care costs and crushing American innovation in medicine.”View image in fullscreenThe double act attracted a raucous audience, with hundreds of people waiting in the summer heat to glimpse the president’s final act and the vice-president’s ascent.“I’ve been waiting for this moment for a long, long time,” Biden said, noting that the first time he introduced legislation to allow Medicare to negotiate drug prices was as a freshman senator shortly after he was elected, in 1972.“For the longest time I was too damn young because I was only 29 when I got elected,” he said. “Now I’m too damn old.”The negotiated prices, which take effect in 2026, are expected to save billions of dollars for the taxpayer-funded Medicare program. But they will lead to direct out-of-pocket savings for only a subset of the millions of older Americans who take the drugs subject to negotiations. Healthcare costs in the US have been rising for several decades, and Americans spend upwards of $13,000 a year on medical services and medications.The law already caps out-of-pocket costs for insulin at $35 a month for Medicare patients. It also calls for a $2,000 cap on out-of-pocket drug spending.Earlier this week, Harris and Biden participated in a Situation Room meeting to discuss the situation in the Middle East. They also appeared together on the tarmac at Joint Base Andrews to welcome home US citizens wrongfully detained in Russia.On the campaign trail, the economy and cost of living remain top issues for voters, as Democrats seek to convince them that the president’s economic policies have had an impact on their pocketbooks. Democrats cheered news on Wednesday of easing inflation. Consumer prices rose 2.9% July, falling below 3% for the first time since 2021, new government data showed. But Americans continue to be squeezed by the high cost of rent and groceries.On Friday, Harris will travel to North Carolina to deliver an economic policy speech, during which her campaign said she would call for a federal ban on price gouging on groceries. Though Trump had held an advantage on the economy over Biden, recent polling suggests Harris has erased much of his early lead.Wes Moore, the governor of Maryland, introduced Biden and Harris, referring to them as the 46th and 47th president of the United States, which prompted chants of “48” – a promising sign for the charismatic Democratic rising star.Linda Hunt, 80, said she rarely attended political events, but came to witness history.“I came to pay him respect – that’s primary but I also wanted to see and hear her in person,” she said. “It was historical.” More

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      Tim Walz pick excites hopes of taking US healthcare beyond Obamacare era

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      When Kamala Harris picked the Minnesota governor, Tim Walz, as veep for the Democratic presidential ticket, advocates for healthcare reform felt a jolt of electricity.Here, they saw a man who proclaimed healthcare a “basic human right”, reformed medical debt collections, and who laid the groundwork for expanded government insurance and denied corporate health insurers contracts with Medicaid, a state-run health insurance program for the poor. Walz even once joined Harris at an abortion clinic in support of abortion rights.It was a sense of possibility some had not felt since the Obama era, and hard for some to contain their excitement.“We’re celebrating here at the cabin,” said the Democratic Minnesota state representative Liz Reyer, who helped Walz pass a medical debt collection reform bill in 2023. She was on vacation in northern Wisconsin, sipping coffee next to her sleeping dog – a quiet, midwestern kind of celebration. Reyer felt compelled to stress “how absolutely strongly I was pulling for Governor Walz to be the VP pick”.“It feels really important and like a huge opportunity,” said Reyer, about the possibility of making such reforms nationally. “I share with Governor Walz the bedrock belief that healthcare is a human right. So, to me – yeah, let’s go.”Since the Obama era, health reformers have had a tough run. After the passage of the Affordable Care Act (ACA) better known as “Obamacare”, in 2010, the Democratic party suffered heavy midterm losses to what would become known as the conservative Tea Party movement.Perhaps worse, the ACA became a focal point of Republican rage well into the Trump administration. Republicans only abandoned calls to “repeal and replace” the ACA in 2017, after the now-deceased Republican senator John McCain stunned party leaders by casting the decisive vote against Trump’s plan, returning to Washington amid a brain cancer diagnosis.Although Republicans were not able to repeal Obamacare, they were successful in another way: years of attacks left little room to expand coverage or rein in healthcare prices, essentially the unfinished work of Obamacare.Republicans policy wonks have since retreated to time-worn proposals for a second Trump term, primarily fleshed out in the Project 2025 document. Among the early 2000s hits now on a nostalgia tour: Make healthcare shoppable! More privatization! Less regulation! Tax-free savings accounts!The former president has disavowed Project 2025, though the official Republican platform does not look dissimilar. Notably, Trump’s current campaign and former administration has close ties to authors of the project.The 