HealthBent Archives - KFF Health News

Why Medication Abortion Is the Top Target for Anti-Abortion Groups in 2026

Julie Rovner, KFF Health News — Fri, 23 Jan 2026 10:00:00 +0000

This week would have marked the 53rd anniversary of Roe v. Wade, the 1973 Supreme Court decision that legalized abortion nationwide — that is, until 2022, when the court overturned it. Since then, abortion has been banned in 13 states and severely limited in 10 others.

Yet anti-abortion activists remain frustrated, in some cases even more so than before Roe was overturned.

Why? Because despite the new legal restrictions, abortions have not stopped taking place, not even in states with complete bans. In fact, the number of abortions has not dropped at all, according to the latest statistics.

“Indeed, abortions have tragically increased in Louisiana and other pro-life states,” Liz Murrill, Louisiana’s attorney general, said at a Senate Health, Education, Labor, and Pensions Committee hearing this month.

That’s due in large part to the easier availability of medication abortion, which uses a combination of the drugs mifepristone and misoprostol, and particularly to the pills’ availability via mail after a telehealth visit with a licensed health professional.

Allowing telehealth access was a major change originally made on a temporary basis during the covid pandemic, when visits to a doctor’s office were largely unavailable. Before that, unlike most medications, mifepristone could be dispensed only directly, and only by a medical professional individually certified by the Food and Drug Administration.

The Biden administration later permanently eliminated the requirement for an in-person visit — a change the second Trump administration has not undone.

While the percentage of abortions using medication had been growing every year since 2000, when the FDA first approved mifepristone for pregnancy termination, the Biden administration’s decision to drop the in-person dispensing requirement supercharged its use. More than 60% of all abortions were done using medication rather than a procedure in 2023, the most recent year for which statistics are available. More than a quarter of all abortions that year were managed via telehealth.

Separately, President Donald Trump’s FDA in October approved a second generic version of mifepristone, angering abortion opponents. FDA officials said at the time that they had no choice — that as long as the original drug remains approved, federal law requires them to OK copies that are “bioequivalent” to the approved drug.

It’s clear that reining in, if not canceling, the approval of pregnancy-terminating medication is a top priority for abortion opponents. This month, Susan B. Anthony Pro-Life America called abortion drugs “America’s New Public Health Crisis,” referencing their growing use in ending pregnancies as well as claims of safety concerns — such as the risk a woman could be given the drugs unknowingly or suffer serious complications. Decades of research and experience show medication abortion is safe and complications are rare.

Another group, Students for Life, has been trying to make the case that the biological waste from the use of mifepristone is contaminating the nation’s water supply, though environmental scientists refute that claim.

Yet the groups are most frustrated not with supporters of abortion rights but with the Trump administration. The object of most of their ire is the FDA, which they say is dragging its feet on a promised review of the abortion pill and the Biden administration’s loosened requirements around its availability.

President Joe Biden’s covid-era policy allowing abortion drugs to be sent via mail ”should’ve been rescinded on day one of the administration,” SBA Pro-Life America’s president, Marjorie Dannenfelser, said in a recent statement. Instead, almost a year later, she continued, “pro-life states are being completely undermined in their ability to enforce the laws that they passed.”

Lawmakers who oppose abortion access are also pressing the administration. “At an absolute minimum, the previous in-person safeguards must be restored immediately,” Senate HELP Committee Chairman Bill Cassidy said during the hearing with Murrill and other witnesses who want to see abortion pill availability curtailed.

Sen. Jim Banks (R-Ind.) said at the hearing that he hoped “the rumors are false” that “the agency is intentionally slow-walking its study on mifepristone’s health risks.”

The White House and spokespeople at the Department of Health and Human Services have denied the review is being purposely delayed.

“The FDA’s scientific review process is thorough and takes the time necessary to ensure decisions are grounded in gold-standard science,” HHS spokesperson Emily Hilliard said in an emailed response to KFF Health News. “Dr. Makary is upholding that standard as part of the Department’s commitment to rigorous, evidence-based review.” That’s a reference to Marty Makary, the FDA commissioner.

Revoking abortion pill access may not be as easy as advocates hoped when Trump moved back into the White House. While the president delivered on many of the goals of his anti-abortion backers during his first term, especially the confirmation of Supreme Court justices who made overturning Roe possible, he has been far less doctrinaire in his second go-round.

Earlier this month, Trump unnerved some of his supporters by advising House Republicans that lawmakers “have to be a little flexible” on the Hyde Amendment to appeal to voters, referring to a decades-old appropriations rule that bans most federal abortion funding and that some Republicans have been pushing to enforce more broadly.

And while the anniversary of Trump’s inauguration has many analysts noting how much of the Heritage Foundation’s Project 2025 blueprint has been realized, the most headline-grabbing portions on reproductive health have yet to be enacted. The Trump administration has not, for example, revoked the approval of mifepristone for pregnancy termination, nor has it invoked the 1873 Comstock Act, which could effectively ban abortion nationwide by stopping not just the mailing of abortion pills but also anything else used in providing abortions.

Still, abortion opponents have decades of practice at remaining hopeful — and playing a long game.

HealthBent, a regular feature of KFF Health News, offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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To Cut Medicaid, the GOP’s Following a Path Often Used To Expand Health Care

Julie Rovner, KFF Health News — Wed, 02 Jul 2025 09:00:00 +0000

President Donald Trump’s “One Big Beautiful” budget reconciliation bill would make some of the most sweeping changes in health policy in years, largely affecting Medicaid and Affordable Care Act plans — with reverberations felt throughout the health care system.

With only a few exceptions, the budget reconciliation process — which allows the political party in control to pass a bill with only 51 votes in the Senate, rather than the usual 60 — is how nearly every major piece of health legislation has passed Congress since the 1980s.

