Voters in three states — Arizona, Missouri, and Nevada — chose on Tuesday to advance protections for abortion rights in their state constitutions. Donald Trump, meanwhile, is likely to win all three states in his victorious bid for the White House.

It’s a conundrum for Democrats, who expected ballot initiatives on abortion rights in those states to boost the prospects of their candidates, including Vice President Kamala Harris. But data from VoteCast, a large survey of U.S. voters conducted by The Associated Press and partners including KFF, found that about 3 in 10 voters in Arizona, Missouri, and Nevada who supported the abortion rights measures also voted for Trump.

“We saw lots of people who voted in favor of abortion access and still voted for Donald Trump,” said Liz Hamel, director of Public Opinion and Survey Research for KFF, a health information nonprofit that includes KFF Health News.

VoteCast is a survey of more than 115,000 registered voters in all 50 states conducted between Oct. 28 and Nov. 5. It’s intended to be “the most accurate picture possible of who has voted, and why,” according to the AP.

About 1 in 4 of the polled voters said abortion was the “single most important” factor to their vote, though that number was higher among Democrats, young women, Black adults, and Hispanic adults.

Abortion rights referendums passed in seven states on Tuesday, including Missouri and Arizona, where state bans were overturned. Vice President Kamala Harris made reproductive rights a cornerstone of her campaign, but the VoteCast results reinforce earlier surveys that indicated economic concerns were the foremost issue in the election.

Tuesday’s was the first presidential election since the U.S. Supreme Court’s conservative majority overturned Roe v. Wade. During Trump’s first term as president, he nominated three Supreme Court justices who later joined the 2022 ruling that eliminated women’s constitutional right to abortion care.

Mike Islami, 20, voted for Trump in Madison, Wisconsin, where he’s a full-time student. He said abortion is “a woman’s right” that “was definitely in the back of my mind” when he cast his ballot.

“I don’t think much is going to change” about abortion access during Trump’s second term, he said. “I believe his policy is that he’s just going to give it back to the states and from there they could decide how important it was.”

The survey found that the percentage of voters who said abortion was the most important factor in their vote was similar in states that had abortion measures on the ballot and states without them.

When voters cast their ballots, they were more motivated by economic anxiety and the cost of filling up their gas tanks, housing, and food, according to the survey results. Trump won those voters as much in hotly contested states such as Pennsylvania and Wisconsin as in reliably red states.

Glen Bolger, a Republican campaign strategist, said the 2022 election results demonstrated that Republican candidates are better off talking about the economy and the cost of living than they are about abortion.

This year, Trump voters who supported abortion rights amendments may have decided to take Trump “at his word that he was not going to support a national ban,” Bolger said. In casting their vote for Trump, he said, those supporters may have thought, “Let’s elect him to deal with the cost of living and health care and gasoline and everything else.”

The VoteCast survey found stronger support for abortion ballot initiatives from female voters: 72% of women in Nevada, 69% in Arizona, 62% in Missouri.

Erica Wallace, 39, of Miami, voted for Harris and in favor of an abortion rights ballot measure in Florida, which fell just short of the 60% threshold needed to amend the state constitution.

“As a grown woman, you’re out and you’re working, living your life,” said Wallace, an executive secretary who lives in Miami. She said the state’s ban, which criminalizes abortion care before many women know they’re pregnant, amounts to unequal treatment for women.

“I pay my taxes. I live good,” she said. “I’m doing everything every other citizen does.”

Men were more likely to vote against protecting abortion rights. Men voted 67% in Nevada, 64% in Arizona, and 55% in Missouri for the abortion rights ballot initiatives.

The VoteCast survey found that, overall, voters believed Harris was better able to handle health care. That is consistent with the long-standing view that “Democrats traditionally have the advantage on health care,” Hamel said. Still, Trump outperformed Harris among more than half of voters who said they were very concerned about health care costs.

Family premiums for employer-sponsored health insurance rose 7% in 2024 to an average of $25,572 annually, according to KFF’s 2024 Employer Health Benefits Survey. On average, workers contribute $6,296 annually to the cost of family coverage.

“Everybody is impacted by high health-care costs, and nobody has a solution to it,” Bolger said. “That’s something voters are very frustrated about.”

Florence Robbins in Madison, Wisconsin, and Denise Hruby in Miami contributed to this report.

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Voters in Missouri and Nebraska approved ballot measures Tuesday that guarantee paid leave for sick workers. Alaska voters seem poised to pass a similar measure that has a wide lead.

