In 2016, when Tennessee OBGYN Susan Lacy learned she would be providing gender-affirming care to transgender patients in her new job at a reproductive health clinic in Memphis, she felt out of her depth. But it didn’t take long to realize that hormone treatments for trans folks weren’t so different from those she’d been providing for years to cisgender patients. She already knew how to use pills, patches, gels, and injections, with their different formulations and side effects, to reduce menopausal night sweats, hot flashes, and brain fog. Patients who took hormones for gender dysphoria told her they felt a similar sense of relief. “It didn’t matter about socioeconomics, age, race, feminizing or masculinizing hormone therapy,” Lacy says. Often the first reaction was, “I finally feel like I can think straight.”

Now a gynecologist in solo practice, Lacy has more than 300 adult trans patients. At one time, her patient list also included trans teenagers with the consent of their parents. But last year, Tennessee prohibited the prescription of certain medications to minors to treat the distress many trans people feel when their bodies do not align with their gender identity. Under the law, cisgender kids could keep receiving the meds: puberty blockers for those who start puberty too early, for instance, or testosterone or estrogen for teens who enter puberty late. But if the purpose was to treat gender dysphoria, those same medications were forbidden.

On Wednesday, the US Supreme Court will hear oral arguments in a landmark lawsuit challenging the Tennessee ban, brought by the Biden administration’s Department of Justice, Lacy, and three trans minors and their families. United States v. Skrmetti is one of the biggest cases of the term and the first major trans-rights case to be heard by the court since far-right lawmakers and policy groups launched a coordinated campaign inundating statehouses with hundreds of anti-trans bills a few years ago. Legal experts say the Skrmetti case could shape the landscape for trans rights for years to come, while testing how far the Court’s conservative supermajority is willing to extend its 2022 decision allowing states to ban abortion: Will the justices give states free rein to outlaw yet another form of healthcare?

“Before treatment, I hid,” one plaintiff, 15-year-old Ryan Roe, wrote in a declaration asking a federal judge to put the ban on hold. But with hormone therapy, “I am raising my hand in class again and participating in all aspects of school. I feel stronger—physically, mentally and emotionally. I feel so happy with myself and that makes me feel like I can do and be more.” 

That changed, he added, when Tennessee lawmakers began debating the gender-affirming care ban. “Hopelessness creeped in again.”

The Skrmetti arguments are happening at a time of intense fear and vulnerability for the trans community. President-elect Donald Trump and his allies bet on transphobia to take back the White House and Congress, pouring millions into anti-trans campaign ads and vowing a broad crackdown on what Trump refers to as “left-wing gender insanity” (though the extent to which trans issues swayed the electorate remains unclear). Supported by groups like the Heritage Foundation, the think tank behind Project 2025, and Alliance Defending Freedom, a religious-right legal behemoth, states have made particular targets of trans young people, restricting their use of school bathrooms and locker rooms, their participation in sports, and discussion of LGBTQ-related topics in classrooms and libraries. 

They have also targeted medical care, with nearly half of states outlawing gender-affirming treatments for people under 18, cutting off access for an estimated 118,300 trans teens. The bans have been enacted over the objections of virtually all leading US medical associations, which consider such treatments clinically appropriate. One study of almost 12,000 trans teenagers found that those who received hormone therapy reported lower rates of depression and suicidality compared to those who wanted but didn’t receive the treatment. When Tennessee’s ban took effect, Lacy says, “the biggest sense from the patients was despair—anger and despair.” Parents, meanwhile, were frustrated: “Why can I not make this decision for my child?”

“It is painful to even think about having to go back to the place I was in before I was able to come out and access the care that my doctors have prescribed for me,” one of the plaintiffs, a 15-year-old trans girl known as L.W., wrote in a declaration. She struggled to focus and connect with friends, and got sick when she had to use the boy’s bathroom at school.

“It is painful to even think about having to go back to the place I was in before I was able to come out and access the care that my doctors have prescribed for me.”

L.W.’s mother, Samantha Williams, wrote in a declaration of her own that starting gender-affirming medical care had improved her daughter’s physical and mental health: “She has more confidence, she is fully present, and not only does she accept hugs, but she also gives hugs.” The Tennessee ban prompted Williams and her husband to consider moving their family away from relatives, work, and the community where their two children had grown up. “I do not want to see her go back to the dark place she was in prior to coming out and receiving the life-saving treatment she needs,” Williams wrote.

LGBTQ-rights organizations have filed lawsuits over almost every gender-affirming care ban, with Skrmetti the first case to reach the Supreme Court. Now, justices are being asked to set the standard under which lower-court judges must evaluate whether laws like Tennessee’s violate the Equal Protection Clause of the US Constitution. The justices’ eventual decision could have implications not just for gender-affirming care bans, but for future anti-trans laws in statehouses and Congress. “It will tell the next administration whether it’s open season to continue with these attacks on trans young folks and transgender people more broadly,” says Jenny Pizer, chief legal officer of the LGBTQ civil rights organization Lambda Legal, “or whether there’s going to be some limits.”

There’s a potential wild card in the mix: When Trump takes office, his Department of Justice is likely to try to reverse the Biden administration’s position and withdraw the case. Pizer says that if that happens, there’s no telling how the Supreme Court would respond. They could agree to kill the case, deny the request, or push a decision off till next term. Or, they could let the federal government withdraw but allow the case to proceed, with only the Tennessee families and Lacy as plaintiffs.

Legally speaking, the main issue in the case boils down to the question of whether bans on gender-affirming care are a form of sex-based discrimination. If they are, then states going forward will have to prove, when challenged, that the bans are “substantially related” to an “important state interest.” That’s a fairly high bar—one that would require judges to weigh the medical and scientific evidence around the prohibited treatments. When trial courts have looked at that evidence in the past, they’ve overturned the bans, siding with the trans youth and their families.

