| Good morning! This newsletter top was reported with Caroline Kitchener, who covers abortion for The Post. (Give her a follow here.) We'll be back with more for you tomorrow. Not a subscriber? Sign up here. Today's edition: PhRMA has joined the legal fight to stop Medicare from negotiating drug prices. Democrats launch their efforts aimed at putting Republicans on the defense on abortion. But first … | The fight over abortion has entered a fragile new phase one year after the fall of Roe |  Demonstrators outside the U.S. Supreme Court. (Michael S. Williamson/The Washington Post) | | | This is what the nation's abortion landscape looks like a year after the Supreme Court overturned Roe v. Wade. About a quarter of women of reproductive age live where abortion is banned or mostly banned. About 55 clinics across the South and Midwest have stopped providing abortions. And new restrictions have led to at least 24,290 fewer legal abortions since the nation's highest court overturned the nearly 50-year constitutional right to an abortion. The numbers help paint a portrait of the state of abortion in a post-Roe America. But they don't tell the full story. Over the past few weeks, Caroline and I conducted more than 30 interviews with key players in the abortion debate, including advocates, lawmakers and doctors. What emerged was a complicated picture of abortion access, where the stark lines dividing post-Roe America — with some states restricting abortion and others expanding protections — have become far blurrier than many anticipated in the 12 months since the ruling. | | On June 24, 2022, the Supreme Court cleared the way for 11 states to immediately halt all or most abortions. (Oklahoma already had a near-total ban in place.)  | | | One year later, abortion is banned or mostly banned in 15 states. Abortion restrictions are blocked by the courts in at least six more.  | | | As the country begins its second year post-Roe, the full impact of the landmark decision remains unclear and in flux. | | Here are a few reasons. A rapidly expanding underground network of abortion pill providers is helping people who live in states with bans self-manage their own abortions, which has ended an unknown number of pregnancies. There hasn't been a swell of prosecutions as abortion rights advocates had feared, emboldening those who help distribute pills — and a shift is underway that may let women in banned states get the medication faster. Meanwhile, legal abortions have spiked in states neighboring regions with strict abortion bans, such as Florida, Illinois, North Carolina and Colorado. National abortion funds are trying to expand their efforts to help pay for travelers with the National Abortion Federation's hotline averaging spending around $1,100 in costs per person the group helps. Abortion rights advocates argue such options aren't a substitute for widespread access to abortion in clinics, and say such bans have caused confusion among patients and providers as laws sometimes change by the day. The landscape could shift again. Major antiabortion groups say they're aiming for further restrictions in more states and at the federal level. The 2024 presidential election looms, and so do key court decisions that could greenlight additional bans or revoke government approval of an abortion pill used in more than half of abortions across the country. | | Abortion clinic operator Alan Braid had already planned out his facilities' post-Roe future: Move operations to states where abortion is sure to remain legal, but near states with bans. He's not the only one. In total, 16 new clinics have opened in states where abortion is largely permitted, according to a database maintained by Caitlin Myers, an economics professor at Middlebury College who studies abortion. | - While some women have traveled to states where abortion is legal, those journeys come with a high price tag — hundreds of dollars for transportation, hotels and child care, in addition to the $500 to $800 typically required for the procedure or medication itself — making doing so difficult for low-income patients who can't cover the costs or take time off work.
| | Meanwhile, the number of women seeking pills from Aid Access — a Europe-based organization that mails abortion pills to all 50 states, including states where abortion is banned — has increased. The group received almost 60 percent more requests this spring than in the months immediately following the Supreme Court decision. | - This comes as Aid Access streamlined its process for mailing pills in mid-June, founder Rebecca Gomperts told Caroline. No longer do all pills need to be shipped from India. Now, the organization has revamped its operation to let doctors in Democratic-led states with "shield laws" — which aim to protect providers practicing in states where abortion is legal — mail abortion pills to states where the medication is banned.
| | On the other side, some abortion opponents are urging Republican lawmakers to do more to crack down on illegal pill networks, backing measures that could help states to fully enforce their abortion bans. | | One thing that's not yet clear: Whether the bans are succeeding in having significantly more women carry their pregnancies to term. Data on legal abortions is muddied by the many who choose to self-manage their abortions with medication. That's coupled with the fact that most strict new abortion limits have only been in effect for roughly 12 months. Researchers are looking to Texas for clues. The state's roughly six-week ban went into effect in September 2021 and relevant birth data has started to emerge. | - In the year after Texas implemented Senate Bill 8, the birthrate in the state rose by 4.7 percent, according to a Washington Post analysis of provisional data from the Centers for Disease Control and Prevention, while birthrates across the country remained flat, upticking by only 0.2 percent.
