Watch: ‘Breaking the Silence Is a Step’ — Beyond the Lens of ‘Silence in Sikeston’
KFF Health News Midwest correspondent Cara Anthony took a reporting trip to the small southeastern Missouri city of Sikeston and heard a mention of its hidden past. That led her on a multiyear reporting journey to explore the connections between a 1942 lynching and a 2020 police killing there — and what they say about the nation’s silencing of racial trauma. Along the way, she learned about her own family’s history with such trauma.
This formed the multimedia “Silence in Sikeston” project from KFF Health News, Retro Report, and WORLD as told through a documentary film, educational videos, digital articles, and a limited-series podcast. Hear about Anthony’s journey and join this conversation about the toll of racialized violence on our health and our communities.
Explore more of the “Silence in Sikeston”project:
LISTEN: The limited-series podcast is available on PRX, Apple Podcasts, Spotify, iHeart, or wherever you get your podcasts.
- Episode 1: “Racism Can Make You Sick”
- Episode 2: “Hush, Fix Your Face”
- Episode 3: “Trauma Lives in the Body”
- Episode 4: “Is There a Cure for Racism”
WATCH: The documentary film “Silence in Sikeston,” a co-production of KFF Health News and Retro Report, is now available to stream on WORLD’s YouTube channel, WORLDchannel.org, and the PBS app.
READ: KFF Health News Midwest correspondent Cara Anthony wrote an essay about what her reporting for this project helped her learn about her own family’s hidden past.
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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Asian Health Center Tries Unconventional Approach to Counseling
In her first months as a community health worker, Jee Hyo Kim helped violent crime survivors access supportive services and resources. When a client with post-traumatic stress disorder sought a therapist, she linked him to one that fit his needs. She helped clients afraid to leave their homes obtain food delivery vouchers. As one client described her, Kim was a “connector.”
Then, Kim learned to go further. Through a training program, she gained the know-how and confidence to provide emotional support. She learned evidence-based mental health counseling skills such as asking open-ended questions. She also discovered that some things she was already doing, such as listening attentively and restating what she hears, are core to communicating empathy — a vital component of a successful relationship between a client and their mental health provider.
“It was very refreshing to see that it’s named and to realize those are skills,” she said.
Asian Health Services, where Kim works, is a part of a fledgling movement trying to address a dire shortage of therapists by training community health workers and other nonlicensed professionals who have trusted relationships with their communities to add mental health counseling to their roles. This approach, already implemented abroad and proven to help address some common mental health conditions, is called lay counseling.
The Oakland, California-based community health center serves mostly low-income Asian immigrants who speak limited English. As a community health worker, Kim now also practices lay counseling under a licensed therapist’s supervision. She does not have a license, but as a Korean immigrant and strong-arm robbery survivor, she shares lived experiences with many of the people she serves, enabling her to build trust.
Research suggests Asian Americans see mental health providers at lower rates than people of other races, and up to half of some subgroups report difficulty accessing mental health care. Figures like these may be only the tip of the iceberg, as Asian Americans can be reluctant even to seek help. Cultural stigma against mental illness and feeling like one’s problems pale in comparison to the trauma faced by earlier generations are among the reasons, said Connie Tan, senior research analyst at AAPI Data, a think tank.
Asian Health Services introduced lay counseling during the covid-19 pandemic. Violence against Asian Americans was spiking, and therapists fluent in any of the 14 languages spoken by the communities the health center cares for were in short supply. Six percent of people in the U.S. identify as Asian, Native Hawaiian, or Pacific Islander, but these groups account for only 3% of psychologists.
Concerned that people were falling through the cracks, the health center in 2021 launched a grant-funded initiative to support victims of violence. In addition to lay counseling and therapy by licensed providers, available in several languages, the program, known as the Community Healing Unit, provides services such as helping clients access crime victim funds.
The program has sent 43 community health workers, case managers, and other employees to a lay counseling training program, said Ben Wang, the health center’s director of special initiatives. Trainees learn through formal instruction, observing teachers providing counseling, and practicing counseling with one another, along with feedback from instructors.
Thu Nguyen, a domestic violence survivor, was struggling with anxiety and self-blame. “My inside talk eats me up,” she explained. Worried that sharing with family members would burden them, she was unsure where else to turn for support after meeting with a therapist she didn’t click with. Through the program, Nguyen was assigned to Kim, who connected her to a compatible therapist.
Nguyen also leaned on Kim for emotional support. When she confided feeling guilty and inadequate as a single mother, Kim responded without judgment and affirmed Nguyen’s dedication.
“She validates my feeling,” said Nguyen, a Vietnamese immigrant. “She would say, ‘I understand that it’s hard. You’re doing the best.’”
Asian Americans can struggle to find therapists who understand their culture, speak their language, or come from similar communities. Licensed therapists typically must complete an advanced degree, pass professional exams, and work at least two years under supervision. Requirements vary by state and by type of license. It has long been held that the process ensures high-quality care.
Lay counseling proponents contend this path is costly and time-consuming, limiting the field’s diversity and exacerbating the therapist shortage. They also point to favorable research. Lay counseling has been implemented in several countries, where mounting evidence has shown it can improve symptoms of depression, anxiety, and a few other mental health conditions.
“The idea that someone without a license could not [communicate empathy] skillfully is ridiculous,” said Elizabeth Morrison, a psychologist and co-founder of Lay Counselor Academy, which has trained 420 people, including Kim, to add lay counseling to their roles since launching two years ago. Trainees hail from a variety of jobs, including faith leaders and first responders.
The 65-hour primarily virtual course teaches topics such as supporting people who have experienced trauma, counseling methods such as cognitive behavioral therapy and motivational interviewing, first-line strategies for treating depression and anxiety, and setting boundaries. The course does not teach how to diagnose mental health conditions. Instead, trainees learn to affirm strengths, acknowledge feelings, avoid giving advice, and otherwise listen empathically.
Asian Health Services staff members who provide lay counseling receive ongoing support and guidance after the training from a program manager and a licensed therapist, Wang said.
Raquel Halfond, a senior director at the American Psychological Association, said she believes it’s important for lay counselors to receive training and to practice under the supervision of a licensed mental health professional, but the group has no formal model or standards for the use of lay counselors.
The course not only upskills but also recognizes what many trainees already do or have learned that may not be acknowledged as counseling. “It’s like this invisible, unpaid work, and people chalk it up as someone being nice,” Morrison said.
Lay counseling is still nascent, and it often takes years for a new field to become established — and for insurers to get on board. Morrison and Laura Bond, a research fellow at Harvard Medical School’s Mental Health For All Lab, another lay counseling training initiative, said they are not aware of any organizations that can bill public or private insurers for lay counseling.
In an email, Leah Myers, a spokesperson for the California Department of Health Care Services, which oversees Medi-Cal, the state’s Medicaid program, acknowledged there is no billing code for lay counseling or certification for lay counselors. She said Medi-Cal reimburses certain nonlicensed providers for services that “may include what would be considered ‘lay counseling’-like activities” but would need more details to make a determination.
The Community Healing Unit’s largest grant, from the state of California to support victims of hate crimes, ends in 2026. The program has served over 300 people and is developing a survey to gather feedback, Wang said.
Nguyen knew Kim wasn’t a licensed therapist but didn’t care, she said; she appreciated that Kim, a fellow Asian woman, made her feel safe to process her feelings. Kim was also easily accessible through biweekly check-ins, and responded promptly if Nguyen called at other times.
Now, Nguyen said, telling herself “you’re doing good” comes more easily.
Supplemental support comes from the Asian American Journalists Association-Los Angeles through The California Endowment.
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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Calif. Ballot Measure Targets Drug Discount Program Spending
Californians in November will weigh in on a ballot initiative to increase scrutiny over the use of health-care dollars — particularly money from a federal drug discount program — meant to support patient care largely for low-income or indigent people. The revenue is sometimes used to address housing instability and homelessness among vulnerable patient populations.
Voters are being asked whether California should increase accountability in the 340B drug discount program, which provides money for community clinics, safety net hospitals and other nonprofit health-care providers.
The program requires pharmaceutical companies to give drug discounts to these clinics and nonprofit entities, which can bank revenue by charging higher reimbursement rates.
Advocates pushing the measure, Proposition 34, say some entities are using the drug discount program as a slush fund, plowing money into housing and homelessness initiatives that don’t meet basic patient safety standards. Researchers and advocates have called for greater oversight.
“There are 340B entities that are misusing these public dollars,” said Nathan Click, a spokesperson for the pro-Proposition 34 campaign. “The whole point of this program is to use this money to get more low-income people health-care services.”
The initiative wouldn’t bar 340B providers from using health-care funds for housing or homelessness programs. Instead, it targets providers that spend more than $100 million on purposes other than direct patient care over 10 years. It would mandate that 98 percentof 340B revenues go to direct patient care. It also targets 340B providers with health insurer contracts and pharmacy licenses and those serving low-income Medicaid or Medicare patients that have been dinged with at least 500 high-severity housing violations for substandard or unsafe conditions.
That has placed a bull’s eye on the Los Angeles-based AIDS Healthcare Foundation, a nonprofit that provides direct patient care via clinics and pharmacies in California and other states, including Illinois, Texas and New York. It also owns housing for low-income and homeless people.
A Los Angeles Times investigation found that many residents of AIDS Healthcare Foundation properties are living in deplorable, unhealthy conditions.
Michael Weinstein, the foundation’s president, disputes those claims and argues that Proposition 34 proponents, including real estate interests, are going after him for another ballot initiative that seeks to implement rent control in more communities across California.
“It’s a revenge initiative,” Weinstein said, arguing that the deep-pocketed California Apartment Association is targeting his foundation — and its health and housing operations — because it has backed ballot measures pushing rent control across California. “This is a two-pronged attack against us to defeat rent control.”
Weinstein is locked in a feud with the apartment association, the chief sponsor of the initiative, which has contributed handsomely to pass Proposition 34. Opponents argue that the initiative is “a wolf in sheep’s clothing.”
Weinstein acknowledged to KFF Health News that his nonprofit uses money from 340B drug discounts to support its housing initiatives but argued they are helping treat and house some of the most vulnerable people, who would otherwise be homeless.
The apartment association declined several requests for comment. But Proposition 34 backers say they aren’t going after rent control — or Weinstein and his nonprofit.
Supporters argue that “rising health care costs are squeezing millions of Californians” and say that the initiative would “give California patients and taxpayers much needed relief, and lowers state drug costs, while saving California taxpayers billions.”
If the initiative passes and 340B providers do not spend 98 percent of the revenue on direct patient care, they could lose their license to practice health care and their nonprofit status.
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A Boy’s Bicycling Death Haunts a Black Neighborhood. 35 Years Later, There’s Still No Sidewalk.
DURHAM, N.C. — It’s been 35 years since John Parker died after a pickup collided with the bike he was riding on Cheek Road in east Durham before school. He was 6.
His mother, Deborah Melvin-Muse, doesn’t display photos of him, the second-youngest of six children. His brother’s birthday was the day after the crash — and he hasn’t celebrated it since. An older brother carries a deep sense of guilt because he was looking after John that morning.
And Cheek Road, in a predominantly Black neighborhood, still lacks sidewalks for children to safely make their way to the local elementary school.
This, despite the years community activists and academic researchers have spent pleading with city leaders for safety improvements along the busy thoroughfare with sloping shoulders where John died. Drivers zoom along Cheek Road in the Merrick-Moore neighborhood, which connects downtown Durham to industrial sites and newer suburban developments.
Melvin-Muse moved her family out of the neighborhood after John’s death. “Now when I go down there, I look and see, you know, nothing really changed,” she said. “It still looks the same.”
Cheek Road has been “identified as needing improvements” by a local metropolitan planning board, said Erin Convery, Durham’s transportation planning manager, in an email.
“The infrastructure that exists is not well implemented,” concluded a May preliminary report produced by University of North Carolina-Chapel Hill students who collected data on speeding, noise, and air quality along Cheek Road. “Poorly marked crosswalks and inadequately positioned bus stops show a need for safety and accessibility improvements,” the report said.
Data was difficult to collect because “there were areas we didn’t want to get out of our cars because of the dangerous conditions,” said Ari Schwartz, one of the researchers.
In the 1940s, Black military veterans returning from World War II helped establish the Merrick-Moore neighborhood. Since then, residents say they have endured everything from noisy industrial trucks and speeding cars to illegal tire dumping and air pollution that threaten their health and safety.
Pedestrian deaths are highest in formerly redlined areas, neighborhoods where Black people lived because of discriminatory federal mortgage lending practices, research shows. The lack of sidewalks, damaged walkways, and roads with high speed limits are concentrated in these neighborhoods, studies show, creating a little-recognized public health crisis.
Governments invest in roads for people driving through such neighborhoods, but not in safety measures — like sidewalks, crosswalks, traffic circles, and speed bumps — that protect people living in them, researchers and advocates say.
“People will talk about vulnerable communities as if there is a problem with these communities, when in fact it is our systems and policies that have created these failings,” said Darya Minovi, a senior analyst at the Union of Concerned Scientists who studies environmental health and justice.
While the share of Black residents in Merrick-Moore has dropped in recent decades, data shows the neighborhood remains more than 80% Black or Hispanic and households there are typically less well-off than in other parts of the city.
“Local government takes money from the neighborhood but does not invest in it,” said Bonita Green, head of the Merrick-Moore Community Development Corporation and a former City Council candidate.
Green said the community group had documented more than 100 auto crashes along Cheek Road during a recent four-year span and at least three pedestrian deaths before 2020. In this fast-growing city of roughly 300,000, students at Merrick-Moore Elementary and others at a nearby high school sometimes walk along the road — where traffic is heavy, drivers are known to disregard the 25-mph speed limit, and the shoulders slope steeply.
When longtime residents like Ponsella Brown see kids walking there or hear about another accident, they remember the death of John Parker, who was in first grade.
“I just cringe,” said Brown, who worked as an administrative assistant at Merrick-Moore Elementary when John died. “Every time it comes up, it’s like really vivid in my mind.”
On the day John died, someone rushed into the office and said a child had been hit by a car on Cheek Road, recalled Brown, who said she ran to the scene.
“I remember the way his head was turned. I remember the spot of blood on his face. Like one speck of blood,” said Brown, who also works for the Merrick-Moore Community Development Corporation and is now a counselor at another school.
Traffic on Cheek Road is expected to increase as the population grows in Durham and surrounding areas, according to a separate April report from UNC graduate students. It noted that during the morning school drop-off time, many cars driving on Cheek Road don’t observe the posted speed limits.
Under an equity program meant to reverse the harm done to communities of color, Convery said, Durham officials are considering traffic-calming measures, including traffic circles, speed cushions, and high-visibility crosswalks.
“We’re open to future conversations that will help us achieve zero traffic deaths and injuries,” Convery said.
Yet a 2017 plan that prioritized more than 600 sidewalk projects based on safety, equity, and demand did not include Merrick-Moore Elementary School on Cheek Road, she said.
A strike by Durham school bus drivers this year only heightened concerns about the lack of safe walking routes for the 650 students who attend the elementary school, according to the April report.
Melvin-Muse, now 67, was at work when she got a call that John had been struck by a truck in front of their house. Before she left home that late May morning in 1989, she put her older kids in charge of the younger ones. They passed the time before school riding bicycles near their house, a few blocks from Merrick-Moore Elementary School, when the accident occurred.
John died two months shy of his 7th birthday from “massive head injuries,” according to The (Raleigh) News & Observer, which wrote about his death on Cheek Road at the time. John was buried in Markham Memorial Gardens, according to his obituary in The (Durham) Herald-Sun.
Melvin-Muse said his death sent the family into a tailspin of grief, anger, and regret.
“It caused a big rip in the family,” Melvin-Muse said.
Melvin-Muse and John’s father later divorced. She said she paid for therapy for her other kids, but they still got in trouble at school and two of her children ended up living in a home for kids with behavioral health issues. “It was just a bad time,” she said.
Years after the accident, Melvin-Muse said, she worked up the courage to call the driver who had hit her son. When he answered, he didn’t recognize her name, or John’s, fueling her rage, she recalled.
“I wanted revenge. An eye-for-an-eye kind of thing,” she said. “And I plotted to take him out the same way my son was taken out.”
She went so far as to get a job where he worked, the Durham County tax department, only to find he had left a week before she started.
“God knows what was in my heart and what I planned on doing,” Melvin-Muse said. “God moved him out of that place before I got there.”
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Silence in Sikeston: Is There a Cure for Racism?
SIKESTON, Mo. — In the summer of 2021, Sikeston residents organized the biggest Juneteenth party in the city’s history. Sikeston police officers came too, both to provide security for the event and to try to build bridges with the community. But after decades of mistrust, some residents questioned their motives.
In the series finale of the podcast, a confident, outspoken Sikeston teenager shares her feelings in an uncommonly frank conversation with Chief James McMillen, head of Sikeston’s Department of Public Safety, which includes Sikeston police.
Host Cara Anthony asks what kind of systemic change is possible to reduce the burden of racism on the health of Black Americans. Health equity expert Gail Christopher says it starts with institutional leaders who recognize the problem, measure it, and take concrete steps to change things.
“It is a process, and it’s not enough to march and get a victory,” Christopher said. “We have to transform the systems of inequity in this country.”
Host Cara Anthony Midwest correspondent, KFF Health News @CaraRAnthony Read Cara's stories Cara is an Edward R. Murrow and National Association of Black Journalists award-winning reporter from East St. Louis, Illinois. Her work has appeared in The New York Times, Time magazine, NPR, and other outlets nationwide. Her reporting trip to the Missouri Bootheel in August 2020 launched the “Silence in Sikeston” project. She is a producer on the documentary and the podcast’s host. In Conversation With … Gail Christopher Public health leader and health equity expert click to open the transcript Transcript: Is There a Cure for Racism?Editor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.
[Ambient sounds from Sikeston, Missouri’s 2021 Juneteenth celebration — a DJ making an announcement over funky music, people chatting — begin playing.]
Cara Anthony: It’s 2021. It’s hot and humid. We’re at a park in the heart of Sunset — Sikeston, Missouri’s historically Black neighborhood.
Emory: Today is Juneteenth, baby.
Cara Anthony: The basketball courts are jumping. And old-school funk is blaring from the speakers. Kids are playing.
Cara Anthony: [Laughter] Are you enjoying the water?
Cara Anthony: People are lining up for barbecue.
I’ve been here reporting on the toll racism and violence can take on a community’s health. But today, I’m hoping to capture a little bit of Sikeston’s joy.
Taneshia Pulley: When I look out to the crowd of my people, I see strength. I see power. I just see all magic.
Cara Anthony: I drift over to a tent where people are getting their blood pressure, weight, and height checked … health screenings for free.
Cara Anthony: I’m a journalist.
Community Health Worker: Ooooh! Hi! Hi!
Cara Anthony: The ladies working the booth are excited I’m there to report on the event.
Cara Anthony: OK, and I’m a health journalist.
Community health worker: Baby, that’s what I told them. Yeah, she healthy. [Laughter]
[Dramatic instrumental music plays.]
Cara Anthony: This Juneteenth gathering is happening a little over a year after Sikeston police officers shot and killed 23-year-old Denzel Taylor.
We made a documentary about Denzel’s death and the death of another young Black man — also killed in Sikeston.
Denzel was shot by police. Nearly 80 years earlier, Cleo Wright was lynched by a white mob.
Both were killed before they got their day in court.
In these years of reporting, what I’ve found is that many Black families worry that their kids don’t have an equal chance of growing up healthy and safe in Sikeston.
[Dramatic instrumental ends.]
Rosemary Owens: Being Black in the Bootheel can get you killed at any age.
Cara Anthony: That’s Rosemary Owens. She raised her children here in Southeast Missouri.
Cara Anthony: About 10 Sikeston police officers showed up to Juneteenth — for security and to connect with the community. Some are in uniform; some are in plain clothes.
Rosemary has her doubts about why they came today.
Cara Anthony: You see the police chief talking to people. What’s going through your mind as you see them milling about?
Rosemary Owens: I hope they are real and wanting to close the gap between the African Americans and the white people.
Anybody can come out and shake hands. But at the end of the day, did you mean what you said? Because things are still going on here in Sikeston, Missouri.
Cara Anthony: For Rosemary, this brings to mind an encounter with the police from years ago.
[Slow, minor, instrumental music plays softly.]
When her son was maybe 16 years old, she says, she and her sister gave their boys the keys to their new cars — told them they could hang out in them.
Rosemary had gotten her new car for Mother’s Day.
Rosemary Owens: A brand-new red Dodge Caravan. We, we knew the boys were just going from the van to the car. You know, just showing out — they were boys. They weren’t driving.