But using reconciliation to constrict rather than expand health coverage, as the GOP is attempting now? That is unusual.

One of the best-known programs born via reconciliation is the “COBRA” health insurance continuation, which allows people who leave jobs with employer-provided insurance to keep it for a time, as long as they pay the full premium.

That is one of dozens of health provisions tucked into COBRA, or the Consolidated Omnibus Budget Reconciliation Act of 1985. Also included was the Emergency Medical Treatment and Active Labor Act , which requires hospitals that take Medicare to treat or transfer patients with medical emergencies, regardless of their insurance status — a law that’s become a focus of abortion opponents as they seek to limit access to the procedure.

A key reason so much health policy has passed this way has to do with how Congress manages the federal budget. Federal government spending falls into two categories: mandatory, or spending required by existing law, and discretionary, which traditionally is allocated and renewed each year as part of the appropriations process.

Lawmakers use the reconciliation process to make changes to mandatory spending programs — Medicare and Medicaid are among the largest — as well as tax policy. (For complicated political reasons, reconciliation bills cannot touch Social Security, the last prong in the entitlement program trifecta.)

Reconciliation comes into play only if it is needed to reconcile taxes or mandatory spending to comply with the terms Congress sets for itself each year, through the annual budget resolution. This year the GOP’s focus is finding the cash to renew Trump’s expiring tax cuts, which largely benefit wealthier Americans, and boost military and border security spending.

In years when Congress orders a reconciliation bill, health policy almost always plays a major part. Usually, reconciliation instructions call for reductions in payments to health providers under Medicare — which costs the most of the federal health programs.

For much of the 1980s and 1990s, Democrats in Congress quietly used reconciliation to expand eligibility for the Medicaid program, often by cutting more than the budget called for from Medicare. For every $5 cut from Medicare, about $1 would be redirected to provide Medicaid to more low-income people.

But budget reconciliation has also become a convenient way to make policy changes to the nation’s major health programs, as it is usually considered a “must-pass” bill likely to be signed by the president and not subject to filibuster in the Senate.

As a result, all manner of now-familiar health programs were created by budget reconciliation bills, many of which provided health coverage to more Americans.

The 1989 reconciliation bill created a new system for paying doctors who treat Medicare patients, as well as a new federal agency to study the cost, quality, and effectiveness of health care, today known as the Agency for Healthcare Research and Quality.

Children’s health has been a popular add-on over the years, including the gradual expansion of Medicaid coverage to more children based on family income. The 1993 reconciliation bill created the Vaccines for Children program, which ensures the availability and affordability of vaccines nationwide for uninsured and underinsured kids. The 1997 reconciliation bill created the Children’s Health Insurance Program, which today provides insurance to more than 7 million children.

In fact, the list of major health bills of the past 50 years not passed using budget reconciliation is short. For instance, the 2003 Medicare Modernization Act, which added a prescription drug benefit to the program for the first time, attracted just enough bipartisan support to pass on its own.

The biggest health care law of recent decades — the Affordable Care Act — didn’t start out as a reconciliation bill, but it ended up using the process to clear its final hurdles.

After initial passage of the bill in December 2009, a special election cost Democrats their 60th seat in the Senate — and with it, the supermajority they needed to pass the bill without Republican votes. In the end, the two chambers used a separate reconciliation measure, the Health Care and Education Reconciliation Act of 2010, to negotiate a compromise that included the ACA.

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Trump’s Already Gone Back on His Promise To Leave Abortion to States

Julie Rovner, KFF Health News — Wed, 05 Feb 2025 10:00:00 +0000

Abortion foes worried before his election that President Donald Trump had moved on, now that Roe v. Wade is overturned and abortion policy, as he said on the campaign trail, “has been returned to the states.”

Their concerns mounted after Trump named Robert F. Kennedy Jr., a longtime supporter of abortion rights, to lead the Department of Health and Human Services — and then as he signed a slew of Day 1 executive orders that said nothing about abortion.

As it turns out, they had nothing to worry about. In its first two weeks, the Trump administration went further to restrict abortion than any president since the original Roe decision in 1973.

Hours after Trump and Vice President JD Vance spoke to abortion opponents gathered in Washington for the annual March for Life, the president issued a memorandum reinstating what’s known as the Mexico City Policy, which bars funding to international aid organizations that “perform or actively promote” abortion — an action taken by every modern Republican president.

But Trump also did something new, signing an executive order ending “the forced use of Federal taxpayer dollars to fund or promote elective abortion” in domestic programs — effectively ordering government agencies to halt funding to programs that can be construed to “promote” abortion, such as family planning counseling.

Dorothy Fink, the acting secretary of Health and Human Services, followed up with a memo early last week ordering the department to “reevaluate all programs, regulations, and guidance to ensure Federal taxpayer dollars are not being used to pay for or promote elective abortion, consistent with the Hyde Amendment.”

The emphasis on the word “promote” is mine, because that’s not what the Hyde Amendment says. It is true that the amendment — which has been included in every HHS spending bill since the 1970s — prohibits the use of federal dollars to pay for abortions except in cases of rape or incest or to save the mother’s life.

But it bars only payment. As the current HHS appropriation says, none of the funding “shall be expended for health benefits coverage that includes coverage of abortion.”

In fact, for decades, the Hyde Amendment existed side by side with a requirement in the federal family planning program, Title X, that patients with unintended pregnancies be given “nondirective” counseling about all their options, including abortion. Former President Joe Biden reinstated that requirement in 2021 after Trump eliminated it during his first term.

So, what is the upshot of Trump’s order?

For one thing, it directly overturned two of Biden’s executive orders. One was intended to strengthen medical privacy protections for people seeking abortion care and enforce a 1994 law criminalizing harassment of people attempting to enter clinics that provide abortions. The other sought to ensure women with pregnancy complications have access to emergency abortions in hospitals that accept Medicare even in states with abortion bans. The latter policy is making its way through federal court.