2024 Republican platform focuses on “transparency”, “choice” and “competition” (read: shoppable prices and fewer regulations). It also promises “no cuts” to Medicare, a government program for the elderly, though Project 2025 promotes further privatizing the program.Today, about 92% of Americans have health insurance. That still leaves about 26 million people out of the system – potentially vulnerable to the full force of market prices in the world’s most expensive health system. A catastrophic illness or ailment can easily lead to financial ruin.What’s more, even for people who have health insurance, medical debt remains a persistent problem. Forty-one per cent of Americans owe money to a medical provider, credit card or family member for healthcare. Often, when people have or fear medical debt, they cut back on food, clothing and other household items, according to a widely cited Peterson-KFF Health System Tracker poll. People with medical debt tend to be sicker and die sooner.At the same time, the cost of healthcare now eats up 17% of America’s gross domestic product, nearly double that of peer nations. That is in spite of the fact that Americans see the doctor less than peers in other wealthy nations and have worse health outcomes.View image in fullscreenWhile not all of America’s health problems can be pegged to problems with the insurance industry, anecdotal reports show at least some can be – such as adults waiting until they reach Medicare eligibility age to get cataract surgery or Americans feeling reticent to smile for fear of revealing a mouth full of decay.Exactly what Harris and Walz’s healthcare platform will be remains to be seen. The 2020 Democratic platform included a call for a public option, reining in pharmaceutical spending and strengthening Obamacare. The administration accomplished some of this.Notably, the Biden administration just finished its first Medicare prescription drug price negotiation – a process common in peer nations but which was prohibited when Biden took office. The most recently released Democratic party platform came in July, before Biden dropped out of the race.What is clear is the similarities in Harris’s and Walz’s records. The Biden administration capped insulin prices at $35 a month for Medicare beneficiaries. So did Walz for Minnesotans not on Medicare – an act he named after resident Alec Smith, a 26-year-old who died from rationing his $1,300-a-month insulin supply.Walz worked closely with Reyer to pass a comprehensive package of reforms for medical debt collection, which included a prohibition on hospitals from denying care to patients with outstanding balances, and which stopped the automatic transfer of debt liability to spouses. Similarly, the Biden administration has sought medical debt restrictions through rule-making with the Consumer Financial Protection Bureau.Walz said in his inaugural address as governor that he believed healthcare was a “human right”. That’s widely accepted wisdom outside the US, and all but the unofficial tagline for single-payer healthcare advocates – the kind of government-run universal healthcare that is a source of pride for the UK’s National Health Service.Similarly, Harris co-sponsored 2019 legislation introduced by Senator Bernie Sanders that would have established single-payer healthcare nationally. The revolutionary proposal stood no chance of passing, and she has since sought to moderate from that moment. Her campaign has said she would “not push” single-payer as president. Still, it has got advocates excited.“From our standpoint, this is fantastic,” said Dr Philip A Verhoef, a critical care doctor in Hawaii and president of Physicians for a National Health Program, the nation’s largest single-payer advocacy organization.“Ten years ago, single-payer burst on to the scene,” with Sanders’s presidential run, said Verhoef. “Prior to that, nobody ever talked about this.” Similarly, single-payer advocates were “shut out” of Obamacare discussions, Verhoef added.Walz also laid the groundwork for a “public option” health insurance plan in Minnesota, where the government would allow people to buy into Medicaid, and banned private health insurance companies, such as behemoth UnitedHealth, from contracting with Minnesota’s Medicaid plan.How the Harris-Walz ticket will translate the excitement of reformers into action – and what exactly their proposals will be – remains to be seen. For the time being, activists are enjoying a sense of possibility, knowing difficult discussions lie ahead.“So often, we see people in positions of political power are thinking, ‘Well, what can we get done without blowing up the system,’” said Verhoef. “I appreciate that attitude – in a way that’s what the ACA was. It helped a lot of people. But it still left 30 million people uninsured in this country and it hasn’t stopped people from going bankrupt from healthcare bills.” More

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      Arizona supreme court delays enforcement of 1864 abortion ban