These two Republican-led states join 15 others and D.C. — largely Democratic-controlled places — in requiring some employers to provide workers with paid sick leave.

Proponents cheered Tuesday’s results. “Thanks to the voters, we can ensure that hard working Nebraskans don’t have to choose between paying their bills or caring for their health,” Jodi Lepaopao, campaign manager for Paid Sick Leave for Nebraskans, wrote in a statement.

The coronavirus pandemic elevated the issue by highlighting gaps in such benefits. At the height of the health crisis, the federal government provided temporary relief for sick workers, but those federal protections ended in 2021.

Beginning next year, many workers in these two states will be able to accrue paid time off as they work, earning about a week of paid leave per year. In Missouri and Nebraska, workers for larger organizations could earn one hour of paid sick time for every 30 hours worked. In Alaska, eligible workers would accrue a maximum of 56 hours of paid time each year.

In Missouri and Alaska, the measures also called for boosting the minimum wage.

Opponents in Missouri said they were disappointed with Tuesday’s results and were exploring legal action.

“We stand by our belief that Missouri business owners are best equipped to run their businesses without additional government mandates and regulations,” according to a joint statement from the Missouri Chamber of Commerce and Industry, the National Federation of Independent Business and other business groups.

Opponents had argued that employers should be the ones deciding which benefits are best.

These paid sick leave ballot measures flew under the radar compared with more high-profile ballot initiatives such as those on abortion, which was on the ballot in 10 states, including in Missouri and Nebraska. Voters approved abortion protections in seven states.

Campaigns supporting the sick leave initiatives in Alaska, Missouri and Nebraska raked in less than $9 million combined in cash contributions, according to a KFF Health News analysis of state campaign filings as of Oct. 28. That’s significantly less than Missouri’s ballot measures on abortion and sports betting, which state records show had amassed more than $55 million combined in cash contributions.

Most of the money funneled to the paid sick leave campaigns came from backers outside those states, the filings show. The Sixteen Thirty Fund, a D.C.-based advocacy group, was a top contributor to the three campaigns.

“We will build on these victories and continue to support organizations fighting for paid leave policies nationwide,” the group said in a statement.

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Voters backed abortion rights in seven of the 10 states where the issue appeared on ballots Tuesday, including in Missouri, among the first states to ban abortion after the U.S. Supreme Court overturned federal abortion protections with its 2022 decision in Dobbs v. Jackson Women’s Health Organization. At first glance, the nation’s patchwork of abortion rules was seemingly reshaped.

But when Alison Dreith, director of strategic partnerships at the Midwest Access Coalition abortion fund, which has helped people from Missouri and 27 other states get abortions, was asked before the results came in how her organization was preparing for logistic changes, she simply said: “We’re not.”

That’s because actual access to abortion in the country remains largely unchanged despite Tuesday’s results. The web of preexisting state laws on abortions could remain in place while they are contested in court, a process that could take months or longer.

States that passed abortion rights amendments in 2022 and 2023 offer a view into the lengthy legal road ahead for abortion policies to take effect. It took nine months after Ohio voters added abortion protections to their state’s constitution for a judge to strike down the state’s 24-hour waiting period for abortions. And some of Michigan’s abortion restrictions, including its 24-hour waiting period, were suspended only in June, 19 months after Michigan voters approved their state’s abortion rights amendment.

Missouri has an extensive set of such rules. Legal abortions had almost ceased even before the state’s ban was triggered by the Dobbs decision. Over three decades, state lawmakers passed restrictions on abortion providers that made it increasingly difficult to operate there. By 2018, only one clinic was providing abortions in the state, a Planned Parenthood affiliate in St. Louis. Anticipating further tightened restrictions, it opened a large facility 20 miles away in Illinois in 2019.

The laws that reduced the number of recorded abortions in the state from 5,772 in 2011 to 150 in 2021 remain on the books, despite the newly passed amendment protecting abortion rights. The state’s two Planned Parenthood affiliates filed a lawsuit Wednesday challenging those laws and requesting a preliminary injunction blocking their enforcement so the groups may resume abortion services in the state when the amendment goes into effect Dec. 5.

The state’s Republican-dominated legislature has attempted to ignore previous voter-passed amendments. After Missouri voters added Medicaid expansion to the state’s constitution in 2020, the state legislature refused to fund the program until a judge ordered the state to start accepting applications, prompting significant delays in enrollment. The state’s presumptive House speaker, Republican Jon Patterson, has said the legislature must respect the outcome of the Nov. 5 ballot measure vote, while others have pledged to bring the issue to voters again.