Cara Anthony: Someone nearby saw the boys …
Rosemary Owens: … called and told the police that two Black men were robbing cars.
When the boys saw the police come up, there was three police cars. So they were like, something’s going on. So their intention, they were like, they were trying to run to us. And my brother said, stop. When they looked back, when the police got out of the car, they already had their guns drawn on my son and my nephew. Cara Anthony: That’s what Rosemary thinks about when she sees Sikeston police at Juneteenth.
[Slow, minor, instrumental music ends.]
[“Silence in Sikeston” theme song plays.] Cara Anthony: In this podcast series, we’ve talked about some of the ways racism makes Black people sick. But Juneteenth has me thinking about how we get free — how we STOP racism from making us sick.
The public health experts say it’s going to take systemwide, institutional change.
In this episode, we’re going to examine what that community-level change looks like — or at least what it looks like to make a start.
From WORLD Channel and KFF Health News, distributed by PRX, this is “Silence in Sikeston.”
Episode 4 is our final episode: “Is There a Cure for Racism?”
[“Silence in Sikeston” theme song ends.]
James McMillen: How you doing?
Juneteenth celebration attendee: Good. Good.
James McMillen: Good to see you, man.
Juneteenth celebration attendee: What’s up? How are you?
Cara Anthony: When I spot Sikeston’s director of public safety in his cowboy hat, sipping soda from a can, I head over to talk. James McMillen: Well, you know, I just, I, I’m glad to be … on the inside of this.
Cara Anthony: James McMillen leads the police department. He says he made it a point to come to Juneteenth. And he encouraged his officers to come, too.
James McMillen: I remember as being a young officer coming to work here, not knowing anybody, driving by a park and seeing several Black people out there. And I remember feeling, you know, somewhat intimidated by that. And I don’t really know why.
I hadn’t always been, um, that active in the community. And, um, I, I have been the last several years and I’m just wanting to teach officers to do the same thing.
Cara Anthony: The chief told me showing up was part of his department’s efforts to repair relations with Sikeston’s Black residents.
James McMillen: What’s important about this is, being out here and actually knowing people, I think it builds that trust that we need to have to prevent and solve crimes.
Cara Anthony: A few minutes into our conversation, I notice a teenager and her friend nearby, listening.
Cara Anthony: Yeah, we have two people who are watching us pretty closely. Come over here. Come over here. Tell us your names.
Lauren: My name is Lauren.
Michaiahes: My name is Michaiahes.
Cara Anthony: Yeah. And what are you all … ?
James McMillen: I saw you over there.
Cara Anthony: So, what do you think about all of this?
Michaiahes: Personally, I don’t even know who this is because I don’t mess with police because, because of what’s happened in the past with the police. But, um …
Cara Anthony: As she starts to trail off, I encourage her to keep going.
Cara Anthony: He’s right here. He’s in charge of all of those people.
Michaiahes: Well, in my opinion, y’all should start caring about the community more.
Cara Anthony: What are you hearing? She’s speaking from the heart here, Chief. What are you hearing?
James McMillen: Well, you know what? I agree with everything she said there.
Cara Anthony: She’s confident now, looking the chief in the eye.
Michaiahes: And let’s just be honest: Some of these police officers don’t even want to be here today. They’re just here to think they’re doing something for the community.
James McMillen: Let’s be honest. Some of these are assumptions that y’all are making about police that y’all don’t really know.
[Subtle propulsive music begins playing.]
Michaiahes: If we seen you protecting community, if we seen you doing what you supposed to do, then we wouldn’t have these assumptions about you.
James McMillen: I just want to say that people are individuals. We have supervisors that try to keep them to hold a standard. And you shouldn’t judge the whole department, but, but just don’t judge the whole department off of a few. No more than I should judge the whole community off of a few.
Cara Anthony: But here’s the thing … in our conversations over the years, Chief McMillen has been candid with me about how, as a rookie cop, he had judged Sikeston’s Black residents based on interactions with just a few.
James McMillen: Some of, um, my first calls in the Black community were dealing with, obviously, criminals, you know? So if first impressions mean anything, that one set a bad one. I had, um, really unfairly judging the whole community based on the few interactions that I had, again, with majority of criminals.
Cara Anthony: The chief says he’s moved past that way of thinking and he’s trying to help his officers move past their assumptions.
And he told me about other things he wants to do …
Hire more Black officers. Invest in racial-bias awareness education for the department. And open up more lines of communication with the community.
James McMillen: I know that we are not going to see progress or we’re not going to see success without a little bit of pain and discomfort on our part.
Cara Anthony: I don’t think I’ve ever heard the chief use the term institutional change, but the promises and the plans he’s making sound like steps in that direction.
Except … here’s something else the chief says he wants …
[Subtle propulsive music ends with a flourish.]
James McMillen: As a police officer, I would like to hear more people talk about, um, just complying with the officer.
Cara Anthony: That phrase is chilling to me.
[Quiet, dark music starts playing.]
When I hear “just comply” … a litany of names cross my mind.
Philando Castile.
Sonya Massey.
Tyre Nichols.
Cara Anthony: After Denzel Taylor was killed, people felt unsafe. I talked to a lot of residents on the record about them feeling like they didn’t know if they could be next.
One thing that you told me was, like, well, one thing that people can do is comply with the officers, you know, if they find themselves having an interaction with law enforcement.
James McMillen: Well, I mean, I think that’s, that’s a good idea to do.
And if the person is not complying, that officer has got to be thinking, is this person trying to hurt me? So, asking people to comply with the officer’s command — that’s a reasonable statement.
Cara Anthony: But, it’s well documented: Black Americans are more likely than our white peers to be perceived as dangerous by police.
That perception increases the chances we’ll be the victim of deadly force. Whether we comply — or not.
[Quiet, dark music ends.]
That’s all to say … even with the promise of more Black officers in Sikeston and all the chief’s other plans, I’m not sure institutional change in policing is coming soon to Sikeston.
[Sparse electronic music starts playing.]
Cara Anthony: I took that worry to Gail Christopher. She has spent her long career trying to address the causes of institutional racism.
Cara Anthony: We’ve been calling most of our guests by their first name, but what’s your preference? I don’t want to get in trouble with my mom on this, you know? [Cara laughs.]
Gail Christopher: If you don’t mind, Dr. Christopher is good.
Cara Anthony: OK. All right. That sounds good. I’m glad I asked.
Cara Anthony: Dr. Christopher thinks a lot about the connections between race and health. And she’s executive director of the National Collaborative for Health Equity. Her nonprofit designs strategies for social change.
She says the way to think about starting to fix structural racism … is to think about the future.
Gail Christopher: What do you want for your daughter? What do I want for my children? I want them not to have interactions with the police, No. 1, right?
Uh, so I want them to have safe places to be, to play, to be educated … equal access to the opportunity to be healthy.
Cara Anthony: But I wonder if that future is even possible.
[Sparse electronic music ends.]
Cara Anthony: Is there a cure for racism? And I know it’s not that simple, but is there a cure?
Gail Christopher: I love the question, right? And my answer to you would be yes. It is a process, and it’s not enough to march and get a victory. We have to transform the systems of inequity in this country.
Cara Anthony: And Dr. Christopher says it is possible. Because racism is a belief system.
[Hopeful instrumental music plays.]
Gail Christopher: There is a methodology that’s grounded in psychological research and social science for altering our beliefs and subsequently altering our behaviors that are driven by those beliefs.
Cara Anthony: To get there, she says, institutions need a rigorous commitment to look closely at what they are doing — and the outcomes they’re creating.
Gail Christopher: Data tracking and monitoring and being accountable for what’s going on.
We can’t solve a problem if we don’t admit that it exists.
Cara Anthony: One of her favorite examples of what it looks like to make a start toward systemic change comes from the health care world.
I know we’ve been talking about policing so far, but — bear with me here — we’re going to pivot to another way institutional bias kills people.
A few years ago, a team of researchers at the Brigham and Women’s Hospital in Boston reviewed admission records for patients with heart failure. They found that Black and Latinx people were less likely than white patients to be admitted to specialized cardiology units.
Gail Christopher: Without calling people racist, they saw the absolute data that showed that, wait a minute, we’re sending the white people to get the specialty care and we’re not sending the people of color.
Cara Anthony: So, Brigham and Women’s launched a pilot program.
When a doctor requests a bed for a Black or Latinx patient with heart failure, the computer system notifies them that, historically, Black and Latinx patients haven’t had equal access to specialty care.
The computer system then recommends the patient be admitted to the cardiology unit. It’s still up to the doctor to actually do that.
The hard data’s not published yet, but we checked in with the hospital, and they say the program seems to be making a difference.
Gail Christopher: It starts with leadership. Someone in that system has the authority and makes the decision to hold themselves accountable for new results.
[Hopeful instrumental music ends.]
Cara Anthony: OK, so it could be working at a hospital. Let’s shift back to policing now.
Gail Christopher: There should be an accountability board in that community, a citizens’ accountability board, where they are setting measurable and achievable goals and they are holding that police department accountable for achieving those goals.
Cara Anthony: But, like, do Black people have to participate in this? Because we’re tired.
Gail Christopher: Listen, do I know that we’re tired! Am I tired? After 50 years? Uh, I think that there is work that all people have to do. This business of learning to see ourselves in one another, to be fully human — it’s all of our work.
[Warm, optimistic instrumental music plays.]
Now, does that preclude checking out at times and taking care of yourself? I can’t tell you how many people my age who are no longer alive today, who were my colleagues and friends in the movement. But they died prematurely because of this lack of permission to take care of ourselves.
Cara Anthony: Rest when you need to, she says, but keep going.
Gail Christopher: We have to do that because it is our injury. It is our pain. And I think we have the stamina and the desire to see it change.
Cara Anthony: Yep. Heard. It’s all of our work.
Dr. Christopher has me thinking about all the Black people in Sikeston who aren’t sitting around waiting for someone else to change the institutions that are hurting them.
People protested when Denzel Taylor was killed even with all the pressure to stay quiet about it.
Protesters: Justice for Denzel on 3. 1, 2, 3 … Justice for Denzel! Again! 1, 2, 3 … Justice for Denzel!
Cara Anthony: And I’m thinking about the people who were living in the Sunset neighborhood of Sikeston in 1942 when Cleo Wright was lynched.
Harry Howard: They picked up rocks and bricks and crowbars and just anything to protect our community.
Cara Anthony: And Sunset did not burn.
[Warm, optimistic instrumental music begins fading out.]
[Piano starts warming up.]
Cara Anthony: After nearly 80 years of mostly staying quiet about Cleo’s lynching, Sikeston residents organized a service to mark what happened to him — and their community.
Reverend: We are so honored and humbled to be the host church this evening for the remembrance and reconciliation service of Mr. Cleo Wright.
[Piano plays along with Pershard singing.]
Pershard Owens: [Singing] It’s been a long, long time coming, but I know a change gonna come, oh yes it will. It’s been too hard a-livin but I’m afraid to die and I don’t know what’s up next, beyond the sky …
[Pershard singing and piano accompaniment fade out.]
Cara Anthony: I want to introduce you to that guy who was just singing then. His name is Pershard Owens.
Remember Rosemary Owens? The woman who told us about someone calling the police on her son and nephew when they were playing with their parents’ new cars? Pershard is Rosemary’s younger son.
Pershard Owens: Yeah, I definitely remember that.
Cara Anthony: Even after all this time, other people didn’t want to talk to us about it. We couldn’t find news coverage of the incident. But Pershard remembers. He was in his weekly karate practice when it happened. He was 10 or 11 years old.
Pershard Owens: My brother and cousin were, like, they were teens. So what do you think people are going to feel about the police when they do that, no questions asked, just guns drawn?
Cara Anthony: Pershard’s dad works as a police officer on a different police force in the Bootheel. Pershard knows police. But that didn’t make it any less scary for him.
Pershard Owens: You know, my parents still had to sit us down and talk and be like, “Hey, this is, that’s not OK, but you can’t, you can’t be a victim. You can’t be upset.” That’s how I was taught. So we acknowledge the past. But we don’t, we don’t stay down.
Cara Anthony: So years later, when Chief James McMillen started a program as a more formal way for people in Sikeston and the police to build better relationships, Pershard signed up. They started meeting in 2020.
The group is called Police and Community Together, or PACT for short.
[Sparse, tentative music begins playing.]
Pershard Owens: It was a little tense that first couple of meetings because nobody knew what it was going to be.
Cara Anthony: This was only five months after Sikeston police killed Denzel Taylor.
PACT is not a citizens’ accountability board. The police don’t have to answer to it.
The committee met every month. For a while. But they haven’t met in over a year now.
Pershard Owens: We would have steps forward and then we would have three steps back.
Cara Anthony: People have different accounts for why that is. Busy schedules. Mutual suspicion. Other things police officers have done that shook the trust of Black residents in Sikeston.
Pershard Owens: And people were like, bro, like, how can you work with these people?
The community is like, I can’t fully get behind it because I know what you did to my little cousin and them. Like, I know what the department did back in, you know, 15 years ago, and it’s hard to get past that.
So, I mean, I’m getting both sides, like, constantly, and listen, that is, that is tough.
[Sparse, tentative music ends.]
Cara Anthony: But Pershard says something important changed because he started working with PACT.
Pershard Owens: Chief did not like me at first [Pershard laughs]. He did not.
Chief didn’t … me and Chief did not see eye to eye. Because he had heard things about me and he — people had told him that I was, I was anti-police and hated police officers, and he came in with a defense up.
So, it took a minute for me and him to, like, start seeing each other in a different way. But it all happened when we sat down and had a conversation.
[Slow instrumental music begins playing.]
Cara Anthony: Just have a conversation. It sounds so simple; you’re probably rolling your eyes right now hearing it.
But Pershard says … it could be meaningful.
Pershard Owens: I truly want and believe that we can be together and we can work together and we can have a positive relationship where you see police and y’all dap each other up and y’all legit mean it. I think that can happen, but a lot of people have to change their mindsets.
Cara Anthony: That’s a challenge Pershard is offering to police AND community members: Have a conversation with someone different from you. See if that changes the way you think about the person you’re talking to. See if it changes your beliefs.
The more people do that, the more systems can change.
Pershard Owens: We got to look in the mirror and say, “Am I doing what I can to try and change the dynamic of Sikeston, even if it does hurt?”
Cara Anthony: Pershard says he’s going to keep putting himself out there. He ran for City Council in 2021. And even though he lost, he says he doesn’t regret it.
Pershard Owens: When you’re dealing with a place like Sikeston, it’s not going to change overnight.
Cara Anthony: And he’s glad he worked with PACT. Even if the community dialogue has fizzled for now, he’s pleased with the new relationship he built with Chief McMillen. And all of this has broadened his view of what kind of change is possible.
[Slow instrumental music ends.]
Pershard Owens: If you want something that has never been done, you have to go places that you’ve never been.
[“Silence in Sikeston” theme music plays.]
Cara Anthony: Places that you’ve never been … stories that you’ve never told out loud … maybe all of that helps build a Sikeston where Black residents can feel safer. Where Black people can live healthier lives.
A world you might not be able to imagine yet, but one that could exist for the next generation.
[“Silence in Sikeston” theme music ends.]
[Upbeat instrumental music plays.]
Cara Anthony: Thanks for listening to “Silence in Sikeston.”
Next, go watch the documentary — it’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD.
Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special.
If you made it this far, thank you. Let me know how you’re feeling.
I’d love to hear more about the conversations this podcast has sparked in your life. Leave us a voicemail at (202) 654-1366.
And thanks to everyone in Sikeston for sharing your stories with us.
This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX.
It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation.
This audio series was reported and hosted by me, Cara Anthony.
Audio production by me, Zach Dyer. And me, Taylor Cook.
Editing by me, Simone Popperl.
And me, managing editor Taunya English.
Sound design, mixing, and original music by me, Lonnie Ro.
Podcast art design by Colin Mahoney and Tania Castro-Daunais.
Tarena Lofton and Hannah Norman are engagement and social media producers for the show.
Oona Zenda and Lydia Zuraw are the landing page designers.
Lynne Shallcross is the photo editor, with photography from Michael B. Thomas.
Thank you to vocal coach Viki Merrick.
And thank you to my parents for all their support over the four years of this project.
Music in this episode is from Epidemic Sound and Blue Dot Sessions.
Some of the audio you heard across the podcast is also in the film.
For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin.
Kyra Darnton is executive producer at Retro Report.
I was a producer on the film.
Jill Rosenbaum directed the documentary.
Kytja Weir is national editor at KFF Health News.
WORLD Channel’s editor-in-chief and executive producer is Chris Hastings.
Help us get the word out about “Silence in Sikeston.” Write a review or give us a quick rating wherever you listen to this podcast.
Thank you! It makes a difference.
Oh yeah! And tell your friends in real life too!
[Upbeat instrumental music ends.]
Credits
Taunya English Managing editor @TaunyaEnglish Taunya is deputy managing editor for broadcast at KFF Health News, where she leads enterprise audio projects. Simone Popperl Line editor @simoneppprl Simone is broadcast editor at KFF Health News, where she shapes stories that air on Marketplace, NPR, and CBS News Radio, and she co-manages a national reporting collaborative. Zach Dyer Senior producer @zkdyer Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production. Taylor Cook Associate producer @taylormcook7 Taylor is an independent producer who does research, books guests, contributes writing, and fact-checks episodes for several KFF Health News podcasts. Lonnie Ro Sound designer Lonnie Ro is an audio engineer and a composer who brings audio stories to life through original music and expert sound design for platforms like Spotify, Audible, and KFF Health News.Additional Newsroom Support
Lynne Shallcross, photo editorOona Zenda, illustrator and web producerLydia Zuraw, web producerTarena Lofton, audience engagement producer Hannah Norman, video producer and visual reporter Chaseedaw Giles, audience engagement editor and digital strategistKytja Weir, national editor Mary Agnes Carey, managing editor Alex Wayne, executive editorDavid Rousseau, publisher Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chief Tammie Smith, communications officer
The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.
Watch the accompanying documentary from WORLD, Retro Report, and KFF here.
To hear other KFF Health News podcasts, click here.
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.
USE OUR CONTENTThis story can be republished for free (details).
Even Political Rivals Agree That Medical Debt Is an Urgent Issue
While hot-button health care issues such as abortion and the Affordable Care Act roil the presidential race, Democrats and Republicans in statehouses around the country have been quietly working together to tackle the nation’s medical debt crisis.
New laws to curb aggressive hospital billing, to expand charity care for lower-income patients, and to rein in debt collectors have been enacted in more than 20 states since 2021.
Democrats championed most measures. But the legislative efforts often passed with Republican support. In a few states, GOP lawmakers led the push to expand patient protections.
“Regardless of their party, regardless of their background … any significant medical procedure can place people into bankruptcy,” Florida House Speaker Paul Renner, a conservative Republican, said in an interview. “This is a real issue.”
Renner, who has shepherded controversial measures to curb abortion rights and expand the death penalty in Florida, this year also led an effort to limit when hospitals could send patients to collections. It garnered unanimous support in the Florida Legislature.
Bipartisan measures in other states have gone further, barring unpaid medical bills from consumer credit reports and restricting medical providers from placing liens on patients’ homes.
About 100 million people in the U.S. are burdened by some form of health care debt, forcing millions to drain savings, take out second mortgages, or cut back on food and other essentials, KFF Health News has found. A quarter of those with debt owed more than $5,000 in 2022.
“Republicans in the legislature seem more open to protecting people from medical debt than from other kinds of debt,” said Marceline White, executive director of Economic Action Maryland, which helped lead efforts in that state to stop medical providers from garnishing the wages of low-income patients. That bill drew unanimous support from Democrats and Republicans
“There seems to be broad agreement that you shouldn’t lose your home or your life savings because you got ill,” White said. “That’s just a basic level of fairness.”
Medical debt remains a more polarizing issue in Washington, where the Biden administration has pushed several efforts to tackle the issue, including a proposed rule by the Consumer Financial Protection Bureau, or CFPB, to bar all medical debt from consumer credit reports.
Vice President Kamala Harris, who is spearheading the administration’s medical debt campaign, has touted the work on the presidential campaign trail while calling for new efforts to retire health care debt for millions of Americans.
Former President Donald Trump doesn’t typically talk about medical debt while stumping. But congressional Republicans have blasted the CFPB proposal, which House Financial Services Committee Chairman Patrick McHenry (R-N.C.) called “regulatory overreach.”