Trump’s order is also leading government agencies to reverse other key Biden administration policies implemented after the fall of Roe v. Wade. They include a 2022 Department of Defense policy explicitly allowing service members and their dependents to travel out of states with abortion bans to access the procedure and providing travel allowances for those trips. (The Pentagon officially followed through on that change on Jan. 30, just a few days after Defense Secretary Pete Hegseth took over the job: Service members are no longer allowed leave or travel allowances for such trips.) The order is also likely to reverse a policy allowing the Department of Veterans Affairs to provide abortions in some cases, as well as to provide abortion counseling.

But it could also have more wide-ranging effects.

“This executive order could affect other major policies related to access to reproductive health care,” former Biden administration official Katie Keith wrote in the policy journal Health Affairs. These include protections for medication abortion, emergency medical care for women experiencing pregnancy complications, and even in vitro fertilization.

“These and similar changes would, if and when adopted, make it even more challenging for women and their families to access reproductive health care, especially in the more than 20 states with abortion bans,” she wrote.

Anti-abortion groups praised the new administration — not just for the executive orders, but also for pardoning activists convicted of violating a law that protects physical access to abortion clinics.

“One after another, President Trump’s great pro-life victories are being restored and this is just the beginning,” Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said in a statement.

Abortion rights groups, meanwhile, were not surprised by the actions or even their timing, said Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association. The association represents grantees of Title X, which has been a longtime target of abortion opponents.

“We said we didn’t think it would be a Day 1 thing,” Coleman said in an interview. “But we said they were coming for us, and they are.”

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Trump Doesn’t Need Congress To Make Abortion Effectively Unavailable

Julie Rovner, KFF Health News — Wed, 27 Nov 2024 10:00:00 +0000

On the campaign trail, Donald Trump tried mightily to reassure abortion rights supporters, vowing he would not sign into law a nationwide abortion ban even if Congress sent him one.

But once he returns to the White House in January, Trump can make abortions difficult — or illegal —across the United States without Congress taking action at all.

The president-elect will have a variety of tools to restrict reproductive rights in general and abortion rights in particular, both directly from 1600 Pennsylvania Ave. and from the executive agencies he’ll oversee. They include strategies he used during his first term, but also new ones that emerged in the wake of the Supreme Court’s overturn of Roe v. Wade in 2022.

The Trump transition team did not respond to a request for comment on this topic.

By far the most sweeping thing Trump could do without Congress would be to order the Justice Department to enforce the Comstock Act, an 1873 anti-vice law that bars the mailing of “obscene matter and articles used to produce abortion.”

While Roe was in effect, the law was presumed unconstitutional, but many legal scholars say it could be resurrected. “And it is so broad that it would ban abortion nationwide from the beginning of a pregnancy without exception. Procedural abortion, pills, everything,” Greer Donley, an associate professor and abortion policy researcher at the University of Pittsburgh Law School, said on KFF Health News’ “What the Health?” podcast early this year.

Even if he does not turn to Comstock, Trump is expected to quickly reimpose restrictions embraced by every GOP president for the past four decades. When Trump took office in 2017, he reinstituted the “Mexico City Policy” (also known as the “global gag rule”), a Ronald Reagan-era rule that banned U.S. aid to international organizations that support abortion rights. He also pulled U.S. funding for the United Nations Population Fund. Both actions were undone when President Joe Biden took office in 2021.

Those aren’t the only policies Trump could resurrect. Others that Trump imposed and Biden overturned include:

Barring providers who perform abortions and entities that provide referrals for abortion (such as Planned Parenthood) from the federal family planning program, Title X. The Trump administration imposed the rules in 2019; Biden formally overturned them in 2021.
Banning the use of human fetal tissue in research funded by the National Institutes of Health. The Trump administration issued guidance barring the practice in 2019; the Biden administration overturned it in 2021.
Requiring health plans under the Affordable Care Act to collect separate premiums if they offer coverage for abortion. The 2019 Trump administration regulation was overturned by Biden officials in 2021.
Allowing health providers to refuse to offer any service that violates their conscience. The 2019 Trump administration regulation — a revision of one originally implemented by President George W. Bush — had already been blocked by several appeals courts before being rescinded and rewritten by the Biden administration. The new, narrower rule was issued in January.

Anti-abortion groups say those changes are the minimum they expect. “The commonsense policies of President Trump’s first term become the baseline for the second, along with reversing Biden-Harris administration’s unprecedented violation of longstanding federal laws,” Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said in a statement to KFF Health News.

Dannenfelser was referring to the expectation that Trump will overturn actions that Biden took toward protecting abortion rights after the Supreme Court’s decision. Some included:

Providing that members of the military and their dependents who live in states with abortion bans be permitted to take leave and travel to other states for reproductive health care.
Allowing VA medical facilities to provide abortion counseling and, in limited circumstances, abortions to veterans and VA beneficiaries, regardless of the laws in the state where the facility is located.
Expanding the availability of the abortion pill mifepristone.
Clarifying that the Emergency Medical Treatment and Active Labor Act of 1986 requires hospitals to provide abortions to women with pregnancy complications that threaten their health, not just their life regardless of state law.

Even easier than formal changes of policy, though, Trump could simply order the Justice Department to drop several cases being heard in federal court in which the federal government is effectively arguing to preserve abortion rights. Those cases include:

FDA v. The Alliance for Hippocratic Medicine. This case out of Texas challenges the FDA’s approval of the abortion pill mifepristone. The Supreme Court in June ruled that the original plaintiffs lacked standing to sue, but attorneys general in three states (Missouri, Idaho, and Kansas) have stepped in as plaintiffs. The case has been revived at the U.S. District Court for the Northern District of Texas.
Texas v. Becerra. In this case, the state of Texas is suing the Department of Health and Human Services, charging that the Biden administration’s interpretation of a law requiring emergency abortions to protect the health of the pregnant woman oversteps its authority. The Supreme Court denied a petition to hear the case in October, but that left the possibility that the court would have to step in later — depending on the outcome of a similar case from Idaho that the justices sent back to the Court of Appeals.