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      The Arizona supreme court on Monday granted a motion to stay the enforcement of an 1864 law that bans almost all abortions, a win for reproductive rights activists in the swing state.The state’s highest court agreed to the Arizona attorney general Kris Mayes’s request for a 90-day delay of the near-total ban, further pushing back enforcement of the 1864 legislation after a repeal of the ban was passed earlier this month.The stay will last until 12 August. A separate court case on the legislation which granted an additional 45-day stay means the law cannot be enforced until 26 September, Mayes said in a statement.“I am grateful that the Arizona supreme court has stayed enforcement of the 1864 law and granted our motion to stay the mandate in this case for another 90 days,” she said.Mayes added that her office is weighing the “best legal course of action”, including a petition to the US supreme court.The latest decision comes two weeks after the Democratic Arizona governor, Katie Hobbs, signed a law to repeal the ban.But the most recent repeal can only take place 90 days after the Arizona legislative session ends, possibly allowing for a small window when the ban could be enforced.Last year’s session ended on 31 July, NBC News reported. If lawmakers adhere to that timeline, the ban could be in effect for approximately a month, until late October.Hobbs has said that she will not prosecute any medical practitioners under the 1864 law.The Arizona supreme court rejected a motion from Planned Parenthood Arizona on Monday to hold off on enforcing the 1864 ban until the repeal takes effect.On the latest court ruling, the reproductive health organization vowed to continue fighting to “[ensure] all Arizonans can access the care they need in a safe, caring environment”, according to a statement.“We will not be intimidated or silenced by anti-abortion extremists, because our bodies and our autonomy are at stake.”In Arizona, abortion is currently banned after 15 weeks of pregnancy. The 1864 abortion law bans nearly all abortions, except to save a woman’s life. The US civil war-era law does not make exceptions for rape or incest.Residents of the swing state will probably vote on a referendum on abortion come November after a coalition of reproductive rights organizations collected enough signatures to get the issue on the 2024 ballot. More

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      US investigates organ collection groups for potentially defrauding government

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      US authorities are investigating organizations that coordinate organ donations over allegations that the non-profits are potentially defrauding the federal government.The federal investigation, first reported by the Washington Post, is looking at several organ procurement organizations (OPOs) that secure organs for transplants within the United States.A focus of the inquiry is investigating whether the organizations knowingly overbilled the Department of Veteran Affairs as well as Medicare, two agencies that reimburse OPOs for the procurement of organs.The investigation is also looking into whether OPOs arranged kickbacks between organizations, the Post reported, citing one person with knowledge of the investigation.The latest investigation, led by the Department of Health and Human Services as well as inspector general Michael Missal with the Department of Veterans Affairs, could lead to a mass overhaul of the organ transplant industry, the Post reported.Missal and the Department of Health and Human Services did not return the Guardian’s request for comment.At least six people with knowledge of the investigation told the Post that the inquiry has been taking place for several months. But it recently intensified as investigators visited the offices and homes of at least 10 chief executives at different OPOs.In a message to its membership, the Association of Organ Procurement Organizations also acknowledged that federal investigators had visited several OPOs in February “as part of an inquiry”.Lawmakers in recent years have attempted to reform the organ transplant system, which has been rife with issues.Last March, the Biden administration announced that it would break up the monopoly on the US’s organ transplant system, the New York Times reported.The organ transplant system for 38 years has been run by United Network for Organ Sharing (UNOS).Within the system, a total of 56 organizations collect organs for donations and coordinate their transportation to US surgeons, the Post reported.Several organizations for years have not collected enough organs to meet growing demand. But of the 56 organizations, none of have been decertified by the federal overseers, the Post reported.A 2022 investigation by the Senate finance committee uncovered additional problems within the organ transplant system. The committee discovered that transporters had lost donated organs and that poor screening of donated organs led to 70 deaths between 2008 and 2015.More than 100,000 Americans are now on the national transplant waiting list, with 17 people dying each day while waiting for an organ, according to the federal government. More

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      Anti-abortion centers raked in $1.4bn in year Roe fell, including federal money