Nevertheless, pollster Michael Perry, who has surveyed Americans extensively about health care, said that conservative voters typically wary of government seem to view medical debt through another lens. “I think they feel it’s so stacked against them that they, as patients, don’t really have a voice,” he said. “The partisan divides we normally see just aren’t there.”
When Arizona consumer advocates put a measure on the ballot in 2022 to cap interest rates on medical debt, 72% of voters backed the initiative.
Similarly, nationwide polls have found more than 80% of Republicans and Democrats back limits on medical debt collections and stronger requirements that hospitals provide financial aid to patients.
Perry surfaced something else that may be driving bipartisan interest in medical debt: growing mistrust as health systems get bigger and act more like major corporations. “Hospitals aren’t what they used to be,” he said. “That is making it clear that profit and greed are driving lots of the decision-making.”
Not every state effort to address medical debt has garnered broad bipartisan support.
When Colorado last year became the first state to bar medical debt from residents’ credit reports, just one Republican lawmaker backed the measure. A Minnesota bill that did the same thing this year passed without a single GOP vote.
But elsewhere, similarly tough measures have sailed through.
A 2024 Illinois bill to bar credit reporting for medical debt passed unanimously in the state Senate and cleared the House of Representatives 109-2. In Rhode Island, not a single GOP lawmaker opposed a credit reporting ban.
And when the California Legislature took up a 2021 bill to require hospitals in the state to provide more financial assistance to patients, it passed 72-0 in the state Assembly and 39-0 in the Senate.
Even some conservative states, such as Oklahoma, have taken steps, albeit more modest. A new law there bars medical providers from pursuing patients for debts if the provider has not publicly posted its prices. The measure, signed by the state’s Republican governor, passed unanimously.
New Mexico state Sen. Steve Neville, a Republican who backed legislation to restrict aggressive collections against low-income patients in that state, said he was simply being pragmatic.
“There was not much advantage to spending a lot of time trying to do collections on indigent patients,” Neville said. “If they don’t have the money, they don’t have the money.” Three of 12 GOP senators supported the measure.
North Carolina state Treasurer Dale Folwell, a Republican who as a state legislator spearheaded a 2012 effort to ban same-sex marriage, said all elected officials, no matter their party, should care about what medical debt is doing to patients.
“It doesn’t matter if, as a conservative, I’m saying these things, or if Bernie Sanders is saying these things,” Folwell said, referencing Vermont’s liberal U.S. senator. “At the end of the day, it should be all our jobs to advocate for the invisible.”
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.
USE OUR CONTENTThis story can be republished for free (details).
Catholic Hospital Offered Bucket, Towels to Woman It Denied an Abortion, California AG Said
When Anna Nusslock showed up at her local hospital 15 weeks pregnant and in severe pain earlier this year, she said, a doctor delivered devastating news: The twins she and her husband had so desperately wanted were not viable. Further, her own health was in danger, and she needed an emergency abortion to prevent hemorrhaging and infection.
Providence St. Joseph Hospital, in the small Northern California coastal city of Eureka, refused to provide the care she required because doctors could detect fetal “heart tones,” Nusslock said at a news conference Monday. California Attorney General Rob Bonta filed a lawsuit against the Catholic hospital detailing Nusslock’s dangerous experience and alleging the hospital violated multiple state laws when it discharged Nusslock — with an offer of a bucket and towels — to go elsewhere for what he described as standard medical care.
Bonta also filed a motion for a preliminary injunction in Humboldt County Superior Court, asking that it require Providence to treat anyone with an emergency medical condition. “The need for immediate relief is about to intensify,” the motion said. That’s because Mad River Community Hospital, where Nusslock ultimately got care 12 miles up the road, is slated to close its birth center this month.
Providence will be the only hospital within about 85 miles to offer labor and delivery, according to a KFF Health News analysis. When care is more than an hour away, academic researchers typically define the area as a hospital desert.
“It begs the question, what happens next time someone in Anna’s situation shows up at Providence? There will be no Mad River for them to go to,” Bonta said at a news conference. “With a dire lack of services, even here in California, and an influx of patients from states with abortion bans, we need hospitals to follow the law.”
The case illustrates how even in California, where the right to an abortion is enshrined in state law, there’s a glaring loophole. Catholic hospitals, which restrict reproductive health care because they follow the church’s “Ethical and Religious Directives,” are aggressively expanding nationally by acquiring secular hospitals. In swaths of the country, including parts of Northern California, they are the only choice. At the same time, maternity wards are closing rapidly, leaving more patients to contend with religious directives instead of accepted medical standards.
California’s lawsuit also comes amid uncertainty that emerged after the Supreme Court in 2022 overturned the constitutional right to an abortion: whether federal law requires hospitals to provide abortions as emergency medical care even in states that have banned the procedure. The high court punted on the question this summer. The Biden administration reaffirmed its policy that the Emergency Medical Treatment and Labor Act requires hospitals to stabilize or treat any patient who shows up at an emergency room. Texas is suing the administration over the policy.
The issue is also playing out in the presidential election. During the Oct. 1 vice presidential debate, Democratic Minnesota Gov. Tim Walz noted a Georgia woman who died because a hospital delayed care. Sen. JD Vance (R-Ohio) answered, in part, by asking Walz if he wanted to force Catholic hospitals to perform abortions against their religious beliefs, saying that “Kamala Harris has supported suing Catholic nuns.”
With federal protections in limbo, Bonta said California must rely on its state laws to protect patients. Specifically, Bonta, who is widely expected to run for governor, alleges that Providence violated a California law mandating that hospitals provide care “necessary to relieve or eliminate the emergency medical condition.”
Nusslock’s case isn’t an isolated incident, the lawsuit said. “One to two women per year receive abortion care at Mad River, after being refused care at Providence Hospital,” the lawsuit said. "These individuals, like Anna Nusslock, had all been discharged from Providence Hospital with instructions to go somewhere else." Bonta said his office is investigating how widespread cases are in California, where Catholic hospitals represent 15% of hospital beds.
In an Oct. 1 letter to employees that was obtained by KFF Health News, Providence Northern California Service Area Chief Executive Garry Olney said the hospital is “heartbroken” about Nusslock’s experience, which “did not meet our high standards for safe, quality, compassionate care.” He added the hospital is revisiting its training, education, and escalation processes to ensure it doesn’t happen again.
Providence spokesperson Bryan Kawasaki said its 51 hospitals abide by applicable federal and state laws, including EMTALA. Kawasaki declined to comment specifically on Nusslock’s case.
More women are running into barriers to obtaining care as Catholic health systems have gained market power, a KFF Health News investigation found. Four of the 10 largest hospital chains by number of beds are Catholic, according to federal data from the Agency for Healthcare Research and Quality.
Many Americans don’t have a choice — ambulances may take patients to a Catholic-run health system without giving them a say. Non-Catholic hospitals could be out of their insurance networks or too far to reach in an emergency. In the U.S, nearly 800,000 people have only Catholic or Catholic-affiliated birth hospitals within an hour’s drive, including pockets of Northern California.
Pregnant women who must drive farther to a delivery facility are at higher risk of harm to themselves or their fetus, research shows.
“It's really concerning, especially in a state like California, where people expect to have comprehensive access to care,” said Debra Stulberg, a family medicine physician at the University of Chicago. “The growth of Catholic hospitals, especially in this post-Dobbs era, continues to constrain the quality of care people get.”
The directives guiding care at Catholic-based health systems are issued by the U.S. Conference of Catholic Bishops. They state that abortions are “intrinsically evil” and “never permitted.”
The document does offer this guidance as an exception: Treatments that could cure “a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.”
“The church, I would say, helps Catholic hospitals to apply some of our deepest beliefs and moral principles to very, very complex situations,” said John Brehany, executive vice president of The National Catholic Bioethics Center, an ethics authority for Catholic health institutions. “And one of those beliefs is that you can never directly intend to end the life of a developing human being."
Brehany wouldn’t comment on Nusslock’s case but gave the example that if a woman needed cancer treatment, the church would allow her to proceed with the treatment even if it “results in the death of an unborn child.” He added that some situations are “more debatable” than others.
As Catholic-based systems have consolidated and acquired more medical facilities, their care denials have been compounded by other hospitals closing their labor and delivery wards at alarming rates across the country. In California, 56 hospitals have shuttered their maternity wards in the past 12 years, according to an investigation by CalMatters. Nationwide, at least 267 hospitals closed labor and delivery units between 2011 and 2021, representing about 5% of the country’s hospitals, according to Chartis, a health analytics and consulting firm.
With each closure, patients could lose options for abortion care, contraceptives, tubal ligations, and gender-affirming care, said Mona Shah, senior policy and strategy director with Community Catalyst, a national health equity organization.
Nusslock’s 12-mile trip for care at Mad River cost her, according to the lawsuit and her public statement. She had passed an “apple-sized blood clot” and was hemorrhaging in “blinding pain,” she said, by the time she reached the operating room. In the lawsuit, Nusslock said her doctor told her later that her test results showed she most likely had an infection.
It’s a trip Bonta described as “patient dumping” and one Nusslock should never have made.
Seven months later, Nusslock said, she has trouble sleeping, recalling how Providence sent her away.
“I’ll never forget looking at my doctor, tears streaming down my face, my heart shattered into a million pieces, and just pleading with her, ‘Don’t let me die,’” she said.
KFF Health News data editor Holly K. Hacker contributed to this article.
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.
USE OUR CONTENTThis story can be republished for free (details).
On the Campaign Trail, Democrats Call Out Opponents on Abortion
As Nov. 5 approaches and the struggle for control of the U.S. House reaches a fever pitch, Democrats are doing everything they can to tie their Republican opponents to their antiabortion voting records. Some Republican candidates, meanwhile, seem to be softening their positions. And political analysts say it’s part of a larger trend playing out nationwide, up and down the ballot.
“The politics of abortion and reproductive health can get voters to participate at higher rates,” said David McCuan, a political science professor at Sonoma State University. “Republicans have to moderate their stance if they’re going to be in the battle.”
After all, polls show most voters support restoring abortion rights overturned in 2022 by the Supreme Court. Aggressive ads are going up in competitive districts where Democrats see an opportunity to take control of the House by engaging voters who might not vote straight-ticket — or at all.
In New York, Democrat Josh Riley blasted Republican incumbent Marcus J. Molinaro in a 30-second ad for voting against abortion rights 13 times. Next door in New Jersey, Democratic hopeful Sue Altman called out Republican opponent Tom Kean Jr. for a “secret antiabortion agenda.” And in California, Democrat Will Rollins denounced Republican rival “Ken Calvert and MAGA extremists” for backing a national abortion ban.
Meanwhile, in March, shortly after her primary, Rep. Michelle Steel (R-Calif.) removed her support for a blanket abortion ban — the Life at Conception Act — saying it could create confusion because the bill could threaten in vitro fertilization. Following news reports about her reversal, the Orange County-area Republican released an ad in which she shared that she had used IVF and reiterated her support for the procedure.
On the campaign trail, Steel has said she supports exceptions to abortion bans in cases of rape, incest, and in which the mother’s health or life is at risk, a departure from bills she previously supported.
“What we all need to do is to make sure we look at her record, and that record is contrary to what she’s putting out there in her ads,” Steel’s Democratic challenger, Derek Tran, told me.
The Steel and Calvert campaigns told KFF Health News that their candidates oppose a national abortion ban. Calvert, who last backed a 20-week abortion ban in 2017, issued a statement saying the issue is best left to states.
Tim Rosales, a political strategist who has represented Republican candidates, said incumbents shouldn’t get heat for changing their minds over time.
Meanwhile, Rolling Stone reported in March that Rep. Don Bacon (R-Neb.) had deleted antiabortion endorsements from his website. Arizona Republican incumbent Rep. David Schweikert said he opposed a state abortion ban, even though he had co-sponsored a national ban six times.
And vice-presidential candidate JD Vance removed his antiabortion stance from his website the month former president Donald Trump selected him as his running mate.
This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.
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.
USE OUR CONTENTThis story can be republished for free (details).
Trump Leads, and His Party Follows, on Vaccine Skepticism
More than four years ago, former President Donald Trump’s administration accelerated the development and rollout of the covid-19 vaccine. The project, dubbed Operation Warp Speed, likely saved millions of lives. But a substantial number of Republican voters now identify as vaccine skeptics — and Trump rarely mentions what’s considered one of the great public health accomplishments in recent memory.
“The Republicans don’t want to claim it,” Trump told an interviewer in late September.
Instead, on at least 17 occasions this year, Trump has promised to cut funding to schools that mandate vaccines. Campaign spokespeople have previously said that pledge would apply only to schools with covid mandates. But speeches reviewed by KFF Health News included no such distinction — raising the possibility Trump would also target vaccination rules for common, potentially lethal childhood diseases like polio and measles.
The Trump campaign did not respond to requests for comment on this article.
Trump has presided over a landslide shift in his party’s views on vaccines, reflected this campaign season in false claims by Republican candidates during the primaries and puzzling conspiracies from prominent conservative voices. Republicans increasingly express worry about the risks of vaccines. A September 2023 poll from Politico and Morning Consult showed a narrow majority of those voters cared more about the risks than the benefits of getting inoculated.
A surge in anti-vaccine policy in statehouses has followed the rhetoric. Boston University political scientist Matt Motta, who tracks public health policy, said preliminary data shows that states enacted at least 42 anti-vaccine bills in 2023 — nearly a ninefold surge since 2019.
In some states, it has the look of a crusade: The 2024 Texas GOP platform, for example, proposes a ban on mRNA technology, the innovation behind some covid-19 vaccines that scientists believe could have significant applications for cancer care.
Last month, Trump made an appeal to anti-vaccine voters by landing the endorsement of Robert F. Kennedy Jr., one of the nation’s most prominent vaccine skeptics — and appointing him to his transition team. In a recent tour with former Fox News broadcaster Tucker Carlson, Kennedy said he was “going to be deeply involved in helping to choose the people who run FDA, NIH, and CDC.”
Trump’s outreach can be more discreet: He recently met with a delegation of vaccine-skeptical activists — including one group pushing an end to mandates and certain types of vaccines — at his New Jersey golf club; the discussion was publicized by the conservative blog “Gateway Pundit.”
Trump has options in advancing anti-vaccine goals as president, such as by sowing further doubt and undermining the federal government’s ability to make vaccine recommendations. He has promised to appoint Kennedy, along with “top experts,” to a panel exploring chronic diseases, some of which Kennedy’s nonprofit has linked to inoculations. “Nobody’s done more” to advocate for “the health of our families and our children,” Trump declared at a rally accepting Kennedy’s endorsement.
Still, it’s hard to tell how Trump’s most frequently made proposal — defunding schools that mandate vaccinations — would translate into action, said Judith Winston, former general counsel of the Department of Education during the Obama administration.
Currently, the Department of Education lacks the power to turn off public school funding all at once, she said — meaning a second Trump administration would have to take away money program by program.
And the legal basis for such a move isn’t clear. “I am unaware of any federal law that mandates school districts either provide or not provide a vaccine,” Winston said, adding it would probably require congressional action.
All 50 states have a vaccine requirement tied to school attendance.
Trump’s outreach to anti-vaccine constituencies comes as vaccine hesitancy increases and preventable disease surges. This summer, Oregon experienced its worst outbreak of measles since 1991.
The situation could get worse, said Tom Frieden, a former director of the Centers for Disease Control and Prevention: In the Nineties, during a time when vaccine skepticism also proliferated, the U.S. saw thousands of measles cases. According to the CDC, we haven’t yet returned to those bad old days — but the number of measles cases recorded this year is already quadruple that of last year.
“It was highly disruptive,” he said. “Many children who had measles ended up with hearing problems or cognitive problems that were lifelong. A small number died in this country.”
Worldwide, the disease killed over 100,000 in 2022, mostly among children under age 5, according to the World Health Organization.
Polling shows a substantial minority of Americans, concentrated in the Republican Party, hold vaccine-skeptical positions, said Harvard professor and health politics expert Robert Blendon. And skepticism about covid vaccines is blossoming into suspicion of vaccines generally among that group, he said. “It follows from this rebellion against the covid vaccine mandates.”
Vaccine opposition has divided the GOP. Florida Gov. Ron DeSantis made opposition to vaccines a core part of his ill-fated campaign for the GOP presidential nomination. In states such as Wyoming and Missouri, pitched primary campaigns centered on anti-vaccine themes this year.
Bob Onder, a physician and Republican candidate for Congress in Missouri, was accused in Facebook ads placed by his top opponent of taking millions from pharmaceutical companies to test vaccines. “He profited from our pain,” one ad said. “You suffered the consequences.”
Onder “has never done covid vaccine research” and opposes covid vaccine mandates, his campaign manager, Charley Lovett, told KFF Health News. (Lovett said Onder “conducted” one study sponsored by AstraZeneca on preventing covid in high-risk patients using monoclonal antibodies, not vaccines.)
Onder won the Republican primary, but his vaccine-disparaging opponent still scored just over 37% of the vote.
Anti-vaccine candidates typically become anti-vaccine policymakers. The impact can be seen in Texas, where vaccine politics were once a bipartisan matter. According to researchers, from 2009 to 2019, legislators there passed 19 pro-vaccine bills, such as a measure allowing pharmacists to administer immunizations.
But that consensus began to shift toward the end of the decade. Small groups, often nurtured on Facebook, made their influence felt. One such group, Texans for Vaccine Choice, spurred testimony before the state legislature in 2021 and targeted pro-immunization legislators, some of whom fell in their GOP primaries.
Misinformation has fueled the anti-vaccine turn in Texas, alongside traditional conservative attitudes about individual autonomy, said Summer Wise, a former executive committee member of the state’s Republican Party — particularly misconceptions about the use of fetal cells in vaccine development; falsified research about a link between vaccines and autism; and conspiracy theories about Bill Gates, the billionaire philanthropist who has championed vaccination.
“Politicians see vaccines as an easy foil to propagate fear among the electorate, which can then be leveraged and directed to control a voting bloc,” Wise said.
In addition to calling for a ban on mRNA technology, the Texas GOP’s 2024 platform features a laundry list of policies that could undermine vaccination, including allowing medical residents and physicians the ability to opt out of administering shots for religious reasons. It also calls for enshrining a patient’s ability to opt out of vaccine mandates in the state’s Bill of Rights.
Nationally, anti-immunization policies could take an aggressive turn under a second Trump administration.
Roger Severino, formerly head of the Department of Health and Human Services’ Office of Civil Rights and now with the Heritage Foundation, penned the health agency section of Project 2025, the Heritage Foundation-led initiative to plan for a Republican administration.
Among other ideas, the document proposes clipping CDC authority to issue vaccine or quarantine guidance of a “prescriptive” nature, targeted at schools or elsewhere.
A spokesperson for the Heritage Foundation noted Severino has said the agency’s credibility has been hurt, and it has a burden to explain “all the vaccines on the schedule being taken in combination.”
The proposal misunderstands CDC’s history and powers, said Lawrence Gostin, a public health law professor at Georgetown University. The agency “rarely if ever” makes binding recommendations, he said.
“When the next pandemic hits, we will look to CDC to offer guidance based on the best-known evidence,” he said. “We don’t want a disempowered agency in a public health emergency.”
Some Republican intellectuals have spun dystopian visions surrounding vaccines. Take “Dawn’s Early Light,” a yet-to-be-published book by Heritage president Kevin Roberts. The tome — which earned a glowing foreword by Republican vice presidential nominee JD Vance — reserves especially sharp words for vaccines.
In one section of the book, Roberts imagines that the federal government would somehow use alleged new capabilities to “deplatform drivers” of cars for “failing to follow the latest vaccine mandate.”
“Yet another powerful tool of social control falls into place,” he wrote.
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Here’s Why Getting a Covid Shot During Pregnancy Is Important
Nearly 90% of babies who had to be hospitalized with covid-19 had mothers who didn’t get the vaccine while they were pregnant, according to new data released by the Centers for Disease Control and Prevention. The findings appear in the agency’s Morbidity and Mortality Weekly Report.
Babies too young to be vaccinated had the highest covid hospitalization rate of any age group except people over 75.
The study looked at infant medical data from October 2022 to April 2024 in 12 states and underscores the critical importance of vaccinating pregnant people. It also echoes what physicians have anecdotally reported for more than three years — that people are still skeptical of covid vaccines due to persistent misinformation.
Of the 1,470 infants sick enough to be hospitalized due to covid, severe outcomes occurred “frequently,” according to the report. Excluding newborns hospitalized at birth, about 1 in 5 infants hospitalized with covid required intensive care, and nearly 1 in 20 required a ventilator.
