On Sunday morning, Donald Trump made something crystal clear: Robert F. Kennedy Jr. is “going to have a big role in the administration” if he wins. And some of RFK Jr.’s wildest ideas—including banning certain vaccines and removing fluoride from drinking water—could be on the table.

Trump made the comments to NBC News reporter Dasha Burns, who said she got ahold of him by phone just 48 hours out from Election Day. This is not the first time Trump has indicated that Kennedy could wield a terrifying amount of power: At a campaign rally last Sunday, Trump said he would let the conspiracy theorist and failed presidential candidate “go wild on health” if he’s reinstalled in the White House. (Kennedy also said recently that Trump promised him control of the Department of Health and Human Services and the Department of Agriculture.) But Trump’s latest comments make clear just how far he’d let RFK Jr. go.

When Burns asked Trump on Sunday if he would, in fact, push to remove fluoride from drinking water—as RFK Jr. claimed on Saturday—Trump reportedly replied: “Well, I haven’t talked to him about it yet, but it sounds okay to me. You know it’s possible.”

As the Centers for Disease Control and Prevention points out, fluoride prevents cavities in teeth, and “consistent, low levels of fluoride” are necessary to keep teeth healthy.

And when Burns asked Trump if he’d let RFK Jr. ban certain vaccines, the Republican nominee had this to say: “I’m going to talk to him and talk to other people, and I’ll make a decision, but he’s a very talented guy and has strong views.” As my colleague Julia Métraux reported, RFK Jr. has signaled his opposition to several vaccines, including for Covid-19, Hepatitis B, and the flu.

Trump’s comments are a reminder of both the havoc RFK Jr. could wreak if he is installed in a high-ranking federal position, as well as the kinds of people the Republican nominee plans to appoint to key positions should he win. As David Corn has noted, RFK Jr. has spread anti-vaccine misinformation connected to a deadly 2019 measles outbreak in Samoa.

If you think that’s wild, just wait. If Trump wins, there will be RFK-esque figures installed across government, many of whom have ambitious plans to deregulate health in America. As my colleague Anna Merlan has reported, Project 2025—the extremist right-wing guidebook to a second Trump term—calls for the CDC to be broken up and demonizes the National Institutes of Health. In other words: RFK Jr. banning vaccines and fluoride would be just the start.

On Sunday morning, Donald Trump made something crystal clear: Robert F. Kennedy Jr. is “going to have a big role in the administration” if he wins. And some of RFK Jr.’s wildest ideas—including banning certain vaccines and removing fluoride from drinking water—could be on the table.

Trump made the comments to NBC News reporter Dasha Burns, who said she got ahold of him by phone just 48 hours out from Election Day. This is not the first time Trump has indicated that Kennedy could wield a terrifying amount of power: At a campaign rally last Sunday, Trump said he would let the conspiracy theorist and failed presidential candidate “go wild on health” if he’s reinstalled in the White House. (Kennedy also said recently that Trump promised him control of the Department of Health and Human Services and the Department of Agriculture.) But Trump’s latest comments make clear just how far he’d let RFK Jr. go.

When Burns asked Trump on Sunday if he would, in fact, push to remove fluoride from drinking water—as RFK Jr. claimed on Saturday—Trump reportedly replied: “Well, I haven’t talked to him about it yet, but it sounds okay to me. You know it’s possible.”

As the Centers for Disease Control and Prevention points out, fluoride prevents cavities in teeth, and “consistent, low levels of fluoride” are necessary to keep teeth healthy.

And when Burns asked Trump if he’d let RFK Jr. ban certain vaccines, the Republican nominee had this to say: “I’m going to talk to him and talk to other people, and I’ll make a decision, but he’s a very talented guy and has strong views.” As my colleague Julia Métraux reported, RFK Jr. has signaled his opposition to several vaccines, including for Covid-19, Hepatitis B, and the flu.

Trump’s comments are a reminder of both the havoc RFK Jr. could wreak if he is installed in a high-ranking federal position, as well as the kinds of people the Republican nominee plans to appoint to key positions should he win. As David Corn has noted, RFK Jr. has spread anti-vaccine misinformation connected to a deadly 2019 measles outbreak in Samoa.

If you think that’s wild, just wait. If Trump wins, there will be RFK-esque figures installed across government, many of whom have ambitious plans to deregulate health in America. As my colleague Anna Merlan has reported, Project 2025—the extremist right-wing guidebook to a second Trump term—calls for the CDC to be broken up and demonizes the National Institutes of Health. In other words: RFK Jr. banning vaccines and fluoride would be just the start.

In overturning Roe v. Wade, the US Supreme Court gave state-level judges enormous new power to decide the reproductive fates of tens of millions of people of childbearing age. With the national right to abortion wiped out, states were forced to decide if abortions were legal for their residents as pre-Roe “zombie” laws, trigger bans, and state constitutional protections whipsawed pregnant people trying to receive care. And now, in ten states, abortion-rights ballot measures are going before voters.

It has been up to state courts to sort out this increasingly convoluted mess. Could a 150-year-old law criminalizing abortion be used to prosecute modern-day doctors? The Arizona Supreme Court decided it could. Do frozen embryos count as “children”? The Alabama Supreme Court said so in February. And does a state constitution’s guarantee of “life, liberty, and the pursuit of happiness” protect a woman’s right to end her own pregnancy? Last month, a North Dakota state judge decided yes. Meanwhile, over the last year, state supreme courts in Iowa, Florida, and Georgia have all allowed six-week bans on abortion to take effect.

Yet unlike their federal counterparts, these black-robed figures don’t enjoy lifetime appointments. Two years after Dobbs, state supreme courts have become among the most critical battlegrounds of the 2024 elections. Twenty-two states allow voters to elect their state supreme court justices, and several more let voters decide whether to retain justices appointed by the governor. Anti-abortion forces have long understood that controlling who sits on state high courts is critical to cementing and expanding their far-right agenda. Indeed, it was only after the GOP governors of Iowa and Florida packed their supreme courts with conservative justices did those courts overturn prior state precedents and uphold draconian abortion bans.

“State courts have been an under-resourced and overlooked tool for reproductive and gender equity.”

Abortion rights supporters are finally seeing the light. “State courts have been an under-resourced and overlooked tool for reproductive and gender equity,” says Christina Uribe, director of the Gender Equity Action Fund, which channels money to local progressive and reproductive-rights advocacy groups that educate voters about state-level judicial races. “There’s a lot of opportunity here, and a lot of work left to do to make sure people understand the power that state courts have over their daily lives and the power they have to decide who sits on the bench.”

Progressives made the most of that opportunity in last year’s Wisconsin Supreme Court special election, which shattered turnout and spending records in a battle for ideological control of the highest court in a crucial swing state. The victory of an openly pro-choice justice, Janet Protasiewicz, swung control of the court leftward for the first time in 15 years, with consequences for both abortion access and voter rights. The court has the final say over Wisconsin’s congressional maps, for instance, which have been heavily gerrymandered to favor the GOP.

Advocates like Uribe are hoping that concerns over reproductive rights will have the same impact this November. “Abortion turns out to be really highly mobilizing,” she says. (It’s true.) “I do believe voters subconsciously associate the US Supreme Court with ‘they created this mess.’ They don’t want the state court creating more of a mess.”

So which states have supreme court elections to watch? Here are seven states where the outcome on November 5 could influence the future of abortion rights for tens of millions of people.

Ohio

A trio of partisan Supreme Court races are expected to shape how Ohio implements an abortion-rights amendment that passed with broad support last year.

In November 2023, Ohioans voted overwhelmingly to create a state constitutional right to “make and carry out one’s own reproductive decisions.” But what does that mean for the state’s six-week abortion ban, which is still on the books? What about the many other incremental restrictions on abortion that lawmakers have passed over the decades? As long as the Republican-dominated state legislature doesn’t repeal these laws—and they haven’t—it’s up to the courts to decide.

So far, in response to lawsuits by abortion-rights advocates, lower-court Ohio judges have permanently blocked the six-week ban and have temporarily blocked a 24-hour waiting period and a rule against physician assistants and nurse practitioners providing abortion pills. But those fights aren’t over—and they will almost certainly be appealed all the way up to the state’s high court, which is now controlled 4-3 by Republican justices.

Ohio Supreme Court terms last six years, and races were nonpartisan until 2021, when GOP state lawmakers voted to add candidates’ party affiliations to the ballot, claiming it was needed to better inform voters (they had just lost three seats to liberal candidates.) This year’s races are uphill battles for Democrats, who need to win all three state seats to gain a majority and potentially determine the outcome of the abortion rights cases. If Republicans win all three, they’ll hold a 6-1 supermajority, with a clear advantage for abortion opponents. 

Michigan

As in Ohio, Michigan’s Supreme Court has the final word on whether old anti-abortion laws will be overturned after voters passed a constitutional amendment enshrining abortion rights in 2022. Democratic Gov. Gretchen Whitmer has already signed a package of bills repealing some laws that conflicted with the new amendment. But other restrictions persist, including a ban on Medicaid-funded abortions and a parental consent requirement for minors.

Michigan justices serve eight-year terms, with two seats up for election at a time, and no term limits. Democratic-backed justices currently hold a 4-3 majority on the court, and Republican-backed candidates will need to win both races on the November ballot to flip control. (While Michigan Supreme Court races are ostensibly nonpartisan, candidates are selected at party nominating conventions.) Justice Kyra Harris Bolden, an incumbent appointed by Whitmer, is running against Judge Patrick O’Grady, who was nominated after a Trump ally charged with election tampering dropped out. Meanwhile, law professor Kimberly Thomas is the Democrat vying for an open seat against Republican state representative Andrew Fink. In 2021, Fink supported a city ordinance making it a crime to “aid or abet” abortion in the Ohio city of Hillsdale, the home of an influential conservative Christian college.

Montana

In a red state where voters put a premium on keeping the government out of people’s daily lives, the Montana Supreme Court has often taken a remarkably permissive approach to abortion rights. In a 1999 case, Armstrong v. State, it ruled that the state constitution’s strong language around privacy implies a right to “procreative autonomy.” Based on this precedent, even before Dobbs, state courts struck down a parade of anti-abortion laws:: a 20-week ban, waiting periods, mandatory ultrasounds, parental notification requirements, and prohibition of telemedicine abortion, among others.

But with two of the seven state Supreme Court seats up for grabs this November, reproductive rights advocates are worried the tide could shift, especially with the state attorney general firing shots at Armstrong. Justices serve eight-year terms, and the court is officially nonpartisan, but both retiring justices are seen as left-leaning. Two candidates to replace them, Jerry Lynch and Katherine Bidegaray, have both said they agreed with Armstrong’s reasoning (responding to a Montana ACLU questionnaire). Two others, Cory Swanson and Dan Wilson, have been dubbed part of a “pro-life team for Montana” by the anti-abortion group Susan B. Anthony Pro-Life America—and neither answered the ACLU question.

One additional factor: If Montana voters pass a constitutional amendment known as CI-128 that’s also on the November ballot, they’ll enshrine an explicit right to abortion until the point of fetal viability, around 24 weeks. As in Ohio and Michigan, it will be up to the state Supreme Court to interpret the amendment, if it passes.

North Carolina

Over the past few years, conservatives have gradually flipped control of North Carolina’s supreme court, and Republican justices now hold a 5-2 majority. They could extend that margin to 6-1 this year if state Court of Appeals Judge Jefferson Griffin beats incumbent Justice Allison Riggs, who was appointed by Democratic Gov. Roy Cooper to fill a vacancy.

Griffin is seen as a threat to abortion rights. Last year, he was part of a three-judge panel that ruled that a mother’s parental rights could be terminated if her child was in utero at the time she committed a crime—because “life begins at conception.” The ruling was so error-ridden, and the outcry so loud, that it was withdrawn three weeks later.

Now, Griffin could ascend to the state’s highest court for an eight-year term. But even if Riggs keeps her seat, Democrats would need to win Supreme Court races again in 2026 and 2028 to recover the majority. It’s a long game in a state that once served as an abortion-access lifeline to pregnant people in the South— until a single state representative switched parties and gave Republicans the supermajority they needed to enact a 12-week abortion ban over Cooper’s veto last year.

Retention elections in Arizona and Indiana

In Arizona and Indiana, supreme court justices are appointed by governors but must run for a retention election after two years, and then every six or ten years thereafter. (In Arizona, for instance, an initial 2-year term would be followed followed by 6-year terms. Indiana’s initial 2-year term is then followed by a 10- year term.) Usually, these up-or-down votes in the retention election are perfunctory: Only six judges in Arizona’s 112-year history have not been retained, according to the Tucson Sentinel, and it’s never happened at the supreme court level.

Voters this year could buck that trend, as progressive and abortion-rights advocates try to mobilize a “No” vote on retention elections for Justices Clint Bolick and Kathryn King in Arizona; and Justices Mark Massa, Derek Molter, and Loretta Rush in Indiana.

All these justices have signed on to opinions that blocked access to abortion in their states. In Arizona, Bolick and King joined a ruling in April that said the state could enforce its 1864 “zombie” abortion ban—triggering so much public outcry, the legislature soon repealed the old law. In Indiana, the three justices upheld a near-total abortion ban, interpreting the state constitution to only protect abortion when the procedure was “necessary to protect [the pregnant person’s] life or to protect her from a serious health risk.”

While retention elections have been sleepy in the past, the campaigns against these justices have made some sit up and take notice. Supporters of the Arizona judges are trying to stop the judicial elections altogether, by filing their own ballot initiative. Proposition 137 would eliminate the state’s retention election system, and instead allow appointed judges to keep their seats indefinitely unless they are convicted of a crime or a commission finds their performance lacking. If it passes, it would nullify “No” votes against King or Bolick. 

Texas

The Texas Supreme Court has been uniformly Republican since 1998. So it seemed like a safe bet that the three incumbent Republican justices—Jimmy Blacklock, John Devine, and Jane Bland—would easily swat away their trio of Democratic challengers this November. That was until the emergence of Find Out PAC—a committee formed this spring by former US Air Force undersecretary Gina Ortiz Jones to go after the Texas justices who “f*cked around with our reproductive freedoms, and now they’re going to find out,” as the group’s website puts it.

Find Out PAC’s ads draw attention to the justices’ recent rulings against women who were denied abortions amid dangerous pregnancies. Last December, the court ruled against Kate Cox, a pregnant woman who found out her fetus had no chance of survival. Her doctor said carrying the pregnancy to term would put her at high risk for serious medical complications and require her to undergo a C-section, so Cox sought to temporarily block the state’s ban so she could get an abortion. A lower court initially agreed, but the Texas Supreme Court stepped in to block the order. Then, in May, the court unanimously decided that the state abortion ban’s medical exceptions were sufficiently clear, even though a group of women said they were denied abortions despite experiencing serious pregnancy complications. One of the plaintiffs, Amanda Zurawski, had been forced to wait until she was diagnosed with a life-threatening case of sepsis and a fallopian tube infection that affected her future fertility.