Whether Trump will take any or all of these actions is anyone’s guess. Whether he can take these actions, however, is unquestioned.

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Republicans Are Downplaying Abortion, but It Keeps Coming Up

Julie Rovner, KFF Health News — Fri, 28 Jun 2024 09:00:00 +0000

For generations, the GOP campaigned on eliminating the right to an abortion in the United States. Now, torn between a base that wants more restrictions on reproductive health care and a moderate majority that does not, it seems many Republicans would rather take an off-ramp than a victory lap.

And yet, they just can’t escape talking about it.

The policy high point for abortion opponents — the Supreme Court’s 2022 decision to strike down Roe v. Wade — is proving a low point for public support for their cause. More American adults consider themselves “pro-choice” than at any time in the past 30 years, according to a recent survey from Gallup: 54%, compared with 41% who identify as “pro-life.”

The tide is turning even as some conservatives seek restrictions on birth control and fertility treatments. A new KFF survey of women voters found that Democrats are more likely than Republicans to say that abortion is the most important issue in their vote for president — a reversal from recent elections. One in 5 women under age 30 and 13% of those under age 50 said it is their top concern. Among independents, 81% said they believed abortion should be legal.

Democrats are counting on the issue to help turn out their votes and ensure President Joe Biden’s reelection, despite persistent dissatisfaction with his leadership. Abortion could prove particularly disruptive in battleground states expected to have initiatives on the ballot to enshrine access to abortion in state constitutions, including Arizona and Nevada.

Eight in 10 Democratic women in states with possible ballot measures said they were “absolutely certain” they would vote — and also said they were more likely to back Biden compared with Democratic women in other states, KFF found.

So far, abortion rights supporters have prevailed in each of the seven states that have put ballot initiatives before voters — including in states where Republicans control the legislatures, such as Kansas, Ohio, and Kentucky. About two-thirds of women in Arizona told KFF they support the state’s proposed Right to Abortion Initiative, including 68% of independents.

On the campaign trail, Republicans are bobbing and weaving to avoid the subject, even when that means distancing themselves from — well, themselves. Former President Donald Trump, who has taken a few different stances since calling himself “pro-choice” in 1999, reportedly urged lawmakers during a recent closed-door visit to the Capitol not to shy away from the issue, but also to support exceptions to bans, including to protect the life of the pregnant person.

In pivotal Arizona, U.S. Senate Republican candidate Kari Lake, who embraced a near-complete abortion ban while running for governor two years ago, recently said “a full ban on abortion is not where the people are.” In Nevada, the GOP Senate nominee, Sam Brown, who as recently as 2022 headed up a branch of a conservative anti-abortion group, has said he will respect his state’s permissive abortion law and would not vote for a nationwide ban if elected.

The Supreme Court is keeping the issue on the front burner. In a decision June 27, the court left emergency abortions legal in Idaho, a state with a strict ban, though the issue remains unsettled nationally. Justice Ketanji Brown Jackson, who joined the majority in an unusual ruling that sent the case back to the lower court and declared it had been accepted prematurely, accused her colleagues of dawdling on the issue.

“Pregnant people experiencing emergency medical conditions remain in a precarious position, as their doctors are kept in the dark about what the law requires,” she wrote.

The KFF survey found broad, strong support for preserving access to abortion in cases of pregnancy-related emergencies: 86% of women voters — including 79% of Republican women — support laws protecting access in those circumstances.

In mid-June, the court rejected an effort to overturn the FDA’s 24-year-old approval of the abortion pill mifepristone, but only on a technicality. With no actual ruling on the merits of the case, the justices left open the possibility that different plaintiffs could provoke a different outcome. Nevertheless, the push to redefine reproductive health care post-Roe v. Wade continues. The influential evangelical Southern Baptist Convention recently called for significant legislative restrictions on in vitro fertilization, which its members call morally incompatible with the belief that life begins at fertilization.

Abortion opposition groups are pressing Trump not to discard a main plank of the GOP’s presidential platform since 1976: a federal abortion ban. Trump has recently said states should make their own decisions about whether to restrict abortion.

Democrats and Democratic-aligned groups are exploiting Republicans’ discomfort with the issue. On the day Senate Democrats forced a vote on legislation that would have guaranteed a federal right to contraception, a group called Americans for Contraception floated a giant balloon shaped like an IUD near the Capitol. (Republicans blocked the bill, as expected — and no doubt Democrats will frequently remind voters of that this year.)

A week later, Senate Democrats tried to bring up a bill to guarantee access to IVF, which Republicans also voted down. No giant balloon for that one, though.

Republicans still appear bent on dodging accountability for the unpopularity of their reproductive health positions, if only by highlighting other issues they hope voters care about even more — notably, the economy. But one thing they’re unlikely to accomplish is keeping the issue out of the news.

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Abortion Bans Are Driving Off Doctors and Closing Clinics, Putting Basic Health Care at Risk

Julie Rovner, KFF Health News — Wed, 24 May 2023 09:00:00 +0000

The rush in conservative states to ban abortion after the overturn of Roe v. Wade is resulting in a startling consequence that abortion opponents may not have considered: fewer medical services available for all women living in those states.

Doctors are showing — through their words and actions — that they are reluctant to practice in places where making the best decision for a patient could result in huge fines or even a prison sentence. And when clinics that provide abortions close their doors, all the other services offered there also shut down, including regular exams, breast cancer screenings, and contraception.

The concern about repercussions for women’s health is being raised not just by abortion rights advocates. One recent warning comes from Jerome Adams, who served as surgeon general in the Trump administration.