“These aren’t necessarily high-risk, ill newborns. These are just regular, full-term, healthy newborn kids who happen to get covid and wind up on a ventilator in the hospital,” said Neil Silverman, a professor of clinical obstetrics and gynecology and the director of the Infectious Diseases in Pregnancy Program at the David Geffen School of Medicine at UCLA.
Babies can’t get the covid vaccination until they are at least 6 months old. That leaves a “huge window” when infants are most vulnerable, Silverman said. Vaccinating pregnant women so they pass the antibodies on to their newborns is an effective way of protecting babies during that time. Vaccination during pregnancy also protects pregnant people from severe disease.
But persistent vaccine misinformation online has led to skepticism among Silverman’s pregnant patients.
“The most frustrating response that I get from folks is that they need to do more research before they think about getting the covid vaccine,” Silverman said. “We have dozens and dozens of studies showing the safety of the mRNA vaccine. I don’t know how much more research we can provide to skeptics.”
Among the 1,000-plus babies hospitalized with covid, the median age was just 2 months old, according to the report. Nine of the infants died.
South Carolina pediatrician Deborah Greenhouse said she plans to share the study with families she cares for. “There absolutely is a proportion of the population who will look at this and say, ‘Hey, wow, I should get that vaccine. It could protect my baby,’” she said.
Greenhouse believes the new data could solidify the risk of skipping the vaccine when she speaks to families.
“I think that it might help to convince some parents when you can actually show them hospitalization numbers and you can show them intensive care numbers and you can show them mechanical ventilation numbers,” Greenhouse said. “Those things are a big deal.”
Often, Greenhouse waits to be informed that a person is pregnant before bringing up the updated covid shot. Now she’s rethinking that strategy. “As pediatricians we do get moms in our office who are pregnant and we have an opportunity to intervene and to do some education and make them understand how important this is,” she said.
Physicians can encourage vaccination by making it as easy and simple as possible, Silverman said. He encouraged fellow doctors to offer the shots in their offices, rather than sending patients to pharmacies or other providers.
“We lose probably 30 to 40% of vaccination opportunities once someone has to leave the office to get a vaccine,” Silverman said.
But offering covid shots in their clinics leaves some doctors with a difficult calculation. They are struggling to predict how many patients will be interested in the vaccine and may not be able to return all their excess doses. Many providers can’t afford to lose money on doses that won’t be used, but they still need to order enough to vaccinate vulnerable patients who want the shot.
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More Restrooms Have Adult-Size Changing Tables To Help People With Disabilities
ADAIR, Iowa — The blue-and-white highway sign for the eastbound rest stop near here displays more than the standard icon of a person in a wheelchair, indicating facilities are accessible to people who can’t walk. The sign also shows a person standing behind a horizontal rectangle, preparing to perform a task.
The second icon signals that this rest area along Interstate 80 in western Iowa has a bathroom equipped with a full-size changing table, making it an oasis for adults and older children who use diapers because of disabilities.
“It’s a beacon of hope,” said Nancy Baker Curtis, whose 9-year-old son, Charlie, has a disability that can leave him incontinent. “I’m like, ‘Oh my gosh, we’re finally there.’”
The white changing table is 6 feet long and can be lowered and raised with a handheld controller wired to an electric motor. When not in use, the table folds up against the wall.
The table was recently installed as part of a national effort to make public bathrooms more accessible in places like airports, parks, arenas, and gas stations. Without such options, people with disabilities often wind up being changed on bathroom floors, in cars, or even on the ground outside.
Many families hesitate to go out because of the lack of accessible restrooms. “We all know somebody who’s tethered to their home by bathroom needs,” Baker Curtis said. She doesn’t want her son’s life to be limited that way. “Charlie deserves to be out in the community.”
She said the need can be particularly acute when people are traveling in rural areas, where bathroom options are sparse.
Baker Curtis, who lives near Des Moines, leads the Iowa chapter of a national group called “Changing Spaces,” which advocates for adult-size changing tables. The group offers an online map showing scores of locations where they’ve been installed.
Advocates say such tables are not explicitly required by the federal Americans with Disabilities Act. But a new federal law will mandate them in many airports in coming years, and states can adopt building codes that call for them. California, for example, requires them in new or renovated auditoriums, arenas, amusement parks, and similar facilities with capacities of at least 2,500 people. Ohio requires them in some settings, including large public facilities and highway rest stops. Arizona, Illinois, Maryland, Minnesota, and New Hampshire also have taken steps to require them in some public buildings.
Justin Boatner of Arlington, Virginia, advocates for more full-size changing tables in the Washington, D.C., area. Boatner, 26, uses a wheelchair because of a disability similar to muscular dystrophy. He uses diapers, which he often changes himself.
He can lower an adjustable changing table to the height of his wheelchair, then pull himself onto it. Doing that is much easier and more hygienic than getting down on the floor, changing himself, and then crawling back into the wheelchair, he said.
Boatner said it’s important to talk about incontinence, even though it can be embarrassing. “There’s so much stigma around it,” he said.
He said adult changing tables are still scarce, including in health care facilities, but he’s optimistic that more will be installed. Without them, he sometimes delays changing his diaper for hours until he can get home. That has led to serious rashes, he said. “It’s extremely uncomfortable.”
Iowa legislators in recent years have considered requiring adult changing tables in some public restrooms. They declined to pass such a bill, but the discussion made Iowa Department of Transportation leaders aware of the problem. “I’m sorry to say, it was one of those things we’d just never thought of,” said Michael Kennerly, director of the department’s design bureau.
Kennerly oversees planning for rest stops. He recalls an Iowan telling him about changing a family member outside in the rain, with only an umbrella for shelter. Others told him how they changed their loved ones on bathroom floors. “It was just appalling,” he said.
Iowa began installing adult changing tables in rest stops in 2022, and it has committed to including them in new or remodeled facilities. So far, nine have been installed or are in the process of being added. Nine others are planned, with more to come, Kennerly said. Iowa has 38 rest areas equipped with bathrooms.
Kennerly estimated it costs up to $14,000 to remodel an existing rest-stop bathroom to include a height-adjustable adult changing table. Incorporating adult changing tables into a new rest stop building should cost less than that, he said.
Several organizations offer portable changing tables, which can be set up at public events. Some are included in mobile, accessible bathrooms carried on trailers or trucks. Most permanent adult changing tables are set up in “family restrooms,” which have one toilet and are open to people of any gender. That’s good, because the act of changing an adult is “very intimate and private,” Baker Curtis said. It’s also important for the tables to be height-adjustable because it’s difficult to lift an adult onto a fixed-height table, she said.
Advocates hope adult changing tables will become nearly as common as infant changing tables, which once were rare in public bathrooms.
Jennifer Corcoran, who lives near Dayton, Ohio, has been advocating for adult changing tables for a decade and has seen interest rise in recent years.
Corcoran’s 24-year-old son, Matthew, was born with brain development issues. He uses a wheelchair and is unable to speak, but he accompanies her when she lobbies for improved services.
Corcoran said Ohio leaders this year designated $4.4 million in federal pandemic relief money to be distributed as grants for changing-table projects. The program has led to installations at Dayton’s airport and art museum, plus libraries and entertainment venues, she said.
Ohio also is adding adult changing tables to rest stops. Corcoran said those tables are priceless because they make it easier for people with disabilities to travel. “Matthew hasn’t been on a vacation outside of Ohio for more than five years,” she said.
Kaylan Dunlap serves on a committee that has worked to add changing-table requirements to the International Building Code, which state and local officials often use as a model for their rules.
Dunlap, who lives in Alabama, works for an architecture firm and reviews building projects to ensure they comply with access standards. She expects more public agencies and companies will voluntarily install changing tables. Maybe someday they will be a routine part of public bathrooms, she said. “But I think that’s a long way out in the future, unfortunately.”
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Doctors Urging Conference Boycotts Over Abortion Bans Face Uphill Battle
Soon after the U.S. Supreme Court issued its Roe v. Wade abortion ruling in 1973, Laura Esserman used her high school graduation speech to urge her classmates to vote for the Equal Rights Amendment to expand women’s access to property, divorce, and abortion.
Five decades later, with 14 states banning abortion in almost all circumstances, the University of California-San Francisco breast cancer surgeon has once again taken up the fight for women’s reproductive rights. Since 2021, when Texas prohibited most abortions, she has boycotted the San Antonio Breast Cancer Symposium — a conference she had regularly attended, and frequently headlined, for 34 years.
“People are passing laws that are legislating what should be a medical decision,” she said. “And I am objecting in whatever way I can.”
Esserman and other physicians have urged their colleagues and medical societies to move all professional meetings out of states that criminalize abortion. Short of a move, they have called for boycotts of the events.
In November, Esserman expects 300 health providers and researchers to meet in San Francisco for an alternative breast cancer conference.
The effort to move annual conferences — which pump substantial revenue into local communities and attract many of the nation’s 1.1 million physicians and other medical professionals looking to network, satisfy continuing education requirements, and learn about the latest developments in their fields — has led to some notable relocations.
The American College of Obstetricians and Gynecologists moved its 2023 annual meeting and an estimated 4,000 participants from New Orleans to Maryland in response to Louisiana’s abortion ban. An estimated 3,600 health care professionals attended the American Association of Immunologists’ conference in Chicago this year, after the group moved the meeting from its planned Phoenix location in response to Arizona’s restrictive abortion law.
“In addition to causing great physical and psychological harm to patients,” the association said in a statement, abortion bans “threaten irreparable damage to the private and trusted relationship between medical professionals and their patients.”
Yet even doctors who agree about reproductive rights disagree about how to express dissent. Some argue it’s more important than ever to visit states where abortion has been outlawed, to learn about the issues surfacing because of the laws, and to help people organize against them.
“We cannot support penalizing communities that are already harmed by this legislation,” said obstetrician and gynecologist Jamila Perritt, president and CEO of Physicians for Reproductive Health. “As opposed to withdrawing support, what we’re calling for is actually flooding those folks with support.”
Physicians for Reproductive Health has been providing security for doctors targeted by anti-abortion activists, Perritt said, and training doctors to teach abortion care in abortion-restricting states and to testify to state legislatures about the need for abortion access.
“There is a lot to be gained by coming to these states, supporting us, seeing the reality, and bringing these conversations into your conference space so that you can better understand our reality, rather than just boycotting that state completely, which is not helpful,” said Bhavik Kumar, chief medical officer for Planned Parenthood of Greater Ohio and a medical director for Planned Parenthood Gulf Coast in Texas and Louisiana.
Since the Supreme Court’s 2022 decision to overturn Roe and eliminate a federal constitutional right to abortion, all but nine states and Washington, D.C., have imposed abortion restrictions, according to the Guttmacher Institute.
The San Antonio Breast Cancer Symposium continues to be held in Texas, where abortion is banned in almost all instances, and boycott calls do not appear to have slowed turnout. In fact, the number of in-person attendees increased from just under 8,000 in 2019 to 8,220 last year, organizers said.
Breast oncologist Virginia Kaklamani, a University of Texas Health Science Center-San Antonio professor of medicine who co-directs the San Antonio symposium, plans to stay in Texas. She doesn’t believe in boycotts, though she does share boycott proponents’ concerns. Despite exceptions, such as the American Association of Pro-Life Obstetricians and Gynecologists, doctors have by and large spoken against abortion restrictions.
“I think the way to handle it is to talk to our elected officials, to go out and vote. Moving meetings from one place to another is not going to help,” Kaklamani said. “You stay and you fight for your patients.”
Esserman recognizes that boycott calls have not had significant impact, but she feels compelled to keep applying pressure anyway.
She can’t help but think about a patient who recently came to her San Francisco practice nine weeks pregnant and with an aggressive breast cancer. If she were to continue the pregnancy, she would be ineligible for the most effective treatment. “Where I live, she has a choice,” Esserman said. In some states, she would have no choice but to carry the pregnancy to term.
Cary Gross, a Yale School of Medicine professor who co-authored a JAMA Internal Medicine opinion piece last year advocating boycotts, cited three arguments: expressing the profession’s values, acting as an ethical consumer, and protecting the health of attendees. Women physicians of childbearing age have voiced fears about traveling to anti-abortion states, especially while pregnant.
“The legislators passing these laws are probably not going to change their stance,” Gross said. “But for the general population, the more you can do to alert people, to remind people there’s another way, you have to make your voice heard.”
Still, Gross, Esserman, and others pushing for boycotts can point to no evidence that their efforts have changed hearts and minds, let alone laws.
Instead of moving the American Society of Hematology’s 2022 meeting out of New Orleans after Louisiana imposed a trigger law to ban abortion, Jane Winter, the society’s president at the time, met with Louisiana’s then-governor, John Bel Edwards, and told him about women whose survival might depend on getting an abortion. They talked about her 22-year-old patient who had Hodgkin lymphoma and learned she was pregnant just before a planned stem cell transplant.
“Gov. Edwards was visibly moved by our clinical cases and shared that lawmakers had not considered the impact of abortion restrictions on the care of our patients,” Winters wrote in a column for The Hematologist.
Last year, the hematologists held their meeting in San Diego, and they will meet again in California, which has no post-Roe abortion restrictions, in December.
In an email, Winter said her conversation with Edwards changed nothing concrete, as far as she knows. But she added, “I do believe that telling the stories of specific individuals – in my case, those of my patients – is one way to begin to change minds.”
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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Harris’ Emphasis on Maternal Health Care Is Paying Dividends With Black Women Voters
Vice President Kamala Harris is seeing a surge of support from Black women voters, galvanized in part by her work on health care issues such as maternal mortality, reproductive rights, and gun control.
The enthusiasm may be key for Democratic turnout at the polls in critical battleground states.
Black women have always been among the most reliable voters in the Democratic base and were central to former President Barack Obama’s victories in 2008 and 2012. Enthusiasm was also robust for President Joe Biden in 2020. But this year, before he bowed out of the race and Harris became the Democratic nominee, his support among this critical demographic had been fading, which could have dampened turnout in swing states.
Black voters’ support for the top of the Democratic ticket has since increased. In July, before he left the race, 64% of Black voters supported Biden, according to the Pew Research Center. Seventy-seven percent of Black voters supported Harris in August.
Black voter turnout, especially in rural areas of Georgia, North Carolina, and Pennsylvania, could help propel Harris to victory. That support — especially among Black women — has swelled since Biden’s departure, polling shows.
“This is a renaissance,” said Holli Holliday, a lawyer in the Washington, D.C., area who is president of Sisters Lead Sisters Vote, a group that works to advance Black women’s political leadership. “We’re partnering with a collective of Black women organizations to collaborate and collectively move like we never have before.”
Gun safety issues could especially resonate in Georgia, where both Harris and the Republican nominee, former President Donald Trump, are vying for the support of Black voters. A Sept. 4 shooting at Apalachee High School near Winder, Georgia, killed four people and left nine hospitalized with injuries, with scores more facing mental and emotional scars.
Eighty-two percent of Black women had a favorable view of Harris in August, according to the Pew Research Center, up from 67% in May.
And more Black women than before say they will go to the polls. Almost 70% of Black women said in August they were extremely or very motivated to vote, according to Pew, up from 51% in July. Sixteen million Black women in the U.S. are eligible to vote and 67% of them are registered, according to Higher Heights, a political action committee focused on mobilizing and electing Black women.
Trump has also sought support from Black women voters. His campaign released a video in August showcasing Black women pledging to support him over Harris, pointing to his economic policies as a key reason.
Still, only 8% of Black women voters say the Republican Party does a better job of looking out for their interests, according to a poll done in May and June by KFF, a health information nonprofit that includes KFF Health News.
Harris’ attention to health issues particularly important to Black women is helping to draw their support, said Kimberly Peeler-Allen, a co-founder of Higher Heights. In 2021, the vice president called for a more robust government response to the nation’s high maternal mortality rates.
The Centers for Disease Control and Prevention say Black women are three times as likely to die from pregnancy-related complications as white women. The disparity is driven in part by differing access to quality health care, underlying health conditions, bias, and racism.
“The vice president’s focus on Black maternal morbidity has gotten a lot of attention and gratitude,” Peeler-Allen said. “High-quality and affordable care, as well as the economy, are one of the top issues that drive Black women voters to get to the polls.”
As a senator, Harris co-sponsored a package of legislation aimed at improving maternal health, with a focus on Black women. The Biden administration pushed to expand maternal health initiatives in rural communities and improve bias training for health care providers, including by awarding more than $103 million in grants in 2023 to support and expand access to maternal health care.
Trump in 2018 signed legislation intended to reduce the maternal mortality rate that provided $58 million a year for five years to help states investigate and prevent pregnancy-related deaths.
As vice president, Harris also pushed states to extend postpartum care in Medicaid, the state-federal health program for low-income and disabled people. Biden signed legislation that temporarily gave states the option to expand the coverage to a full year from the required 60 days, with federal matching funds, and later signed a law allowing states to make the extended benefits permanent.
Illinois, New Jersey, and Virginia were the only states providing 12 months of postpartum Medicaid coverage when Harris became vice president. Today, the yearlong benefit has been adopted by at least 46 states and Washington, D.C., according to KFF.
“I am so thrilled out of my mind. I didn’t think we’d get there that quick,” said Rep. Robin Kelly (D-Ill.), who has helped lead congressional efforts to reduce mortality and morbidity among mothers and pregnant women, especially Black women. “It helps having everybody at the Senate, House, and White House working together. I am optimistic we are going to have someone at the top who gets it. We still have a ways to go.”
Harris’ support for measures to stem gun violence also helps her appeal to Black women. Harris said during her debate with Trump last month that she’s a gun owner. But she has pressed for banning what are often known as assault weapons and to implement universal background checks ahead of gun purchases — issues that may resonate in Georgia, especially, after the Apalachee shooting.
Eighty-four percent of Black women favor Harris on gun reform over Trump, according to a 2024 poll conducted for The Highland Project, a women-led coalition focused on creating multigenerational wealth in Black communities.
Trump’s campaign advisers have said he would protect access to guns by appointing federal judges who oppose restrictions. He has supported gun rights despite two apparent assassination attempts during the campaign, and as president in 2017 he reversed a controversial Obama administration regulation making it harder for people with mental health issues to purchase guns.
Win With Black Women, a network of Black women leaders, hosted a planning call with Black women the day Biden withdrew from the race. About 44,000 participants joined the meeting.
Waning enthusiasm for the Democratic ticket among Black women before Harris entered the race could have undermined turnout. And turnout matters: In the 2020 presidential race, seven states were won by less than three percentage points each.
“To have 44,000 black women on a phone call that Sunday night? That enthusiasm, that’s good for Democrats,” said Kelly Dittmar, research director at Rutgers’ Center for American Women and Politics. “If Democrats selected someone with less enthusiastic backing, a lot of women who supported Biden may have stayed home.”
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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How Minnesota Figures Into the Presidential Politics of Insulin Prices
In June 2019, Lija Greenseid handed Minnesota Gov. Tim Walz an empty vial of insulin that her 13-year-old daughter had painted gold.
Greenseid’s daughter has Type 1 diabetes, which means she requires daily injections of manufactured insulin to stay alive. The price of a single vial of insulin rose by about 1,200% between 1996 and 2018, and the gold vial was a reminder, Greenseid said, that this lifesaving pharmaceutical shouldn’t be as expensive as precious metal.
“What I heard is that that gold vial remained on his desk at the governor’s office, and he brought it up throughout that summer and fall when he was trying to talk to legislators to get them moving,” Greenseid said.
Ten months later, in April 2020, Walz signed the Alec Smith Insulin Affordability Act. The law was named after the 26-year-old Minnesotan whose 2017 death from rationing insulin became a catalyst for the patient advocates who turned the high cost of insulin in the U.S. into a national political priority.
Now it’s an issue in the presidential campaign. Both former President Donald Trump and Vice President Kamala Harris and her running mate, Walz, have sought to appeal to the nation’s 8.4 million insulin users and their families by touting policies that make insulin cheaper for some patients.
But advocates for diabetes patients fret that neither presidential candidate would go as far as Walz’s Minnesota law, which helps patients even if they are uninsured, despite the law being under legal attack by the drug industry.
The landscape on insulin pricing has already changed significantly in the past five years. One month after Walz signed the Minnesota law, the Trump administration announced a voluntary program for Medicare prescription drug plans to cap copayments for some insulin products at $35. Two years later, President Joe Biden signed a law requiring all Medicare drug plans to cap copayments for insulin at $35 a month.
Now, amid the current presidential campaign, Harris has proposed extending that $35 cap on insulin copayments to Americans with commercial health insurance.
The Trump campaign’s national press secretary, Karoline Leavitt, touted his efforts on prescription drug prices when he was in the White House, including approval of a pathway for prescription drugs to be imported from Canada as well as the voluntary $35 insulin Medicare copayment cap. But she did not offer new insulin-specific initiatives for his possible second stint as president.