The odds are still long in all three races, but the seat considered most likely to flip is currently held by Justice John Devine, who has bragged about being arrested outside abortion clinics; he also missed more than half of oral arguments between last September and February because he was too busy campaigning. “These folks are elected; they can be unelected,” Jones told the Austin-American Statesman. “Republicans understand that the bench is a stepping stone for higher office, while we’re not even fighting for those seats.”

If Donald Trump becomes president again, it looks like Robert F. Kennedy Jr. will have his say over who gets which vaccines: Trump said at a rally last weekend that he would let RFK Jr. “go wild” on health should he win the White House. RFK Jr. said Trump promised him control of the Department of Health and Human Services, where the CDC and FDA are housed; Trump’s campaign seemed to suggest that wasn’t set in stone.

A world where an anti-vax advocate would play a large role in shaping vaccine policy is kind of terrifying. While RFK Jr. does make extremely off-the-cuff comments, including about Covid-19 vaccines, some of Kennedy’s specific claims about vaccines may not be apparent unless you go looking for them.

Well, I went looking for them. Here are some of RFK Jr.’s claims about various childhood vaccines throughout the decades, most of which are usually required if you go to public schools. What’s perhaps the most disturbing underlying factor of all his vaccine conspiracy theories is the suggestion that a dead child—vaccines save a lot of lives—is better than an autistic or chronically ill one, conditions he claims vaccines cause.

Measles, Mumps, and Rubella 

In a 2005 Rolling Stone article, RFK Jr. suggests that a rise in childhood vaccines was tied to an increase in kids being diagnosed with autism.

Before 1989, American preschoolers received 11 vaccinations—for polio, diphtheria-tetanus-pertussis and measles-mumps-rubella. A decade later, thanks to federal recommendations, children were receiving a total of 22 immunizations by the time they reached first grade. As the number of vaccines increased, the rate of autism among children exploded.

RFK Jr. was not the first person to suggest a link between the MMR vaccine and autism. Andrew Wakefield’s retracted Lancet study linking the two, which was total nonsense, should take a lot of the blame. But RFK Jr. still promoted the conspiracy theory that the measles vaccine was linked to autism in a 2021 Fox News interview, and in his 2023 co-written book Vax Unvax, Kennedy also suggests that the measles vaccine is linked to Crohn’s disease and ulcerative colitis.

Diphtheria-Tetanus-Pertussis (and Haemophilus Influenzae B)

In the same Rolling Stone piece, RFK Jr. essentially claimed that Americans had been poisoning their kids with vaccines that contained thimerosal, which is no longer in routine childhood vaccines, except some versions of the flu vaccine.

Tragically, that same year, the CDC recommended that infants be injected with a series of mercury-laced vaccines. Newborns would be vaccinated for hepatitis B within 24 hours of birth, and 2-month-old infants would be immunized for haemophilus influenzae B and diphtheria-tetanus-pertussis.

The FDA says that the thimerosal in vaccines has “significantly declined due to reformulation and development of new vaccines—not that the tiny amount of it in vaccines was linked to autism or other health issues. Kennedy also claimed that receiving multiple DTP vaccines raised infant mortality (the 2004 study which Kennedy and Brian Hooker, his cowriter, cite has not been replicated).

Hepatitis B

In a 2017 interview with Stat News, RFK Jr. said that the Hepatitis B vaccine hadn’t received enough testing. He seemed to find a new argument as to why the treatment wasn’t when thimerosal was removed:

The hepatitis B vaccines that are currently approved had fewer than five days of safety testing. That means that if the child has a seizure on the sixth day, it’s never seen.

Also, people can report an adverse event at any point.

Rotavirus

Back to the infamous 2005 Rolling Stone piece: RFK Jr. seems to suggest that people should not trust the rotavirus vaccine because of financial conflicts of interest in its advocacy.

The House Government Reform Committee discovered that four of the eight CDC advisors who approved guidelines for a rotavirus vaccine “had financial ties to the pharmaceutical companies that were developing different versions of the vaccine.” Offit, who shares a patent on one of the vaccines, acknowledged to me that he “would make money” if his vote eventually leads to a marketable product. But he dismissed my suggestion that a scientist’s direct financial stake in CDC approval might bias his judgment. “It provides no conflict for me,” he insists. “I have simply been informed by the process, not corrupted by it.”

In a 2023 Substack post, Paul Offit, the doctor RFK Jr. referred to in that excerpt, debunked both Kennedy’s claims about himself, and the shoddy science he relied on.

Polio

Type I diabetes is a serious illness—one that Kennedy stokes fears of in his book Vax Unvax. The book claims that Type I diabetes appears in about 21 of 100,000 kids vaccinated against polio, more than double the rate for those who were not vaccinated, according to research performed between 1990 and 2000. Kennedy and Hooker cite a single study to support their claim that the typical polio vaccine given until the year 2000 was dangerous. But most other research refutes this claim. Vax Unvax claims to want to “let the science speak,” per its subtitle, but doesn’t mention how polio can lead to permanent paralysis.

Influenza

As you can probably tell by now, Kennedy likes picking single studies to back his narrative. In Vax Unvax, Kennedy and Hooker point to one study that claims that kids who have gotten the seasonal flu vaccine are almost four times more likely to be hospitalized.

Kennedy’s strategy on childhood vaccines is to instill fear backed by lone studies, claiming they can make kids sicker, in opposition to decades of research that show that childhood vaccines stop kids from getting sicker—and let them avoid preventable long-term health effects.

If Donald Trump becomes president again, it looks like Robert F. Kennedy Jr. will have his say over who gets which vaccines: Trump said at a rally last weekend that he would let RFK Jr. “go wild” on health should he win the White House. RFK Jr. said Trump promised him control of the Department of Health and Human Services, where the CDC and FDA are housed; Trump’s campaign seemed to suggest that wasn’t set in stone.

A world where an anti-vax advocate would play a large role in shaping vaccine policy is kind of terrifying. While RFK Jr. does make extremely off-the-cuff comments, including about Covid-19 vaccines, some of Kennedy’s specific claims about vaccines may not be apparent unless you go looking for them.

Well, I went looking for them. Here are some of RFK Jr.’s claims about various childhood vaccines throughout the decades, most of which are usually required if you go to public schools. What’s perhaps the most disturbing underlying factor of all his vaccine conspiracy theories is the suggestion that a dead child—vaccines save a lot of lives—is better than an autistic or chronically ill one, conditions he claims vaccines cause.

Measles, Mumps, and Rubella 

In a 2005 Rolling Stone article, RFK Jr. suggests that a rise in childhood vaccines was tied to an increase in kids being diagnosed with autism.

Before 1989, American preschoolers received 11 vaccinations—for polio, diphtheria-tetanus-pertussis and measles-mumps-rubella. A decade later, thanks to federal recommendations, children were receiving a total of 22 immunizations by the time they reached first grade. As the number of vaccines increased, the rate of autism among children exploded.

RFK Jr. was not the first person to suggest a link between the MMR vaccine and autism. Andrew Wakefield’s retracted Lancet study linking the two, which was total nonsense, should take a lot of the blame. But RFK Jr. still promoted the conspiracy theory that the measles vaccine was linked to autism in a 2021 Fox News interview, and in his 2023 co-written book Vax Unvax, Kennedy also suggests that the measles vaccine is linked to Crohn’s disease and ulcerative colitis.

Diphtheria-Tetanus-Pertussis (and Haemophilus Influenzae B)

In the same Rolling Stone piece, RFK Jr. essentially claimed that Americans had been poisoning their kids with vaccines that contained thimerosal, which is no longer in routine childhood vaccines, except some versions of the flu vaccine.

Tragically, that same year, the CDC recommended that infants be injected with a series of mercury-laced vaccines. Newborns would be vaccinated for hepatitis B within 24 hours of birth, and 2-month-old infants would be immunized for haemophilus influenzae B and diphtheria-tetanus-pertussis.

The FDA says that the thimerosal in vaccines has “significantly declined due to reformulation and development of new vaccines—not that the tiny amount of it in vaccines was linked to autism or other health issues. Kennedy also claimed that receiving multiple DTP vaccines raised infant mortality (the 2004 study which Kennedy and Brian Hooker, his cowriter, cite has not been replicated).

Hepatitis B

In a 2017 interview with Stat News, RFK Jr. said that the Hepatitis B vaccine hadn’t received enough testing. He seemed to find a new argument as to why the treatment wasn’t when thimerosal was removed:

The hepatitis B vaccines that are currently approved had fewer than five days of safety testing. That means that if the child has a seizure on the sixth day, it’s never seen.

Also, people can report an adverse event at any point.

Rotavirus

Back to the infamous 2005 Rolling Stone piece: RFK Jr. seems to suggest that people should not trust the rotavirus vaccine because of financial conflicts of interest in its advocacy.

The House Government Reform Committee discovered that four of the eight CDC advisors who approved guidelines for a rotavirus vaccine “had financial ties to the pharmaceutical companies that were developing different versions of the vaccine.” Offit, who shares a patent on one of the vaccines, acknowledged to me that he “would make money” if his vote eventually leads to a marketable product. But he dismissed my suggestion that a scientist’s direct financial stake in CDC approval might bias his judgment. “It provides no conflict for me,” he insists. “I have simply been informed by the process, not corrupted by it.”

In a 2023 Substack post, Paul Offit, the doctor RFK Jr. referred to in that excerpt, debunked both Kennedy’s claims about himself, and the shoddy science he relied on.

Polio

Type I diabetes is a serious illness—one that Kennedy stokes fears of in his book Vax Unvax. The book claims that Type I diabetes appears in about 21 of 100,000 kids vaccinated against polio, more than double the rate for those who were not vaccinated, according to research performed between 1990 and 2000. Kennedy and Hooker cite a single study to support their claim that the typical polio vaccine given until the year 2000 was dangerous. But most other research refutes this claim. Vax Unvax claims to want to “let the science speak,” per its subtitle, but doesn’t mention how polio can lead to permanent paralysis.

Influenza

As you can probably tell by now, Kennedy likes picking single studies to back his narrative. In Vax Unvax, Kennedy and Hooker point to one study that claims that kids who have gotten the seasonal flu vaccine are almost four times more likely to be hospitalized.

Kennedy’s strategy on childhood vaccines is to instill fear backed by lone studies, claiming they can make kids sicker, in opposition to decades of research that show that childhood vaccines stop kids from getting sicker—and let them avoid preventable long-term health effects.

When Wendy Davis wanted to get birth control as a teenager in the 1980s, she went to her local Planned Parenthood in Fort Worth, Texas, with a friend. “There is absolutely no way I would have asked my mother for her permission to do that,” says Davis, the former Texas state senator who famously filibustered an anti-abortion bill for 11 hours in a pair of pink sneakers. “That’s just not something that’s possible for many, many, many teenage girls.” 

Forty years later, with abortion banned in wide swaths of the country, access to reliable contraception is more important than ever. Yet for Texas teens, getting prescription birth control is arguably harder now than it was when Davis was an adolescent. Over the past two years, federal courts—including the notoriously conservative 5th Circuit—have ruled that minors must have parental consent to obtain prescription birth control from Texas clinics subsidized by a federal family planning program known as Title X. Flush with victory, Texas Republicans have made it clear: They have no intention of stopping there. In late July, Attorney General Ken Paxton filed suit to overturn a new federal rule that reaffirmed teens’ ability in other states to get contraception without their parents’ consent. “The Biden Administration continues to prove they will do anything to implement their extremist agenda,” Paxton said in a press release.

To anyone paying even a modicum of attention, the far right’s plans to limit access to birth control have long been hiding in plain sight. When the Supreme Court overturned the federal right to abortion in the Dobbs decision in 2022, Justice Clarence Thomas wrote that the court “should reconsider” other rulings with similar legal principles, including Griswold v. Connecticut, the 1965 decision establishing a right to contraception (and, more fundamentally, a constitutional right to privacy). The ultra-conservative strategists behind Project 2025— including Roger Severino, longtime anti-abortion movement lawyer, and Russell Voght, an avowed Christian nationalist—have spelled out a plan for how a Republican-led White House could gut or rewrite key federal birth-control regulations, building on efforts that began during the first Trump administration. (While Trump has tried to distance himself from Project 2025, even claiming he doesn’t know who wrote it, at least 140 members of Trump’s team, including Severino and Voght, had a hand in drafting it.)

But what has escaped many Americans is that these threats aren’t just terrifying what-if-this-happens scenarios. As the Texas lawsuits show, in some parts of the United States, that scary future has already arrived. States have been passing laws allowing pharmacies to refuse to fill birth control prescriptions based on moral objections, or proposing legislation that unscientifically classifies emergency contraception and IUDs as “abortifacients.” Reproductive Health and Freedom Watch has found that since 2021, at least 21 states have directed a total of $513 million to religiously affiliated crisis pregnancy centers and “alternatives to abortion” programs that actively spread misinformation about birth control and discourage its use.

And though contraception is supported by around 90 percent of voters, when Congress had the chance earlier this year to pass a law protecting access to birth control, Republican senators blocked it, claiming it was unnecessary.

The Biden administration has repeatedly pushed back—most recently, with a new proposed rule under the Affordable Care Act to require private insurance to cover 100 percent of the cost of over-the-counter birth control and offer patients more choices for prescription contraception. In a statement, Vice President Kamala Harris described the move as “the largest expansion of contraception coverage in more than a decade.” But the regulations won’t be finalized until after the presidential election, and the new rules are virtually certain to be challenged in GOP-packed federal courts even if Harris wins. 

And what if she doesn’t?

A new Trump administration and its right-wing allies are expected to escalate attacks on contraception on a multitude of fronts, including appointing extremists to key government positions. Rather than outright bans, we should expect more subtle incursions—regulatory changes, limits on insurance coverage, and funding reductions for family planning, as well as rules like the parental consent requirement for teens, according to reproductive health policy experts interviewed by Mother Jones. “It would be cleaner if there was some direct attack on the right to contraception that opponents of reproductive healthcare were pursuing,” says Kelly Baden, vice president for public policy at the Guttmacher Institute. “They’re not. It is much more behind-the-scenes, around the margins. And yet, the impact is still potentially devastating.”

“It would be cleaner if there was some direct attack on the right to contraception that opponents of reproductive healthcare were pursuing. They’re not.”