In a tweet thread in April, Adams wrote that “the tradeoff of a restricted access (and criminalizing doctors) only approach to decreasing abortions could end up being that you actually make pregnancy less safe for everyone, and increase infant and maternal mortality.”

An early indication of that impending medical “brain drain” came in February, when 76% of respondents in a survey of more than 2,000 current and future physicians said they would not even apply to work or train in states with abortion restrictions. “In other words,” wrote the study’s authors in an accompanying article, “many qualified candidates would no longer even consider working or training in more than half of U.S. states.”

Indeed, states with abortion bans saw a larger decline in medical school seniors applying for residency in 2023 compared with states without bans, according to a study from the Association of American Medical Colleges. While applications for OB-GYN residencies were down nationwide, the decrease in states with complete abortion bans was more than twice as large as those with no restrictions (10.5% vs. 5.2%).

That means fewer doctors to perform critical preventive care like Pap smears and screenings for sexually transmitted infections, which can lead to infertility.

Care for pregnant women specifically is at risk, as hospitals in rural areas close maternity wards because they can’t find enough professionals to staff them — a problem that predated the abortion ruling but has only gotten worse since.

In March, Bonner General Health, the only hospital in Sandpoint, Idaho, announced it would discontinue its labor and delivery services, in part because of “Idaho’s legal and political climate” that includes state legislators continuing to “introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care.”

Heart-wrenching reporting from around the country shows that abortion bans are also imperiling the health of some patients who experience miscarriage and other nonviable pregnancies. Earlier this year, a pregnant woman with a nonviable fetus in Oklahoma was told to wait in the parking lot until she got sicker after being informed that doctors “can’t touch you unless you are crashing in front of us.”

A study by researchers from the State University of New York-Buffalo published in the Women’s Health Issues journal found that doctors practicing in states with restrictive abortion policies are less likely than those in states with supportive abortion policies to have been trained to perform the same early abortion procedures that are used for women experiencing miscarriages early in pregnancy.

But it’s more than a lack of doctors that could complicate pregnancies and births. States with the toughest abortion restrictions are also the least likely to offer support services for low-income mothers and babies. Even before the overturn of Roe, a report from the Commonwealth Fund, a nonpartisan research group, found that maternal death rates in states with abortion restrictions or bans were 62% higher than in states where abortion was more readily available.

Women who know their pregnancies could become high-risk are thinking twice about getting or being pregnant in states with abortion restrictions. Carmen Broesder, an Idaho woman who chronicled her difficulties getting care for a miscarriage in a series of viral videos on TikTok, told ABC News she does not plan to try to get pregnant again.

“Why would I want to go through my daughter almost losing her mom again to have another child?” she said. “That seems selfish and wrong.”

The anti-abortion movement once appeared more sensitive to arguments that its policies neglect the needs of women and children, a charge made most famously by former Rep. Barney Frank (D-Mass.), who once said: “Conservatives believe that from the standpoint of the federal government, life begins at conception and ends at birth.”

In fact, an icon of the anti-abortion movement — Rep. Henry Hyde (R-Ill.), who died in 2007 — made a point of partnering with liberal Rep. Henry Waxman (D-Calif.) on legislation to expand Medicaid coverage and provide more benefits to address infant mortality in the late 1980s.

Few anti-abortion groups are following that example by pushing policies to make it easier for people to get pregnant, give birth, and raise children. Most of those efforts are flying under the radar.

This year, Americans United for Life and Democrats for Life of America put out a joint position paper urging policymakers to “make birth free.” Among their suggestions are automatic insurance coverage, without deductibles or copays, for pregnancy and childbirth; eliminating payment incentives for cesarean sections and in-hospital deliveries; and a “monthly maternal stipend” for the first two years of a child’s life.

“Making birth free to American mothers can and should be a national unifier in a particularly divided time,” says the paper. Such a policy could not only make it easier for women to start families, but it could address the nation’s dismal record on maternal mortality.

In a year when the same Republican lawmakers who are supporting a national abortion ban are even more vehemently pushing for large federal budget cuts, however, a make-birth-free policy seems unlikely to advance very far or very quickly.

That leaves abortion opponents at something of a crossroads: Will they follow Hyde’s example and champion policies that expand and protect access to care? Or will women’s health suffer under the anti-abortion movement’s victory?

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Doctors’ Lesson for Drug Industry: Abortion Wars Are Dangerous to Ignore

Julie Rovner, KFF Health News — Tue, 11 Apr 2023 09:00:00 +0000

Texas District Court Judge Matthew Kacsmaryk’s decision April 7 to rescind the approval of the abortion pill mifepristone dealt a blow to more than just people seeking a medication abortion.

It appears to be the first time a court has directly usurped the FDA’s authority to provide the final word on which medicines are safe and effective and, thus, allowed to be sold in the United States. And it could well throw the pharmaceutical industry into turmoil.

If the decision is allowed to stand, it could affect far more than abortion drugs. “It will radically alter the process for approving drugs and will kill innovation and hinder bringing new drugs to market,” Jennifer Dalven, director of the ACLU’s Reproductive Freedom Project, told reporters in a briefing April 10. It might also invite what she called “fringe groups” to challenge any other drug they object to for political reasons.

So you’d think challenging the decision would be a top priority for the prescription drug industry’s national advocacy group, the Pharmaceutical Research and Manufacturers of America, or PhRMA. Yet the drug lobby did not join the long list of medical, legal, and academic groups that filed “friend of the court,” or amicus, briefs in the Texas case.

And since the ruling, PhRMA has declined to weigh in beyond the relatively bland statement it made weeks ago. “The FDA is the gold standard for determining whether a medicine is safe and effective for people to use,” said Priscilla VanderVeer, PhRMA’s vice president for public affairs. “While PhRMA and our members are not a party to this litigation, our focus is on ensuring a policy environment that supports the agency’s ability to regulate and provides access to FDA-approved medicines.”