“President Trump will finish what he started in his first term,” Leavitt wrote in a statement.
Copayment caps, which have been enacted by 25 states, are popular policies because they provide an immediate financial benefit that many patients see at the pharmacy, according to University of Southern California economist Neeraj Sood. They’re also relatively easy to implement.
But copayment caps don’t address the high list price of insulin itself, so uninsured patients don’t benefit from such rules. About 1 in 12 Americans lacked health insurance last year.
That’s what makes Minnesota’s insulin safety net different. The system has two parts: an emergency program that allows individuals to get a one-time, 30-day supply of insulin for $35, and a continuing need program that provides insulin to eligible patients for a year at no more than $50 for a 90-day supply.
By contrast, list prices for a 30-day supply of insulin can easily top $215, depending on the insulin.
The bill that created Minnesota’s program was bipartisan out of necessity. Republicans controlled the state Senate at the time, while the Minnesota Democratic-Farmer-Labor Party held the House and governor’s office.
Nicole Smith-Holt, whose son the bill was named after, watched in tears as it finally passed the state legislature in 2020.
“I was happy. I was relieved,” Smith-Holt said. “I was sad that it took Alec dying to get to the point where people could walk into the pharmacy and pick up their prescription for an affordable price.”
But because Minnesota’s program requires insulin manufacturers to provide the insulin, it has prompted a backlash from manufacturers. Pharmaceutical industry lobbying group PhRMA filed a lawsuit in 2020 to block the Minnesota law, arguing it violates the “takings clause” of the U.S. Constitution, which says private property can’t be taken for public use “without just compensation.”
That suit is ongoing, yet the state program is up and running and by the end of 2023 it had been used over 1,500 times.
PhRMA spokesperson Reid Porter said his group is committed to helping patients afford medicines. Insulin makers voluntarily dropped list prices last year and now offer patient assistance programs for affording the drugs. And the CEO of insulin maker Eli Lilly first proposed the voluntary Medicare copay cap Trump announced in 2020.
Porter said insulin costs have been driven up by insurance companies and pharmacy benefit managers, also known as PBMs — the middlemen between insurance plans or employers and drug manufacturers — when they pocket the discounts from the list price of drugs that they negotiate with manufacturers.
“Minnesota’s insulin program does not solve this problem and is unconstitutional,” Porter said. “This is not how the system should work, and why it’s critical that policymakers should prioritize reforming the PBM system, a solution that puts patient health over politics.”
In 2021, Sood co-authored a study that found that, despite insulin list prices rising between 2014 and 2018, income received by drugmakers decreased while increasing for intermediaries like PBMs and pharmacies.
In September, the Federal Trade Commission announced a lawsuit against the nation’s three biggest PBMs, alleging they created a system that inflated insulin prices. The companies denied the claims.
Jing Luo, a physician at the University of Pittsburgh, said that regardless of who wins in November he doesn’t expect existing insulin policies like Medicare’s popular copay cap to be rolled back, due in part to the advocacy of people like Smith-Holt and Greenseid.
“They’ve been really effective at tying high insulin prices with really bad, morally repugnant outcomes,” Luo said.
The key in Minnesota was including real stories, Greenseid said.
“We had enough real people who reached out and had conversations and helped to show politicians the extent of the problem,” Greenseid said, “and they listened.”
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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Silence in Sikeston: Trauma Lives in the Body
SIKESTON, Mo. — At age 79, Nannetta Forrest, whose father, Cleo Wright, was lynched in Sikeston, Missouri, before she was born, wonders how the decades-long silence that surrounded his death in 1942 influenced her life.
In 2020, Sikeston police killed another young Black man, 23-year-old Denzel Taylor. Taylor’s shooting death immediately made local headlines, but then the cycle of silence in Sikeston repeated itself.
Host Cara Anthony and pediatrician Rhea Boyd draw health parallels between the loss experienced by two families nearly 80 years apart. In both cases, young daughters were left behind to grapple with unanswered questions and devastating loss.
“Regardless of the age, children experience longing,” Boyd said. “They miss people when they don’t see them again; even babies can experience that.”
[Editor’s note: A swear word is bleeped out in this episode.]
Host Cara Anthony Midwest correspondent, KFF Health News @CaraRAnthony Read Cara's stories Cara is an Edward R. Murrow and National Association of Black Journalists award-winning reporter from East St. Louis, Illinois. Her work has appeared in The New York Times, Time magazine, NPR, and other outlets nationwide. Her reporting trip to the Missouri Bootheel in August 2020 launched the “Silence in Sikeston” project. She is a producer on the documentary and the podcast’s host. In Conversation With … Rhea Boyd Pediatrician and public health scholar click to open the transcript Transcript: Trauma Lives in the BodyEditor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.
[Solemn instrumental music begins playing softly.]
Cara Anthony: When Nannetta Forrest was growing up, a lot went unsaid in her family.
Nannetta Forrest: You know, people didn’t do a lot of talking back then. And it was almost like trying to pull teeth out of a hen.
Cara Anthony: She lived nearly her whole life in Indiana, but Nannetta’s story — the secrets and the silence — all started in Sikeston, Missouri.
Nannetta was born there in 1942. Several months earlier, while her mother was pregnant, Nannetta’s father was lynched.
His name … was Cleo Wright.
Nannetta Forrest: He was taken away before I got here!
Cara Anthony: Taken from a jail cell. Taken and dragged through the streets by a white mob. Taken to Sunset Addition, the center of Black life in Sikeston, and lynched. Taken from his family.
Nannetta’s mother kept quiet. She never wanted her daughter to know what happened to her father.
But one day, Nannetta was with her grandfather. A game show that aired on CBS in the 1950s was on TV. It was called “Strike it Rich.”
[Clip from “Strike it Rich” begins playing.]
“Strike It Rich” clip: Mr. “Strike It Rich” himself, Warren Hull. [Applause]
Nannetta Forrest: Celebrities would go on, and they’d try to win money for, like, underprivileged people.
“Strike It Rich” clip: Thanks a lot!
Nannetta Forrest: And that’s when Grandpa told me, he said, “You can go on there, Nan.” And I said, “Go on there with what?” And that’s when he went in his wallet and pulled out this yellow piece of paper.
[Solemn instrumental music plays.]
Cara Anthony: It was a newspaper clipping about the lynching of her father.
Nannetta Forrest: And that was my first time ever becoming aware of it.
Cara Anthony: It was around 1955. Nannetta was 13 or 14 at the time.
Nannetta Forrest: I did wanna know the story behind it, what happened, but nobody seemed to wanna talk about it.
Cara Anthony: Over the years, she pieced together bits of what happened. But there was always one nagging question that didn’t have an answer:
What would her life have been like if that mob hadn’t lynched her dad?
Nannetta Forrest: Now, I do often wonder that. Had he been alive when I was born and been in my life, what type of person would I have been? Would I have been the same person? Would I have been a different person? And this is something I’ll never know.
Cara Anthony: I’m Cara Anthony. I’m a health reporter.
I’ve traveled to Sikeston, Missouri, for years, asking people about the killing of Cleo Wright — and the silence that surrounds his death.
Nearly eight decades after the killing, that silence was still stifling. Like generations of stuffed-down fear and anger.
At nearly every turn, locals refused to talk to me. In fact, many people felt they could not talk to me. Until I met … Mikela Jackson.
[Solemn instrumental music fades out.]
Mikela Jackson: It’s … it’s … it’s no healing from grief. It’s an everyday thing for me.
Cara Anthony: Mikela goes by Keke. She’s in her mid-20s. But she’s heard about the lynching back in 1942.
Cara Anthony: Talk to me a little bit about that. Have you ever heard of Cleo Wright?
Mikela Jackson: Denzel brung that up to me. Denzel brung it up to me because we used to live on Sunset Street, and he was telling me, like, they dragged him through Sunset.
Cara Anthony: “Denzel” is Denzel Taylor, Keke’s fiancé.
Sikeston police shot him at least 18 times — and killed Denzel in April 2020. He was 23 years old.
That year, everyone was talking about new research that found that a Black man had a 1-in-1,000 chance of being killed by police.
Denzel Taylor became that 1 in a thousand.
[Sparse, minor music plays quietly.]
Right in the middle of her grief, Keke refused to be quiet.
Mikela Jackson: The Bootheel knows what happened to him. The world, they have no idea who Denzel Taylor is.
Cara Anthony: The Bootheel is where Sikeston sits — in the far southeast corner of Missouri.
Mikela Jackson: So that’s why I want his story … I wanna make him proud, actually. ’Cuz I want him to know, look, Babe, they going to hear this one way or another.
Cara Anthony: I made a film about the deaths of Denzel and Cleo — two Black men killed decades apart — in the same community.
For the documentary, we explored questions about the impact of racial trauma and the persistent harm it causes.
Here, for the podcast, we’re exploring another layer. How does systemic racial violence impact health? The health of Black people, in particular?
[“Silence in Sikeston” theme begins playing.]
Denzel’s story reminds me so much of Cleo’s. So many things about their lives — and their deaths — are similar.
They both left behind a daughter they never got to meet.
They both were killed by a public health threat of their time.
A threat to Black men of their time.
For Cleo, that was lynching.
For Denzel, it was police violence.
Neither of them got their day in court.
In this episode, we’re looking at what happened to Denzel Taylor.
We’re exploring police violence as a public health problem. One that’s making us sick and cutting lives short.
From WORLD Channel and KFF Health News, and distributed by PRX, this is “Silence in Sikeston,” the podcast about finding the words to say the things that go unsaid.
Episode 3: “Trauma Lives in the Body.”
[“Silence in Sikeston” theme ends.]
[Gentle, bright instrumental music plays.]
Cara Anthony: Denzel was from Chicago. Growing up, he spent time in southeastern Missouri with his dad’s family.
Denzel and Keke met in Sikeston. And Keke says they fell in love immediately.
Mikela Jackson: It was a butterfly feeling, like you could just tell it was love. It was the best energy ever.
Cara Anthony: They started their family. De’nia was born first. Denzel used to call her “Cupcake.”
Denzel Taylor: Hey, Cupcake. Say hey, y’all. I love you, princess. [Baby babbles.]
Cara Anthony: Aiyana came next. In 2020, Keke was pregnant with their third daughter, Brookelynn.
Mikela Jackson: He said he wanted seven kids. I said, Denzel, what? He wanted seven kids. That’s a basketball team. I can’t handle that.
Cara Anthony: They were planning to get married after Brookelynn was born.
Mikela Jackson: I really wanted a big family with Denzel. I wanted to get married. I wanted to go to D- … We was planning on moving to Dallas and everything and it’s just like, my whole world is just like, it just blew up on me.
Cara Anthony: Remember 2020? It felt like the news was full of stories about Black people getting killed by police.
Videos from body cameras were all over social media. Around that same time, Keke remembers Denzel getting pulled over by police more and more.
And, Keke says, he started to become convinced that someday he might be killed by police too.
Mikela Jackson: He said if he was to ever get in any type of interaction with the police, he would let them kill him just to show how America is.
He would bring it up, like, outta nowhere. And he would say it, and I would wonder, like, why is you constantly saying it? And I kind of will get irritated because it’s, like, that’s not a way that I will want you to go out. Like, we’re supposed to grow old together.
Cara Anthony: On April 29 that year, Denzel’s premonition came true.
Police body cameras captured what happened the night Denzel was killed.
You’re about to hear a retelling of what happened the night Denzel died — based on interviews with his family and audio pulled from those body cam videos.
When I first got the videos, I stared at the attachments in my email for a long time. I didn’t want to look.
[Soft droning music fades in.]
But I think it’s important that we do look at what happened. It’s part of what I have to do to examine police killings as a public health threat.
Denzel was staying with his father and his stepmom.
[Rain sounds play.]
It was raining that night. Denzel and his dad, Milton Taylor, were stuck in the house together.
They got into an argument. Things escalated.
Denzel’s mom, Jean Kelly, was asleep in Chicago some 400 miles away. In the early hours of the morning, Denzel’s sister ran into her room yelling.
Jean Kelly: “Mom, wake up.” I said, “What happened?” She said, “Denzel just shot Daddy.” I said, “What? Denzel just shot Daddy? That doesn’t make any sense at all.”
EMS audio: 49-year-old. Male. Gunshot wound. Two to three shots to the chest. Five officers on scene.
Cara Anthony: By the time police arrived at Milton’s home, Denzel had left. EMTs stabilized Milton and took him to the hospital.
EMS audio: We’re running hot. St. Francis. One patient.
Cara Anthony: Meanwhile, up in Chicago, Jean is trying to figure out what’s going on. She calls Milton’s wife, Denzel’s stepmom.
Jean Kelly: She said she had a couple of family members out looking for Denzel, you know, because she was saying, “I want them to find him before the police finds him.”
Cara Anthony: Police are speaking with Denzel’s stepmom when he appears.
The body-camera video shows the scene from an officer’s perspective.
[Music fades out.]
Cara Anthony: By now, it’s stopped raining. A streetlamp lights up the end of the block. Police had wrapped the area in yellow police tape. The camera shows Denzel standing in the near distance on the other side of the yellow tape. He’s wearing a hoodie.
Officers: Show me your hands now! Take your hand out of your pocket!
Denzel Taylor: Just kill me, bro.
Jean Kelly: They were saying, uh, “Put your hands up” or whatever the, the, they said to him, and there was some words exchanged. And, uh, it sounded like he said, “Well, shoot me, bro. Just go ahead, shoot me.”
Cara Anthony: The officers fire their guns.
Jean Kelly: They hit my son one time, I believe, if not two, and my son fell. He went, he dropped to his knees and fell face down.
Cara Anthony: There’s a pause. It’s just a moment or two, but as I watch it, it feels longer.
And then, the police fire again, sending bullets into his body on the ground. They keep shooting. You can hear dozens of shots.
Police body cam video: We got shots fired. We need EMS. We got one subject down, shots fired! Hands now! Hands! Hands!
Cara Anthony: One officer walks up — and uses his foot to roll Denzel the rest of the way onto his stomach. Denzel groans as the officer pins his arms behind his back and handcuffs him.
[Handcuffs click]
Cara Anthony: They search his body.
Police body cam video: Goddamn it.
Cara Anthony: Police don’t find a gun. Or any weapon. Just a piece of wood in his hoodie pocket.
Police body cam video: Are you [expletive] serious? He had a [expletive] stick of wood.
Cara Anthony: Police call for an ambulance.
EMS audio: … EMS respond to one subject shot. Time of page, 02 36.
Cara Anthony: On the body camera video, one officer points a flashlight in Denzel’s face.
Police body cam video: Why didn’t you just take your hand out of your pocket, man?
Cara Anthony: Minutes tick by. Red and blue police lights flash off the wet pavement. Denzel is still in the street, motionless.
[Ambulance sirens]
Cara Anthony: EMS arrive, but it’s too late. Denzel is dead.
Over the radio, the dispatcher calls for the coroner.
EMS audio: That’s yes, ma’am. Contact coroner. Ten-four.
[Somber instrumental music plays softly.]
Cara Anthony: Keke had been out of town. She got the call as she was driving back to Sikeston. The police had killed Denzel.
Mikela Jackson: And I said, “No, they did not. No, they did not.” I couldn’t believe it. It was heartbreaking.
Cara Anthony: A special prosecutor declined to file charges against the police officers who killed Denzel. The officers did not comment for this project. Sikeston Chief of Public Safety James McMillen says the officers believed Denzel was armed and that they were in fear for their life.
Denzel’s family sued the city of Sikeston. The city and the family reached a wrongful death settlement for $2 million. Close to half of it went to legal fees. Most of the rest of it will go to Denzel’s daughters.
Keke thinks a lot about how life goes on for the officers who killed Denzel.
Mikela Jackson: They still get to see their family every single day of their life. They still get to call their daughters. They still get to go home and tuck their kids into bed. Denzel can never do that ever, ever again.
I’m a forced single parent. I have to push through every single day.
Keke watched the body cam video over and over. But Denzel’s death just wouldn’t sink in. And she’s worried about their daughters.
Mikela Jackson: I hope they never see the video ’cause that’s traumatizing. ’Cause that’s their dad.
Cara Anthony: Eventually, Keke left Sikeston. She says there are too many memories of Denzel and what happened to him there.
On the day I visited her new home, it was just over a year after Denzel’s death.
[Cara and Keke laugh together in the background.]
Two-year-old Aiyana is napping in the next room. Keke has the youngest, Brookelynn, on her lap. And the oldest, De’nia, is … everywhere.
Right now, she’s zooming through the dining room on a scooter.
Cara Anthony: She just did, like, a trick, like a BMX. She’s BMXing in this apartment right now. Is she a daredevil?
Mikela Jackson: She do that all the time. [Laughter] Too much. No. No bike.
Cara Anthony: Eventually, De’nia parked her wheels and talked to me.
Cara Anthony: Let’s just get this started. Tell me your name again and how old you are.
De’nia: Four.
Cara Anthony: And what is your name?
De’nia: De’nia.
Cara Anthony: In my time as a health reporter, I’ve written a lot about the impact gun violence has on kids. I’ve gotten some training in how to talk to them about it on their level — without retraumatizing them.
Cara Anthony: Your mommy’s sitting here, and she said I have permission to ask you about your daddy.
De’nia: Daddy?
Cara Anthony: Do you miss your daddy?
De’nia: Yes.
Cara Anthony: Yeah? Where’s your daddy?
De’nia: I don’t know.
Cara Anthony: Yeah.
De’nia: He’s sleeping.
Cara Anthony: Hmm?
De’nia: He’s sleeping.
Cara Anthony: You said he’s sleeping?
De’nia: Yes.
Mikela Jackson: That’s what she say. She said, “My daddy’s sleeping.”
Cara Anthony: De’nia is trying to make sense of why her dad isn’t with them anymore. And Keke doesn’t know what to tell her.
Mikela Jackson: Like last night she actually woke up out of her sleep and she was crying and she was like, Mama, my daddy. And I didn’t know what to tell her because it’s, like, what do you tell a 4-year-old that they’re never ever going to see their dad again?
[Subtle instrumental music plays.]
Cara Anthony: I called a pediatrician, Rhea Boyd, to talk about what losing a parent to police violence could mean for kids like De’nia, Aiyana, and Brookelynn.
Rhea Boyd: Regardless of the age, children experience longing. They miss people when they don’t see them again, even babies can experience that.
Cara Anthony: Losing a parent — especially to violence — can have a major impact on a child’s future health.
Rhea Boyd: Certain experiences, including the death of a parent, increases a child’s risk for certain physical health ailments, like heart disease, um, kind of neurologic ailments, like increased risk for Alzheimer’s. Mental health impairments, like increased risk for depression. And these are increased risks as they move into adulthood.
Cara Anthony: Study after study show the link, even though we don’t totally understand all the mechanisms.
Rhea Boyd: It’s not just innate to our biology. It’s because of the conditions in which Black folks have been forced to live.
Cara Anthony: Black people in the United States carry more stress throughout their lives than white people. That doesn’t change, even when they make more money.
Researchers have tied that stress to the racism we deal with in everyday interactions — and to the institutional racism that makes it harder for us to take care of ourselves and our families.
Black people age faster, get sicker, and die sooner than our white peers — and carrying chronic stress is a factor.
Rhea says police violence contributes to this, too.
Rhea Boyd: Police are a public institution. And when they disproportionately take the lives of Black folks, or disproportionately police Black neighborhoods, that has direct impacts on our lives, on our well-being.
Cara Anthony: Keke says, back when she was living in Sikeston, she felt anxious every time she saw police lights in her rearview mirror.
[Subtle instrumental music ends.]
Mikela Jackson: Now, it’s like, OK, here it go again. I’m getting pulled over. Because it, I’m, it’s, I’m used to it at this point. I’m used to it.
Cara Anthony: Used to it, maybe. But not numb to it.
Mikela Jackson: I can’t tell my kids, “Hey, don’t be scared when you get pulled over.” I can’t tell them that. ’Cause I’m still scared myself, even a year later. I’m still scared.
Cara Anthony: Rhea calls this “anticipatory stress.”
Rhea Boyd: Anticipatory stress means you carry a level of vigilance and worry and concern about things that might happen to you or your kids.
Cara Anthony: Children can pick up on what’s going on in these situations and can end up carrying that toxic stress, too.
Denzel Taylor’s mother, Jean Kelly, told me about the worry that comes with having a Black son in America. The fear that he could become that 1 in 1,000 Black men killed by police.
[Grand, angelic music plays in the background.]