Abortion services often get talked about like a light switch, according to Kimya Forouzan, principal state policy adviser at the Guttmacher Institute, a nonprofit that supports abortion rights. But the infrastructure needed to provide abortions is not so easy to turn on and off.

North Dakota’s abortion ban was repealed by the courts in September, for example, but the lone provider of abortions in the state before the ban took effect has no plans to return, having moved operations a five-minute drive away to Minnesota.

Check out my full article here.

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To discover how millions in opioid settlement funds are being spent in Idaho, you can visit the state attorney general’s website, which hosts 91 documents from state and local entities getting the money.

What you’ll find is a lot of bureaucratese.

Nearly three years ago, these jurisdictions signed an agreement promising annual reports “specifying the activities and amounts” they have funded.

But many of those reports remain difficult, if not impossible, for the average person to decipher.

It’s a scenario playing out in a host of states. As state and local governments begin spending billions in opioid settlement funds, one of the loudest and most frequent questions from the public has been: Where are the dollars going? Victims of the crisis, along with their advocates and public policy experts, have repeatedly called on governments to transparently report how they’re using these funds, which many consider “blood money.”

Last year, KFF Health News published an analysis by Christine Minhee, founder of OpioidSettlementTracker.com, that found 12 states — including Idaho — had made written commitments to publicly report expenditures on 100% of their funds in a way an average person could find and understand. (The other 38 states promised less.)

But there’s a gap between those promises and the follow-through.

This year, KFF Health News and Minhee revisited those 12 states: Arizona, Colorado, Delaware, Idaho, Massachusetts, Minnesota, Missouri, New Hampshire, New Jersey, Oregon, South Carolina, and Utah. From their reports, it became clear that some did not fulfill their promises. And several just squeaked by, meeting the letter of the law but falling far short of communicating to the public in a clear and meaningful manner.

Take Idaho, for instance. Jurisdictions there completed a standard form showing how much money they spent and how it fell under approved uses of the settlement. Sounds great. But in reality, it reads like this: In fiscal year 2023, the city of Chubbuck spent about $39,000 on Section G, Subsection 9. Public Health District No. 6 spent more than $26,000 on Section B, Subsection 2.

Cracking that code requires a separate document. And even that provides only broad outlines.

G-9 refers to “school-based or youth-focused programs or strategies that have demonstrated effectiveness in preventing drug misuse.” B-2 refers to “the full continuum of care of treatment and recovery services for OUD and any co-occurring SUD/MH conditions,” referring to opioid use disorder and substance use disorder or mental health conditions.

“What does that mean? How exactly are you doing that?” asked Corey Davis, a project director at the Network for Public Health Law, when he first saw the Idaho reports.

Does a school-based program involve hiring mental health counselors or holding a one-time assembly? Does treatment and recovery services mean paying for someone’s rehab or building a new recovery house?

Without details on the organizations receiving the money or descriptions of the projects they’re enacting, it’s impossible to know where the funds are going. It would be similar to saying 20% of your monthly salary goes to food. But does that mean grocery bills, eating out at restaurants, or hiring a cook?

The Idaho attorney general’s office, which oversees the state’s opioid settlement reports, did not respond to requests for comment.

Although Idaho and the other states in this analysis do better than most in having any reports publicly available, Davis said that doesn’t mean they get an automatic gold star.

“I don’t think we should grade them on a curve,” he said. It’s not “a high bar to let the public see at some reasonable level of granularity where their money is going.”

To be sure, many state and local governments are making concerted efforts to be transparent. In fact, seven of the states in this analysis reported 100% of their expenditures in a way that is easy for the public to find and understand. Minnesota’s dashboard and downloadable spreadsheet clearly list projects, such as Renville County’s use of $100,000 to install “a body scanner in our jail to help staff identify and address hidden drugs inside of inmates.” New Jersey’s annual reports include details on how counties awarded funds and how they’re tracking success.

There are also states such as Indiana that didn’t originally promise 100% transparency but are now publishing detailed accounts of their expenditures.

However, there are no national requirements for jurisdictions to report money spent on opioid remediation. In states that have not enacted stricter requirements on their own, the public is left in the dark or forced to rely on ad hoc efforts by advocates and journalists to fill the gap.

Wading Through Reports

When jurisdictions don’t publicly report their spending — or publish reports without meaningful details — the public is robbed of an opportunity to hold elected officials accountable, said Robert Pack, a co-director of East Tennessee State University’s Addiction Science Center and a national expert on addiction issues.