By contrast, many individual drug companies, as well as the biotech industry’s trade group, were quick to decry the ruling. The Biotechnology Innovation Organization said the ruling sets “a dangerous precedent for undermining the FDA and creating regulatory uncertainty that will impede the development of important new treatments and therapies.”

PhRMA’s relative silence is puzzling, said Carole Joffe, a professor at the University of California-San Francisco and an expert on the sociology of reproductive health issues. “PhRMA now has to contemplate the politicization of potentially everything. For Big Pharma, one could argue that a Pandora’s box has been opened.”

Even more puzzling, though, is that PhRMA has only to look at another major health industry player, the physicians’ major lobbying group, the American Medical Association, for an object lesson in how sitting on the sidelines of a polarizing political issue can cost an industry or profession a chunk of its autonomy.

When it comes to abortion, lawmakers at the state and federal level, not to mention judges, have been essentially practicing medicine without a license for over a half-century, since the decision in Roe v. Wade itself. In that case, seven Supreme Court justices signed on to a framework for pregnancy (dividing it into “trimesters”) that did not exist before, at least not medically.

The AMA played a major role in making abortion illegal in the 19th century, when it sought to supplant midwives and others whom doctors saw as threats to their economic and professional power. But in the 20th century, the organization was slow to recognize that doctors’ professional judgments were being supplanted by those of others — lawmakers and judges. The AMA did not even file an amicus brief in the Roe case itself, and for much of the next four decades tried mightily to stay out of the abortion fray, even as warnings grew that medical professionals were losing the right to practice according to the best medical evidence.

After the Supreme Court upheld the first ban on a specific abortion procedure in 2007 — a ban the AMA had initially endorsed, then opposed — it was clear that physicians were losing their primacy over the practice of medicine.

Yet the stigma attached to abortion remained. Even after the AMA formally supported abortion rights, the group “did as little as possible,” said Joffe. Over several decades, most doctors tried to distance themselves from both the abortion issue and their colleagues who performed the procedure, Joffe said.

It wasn’t until 2019 that the AMA stepped out of the shadows on the subject of lawmakers interfering in the doctor-patient relationship. That’s when the group filed suit to block two North Dakota abortion laws, which the organization said “compel physicians and other members of the care team to provide patients with false, misleading, non-medical information about reproductive health.” (A federal judge subsequently blocked the law.)

By the time the Supreme Court was ready in 2021 to take up the Mississippi case that would eventually overturn Roe, the AMA realized what was at stake. The state law being challenged — a ban on all abortions after 15 weeks — “threatens the health of pregnant patients by arbitrarily barring their access to a safe and essential component of health care,” the AMA said in an amicus brief it filed with two dozen other medical groups.

And after the decision reversing Roe in 2022, the AMA’s new president, Dr. Jack Resneck Jr., was quick to lament what had been lost. “Medicine is hard, and it’s hard enough without members of Congress or governors or state legislators or others trying to sit in your exam room with you and second-guess all the decisions that you’re making,” he told KHN’s “What the Health?” podcast in July.

So the AMA has apparently learned its lesson the hard way. Now the question is whether the drug industry will learn that same lesson — and when.

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Why Do Politicians Weaponize Medicare? Because It Works

Julie Rovner, KFF Health News — Tue, 21 Feb 2023 10:00:00 +0000

The Medicare wars are back, and almost no one in Washington is surprised.

This time it’s Democrats accusing Republicans of wanting to maim the very popular federal health program that covers 64 million seniors and people with disabilities. In the past, Republicans have successfully pinned Democrats as the threat to Medicare.

Why do politicians persistently wield Medicare, as well as Social Security, as weapons? Because history shows that works at the ballot box. Generally, the party accused of menacing the sacrosanct entitlements pays a price — although it’s the millions of beneficiaries relying on feuding lawmakers to keep the programs funded who stand to lose the most.

Republicans have repeatedly warned they would hold raising the federal debt ceiling hostage unless Democrats negotiated changes to Medicare, Medicaid, and Social Security. The three programs together, along with funding for the Affordable Care Act and Children’s Health Insurance Program, account for nearly half of the federal budget.

The political bomb that went off during President Joe Biden’s State of the Union speech on Feb. 7 had been ticking for weeks. In his speech, Biden threatened to veto any Republican efforts to cut Social Security or Medicare. It was one of only three veto threats he made that night. During a trip to Florida after the speech, he said it more forcefully: “I know a lot of Republicans, their dream is to cut Social Security and Medicare. Well, let me say this: If that’s your dream, I’m your nightmare.”

Senior Republicans have distanced themselves from the proposals Biden was referencing, notably ideas from the House Republican Study Committee and Sen. Rick Scott (R-Fla.) to make cuts or even let Medicare expire unless Congress votes to keep it going.

“That’s not the Republican plan; that’s the Rick Scott plan,” Senate Minority Leader Mitch McConnell said on a Kentucky radio show Feb. 9, echoing his opposition to the plan last year.

“Cuts to Social Security and Medicare are off the table,” House Speaker Kevin McCarthy declared the day before Biden’s veto threat.

McConnell and McCarthy know something that Rick Scott apparently does not: Politicians threaten big, popular entitlement programs at their peril. And, usually, it’s been Republicans who suffer the electoral consequences.

This dates at least to 1982, when Democrats used threats of Republican cuts to Social Security to pick up more than two dozen House seats in President Ronald Reagan’s first midterm elections. In 1996, President Bill Clinton won reelection in part by convincing voters that Republicans led by House Speaker Newt Gingrich wanted to privatize Medicare and Social Security.