In fact, that’s what happened in the Middle District of Tennessee federal court, where the Skrmetti case started. “The Court acknowledges that the state feels strongly that the medical procedures banned by [the law] are harmful to minors,” District Judge Eli Richardson wrote last year in an order temporarily blocking the law. “The medical evidence on the record, however, indicates otherwise.”

Richardson’s decision wasn’t controversial at the time—every federal judge, including Trump appointees, who had looked at gender-affirming care bans up until that point had blocked them. But the Sixth Circuit Court of Appeals, which oversees Tennessee, went the other way, ruling 2 to 1 that the law did not discriminate based on sex, and thus it didn’t have to meet the higher level of scrutiny. (The judges also shot down the plaintiffs’ two other arguments—that anti-trans discrimination is unique and merits a closer look by the courts, and that the ban violates parents’ right to direct their children’s medical care.) In the 14 months since that decision, more courts have upheld gender-affirming care bans for minors, including in Ohio, Oklahoma, and Missouri.

If the Supreme Court agrees with the Sixth Circuit’s approach, courts going forward will apply the lowest level of scrutiny to gender-affirming care bans. The result, says Jess Braverman, legal director at the advocacy group Gender Justice, would be “like a rubber stamp.”

Casual Supreme Court observers would be forgiven for thinking that the question of whether anti-trans discrimination counts as sex discrimination has already been settled. In his majority opinion in the court’s last major trans-rights case, Bostock v. Clayton County in 2020, Justice Neil Gorsuch stated, “It is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex.” But since that ruling, which involved a funeral home employee who was fired after transitioning, conservative lawyers and public officials have been trying to limit Bostock from being applied to situations beyond employment. The result has been an escalation of the legal battles over federal protections for trans people: Do existing sex-discrimination laws shield them at school? What about at the doctor’s office?

In arguing that Tennessee’s ban discriminates based on sex, DOJ lawyers point to the text of the law, which explicitly says that the state wants to “encourage[e] minors to appreciate their sex” and forbid treatments that might “encourage minors to become disdainful of their sex.” The “purpose is to force boys and girls to look and live like boys and girls,” appellate judge Helene White summarized in a dissent from the Sixth Circuit ruling. Under the law, kids can receive puberty blockers and hormone therapy if the medications are provided to help them conform their bodies to their sex assigned at birth, but not if the treatments are provided to help them not conform. “There is no way to determine whether these treatments must be withheld from any particular minor without considering [the minor’s] sex,’” DOJ lawyers argue in their Supreme Court briefing.

Tennessee Attorney General Jonathan Skrmetti contends that the ban does not discriminate based on sex. Instead, he says, the law is a health care regulation that applies to everyone. “The law draws a line between minors seeking drugs for gender transition and minors seeking drugs for other medical purposes,” he argues in his brief. “Boys and girls fall on both sides of that line.”

In making that argument, Skrmetti repeatedly cited Dobbs v. Jackson Women’s Health Organization, the 2022 case that overturned the federal right to abortion. As Susan Rinkunas has noted over at The New Republic, the Tennessee AG is picking up on an aside by Justice Samuel Alito in the Dobbs ruling that Mississippi’s abortion ban didn’t violate the Equal Protection Clause because, according to the justice, the ban didn’t discriminate based on sex. To back up this assertion, Alito cited a Supreme Court ruling from 1974, Geduldig v. Aiello, which held that an insurance policy specifically excluding pregnancy-related coverage was not a form of sex discrimination, and applied to everyone. That ruling and a related decision were deemed so outrageous at the time that Congress swiftly enacted the Pregnancy Discrimination Act to override them.

Now, there is a risk that when the Supreme Court decides Skrmetti, it will apply the same reasoning from Geduldig and Alito’s sidenote in Dobbs: Even when laws restrict medical treatments that only matter for certain groups—like pregnant women, or trans people—those laws aren’t inherently discriminatory, because not every member of that group requires that type of care. “It’s kind of like our Supreme Court is a bunch of freshman philosophy students,” Braverman says. “It’s like they’re all asking, ‘Do we see the same color when we see yellow?’ Except lives are at stake.”

“It’s kind of like our Supreme Court is a bunch of freshman philosophy students. It’s like they’re all asking, ‘Do we see the same color when we see yellow?’ Except lives are at stake.”

To Braverman, it’s no surprise that the arguments being used to defend bans on gender-affirming care are the same as those used to defend bans on abortion. “It’s the same people who are litigating it in court, and they’re making the same argument,” Braverman says. “If we treat what’s happening to transgender people as though it’s happening in a vacuum, everyone’s going to lose all their rights.” If the Supreme Court sides with Tennessee, for example, states might be emboldened to try banning other types of sex-specific healthcare, such as IVF or birth control, the ACLU warns.

“The real question in this case is, ‘Can powerful interest groups like the Heritage Foundation or Alliance Defending Freedom make up lies about your health care, and then use those lies to make your healthcare illegal?” Shawn Thomas Meerkamper, senior staff attorney at the Transgender Law Center, said in a briefing for journalists. “Because that’s what’s happening here.”

“One of the things that I think is so concerning about these laws is allowing legislators with no medical knowledge to restrict care for a specific diagnosis,” Lacy says from her office in Memphis. When the Tennessee ban came down, she tried to help her young patients find ways to keep up their existing prescriptions. Some families drove across the border to a clinic in Illinois or flew to other states where the medications were still legal. But for patients needing new prescriptions, her hands were tied.

She thinks about the families that never call her office in the first place—the “chilling effect” stopping parents from even considering medical care as an option after their children come out as trans. “I think when that law was passed, a lot of those parents just said, ‘Nope, can’t even deal with it,’” Lacy says. “Prior, they would say, ‘Well, let’s go in and let’s at least have the conversation.’”