- Experts say the state's abortion ban has probably played a role. But they also cite several other factors, such as a rise in births after the coronavirus pandemic amid a post-covid spike in immigration among Hispanics, a population that tends to have a higher birthrate.
| | |  | In the courts | | PhRMA joins legal fight over Medicare drug-pricing negotiations |  The new program is aimed at lowering the cost of medications for seniors. (iStock) | | | The pharmaceutical industry's leading lobbying group is taking the Biden administration to court. In a lawsuit filed yesterday, the Pharmaceutical Research and Manufacturers of America, along with two other groups, argues that a signature provision of President Biden's Inflation Reduction Act granting Medicare the power to negotiate certain prescription drug prices is unconstitutional on several grounds. | - The groups contend that the forthcoming program unlawfully forces companies to agree to lower their drug prices by threatening them with massive penalties, calling it "a government mandate disguised as negotiation."
| | Zooming out: The long-anticipated lawsuit marks the fourth such legal challenge against the policy this month — including by drugmakers Merck and Bristol Myers Squibb — raising the prospect that older Americans may never see lower pharmacy bills, The Post's Tony Romm writes. | | Stephen Ubl, CEO of PhRMA: |  | | | | | |  | On the Hill | | Senate Democrats seek to put Republicans on defense on abortion |  Sen. Patty Murray (D-Wash.) led an effort to mark the anniversary of the high court's abortion decision. (J. Scott Applewhite/AP) | | | Democrats attempted to use a procedural move to greenlight several abortion and reproductive health bills on the Senate floor yesterday — and they were met with objections from Republicans. Unsurprisingly, GOP lawmakers blocked all four bills that Democrats called up for consideration, which included proposals to enshrine the right to travel for an abortion and use contraceptives in federal law, shield doctors that provide legal abortion care from legal threats, and expand privacy protections for online health and location data. The maneuver was a Democratic messaging moment. Asking to pass bills via unanimous consent doesn't require all senators to cast votes, and even a single objection would result in their failure. But for Democrats, it was a chance to put Republicans on the spot and push the issue to the forefront of voters' minds as the anniversary of the Supreme Court's decision overturning Roe v. Wade nears. | | Democratic Sen. Patty Murray (Wash.): |  | | | | | Republican Sen. Mike Lee (Utah): |  | | | | Meanwhile, on the other side of the Capitol … | | House Republicans passed legislation yesterday that includes a provision to codify a Trump-era rule expanding health reimbursement arrangements. The chamber voted 220-209 along party lines to advance the CHOICE Arrangement Act, which is likely to face head winds in the Democratic-controlled Senate after catching heat from some patient advocacy groups and the Biden administration. | - In a statement of administration policy yesterday, the White House said it "strongly opposes" the bill and called it "yet another attack on the Affordable Care Act."
- Rep. Kevin Hern (R-Okla.), sponsor of the bill, defended the legislation, saying in a statement that it "puts employees in the driver's seat when it comes to picking their health care plan."
| | |  | Agency alert | | GSK, Pfizer RSV shots secure key votes from CDC advisers |  Manufacturers hope to roll out the shots ahead of the winter RSV season. (iStock) | | | Independent advisers to the Centers for Disease Control and Prevention voted in favor of making a pair of newly approved RSV vaccines available to older adults, but the group stopped short of recommending that all of them get the shots, Helen Branswell reports for Stat. In two separate votes yesterday, the committee said that people 60 and older "may" receive a single dose of either Pfizer or GSK's RSV vaccine after consulting with their doctor. The panel had initially looked to issue a stronger recommendation, but it was watered down after some advisers expressed concerns about the decisions they were being asked to make based on data that the drugmakers provided. Next steps: Outgoing CDC Director Rochelle Walensky needs to sign off on the recommendation before the vaccines can be made available to the public. She is expected to do so sometime later this week or early next. | | |  | In other health news | | - Sen. Bill Cassidy (La.), the top Republican on the Senate's health panel, expressed concern that the committee isn't far enough along in clinching deals to reauthorize critical programs expiring at the end of September as August recess looms.
- A trio of House Democrats filed a discharge petition yesterday in a long-shot bid to bring a vote on a bill to codify abortion protections that were in place under Roe v. Wade to the House floor.
- The Department of Health and Human Services will collaborate with the company Upstream to connect health-care providers across the country with free technical assistance, training and education on contraceptive services, HHS announced yesterday.
- Starting next school year, every student enrolled in the District's traditional public and charter schools will take classes on menstrual health, regardless of their gender, making D.C. the first jurisdiction in the nation with specific universal standards, The Post's Lauren Lumpkin reports.
| | |  | Health reads | | | By Donna St. George | The Washington Post ● Read more » | | | | | |  | Sugar rush | | | Thanks for reading! See y'all tomorrow. | |
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