At the beginning of his second term, in 2005, President George W. Bush made it his top priority to “partially privatize” Social Security. That proved singularly unpopular. In the following midterm elections, Democrats won back the House for the first time since losing it in 1994.

In 2010, Republicans turned the tables, using what they described as “Medicare cuts” in the Affordable Care Act to sweep back to power in the House. (Those “cuts” were mostly reductions in payments to providers; beneficiaries actually got extra benefits through the ACA.)

The use of the Medicare cudgel likely reached its zenith in 2012, when Democrats took aim at Medicare privatization proposals offered by Paul Ryan, the House Budget Committee chair and Republican vice presidential candidate. That debate produced the infamous “pushing Granny off the cliff” ad.

The reality is that Medicare’s value as a political weapon also sabotages any effort to come together to solve the program’s financing problems. The last two times the Medicare Hospital Insurance Trust Fund was this close to insolvency — in the early 1980s and late 1990s — Congress passed bipartisan bills to keep the program afloat.

Even the word “cut” can be political. One stakeholder’s Medicare “cut” is another’s benefit. Reducing payments to medical providers (or, more often, reducing the size of payment increases to doctors and hospitals) may reduce premiums for beneficiaries, whose payments are based on total program costs. Raising premiums or cost sharing for beneficiaries is a benefit to taxpayers, who help fund Medicare. Increasing available benefits helps providers and beneficiaries, but costs more for taxpayers. And on, and on.

There are fundamental differences between the parties that can’t be papered over. Many Republicans want Medicare to shift from a “defined benefit” program — in which beneficiaries are guaranteed a certain set of services and the government pays whatever they cost — to a “defined contribution” program, in which beneficiaries would get a certain amount of money to finance as much as they can — and would be on the hook for the rest of their medical expenses.

This would shift the risk of health inflation from the government to the beneficiary. And while it clearly would benefit the taxpayer, it would disadvantage both providers and beneficiaries of the program.

But there are many, many intermediate steps Congress could take to at least delay insolvency for both Medicare and Social Security. Some are more controversial than others (raising the payroll tax that funds Medicare, for example), but none are beyond the steps previous Congresses have taken every time the programs have neared insolvency.

Republicans are correct about this: Medicare and Social Security can’t be “fixed” until both sides lay down their weapons and start talking. But every time a granny in a wheelchair gets pushed off a cliff, that truce seems less and less possible.

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Ask Voters Directly, and Abortion Rights Wins Most Ballot Fights

Julie Rovner, KFF Health News — Fri, 13 Jan 2023 10:00:00 +0000

This is shaping up as a critical year in the country’s battle over abortion rights, as both sides struggle to define a new status quo after the Supreme Court struck down the nearly half-century-old constitutional right last year.

It is important not to misread what happened in 2022. After a 6-3 majority of justices overturned Roe v. Wade, voters in six states were asked to choose between preserving or reducing abortion rights. In all six — Kansas, Michigan, California, Kentucky, Montana, and Vermont — voters sided with abortion rights.

Anti-abortion politicians have fared well in recent elections, contributing to a wave of anti-abortion legislation in many statehouses. But when voters are asked to consider a direct ballot question about abortion access — as opposed to weighing in on a candidate, whose anti-abortion position may be one of many stances they hold — voters strongly favor abortion rights.

Many pundits were shocked by last year’s results, particularly in Kansas, where voters have backed the Republican candidate in nearly every presidential election since 1940. Less than six weeks after the court’s decision, Kansas residents — including a large, mostly female contingent of newly registered voters — rejected an amendment to the state constitution that was put on the ballot by anti-abortion state legislators in an effort to overturn a 2019 decision by the Kansas Supreme Court.

It was unquestionably a big deal that the abortion-rights side won by 18 percentage points, particularly since the measure appeared on the ballot during the state’s August primary, when its backers anticipated lower and Republican-leaning voter turnout.

But was the defeat of their effort to limit abortion truly a surprise? Not if you look at the history of state-level ballot measures related to abortion.

According to the website Ballotpedia, there have been 53 abortion-related ballot measures in 24 states since 1970. Of the 43 questions supported or placed by anti-abortion groups or legislators, voters approved 26% and rejected 74%. Of the 10 questions supported by abortion-rights backers, voters approved 70% and rejected 30%.

In other words, the abortion-rights side has won nearly three-quarters of the ballot measures.

More than a few of these ballot questions have been in states where Republicans have even more control than in Kansas. In South Dakota, for example, voters in 2006 overturned a sweeping abortion ban passed by the legislature, which was designed to prompt the Supreme Court to reconsider Roe v. Wade. Two years later, South Dakota voters also rejected a second, slightly less draconian ban.

Even in Mississippi, historically one of the most conservative states, voters in 2011 rejected a “personhood” amendment that would have added language to the state constitution stating that life begins at fertilization. Voters demurred after it was pointed out that such a law could outlaw some common types of birth control and in vitro fertilization.

And many of the anti-abortion ballot measures that were approved dealt with issues that have long enjoyed considerable public support — such as banning public funding of abortion and requiring parents to be involved in a minor’s abortion decision.

That is in stark contrast to the more recent success of candidates who oppose abortion, whose numbers have dramatically increased at both the state and federal levels in recent years. Conservative Republicans won control of so many governorships and state legislatures in 2010 that it led to a landslide of anti-abortion legislation in the following years.

Abortion isn’t the only issue for which voters have split ballots, weighing in on a ballot initiative while backing a candidate with an opposing viewpoint. Expanding Medicaid coverage under the Affordable Care Act is another example. So far, in seven states where Republican governors, lawmakers, or both have refused to extend Medicaid coverage to certain moderate-income residents, voters have approved expansion over those objections.

What explains how some of the same voters who elect and reelect candidates opposed to abortion also support abortion rights in stand-alone ballot questions?