“That’s what happened to abortion,” adds Amanda Stevenson, an assistant professor at the University of Colorado-Boulder who studies the impact of family planning policy. “Death by a thousand cuts.”

Here are four key strategies we can expect under a new Trump administration intent on undermining access to contraception:

Doubling Down on False Claims that Birth Control Causes Abortion

One of the most common attack lines against contraception is the claim that certain methods—notably IUDs and morning-after pills—are abortifacients, which is to say they cause abortion, purportedly by preventing fertilized eggs from implanting in the uterus. In fact, decades of research show that these methods block fertilization from ever happening—by preventing the release of eggs, for instance, or stopping sperm from reaching them. Yet the belief that IUDs and emergency contraception, like Plan B and Ella, end pregnancies rather than preventing them has become distressingly common, thanks in part to rampant misinformation spread by the anti-abortion movement—including appointees in the first Trump administration.

The falsehoods have made their way into Food and Drug Administration policy, with decades-long repercussions for reproductive health. Back in the early 2000s, when the FDA was trying to decide whether Plan B should be sold over the counter, it relied on an advisory committee that included several abortion opponents. Over the objections of their colleagues, those committee members persuaded the agency to include language in Plan B’s packaging that stated the drug “may also work” by preventing implantation. Not until 2022 did the FDA finally update the Plan B label to clarify the drug “does not terminate a pregnancy.” But anti-abortion groups could challenge that update in a second Trump administration.

Meanwhile, since 2015, the “abortifacient claim” has inspired lawmakers in at least seven states to vote to cut off funding for contraception or block bills to protect access to it, USA Today found in a recent investigation. Project 2025 also continues this line of attack, describing Ella as a “potential abortifacient” and proposing to wipe out mandatory insurance coverage for it. Some anti-abortion organizations, including the influential Students for Life, even falsely claim that the daily birth control pill is an abortifacient. As my colleague Kiera Butler has written, it’s all part of a growing right-wing movement to persuade women that hormonal contraception is just plain bad for them. If Trump wins, his appointees are likely to bring those arguments with them to the agencies they oversee, further threatening birth control access.

Rewriting Title X

Attacking government subsidies for contraception has been part of the GOP playbook for decades. A favorite target is Title X, a federal safety-net program that underwrites free reproductive health services—birth control, cervical cancer screenings, and STI screening and treatment, but not abortion—for low-income and uninsured people. Planned Parenthood clinics, a common provider of these services, receive about 20 percent of Title X funds.

No surprise: Texas has led the way in attacking the federal program since 2011, when the legislature slashed state funding for reproductive health care and redirected Title X money to primary care providers. The changes that year—designed to kneecap Planned Parenthood—forced scores of reproductive health clinics to close, and others to reduce hours, charge patients new fees, or ration the most effective (but expensive) forms of contraception, such as IUDs. As a result of the changes, the number of clients served by Texas family planning organizations fell by more than half, and the teen birth rate rose an estimated 3.4 percent. “It shredded the safety net for women’s health care in our state,” says Davis, now a senior adviser to Planned Parenthood Texas Votes. “Tens of thousands of women literally lost the only health care they had ever known, overnight. It was devastating, and slowly, we’ve been building our way back.”

“Tens of thousands of women literally lost the only health care they had ever known, overnight.”

Trump’s first-term appointees, following Texas’ lead, set about dramatically reshaping the entire Title X program. The administration’s “gag rule,” first proposed under Ronald Reagan but never fully implemented, which forbids any clinics that took Title X money from referring patients to abortion providers. It also required them to keep separate books and separate facilities from their abortion services, if they offered them—a logistical nightmare. Some 1,300 reproductive health facilities, including 400 Planned Parenthood clinics, withdrew from the program rather than withhold abortion referrals from patients who wanted them, and roughly 1.6 million patients lost access to federally subsidized birth control. “It was a very difficult time in the program,” says Clare Coleman, president of the National Family Planning & Reproductive Health Association. “Of course, the numbers plummeted.” What happened to the freed-up Title X money? The Trump administration sent some of it to a chain of Christian “crisis pregnancy centers” that refused to provide contraception or even referrals for birth control, as my colleague Stephanie Mencimer found in a 2019 investigation.

When Joe Biden took office, his administration promptly revoked the Trump rule, and the Title X network started rebuilding. But Vice presidential candidate Ohio Sen. JD Vance has already signaled that a second Trump administration would try again to defund Planned Parenthood—code for attacking Title X. Project 2025 urges the next president to “quickly” reissue the gag rule. It also advocates that Title X be “reframed with a focus on better education around fertility awareness”—a less-reliable method of cycle tracking favored by anti-abortion activists and wellness influencers—with grants opened up once again to anti-abortion religious organizations.

In anticipation of a Trump win, Coleman’s organization has been working with reproductive health clinics to prepare for the old gag rule to be reissued and even expanded soon after Inauguration Day. Not only could the next version of the rule pick up on Texas’ efforts to require parental consent for teenagers, Coleman warns Trump appointees are also likely to attack gender-affirming care. (Title X does not explicitly fund such care but some providers offer those services separately, just as they do abortion.) “They may say, if you take Title X, you can’t provide any of that care,” Coleman speculates. “We are quite concerned about them trying to enforce not only a gender binary—because we also do see men in the Title X program—but to recast it as: ‘This is a program about biological sex.’”

That’s if Title X survives at all: House Speaker Mike Johnson’s budget bill in September 2023 would have defunded the program entirely.

Gutting the Affordable Care Act

Before the Obama administration passed the Affordable Care Act, birth control accounted for around a third of women’s out-of-pocket healthcare expenses, according to the National Women’s Law Center. Monthly copays deterred women from getting the Pill, while an IUD could have an up-front cost of $1,000.

The ACA changed all that for over 62 million women. Starting in 2012, the law classified contraception as a form of preventive care and made it mandatory for private insurance to cover a wide range of prescription birth control at no cost to consumers. Last year, responding to the fallout from Dobbs, the Biden administration directed agencies to find ways to strengthen the contraception mandate and make sure insurers follow it; last month’s announcement on coverage of over-the-counter contraception follows that effort.

Fighting the contraception mandate has been one of the key ways conservatives and religious groups have sought to erode access to birth control. In 2014, the Supreme Court’s infamous Hobby Lobby ruling blew a crater in the ACA’s contraception mandate in the name of protecting religious freedom. There had always been a religious exemption for churches and houses of worship. But Hobby Lobby expanded that exemption to include 90 percent of US businesses—letting them deny coverage for birth control in employee insurance plans if the owners had a religious objection.

Trump broadened the exemption even further in his first term, allowing employers to decline to provide birth control based on moral, not just religious, objections. “It opens the door wide for any employer that provides health insurance to pick and choose what kind of contraception they would like to cover,” says Dana Singiser, cofounder of the Contraceptive Access Initiative.

Of course, there’s always the chance that a Republican White House and Congress would wipe out the ACA altogether, as Trump tried to do in 2017. Trump has since made conflicting statements about whether he would try again for a repeal or impose “concepts of a plan” to replace it. In late October, Speaker Johnson promised a “massive reform” of the ACA if Trump is elected.

Even with the ACA still on the books, experts say Trump could do significant damage, bypassing Congress by issuing new regulations or guidance from executive-branch agencies. Project 2025 leans in on this idea, urging the next president to make regulatory moves that would hobble the contraceptive mandate. “It’s not flashy,” says Lauren Wallace, senior counsel for reproductive rights and health at the National Women’s Law Center. “Every administration is allowed to put out proposed rules, put out guidance. So those are the ways this coverage can be stripped.”

“Every administration is allowed to put out proposed rules, put out guidance. So those are the ways this coverage can be stripped.”

The Biden administration is currently finalizing a replacement to Trump’s rule allowing moral objections to the contraceptive mandate; it’s safe to say that Trump would block or revoke it. He could also issue other regulations to make the contraceptive mandate “unworkable,” Wallace says. He could give insurers more agency to make rules around which types of birth control they choose to insure or require patients to try certain methods, before covering more expensive ones.

Project 2025’s authors, of course, have their own ideas about which forms of birth control are preferable. Their blueprint urges the next president to require the Department of Health and Human Services to issue new regulations about what is covered by the ACA contraceptive mandate. In: “fertility awareness” methods. Out: male condoms and Ella.

Shrinking Medicaid While Increasing Surveillance

Back to Texas.

Over the past decade or so, at the same time the state was attacking family planning clinics, it found a way to mess with the most common way people pay for birth control: Medicaid. And Davis sees what it did as a potential model for other states should Trump win.

First, the state passed a law banning abortion providers and their affiliates from participating in the state’s Medicaid-funded family planning program. The law conflicted with a federal rule allowing Medicaid patients to choose any “willing” provider. That meant Texas had to apply to the Obama administration for a waiver of the rule. “They got into a standoff,” Davis recalls. “The Obama administration said, ‘We’re going to remove all of your funding if you do this.’ And Texas said, ‘Fine, do it.’”

For the next few years, Texas ran a shrunken version of the program using state funding. Then Trump appeared, installing a National Right to Life Committee lobbyist to oversee national family planning policy. Texas applied for the Medicaid waiver again—and this time, received it. The Trump administration also gave the state permission not to cover emergency contraception in its Medicaid-funded program.

Davis predicts that other states will use the same maneuver to sever Planned Parenthood from Medicaid, should Trump return to office. Tennessee, which bans virtually all abortions, and South Carolina, which bans them at six weeks, have already applied for similar waivers. And Missouri recently enacted a law to ban all Medicaid reimbursements for abortion providers and their affiliates—even though the state’s abortion ban means they now only provide services like contraception and cancer screening.

Project 2025 proposes making federal Medicaid family planning funding conditional on states participating in a frighteningly detailed abortion surveillance system. “Because liberal states have now become sanctuaries for abortion tourism,” the blueprint says, “HHS should use every available tool, including the cutting of funds, to ensure that every state reports exactly how many abortions take place within its borders.” The database would include the gestational age at which the abortion was performed, the method, and the reason for it.

The proposal would force states to make an “impossible choice,” says Madeline Morcelle, senior attorney at the National Health Law Program. Participating in that “weaponized program,” she says, “would likely be used to criminalize pregnant people,” particularly immigrants, Black, Indigenous, and other people of color, young people, and people with disabilities. But dropping out would likely mean losing federal funding for vital Medicaid services affecting millions of those same low-income people.

Davis, in Texas, says she knows that predictions about losing access to birth control can sound exaggerated. She’s heard such criticisms before—from people who believed that Roe would never fall. “There are those out there who believe that this is hyperbole,” she says. But as a Texan who has witnessed how what appears radical becomes normalized, she has no illusions about the potential dangers. “I don’t think it’s unlikely at all that as Republicans become more and more extreme, and governed in a more and more extreme way by their rightward flank, that we are going to see these things become a reality.”

Correction, October 31: An earlier version of this story misstated which funds Project 2025 suggests withholding from states that don’t participate in an expanded abortion surveillance program.

When Wendy Davis wanted to get birth control as a teenager in the 1980s, she went to her local Planned Parenthood in Fort Worth, Texas, with a friend. “There is absolutely no way I would have asked my mother for her permission to do that,” says Davis, the former Texas state senator who famously filibustered an anti-abortion bill for 11 hours in a pair of pink sneakers. “That’s just not something that’s possible for many, many, many teenage girls.” 

Forty years later, with abortion banned in wide swaths of the country, access to reliable contraception is more important than ever. Yet for Texas teens, getting prescription birth control is arguably harder now than it was when Davis was an adolescent. Over the past two years, federal courts—including the notoriously conservative 5th Circuit—have ruled that minors must have parental consent to obtain prescription birth control from Texas clinics subsidized by a federal family planning program known as Title X. Flush with victory, Texas Republicans have made it clear: They have no intention of stopping there. In late July, Attorney General Ken Paxton filed suit to overturn a new federal rule that reaffirmed teens’ ability in other states to get contraception without their parents’ consent. “The Biden Administration continues to prove they will do anything to implement their extremist agenda,” Paxton said in a press release.

To anyone paying even a modicum of attention, the far right’s plans to limit access to birth control have long been hiding in plain sight. When the Supreme Court overturned the federal right to abortion in the Dobbs decision in 2022, Justice Clarence Thomas wrote that the court “should reconsider” other rulings with similar legal principles, including Griswold v. Connecticut, the 1965 decision establishing a right to contraception (and, more fundamentally, a constitutional right to privacy). The ultra-conservative strategists behind Project 2025— including Roger Severino, longtime anti-abortion movement lawyer, and Russell Voght, an avowed Christian nationalist—have spelled out a plan for how a Republican-led White House could gut or rewrite key federal birth-control regulations, building on efforts that began during the first Trump administration. (While Trump has tried to distance himself from Project 2025, even claiming he doesn’t know who wrote it, at least 140 members of Trump’s team, including Severino and Voght, had a hand in drafting it.)

But what has escaped many Americans is that these threats aren’t just terrifying what-if-this-happens scenarios. As the Texas lawsuits show, in some parts of the United States, that scary future has already arrived. States have been passing laws allowing pharmacies to refuse to fill birth control prescriptions based on moral objections, or proposing legislation that unscientifically classifies emergency contraception and IUDs as “abortifacients.” Reproductive Health and Freedom Watch has found that since 2021, at least 21 states have directed a total of $513 million to religiously affiliated crisis pregnancy centers and “alternatives to abortion” programs that actively spread misinformation about birth control and discourage its use.

And though contraception is supported by around 90 percent of voters, when Congress had the chance earlier this year to pass a law protecting access to birth control, Republican senators blocked it, claiming it was unnecessary.

The Biden administration has repeatedly pushed back—most recently, with a new proposed rule under the Affordable Care Act to require private insurance to cover 100 percent of the cost of over-the-counter birth control and offer patients more choices for prescription contraception. In a statement, Vice President Kamala Harris described the move as “the largest expansion of contraception coverage in more than a decade.” But the regulations won’t be finalized until after the presidential election, and the new rules are virtually certain to be challenged in GOP-packed federal courts even if Harris wins. 

And what if she doesn’t?

A new Trump administration and its right-wing allies are expected to escalate attacks on contraception on a multitude of fronts, including appointing extremists to key government positions. Rather than outright bans, we should expect more subtle incursions—regulatory changes, limits on insurance coverage, and funding reductions for family planning, as well as rules like the parental consent requirement for teens, according to reproductive health policy experts interviewed by Mother Jones. “It would be cleaner if there was some direct attack on the right to contraception that opponents of reproductive healthcare were pursuing,” says Kelly Baden, vice president for public policy at the Guttmacher Institute. “They’re not. It is much more behind-the-scenes, around the margins. And yet, the impact is still potentially devastating.”