He added: People need to see the names of organizations receiving the money and descriptions of their work to ensure projects are not duplicating efforts or replacing existing funding streams to save money.

“We don’t want to burden the whole thing with too much reporting,” Pack said, acknowledging that small governments run on lean budgets and staff. But organizations typically submit a proposal or project description before governments give them money. “If the information is all in hand, why wouldn’t they share it?”

Norman Litchfield, a psychiatrist and the director of addiction medicine at St. Luke’s Health System in Idaho, said sharing the information could also foster hope.

“A lot of people simply are just not aware that these funds exist and that these funds are currently being utilized in ways that are helping,” he said. Greater transparency could “help get the message out that treatment works and treatment is available.”

Other states that lacked detail in some of their expenditure reports said further descriptions are available to the public and can be found in other state documents.

In South Carolina, for instance, more information can be found in the meeting minutes of the Opioid Recovery Fund Board, said board chair Eric Bedingfield. He also wrote that, following KFF Health News’ inquiry, staff will create an additional report showing more granular information about the board’s “discretionary subfund” awards.

In Missouri, Department of Mental Health spokesperson Debra Walker said, further project descriptions are available through the state budget process. Anyone with questions is welcome to email the department, she said.

Bottom line: The details are technically publicly available, but finding them could require hours of research and wading through budgetary jargon — not exactly a system friendly to the average person.

Click Ctrl+F

New Hampshire’s efforts to report its expenditures follow a similar pattern.

Local governments control 15% of the state’s funds and report their expenditures in yearly letters posted online. The rest of the state’s settlement funds are controlled by the Department of Health and Human Services, along with an opioid abatement advisory commission and the governor and executive council.

Grant recipients from the larger share explain their projects and the populations they serve on the state’s opioid abatement website. But the reports lack a key detail: how much money each organization received.

To find those dollar figures, people must search through the opioid abatement advisory commission’s meeting minutes, which date back several years, or search the governor and executive council’s meeting agendas for the proposed contracts. Typing in the search term “opioid settlement” brings up no results, so one must try “opioid” instead, surfacing results about opioid settlements as well as federal opioid grants. The only way to tell which results are relevant is by opening the links one by one.

Davis, from the Network for Public Health Law, called the situation an example of “technical compliance.” He said people in recovery, parents who lost their kids to overdose, and others interested in the money “shouldn’t have to go click through the meeting notes and then control-F and look for opioids.”

James Boffetti, New Hampshire’s deputy attorney general, who helps oversee the opioid settlement funds, agreed that “there’s probably better ways” to share the various documents in one place.

“That doesn’t mean they aren’t publicly available and we’re somehow not being transparent,” he said. “We’ve certainly been more than transparent.”

The New Hampshire Department of Health and Human Services said it will be compiling its first comprehensive report on the opioid settlement funds by the end of the year, as laid out in statute.

Where’s the Incentive?

With opioid settlement funds set to flow for another decade-plus, some jurisdictions are still hoping to improve their public reporting.

In Michigan, the state is using some of its opioid settlement money to incentivize local governments to report on their shares. Counties were offered $1,000 to complete a survey about their settlement spending this year, said Laina Stebbins, a spokesperson for the Michigan Department of Health and Human Services. Sixty-four counties participated — more than double the number from last year, when there was no financial incentive.

In Maryland, lawmakers took a different approach. They introduced a bill that required each county to post an annual report detailing the use of its settlement funds and imposed specific timelines for the health department to publish decisions on the state’s share of funds.

But after counties raised concerns about undue administrative burden, the provisions were struck out, said Samuel Rosenberg, a Democrat representing Baltimore who sponsored the House bill.

Lawmakers have now asked the health department to devise a new plan by Dec. 1 to make local governments’ expenditures public.

Toni Torsch, a Maryland resident whose son Dan died of an overdose at age 24, said she’ll be watching to ensure the public gets a clear picture of settlement spending.

“This is money we got because people’s lives have been destroyed,” she said. “I don’t want to see that money be misused or fill a budget hole.”