Beyond the chilling effect, Lacy fears how laws like Tennessee’s worsen hostility toward transgender people. She worries about her own daughter, who came out as trans as a young adult, being judged based on how others perceive her gender identity. “There’s just a fear of the risk of existing in the world where the state is saying that you don’t have a right to exist,” Lacy says. “And that’s very, very frightening.”

What do anti-vaxxers and abortion opponents have in common? They both see an ally in David Weldon, who is now President-elect Donald Trump’s pick to run the Centers for Disease Control and Prevention.

The physician and ex–Florida congressman’s track record includes introducing legislation that would have stripped the CDC of its authority to conduct research on vaccine safety and instead given it to an independent agency within the Department of Health and Human Services. Weldon has also promoted the unfounded theory that vaccines lead to childhood autism—a false claim boosted infamously in the past by Trump’s pick for HHS Secretary, Robert F. Kennedy, Jr. And on abortion, Weldon is responsible for an eponymous federal law that prohibits HHS from funding any entities that “discriminate” against health care providers, hospitals, or insurance plans who opt out of providing abortion care—which the Trump administration “weaponized” to enact its anti-abortion agenda during his first term, according to the National Women’s Law Center. Weldon introduced the amendment in the House in 2004, and it has been passed as part of the HHS spending bill every year since 2005.

While in Congress, Weldon also co-sponsored legislation that sought to bar HHS from providing any Title X family planning funding to entities that provide abortions. (Then-Rep. Mike Pence sponsored that bill, and Trump enacted that policy in office, when Pence was vice president.) Weldon also supported a bill that proposed studying unsubstantiated links between abortion and depression.

Neither Weldon nor Trump have been shy about acknowledging these positions. On Weldon’s campaign site for his unsuccessful run for the Florida statehouse earlier this year, he promotes his record on so-called “vaccine safety,” as well as his “100% pro-life voting record” and the anti-abortion amendments he passed in Congress. When Trump announced Weldon as his choice to run the CDC on Nov. 22, he noted Weldon’s history “addressing issues within HHS and CDC,” including that he “worked with the CDC to enact a ban on patents for human embryos.”

“Dave will proudly restore the CDC to its true purpose, and will work to end the Chronic Disease Epidemic, and Make America Healthy Again!” Trump wrote.

Anti-vaxxers and abortion opponents are now celebrating the fact that Weldon could potentially control the CDC’s more than $9 billion budget.

“He is one of us!! Since before our movement had momentum,” the co-director of the anti-vaxx group Mississippi Parents for Vaccine Rights wrote on social media.

“This is YUGE!” a similar group in Oklahoma claimed, praising Weldon’s efforts to stop the CDC from conducting vaccine research.

And both the anti-abortion site Live Action and the right-wing Daily Signal ran pieces highlighting Weldon’s anti-abortion record, following Trump’s announcement. Marjorie Dannenfelser, president of the anti-abortion group Susan B. Anthony Pro-Life America, told the Daily Signal that Weldon “is a proven leader for life, and we look forward to working with him.”

Now in the national spotlight, Weldon appeared to walk back his most ardent anti-vaccine beliefs of the past: He told the New York Times this week, “I give shots, I believe in vaccination.” On abortion, though, Weldon seems to be more status quo: His campaign website from this year says, “I will always vote to protect the unborn and support a culture that celebrates the value of life.”

On Tuesday, President-elect Donald Trump announced that he would nominate Dr. Jay Bhattacharya to lead the National Institutes of Health, a government agency composed of more than 18,000 employees with an annual budget of $47 billion. Bhattacharya, a professor of economics and health policy at Stanford University, has no leadership experience in either government or large organizations, but, like some other Trump nominees, he is outspoken about what he sees as the tyranny of public health restrictions and censorship on social media platforms. Bhattacharya came into prominence as a strong critic of Covid vaccine mandates, though he has said publicly that he supports some routine childhood vaccinations, including those that prevent polio and measles, mumps, and rubella (MMR).

Bhattacharya, who didn’t respond to a list of questions emailed by Mother Jones, has held several appointments at Stanford, including at the university’s libertarian-leaning Hoover Institution. But it was during the pandemic that he emerged as a high-profile public health iconoclast, criticizing lockdowns, and then mask and vaccine mandates. Bhattacharya was one of the three authors of the Great Barrington Declaration, a 2020 document—developed at a meeting of the American Institute for Economic Research, a libertarian think tank—that recommended that the United States achieve Covid herd immunity by employing a strategy of mass infection. Bhattacharya and his co-authors—biostatistician Martin Kulldorff and epidemiologist Sunetra Gupta—suggested sequestering vulnerable populations, such as the elderly and those with weakened immune systems, while permitting other citizens to go about business as usual.

At a conference hosted by the anti-lockdown group the Brownstone Institute in November 2021, nearly a year after the rollout of the Covid vaccines, Bhattacharya lamented that public health had become a tool “for authoritarian power” and “to enforce the biosecurity state.” He has repeatedly criticized the agency he is now poised to lead, suggesting that it punishes scientists who buck consensus by denying them funding.

Bhattacharya lamented that public health had become a tool “for authoritarian power” and “to enforce the biosecurity state.”

Bhattacharya’s critique of pandemic protocols caught on in right-wing circles, and he became a regular at conservative gatherings. He railed against what he called the stifling of academic freedom at events at the ultra-right-wing Hillsdale College, as well as the rally where then–presidential hopeful Robert F. Kennedy Jr. announced lawyer and philanthropist Nicole Shanahan as his running mate.

But in other venues, Bhattacharya’s criticisms of pandemic management haven’t gone over as well. The Great Barrington Declaration was panned by the American Public Health Association; in a public letter in the Lancet, a group of 80 scientists called it “a dangerous fallacy unsupported by scientific evidence.” In 2021, as journalist Walker Bragman reported, Bhattacharya testified in a Tennessee court in favor of Gov. Bill Lee’s order to allow parents to send their children to school unmasked. The US district judge, Waverly D. Crenshaw, blocked the order and wrote that Bhattacharya’s “demeanor and tone while testifying suggest that he is advancing a personal agenda.”