“It would be cleaner if there was some direct attack on the right to contraception that opponents of reproductive healthcare were pursuing. They’re not.”

“That’s what happened to abortion,” adds Amanda Stevenson, an assistant professor at the University of Colorado-Boulder who studies the impact of family planning policy. “Death by a thousand cuts.”

Here are four key strategies we can expect under a new Trump administration intent on undermining access to contraception:

Doubling Down on False Claims that Birth Control Causes Abortion

One of the most common attack lines against contraception is the claim that certain methods—notably IUDs and morning-after pills—are abortifacients, which is to say they cause abortion, purportedly by preventing fertilized eggs from implanting in the uterus. In fact, decades of research show that these methods block fertilization from ever happening—by preventing the release of eggs, for instance, or stopping sperm from reaching them. Yet the belief that IUDs and emergency contraception, like Plan B and Ella, end pregnancies rather than preventing them has become distressingly common, thanks in part to rampant misinformation spread by the anti-abortion movement—including appointees in the first Trump administration.

The falsehoods have made their way into Food and Drug Administration policy, with decades-long repercussions for reproductive health. Back in the early 2000s, when the FDA was trying to decide whether Plan B should be sold over the counter, it relied on an advisory committee that included several abortion opponents. Over the objections of their colleagues, those committee members persuaded the agency to include language in Plan B’s packaging that stated the drug “may also work” by preventing implantation. Not until 2022 did the FDA finally update the Plan B label to clarify the drug “does not terminate a pregnancy.” But anti-abortion groups could challenge that update in a second Trump administration.

Meanwhile, since 2015, the “abortifacient claim” has inspired lawmakers in at least seven states to vote to cut off funding for contraception or block bills to protect access to it, USA Today found in a recent investigation. Project 2025 also continues this line of attack, describing Ella as a “potential abortifacient” and proposing to wipe out mandatory insurance coverage for it. Some anti-abortion organizations, including the influential Students for Life, even falsely claim that the daily birth control pill is an abortifacient. As my colleague Kiera Butler has written, it’s all part of a growing right-wing movement to persuade women that hormonal contraception is just plain bad for them. If Trump wins, his appointees are likely to bring those arguments with them to the agencies they oversee, further threatening birth control access.

Rewriting Title X

Attacking government subsidies for contraception has been part of the GOP playbook for decades. A favorite target is Title X, a federal safety-net program that underwrites free reproductive health services—birth control, cervical cancer screenings, and STI screening and treatment, but not abortion—for low-income and uninsured people. Planned Parenthood clinics, a common provider of these services, receive about 20 percent of Title X funds.

No surprise: Texas has led the way in attacking the federal program since 2011, when the legislature slashed state funding for reproductive health care and redirected Title X money to primary care providers. The changes that year—designed to kneecap Planned Parenthood—forced scores of reproductive health clinics to close, and others to reduce hours, charge patients new fees, or ration the most effective (but expensive) forms of contraception, such as IUDs. As a result of the changes, the number of clients served by Texas family planning organizations fell by more than half, and the teen birth rate rose an estimated 3.4 percent. “It shredded the safety net for women’s health care in our state,” says Davis, now a senior adviser to Planned Parenthood Texas Votes. “Tens of thousands of women literally lost the only health care they had ever known, overnight. It was devastating, and slowly, we’ve been building our way back.”

“Tens of thousands of women literally lost the only health care they had ever known, overnight.”

Trump’s first-term appointees, following Texas’ lead, set about dramatically reshaping the entire Title X program. The administration’s “gag rule,” first proposed under Ronald Reagan but never fully implemented, which forbids any clinics that took Title X money from referring patients to abortion providers. It also required them to keep separate books and separate facilities from their abortion services, if they offered them—a logistical nightmare. Some 1,300 reproductive health facilities, including 400 Planned Parenthood clinics, withdrew from the program rather than withhold abortion referrals from patients who wanted them, and roughly 1.6 million patients lost access to federally subsidized birth control. “It was a very difficult time in the program,” says Clare Coleman, president of the National Family Planning & Reproductive Health Association. “Of course, the numbers plummeted.” What happened to the freed-up Title X money? The Trump administration sent some of it to a chain of Christian “crisis pregnancy centers” that refused to provide contraception or even referrals for birth control, as my colleague Stephanie Mencimer found in a 2019 investigation.

When Joe Biden took office, his administration promptly revoked the Trump rule, and the Title X network started rebuilding. But Vice presidential candidate Ohio Sen. JD Vance has already signaled that a second Trump administration would try again to defund Planned Parenthood—code for attacking Title X. Project 2025 urges the next president to “quickly” reissue the gag rule. It also advocates that Title X be “reframed with a focus on better education around fertility awareness”—a less-reliable method of cycle tracking favored by anti-abortion activists and wellness influencers—with grants opened up once again to anti-abortion religious organizations.

In anticipation of a Trump win, Coleman’s organization has been working with reproductive health clinics to prepare for the old gag rule to be reissued and even expanded soon after Inauguration Day. Not only could the next version of the rule pick up on Texas’ efforts to require parental consent for teenagers, Coleman warns Trump appointees are also likely to attack gender-affirming care. (Title X does not explicitly fund such care but some providers offer those services separately, just as they do abortion.) “They may say, if you take Title X, you can’t provide any of that care,” Coleman speculates. “We are quite concerned about them trying to enforce not only a gender binary—because we also do see men in the Title X program—but to recast it as: ‘This is a program about biological sex.’”

That’s if Title X survives at all: House Speaker Mike Johnson’s budget bill in September 2023 would have defunded the program entirely.

Gutting the Affordable Care Act

Before the Obama administration passed the Affordable Care Act, birth control accounted for around a third of women’s out-of-pocket healthcare expenses, according to the National Women’s Law Center. Monthly copays deterred women from getting the Pill, while an IUD could have an up-front cost of $1,000.

The ACA changed all that for over 62 million women. Starting in 2012, the law classified contraception as a form of preventive care and made it mandatory for private insurance to cover a wide range of prescription birth control at no cost to consumers. Last year, responding to the fallout from Dobbs, the Biden administration directed agencies to find ways to strengthen the contraception mandate and make sure insurers follow it; last month’s announcement on coverage of over-the-counter contraception follows that effort.

Fighting the contraception mandate has been one of the key ways conservatives and religious groups have sought to erode access to birth control. In 2014, the Supreme Court’s infamous Hobby Lobby ruling blew a crater in the ACA’s contraception mandate in the name of protecting religious freedom. There had always been a religious exemption for churches and houses of worship. But Hobby Lobby expanded that exemption to include 90 percent of US businesses—letting them deny coverage for birth control in employee insurance plans if the owners had a religious objection.

Trump broadened the exemption even further in his first term, allowing employers to decline to provide birth control based on moral, not just religious, objections. “It opens the door wide for any employer that provides health insurance to pick and choose what kind of contraception they would like to cover,” says Dana Singiser, cofounder of the Contraceptive Access Initiative.

Of course, there’s always the chance that a Republican White House and Congress would wipe out the ACA altogether, as Trump tried to do in 2017. Trump has since made conflicting statements about whether he would try again for a repeal or impose “concepts of a plan” to replace it. In late October, Speaker Johnson promised a “massive reform” of the ACA if Trump is elected.

Even with the ACA still on the books, experts say Trump could do significant damage, bypassing Congress by issuing new regulations or guidance from executive-branch agencies. Project 2025 leans in on this idea, urging the next president to make regulatory moves that would hobble the contraceptive mandate. “It’s not flashy,” says Lauren Wallace, senior counsel for reproductive rights and health at the National Women’s Law Center. “Every administration is allowed to put out proposed rules, put out guidance. So those are the ways this coverage can be stripped.”

“Every administration is allowed to put out proposed rules, put out guidance. So those are the ways this coverage can be stripped.”

The Biden administration is currently finalizing a replacement to Trump’s rule allowing moral objections to the contraceptive mandate; it’s safe to say that Trump would block or revoke it. He could also issue other regulations to make the contraceptive mandate “unworkable,” Wallace says. He could give insurers more agency to make rules around which types of birth control they choose to insure or require patients to try certain methods, before covering more expensive ones.

Project 2025’s authors, of course, have their own ideas about which forms of birth control are preferable. Their blueprint urges the next president to require the Department of Health and Human Services to issue new regulations about what is covered by the ACA contraceptive mandate. In: “fertility awareness” methods. Out: male condoms and Ella.

Shrinking Medicaid While Increasing Surveillance

Back to Texas.

Over the past decade or so, at the same time the state was attacking family planning clinics, it found a way to mess with the most common way people pay for birth control: Medicaid. And Davis sees what it did as a potential model for other states should Trump win.

First, the state passed a law banning abortion providers and their affiliates from participating in the state’s Medicaid-funded family planning program. The law conflicted with a federal rule allowing Medicaid patients to choose any “willing” provider. That meant Texas had to apply to the Obama administration for a waiver of the rule. “They got into a standoff,” Davis recalls. “The Obama administration said, ‘We’re going to remove all of your funding if you do this.’ And Texas said, ‘Fine, do it.’”

For the next few years, Texas ran a shrunken version of the program using state funding. Then Trump appeared, installing a National Right to Life Committee lobbyist to oversee national family planning policy. Texas applied for the Medicaid waiver again—and this time, received it. The Trump administration also gave the state permission not to cover emergency contraception in its Medicaid-funded program.

Davis predicts that other states will use the same maneuver to sever Planned Parenthood from Medicaid, should Trump return to office. Tennessee, which bans virtually all abortions, and South Carolina, which bans them at six weeks, have already applied for similar waivers. And Missouri recently enacted a law to ban all Medicaid reimbursements for abortion providers and their affiliates—even though the state’s abortion ban means they now only provide services like contraception and cancer screening.

Project 2025 proposes making federal Medicaid family planning funding conditional on states participating in a frighteningly detailed abortion surveillance system. “Because liberal states have now become sanctuaries for abortion tourism,” the blueprint says, “HHS should use every available tool, including the cutting of funds, to ensure that every state reports exactly how many abortions take place within its borders.” The database would include the gestational age at which the abortion was performed, the method, and the reason for it.

The proposal would force states to make an “impossible choice,” says Madeline Morcelle, senior attorney at the National Health Law Program. Participating in that “weaponized program,” she says, “would likely be used to criminalize pregnant people,” particularly immigrants, Black, Indigenous, and other people of color, young people, and people with disabilities. But dropping out would likely mean losing federal funding for vital Medicaid services affecting millions of those same low-income people.

Davis, in Texas, says she knows that predictions about losing access to birth control can sound exaggerated. She’s heard such criticisms before—from people who believed that Roe would never fall. “There are those out there who believe that this is hyperbole,” she says. But as a Texan who has witnessed how what appears radical becomes normalized, she has no illusions about the potential dangers. “I don’t think it’s unlikely at all that as Republicans become more and more extreme, and governed in a more and more extreme way by their rightward flank, that we are going to see these things become a reality.”

Correction, October 31: An earlier version of this story misstated which funds Project 2025 suggests withholding from states that don’t participate in an expanded abortion surveillance program.

“Don’t you want a president who’s going to make America healthy again?” Robert F. Kennedy Jr. asked a roaring crowd, during Sunday’s triumphal rally in support of Trump at Madison Square Garden. 

When Kennedy, the country’s most famous anti-vaccine activist, suspended his campaign to endorse Donald Trump, it not only represented the death of his presidential aspirations, but the dawn of something new: the so-called “Make America Healthy Again” movement, a tidy bit of sloganeering designed to highlight where Trump and Kennedy’s agendas overlap.

“How can you claim this is going to make people healthy?”

The concept is meant to convince skeptical Kennedy supporters to back Trump. But so far it’s mainly illustrated the various ways Kennedy is on board with Trump’s radical deregulation agenda, which would see the agencies responsible for policing food, environmental and medication safety defunded.

After all, the ex-president has done it before: Trump came into office pledging to make huge cuts to scientific and medical research. Under his administration, the FDA took fewer enforcement actions against companies suspected of marketing dangerous, unsafe, or ineffective products, and cuts to public health agencies may have harmed the country’s readiness to respond to COVID. 

There are signs that another Trump administration will be even worse for public health: Project 2025, an agenda for his second administration prepared by his allies, calls for the CDC to be broken up, slamming it as “perhaps the most incompetent and arrogant agency in the federal government.” It also demonizes the National Institutes of Health, claiming the agency has an “incestuous relationship” with vaccine manufacturers and is in the grip of “woke gender ideology.”  

Despite his governing record, Trump has adopted some MAHA talking points, promising to end the “chronic illness epidemic” in America, which, like Kennedy, he has previously blamed partly on vaccines. Trump, who already installed Kennedy on his presidential transition team, also publicly promised to put him on a panel to study what he called “the decades-long increase in chronic health problems, including autoimmune disorders, autism, obesity, infertility, and many more.” 

The main overlap between Trump and Kennedy—and the driving force behind the MAHA movement—is a their shared conviction that the institutions responsible for policing the safety of food and drugs should be defunded and their employees investigated and possibly jailed.

On Monday, Kennedy told a group of MAHA supporters that Trump had “promised me…control of the public health agencies,” including HHS, the CDC, FDA, NIH, USDA, “and a few others.” Kennedy recently tweeted that the FDA’s “war on public health is about to end” under a new Trump administration, before listing an array that encompassed pseudoscientific practices and products: “This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma.” He added, “If you work for the FDA and are part of this corrupt system, I have two messages for you: 1. Preserve your records, and 2. Pack your bags.” 

At the Madison Square Garden rally, Kennedy accused Democrats of “giving us the sickest children in the world,” called the chronic disease crisis “existential for our country,” and said he was focused on “ending the corruption” at agencies including the NIH, the CDC, and the FDA, all which he lumped in with the CIA as being in dire need of top-to-bottom reform.  

According to researcher and author Matthew Remski, Kennedy’s recent appearances have seen him deemphasize attacks on vaccines to instead focus on a much broader set of purported issues around health.

“It’s probably the most successful rebrand that he’s managed since his anti-vax turn back in 2005,” says Remski, a co-host of Conspirituality, a podcast examining the alignment between New Age and right wing spheres. “MAHA represents his organizational capacity to bring the full spectrum of anti-vax-adjacent issues and concerns and grievances together under one umbrella.”

And could be a profitable one. The brand has given rise to the MAHA Alliance—a new conservative super PAC led by Del Bigtree, an anti-vaccine personality and Kennedy’s former campaign communications director. Bigtree says the group has already raised nearly $8 million, including a recent $3 million donation from Elon Musk.