Methodology

In March 2023, KFF Health News published an analysis by Christine Minhee, founder of OpioidSettlementTracker.com, assessing states’ written commitments to report how they use opioid settlement dollars. That analysis determined that 12 states had promised to publicly report expenditures on 100% of their funds in a way an average person could track.More than a year later, KFF Health News senior correspondent Aneri Pattani and Minhee revisited those 12 states’ reporting practices to determine if they had fulfilled their promises and to assess how useful the resulting expenditure reports were to the public.Expenditure reports were gathered via state and local government websites, Google searches, and Minhee’s Expenditure Report Tracker. If Minhee and Pattani were unable to find public reports, they contacted state governments directly.For expenditures to be considered “publicly reported,” they had to meet the following criteria:1. Expenditures had to be expressed as specific dollar amounts. Descriptions of how the money was used without a dollar figure would not qualify.2. The report passes the “Googleability test”: Could a typical member of the public reasonably be expected to find expenditure information by keyword-searching online? If people had to file a public records request, navigate lengthy budget or appropriations documents, or rifle through meeting minutes for the information, it would not qualify.For an expenditure report to be considered “publicly reported with clarity,” it had to meet one additional criterion:3. Reports had to contain some combination of vendor name (e.g., an individual or organization) that received the money and a description of the money’s use such that a typical member of the public could understand the specific service, product, or effort the money supported.Each state divides opioid settlement funds into shares controlled by different entities. The majority of expenditures in each share were required to meet the above-listed criteria in order for that share to be classified as “publicly reported” or “publicly reported with clarity.”For example, in Utah, 50% of opioid settlement funds are controlled by county governments. As of Oct. 9, less than half of all counties had reported expenditures in a manner that was easily accessible to the public. As such, that 50% share was not counted as “publicly reported.”This analysis was conducted by Pattani and Minhee from July to October. Classifications were made based on states’ expenditure reports as of Oct. 9.

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Natalie Holt sees reminders nearly everywhere of the serious toll a years-long syphilis outbreak has taken in South Dakota. Scrambling to tamp down the spread of the devastating disease, public health officials are blasting messages to South Dakotans on billboards and television, urging people to get tested.

Holt works in Aberdeen, a city of about 28,000 surrounded by a sea of prairie, as a physician and the chief medical officer for the Great Plains Area Indian Health Service, one of 12 regional divisions of the federal agency responsible for providing health care to Native Americans and Alaska Natives in the U.S.

The response to this public health issue, she said, is not so different from the approach with the coronavirus pandemic — federal, state, local, and tribal groups need to “divide and conquer” as they work to test and treat residents. But they are responding to this crisis with fewer resources because federal officials haven’t declared it a public health emergency.

The public pleas for testing are part of health officials’ efforts to halt the outbreak that has disproportionately hurt Native Americans in the Great Plains and Southwest. According to the Great Plains Tribal Epidemiology Center, syphilis rates among Native Americans in its region soared by 1,865% from 2020 to 2022 — over 10 times the 154% increase seen nationally during the same period. The epidemiology center’s region spans Iowa, Nebraska, North Dakota, and South Dakota. The center also found that 1 in 40 Native American and Alaska Native babies born in the region in 2022 had a syphilis infection.

The rise in infections accelerated in 2021, pinching public health leaders still reeling from the coronavirus pandemic.

Three years later, the outbreak continues — the number of new infections so far this year is 10 times the full 12-month totals recorded in some years before the upsurge. And tribal health leaders say their calls for federal officials to declare a public health emergency have gone unheeded.

Pleas for help from local and regional tribal health leaders like Meghan Curry O’Connell, the chief public health officer for the Great Plains Tribal Leaders’ Health Board and a citizen of the Cherokee Nation, preceded a September letter from the National Indian Health Board, a Washington, D.C.-based nonprofit that advocates for health care for U.S. tribes, to publicly urge the Department of Health and Human Services to declare a public health emergency. Tribal leaders said they need federal resources including public health workers, access to data and national stockpile supplies, and funding.

According to data from the South Dakota Department of Health, 577 cases of syphilis have been documented this year in the state. Of those, 430 were among Native American people — making up 75% of the state’s syphilis cases, whereas the group accounts for just 9% of the population.

The numbers can be hard to process, O’Connell said.

“It’s completely preventable and curable, so something has gone horribly wrong that this has occurred,” she said.

The Great Plains Tribal Leaders’ Health Board first called on HHS to declare a public health emergency in February. O’Connell said the federal agency sent a letter in response outlining some resources and training it has steered toward the outbreak, but it stopped short of declaring an emergency or providing the substantial resources the board requested. The board’s now months-old plea for resources was like the recent one from the National Indian Health Board.

“We know how to address this, but we do need extra support and resources in order to do it,” she said.

Syphilis is a sexually transmitted infection that can result in life-threatening damage to the heart, brain, and other organs if left untreated. Women infected while pregnant can pass the disease to their babies. Those infections in newborns, called congenital syphilis, kill dozens of babies each year and can lead to devastating health effects in others.