Bhattacharya has questioned the effectiveness of masks in preventing the spread of Covid, often citing a 2023 review by the medical database Cochrane Library. “It has been disheartening to watch once reputable experts discount the Cochrane review’s negative verdict on community masking to prevent Covid spread in favor of low-quality evidence,” he posted to his 548,000 followers on X. “Medicine has rejected evidenced-based medicine.” Yet Cochrane itself disagrees with Bhattacharya’s conclusion. “Many commentators have claimed that a recently-updated Cochrane Review shows that ‘masks don’t work’, which is an inaccurate and misleading interpretation,” wrote Karla Soares-Weiser, editor-in-chief of the Cochrane Library.

Meanwhile, Bhattacharya’s connections with powerful conservative groups and Silicon Valley titans have increased his status and visibility. PayPal founder and conservative super-donor Peter Thiel praised Bhattacharya and referred to him as his friend at the 2021 National Conservatism conference, WhoWhatWhy’s Allison Neitzel reported. The following year, shortly after Tesla CEO Elon Musk bought Twitter, Musk invited Bhattacharya to the Twitter headquarters, where the two discussed the platform’s alleged “blacklisting” of him for his tweets that criticized public health guidelines around the pandemic.

It will take some time to find out more about what led Twitter 1.0 to act so imperiously, but I am grateful to @elonmusk, who has promised access to help find out. I will report the results on Twitter 2.0, where transparency and free speech rule.
4/4

— Jay Bhattacharya (@DrJBhattacharya) December 11, 2022

In 2023, a promotional video for Teneo Group, a political strategy organization helmed by the conservative judicial kingmaker Leonard Leo, included a montage that briefly showed Bhattacharya.

Since the start of the pandemic, Bhattacharya has been outspoken about the censorship that he claimed was silencing scientists who, like himself, questioned the wisdom of the government’s approach to pandemic restrictions. He was especially critical of the censorship he saw at his own university—specifically the pandemic disinformation-tracking work at the Stanford Internet Observatory’s Virality Project. Bhattacharya claimed that the group served as “a conduit to launder Biden Administration social media censorship activities” and embedding “within social media companies and pass on gov’t censorship demands.” Renée DiResta, a disinformation scholar who served as the group’s technical research manager, said she was instructed by her bosses not to publicly refute Bhattacharya’s claims—and that the damage he did to the group’s reputation may have contributed to the dissolution of the group earlier this year. Bhattacharya’s criticisms, she told me, “led to continued public pressure and the university deciding that some of the work was not worth continuing to support.” Stanford University didn’t respond to a request for comment from Mother Jones.

In 2022, Bhattacharya joined a group of plaintiffs in suing the Biden administration, claiming that the US government had pressured social media companies to suppress posts that criticized pandemic policies. He was represented pro bono by the New Civil Liberties Alliance, a legal group that says it aims to “tame the unlawful power of state and federal agencies,” and the case wound its way up to the US Supreme Court, which dismissed it earlier this year because the plaintiffs lacked standing.

As the pandemic increasingly receded from view, Bhattacharya became involved in causes beyond public health. Today, he serves as an adviser to Third Rail, a consulting group that says it helps “neutralize” “self-censoring environments” and “counterproductive DEI initiatives.” The group’s founder is former New York City Community Education Council president Maud Maron, who has crusaded against transgender inclusivity initiatives. Last year, Bhattacharya joined independent journalist Rav Arora in creating a podcast called Illusion of Consensus, in which the two hosts “dissect the misconceptions of consensus in science, from COVID-19 policies to gender-affirming care.” Earlier this year, Neitzel reported, Bhattacharya joined a group of scientists who aim to convince the public that Covid-19 was the result of a lab leak.

If confirmed as the director of NIH, Bhattacharya would be in charge of the agency responsible for allocating government funding for biomedical and public health research in the United States. He would help shape the research goals of the 27 institutes within the agency, including the National Institute of Allergy and Infectious Diseases, the group that Dr. Anthony Fauci led until he retired in 2022.

In a post on X, before he was announced as the official nominee, Bhattacharya vowed to his followers that “no matter what happens, I will do my best in the coming years, in whatever role I have, to help support the reform of the American scientific and public health institutions after the Covid era fiasco so that they work for the benefit of the American people.”

When Gwen Williams’ mother was dying, taking her to an in-person appointment to get more medicine seemed impossible. So Williams made a telehealth appointment with the doctor—a video call. It was that easy.

“Her comfort was paramount,” Williams, who lives in Minnesota, recounts. “My mother wasn’t conscious during the visit, but [the doctor] was able to see her and was able to get the hospice medications and everything refilled.” 

Williams’ mother was on Medicare, as is she. Since 2020, Medicare has covered a wide range of remote medical services, some in critical situations like theirs, and others for routine care. Around one in four telehealth appointments are made by people on Medicare.

Around one in four telehealth appointments are made by people on Medicare.

The fact that Medicare will abruptly cut off that coverage for most specialties on January 1—barely a month away—Williams said, “just blows my mind.”

What we now call telehealth, an umbrella term for remote and digitally assisted medical care, was first developed by NASA in 1960 as a suite of tools to monitor astronauts’ health in space. While it has been gaining traction as a widespread, normalized aspect of care since the beginning of this century, telehealth really exploded in 2020 with the onset of the Covid-19 pandemic.

Until then, for Medicare patients—which includes most Americans over 65, and some younger disabled people—remote care coverage had been limited. In rural areas, for instance, people on Medicare could speak to a non-local specialist via telehealth, but not from home; they still had to go to a local hospital to place the call.