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      Anti-abortion facilities raked in at least $1.4bn in revenue in the 2022 fiscal year, the year Roe v Wade fell – a staggering haul that includes at least $344m in government money, according to a memo analyzing the centers’ tax documents that was compiled by a pro-abortion rights group and shared exclusively with the Guardian.These facilities, frequently known as anti-abortion pregnancy centers or crisis pregnancy centers, aim to convince people to keep their pregnancies. But in the aftermath of Roe’s demise, the anti-abortion movement has framed anti-abortion pregnancy centers as a key source of aid for desperate women who have lost the legal right to end their pregnancies and been left with little choice but to give birth.Accordingly, abortion opponents say, the centers need an influx of government cash.“Those are the centers that states rely on to assist expecting moms and dads,” Mike Johnson, the speaker of the US House of Representatives, told anti-abortion protesters at the March for Life in January. The Louisiana Republican praised the centers for providing “the important material support that expecting and first-time mothers get from these centers”.Earlier this year, under Johnson’s leadership, the House passed a bill that would block the Department of Health and Human Services from restricting funding for anti-abortion pregnancy centers. State governments are also in the midst of sending vast sums of taxpayer dollars to programs that support anti-abortion pregnancy centers. Since the demolition of Roe, at least 16 states have agreed to send more than $250m towards “alternative to abortion” programs in 2023 through 2025. Those programs funnel money towards anti-abortion pregnancy centers, maternity homes and assorted other initiatives meant to dissuade people from abortions.Still, abortion rights supporters say, much of the anti-abortion pregnancy center industry remains shrouded in mystery – including their finances.“Stewards of both taxpayer and charitable funds should insist on a real impact analysis of the industry, whether investments that are being made are achieving their desired outcomes and are cost-effective,” said Jenifer McKenna, the crisis pregnancy center program director at Reproductive Health and Freedom Watch, the group behind the analysis of tax documents. “Taxpayers deserve performance standards and hard metrics for use of their dollars on these centers.”The analysis by Reproductive Health and Freedom Watch examined 990 tax documents, which most US tax-exempt organizations must file annually, from 1,719 anti-abortion pregnancy centers in fiscal year 2019 and from 1,469 in fiscal year 2022. The analysis confirms that the anti-abortion pregnancy center industry is growing: while the centers’ revenue in 2022 exceeds $1.4bn, it was closer to $1.03bn in 2019, even though more centers were included in the earlier analysis.Centers reported receiving hundreds of millions of dollars in donations from private funders between 2018 and 2022. While only a relatively small fraction of the centers reported receiving grants from state and federal governments in both 2022 and 2019, that number is on the rise, according to the Reproductive Health and Freedom Watch analysis memo. In 2022, the centers said they received $344m in such grants, but they received less than $97m in 2019.Just 21 centers identified the federal grants that they received in 2022, the analysis found. Those grants included the Fema-funded Emergency Food and Shelter Program, which is primarily meant for organizations that alleviate hunger and homelessness, and the Temporary Assistance for Needy Families, a program for low-income families.This accounting does not represent the full financial picture of the anti-abortion pregnancy center industry. More than 2,500 anti-abortion pregnancy centers are believed to dot the United States – a number that far outstrips the number of abortion clinics in the country.‘What did they do with all that money?’Much of the modern, publicly available information on anti-abortion pregnancy centers comes from one of their biggest cheerleaders: the Charlotte Lozier Institute, which assembles reports on the industry and operates as an arm of Susan B Anthony Pro-Life America, one of the top anti-abortion organizations in the United States.In 2019, the Charlotte Lozier Institute said that 2,700 anti-abortion pregnancy centers provided consulting services to 967,251 new clients on-site. In 2022, the Institute said 2,750 centers provided consulting services for 974,965 new clients – an increase of 0.08%.Even though the US supreme court overturned Roe at the halfway point of 2022, it did not appear to result in a crush of new clients – despite anti-abortion advocates’ argument that the pregnancy centers need an infusion of funding to handle post-Roe clients.“The new client numbers alone don’t fully tell the story,” a bevy of Charlotte Lozier Institute scholars – Moira Gaul, Jeanneane Maxon and Michael J New – said in an email to the Guardian, adding that anti-abortion centers and groups have seen an increase in violence following the fall of Roe. (The abortion clinics that remain post-Roe have also faced rising violence. That has not stoppered the demand for their services, as rates of abortions have risen since Roe’s demise.)Anti-abortion pregnancy centers are seeing a dramatic rise in calls for certain kinds of help. Data from the Charlotte Lozier Institute reports show that centers handed out 64% more diapers, 52% more baby clothing and 43% more wipes in 2022, compared to 2019. Demand for new car seats and strollers also increased by about a third.All of these items would presumably go to new parents. The fall of Roe led to an estimated 32,000 more births, particularly among young women and women of color, a 2023 analysis found.The total dollar value of these goods and services was about $358m, according to the Charlotte Lozier Institute report. Reproductive Health and Freedom Watch found that the roughly 1,500 centers included in the group’s 2022 analysis reported expenses of more than $1.2bn on their 990 tax documents.