Jean Kelly: [Singing] Lord, have mercy on me …
Cara Anthony: Jean says before Denzel’s death, her spirit was on alert, like she was bracing for something bad. And a tune kept playing over and over in her mind.
Jean Kelly: [Singing] Lord, have mercy on me. I said, Lord, have mercy on me.
I just needed his, I needed his mercy and his grace and strength and everything to prepare me for what was to be … whatever it was to be, I was going to need his mercy.
[Grand, angelic music fades out]
Cara Anthony: I know what Black people are dealing with today. But I can only imagine what it would have been like in 1942, when Cleo Wright was lynched.
Rhea Boyd: The type of control people had their kids and their body under constantly so that they weren’t the victim of that type of violence, I think, physiologically, it was likely so enormous that the intergenerational effects of that type of terror still live in our bodies as descendants of those who experienced it.
Cara Anthony: Research is starting to explore how living with this kind of terror could go beyond behaviors to something deeper: changing how our genes work.
[Bouncy instrumental music plays.]
Some of this research comes out of a field called “epigenetics.” It’s the idea that something you experience can change how the genes in your body are expressed.
And that can have huge impacts on your health: It could make you age quicker or be more prone to developing a disease like cancer.
And epigenetic research is looking into how things your ancestors experienced could also affect your health today.
A police shooting and a lynching.
Two Black men killed in the same town — nearly 80 years apart.
As I reported their stories, many people have asked why we’re examining the deaths of Cleo Wright and Denzel Taylor side by side.
After years of reporting on these deaths, I’ve decided, as a health reporter, I want to focus on is this: the trauma that remains after the violence against these men — the possible health effects for their families and their communities.
I want to better understand what the loss could mean for Cleo and Denzel’s daughters. Little girls growing up without their dad.
Cleo’s daughter, Nannetta Forrest, wasn’t born yet when her father was killed. When we last spoke a few years before she died, she was 78 years old. And she said she was still asking herself that question that had nagged at her, her whole life: Who would she have been?
Nannetta Forrest: Would I have been the same person? Would I have been a different person?
Cara Anthony: And Denzel’s girls: De’nia and Aiyana. And Brookelynn, who wasn’t born yet. Brookelynn might ask herself the same thing as she grows.
Mikela Jackson: She has no memories. She’s never seen him a day in her life. So it’s like, she’ll never know him, like, as a person. [Den’ia playing in the background]
Cara Anthony: Just like Nannetta, Denzel’s girls are facing higher risks of psychological and mental health problems … and the possibility that losing their father this way could change how their genes work.
[“Silence in Sikeston” theme begins playing.]
In the face of those risks and possibilities, Keke’s looking for ways to protect her daughters.
She’s moved them away from Sikeston to a city where she hopes they’ll have more peace.
She wants them to know all about their dad, and how much he loved them.
She wants them to know his voice.
Denzel Taylor: Hey, Cupcake!
Cara Anthony: It’s the opposite of silence. She wants them to be able to heal out loud.
On the next episode, we’re in Sikeston, where people are looking for ways to heal and move forward after the deaths of Cleo Wright and Denzel Taylor.
Pershard Owens: We got to look in the mirror and say, am I doing what I can to try and change the dynamic of Sikeston, even if it does hurt? That’s what we have to start doing.
Cara Anthony: Including the possibility for big changes — community-level, systemwide changes.
James McMillen: I get frustrated and I’m trying to direct that frustration into something that could actually work.
Cara Anthony: That’s next time, on the final episode of “Silence in Sikeston.”
[“Silence in Sikeston” theme ends.]
[Upbeat instrumental music plays.]
Cara Anthony: Thanks for listening to “Silence in Sikeston.”
Next, go watch the documentary — it’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD.
Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special.
This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX.
It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation.
The audio series was reported and hosted by me, Cara Anthony.
Zach Dyer and Taylor Cook are the producers.
Editing by Simone Popperl.
Taunya English is managing editor of the podcast.
Sound design, mixing, and original music by Lonnie Ro.
Podcast art design by Colin Mahoney and Tania Castro-Daunais.
Oona Zenda and Lydia Zuraw are the landing page designers.
Have you seen the amazing Sikeston photography? It’s from Michael B. Thomas.
And Lynne Shallcross is the photo editor.
Thank you to my vocal coach, Viki Merrick.
Music in this episode is from Epidemic Sound and BlueDot Sessions.
Additional audio from the CBS TV show “Strike It Rich” and Denzel Taylor’s family.
Some of the audio you’ll hear across the podcast is also in the film.
For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin.
Kyra Darnton is executive producer at Retro Report.
I was a producer on the film.
Jill Rosenbaum directed the documentary.
Kytja Weir is national editor at KFF Health News.
WORLD Channel’s editor-in-chief and executive producer is Chris Hastings.
We’re keeping this conversation going on Instagram and X.
Tarena Lofton and Hannah Norman are engagement and social media producers for the show.
Help us get the word out about “Silence in Sikeston.”
Write a review or give us a quick rating wherever you listen to this podcast.
Thank you. It makes a difference.
Oh, yeah. And tell your friends in real life, too.
[Upbeat instrumental music ends.]
Credits
Taunya English Managing editor @TaunyaEnglish Taunya is deputy managing editor for broadcast at KFF Health News, where she leads enterprise audio projects. Simone Popperl Line editor @simoneppprl Simone is broadcast editor at KFF Health News, where she shapes stories that air on Marketplace, NPR, and CBS News Radio, and she co-manages a national reporting collaborative. Zach Dyer Senior producer @zkdyer Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production. Taylor Cook Associate producer @taylormcook7 Taylor is an independent producer who does research, books guests, contributes writing, and fact-checks episodes for several KFF Health News podcasts. Lonnie Ro Sound designer Lonnie Ro is an audio engineer and composer who brings audio stories to life through original music and expert sound design for platforms like Spotify, Audible, and KFF Health News.Additional Newsroom Support
Lynne Shallcross, photo editorOona Zenda, illustrator and web producerLydia Zuraw, web producerTarena Lofton, audience engagement producer Hannah Norman, visual producer and visual reporter Chaseedaw Giles, audience engagement editor and digital strategistKytja Weir, national editor Mary Agnes Carey, managing editor Alex Wayne, executive editorDavid Rousseau, publisher Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chief Tammie Smith, communications officer
The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.
Watch the accompanying documentary from WORLD, Retro Report, and KFF starting Sept. 16, here.
To hear other KFF Health News podcasts, click here.
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.
USE OUR CONTENTThis story can be republished for free (details).
California Voters Consider Tough Love for Repeat Drug Offenders
SACRAMENTO, Calif. — California voters are considering whether to roll back some of the criminal justice reforms enacted a decade ago as concerns about mass incarceration give way to public anger over property crime and a fentanyl crisis that has plagued the state since the covid-19 pandemic hit.
Proposition 36, on the November ballot, would unwind portions of a 2014 initiative, known as Proposition 47, that reduced most shoplifting and drug possession offenses to misdemeanors that rarely carried jail time.
Critics say that has allowed criminality to flourish and given those suffering from addiction little incentive to break the cycle. The law also has become a political weapon for former President Donald Trump and other Republican politicians who have tried to tie it to Vice President Kamala Harris to paint her as soft on crime. As California attorney general she took no position on the issue.
Much of the Proposition 36 debate has focused on the increased penalties for shoplifting, but the drug policy changes are even more dramatic. In addition to boosting penalties for some drug crimes, the measure would create a new “treatment-mandated felony” that could be imposed on people who illegally possess what are called “hard” drugs, including fentanyl, heroin, cocaine, and methamphetamine, and have two or more prior convictions for certain crimes.
Those who admit to the new felony would be required to complete drug or mental health treatment, job training, or other programs intended to “break the cycle of addiction and homelessness.” Those who complete the treatment program would have their charges dismissed, while failure could bring three years in prison.
The measure has opponents, including Gov. Gavin Newsom, warning about renewing a “war on drugs” that once helped swell California’s prison population.
Supporters counter that stricter penalties are necessary as overdose deaths from fentanyl crowd morgues. They also point to studies showing that more than 75% of people experiencing chronic homelessness struggle with substance abuse or a severe mental illness.
“We crafted this not to move people into any kind of custody setting, but to incentivize them into treatment,” said Greg Totten, chief executive officer at the California District Attorneys Association and a spokesperson for the initiative’s supporters.
Totten and others cast the measure as a way to revive drug courts, which they say waned in effectiveness after Proposition 47 removed the stick from what had been a carrot-and-stick approach.
Drug courts are led by a judge with a specialized caseload, use a collaborative approach to promote rehabilitation, and have been found to be effective in California and nationwide. Participants in California had “significantly lower rates of recidivism,” according to a study in 2006 commissioned by the Judicial Council of California: 29% were rearrested compared with 41% of a group who didn’t receive treatment.
The Center for Justice Innovation, a nationwide research and reform group that grew out of the New York state court system, found that drug court caseloads dropped across California after Proposition 47.
Still, advocates who favor decriminalization challenge the idea that the approach is effective and say coerced treatment violates people’s rights. Meanwhile, Lenore Anderson, a co-author of Proposition 47, said “we cannot pretend that this sort of feel-good idea that we’re going to arrest and incarcerate out of it is going to work. It never has.”
Proposition 47 led to an increase in property crime, but there is no evidence that changes in drug arrests sparked any increases in crime, found a recent study by the nonprofit, nonpartisan Public Policy Institute of California.
The latest reform effort leaves many questions, said Darren Urada of the University of California-Los Angeles Integrated Substance Abuse Programs. He was the principal investigator on UCLA’s evaluation of an earlier attempt to promote treatment.
“When policies are properly implemented, treatment obtained through courts can help people. However, there are a lot of details here that are not clear, and therefore a lot of opportunities for this to go poorly,” Urada said.
For instance, the ballot measure doesn’t say what would happen to someone who enters treatment but relapses, as is common; how long they would have to complete the program; or what would constitute completion for someone in long-term treatment for mental illness or substance abuse.
Those details were deliberately left vague so that local experts like community corrections partnerships, which are already established under existing law, could decide what works best in their jurisdictions, Totten said.
Totten expects a range of approaches including diversion programs and inpatient and outpatient treatment, and that judges would be guided by the recommendations of treatment professionals.
“I’m hopeful that that will help people who are really struggling with addiction, living on the streets, who engage in petty theft and other crimes in order to support their habit — that it will be a doorway into treatment for them,” said Anna Lembke, a Stanford University addiction expert.
The November ballot measure also would allow judges to send drug dealers to state prisons instead of county jails and boost penalties for possessing fentanyl. It would make it easier to charge someone with murder if they provide illegal drugs that kill someone.
The changes could increase California’s prison population, currently about 90,000, and its county jail and community supervision population, currently around 250,000, each by “a few thousand people,” projects the state’s nonpartisan Legislative Analyst’s Office. Opponents of the measure project that the increase would be far higher: 65,000 people, most for drug offenses and most of them people of color.
Newsom, one of the initiative’s most outspoken critics, argues that the November ballot measure lacks any funding; would reduce the $800 million in Proposition 47 savings, much of which has gone to treatment and diversion programs; and would only aggravate an existing lack of treatment alternatives.
“Prop. 36 takes us back to the 1980s,” Newsom, a Democrat, said in August as he signed a package of 10 property crime bills that he and legislative leaders tout as an alternative to the broader ballot measure.
Yet, illustrating the contentiousness of the debate, the ballot measure has been endorsed by some Democratic leaders, including San Francisco Mayor London Breed, San Diego Mayor Todd Gloria, and San Jose Mayor Matt Mahan, who often highlight its treatment requirement.
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.
USE OUR CONTENTThis story can be republished for free (details).
Aspirantes demócratas culpan a los republicanos en las bancas por sus antecedentes antiaborto en el Congreso
En un anuncio de campaña este mes, Derek Tran, un demócrata del condado de Orange, California, criticó a su oponente, la representante republicana Michelle Steel, por apoyar una prohibición nacional del aborto y votar para limitar el acceso a anticonceptivos.
El retador demócrata Will Rollins también señaló a su rival, el representante Ken Calvert, y a los “extremistas de MAGA” en un anuncio reciente por respaldar un proyecto de ley que podría criminalizar a los profesionales médicos que brindan abortos.
A pocas cuadras de la ruta estatal 14 en Lancaster, a unas 70 millas al norte del centro de Los Ángeles, el oponente demócrata de Mike Garcia, George Whitesides, colocó dos carteles prometiendo proteger la atención médica reproductiva, una crítica al congresista republicano, quien ha votado para reducir los fondos públicos destinados a los abortos para los miembros del servicio militar y otros estadounidenses.
A medida que se acerca el día de las elecciones, los aspirantes demócratas están haciendo todo lo posible para vincular a sus oponentes republicanos en distritos congresionales disputados con sus antecedentes antiaborto.
Se están lanzando anuncios agresivos en California, Arizona, Nebraska, Nueva Jersey, Nueva York y Oregon, ya que los demócratas ven una oportunidad de tomar el control de la Cámara al involucrar a votantes que podrían no votar por un solo partido o incluso abstenerse de votar. Actualmente, los republicanos controlan la Cámara por un margen estrecho.
“Lo que todos debemos hacer es asegurarnos de revisar su historial, y ese historial es contrario a lo que ella está mostrando en sus anuncios”, dijo Tran en una entrevista sobre Steel. “Nos estamos asegurando de educar y recordar a los votantes quién es realmente”.
Los demócratas también están vinculando a los republicanos en ejercicio con el ex presidente Donald Trump, quien se ha atribuido el mérito de la decisión de la Corte Suprema de 2022 de anular Roe v. Wade.
Los demócratas advierten a los votantes que podrían venir más restricciones. Durante el debate presidencial del 10 de septiembre, Trump evitó una pregunta sobre si vetaría una prohibición nacional del aborto si fuera elegido.
La mayoría de los votantes apoyan la restauración del derecho federal al aborto, según una reciente encuesta de KFF: uno de cada 14 votantes dice que el aborto es el tema más importante a la hora de determinar su elección. Esos votantes tienen el potencial de marcar la diferencia en las contiendas reñidas, dijo David McCuan, profesor de ciencias políticas de la Universidad Estatal de Sonoma.
“La política del aborto y la salud reproductiva puede hacer que los votantes participen en tasas más altas”, dijo McCuan. “Va a ser un tema definitorio”.
Los demócratas esperan que el tema juegue a su favor en California. Hace dos años, los votantes codificaron los derechos al aborto en la ley estatal. En mayo, Planned Parenthood Affiliates of California lanzó una campaña de siete cifras dirigida a siete escaños republicanos y al asiento abierto de la demócrata Katie Porter.
Como resultado, los analistas políticos dicen que los republicanos han evitado hablar de sus votos sobre el aborto y algunos en ejercicio, como Steel, Garcia y el representante estadounidense del Valle Central, David Valadao, han moderado sus posturas para atraer a los votantes.
Steel, al igual que Garcia y Valadao, ha dicho que apoya excepciones a las prohibiciones del aborto en casos de violación, incesto o amenazas a la vida de la madre. Los tres copatrocinaron un proyecto de ley que equivalía a una prohibición total del aborto en el Congreso anterior. Garcia y Valadao dejaron sus nombres fuera del proyecto de ley el año pasado, pero Steel volvió a firmarlo como copatrocinadora, aunque brevemente.
Luego retiró su apoyo después de ganar su primaria en marzo, explicando que podría crear confusión porque el proyecto de ley de tres páginas podría amenazar la fertilización in vitro. En un anuncio de campaña en septiembre, Steel compartió que había utilizado la fertilización in vitro para tener hijos y reiteró su apoyo al procedimiento. Lance Trover, vocero de Steel, dijo que ella se opone a una prohibición nacional del aborto.
Ninguno de los republicanos en ejercicio que representan un distrito “disputado” en California, según lo determinado por el Cook Political Report no partidista, concedió una entrevista a KFF Health News. Aquellos que sí respondieron dijeron que no apoyan una prohibición nacional del aborto.
El representante John Duarte agregó que se opone a una prohibición porque es “pro-elección”, y Calvert dijo que “el tema es mejor decidido por los estados y sus votantes directamente”. Ambos votaron a favor de un proyecto de ley para limitar el aborto con medicamentos y apoyaron una medida que habría autorizado penas de prisión para los proveedores médicos que no reanimen a los bebés nacidos después de un intento de aborto.
Tim Rosales, un estratega político que ha representado a candidatos republicanos, dijo que no debería criticarse a estos legisladores por cambiar de opinión con el tiempo, y señaló que los ex presidentes demócratas Bill Clinton y Barack Obama cambiaron sus posturas sobre el matrimonio entre personas del mismo sexo.
“Debe haber algún margen para la evolución en una variedad de temas”, dijo Rosales.
Ben Petersen, portavoz del Comité Nacional Republicano del Congreso, dijo que los demócratas que han criticado a los republicanos por sus inconsistencias quieren desviar la conversación de otros temas, como la “desastrosa crisis del costo de vida que afecta a las mujeres y las familias, causada por su control monopartidista de Sacramento”.
Este juego político se está desarrollando en el escenario nacional, especialmente en contiendas cruciales donde los republicanos se encuentran a la defensiva en estados donde el aborto está en la boleta electoral. Aproximadamente dos docenas de carreras se consideran disputadas.
En una publicación de marzo en la plataforma social X, el representante republicano de Nebraska, Don Bacon, escribió: “Siempre he defendido la vida de la madre”, después de que su rival demócrata, Tony Vargas, lo criticara por apoyar una prohibición nacional del aborto, que no hace excepciones para casos en los que está en riesgo la vida de la madre.
Ese mismo mes, Rolling Stone informó que el congresista de la zona de Omaha había eliminado algunos respaldos contra el aborto de su sitio web. Los habitantes de Nebraska votarán este noviembre sobre medidas de aborto en la boleta.
En Arizona, donde los votantes también decidirán si consagran los derechos al aborto en la constitución del estado, el representante republicano en ejercicio David Schweikert no apoyó este año una prohibición nacional, que había copatrocinado al menos seis veces desde 2012 hasta 2021. En abril, escribió en X que se oponía a una prohibición del aborto en Arizona, pidiendo a la Legislatura estatal que “abordara este tema de inmediato”.
En los medios, en sus sitios web y en la campaña electoral, los candidatos republicanos están girando para convencer a los votantes de que han votado para proteger a las mujeres. Por ejemplo, Steel lanzó en septiembre un anuncio titulado “Champion” (Campeona), en el que el sheriff del condado de Orange dice que Steel ha “trabajado incansablemente para proteger a las víctimas de violencia doméstica y abuso sexual”.
Trover, el portavoz de Steel, dijo que ella votó hace dos años para reautorizar la Ley de Violencia contra las Mujeres. Esa votación fue parte de un proyecto de ley de gastos gubernamentales más amplio de $1.5 trillones, que incluía la medida.
El año anterior, Steel votó en contra de reautorizar la ley.
Esta historia fue producida por Kaiser Health News, que publica California Healthline, un servicio editorialmente independiente de la 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.
USE OUR CONTENTThis story can be republished for free (details).
Democratic Hopefuls Fault GOP Incumbents for Anti-Abortion Records in Congress
In a campaign ad this month, Derek Tran, a Democrat from Orange County, California, blasted his opponent, Republican U.S. Rep. Michelle Steel, for supporting a national abortion ban and voting to limit access to birth control.
Democratic challenger Will Rollins also called out his rival, Rep. Ken Calvert, and “MAGA extremists” in an ad last week for their backing of a bill that could criminalize medical practitioners who provide abortions.
A few blocks from state Route 14 in Lancaster, about 70 miles north of downtown Los Angeles, Rep. Mike Garcia’s Democratic opponent, George Whitesides, planted two billboards promising to protect reproductive health care, a jab at the Republican congressman, who has voted to cut taxpayer funding of abortions for service members and other Americans.
As Election Day approaches, Democratic hopefuls are doing all they can to tie Republican opponents in contested congressional districts to their anti-abortion records. Aggressive ads are going up in California, Arizona, Nebraska, New Jersey, New York, and Oregon, as Democrats see an opportunity to take control of the House by engaging voters who might not vote straight-ticket — or at all. Republicans currently control the House by a slim margin.
“What we all need to do is to make sure we look at her record, and that record is contrary to what she’s putting out there in her ads,” Tran said in an interview about Steel. “We’re making sure that we educate and remind the voters of who she really is.”
Democrats are also linking Republican incumbents to former President Donald Trump, who has taken credit for the 2022 Supreme Court decision overturning Roe v. Wade. Democrats are warning voters that more restrictions could come. During the Sept. 10 presidential debate, Trump dodged a question about whether he would veto a national abortion ban if elected.