But on March 6, 2020, the Centers for Medicare and Medicaid Services temporarily expanded Medicare’s telehealth coverage to all specialties. That expansion, renewed in 2022, is set to expire at the end of the year, impacting more than 65 million Americans.

Multiple bills have been introduced in the 118th Congress to preserve Medicare telehealth provisions and continue allowing people on Medicare to use telehealth flexibly, but all still await votes in both the House and Senate. Perhaps the likeliest to pass, the Telehealth Modernization Act of 2024, introduced by Rep. Buddy Carter (R-Ga.), received widespread, bipartisan support from members of the House Committee on Energy and Commerce and its subcommittee on health.

“Seniors, individuals with mobility issues, and those living in rural areas rely on telehealth,” Rep. Carter said in a statement to Mother Jones, calling the act “critical legislation that will extend telehealth flexibilities to get Medicare beneficiaries the life-saving health care they need.”

Where so many other health issues can be partisan or controversial, says Telehealth Access for America executive director Alye Mlinar, telehealth manages to be bipartisan. Mlinar hopes the bipartisan support “critical for really any issue” that telehealth has garnered will help lead to another congressional extension.

Epilepsy Foundation chief medical officer Dr. Jacqueline French’s organization has supported telehealth access for people with epilepsy even before the start of the Covid pandemic.

“There’s nothing that we learn from a physical exam that we could not learn from just talking to a person,” said French, who is also a professor of neurology at New York University Langone Health’s Comprehensive Epilepsy Center. The Epilepsy Foundation is one member of Telehealth Access for America, a consortium that includes, among other groups, the American Medical Association, Johns Hopkins Medicine and the National Down Syndrome Society.

There are plenty of patients who can’t make long journeys at all—but for many others, telehealth is still a way to avoid travel risks. Traveling with uncontrolled seizures, for instance, can be dangerous, French notes.

Even if Congress does not extend its current, wide coverage of telehealth for Medicare recipients, a handful of protections—mainly around dialysis, strokes, and mental health—would remain.

Williams, whose mother also relied on telehealth, also praised the separate ways it benefits her: When the doctor who prescribed their mental health medication moved away, telehealth prevented a disruption in her care. She likens the often needless in-person visits to “a meeting that could have just been an email.”

“Just have to have a conversation with your doctor,” Williams said, “paying for transportation, paying for parking if you drive—it’s a real barrier when all you need is to have a conversation, to continue care, or ask a question.”

But there are limitations to a blanket extension of the program, argues Medicare Rights Center senior counsel Casey Schwarz. 

“We had really hoped Congress would take the opportunity to look carefully at what a telehealth benefit could and should look like, because while the pre-pandemic status quo is inadequate,” Schwarz told Mother Jones, “A complete lack of restriction or breaks on telehealth services is also inappropriate, and we think has some risk for beneficiaries.”

Schwarz said that she had heard from Medicare recipients “who have received what they believe to be substandard care through telehealth because something that they think would have been noticed or caught in an in-person visit was missed.”

An investigation by Mayo Clinic researchers found that diagnostic accuracy for people on telehealth ranged from 77 percent for ear, nose, and throat doctors to 96 percent for psychiatrists across a 90-day period in 2020. However, specialists, such as rheumatologists, were more likely to request an in-person appointment to continue care, in comparison to primary care doctors. 

Schwarz also says that telehealth cannot replace other forms of compliance with civil rights laws around accessibility, like the Americans with Disabilities Act.

“We don’t want to see telehealth fill in a way for providers to indicate that they do not need to meet physical access requirements because they provide telehealth services,” she said.

In-person services, especially from specialists, can’t always be replaced—and people like Schwarz raise the risk of telehealth, often cheaper for providers, being used to justify cuts to in-person services. Williams, for instance, does see their neurologists in-person, so they are able to assess her reflexes and the progression of their neuropathy.

With just weeks until the end of the year and Medicare’s telehealth termination, there is not much time for individual bills to pass through Congress and be signed into law by President Biden. 

Mlinar, however, is optimistic that an extension for Medicare telehealth recipients will be part of an annual end-of-year package negotiated by Congress “given the overwhelming support.”

“The biggest question at this point,” Mlinar said, “is [for] how long.”

Federal agents briefly detained infamous ex-hospital CEO Ralph de la Torre early last week and seized his phone, according to an investigative report from the Boston Globe.

De la Torre is the ultra-wealthy former CEO of the now-bankrupt hospital chain Steward, once the largest for-profit health care company in the country. Steward and de la Torre have been accused of being "health care terrorists" and practicing "third-world medicine" that killed and maimed patients as executives extracted millions in payouts, stripping the company of assets.

In September, de la Torre was held in criminal contempt of Congress for failing to abide by a congressional subpoena to attend a Senate hearing over the alleged corruption.

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When Gwen Williams’ mother was dying, taking her to an in-person appointment to get more medicine seemed impossible. So Williams made a telehealth appointment with the doctor—a video call. It was that easy.

“Her comfort was paramount,” Williams, who lives in Minnesota, recounts. “My mother wasn’t conscious during the visit, but [the doctor] was able to see her and was able to get the hospice medications and everything refilled.” 

Williams’ mother was on Medicare, as is she. Since 2020, Medicare has covered a wide range of remote medical services, some in critical situations like theirs, and others for routine care. Around one in four telehealth appointments are made by people on Medicare.

Around one in four Medicare patients takes advantage of telehealth.

The fact that Medicare will abruptly cut off that coverage for most specialties on January 1—barely a month away—Williams said, “just blows my mind.”

What we now call telehealth, an umbrella term for remote and digitally assisted medical care, was first developed by NASA in 1960 as a suite of tools to monitor astronauts’ health in space. While it has been gaining traction as a widespread, normalized aspect of care since the beginning of this century, telehealth really exploded in 2020 with the onset of the Covid-19 pandemic.