Kennedy’s new role in GOP politics has opened doors to him and those in his circles—including some with a track record of promoting harmful or scientifically unsupported health claims. In September, Kennedy and a number of close allies and MAHA boosters took part in a Capitol Hill event on nutrition hosted by Sen. Ron Johnson (R-Wisc.), a longtime friend of the anti-vaccine movement. Billed as “a nonpartisan panel discussion about the industries that impact national health,” in his opening remarks, Kennedy accused the FDA, the USDA, and the CDC of being “sock puppets for the industry they’re supposed to regulate.” 

Other panelists included Calley Means, a self-styled “healthcare reform” advocate who had been involved in Kennedy’s campaign, men’s rights activist and pop psychologist Jordan Peterson (as well as his daughter Mikhaila, who promotes an all-meat regimen she’s dubbed “the Lion Diet”), and Vani Hari, a wellness influencer who uses the moniker Food Babe, who’s previously been accused of making unscientific claims in her quest to pressure food makers to drop certain ingredients.

Given “his distorted views,” Kennedy makes a poor figurehead for a movement purportedly centered on health.

During her panel remarks, Hari pushed a new campaign against Kellogg’s cereals’ use of food dyes as part of a larger agenda against foods with “synthetic preservatives and pesticides.” The science demonstrating danger from the synthetic food dyes Kellogg’s uses in the U.S. is far from settled; according to a 2014 NPR profile, a previous campaign Hari mounted against supposedly-questionable beer additives actually targeted products derived from algae and fish.

Dr. Andrea Love, an immunologist and microbiologist who combats health misinformation, told Mother Jones the panel gave participants like Hari “a huge megaphone.” Love has pointed out that some of the Kellogg’s ingredients that Hari has claimed are “banned” in other countries legally appear there under different names. When Love later criticized a video actress Eva Mendes made praising Hari’s campaign and calling Kellogg’s dyes “harmful for children,” Calley Means baselessly accused Love of “advertising for Monsanto.” Peterson called her “a liar” as well as “incompetent, deceitful, resentful and arrogant.”

Danielle Shine—an Australian registered dietitian and nutritionist who studies nutrition misinformation also drew fire from Means and Peterson after commenting on Mendes’ video—says Kennedy makes a poor figurehead for a movement purportedly centered on health, given “his distorted views.”

“It’s perplexing that someone who seems to lack an understanding of basic science and promotes misinformation about vaccinations, food, and health would be positioned to lead a public health initiative,” she says. “His rhetoric repeatedly demonstrates a fundamental misunderstanding of food and nutrition science.”

Kennedy’s demonization of public health agencies, as he foregrounds influencers who make unsubstantiated claims about science and health, illustrates, Love argues, that the efforts of the so-called Make America Healthy Again circle are entirely misdirected.

“They’re pushing towards an ecosystem where there’s less protection, safety, oversight and regulation,” she says. “They’re not talking about the things that do matter, like getting more Americans insured… They say they’re going to take on a company like Kellogg’s, an entity that has no impact on health outcomes, while also pushing to take all authority, oversight, and funding away from federal entities who do that.”

“How,” she adds, with a measure of disbelief, “can you claim this is going to make people healthy?”

At a Sunday campaign rally, former President Donald Trump promised, if re-elected, to let anti-vaccine conspiracy theorist and failed presidential candidate Robert F. Kennedy, Jr. “go wild on health.” Kennedy has previously signaled his desire to join a second Trump administration, after dropping out of the race and endorsing Trump—who himself has wild ideas about health—in August.

Trump tonight on RFK Jr:

“I'm gonna let him go wild on health. I'm gonna let him go wild on the food. I'm gonna let him go wild on the medicines." pic.twitter.com/tBVXrou1YQ

— Dan Diamond (@ddiamond) October 28, 2024

Trump’s pledge alarmed public health professionals, including Dr. Jerome Adams, his own surgeon general. Unlike many other top officials appointed by Trump, Adams was actually qualified: he was praised by colleagues for successfully limiting an HIV outbreak in Indiana by establishing a needle exchange program, among other public health successes.

On Monday, Adams spoke at a conference of the American Public Health Association—which endorsed his 2017 nomination as Surgeon General—on his concerns about Kennedy, especially his anti-vaccine stances, as New York Times reporter Sheryl Gay Stolberg wrote on X.

Trump's surgeon general, @JeromeAdamsMD warns RFK would hurt America's health:

"If RFK has a significant influence on the next administration, that could further erode people's willingness to get up to date with recommended vaccines, and I am worried about the impact that…

— Sheryl Gay Stolberg (@SherylNYT) October 28, 2024

Adams has been a strong supporter of the development and distribution of Covid vaccines, and others, including by testifying at a 2021 House hearing on how to encourage Covid vaccine uptake. Kennedy, on the other hand, has promoted the debunked, dangerous theory that vaccines cause autism. It definitely does not—but polio and measles do cause people to develop disabilities.

As my colleague David Corn wrote for Mother Jones in July, Kennedy’s anti-vaccine activism could potentially be linked to the deaths of children in Samoa who contracted measles. (Kennedy denied fault.)

During the stretch in which the vaccination coverage was dropping in Samoa, Kennedy visited the nation in June 2019 and gave a boost to anti-vaxxers there who had used the death of those two infants to help cause the drop in vaccination rates…Public health experts complained Kennedy’s visit to Samoa helped amplifly anti-vax voices.

During his speech, Adams also directly appealed to Republicans, asking them to not play a role in “allowing vaccine confidence to continue to be eroded, and for us to go backwards on one of the number-one public health achievements made in the last 50 to 75 years in this country.”

As Donald Trump campaigns to be a dictator for one day, he’s asking: “Are you better off now than you were when I was president?” Great question! To help answer it, our Trump Files series is delving into consequential events from the 45th president’s time in office that Americans might have forgotten—or wish they had.

Abby Mahler blames Donald Trump and Elon Musk for the challenges faced by people who need hydroxychloroquine for lupus. In the early days of the Covid pandemic, both Trump and Musk promoted the drug as a possible Covid treatment, helping lead to widespread shortages that made it difficult for people like Mahler to obtain the medication she needed. “What Trump did could not have happened without Elon,” Mahler told Mother Jones.

For nearly four years, Mahler, who is based in Los Angeles, has been using TikTok to address misinformation about hydroxychloroquine, which was originally created to prevent and treat malaria, and can be used for a range of autoimmune disorders, including lupus, vasculitis and Sjogren’s syndrome. When they heard that hydroxychloroquine was being prescribed to patients with Covid-19, they were not concerned at first. A drug they already needed and used could also treat Covid-19?

“I remember very vividly joking with my friends,” Mahler said. “Like, ‘Ha ha, I’m going to live forever.'”

On March 16, 2020—just days after Trump declared Covid-19 a nationwide emergency—Musk tweeted a link to a Google Doc which claimed that HCQ, as it’s often known, and a related drug called chloroquine could help fight Covid-19. The Google Doc itself noticeably did not contain any notable statistics. “Maybe worth considering chloroquine for C19,” Musk wrote on Twitter, adding the following day: “Hydroxychloroquine probably better.” (In what turned out to be a darkly accurate bit of foreshadowing, Musk posted another tweet warning that “if we over-allocate medical resources to corona, it will come at expense of treating other illnesses.”)

Days later, a different study was published as a pre-print, meaning it had not yet been peer-reviewed. From a scientific standpoint, the evidence in that study was slim: The paper said that 12 patients benefited from HCQ after seven days, out of the 26 studied (not including the control group), after being diagnosed with Covid-19. The researchers also admitted that five of the patients had to stop taking HCQ after their health symptoms worsened.

Hydroxychloroquine, experts later concluded, wasn’t actually useful for preventing or treating Covid. But as infectious disease specialist Michael Saag wrote in a JAMA Network editorial in November 2020, desperation in the face of an unfolding pandemic had helped create a perfect storm in which the early HCQ research gained traction:

These findings suggestive of possible benefit, along with the desperation of clinicians who were providing care for patients with a potentially fatal disorder for which there was no treatment, undoubtedly contributed to increased use of hydroxychloroquine for patients with COVID-19, despite lack of rigorous evidence for efficacy.

The sudden demand spike for HCQ came alongside a price increase for a key ingredient in the drug. Within a week of Musk’s tweet, Mahler had to try several pharmacies in order to get her HCQ, and had to pay $60, instead of her usual $15. Unlike many other people with lupus, she didn’t have to go without, but she did have to ration over the next few months, occasionally taking a half-dose to cope with the shortage.

Gregory Rigano, an attorney who was one of the authors of the Google Doc Musk promoted, appeared on Laura Ingraham’s Fox News program the very day Musk tweeted it out. Ingraham herself would later to Trump about how great HCQ was for Covid-19 in a private meeting in early April. (Trump’s campaign team and Musk did not respond to recent requests for comment from Mother Jones.) As Saag wrote:

On April 4, the US president, “speaking on gut instinct,” promoted the drug as a potential treatment and authorized the US government to purchase and stockpile 29 million pills of hydroxychloroquine for use by patients with COVID-19. Of note, no health official in the US government endorsed use of hydroxychloroquine owing to the absence of robust data and concern about adverse effects. 

As Stat News reported at the time, Trump even stopped Anthony Fauci, then chief of the National Institute of Allergy and Infectious Diseases, from answering a question on the drug’s efficiency at a White House briefing. In May 2020, Trump proudly announced that he was taking hydroxychloroquine to prevent Covid-19, despite an FDA statement weeks earlier that it should not be used for Covid-19 outside of hospitals or clinical trials.

But in a “twist of irony,” Saag wrote, when Trump really did contract—and was hospitalized for—a serious case of Covid, he “did not receive hydroxychloroquine.”

That makes good medical sense: Trump’s praise for HCQ never included a disclosure that it can have serious side effects, like cardiac issues and changes to eyesight. Many patients on hydroxychloroquine, including myself, have to be tested regularly for HCQ-related vision issues. It’s hard to know just how widespread complications were in 2020.

“As soon as Trump started talking about, it became very obvious that things were gonna get bad quick,” Mahler said. In mid-May, they also had to argue with their health insurance company to avoid paying more than $100 for the medication, which had previously been quite inexpensive.

A survey by the Lupus Research Alliance found that a third of lupus patients reported difficulties filling HCQ prescriptions between March and May 2020. That can mean severe complications, including hospitalization—a frequent area of Covid transmission. Trump’s claims about hydroxychloroquine weren’t just another case of buffoonery, Mahler says, but a source of real harm in people’s lives.

@babs_zone Time to hold some shills accountable. #HCQRewind #HerStory #CrowdCheers #hydroxychloroquine #DisabilityJustice #lupus #hcq #disabilitytiktok #fyp ♬ Drive Forever – Remix – Sergio Valentino

Even outside the US, HCQ shortages became more common. A February 2021 study found new anxieties among lupus patients in Europe about such shortages during the first year of the pandemic.

I’m now on hydroxychloroquine myself, and though I wasn’t at the time, I remember watching in fear as rumors spread that the anti-inflammatory colchicine, which I was taking, would be Trump’s next proposed Covid treatment. I remember asking my then-rheumatologist if she was concerned that would happen. She told me that there’s no evidence it would help, but there wasn’t much evidence that HCQ would help either. Trump never embraced colchicine, but hydroxychloroquine shortages struck a nerve.

In mid-June 2020, the FDA ended its study on HCQ and Covid—results showed it wasn’t helping. Weeks later, Trump called hydroxychloroquine “a cure for Covid” and a reason not to wear a mask. Trump was very much wrong, and high quality masks do help prevent the ongoing spread of Covid-19.

As Saag, the infectious disease expert, concluded:

The clear, unambiguous, and compelling lesson from the hydroxychloroquine story for the medical community and the public is that science and politics do not mix. Science, by definition, requires diligence and an honest assessment of findings; politics not so much.

When the US Department of Health and Human Services finalized a rule in May asserting that gender dysphoria can be considered a disability under federal anti-discrimination laws, it codified what the overwhelming majority of courts have found for nearly a decade. The new rule put states on notice: Discrimination against transgender people in employment, education, health care, child care, housing, and elsewhere may violate federal disability protections, and the Biden administration was prepared to fight it.

Now, in a lawsuit led by Texas Attorney General Ken Paxton, 17 states are asking a federal court to strike down the rule in its entirety, including numerous provisions that have nothing to do with trans people. This isn’t a random collection of states; 15 of them have passed restrictions on gender-affirming care, and all have embraced myriad anti-trans policies. 

Among the states’ objections to the new federal rule: They would have to “expend time, money, and resources” to accommodate employees with gender dysphoria, including using the pronouns that align with their identities, eliminating sex-specific dress codes, and letting employees use gender-aligned bathrooms or locker rooms. Nebraska’s attorney general is concerned that his state’s restrictions on gender care put it at risk of disability rights complaints and federal investigations. South Dakota objects to the rule “essentially add[ing] a new category of potentially disabled individuals” whose gender care must be covered by Medicaid.

But gender dysphoria is just part of the 130-page federal rule. It also protects disabled parents’ rights in child welfare cases and prevents hospitals from using disability as a factor in determining who gets care in crisis situations, such as equipment shortages during a pandemic. It adds Long Covid to the list of conditions that may constitute a disability and strengthens protections against unnecessary institutionalization, requiring that care be offered in the least restrictive setting and, ideally, in a patient’s community. 

“The attack is really about the regulatory process of the federal government, and this will impact almost every interaction that a disabled person has with the services and supports that they receive.”

Striking down the entire rule would have wide-reaching implications for all disabled Americans and other marginalized groups who rely on federal agencies’ interpretations of decades-old laws to enforce their rights, says Mia Ives-Rublee, senior director of the Center for American Progress’ Disability Justice Initiative. “They’re utilizing LGBTQ issues as a wedge,” Ives-Rublee says. “The attack is really about the regulatory process of the federal government, and this will impact almost every interaction that a disabled person has with the services and supports that they receive.”

The new rule pertains to two federal statutes passed decades ago to protect people with disabilities on multiple fronts. The Rehabilitation Act of 1973 prohibits discrimination on the basis of disability by the federal government, federal contractors, and—in its Section 504—by any organizations or employers that receive federal funds. The Americans with Disabilities Act (ADA), signed into law in 1990, broadened disability protections into most aspects of public life, including education, access to businesses open to the public, and public transportation. Both statutes define a disability as “a physical or mental impairment” that “substantially limits” one or more major life activities. 

When the Rehabilitation Act and ADA were passed, gender dysphoria was not a recognized medical condition, and both statutes expressly excluded “transvestism, transsexualism,” and “gender identity disorders not resulting from physical impairments” from the definition of disability. But over the decades, medical experts and courts have come to understand that for many people who identify with a gender different from the one assigned to them at birth, there can be profound psychological distress and other major negative effects in their work and social lives. In 2013, gender dysphoria was added to the Diagnostic and Statistical Manual of Mental Disorders.