A majority of voters support restoring a federal right to abortion, according to a recent KFF poll. And 1 in 14 voters say abortion is the most important issue in determining their choice. Those voters have the potential to make a difference in the close races, said David McCuan, a political science professor at Sonoma State University.
“The politics of abortion and reproductive health can get voters to participate at higher rates,” McCuan said. “It’s going to be a defining issue.”
Democrats are hoping the issue plays to their favor in California. Voters two years ago codified abortion rights into state law. In May, Planned Parenthood Affiliates of California launched a seven-figure campaign targeting seven Republican seats and Democrat Katie Porter’s open seat.
As a result, political analysts say, Republicans have shied away from their votes on abortion and some incumbents — such as Steel, Garcia, and Central Valley U.S. Rep. David Valadao — have moderated their stances to appeal to voters.
Steel, like Garcia and Valadao, has said she supports exceptions to abortion bans in cases of rape, incest, or threats to the life of the mother. All three co-sponsored a bill amounting to a blanket abortion ban in the previous Congress. Garcia and Valadao left their names off the bill last year, but Steel signed on again as a co-sponsor — briefly.
She withdrew her support after she won her March primary, explaining that it could create confusion because the three-page bill could threaten in vitro fertilization. In a September campaign ad, Steel shared that she had used IVF to have children and reiterated her support for the procedure. Steel spokesperson Lance Trover said she opposes a national abortion ban.
None of the Republican incumbents who represent a California “toss-up” district, as determined by the nonpartisan Cook Political Report, granted KFF Health News an interview. Those who did respond said they do not support a national abortion ban.
Rep. John Duarte added that he opposes a ban because he’s “pro-choice,” and Calvert said “the issue is best decided with the states and their voters directly.” Both voted for a bill to limit medication abortion and supported a measure that would have authorized prison time for medical providers who don’t resuscitate babies born after an attempted abortion.
Tim Rosales, a political strategist who has represented Republican candidates, said these incumbents shouldn’t get heat for changing their minds over time, noting that Democratic former Presidents Bill Clinton and Barack Obama reversed their positions on same-sex marriage.
“There has to be some allowance for evolution on a variety of issues,” Rosales said.
Ben Petersen, a spokesperson for the National Republican Congressional Committee, said Democrats who have called out Republicans for inconsistencies want to move the conversation away from other topics, such as the “disastrous cost of living crisis hurting women and families caused by their one-party control of Sacramento.”
This political dance is playing out on the national stage, especially in battleground races where Republicans find themselves on defense in states where abortion is on the ballot. Roughly two dozen races are considered toss-ups.
In a March post on the social platform X, Republican Nebraska Rep. Don Bacon wrote, “I’ve always defended the life of the mother,” after his Democratic rival, Tony Vargas, called him out for supporting a national abortion ban, which makes no exceptions for cases in which the mother’s life is at risk. That same month, Rolling Stone reported that the Omaha-area congressman had deleted some anti-abortion endorsements from his website. Nebraskans will vote this November on competing abortion ballot measures.
In Arizona, where voters will also be asked whether to enshrine abortion rights into the state constitution, Republican incumbent David Schweikert this year did not support a national abortion ban, which he had co-sponsored at least six times from 2012 to 2021. In April, he wrote on X that he opposed an abortion ban in Arizona, calling on the state legislature to “address this issue immediately.”
On the airwaves, on their websites, and on the campaign trail, Republican candidates are pivoting to convince voters that they have voted to protect women. For example, Steel this month released an ad titled “Champion,” in which the Orange County sheriff says Steel has “worked tirelessly to protect victims of domestic violence and sexual abuse.”
Trover, the Steel spokesperson, said she voted two years ago to reauthorize the Violence Against Women Act. That vote was on a larger $1.5 trillion government spending bill, which included the measure.
The year before, Steel voted against reauthorizing the act.
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.
USE OUR CONTENTThis story can be republished for free (details).
KFF Health News' 'What the Health?': Congress Punts to a Looming Lame-Duck Session
Congress has left Washington for the campaign trail, but after the Nov. 5 general election lawmakers will have to complete work on the annual spending bills for the fiscal year that starts Oct. 1. While the GOP had hoped to push spending decisions into 2025, Democrats forced a short-term spending patch that’s set to expire before Christmas.
Meanwhile, on the campaign trail, abortion continues to be among the hottest issues. Democrats are pressing their advantage with women voters while Republicans struggle — with apparently mixed effects — to neutralize it.
This week’s panelists are Julie Rovner of KFF Health News, Joanne Kenen of Politico and the Johns Hopkins schools of nursing and public health, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.
Panelists Joanne Kenen Johns Hopkins University and Politico @JoanneKenen Read Joanne's stories. Alice Miranda Ollstein Politico @AliceOllstein Read Alice's stories. Lauren Weber The Washington Post @LaurenWeberHP Read Lauren's stories.Among the takeaways from this week’s episode:
- When Congress returns after the election, there’s a chance lawmakers could then make progress on government spending and more consensus health priorities, like expanding telehealth access. After all, after the midterm elections in 2022, Congress passed federal patient protections against surprise medical billing.
- As Election Day approaches, Democrats are banging the drum on health care — which polls show is a winning issue for the party with voters. This week, Democrats made a last push to extend Affordable Care Act subsidies expanded during the pandemic — an issue that will likely drag into next year in the face of Republican opposition.
- The outcry over the first reported deaths tied to state abortion bans seems to be resonating on the campaign trail. With some states offering the chance to weigh in on abortion access via ballot measures, advocates are telling voters: These tragedies are examples of what happens when you leave abortion access to the states.
- And Sen. Bernie Sanders of Vermont summoned the chief executive of Novo Nordisk before the health committee he chairs this week to demand accountability for high drug prices. Despite centering on a campaign issue, the hearing — like other examples of pharmaceutical executives being thrust into the congressional hot seat — yielded no concessions.
Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: KFF Health News’ “How North Carolina Made Its Hospitals Do Something About Medical Debt,” by Noam N. Levey and Ames Alexander, The Charlotte Observer.
Lauren Weber: Stat’s “How the Next President Should Reform Medicare,” by Paul Ginsburg and Steve Lieberman.
Joanne Kenen: The Atlantic’s “The Woo-Woo Caucus Meets,” by Elaine Godfrey.
Alice Miranda Ollstein: Stat’s “How Special Olympics Kickstarted the Push for Better Disability Data,” by Timmy Broderick.
Also mentioned on this week’s podcast:
- KFF Health News’ “Florida’s New Covid Booster Guidance Is Straight-Up Misinformation,” by Arthur Allen, Daniel Chang, and Sam Whitehead.
- KFF Health News’ “Feds Killed Plan To Curb Medicare Advantage Overbilling After Industry Opposition,” by Fred Schulte.
- KFF Health News’ “Audits — Hidden Until Now — Reveal Millions in Medicare Advantage Overcharges,” by Fred Schulte and Holly K. Hacker.
- KFF Health News’ “ACA Plans Are Being Switched Without Enrollees’ OK,” by Julie Appleby.
- KFF Health News’ “Biden Administration Tightens Broker Access to Healthcare.gov To Thwart Rogue Sign-Ups,” by Julie Appleby.
[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]
Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, September 26th, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go.
Today we are joined via teleconference by Lauren Weber of The Washington Post.
Lauren Weber: Hello hello.
Rovner: Alice Ollstein of Politico.
Alice Miranda Ollstein: Good morning.
Rovner: And Joanne Kenen of the Johns Hopkins Schools of Public Health and Nursing, and Politico.
Joanne Kenen: Hi, everybody.
Rovner: Big props to Emmarie for hosting last week while I was in Ann Arbor at the Michigan Daily reunion. I had a great time, but I brought back an unwelcome souvenir in the form of my first confirmed case of covid. So apologies in advance for the state of my voice. Now, let us get to the news.
To steal a headline from Politico earlier this week, Congress lined up in punt formation, passing a continuing resolution that will require them to come back after the election for what could be a busy lame-duck session. Somebody remind us who wanted this outcome — the Let’s only do the CR through December — and who wanted it to go into next year? Come on, easy question.
Ollstein: Well, the kicking it to right before Christmas, which sets up the stage for what we’ve seen so many times before where it just gets jammed through and people who have objections, generally conservatives who want to slash spending and add on a bunch of policy riders, which they tried and failed to do this time, will have a weaker base to operate from, given that everybody wants to go home for the holidays.
And so once again, we’re seeing people mad at Speaker Mike Johnson, who, again and again, even though he is fully from the hard right of the party, is not catering to their priorities as much as they would like. And so obviously his speakership depends on which party wins control of the House in November. But I think even if Republicans win control, I’m already starting to hear rumblings of throwing him overboard and replacing with someone who they think will cater to them more.
Rovner: It was so déjà vu all over again, which is, last year, as we approached October 1st and the Republican House could not pass any kind of a continuing resolution with just Republican votes, that eventually Kevin McCarthy had to turn to Democrats, and that’s how he lost his job.
And yet that’s exactly what happened here, which is the Republicans wanted to go until March, I guess on the theory that they were betting that they would be in full power in March and would have a chance to do a lot more of what they wanted in terms of spending bills than if they just wait and do it in the lame duck. And yet the speaker doesn’t seem to be paying the same price that Kevin McCarthy did. Is that just acknowledgment on the part of the right wing that they can’t do anything with their teeny tiny majority?
Kenen: I mean, yes, it’s pretty stalemate-y up there right now, and nobody is certain who’s going to control the House, and at this point it is likely to still be a narrow majority, whoever wins it. I mean, they’re six weeks out. Things can change. This has been an insane year. Nobody’s making predictions, but it looks like pretty divided.
Rovner: Whoever wins isn’t going to win by much.
Kenen: We have a pretty divided country, and the likelihood is we’re going to have a pretty divided House. So the dynamic will change depending on who’s in charge, but the Republicans are more fractious and divided right now than the Democrats, although that’s really easy to change, and even the Democrats have gone through their rambunctious divided phases, too.
Everybody just doesn’t know what’s next, because the top of the ticket is going to change things. So the more months you push out, the less money you’re spending. If you control the CR, if you make the CR, the continuing resolution, meaning current spending levels for six months, it’s a win for the Republicans in many ways because they’re keeping — they’re preventing increases. But in terms of policy, both sides get some of the things they want extended.
I don’t know if you can call it a productive stalemate. That’s sort of a contradiction in terms. But I mean, for the Republicans, longer, it would’ve been better.
Rovner: So now that we know that Congress has to come back after the election, there’s obviously things that they are able to do other than just the spending bills. And I’m thinking of a lot of unfinished health legislation like the telehealth extensions and the constant, Are we going to do something about pharmacy benefit managers? which has been this bipartisan issue that they never seem to solve.
I would remind the listeners that in 2022 after the election, that’s when they finally did the surprise-bills legislation. So doing big things in the lame duck is not unheard of. Is there anything any of you are particularly looking toward this time that might actually happen?
Kenen: It’s something like telehealth because it’s not that controversial. I mean, it’s easiest to get something through in — in lame duck, you want to get some things off the plate that are either overdue and need to be taken care of or that you don’t want hanging over you next year. So telehealth, which is, there are questions about does it save money, et cetera, and what form it should take and how some of it should be regulated, so forth, but the basic idea, telehealth is popular. Something like that, yes.
PBMs [pharmacy benefit managers] is a lot harder, where there is some agreement on the need to do something but there’s less agreement about what that something should look like. So although I’m not personally covering that day-to-day basis, in any sense, that’s harder. The more consensus there is and the fewer moving parts, the easier it is to do, as a rule. I mean, sometimes they do get something big done in lame duck, but a lot of it gets kicked.
And also there’s a huge, huge, huge tax fight next year, and it’s going to require a lot of wheeling and dealing no matter what shape it takes, because it’s expiring and things have to be either renewed or allowed to die. So that’s just going to be mega-enormous, and a lot of this stuff become bargaining chips in that larger debate, and that becomes the dominant domestic policy vehicle next year.
Rovner: Well, even before we get to the lame duck, we have to finish the campaign, which is only a month and a half away. And we are still talking about the Affordable Care Act in an election where it was not going to be a campaign issue, everybody said.
I know that you talked last week about all the specifics of the ways former President [Donald] Trump actually tried to sabotage rather than save the ACA and all the ways what [Sen.] JD Vance was talking about on “Meet the Press,” dividing up risk pools once again so sicker people would no longer be subsidized by the less sick, would turn the clock back to the individual insurance market as it existed before 2014.
Now the Democrats in the Senate are taking one last shot at the ACA with a bill — that will fail — to renew the expanded marketplace subsidies, so it will expire unless Congress acts by the end of next year. Might this last effort have some impact in the swing states, or is it just a lot more campaign noise?
Weber: I think this is a lot of campaign noise, to some extent. I mean, I think Democrats are clear in polling shows that the average American voter does trust Democrats more than Republicans on ACA and health issues and health insurance. So I do think this is a messaging push in part by the Dems to speak to voters. As we all know, this is a turnout election, so I think anything that they feel like voters care about, which often has to do with their pocketbook, I think they’re going to lead the drum on.
I do think it’s interesting again that JD Vance really is reiterating a talking point that Donald Trump used in the debate, which is that he said he had improved the ACA and many experts would say it was very much the opposite. Again, I think I did this on the last podcast, but let me reread this because I think it’s important as a fact check. Most of the Trump administration’s ACA-related actions included cutting the program.
So they reduced millions of dollars of funding for marketing and enrollment, and he repeatedly tried to overturn the law. So I think some of the messaging around this is getting convoluted, in part because it’s an election year, to your point.
Rovner: And because it’s popular. Because Nancy Pelosi was right. When people found out what was in it, it got popular.
Kenen: I think there are two things. I mean, I agree with what Lauren just said, but the Democrats came out in favor of extending the subsidies yesterday, which not only changed the eligibility criteria — more people, more higher up the middle-income chain could get subsidized — but also everybody in it had extra benefits for it, including people who were already covered. But it’s better for them.
The idea that Republicans are going to try to take that benefit away from people six weeks before an election — they were probably not. How they handle it next year? I was really surprised by the silence yesterday. The Democrats rolled out their plans for renewing this, and I didn’t see a lot of Republican pushback. So they were really quiet about it.
The other thing that struck me is that JD Vance went on on this risk pool thing last week on “Meet the Press” and in Raleigh, in North Carolina, and then there was pushback. And on that particular point, there’s been silence for the last week. I don’t think he stuck his neck out on that one again. Who knows what next week will bring, but it didn’t continue, and nor did I hear other Republicans saying, “Yeah, let’s go do that.”
So if that was a trial balloon, it was somewhat leaden. So I think that we really don’t know how the subsidy fight is going to play —how or when the subsidy fight will play out. It’s really, you know, we’ve all said many times before, once you give people the benefit, it’s really hard to take it away. And—
Rovner: Although we did that with the Child Tax Credit. We gave everybody the Child Tax Credit and then took it away.
Kenen: We did, and other things that were temporary during the pandemic, and we’ll just see how many of those temporary things do in fact go away. I mean, does it come back next year? I mean, now SALT [state and local taxes], right? I mean, Trump backed backing what’s called SALT. It’s a limit based on mortgage and state taxes. And now he’s talking about he’s going to rescue that like it wasn’t him who … So it all comes around again.
Ollstein: Yeah, and I think what you’re seeing is both sides drawing the battle lines for next year and signaling what the core arguments are going to be. And so you had Democrats come out with their bill this year, and you are hearing a lot of Republicans in hearings and speeches sprinkled around talking about claiming that there is a huge amount of fraud in the ACA marketplaces and linking that to the subsidies and saying, Why would we continue to subsidize something where there’s all this fraud?
I think that is going to be a big argument on that side next year for not extending the subsidies. So I would urge people to keep listening for that.
Kenen: And that came from a conservative think tank consulting firm in which they blame — I actually happened to read it this week, so it’s fresh in my mind. They’re blaming the fraud actually on brokers rather than individuals. They’re saying that people are—
Rovner: That was an investigation uncovered by my colleague Julie Appleby here at KFF Health News.
Kenen: Right. And they ran with that, and they were talking about the low end of the income bracket. And I’m waiting for the sequel in which the people at the upper end of the income bracket, which is the law that’s expiring that we’re talking about, it’s pretty — I’m waiting for the sequel Paragon paper saying, See, it’s even worse at the upper end, and that’s easy to get rid of because it’ll expire. That’s the argument of the day, but there’s so many flavors of anti-ACA arguments that we’ve just scratched the beginning of this round.
Rovner: Exactly. It’ll come back. All right, well, let us move on to abortion. Vice President [Kamala] Harris said in an interview this week that she would support ending the filibuster in the Senate in order to restore abortion rights with 51 rather than 60 votes, which has apparently cost her the endorsement of retiring West Virginia Democratic senator Joe Manchin. Was Manchin’s endorsement even that valuable to her? It’s not like West Virginia was going to vote Democratic anytime soon.
Ollstein: The Harris campaign has really leaned into emphasizing endorsements she’s been getting from across the ideological spectrum, from as far right as Dick Cheney to more centrist types and economists and national security people. And so she’s clearly trying to brandish her centrist credentials. So I guess in that sense. But like you said, Democrats are not going to win West Virginia, and so I think also he was getting upset about something, a position she’s been voicing for years now. This is not new, this question of the filibuster. So I doubt it’ll have much of an impact.
Kenen: It’s a real careful-what-you-wish for, because if the Senate goes Republican, which at the moment looks like it’s going to be a narrow Republican majority. We don’t know until November. There’s always a surprise. There’s always a surprise.
Rovner: You’re right. It’s more likely that it’ll be 51-49 Republican than it’ll be 51-49 Democrat.
Kenen: Right. So if the filibuster is going to be abolished, it would be to advance Republican conservative goals. So it’s sort of dangerous territory to walk into right now. The Democrats have played with abolishing the filibuster. They wanted to do it for voting rights issues, and they decided not to go there on legislation. They did modify it a number of years ago on judicial appointments and other Cabinet appointments and so forth.
But legislative, the filibuster still exists. It’s very, very, very heavily used, much more than historically, by both parties, whoever is in power. So changing it would be a really radical change in how things move or don’t move. So it could have a long tail, that remark.
Rovner: Meanwhile, Senate Democrats, who don’t have the votes now, as we know, to abolish the filibuster, because Manchin is among their one-vote margin, are continuing to press Republicans on reproductive rights issues that they think work in their favor. Earlier this week, the Senate Finance Committee had a hearing on EMTALA, the Emergency Medical Treatment and Labor Act.
It’s a federal law that’s supposed to guarantee women access to abortion in medical emergencies. But in practice, it has not. Last week we talked about the ProPublica stories on women whose pregnancy complications actually did lead to their death. Is this something that’s breaking through as a campaign issue? I do feel like we’ve seen so much more on pregnancy complications and the health impacts of those rather than just, straight, women who want to end pregnancies.
Ollstein: I just got back from Michigan, and I would say it is having a big impact. I was really interested in how Democrats were trying to campaign on abortion in Michigan, even now that the state does have protections. And I heard over and over from voters and candidates that Trump’s leave-it-to-the-states stance, they really are still energized by that.
They’re not mollified by that, because they are pointing to stories like the ones that just came out in Georgia and saying: See? That’s what happens when you leave it to the states. We may be fine, but we care about more than just ourselves. We’re going to vote based on our concern for women in other states as well. I found that really interesting to be hearing out in the field.
Rovner: Lauren, you want to add something?
Weber: Yeah, I just was going to add, I mean, Harris obviously highlighted this effectively in the debate, and I think that has helped bring it to more of a crescendo, but there’s obviously been a lot of reporting for months on this. I mean, the AP has talked about — I think they did a count. It’s over 100 women, at least, have been denied emergency care due to laws like this.
I’d be curious — and it sounds like Alice has this, for voters that are in swing states, that it’s breaking through to — I’d be curious how much this has siloed to people that are outraged by this, and so we’re hearing it and how much it’s skidding down to those that — the Republican talking points have been that these are rare, they don’t really happen, it’s a liberal push to get against this. I’d be curious how much it’s breaking through to folks of all stripes.
Rovner: I watched a big chunk of the Finance Committee hearing, and the anti-abortion witnesses were saying this is not how it worked, that ectopic pregnancies, pregnancy complications do not qualify as abortions, and basically just denying that it happened. They’re sitting here. They’re sitting at the witness table with the woman to whom this happened and saying that this does not happen. So it was a little bit difficult, shall we say. Go ahead.