Until then, for Medicare patients—which includes most Americans over 65, and some younger disabled people—remote care coverage had been limited. In rural areas, for instance, people on Medicare could speak to a non-local specialist via telehealth, but not from home; they still had to go to a local hospital to place the call.

But on March 6, 2020, the Centers for Medicare and Medicaid Services temporarily expanded Medicare’s telehealth coverage to all specialties. That expansion, renewed in 2022, is set to expire at the end of the year, impacting more than 65 million Americans.

Multiple bills have been introduced in the 118th Congress to preserve Medicare telehealth provisions and continue allowing people on Medicare to use telehealth flexibly, but all still await votes in both the House and Senate. Perhaps the likeliest to pass, the Telehealth Modernization Act of 2024, introduced by Rep. Buddy Carter (R-Ga.), received widespread, bipartisan support from members of the House Committee on Energy and Commerce and its subcommittee on health.

“Seniors, individuals with mobility issues, and those living in rural areas rely on telehealth,” Rep. Carter said in a statement to Mother Jones, calling the act “critical legislation that will extend telehealth flexibilities to get Medicare beneficiaries the life-saving health care they need.”

Where so many other health issues can be partisan or controversial, says Telehealth Access for America executive director Alye Mlinar, telehealth manages to be bipartisan. Mlinar hopes the bipartisan support “critical for really any issue” that telehealth has garnered will help lead to another congressional extension.

Epilepsy Foundation chief medical officer Dr. Jacqueline French’s organization has supported telehealth access for people with epilepsy even before the start of the Covid pandemic.

“There’s nothing that we learn from a physical exam that we could not learn from just talking to a person,” said French, who is also a professor of neurology at New York University Langone Health’s Comprehensive Epilepsy Center. The Epilepsy Foundation is one member of Telehealth Access for America, a consortium that includes, among other groups, the American Medical Association, Johns Hopkins Medicine and the National Down Syndrome Society.

There are plenty of patients who can’t make long journeys at all—but for many others, telehealth is still a way to avoid travel risks. Traveling with uncontrolled seizures, for instance, can be dangerous, French notes.

Even if Congress does not extend its current, wide coverage of telehealth for Medicare recipients, a handful of protections—mainly around dialysis, strokes, and mental health—would remain.

Williams, whose mother also relied on telehealth, also praised the separate ways it benefits her: When the doctor who prescribed their mental health medication moved away, telehealth prevented a disruption in her care. She likens the often needless in-person visits to “a meeting that could have just been an email.”

“Just have to have a conversation with your doctor,” Williams said, “paying for transportation, paying for parking if you drive—it’s a real barrier when all you need is to have a conversation, to continue care, or ask a question.”

But there are limitations to a blanket extension of the program, argues Medicare Rights Center senior counsel Casey Schwarz. 

“We had really hoped Congress would take the opportunity to look carefully at what a telehealth benefit could and should look like, because while the pre-pandemic status quo is inadequate,” Schwarz told Mother Jones, “A complete lack of restriction or breaks on telehealth services is also inappropriate, and we think has some risk for beneficiaries.”

Schwarz said that she had heard from Medicare recipients “who have received what they believe to be substandard care through telehealth because something that they think would have been noticed or caught in an in-person visit was missed.”

An investigation by Mayo Clinic researchers found that diagnostic accuracy for people on telehealth ranged from 77 percent for ear, nose, and throat doctors to 96 percent for psychiatrists across a 90-day period in 2020. However, specialists, such as rheumatologists, were more likely to request an in-person appointment to continue care, in comparison to primary care doctors. 

Schwarz also says that telehealth cannot replace other forms of compliance with civil rights laws around accessibility, like the Americans with Disabilities Act.

“We don’t want to see telehealth fill in a way for providers to indicate that they do not need to meet physical access requirements because they provide telehealth services,” she said.

In-person services, especially from specialists, can’t always be replaced—and people like Schwarz raise the risk of telehealth, often cheaper for providers, being used to justify cuts to in-person services. Williams, for instance, does see their neurologists in-person, so they are able to assess her reflexes and the progression of their neuropathy.

With just weeks until the end of the year and Medicare’s telehealth termination, there is not much time for individual bills to pass through Congress and be signed into law by President Biden. 

Mlinar, however, is optimistic that an extension for Medicare telehealth recipients will be part of an annual end-of-year package negotiated by Congress “given the overwhelming support.”

“The biggest question at this point,” Mlinar said, “is [for] how long.”

Since winning the election, President-elect Donald Trump has seized headlines with a series of alarming appointments for his incoming administration. Many lack the basic qualifications for their respective posts; nearly all can be fairly characterized as MAGA loyalists.

Dr. Mehmet Oz, the former TV personality and failed Republican Senate candidate, is among the more heavily scrutinized picks—and for good reason. Oz is a celebrity doctor without any experience running a large federal bureaucracy, now tapped to lead the Centers for Medicare and Medicaid Services, a massive agency that administers Medicare, Medicaid, and the Affordable Care Act. Oz also boasts a long history of peddling dubious scientific theories and treatments.

But Oz’s remarkable lack of qualifications does not appear to have dimmed Republican excitement. In fact, they seem thrilled. Sen. Lindsey Graham said he was “very excited” about the nomination; Sen. Tommy Tuberville went as far as to call Oz an “all-star” candidate. Here’s what to know about Oz and why he could be the perfect vessel to help achieve the party’s long-sought goal of dramatically gutting safety net programs.

He Has a Long History of Peddling Pseudoscience

Trained as a heart surgeon, Oz rose to fame as a daytime TV personality. In the 2000s, he made frequent appearances on The Oprah Winfrey Show, where the eponymous TV host dubbed him “America’s Doctor.” He then moved on to his own show in 2009. Throughout his 13 years on air, Oz repeatedly came under fire for pushing questionable remedies, including sketchy weight-loss supplements that landed him in the hot seat with the US Senate.