Since then, lawsuits by individuals—the primary way the ADA is enforced—have forged a body of legal decisions that recognize gender dysphoria as a protected health condition and its exclusion from disability protections as discriminatory, says Ben Klein, senior director of litigation and HIV law at GLBTQ Legal Advocates and Defenders. The exclusion of gender dysphoria “was based on obvious animus toward a disfavored group. That is a concept that judges who look at petitions have easily understood—the bias is so clear,” Klein says. 

The 4th Circuit Court of Appeals broke legal ground in 2022 when it became the first federal appeals court to rule on the issue of whether gender dysphoria could be considered a disability under federal disability protection statutes. The court determined that the basis of a gender dysphoria diagnosis—whether it causes a noticeably negative impact on daily life—distinguishes it from the ADA’s definition of gender identity disorder. (The US Supreme Court declined to hear the case in June 2023, letting the decision stand.) Lower federal courts have found, similar to the 4th Circuit, that gender dysphoria is distinct from gender identity disorder. Others have found that even if gender dysphoria is a gender identity disorder, it results from a physical impairment: a mismatch between a person’s physical body and gender identity that can be remedied through gender care. 

In finalizing its new rule—the first administrative update to Section 504 in half a century—the Department of Health and Human Services alluded to this body of case law, which it said has “shifted the legal landscape of disability discrimination protections.” But none of that matters much to the states that joined the Texas lawsuit, which was filed with little national media attention in late September. 

The lawsuit seizes upon the original exclusionary language in the ADA, claiming that what the medical community now considers gender dysphoria falls under the law’s concept of gender identity disorder. “The Biden Administration is once again abusing executive action to sidestep federal law and force unscientific, unfounded gender ideology onto the public,” Paxton said in a press release announcing the suit. “Texas is suing because HHS has no authority to unilaterally rewrite statutory definitions and classify ‘gender dysphoria’ as a disability.”

Beyond the gender dysphoria issue, the lawsuit also makes broad claims about “new regulatory burdens” and “substantial costs” associated with the rule’s impacts to state Medicaid programs. Alaska, Montana, and Nebraska, for instance, argue that the rule’s “least restrictive setting” requirement will be difficult to implement because of health care worker shortages and their states’ unique geographies. 

“One of the goals of the ADA is to address discrimination and stereotypes, particularly about stigmatized health conditions. Gender dysphoria is the quintessential stigmatized health condition.”

Klein and Ives-Rublee emphasized that both the Rehabilitation Act and ADA were written vaguely with the intent that, over the years, experts working for federal agencies would reexamine and refine the regulations implementing the statutes, as scientific and public understanding of disability evolves. When the ADA was passed, trans identity was pathologized, Klein says. “One of the goals of the ADA is to address discrimination and myths and stereotypes, particularly about stigmatized health conditions,” he tells me. “Gender dysphoria is the quintessential stigmatized health condition.”

The new Texas case is just one of many avenues GOP officials are using to enforce their anti-trans beliefs. As I’ve reported, Republican attorneys general—many from the same states as in the Paxton lawsuit—are also threatening major medical associations with criminal investigations for promoting trans youths’ access to gender care.

Ives-Rublee warns that the Texas suit is also part of a multifaceted attack on the power of federal agencies to interpret civil rights laws, including protections for pregnant workers and access to reproductive health care. This broad conservative effort to rip the teeth out of the administrative state was emboldened by a series of Supreme Court decisions last term, including one that ended courts’ expected deference to federal agency interpretations of vague laws. 

Because the gender dysphoria lawsuit was filed in the federal district court in Lubbock, Texas, any appeal will go to the 5th Circuit Court of Appeals, home to some of the most radically conservative decisions in recent legal history. If the 5th Circuit sides with the states in this case, it would create a conflict with the 4th Circuit decision that could force the Supreme Court, with its far-right supermajority, to weigh in. “I am almost 100 percent sure this is their intention,” Ives-Rublee says.

On Tuesday, Vice President Kamala Harris announced on The View that she would pursue a new Medicare benefit to cover the costs of in-home care for qualifying disabled people and anyone 65 and up.

Disabled people have fought for more than half a century for the right to remain in their homes and communities, rather than being subject to institutionalization—which includes the support, such as home care workers, that they need to do so. A recent poll released by the University of Michigan found that around three in five people older than 50 with a caregiver also have a physical disability. Medicare already covers home care for some people—but in a highly limited way that’s much more challenging to get.

“If you don’t have those services, you might unnecessarily be institutionalized.”

I spoke with Nicole Jorwic, Caring Across Generations’ chief of advocacy and campaigns, about Harris’ new proposal—what it means the people who would qualify, and what it would take for the benefit to succeed, if Harris is elected.

Why does Harris’ plan to expand Medicare excite you?

The plan from the Harris administration to include coverage for home care and Medicare is really a game-changer for disabled people and for older people. This proposal is exciting, not only for the folks that would get the care that they need but also because of the people that would be impacted by not having to provide that care themselves.

The most exciting thing about it for me is that something that I hear when I’m out and about, meeting with folks in the in the care advocacy community—is so many people think Medicare already does this. It’s creating a a benefit in a government funded system that people already think that they’re going to get—fixing a problem that many people don’t even know that they’re going to have until they’re in a crisis.

How could it help disabled people remain at home, rather than in institutions like nursing homes or group homes?

95 percent of disabled people want to live in their homes and in their communities. But the reality is, because Medicaid has traditionally been the main funder for these services, you have to remain in poverty in order to access these services. Also because states can limit how many people they serve, there’s waiting lists.

Adding home care into Medicare would mean that more of the 7 million disabled people who are currently eligible for Medicare— 12 percent of Medicare beneficiaries—then maybe [do] not need to go on waiting lists for services. If you don’t have those services, you might unnecessarily be institutionalized. This proposal to add home care to Medicare would also take some pressure off of the Medicaid system. We could hopefully continue to pull people off of the waiting list and remove the institutional bias that currently exists today.

Why is it also crucial to address the care-worker shortage for a plan like this to be successful?

Anybody who needs home care, those services are going to be provided by a direct care worker, and we are in a direct care worker crisis. Not because there’s not enough people, but because there’s not enough good direct care jobs. What this proposal does also include is ensuring that the folks that are providing these Medicare services are being paid a good wage.

Disability advocates and aging advocates, when we have the opportunity to implement a policy like this [which] would have to move through Congress, we would also ensure that it rides alongside investments that would ensure that every direct care worker, whether they’re paid by Medicaid or Medicare, are paid a family sustaining wage. We have to also address the direct care workforce, that’s the human infrastructure, the people that are actually providing the services, for this program to be successful.

Right now we think about those direct support professionals or home care workers, those folks when they age, don’t have access to home care right away, unless they qualify for Medicaid, which we know can have waiting lists. Vice President Harris’s proposal to add home care to Medicare also would guarantee that those direct care workers who have been historically low-paid would also have peace of mind if they need home care.

Have there been examples of programs at a state level similar to what Harris is proposing?

There isn’t necessarily an example of a state adding to a federal program, but there are some examples of where states have invested in folks that just need a little bit of extra support at home. Under the Affordable Care Act, there was a program that was passed called the Community First Choice Option. It requires states who take up this option, like Oregon and Texas, to provide home and community based care for eligible folks, mostly through personal care assistance, in the same way that that Vice President Harris’s proposal does.

For folks that are on a waiting list, it provides a narrow benefit. We know that if we provide some benefit to people right when they need it, it actually can prevent them, maybe, from needing longer-term care further down the road.

Are there any lessons to learn from the state-level implementation of the Community First Choice Option?

When you look at implementing programs like the Community First Choice Option at the state level, something that’s important to think about is that you want to create as much flexibility as possible. You want to make sure that the services that are being provided are going to meet the unique needs of the senior or the disabled person who needs that care—also making sure that the definition of a workforce is broad enough. There might be somebody who might want it to be their family member, or a disabled person who might want it to be their spouse. You can’t just throw more people into the system without also addressing the workforce.

This interview has been edited for length and clarity.

On Tuesday, Vice President Kamala Harris announced on The View that she would pursue a new Medicare benefit to cover the costs of in-home care for qualifying disabled people and anyone 65 and up.

Disabled people have fought for more than half a century for the right to remain in their homes and communities, rather than being subject to institutionalization—which includes the support, such as home care workers, that they need to do so. A recent poll released by the University of Michigan found that around three in five people older than 50 with a caregiver also have a physical disability. Medicare already covers home care for some people—but in a highly limited way that’s much more challenging to get.

“If you don’t have those services, you might unnecessarily be institutionalized.”

I spoke with Nicole Jorwic, Caring Across Generations’ chief of advocacy and campaigns, about Harris’ new proposal—what it means the people who would qualify, and what it would take for the benefit to succeed, if Harris is elected.

Why does Harris’ plan to expand Medicare excite you?

The plan from the Harris administration to include coverage for home care and Medicare is really a game-changer for disabled people and for older people. This proposal is exciting, not only for the folks that would get the care that they need but also because of the people that would be impacted by not having to provide that care themselves.

The most exciting thing about it for me is that something that I hear when I’m out and about, meeting with folks in the in the care advocacy community—is so many people think Medicare already does this. It’s creating a a benefit in a government funded system that people already think that they’re going to get—fixing a problem that many people don’t even know that they’re going to have until they’re in a crisis.

How could it help disabled people remain at home, rather than in institutions like nursing homes or group homes?

95 percent of disabled people want to live in their homes and in their communities. But the reality is, because Medicaid has traditionally been the main funder for these services, you have to remain in poverty in order to access these services. Also because states can limit how many people they serve, there’s waiting lists.

Adding home care into Medicare would mean that more of the 7 million disabled people who are currently eligible for Medicare— 12 percent of Medicare beneficiaries—then maybe [do] not need to go on waiting lists for services. If you don’t have those services, you might unnecessarily be institutionalized. This proposal to add home care to Medicare would also take some pressure off of the Medicaid system. We could hopefully continue to pull people off of the waiting list and remove the institutional bias that currently exists today.

Why is it also crucial to address the care-worker shortage for a plan like this to be successful?

Anybody who needs home care, those services are going to be provided by a direct care worker, and we are in a direct care worker crisis. Not because there’s not enough people, but because there’s not enough good direct care jobs. What this proposal does also include is ensuring that the folks that are providing these Medicare services are being paid a good wage.

Disability advocates and aging advocates, when we have the opportunity to implement a policy like this [which] would have to move through Congress, we would also ensure that it rides alongside investments that would ensure that every direct care worker, whether they’re paid by Medicaid or Medicare, are paid a family sustaining wage. We have to also address the direct care workforce, that’s the human infrastructure, the people that are actually providing the services, for this program to be successful.

Right now we think about those direct support professionals or home care workers, those folks when they age, don’t have access to home care right away, unless they qualify for Medicaid, which we know can have waiting lists. Vice President Harris’s proposal to add home care to Medicare also would guarantee that those direct care workers who have been historically low-paid would also have peace of mind if they need home care.

Have there been examples of programs at a state level similar to what Harris is proposing?

There isn’t necessarily an example of a state adding to a federal program, but there are some examples of where states have invested in folks that just need a little bit of extra support at home. Under the Affordable Care Act, there was a program that was passed called the Community First Choice Option. It requires states who take up this option, like Oregon and Texas, to provide home and community based care for eligible folks, mostly through personal care assistance, in the same way that that Vice President Harris’s proposal does.

For folks that are on a waiting list, it provides a narrow benefit. We know that if we provide some benefit to people right when they need it, it actually can prevent them, maybe, from needing longer-term care further down the road.

Are there any lessons to learn from the state-level implementation of the Community First Choice Option?

When you look at implementing programs like the Community First Choice Option at the state level, something that’s important to think about is that you want to create as much flexibility as possible. You want to make sure that the services that are being provided are going to meet the unique needs of the senior or the disabled person who needs that care—also making sure that the definition of a workforce is broad enough. There might be somebody who might want it to be their family member, or a disabled person who might want it to be their spouse. You can’t just throw more people into the system without also addressing the workforce.

This interview has been edited for length and clarity.

When Dr. Veronica Gillispie-Bell, a board-certified OB-GYN based in New Orleans, walks into a hospital room to deliver a baby, one of the first things she does is ask the nurse on duty, “Do we have our hemorrhage meds?”

Postpartum hemorrhage, or severe bleeding after childbirth, is a leading—but preventable—cause of maternal death in the US and around the world. It occurs in an estimated 1 to 5 percent of pregnancies. For doctors like Gillispie-Bell, who has testified before Congress about the Black maternal mortality crisis, having medications on hand to treat patients immediately is critical to saving lives. Until last week, those drugs included misoprostol, which also happens to be one of the two pills used in medication abortion.

But obtaining access to the drug has suddenly become far more complicated. On October 1, Louisiana—which has a near-total ban on abortion—became the first state to officially begin classifying misoprostol and mifepristone, the other drug in the standard abortion pill regimen, as schedule IV controlled substances. The new law threatens anyone who possesses the medications without a prescription—except for pregnant women themselves—with up to five years in prison and a $5,000 fine.

To say that this designation—the same one applied to opioids and other addictive drugs—is without scientific or medical merit is an understatement. More than 100 studies have found that mifepristone and misoprostol offer a safe and effective way to terminate a pregnancy. As I reported earlier this year, that includes a study showing that abortion pills are just as safe and effective when prescribed via telemedicine and mailed to patients as when prescribed and dispensed in person. In a letter to state Sen. Thomas Pressly, the Republican behind the new law, hundreds of doctors—including Gillispie-Bell—pointed out that mifepristone and misoprostol don’t have addictive potential or high rates of negative side effects, but do have important medical benefits, including managing miscarriages, preventing ulcers, and inducing labor.

But abortion opponents have shown time and time again that they are impervious to scientific and medical expertise. Pressly, for example, has publicly attacked journalists who have reported critically on the law and blamed the deaths of two Georgia women on abortion pills rather than the actual cause, a draconian abortion law that prevented them from obtaining emergency care. The anti-abortion group Louisiana Right to Life reportedly requested that the now-law be added as an amendment to legislation Pressly originally introduced to criminalize so-called coerced abortion, after his estranged brother-in-law spiked Pressly’s sister’s water with misoprostol when she was pregnant in 2022. The baby survived but was reportedly born prematurely with developmental delays. (In February, the husband was sentenced to 180 days in jail and 10 years’ probation.)