Holt said the Indian Health Service facilities she oversees have averaged more than 1,300 tests for syphilis monthly. She said a recent decline in new cases detected each month — down from 92 in January to 29 in September — may be a sign that things are improving. But a lot of damage has been done during the past few years.

Cases of congenital syphilis across the country have more than tripled in recent years, according to the Centers for Disease Control and Prevention. In 2022, 3,700 cases were reported — the most in a single year since 1994.

The highest rate of reported primary and secondary syphilis cases in 2022 was among non-Hispanic American Indian or Alaska Native people, with 67 cases per 100,000, according to CDC data.

O’Connell and other tribal leaders said they don’t have the resources needed to keep pace with the outbreak.

Chief William Smith, vice president of Alaska’s Valdez Native Tribe and chairperson of the National Indian Health Board, told HHS in the organization’s letter that tribal health systems need greater federal investment so the system can better respond to public health threats.

Rafael Benavides, HHS’ deputy assistant secretary for public affairs, said the agency has received the letter sent in early September and will respond directly to the authors.

“HHS is committed to addressing the urgent syphilis crisis in American Indian and Alaska Native communities and supporting tribal leaders’ efforts to mobilize and raise awareness to address this important public health crisis,” he said.

Federal officials from the health department and the CDC have formed task forces and hosted workshops for tribes on how to address the outbreak. But tribal leaders insist a public health emergency declaration is needed more than anything else.

Holt said that while new cases seem to be declining, officials continue to fight further spread with what resources they have. But obstacles remain, such as convincing people without symptoms to get tested for syphilis. To make this easier, appointments are not required. When people pick up medications at a pharmacy, they receive flyers about syphilis and information about where and when to get tested.

Despite this “full court press” approach, Holt said, officials know there are people who do not seek health care often and may fall through the cracks.

O’Connell said the ongoing outbreak is a perfect example of why staffing, funding, data access, and other resources need to be in place before an emergency develops, allowing public health agencies to respond immediately.

“Our requests have been specific to this outbreak, but really, they’re needed as a foundation for whatever comes next,” she said. “Because something will come next.”

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If President-elect Donald Trump and a Republican Senate try to roll back reproductive health rights or pursue a widely prophesied national abortion ban, California Attorney General Rob Bonta is poised to challenge him.

Two years ago, Bonta, a Democrat who heads the state justice department, directed his staff to draft legal analyses against a possible national abortion ban after the U.S. Supreme Court overturned 50 years of abortion protections under Roe v. Wade. Bonta said they thought through arguments, even going so far as to decide in which court they would file suit.

Bonta said his team had a strategy in place starting from Election Day.

After the Dobbs decision, Trump boasted that he “was able to kill” Roe v. Wade. He said he would veto any federal abortion ban after declining to say whether he’d veto one. And Project 2025’s Mandate for Leadership, a road map for the next conservative president that was crafted by many former Trump advisers, described the overturning of Roe as “just the beginning.” It also calls for ending a requirement that Obamacare plans cover emergency contraceptives; the mailing of medication abortion pills; and federal funding of Planned Parenthood and other clinics that provide abortion.

By comparison, Californians have enshrined rights to abortion and contraception into the state constitution. The state in 2022 also enacted 15 bills and approved $200 million in new spending to expand abortion protections in the Golden State and make it easier for low-income and out-of-state patients to get care.

Bonta, who was appointed attorney general in 2021 by Gov. Gavin Newsom, has sued a national anti-abortion group and a chain of anti-abortion crisis pregnancy centers for marketing unproven and potentially harmful “abortion pill reversal” procedures. In September, he sued Providence St. Joseph Hospital, a Catholic hospital that had allegedly denied a patient an emergency abortion, instead discharging her with an offer of a bucket and towels. Last week, Bonta reached a settlement with the city of Beverly Hills over its alleged blocking of an abortion clinic from opening.

He has joined other states in lawsuits over medication abortion, emergency abortions, and travel between states for care. For Bonta, the issue of abortion is personal. His wife, Assembly member Mia Bonta, shared in 2022 that she had an abortion when she was 21. As her boyfriend, Bonta held her hand when she made the decision.

Bonta spoke to KFF Health News correspondent Molly Castle Work about his passion to protect women’s reproductive health rights and how his upbringing influences his legal decisions. This interview, which took place Oct. 31, has been edited for length and clarity.

Q: How do you think your upbringing prepared you for this job?