“My show is about hope,” Oz told senators in 2014. “We’ve engaged millions in programs, including programs we did with the CDC, to get folks to realize there are different ways they can rethink their future.”

In 2011, Oz told viewers to stop drinking apple juice out of concern that it contained dangerous levels of arsenic. The FDA slammed the advice, calling it “irresponsible and misleading to” make such a suggestion.

Throughout the pandemic, Oz encouraged people to use hydroxychloroquine and chloroquine, malaria medication that then-President Donald Trump heralded as an effective treatment for Covid. (It is not.) In emails reported by the Washington Post, Oz even urged Jared Kushner to help expedite the medication to patients, writing, “We have a potential pandemic solution at our fingertips.”

Oz’s previous support for Joseph Mercola, an osteopath who’d eventually become one of the leading spreaders of Covid misinformation, was also condemned. As my colleague David Corn reported:

With his cheerleading for hydroxychloroquine, Oz helped distort the national public conversation about Covid. But his greater impact on the pandemic might be his previous support for Mercola. Advancing the career of the fellow who would become a top promoter of Covid misinformation—and whose efforts may have prompted many Americans to not become vaccinated and, thus, face terrible consequences—hardly meets the oath that Oz once swore: first, do no harm.

Oz Has Invested in Private Health Care Programs

One of the major concerns raised by Oz’s critics is whether he will cut funding to Medicare and Medicaid. As the Washington Post reported, Trump’s advisers are preparing to cut Medicaid, which currently serves about 80 million low-income people, in addition to a slew of other safety-net programs, to offset the cost of extending Trump’s 2017 tax cuts.

Oz does not appear to have taken any public positions concerning Medicaid. However, he has been a vocal supporter of the privatization of health care programs. In 2020, he wrote an op-ed supporting Medicare Advantage, a private coverage option supported by Trump and Project 2025.

As William Gavin at Quartz reported, Oz has previously disclosed owning at least $600,000 of stocks in companies that benefit from private Medicare services, raising serious concerns that, if confirmed, Oz could stand to finally benefit from the services his agency oversees.

Experts have long warned that privatizing Medicare is not a viable solution for cutting government waste, and will instead potentially make health care far more inaccessible for vulnerable communities.

But there is some reason to be hopeful. As my colleague Julia Métraux reported, existing laws will make it somewhat challenging for Oz to completely wreck Medicare.

His Peers Have Questioned His Ethics—A Lot

For nearly as long as Oz has been famous, peers have questioned his motives. In 2011, ABC News’ Richard Besser accused Oz of fearmongering, stating his apple juice claims reminded him of “screaming fire in a crowded theater.” In 2015, doctors wrote a letter calling for Columbia University to cut its ties to Oz, stating that Oz had “repeatedly shown disdain for science and for evidence-based medicine.” It didn’t work at the time. But seven years later, as Oz campaigned for Senate, the university finally severed its ties.

“It took Columbia far too long to remove Oz from its otherwise distinguished medical faculty,” Dr. Henry Miller, of the Pacific Research Institute, in California, told MedPage Today. Miller called Oz “an unethical grifter whose claims and pronouncements were not supported by science, and were injurious to consumers—in the interest of financial benefit to Oz himself.”

In 2017, academics wrote a paper titled The Case of Dr. Oz: Ethics, Evidence, and Does Professional Self-Regulation Work?, in which they called the media personality “a dangerous rogue unfit for the office of America’s doctor.”

His Failed Senate Campaign Was Rife With Ableism

While running for Senate, Oz’s campaign also took several ableist potshots at his competitor, Sen. John Fetterman. “If John Fetterman had ever eaten a vegetable in his life,” Oz’s senior communications officer told Business Insider after Fetterman poked fun at the infamous crudité video, “then maybe he wouldn’t have had a major stroke and wouldn’t be in the position of having to lie about it constantly.”

Oz’s campaign also mocked Fetterman in September 2022 by including the following line in a press release: “We will pay for any additional medical personnel he might need to have on standby.”

Some 15 percent of Americans are enrolled in Medicare Part D, which covers outpatient prescription drug costs for older adults and other qualifying individuals, providing nearly $140 billion a year in support to about 50 million people. But the program is administered by the Centers for Medicare and Medicaid Services—which President-elect Donald Trump has nominated celebrity physician Mehmet Oz to lead.

It’s questionable how a man infamous for promoting questionable supplements, who has commented that there’s no right to health for people who can’t afford it, will help lead and provide government health insurance in the United States. On his show, the cardiothoracic surgeon has mounted attacks on medications that Part D covers, such as antidepressants, claiming that they do not work for most patients (the evidence is against him).

Given his history, it makes sense that Oz would be part of Trump’s “Make America Healthy Again” cohort, which does seem fairly anti-science: Robert F. Kennedy Jr.’s attacks on vaccines, for instance, also conveniently ignore that measles and polio can cause lifelong health conditions. Medicare Part D currently covers the costs of all recommended vaccines.

But what kind of damage could Oz do from his new post? Will he be able to cut medications that actually help people manage chronic health conditions—conditions that people who qualify for Medicare are more likely to have? The short answer is no. At least not on his own.

Juliette Cubanski, deputy director of health nonprofit KFF‘s program on Medicare policy, explains that the range of medications covered by Medicare Part D is specified in the Social Security Act.

“Generally speaking, Medicare Part D covers drugs and vaccines that are approved by the Food and Drug Administration,” Cubanski told Mother Jones. “The law specifically excludes some types of drugs from coverage under Part D, including drugs used for weight loss or cosmetic purposes.” So dubious supplements that Oz promoted on his show could not readily be added to the list, nor could he easily remove actual medication.