Now, mifepristone and misoprostol will have to be kept locked away inside hospitals along with other narcotics, the Louisiana Department of Health told health care providers last month. Staff at some hospitals have been bracing for the worst: running timed drills and sprinting through hallways to determine how long it would take to reach the locked cabinets where the drugs are now stored. Meanwhile, Republican state Attorney General Liz Murrill has accused the press and abortion rights activists of “disinformation and fear-mongering” about the new law.

Gillispie-Bell says she worries about what the delays will mean in emergencies, when minutes can mean the difference between life and death. “The last thing I want in the middle of a hemorrhage is for my nurse—who needs to be monitoring patients’ vital signs and doing other things—to have to leave the room to go get something,” she told me the day after the law took effect. “We want them at the bedside.” Our conversation has been edited for length and clarity.

Since abortion is already almost entirely banned in Louisiana, what impacts do you expect this new law will have?

Most of the impact—at least from my perspective—will be the ability to access the medications for non-abortion–related care. In recent years, we have seen improvement in severe maternal morbidity related to postpartum hemorrhage, and one of the reasons is because we have quick access to medication that can treat hemorrhage.

Misoprostol is not the first medication we go to for patients who are bleeding—Pitocin is—but it is one of the medications that we use with low cost and little side effects. I’m very concerned about the ability for medical staff to access those medications in hospitals. I’m also concerned for our patients to be able to access the medication in the outpatient setting—again, for indications that don’t have anything to do with abortion. Now that it’s been labeled as a schedule IV medication, I think there is [worry] that pharmacists are going to have concern about filling a prescription and whether it’s being used appropriately.

What are some other common situations in which mifepristone and/or misoprostol might be used?

I use misoprostol for patients when I’m going to place an intrauterine device, to soften the cervix and make it easier to place the IUD. We use it for induction of labor as well. We use it for patients that need to have an endometrial biopsy, typically for patients who are having post-menopausal bleeding, to make sure they don’t have endometrial cancer. One of the things that happens in menopause is the cervix gets really tight. And so we’ll use that medication to help open the cervix to facilitate being able to do the endometrial biopsy.

How do you think that mifepristone and misoprostol being classified as equivalent to narcotics will affect perceptions of these drugs and abortion stigma? Are you worried that these kinds of laws will spread to other states?

I do worry about the stigma that’s going to be associated with the medications because of this new law. And I am worried about this happening in other states. It’s really a dangerous slippery slope when we have legislation that interferes with what we know to be evidence-based medicine.

How did it feel for legislators to ignore the combined medical expertise of you and hundreds of other doctors when you asked them not to pass this bill? 

It was disappointing but not surprising. We’ve seen something similar happen with so-called “abortion pill reversal” bills. Several states have enacted legislation that says if a doctor prescribes mifepristone for an abortion, the doctor has to tell the patient that if she changes her mind, she could take progesterone to reverse that abortion. That is absolutely not true. The American College of Obstetricians and Gynecologists has a statement that says there’s no evidence to support the claim that abortion pill reversal works. But that’s something that, in these states, as a provider, you have to do.

The lawmaker who introduced this bill said his sister was given these pills without her knowledge in an attempt to end her pregnancy. This was an argument that abortion opponents also brought to the Supreme Court last term in the case that tried to restrict mifepristone—they alleged that abortion pills can facilitate reproductive coercion and abuse, even though there’s no evidence that this is a widespread problem. What is your response to this?

It’s incredibly unfortunate that this happened to the legislator’s sister. But that is the only such case that I have any knowledge of. And so, while I understand his argument, it’s a very slippery-slope argument, because that logic can be applied to anything. If you take too much Tylenol, that can cause liver failure. If you take too much ibuprofen, that can cause kidney failure. Everything has a potential side effect and a potential risk. The US Drug Enforcement Administration defines a controlled substance as something that has addictive properties, and misoprostol and mifepristone just do not meet that criteria.

I know it’s early, but have you had to use these drugs yet to stop a patient from bleeding out?

Not yet. Hemorrhages are not something that happen every single day, so it’s going to be some time, I think, before we see the real impact.

Given that postpartum hemorrhage is one of the leading causes of maternal mortality nationwide, do you think this law will increase maternal deaths in Louisiana? Do you think we’re going to hear stories similar to the ones about the women who died in Georgia? 

As physicians and health care providers, I believe we are going to do whatever we need to do to make sure our patients are taken care of. So I really don’t think we’re going to see an increase in maternal deaths. I think we may see an increase in maternal morbidity. We may see an increase in blood transfusions, for example, because we’re not able to control hemorrhages as quickly. But I don’t think that we will necessarily see an increase in deaths. 

But it definitely is going to be a stress on the system. It’s one more thing we have to do, and that one more thing takes time. And when we’re talking about a hemorrhage, time matters. 

Do you worry about the impacts the new law will have on recruiting OB-GYNs to Louisiana? And have you already seen impacts to recruitment from the abortion ban? 

Yes. The Association of American Medical Colleges recently published a study that shows that since the Dobbs decision, the states with the strictest abortion bans have had a decrease in medical students applying for residency in any specialty, not just OB-GYN care. As we continue to pass more restrictions, I think that’s only going to make that problem worse.

The infamous CEO of a failed hospital system is suing an entire Senate committee for being held in contempt of Congress on civil and criminal charges that were unanimously approved by the full Senate last week.

In a federal lawsuit filed Monday, Steward CEO Ralph de la Torre claimed the senators "bulldozed over [his] constitutional rights" as they tried to "pillory and crucify him as a loathsome criminal" in a "televised circus."

The Senate committee—the Committee on Health, Education, Labor, and Pensions (HELP), led by Bernie Sanders (I-Vt.)—issued a rare subpoena to de la Torre in July, compelling him to testify before the lawmakers. They sought to question the CEO on the deterioration of his hospital system, which previously included more than 30 hospitals across eight states. Steward filed for bankruptcy in May.

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One in every 10 pregnancies in the US ends in a miscarriage, a common medical event for which there are safe and effective treatments should there be complications. But over the past two years, having a miscarriage in many states has become far more dangerous, thanks in part to the Supreme Court’s 2022 Dobbs decision overturning Roe v Wade.

Thirteen states have passed total abortion bans. Three others ban abortion after six weeks—a de facto ban. These laws have resulted in a rash of horror stories—not about the anticipated illegal backroom abortion deaths, but about ordinary women having ordinary but occasionally life-threatening pregnancy complications, while hospitals and doctors refuse to treat them for fear of being prosecuted.

Reporters and lawyers have chronicled stories of miscarrying women nearly dying from blood loss and infection, suffering debilitating injuries, and future infertility because of delayed care. One Texas hospital, the AP reported, even left a woman to miscarry in the ER restroom because the staff refused to treat her. Her husband had to call 911 from the ER for help.

Among the legion of GOP anti-abortion politicians in the US who’ve helped create this carnage, there is one you might expect to have some sympathy for the suffering of these women: Vice presidential candidate and Ohio Sen. JD Vance. On the surface, the politician who denigrated Democrats as the party of “childless cat ladies” and suggested that “the whole purpose of the postmenopausal female, in theory,” was to take care of children, would not be an obvious softie for the victims of policies that have left women bleeding out in hospital restrooms. And yet, he might understand the situation better than many of his Republican colleagues.

Vance owes much of his fame and political career to his bestselling 2016 memoir, Hillbilly Elegy, a coming-of-age story about his triumph over family dysfunction, addiction, absent fathers, and cycles of abuse.

The memoir’s beating heart is Bonnie Blanton Vance, or “Mamaw,” the maternal grandmother Vance called his “guardian angel” in his July acceptance speech at the Republican National Convention. Blanton helped raise the future Yale Law School grad when his drug-addicted mother could not, saving him from becoming just another entry in a long family history of shiftless angry men.

In Hillbilly Elegy, Vance holds Blanton up as the force of nature behind his successes. But the book also suggests she may be an unintended case study of something quite different: the importance of reproductive health care for everyone. In his memoir, Vance says that his beloved grandmother suffered eight miscarriages over 10 years, plus four pregnancies that came to term. Today, many of the women suffering from denied miscarriages and abortion care “have similar life stories to his grandmother,” says Debra Stulberg, a professor of family medicine at the University of Chicago who studies miscarriage care.

The word “abortion” never appears in Hillbilly Elegy, and Vance doesn’t seem to have ever spoken publicly about the particular chapter of his grandmother’s difficult life. (A spokesperson for Vance did not respond to questions for this story by publication.) But his grandmother’s story, which helped make him famous, seems to underly Vance’s intense opposition to abortion—one that’s even more extreme than the man he shares the GOP ticket with.

In 2023, Vance signed on to a letter to the secretary of the US Department of Health and Human Services, along with 29 other Republican lawmakers, urging the agency to reverse a new rule that bars law enforcement officers from accessing patients’ reproductive healthcare records, particularly those trying to prosecute women for crossing state lines for abortion care. “Abortion is not health care,” the letter said. “It is a brutal act that destroys the life of an unborn child and hurts women.”

Vance supports a national abortion ban, and he doesn’t believe in exceptions for rape and incest. “Two wrongs don’t make a right,” he said in an interview during his 2022 Ohio Senate campaign. “It’s not whether a woman should be forced to bring a child to term, it’s whether a child should be allowed to live, even though the circumstances of that child’s birth are somehow inconvenient or a problem to the society.”

“It’s not whether a woman should be forced to bring a child to term, it’s whether a child should be allowed to live, even though the circumstances of that child’s birth are somehow inconvenient or a problem to the society.”

Vance’s position is a curious one for someone whose origin story begins with the pregnancy of a 13-year-old girl.

In his memoir, Vance writes that his grandfather, Jim Vance, and his grandmother’s best friend, Bonnie Smith, were lovers. At some point, he writes, 16-year-old Jim cheated on Bonnie Smith with 13-year-old Bonnie Blanton. The “affair” resulted in a pregnancy that prompted the couple to flee Appalachian Kentucky for Dayton, Ohio, to escape Blanton’s murderously protective brothers.

Today, Blanton’s first pregnancy would be considered the result of statutory rape in many states, and a felony carrying prison time. The pregnancy was also exceedingly dangerous. “Teen pregnancies, especially 15 and under, are by definition high risk,” says Stulberg. Perhaps no surprise, then, that Blanton’s baby died a week after she was born.

It seems clear from Hillbilly Elegy that Blanton’s unplanned pregnancy at 13 was a singular catastrophic event that trapped her in a violent marriage for decades. “Mamaw never spent a day in high school,” Vance writes. “She’d given birth to and buried a child before she could legally drive a car.” Her husband was an abusive alcoholic; Blanton famously once tried to set him on fire when he had passed out drunk on the couch.

Yet Vance seems to view Mamaw’s adolescent pregnancy not as a catastrophe but as the catalyst that launched his family out of Hatfield and McCoy territory and into suburban Ohio, where there were more opportunities. “Mamaw’s entire life—and the trajectory of our family—may have changed for a baby who lived only six days,” he writes. Blanton died in 2005, at the age of 72, when Vance was only 20 and still in the Marines. As a result, “We don’t get to hear her take on this story,” Stulberg says. “That could be very different from his.”

Having a baby at 13 may have set in motion Vance’s path to the vice president’s office. But it also may have set up Blanton for the years of fertility issues Vance describes in his memoir. According to him, she had eight miscarriages in the decade between the live birth of an uncle in 1951 and the birth of his mother in 1961. But in his book, Vance displays a striking lack of curiosity about the details of those miscarriages, other than to speculate that they may have been triggered by the stress of being married to an abusive alcoholic.  

Without Blanton around to fill in the details, such as how far along in her pregnancies she was when she miscarried, we can only speculate. But experts I spoke with found it highly unlikely that a woman who’d had eight miscarriages, plus four pregnancies, the first at 13, would not at some point have needed either a therapeutic abortion or the sort of miscarriage treatment that Vance’s preferred reproductive health policies now make difficult to obtain in many states.

Having a history of multiple pregnancies itself is a risk factor, Stulberg notes. “The risks of preterm labor and postpartum hemorrhage are higher,” she says. Preterm labor is a common reason for miscarriage management, including what is essentially the abortion of a nonviable fetus.

“Politicians may say very easily that there’s no reason why miscarriage should be affected by these [abortion bans],” says Daniel Grossman, an OB-GYN at the University of California, San Francisco, and head of a research program that has been tracking the state of reproductive health care since the overturning of Roe. “But in fact, the treatments that are done for miscarriage are almost identical to the treatments for abortion, including the abortion pill.”

“The treatments that are done for miscarriage are almost identical to the treatments for abortion, including the abortion pill.”

Grossman recently co-authored a study that compiled accounts from dozens of clinicians who had observed the horrific treatment of pregnant women in need of medical care that they were either denied or forced to obtain at great expense because of strict state abortion bans, often with great trauma.

Consider this account from a clinician in a state with an abortion ban, describing what happened to a woman who was 19 to 20 weeks pregnant. When she arrived at the ER, doctors found that the amniotic sac was protruding through her cervix—evidence of a doomed pregnancy. But they sent her home. The next day, she showed up at the ER in the immense pain of advanced labor.

Anesthesiologists refused to provide her an epidural for pain because they believed it “could be considered [a crime] under the new law,” the clinician reported. Instead, they gave her some IV morphine as she labored for several more hours to deliver a dead fetus. “I overheard the primary provider say to a nurse that so much as offering a helping hand to a patient getting onto the gurney while in the throes of a miscarriage could be construed as ‘aiding and abetting an abortion,’” the horrified clinician reported. “Best not to so much as touch the patient who is miscarrying.”

Even before Roe v. Wade, doctors didn’t treat pregnant patients like this, says Mary Ziegler, a law professor at the University of California Davis who studies the history of abortion care in the United States. Back then, doctors were given more deference to decide when a woman’s life was in danger. She says even in 1946, when Blanton first got pregnant, a family doctor would likely have been able to quietly perform an abortion on a 13-year-old without running afoul of the authorities. Indeed, it was exactly these sorts of child pregnancies that led to legal reforms that created exceptions to anti-abortion laws in the first place, she says.

Today, however, 10 states now have abortion bans with no exceptions for rape or incest, and six have no exceptions for the health of patients, even if they’re children. Politicians like Vance “don’t see exceptions [to abortion bans] as being necessary to address tragedies,” Ziegler says. “They see them as loopholes.”

For Stulberg, Vance may be misreading his grandmother’s story. She says research shows that women who want abortions but can’t get them fare much more poorly than women who do. But they also manage to survive, as Vance’s grandmother did. “It’s almost like women’s resilience protects society from seeing the harm,” she says. “To be that educated,” Stulberg says of Vance, and to have his life experience, and “then choose to support these policies is not caring that women are going to die.”

Women just like his grandmother.