One reason is that until 2022, abortion was not among voters’ top priorities when choosing whom to vote for. As recently as 2016 — when Republican presidential candidate Donald Trump promised to work to ban abortion, while Democrat Hillary Clinton vowed to protect abortion rights — only 45% of voters said abortion was “very important” to their vote, compared with 84% who cited the economy and 80% who said their top issue was terrorism. Out of 14 top issues that year, abortion ranked 13th in the poll from the Pew Research Center.

What does it mean for the future? In 2022, according to an analysis by KFF pollsters, support for abortion rights may have helped Democrats soften their expected midterm losses. As abortion has surfaced more in headlines, the issue has become more salient for voters of both parties.

State and federal lawmakers, emboldened by the court’s decision, may need to be more careful in deciding how to legislate on abortion-related matters in 2023. The voters are watching.

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Three Things About the Abortion Debate That Many People Get Wrong

Julie Rovner, KFF Health News — Fri, 22 Jul 2022 09:00:00 +0000

In the wake of the Supreme Court’s decision to overturn the federal right to abortion, things are more than a little confused.

As lower courts grapple with rapidly changing state laws, patients wonder from day to day if abortion is still legal and, even if legal, whether it is still available in their state. Health professionals in states with abortion bans fear prosecution by state authorities for performing abortions or by federal authorities for not performing them in life- or health-threatening situations.

Even employers are caught between conflicting state and federal rules about what can, cannot, and must be covered by insurance.

But amid all the confusion, some things are simply not true. Here are three myths going around about the abortion debate:

MYTH 1: Only people seeking abortions are affected by the Supreme Court’s action.

The huge changes and uncertainties wrought by the Supreme Court’s erasure of 49 years of largely settled federal policy most directly affect pregnant women. But they are far from the only people whose medical care is being disrupted.

As abortion providers pack up and leave states with bans, they may take with them expertise in managing high-risk pregnancies as well as routine deliveries, particularly in less-populated areas, plus access to long-acting birth control and screening and treatment for cancer and sexually transmitted diseases.

Similarly, medical students and medical residents may not want to train in states where they can’t learn abortion techniques, which are often the same as care for miscarriages. That could lead to shortages of people trained to help patients give birth safely just as more people are being forced to carry pregnancies to term.

Also affected, at this point as much by accident as intent, is birth control. In Missouri, a hospital system temporarily stopped distributing the “morning after” birth control pill, which is a contraceptive that does not cause abortion, before reversing the decision.

That is its own sub-myth — that the Plan B morning-after pill is the same as the abortion pill mifepristone. Plan B is a high dose of regular birth control that prevents ovulation but does not interrupt an existing pregnancy. Mifepristone ends a pregnancy if used in approximately the first 10 weeks.

And it’s not just pregnant women who are affected by the uncertainty. People with severe psoriasis, lupus and other autoimmune disorders are already reporting difficulty obtaining methotrexate, a first-line medication for those ailments that can also be used as an abortion medication.

MYTH 2: The Democratic Congress could have codified abortion protections long before now but chose not to.

The House on July 15 voted — for the second time by this Congress — for a bill that would effectively codify the federal abortion protections of the Supreme Court’s 1973 Roe v. Wade ruling. Ever since the court overturned that decision last month, Democrats on social media and elsewhere have complained that this is a bill Congress should have passed years ago, when the Democrats had firmer control of the House, the Senate, and the White House.

But even though Democrats had bigger majorities in Congress under Democratic Presidents Bill Clinton and Barack Obama, large numbers of anti-abortion Democrats in both chambers effectively meant there was not a majority for such legislation, much less the 60-vote supermajority that would have been required in the Senate.

It was not, contrary to some revisionist historians’ views, for lack of trying. In 1992, Democratic leaders promised to bring the “Freedom of Choice” act to the floor, a bill that would have written the right to abortion into federal law, if only to embarrass then-President George H.W. Bush right before the GOP convention. (Here is a very old clip of me explaining the situation on C-SPAN.) In the end, the bill did not make it to the floor of either the House or the Senate, as Democratic leaders could not muster the votes.

In fact, since the Roe ruling, the House has been more anti-abortion than the Senate, in part because so many Democrats from Southern and/or conservative districts opposed abortion (most have now been replaced by Republicans), and because the Senate has long had at least a handful of Republicans who support abortion rights. Today that is limited to Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska). The House got its first abortion-rights majority only in 2019, when Donald Trump was president.

MYTH 3: Congress could simply eliminate statutory abortion restrictions now.

With Democrats in charge of both Congress and the White House, they can just change the existing laws limiting abortion, advocates claim. Indeed, President Joe Biden’s budgets in 2021 and 2022 proposed eliminating the so-called Hyde Amendment, named for its sponsor, the anti-abortion crusading Rep. Henry Hyde (R-Ill.), which has barred most federal abortion funding since the late 1970s. But while the House voted in 2021 for the funding bill for the Department of Health and Human Services without the abortion rider for the first time in decades, Senate Republicans forced the restrictions back into the final measure. The same is expected later this year. Democrats hold only 50 seats in the Senate and need at least 10 Republicans on any bill that is threatened with a filibuster.

The Hyde Amendment could also keep the federal government from allowing abortion clinics to operate on federal land, as many progressives have been calling for. But other, more complicated federal-state issues would more likely doom that scenario.

Complicating things still more, the Hyde language in the HHS spending bill is far from the only abortion restriction embedded in federal law. While abortion-rights backers have successfully fought off most efforts to make such restrictions permanent, various other spending bills annually include limits on abortion in the military, in federal prisons, by the Indian Health Service, and as an insurance benefit for federal workers. Congress has also limited the ability of the District of Columbia to spend local tax dollars on abortion.

It is possible the reversal of Roe could lead to the reversal of some of these restrictions. But with Democrats’ paper-thin majority in the Senate, it’s not likely, at least not in 2022.

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