“Congress would need to change the law in order to change what drugs Medicare Part D covers,” Cubanski said. “An agency official acting under their own authority can’t do that.”

There is still the possibility that some aspects of Medicare Part D could change through a regulatory process, says University of Pennsylvania health law and policy professor Allison Hoffman, but that too is a rigorous procedure—and attacking Medicare would also be a risky political move.

“Medicare Part D was passed during a Republican administration and with Republican control in Congress, with Democratic support,” Hoffman said. “Trump knows to tread carefully in this space because Medicare is a widely popular program and the Part D program has really created a lot of financial security for people.”

But if Republicans do, as they have pledged, go after the Inflation Reduction Act, which helped fund and improve Medicare affordability, Part D isn’t necessarily in the clear. The IRA instituted a new $2,000-a-year cap on out-of-pocket spending costs for prescriptions—still a lot for many older Medicare patients, and for qualifying younger disabled people, but an extremely short-lived protection if it’s immediately overturned by the GOP.

And while Oz on his own can’t screw up Medicare Part D too badly, there’s no guarantee he’ll let it work smoothly, either. In practice, the plans are administered by private insurance companies, which can choose which pharmacies to work with and even which medications to cover. Federal health reforms like the Affordable Care Act have focused in part on making it harder for insurers to weasel out of providing care—not a likely priority for Trump’s health officials. If someone on Medicare needs to start a new medication, they could meet with a rude awakening.

“That would require them to either switch to a different drug in the class, or switch plans during the next open enrollment period,” says Julie Donohue, chair of the University of Pittsburgh’s Department of Health Policy and Management.

Such limitations in Part D—and related programs, like private-insurer-run Medicare Advantage plans—illustrate the consistent failures of privatizing Medicare, something Oz nevertheless pushed for more of during his unsuccessful 2022 Senate campaign.

With the chaos and uncertainty that’s marked Trump’s White House nominations—like former Rep. Matt Gaetz withdrawing on Thursday from consideration to be his Attorney General—Hoffman also cautions us to “wait to see if people are confirmed,” rather than immediately panicking about “our imagination of what these policies might be.”

Some 15 percent of Americans are enrolled in Medicare Part D, which covers outpatient prescription drug costs for older adults and other qualifying individuals, providing nearly $140 billion a year in support to about 50 million people. But the program is administered by the Centers for Medicare and Medicaid Services—which President-elect Donald Trump has nominated celebrity physician Mehmet Oz to lead.

It’s questionable how a man infamous for promoting questionable supplements, who has commented that there’s no right to health for people who can’t afford it, will help lead and provide government health insurance in the United States. On his show, the cardiothoracic surgeon has mounted attacks on medications that Part D covers, such as antidepressants, claiming that they do not work for most patients (the evidence is against him).

Given his history, it makes sense that Oz would be part of Trump’s “Make America Healthy Again” cohort, which does seem fairly anti-science: Robert F. Kennedy Jr.’s attacks on vaccines, for instance, also conveniently ignore that measles and polio can cause lifelong health conditions. Medicare Part D currently covers the costs of all recommended vaccines.

But what kind of damage could Oz do from his new post? Will he be able to cut medications that actually help people manage chronic health conditions—conditions that people who qualify for Medicare are more likely to have? The short answer is no. At least not on his own.

Juliette Cubanski, deputy director of health nonprofit KFF‘s program on Medicare policy, explains that the range of medications covered by Medicare Part D is specified in the Social Security Act.

“Generally speaking, Medicare Part D covers drugs and vaccines that are approved by the Food and Drug Administration,” Cubanski told Mother Jones. “The law specifically excludes some types of drugs from coverage under Part D, including drugs used for weight loss or cosmetic purposes.” So dubious supplements that Oz promoted on his show could not readily be added to the list, nor could he easily remove actual medication.

“Congress would need to change the law in order to change what drugs Medicare Part D covers,” Cubanski said. “An agency official acting under their own authority can’t do that.”

There is still the possibility that some aspects of Medicare Part D could change through a regulatory process, says University of Pennsylvania health law and policy professor Allison Hoffman, but that too is a rigorous procedure—and attacking Medicare would also be a risky political move.

“Medicare Part D was passed during a Republican administration and with Republican control in Congress, with Democratic support,” Hoffman said. “Trump knows to tread carefully in this space because Medicare is a widely popular program and the Part D program has really created a lot of financial security for people.”

But if Republicans do, as they have pledged, go after the Inflation Reduction Act, which helped fund and improve Medicare affordability, Part D isn’t necessarily in the clear. The IRA instituted a new $2,000-a-year cap on out-of-pocket spending costs for prescriptions—still a lot for many older Medicare patients, and for qualifying younger disabled people, but an extremely short-lived protection if it’s immediately overturned by the GOP.

And while Oz on his own can’t screw up Medicare Part D too badly, there’s no guarantee he’ll let it work smoothly, either. In practice, the plans are administered by private insurance companies, which can choose which pharmacies to work with and even which medications to cover. Federal health reforms like the Affordable Care Act have focused in part on making it harder for insurers to weasel out of providing care—not a likely priority for Trump’s health officials. If someone on Medicare needs to start a new medication, they could meet with a rude awakening.

“That would require them to either switch to a different drug in the class, or switch plans during the next open enrollment period,” says Julie Donohue, chair of the University of Pittsburgh’s Department of Health Policy and Management.

Such limitations in Part D—and related programs, like private-insurer-run Medicare Advantage plans—illustrate the consistent failures of privatizing Medicare, something Oz nevertheless pushed for more of during his unsuccessful 2022 Senate campaign.

With the chaos and uncertainty that’s marked Trump’s White House nominations—like former Rep. Matt Gaetz withdrawing on Thursday from consideration to be his attorney general—Hoffman also cautions us to “wait to see if people are confirmed,” rather than immediately panicking about “our imagination of what these policies might be.”

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.