A: It starts with inspiration from my parents. They learned that you can’t just hope and wait for the things that you want; you have to fight. They joined the United Farm Workers of America. My dad worked in the front office with Cesar Chavez, my mom with Dolores Huerta. They were fighting for the people that feed our state and our nation but weren’t being treated right.

I remember growing up, I would go with my mom … to protests and rallies and demonstrations. I was at her side, slogans in my throat and fist in the air, or placards in my hand, calling out the human rights abuses. There was that belief that everyday people cannot accept the unacceptable, and if something’s not right, we’ll fight, and can and do create the change that they seek.

I want to be the person that comes in with my positional power, my authority, the reach and the strength of this office behind me and on my side working together to protect those people who are being mistreated and wronged.

Q: You’ve been a longtime champion of reproductive rights. Why are you so passionate?

A: Some things you just feel in your gut. And you have your own personal story. My wife has told the story, and it’s her story to tell. She had an abortion, and I accompanied her and held her hand. It was her choice and her right and her decision and her bodily autonomy and self-determination. And every woman deserves that.

And I don’t like bullies. I don’t like people who attack others and try to take things away from them. It’s wrong and it’s my role to protect those rights. And these are not imagined rights — before Dobbs, they existed for 50 years for every woman in the United States of America.

We’re in a fight for freedom right now, certainly including reproductive freedom, and it’s something that I think the entire nation has some connection to, and it’s wrong for elected officials, presidential candidates, to make political decisions, to get in the way of a decision that should be made between a woman, her doctor, her faith.

Q: Tell me more about your wife’s decision to share her own abortion story after the U.S. Supreme Court issued the Dobbs decision. Why was it important for you both to share that story?

A: We talked about it, of course, but it was her decision. And it’s not something that’s easy to talk about, but I think it was important to talk about, especially given that moment.

It was painful to see that people lost faith and trust in the Supreme Court and it was important for people to know that their leaders are side by side with them, have experiences and passions and cares just like them, have worries and fears just like them.

And I think it was important to Mia to emphasize the impact of these decisions on women of color and vulnerable women, poor women. It was important for her to lift up her voice and, through her pain, own her power and show her strength and communicate with others about her own experience.

Q: You have joined and led multistate efforts to defend abortion in states such as Idaho and Texas. Why is it California’s place to push for access outside its borders?

A: We fight the fight wherever it is. We get involved in all sorts of different types of issues, supporting transgender and gender-nonconforming youth, supporting commonsense constitutionally lawful gun safety laws. And certainly when it comes to reproductive health care, we do the same. There are strategic, intentional, deliberate attacks, by design, in certain courts outside of California. And so it’s very important for us to bring our knowledge, our expertise, our legal insight into those fights.

Q: What happens if Trump wins the election? How does that change your job? And what type of preparations are you making?

A: We’ve been preparing since the Dobbs decision dropped. Shortly after that, I asked my team to start writing the brief for a national abortion ban: Just think it through, you know. Think through the arguments. Do we have a pathway to challenge it in court?

Hopefully we’ll never have to challenge it in court. There’s no national abortion ban, and maybe there never will be, but we want to be ready if there is. We want to have thought through it when we had time and been able to do the in-depth and the nuanced review.

I think the people of our state and the people of our country want us to have been doing that.

Q: So, I’m sure you know I have to ask: Are you considering a run for governor?

A: There will be a time to make that decision after the election. That time is not now. I am honored and grateful that I’ve gotten lots of encouragement from people. That gives me inspiration about the work that my team is doing.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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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Voters backed abortion rights in seven of the 10 states where the issue appeared on ballots Tuesday — at first glance, seemingly reshaping the nation’s patchwork of abortion rules.

Colorado, Maryland, Montana, and New York — states where abortions are already permitted at least until fetal viability — all will add abortion protections to their state constitutions. Nevada voters also favored protections and can enshrine them by passing the measure again in the next general election.

Florida and South Dakota voters, meanwhile, did not pass abortion rights amendments, and Nebraska voters essentially affirmed the state’s existing ban on abortions after the first trimester, while rejecting a measure that would have protected abortions later into pregnancy.

The biggest changes came in Arizona, where, in 2022, abortion was banned after 15 weeks, and in Missouri, which has had a near-total ban. Voters in those states approved constitutional amendments to protect abortion rights through fetal viability, opening the door to overturning those states’ restrictions and increasing access to abortion services.

But when Alison Dreith, director of strategic partnerships at the Midwest Access Coalition abortion fund, which has helped people from Missouri and 27 other states get abortions, was asked before the results came in how her organization was preparing for logistical changes, she said simply: “We’re not.”