“They took in – according to the 990s – $1.4bn, and they spent $1.2bn on expenditures,” McKenna said. “What did they do with all that money? There’s so many questions begged by their own reporting.”The Charlotte Lozier scholars said there were other expenses not listed in the report, such as maternity clothing, property-related payments, fundraising, marketing and staff salaries. Data from their report indicates that, between 2019 and 2022, the number of volunteers who work at the centers fell while the number of paid staffers rose. (Volunteers still make up the overwhelming bulk of the workforce.)“Most non-profits prefer to use staff when possible. Centers are attracting more professionals that desire to help women,” the scholars said. “Many centers are now in a place where they can pay them so they are less reliant on volunteers.”The institute’s report on anti-abortion pregnancy centers in 2022 is a very different document to the reports that it released to cover the centers in 2019 and 2017. The earlier reports span dozens of pages; the 2022 report is only four. A longer report is now in the works, the Charlotte Lozier scholars said, which will include information about government funding of centers.A lack of regulationAlthough anti-abortion pregnancy centers may appear to be local mom-and-pop organizations, in reality many are affiliated with national organizations like NIFLA, Care Net and Heartbeat International. These centers thrive in a kind of regulatory dead zone, providing medical services like ultrasounds. But many are not licensed as medical facilities, leaving them unencumbered by the rules or oversight imposed on typical medical providers.“They are changing their names a lot and changing their names in ways like including ‘clinic’ or ‘medical’ or ‘healthcare’ into their names and dropping things like ‘Care Net’ and other types of wording that might instantly identify them as a CPC,” said Andrea Swartzendruber, an associate professor at the University of Georgia College of Public Health who tracks anti-abortion pregnancy centers.These centers, she said, are “changing their names in ways that make them seem more like medical clinics”.The Charlotte Lozier Institute scholars said “calls for governmental regulation are nothing new” post-Roe and that “such efforts have been ongoing for decades”.“They have been found to be politically motivated and have been largely unsuccessful,” the scholars said. “Abortion facilities are in need of far greater government regulation.”Anti-abortion pregnancy centers’ taxes can also be deeply intricate. The analysis by Reproductive Health and Freedom Watch found that the centers used a variety of tax codes to describe themselves, frequently describing themselves as organizations that provide “family services” or “reproductive healthcare”. They were sometimes listed as organizations that work to outlaw abortions, or as explicitly Christian, religious organizations.The National Committee for Responsive Philanthropy, a charity watchdog group, has previously found that many centers share tax identification numbers with much larger organizations that do multiple kinds of charity work, such as non-profits run by Catholic dioceses. By sharing numbers, these organizations are effectively collapsed into one legal and tax entity, the committee said.The Charlotte Lozier Institute scholars told the Guardian that “this is not our understanding at all”. NIFLA, Care Net and Heartbeat International do not share tax identification numbers with affiliated centers, they said.Just because these particular groups do not share tax identification numbers does not preclude centers from sharing them with other organizations. For example, Care Net is affiliated with a string of Florida pregnancy centers – which, rather than sharing Care Net’s tax ID, are instead listed on tax documents for a wide-ranging charity run by a local Catholic diocese.Anti-abortion pregnancy centers tend to be faith-based. Given the industry’s religious bent, courts have proven reluctant to restrict centers in order to avoid treading on their free speech rights.In 2018, the US supreme court ruled to toss a California law that would have forced centers to disclose whether they were a licensed medical provider. Then, last year, a federal judge in Colorado paused a law that would have banned “abortion reversal”, an unproven drug protocol that aims to halt abortions and is often offered by anti-abortion pregnancy centers. (The first randomized, controlled clinical study to try to study the “reversal” protocol’s effectiveness suddenly stopped in 2019, after three of its participants went to the hospital hemorrhaging blood.)“More regulation could lead to better reporting, which would also then help with reducing all of these risks,” said Teneille Brown, a University of Utah College of Law professor who studies anti-abortion pregnancy centers. “Then the consumers could get some sense of like, ‘Oh, this clinic has had a bunch of violations,’ and if there were regulation, they could actually even shut them down.” More