Update, October 1: After this story published, Taylor Van Kirk, a spokeswoman for Vance, sent this comment: “Throughout his campaign for U.S. Senate and during his time in office, Senator Vance has consistently made clear that he supports reasonable exceptions for rape, incest, and life of the mother. Senator Vance has also stated repeatedly that he agrees with President Trump on abortion policy being set at the state level, not the federal level, and like President Trump, he agrees that we need to find common ground on this issue. As a senator, he has not supported any legislation which would impose a federal abortion ban.”

Many Californians are proud of their state’s strong protections for abortion and reproductive rights—safeguards that have become even more important in the post–Roe v. Wade era. But a new lawsuit filed Monday by Attorney General Rob Bonta’s office highlights the risks that blue states face from a vital sector of the health care system that has long considered itself exempt from laws protecting abortion access: Catholic hospitals.

Bonta’s office announced that it was suing the owners of Providence St. Joseph Hospital in Eureka, a small coastal city in the north of the state, for violating various state laws in its treatment of Anna Nusslock, a 36-year-old chiropractor pregnant with twins. This past February, Nusslock’s water broke at 15 weeks—far too early for the fetuses to survive—leaving her in excruciating pain and at high risk of developing a severe infection if treatment was delayed. According to the American College of Obstetricians and Gynecologists, the standard of care in such cases is to remove the fetuses in a procedure akin to an emergency abortion. One of the twins had already died. But medical staff at the Catholic hospital allegedly told Nusslock that because the other twin still had a detectable heartbeat, Catholic ethical rules prevented them from ending the pregnancy until Nusslock’s life was in danger. 

After several hours of waiting, Nusslock’s husband drove her 20 minutes away to the nearest hospital in the even smaller city of Arcata, “where she arrived hemorrhaging and passing a blood clot the size of an apple,” according to an account in the New York Times. “She expelled one fetus and was rushed into the operating room so the other fetus could be removed.” The Arcata doctor who treated Nusslock wrote that she had treated other patients denied abortions by Providence St. Joseph in similar circumstances, the Times reported.

Nusslock told the Times that, six months later, she has recovered physically but still feels the emotional toll. “This experience deeply traumatized me,” she said, “and I have been dealing with tremendous anxiety, grief, and depression ever since.”

“The next person in Anna’s situation will face an agonizing choice of risking a multi-hour drive to another hospital or waiting until they are close enough to death for Providence to intervene.” 

This is exactly the kind of scenario that many pregnant patients with life-threatening complications have been facing in states that imposed onerous abortion restrictions and bans in the aftermath of the US Supreme Court’s Dobbs decision in 2022. Despite the federal Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals to provide stabilizing emergency care to anyone who needs it for any reason, doctors and hospitals in abortion-ban states have been unwilling to provide abortion care for fear of losing their licenses, facing punishing fines, or even being prosecuted and thrown in jail.

After lawsuits in Idaho and Texas, the Supreme Court essentially punted on the EMTALA issue last June, although litigation continues. Meanwhile, the death of Georgia mother Amber Thurman from a catastrophic infection in 2022 shows just how dangerous the medical landscape has become as doctors and hospitals have delayed treating emergencies that require abortion care.

But as I wrote for Mother Jones earlier this year, the same kinds of scenarios have long been common in Catholic healthcare systems. And this reality presents an especially thorny challenge in the post-Roe era, even in blue states that have tried to strengthen their abortion protections.

[Catholic] hospitals—as well as their clinics, pharmacies, and physician practices—follow the Ethical and Religious Directives for Catholic Health Care Services, issued by the US Conference of Catholic Bishops, which ban or limit abortion, contraception, sterilization, fertility treatments, trans care, and physician-assisted suicide. Under the ERDs, Catholic hospitals—even in liberal parts of the country—have long treated pregnancy emergencies in ways that have become chillingly familiar in abortion-ban states. For decades, Catholic hospitals have been “doing as a norm what has now become the post-Dobbs landscape,” Georgetown Law professor and reproductive justice scholar Michele Bratcher Goodwin told my Mother Jones colleague Pema Levy. […]

Under the ERDs, Catholic providers are not allowed to terminate the pregnancy as long as the fetus is alive—even if it has no possibility of surviving—until the woman’s life is in danger, says Lori Freedman, a professor and researcher at the University of California, San Francisco, whose 2023 book, Bishops and Bodies: Reproductive Care in American Catholic Hospitals, is based on interviews with dozens of medical practitioners and patients. “They cannot treat her [with medications or procedures that will terminate the pregnancy], but watch her and wait for signs of infection to develop,” she says. “They have this requirement—if there is a fetal heartbeat, wait till there’s a threat to the mother’s life. Then they have to save her life. That is a low standard of care.”

Making the picture even more complex, Catholic hospitals comprise a huge part of the American healthcare infrastructure—they’re the largest group of nonprofit providers in the country. According to the watchdog group Community Catalyst, about 16 percent of acute-care hospitals around the US are Catholic, caring for one in seven hospital patients every day and accounting for 17.5 million emergency room visits a year. In California, they have about the same percentage of the market. But in some states, Catholic providers account for a much bigger share, including in such reproductive safe havens as Washington (almost 50 percent), Colorado (around 40 percent), and Oregon and Illinois (about 30 percent each). As I wrote, those hospitals have been able to skirt reproductive protections:

Religious providers are protected by what are known as “conscience” clauses sprinkled throughout numerous state and federal laws. The ACLU has sued Catholic hospitals at least three times in the past decade over their treatment of pregnant patients under the ERDs—and lost.

Bonta—whose job is the one Kamala Harris held before she became a senator in 2016, then vice president—told the Times he was filing the case partly because of uncertainty about the fate of EMTALA after the Supreme Court’s landmark (not in a good way) 2023–2024 session. “There were some written opinions by the conservative wing of the court that were very disturbing about whether abortion care, which is health care, will be provided under EMTALA in emergency situations,” Bonta said, “so unfortunately, EMTALA is not reliable right now, in our view, because of the limbo that [it] is in.” As a result, he said, “states are on their own and need to rely on our own laws.” 

The Nusslock suit alleges that the Eureka hospital, owned by St. Joseph Health Northern California, which also operates a second hospital in the area, violated three state statutes: the Emergency Services Law, the Unruh Civil Rights Act, and the Unfair Competition Law. According to the Times, the case is believed to be the first filed by California officials against a hospital under the Emergency Services Law, which says hospitals have to provide care “necessary to relieve or eliminate the emergency medical condition.”

In addition to filing the complaint, the attorney general’s office is moving immediately for a preliminary injunction to force Providence to provide timely emergency care, including abortions. “California is the beacon of hope for so many Americans across this country trying to access abortion services since the Dobbs decision,” Bonta’s office said in a statement. “It is damning that here in California, where abortion care is a constitutional right, we have a hospital implementing a policy that’s reminiscent of heartbeat laws in extremist red states.” 

Bonta’s office said the suit was especially urgent because Mad River Community Hospital, where Nusslock eventually received treatment, is scheduled to close its labor and delivery unit in October due to a steep decline in the number of pregnant patients in recent years. “In a month, Providence will be left as the only hospital with an L&D unit in all of Humboldt County,” the AG’s press release said. “The next person in Anna’s situation will face an agonizing choice of risking a multi-hour drive to another hospital or waiting until they are close enough to death for Providence to intervene.”   

Many Californians are proud of their state’s strong protections for abortion and reproductive rights—safeguards that have become even more important in the post–Roe v. Wade era. But a new lawsuit filed Monday by Attorney General Rob Bonta’s office highlights the risks that blue states face from a vital sector of the healthcare system, one that has long considered itself exempt from many laws safeguarding abortion access: Catholic hospitals.

Bonta’s office announced that it was suing the owners of Providence St. Joseph Hospital in Eureka, a small coastal city in the north of the state, for violating various state laws in its treatment of Anna Nusslock, a 36-year-old chiropractor pregnant with twins. This past February, Nusslock’s water broke at 15 weeks—far too early for the fetuses to survive—leaving her in excruciating pain and at high risk of developing a severe infection if treatment was delayed. According to the American College of Obstetricians and Gynecologists, the standard of care in such cases is to remove the fetuses in a procedure akin to an emergency abortion. One of the twins had already died. But medical staff at the Catholic hospital allegedly told Nusslock that because the other twin still had a detectable heartbeat, Catholic ethical rules prevented them from ending the pregnancy until Nusslock’s life was in danger. 

After several hours of waiting, Nusslock’s husband drove her 20 minutes away to the nearest hospital in the even smaller city of Arcata, “where she arrived hemorrhaging and passing a blood clot the size of an apple,” according to an account in the New York Times. “She expelled one fetus and was rushed into the operating room so the other fetus could be removed.” The Arcata doctor who treated Nusslock wrote that she had treated other patients denied abortions by Providence St. Joseph in similar circumstances, the Times reported.

Nusslock told the Times that, six months later, she has recovered physically but still feels the emotional toll. “This experience deeply traumatized me,” she said, “and I have been dealing with tremendous anxiety, grief, and depression ever since.”

“The next person in Anna’s situation will face an agonizing choice of risking a multi-hour drive to another hospital or waiting until they are close enough to death for Providence to intervene.” 

This is exactly the kind of scenario that many pregnant patients with life-threatening complications have been facing in states that imposed onerous abortion restrictions and bans in the aftermath of the US Supreme Court’s Dobbs decision in 2022. Despite the federal Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals to provide stabilizing emergency care to anyone who needs it for any reason, doctors and hospitals in abortion-ban states have been unwilling to provide abortion care for fear of losing their licenses, facing punishing fines, or even being prosecuted and thrown in jail.

After lawsuits in Idaho and Texas, the Supreme Court essentially punted on the EMTALA issue last June, although litigation continues. Meanwhile, the death of Georgia mother Amber Thurman from a catastrophic infection in 2022 shows just how dangerous the medical landscape has become as doctors and hospitals have delayed treating emergencies that require abortion care.

But as I wrote for Mother Jones earlier this year, the same kinds of scenarios have long been common in Catholic healthcare systems. And this reality presents an especially thorny challenge in the post-Roe era, even in blue states that have tried to strengthen their abortion protections.

[Catholic] hospitals—as well as their clinics, pharmacies, and physician practices—follow the Ethical and Religious Directives for Catholic Health Care Services, issued by the US Conference of Catholic Bishops, which ban or limit abortion, contraception, sterilization, fertility treatments, trans care, and physician-assisted suicide. Under the ERDs, Catholic hospitals—even in liberal parts of the country—have long treated pregnancy emergencies in ways that have become chillingly familiar in abortion-ban states. For decades, Catholic hospitals have been “doing as a norm what has now become the post-Dobbs landscape,” Georgetown Law professor and reproductive justice scholar Michele Bratcher Goodwin told my Mother Jones colleague Pema Levy. […]

Under the ERDs, Catholic providers are not allowed to terminate the pregnancy as long as the fetus is alive—even if it has no possibility of surviving—until the woman’s life is in danger, says Lori Freedman, a professor and researcher at the University of California, San Francisco, whose 2023 book, Bishops and Bodies: Reproductive Care in American Catholic Hospitals, is based on interviews with dozens of medical practitioners and patients. “They cannot treat her [with medications or procedures that will terminate the pregnancy], but watch her and wait for signs of infection to develop,” she says. “They have this requirement—if there is a fetal heartbeat, wait till there’s a threat to the mother’s life. Then they have to save her life. That is a low standard of care.”

Making the picture even more complex, Catholic hospitals comprise a huge part of the American healthcare infrastructure—they’re the largest group of nonprofit providers in the country. According to the watchdog group Community Catalyst, about 16 percent of acute-care hospitals around the US are Catholic, caring for one in seven hospital patients every day and accounting for 17.5 million emergency room visits a year. In California, they have about the same percentage of the market. But in some states, Catholic providers account for a much bigger share, including in such reproductive safe havens as Washington (almost 50 percent), Colorado (around 40 percent), and Oregon and Illinois (about 30 percent each). As I wrote, those hospitals have been able to skirt reproductive protections:

Religious providers are protected by what are known as “conscience” clauses sprinkled throughout numerous state and federal laws. The ACLU has sued Catholic hospitals at least three times in the past decade over their treatment of pregnant patients under the ERDs—and lost.

Bonta—whose job is the one Kamala Harris held before she became a senator in 2016, then vice president—told the Times he was filing the case partly because of uncertainty about the fate of EMTALA after the Supreme Court’s landmark (not in a good way) 2023-24 session. “There were some written opinions by the conservative wing of the court that were very disturbing about whether abortion care, which is health care, will be provided under EMTALA in emergency situations,” Bonta said, “so unfortunately, EMTALA is not reliable right now, in our view, because of the limbo that [it] is in.” As a result, he said, “states are on their own and need to rely on our own laws.” 

The Nusslock suit alleges that the Eureka hospital, owned by St. Joseph Health Northern California, which also operates a second hospital in the area, violated three state statutes: the Emergency Services Law, the Unruh Civil Rights Act, and the Unfair Competition Law. According to the Times, the case is believed to be the first filed by California officials against a hospital under the Emergency Services Law, which says hospitals have to provide care “necessary to relieve or eliminate the emergency medical condition.”

In addition to filing the complaint, the Attorney General’s office is moving immediately for a preliminary injunction to force Providence to provide timely emergency care, including abortions. “California is the beacon of hope for so many Americans across this country trying to access abortion services since the Dobbs decision,” Bonta’s office said in a statement. “It is damning that here in California, where abortion care is a constitutional right, we have a hospital implementing a policy that’s reminiscent of heartbeat laws in extremist red states.” 

Bonta’s office said the suit was especially urgent because Mad River Community Hospital, where Nusslock eventually received treatment, is scheduled to close its labor and delivery unit in October due to a steep decline in the number of pregnant patients in recent years. “In a month, Providence will be left as the only hospital with an L&D unit in all of Humboldt County,” the AG’s press release said. “The next person in Anna’s situation will face an agonizing choice of risking a multi-hour drive to another hospital or waiting until they are close enough to death for Providence to intervene.”   

The infamous CEO of a failed hospital system is suing an entire Senate committee for being held in contempt of Congress on civil and criminal charges that were unanimously approved by the full Senate last week.

In a federal lawsuit filed Monday, Steward CEO Ralph de la Torre claimed the senators "bulldozed over [his] constitutional rights" as they tried to "pillory and crucify him as a loathsome criminal" in a "televised circus."

The Senate committee—the Committee on Health, Education, Labor, and Pensions (HELP), led by Bernie Sanders (I-Vt.)—issued a rare subpoena to de la Torre in July, compelling him to testify before the lawmakers. They sought to question the CEO on the deterioration of his hospital system, which previously included more than 30 hospitals across eight states. Steward filed for bankruptcy in May.

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