That’s because actual access to abortion in the country remains largely unchanged, despite the Nov. 5 results. The web of preexisting state laws on abortions will likely remain in place while they are contested in court, a process that could take months or even years.

Dreith said she doesn’t think many voters understood all that before heading to the polls. “It might not get them the results that they want, especially immediately,” Dreith said.

Further complicating these state results: The election wins of Donald Trump as president-elect and Republicans in the U.S. Senate, giving their party control, have raised the question of whether a national abortion ban will be on the table. Republicans had demurred on the campaign trail. Such a law would take time to enact, too.

The abortion landscape changed dramatically when the U.S. Supreme Court overturned federal abortion protections with its 2022 decision in Dobbs v. Jackson Women’s Health Organization. That left abortion rules up to the states, prompting 14 to enact bans with few exceptions and several others to limit access.

The ruling also led to a raft of ballot measures: Voters in 16 states have now weighed in on abortion-related ballot measures. Thirteen have favored access to abortions in some way. And while the Florida amendment to protect abortion access failed to meet the necessary 60% threshold to pass, it did receive a majority of the vote.

Abortion opponents such as Susan B. Anthony Pro-Life America praised the votes rejecting amendments in Florida and South Dakota and lamented the amendments that passed in states, such as Missouri, with restrictive abortion rules and bans.

“We mourn the lives that will be lost,” Sue Liebel, its director of state affairs, wrote in a statement. “The disappointing results are a reminder that human rights battles are not won overnight.”

States that passed abortion rights amendments in 2022 and 2023 offer a view into the lengthy legal road ahead for abortion policies to take effect. It took nine months after Ohio voters added abortion protections to their state’s constitution for a judge to strike down the state’s 24-hour waiting period for abortions. And some of Michigan’s abortion restrictions, including its own 24-hour waiting period, were suspended only in June, 19 months after Michigan voters approved their state’s abortion rights amendment.

Missouri has an extensive set of such rules. Legal abortions had almost ceased even before the state’s ban was triggered by the Dobbs decision. Over three decades, state lawmakers passed a series of restrictions on abortion providers that made it increasingly difficult to operate there. By 2018, only one clinic was providing abortions in the state, a Planned Parenthood affiliate in St. Louis. Anticipating further tightened restrictions, it opened a large facility 20 miles away in Illinois in 2019.

Those laws that reduced the number of recorded abortions in the state from 5,772 in 2011 down to 150 in 2021 remain on the books, despite the newly passed amendment protecting abortion rights.

Abortion services often get talked about like a light switch, according to Kimya Forouzan, principal state policy adviser at the Guttmacher Institute, a nonprofit that supports abortion rights. But the infrastructure needed to provide abortions is not so easy to turn on and off.

North Dakota’s abortion ban was repealed by the courts in September, for example, but the lone provider of abortions in the state before the ban took effect has no plans to return, having moved operations a five-minute drive away to Minnesota.

And even when clinics quickly ramp up services, the legal wrangling over abortion rules can lead to policy whiplash, with patients caught in the middle.

Georgia’s law banning most abortions after about six weeks spent years in the courts after it passed in 2019. During two brief stretches after the Dobbs decision, once in 2022 and again in 2024, court rulings meant that clinics in the state could provide abortions up to 22 weeks of pregnancy.

Demand for abortion surged during those times, and clinics were able to resume offering services quickly. But when state courts later said the ban should be enforced, those windows slammed shut. During the 2022 period, some patients scheduled for abortions were left sitting in waiting rooms, according to Megan Cohen, medical director of Planned Parenthood Southeast.

The various abortion rights amendments that passed Nov. 5 could also face challenges.

In Missouri, the state’s Republican-dominated legislature has attempted to ignore voter-passed amendments before. After Missouri voters added Medicaid expansion to the state’s constitution in 2020, the state legislature refused to fund the program until a judge ordered the state to start accepting applications, prompting significant delays in enrollment.

The state’s presumptive House speaker, Republican Jon Patterson, has said the legislature must respect the outcome of the Nov. 5 ballot measure vote, while others have pledged to bring the issue to voters again.

In the meantime, Dreith of the Midwest Access Coalition said people seeking abortions in the Midwest will do what they often do in the region for everything from groceries to health care: drive.

“We expect that the resources we need are not in our communities,” Dreith said, “and I think that’s been helpful to us in this crisis.”

KFF Health News’ Renuka Rayasam and Sam Whitehead in Georgia and Arielle Zionts in South Dakota contributed to this report.

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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This story can be republished for free (details).