Ollstein: Well, and the pushback I’ve been hearing from the anti-abortion side is less that it’s not happening and more that it’s not the fault of the laws, it’s the fault of the doctors. They are claiming that doctors are either intentionally withholding care or are wrong in their interpretation of the law and are withholding care for that reason. They’re pointing to the letter of the law and saying, Oh no, it doesn’t say let women bleed out and die, so clearly it’s fine. They’re not really grappling with the chilling effect it’s having.
Rovner: Although we do know that in Texas when, I think it was Amanda Zurawski, there was — no, it was Kate Cox who actually got a judge to say she should be allowed to have an abortion. Ken Paxton, the Texas attorney general, then threatened the hospital, said, If you do this, I will come after you. On the one hand, they say, Well, that’s not what the law says. On the other hand, there are people saying, Yeah, that’s what the law says.
Turning to the Republicans, Donald Trump had some more things to say about abortion this week, including that he is women’s protector and that women will, and I quote, “be happy, healthy, confident, and free. You will no longer be thinking about abortion.”
If that wasn’t enough, in Ohio, Bernie Moreno, who’s the Republican running against Senator Sherrod Brown in the otherwise very red state, said the other night that he doesn’t understand why women over 50 would even care about abortion, since, he suggested, they can no longer get pregnant, which isn’t correct, by the way. But who exactly are the voters that Trump and Moreno are going after here?
Kenen: Moreno is already lagging in the polls. Sherrod Brown is a pretty liberal Democrat in an increasingly conservative state, and he’s also very popular. And it looks like he’s on a glide path to win, and this probably made it easier for him to win. And there are men who support abortion rights, and there are women who oppose.
I mean, this country’s divided on abortion, but it’s not age-related. It’s not like if you’re under 50 and female, you care about abortion and nobody else does. I mean, that’s really not the way it works. Fifty-year-old and older women, some of whom had abortions when they were younger, would want that right for younger women, including their daughters. It’s not a quadrant. It’s not like, oh, only this segment cares.
Ollstein: It’s interesting that it comes amid Democrats really working to broaden who they consider an abortion voter, like I said, trying to encourage people in states where abortion is protected to vote for people in states where abortion is not protected and doing more outreach to men and saying this is a family issue, not just a women’s issue, and this affects everybody.
So as you see Democrats trying to broaden their outreach and get more people to care, you have Bernie Moreno saying the opposite, saying, I don’t understand why people care when it doesn’t affect their own particular life and situation.
Rovner: Although I will say, having listened to a bunch of interviews with undecided voters in the last couple of weeks, I do hear more and more voters saying: Well, such and such candidate, and this is on both sides, is not speaking to me. It’s almost like this election is about them individually and not about society writ large.
And I do hear that on both sides, and it’s kind of a surprise. And I don’t know, is that maybe where Moreno is coming from? Maybe that’s what he’s hearing, too, from his pollsters? It’s only that people are most interested in their own self-interest and not about others? Lauren, you wanted to add to that?
Weber: I mean, I would just say I think that’s a kind interpretation, Julie. I think that more likely than not, he was just speaking out of turn. And in some prior reporting I did this year on misinformation around birth control and contraception, I spoke to a bunch of women legislators, I believe it was in Idaho, who found that in speaking with their male legislator friends, that a lot of them were uncomfortable talking about abortion, birth control, et cetera, which led to a lot of these misconceptions. And I wonder if we’re seeing that here.
Ollstein: Just quickly, I think it’s also reflective of a particular conservative mind-set. I mean, it reminds me of when I was covering the Obamacare fight in Congress and you had Republican lawmakers making jokes about, Oh, well, wouldn’t want to lose coverage for my mammograms. And just what we were just talking about, about the separate risk pools and saying, Oh, I’m healthy. Why should I subsidize a sick person? when that’s literally how insurance works.
But I think just the very individualistic go-it-alone, rugged-individual mind-set is coming out here in different ways. And so it seems like he did not want this particular comment to be scrutinized as it is getting now, but I think we hear versions of this from conservative lawmakers all the time in terms of, Why should I have to care about, pay for, subsidize, et cetera, other people in society?
Rovner: Yeah, there’s a lot of that. Well, finally this week in reproductive health issues that never seem to go away, a federal judge in North Dakota this week slapped an injunction on the Equal Employment Opportunity Commission’s enforcement of some provisions of the 2022 Pregnant Workers Fairness Act, ruling that Catholic employers, including for-profit Catholic-owned entities, don’t have to provide workers with time off for abortions or fertility treatments that violate the church’s teachings.
Now, lest you think this only applies to North Dakota, it does not. There’s a long way to go before this ruling is made permanent, but it’s kind of awkward timing for Republicans when they’re trying to convince voters of their strong support of IVF [in vitro fertilization], and yet here we have a large Catholic entity saying, We don’t even want to give our workers time off for IVF.
Ollstein: Yeah, I think you’ve been hearing a lot of Republicans scoffing at the idea that anyone would oppose IVF, when there are many, many conservatives who do either oppose it in its entirety or oppose certain ways that it is currently commonly practiced. You had the Southern Baptist Convention vote earlier this year in opposition to IVF. You have these Catholic groups who are suing over it.
And so I think there needs to be a real reckoning with the level of opposition there is on the right, and I think that’s why you’re seeing an interesting response to Trump’s promise for free IVF for all and whether or not that is feasible. I think this shows that it would get a lot of pushback from groups on the right if they were ever to pursue that.
Rovner: Yeah, I will also note that this was a Trump-appointed judge, which is pretty … The EEOC, when they were doing these final regulations, acknowledged that there will be cases of religious employers and that they will look at those on a case-by-case basis. But this is a pretty sweeping ruling that basically says, we’re back to the Hobby Lobby Supreme Court case: If you don’t believe in something, you don’t have to do it.
I mean, that’s essentially where we are with this, and we will see as this moves forward. Well, moving on to another big election issue, drug prices, the CEO of Novo Nordisk, makers of the blockbuster obesity and diabetes drugs Ozempic and Wegovy, appeared at the Senate Health, Education, Labor and Pensions Committee on Tuesday in front of Senator Bernie Sanders, who has been one of their top critics.
And maybe it’s just my covid-addled brain, but I watched this hearing and I couldn’t make heads or tails of how Lars Jørgensen, the CEO, tried to explain why either the differences between prices in the U.S. and other countries for these drugs weren’t really that big, or how the prices here are actually the fault of PBMs, not his company. Was anybody able to follow this? It was super confusing, I will say, that he tried to …
First he says that, well, 80% of the people with insurance coverage can get these drugs for $25 a month or less, which I’m pretty sure only applies to people who are using it for diabetes, not for obesity, because I think most insurers aren’t covering it for obesity. And there was much backing and forthing about how much it costs and how much we pay and how much it would cost the country to actually allow people, everybody who’s eligible for these drugs, to use them. And no real response. I mean, this is a big-deal campaign issue, and yet I feel like this hearing was something of a bust.
Weber: I mean, do we really expect a CEO of a highly profitable drug to promise to reduce it immediately on the spot? I mean, I guess I’m not surprised that the hearing was a back-and-forth. From what I understand of what happened, I mean, most hearings with folks that have highly lucrative drugs, they’re not looking to give away pieces of the lucrative drugs. So I think to some extent we come back to that.
But I did think what was interesting about the hearing itself was that Sanders did confront him with promises from PBMs that they would be able to offer these drugs and not short the American consumer, which was actually a fascinating tactic on Sanders part. But again, what did we really walk away with? I’m not sure that we know.
Rovner: Yeah, I mean, even if you were interested in this issue — and I’m interested in this issue and I know this issue better than the average person, as I said —I literally could not follow it. I found it super frustrating. I mean, I know what Sanders was going for here. I just don’t feel like he got what he was hoping to. I don’t know. Maybe he was hoping to get the CEO to say, “We’ve been awful, and so many people need this drug, and we’re going to cut the price tomorrow.” And yes, you point out, Lauren, that did not happen. But we shall see.
Well, speaking of PBMs, the Federal Trade Commission late last week filed an administrative complaint against the nation’s three largest PBMs, accusing them of inflating insulin prices and steering patients toward higher-cost products so they, the PBMs, can make more money, which is, of course, the big problem with PBMs, which is that they get a piece of the action. So the more expensive the drug, the bigger the piece of the action that they get.
I was most interested in the fact that the FTC’s three Democratic appointees voted in favor of the legal action. Its two Republican appointees didn’t vote but actually recused themselves. This whole PBM issue is kind of awkward for Republicans who say they want to fight high drug prices, isn’t it? I feel like the whole PBM issue, which, as we said, is something that Congress in theory wants to get to during the lame-duck session, is tricky.
I mean, it’s less tricky for Democrats who can just demagogue it and a little bit more tricky for Republicans who tend to have more support from both the drug industry and the insurance industry and the PBM industry. How much can they say they want to fight high drug prices without irritating the people with whom they are allied?
Kenen: And the PBMs themselves are owned by insurers. The pharmaceutical drug pricing, it’s really, really, really confusing, right?
Rovner: Nobody understands it.
Kenen: The four of us, none of us cover pharma full time, but the four of us are all pretty sophisticated health care reporters. And if we had to take a final exam on the drug industry, none of us would probably get an A-plus. So I’d be surprised if they figure this out in lame duck. I mean, they could —there’s always the possibility that when they look at the outcome of things, they decide: We do need to cut a deal and get this off the plate. This is the best we’re going to get. We’re going to be in a worse position next month. And they do it.
But it just seems really sticky and complicated, and it doesn’t feel like it’s totally jelled yet to the point that they can move it. I would expect this to spill into next year. If a deal comes through, if a big budget deal comes through at the end of the year, it does have a lot of trade-offs and moving parts, and this could, in fact, get wrapped into it.
If I had to guess, I would say it’s more likely to spill into the following year, but maybe they’ve decided they’ve had enough and want to tie the bow on it and move on. And then it’ll go to court and we’ll spend the next year talking about the court fight against the PBM law. So it’s not going to be gone one way or another, and nor are high drug prices going to be gone one way or another.
Rovner: The issue that keeps on giving. Well, finally this week, a new entry in out This Week in Health Misinformation segment from, surprise, Florida. This is a story from my KFF Health News colleagues Arthur Allen, Daniel Chang, and Sam Whitehead. And the headline kind of says it all: “Florida’s New Covid Booster Guidance Is Straight-Up Misinformation.”
This is the continuing saga involving the state surgeon general, Joseph Ladapo, who’s been talking down the mRNA covid vaccine for several years now and is recommending that people at high risk from covid not get the latest booster. What surprised me about this story, though, was how reluctant other health leaders in Florida, including the Florida Medical Association, have been to call the surgeon general out on this.
I guess to avoid angering his boss, Republican governor Ron DeSantis, who’s known to respond to criticism with retribution. Anybody else surprised by the lack of pushback to this there in Florida? Lauren?
Weber: No, I’m not really surprised. I mean, we’ve seen the same thing over and over and over again. I mean, this is the man who really didn’t make a push to vaccinate against measles when there was an outbreak. He has previously stated that seniors over 65 should not get an mRNA vaccine, with misinformation about DNA fragments. We’ve seen this pattern over and over again.
He is a bit of a rogue state public health officer in a crew that usually everyone else is on pretty much the same page, whether or not they’re red- or blue-state public health officers. And I think what’s interesting about this story and what continues to be interesting is as we see RFK [Robert F. Kennedy Jr.] gaining influence, obviously, in Trump’s potential health picks, you do wonder if this is a bit of a tryout. Although Ladapo is tied to DeSantis, who Trump obviously has feelings about. So who knows there. But it very clearly is the politicization of public health writ large.
Kenen: And DeSantis, during the beginning of the pandemic, he disagreed with the CDC [Centers for Disease Control and Prevention] guidelines about who should get vaccinated, but he did push them for older people. And I think that was his cutoff. If you’re 15 up, you should have them. He was quite negative from the start on under. Florida’s vaccination rates for the older population back when they rolled out in late 2020, early 2021, were not — they were fairly high. And there’s been a change of tone. As the political base became more anti-vax, so did the Florida state government.
Rovner: And obviously, Florida, full of older people who vote. So, I mean, super-important constituency there. Well, we will watch that space. All right, that is this week’s news. Now it is time for our extra credits. That’s when we each recommend a story we read this week we think you should read, too. Don’t worry if you miss the details. We will include links to all these stories in our show notes on your phone or other device. Joanne, why don’t you go first this week?
Kenen: Elaine Godfrey in the Atlantic has a story called “The Woo-Woo Caucus Meets,” and it’s about a four-hour summit on the Hill with RFK Jr., moderated by Senator Ron Johnson of Wisconsin, who also has some unconventional ideas about vaccination and public health. The writer called it the “crunch-ificiation of conservatism.”
It was the merging of the anti-vax pharma-skeptic left and the Trump right and RFK Jr. talking about MAHA, Making America Healthy Again, and his priorities for what he expects to be a leading figure in some capacity in a Trump administration fixing our health. It was a really fun — just a little bit of sarcasm in that story, but it was a good read.
Rovner: Yeah, and I would point out that this goes, I mean, back more than two decades, which is that the anti-vax movement has always been this combination of the far left and the far right.
Kenen: But it’s changed now. I mean, the medical liberty movement, medical freedom movement and the libertarian streak has changed. It started changing before covid, but it’s not the same as it was a few years ago. It’s much more conservative-dominated, or conservative-slash-libertarian-dominated.
Rovner: Alice.
Ollstein: I have an interesting story from Stat. It’s called “How Special Olympics Kickstarted the Push for Better Disability Data.” It’s about how the Special Olympics, which just happened, over the years have helped shine a light on just how many people with developmental and intellectual disabilities just aren’t getting the health care that they need and aren’t even getting recognized as having those disabilities.
And the data we’re using today comes from the Clinton administration still. It’s way out of date. So there have been improvements because of these programs like Healthy Athletes that have been launched around this, but it’s still nowhere near good enough. And so this was a really fascinating story on that front and on a population that’s really falling through the cracks.
Rovner: It really was. Lauren.
Weber: I actually picked an opinion piece in Stat that’s called, quote, “How the Next President Should Reform Medicare,” by Paul Ginsburg and Steve Lieberman. And I want to give a shoutout to my former colleague Fred Schulte, who basically has single-handedly revealed — and now, obviously, there’s been a lot of fall-on coverage — but he was really beating this drum first, how much Medicare Advantage is overbilling the government.
And Fred, through a lot of FOIAs [Freedom of Information Act requests] — and KFF has sued to get access to these documents — has shown that, through government audits, the government’s being charged billions and billions of dollars more than it should be to pay for Medicare Advantage, which was billed as better than Medicare and a free-market solution and so on. But the reality is …
Rovner: It was billed as cheaper than Medicare.
Weber: And billed as cheaper.
Rovner: Which it’s not.
Weber: It’s not. And this opinion piece is really fascinating because it says, look, no presidential candidate wants to talk about changing Medicare, because all the folks that want to vote usually have Medicare. But something that you really could do to reduce Medicare costs is getting a handle around these Medicare Advantage astronomical sums. And I just want to shout out Fred, because I really think this kind of opinion piece is possible due to his tireless coverage to really dig into what’s some really wonky stuff that reveals a lot of money.
Rovner: Yes, I feel like we don’t talk about Medicare Advantage enough, and we will change that at some point in the not-too-distant future. All right, well, my story is from KFF Health News from my colleague Noam Levey, along with Ames Alexander of the Charlotte Observer. It’s called “How North Carolina Made Its Hospitals Do Something About Medical Debt.”
Those of you who are regular listeners may remember back in August when we talked about the federal government approving North Carolina’s unique new program to have hospitals forgive medical debt in exchange for higher Medicaid payments. It turns out that getting that deal with the state hospitals was a lot harder than it looked, and this piece tells the story in pretty vivid detail about how it all eventually got done. It is quite the tale and well worth your time.
OK, that is our show for this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcast. We’d appreciate it if you left us a review. That helps other people find us, too. Special thanks as always to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org, or you can still find me at X. I’m @jrovner. Lauren, where are you?
Weber: I’m still on X @LaurenWeberHP.
Rovner: Alice?
Ollstein: On X at @AliceOllstein.
Rovner: Joanne?
Kenen: X @JoanneKenen and Threads @JoanneKenen1.
Rovner: We will be back in your feed next week. Until then, be healthy.
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In Montana Senate Race, Democrat Jon Tester Misleads on Republican Tim Sheehy’s Abortion Stance
Tim Sheehy “would let politicians like him ban abortion, with no exceptions for rape or to save a woman’s life, and criminalize women.”
A Facebook ad from the campaign of Sen. Jon Tester (D-Mont.), launched on Sept. 6, 2024
In a race that could decide control of the U.S. Senate, Sen. Jon Tester (D-Mont.) is attacking his challenger, Republican Tim Sheehy, for his stance on abortion.
Montana’s Senate race is one of a half-dozen tight contests around the country in which Democrats are defending seats needed to keep their one-seat majority. If Republicans flip Tester’s seat, they could take over the chamber even if they fail to oust Democrats in any other key races.
In a series of Facebook ads launched in early September, Tester’s campaign said Sheehy supports banning abortion with no exceptions.
An ad launched on Sept. 6 said, “Tim Sheehy wants to take away the freedom to choose what happens with your own body, and give that power to politicians. Sheehy would let politicians like him ban abortion, with no exceptions for rape or to save a woman’s life, and criminalize women. We can’t let Tim Sheehy take our freedom away.”
Sheehy’s Anti-Abortion Stance Allows for Rape, Health Exceptions
Sheehy’s website calls him “proudly pro-life,” and he’s campaigning against abortion. He opposes a measure on Montana’s November ballot that would amend the Montana Constitution to provide the right to “make and carry out decisions about one’s own pregnancy, including the right to abortion.”
In July, we rated False Sheehy’s statement that Tester and other Democrats have voted for “elective abortions up to and including the moment of birth. Healthy, 9-month-year-old baby killed at the moment of birth.”
But contrary to the new ad’s message, Sheehy has voiced support for exceptions.
In a Montana Public Radio interview in May, Sheehy was asked, “Yes or no, do you support a federal ban on abortion?”
Sheehy said, “I am proudly pro-life and support commonsense protections for when a baby can feel pain, as well as exceptions for rape, incest, and the life of the mother, and I believe any further limits must be left to each state.”
And in a June debate with Tester, Sheehy said, “I’ll always protect the three rights for women: rape, incest, life of the mother.”
The issues section of Sheehy’s campaign website does not say that he has a no-exceptions stance, nor does it say he would “criminalize women” who have abortions.
In a statement, the Sheehy campaign told PolitiFact that the ad mischaracterizes Sheehy’s abortion position. Allowing no exceptions “has never been Tim’s position,” the campaign said.
Our Ruling
The Tester campaign’s ad says Sheehy “would let politicians like him ban abortion, with no exceptions for rape or to save a woman’s life, and criminalize women.”
Sheehy has said he supports abortion ban exceptions for rape or to save a pregnant woman’s life. We found no instances of him saying he would be OK with states criminalizing women who receive abortions in violation of state laws.
What gives the ad a kernel of truth is that Sheehy has voiced support for letting states decide abortion parameters within their borders. The Tester campaign argues that this means Sheehy would effectively enable legislators to pass abortion restrictions that don’t include exceptions or that criminalize women.
The Tester campaign’s argument relies on hypotheticals and ignores Sheehy’s stated support for exceptions, giving a misleading impression of Sheehy’s position.
We rate it Mostly False.
Our SourcesJon Tester, Facebook ad, Sept. 6, 2024
Tim Sheehy, campaign issues page, accessed Sept. 12, 2024
KFF, “Policy Tracker: Exceptions to State Abortion Bans and Early Gestational Limits,” last updated July 29, 2024
Montana Public Radio, “Q&A: Tim Sheehy, Republican Candidate for U.S. Senate,” May 15, 2024
Montana Senate debate (excerpt), June 9, 2024
Last Best Place PAC, “choice” web page, accessed Sept. 12, 2024
Montana Republican Party, 2024 platform, accessed Sept. 12. 2024
Daily Montanan, “Sheehy criticizes ballot measures, including initiative to protect abortion,” Aug. 22, 2024
Sabato’s Crystal Ball, “Where Abortion Rights Will (or Could) Be on the Ballot,” July 9, 2024
Heartland Signal, “Unearthed audio shows Tim Sheehy calling abortion ‘sinful,’ wanting it to ‘end tomorrow,’” Aug. 30, 2024
Montana Independent, “Jon Tester accuses Tim Sheehy of lying about abortion during first Senate campaign debate,” June 11, 2024
Statement to PolitiFact from the Sheehy campaign
Statement to PolitiFact from the Tester campaign
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