Ahora, mientras los demócratas reconstruyen su candidatura presidencial a pocos meses de las elecciones, se esperaría que, de ser la nueva nominada, Harris adoptase una postura agresiva en apoyo al acceso al aborto, atacando al ex presidente Donald Trump en un tema que podría socavar sus posibilidades de victoria.

Biden respaldó a Harris el domingo 21 de julio cuando anunció su decisión de retirarse de la contienda.

Aunque Biden buscaba mantener el aborto como tema central de su campaña de reelección, defensores seguían teniendo dudas de que el presidente, un católico practicante que ha dicho que no es “muy partidario del aborto”, pudiera ser un abanderado efectivo. Especialmente mientras los esfuerzos republicanos erosionan el acceso al aborto y otros servicios de salud para mujeres en todo el país.

Por otro lado, Harris se convirtió en la primera vicepresidenta en visitar una clínica operada por Planned Parenthood Federation of America. Emprendió una gira nacional centrada en los derechos reproductivos. Y cuando el senador JD Vance de Ohio fue nombrado compañero de fórmula de Trump, Harris utilizó su siguiente mitín de campaña para criticarlo por bloquear protecciones para la fertilización in vitro.

“Lo más significativo es que Harris sería el rostro del impulso para proteger el derecho al aborto”, dijo Larry Levitt, vicepresidente ejecutivo de políticas de salud en KFF, organización sin fines de lucro de información de salud de la que KFF Health News es parte, en una entrevista antes de que Biden se retirara. “El acceso al aborto probablemente sería el tema central en su campaña”.

Una postura firme sobre el aborto no es el único gran contraste con el Partido Republicano (GOP) que ofrece Harris: tiene un gran conocimiento en política de salud. De niña, a menudo acompañaba a su madre al laboratorio donde trabajaba los fines de semana, como investigadora del cáncer de mama.

Durante su campaña presidencial en 2019, apoyó el “Medicare para Todos”, una propuesta de seguro de pagador único, que estableció sus credenciales como una voz más progresista en políticas de salud. Y como fiscal general de California, luchó contra la consolidación en la industria de la salud debido a la preocupación de que esto aumentaría los precios.

En abril, defendió una norma de la administración Biden que establece niveles mínimos de personal en los hogares de adultos mayores financiados con fondos federales.

“Se merece crédito, ha hablado de estos temas en la campaña. No veo ningún cambio en las prioridades sobre lo que los demócratas quieren hacer en salud si ella se convierte en la nominada”, dijo Debbie Curtis, vicepresidenta de McDermott + Consulting.

Un enfoque intensificado en la salud de la mujer y el aborto podría ayudar a consolidar a los votantes demócratas en la recta final hacia las elecciones.

Desde que en 2022 los tres jueces de la Corte Suprema nombrados por Trump ayudaron a derogar Roe vs. Wade, la opinión pública se ha vuelto en contra de los republicanos en el tema del aborto, incluso contribuyendo a un resultado inesperadamente pobre en las elecciones intermedias de ese año.

El 32% de los votantes dijeron que solo votarían por un candidato para un cargo importante que compartiera sus opiniones sobre el aborto, según una encuesta de Gallup realizada en mayo. Ese es un récord alto desde que Gallup hizo la pregunta por primera vez en 1992. Casi el doble de votantes que apoyan el aborto, en comparación con aquellos que se oponen al aborto, tienen esa opinión.

El 63% de los adultos dijeron que el aborto debería ser legal en todos o en la mayoría de los casos, según una encuesta realizada en abril por el Pew Research Center. El 36% dijo que debería ser ilegal en todos o en la mayoría de los casos.

Mientras tanto, los republicanos han estado ansiosos por distanciarse de su propia victoria en este tema. Trump enfureció a algunos miembros de su base al decir que dejaría las decisiones sobre el aborto a los estados.

Sin embargo, defensores advierten que la nueva moderación por omisión del GOP en el tema enmascara su postura real, más extrema. Vance ha sido claro en el pasado sobre su apoyo a una prohibición nacional del aborto.

Y aunque la plataforma del GOP adoptada durante la convención del partido hace pocos días puede no pedir explícitamente una prohibición nacional del aborto, el reconocimiento de los líderes del partido de la “personalidad fetal”, la idea de que tan pronto como se fertiliza un óvulo se convierte en una persona con todos los derechos legales, crearía una prohibición automáticamente si la Corte Suprema la encontrara constitucional.

Esas opiniones contrastan con las de muchos republicanos, especialmente mujeres. Alrededor de la mitad de las votantes republicanas creen que el aborto debería ser legal en todos o en la mayoría de los casos, según una encuesta nacional reciente de KFF.

Y la mayoría de las mujeres que votan por el Partido Republicano creen que el aborto debería ser legal en casos de violación, incesto o una emergencia durante el embarazo.

Si Harris encabeza la candidatura, se esperaría que enfatice esos temas en los próximos meses.

“Ha sido uno de los temas principales, si no el principal, que ha remarcado en el último año o dos”, dijo Matthew Baum, profesor Marvin Kalb de comunicaciones globales en la Universidad de Harvard. “Claramente, los republicanos están tratando de desactivar el tema. Ha sido un desastre para ellos”.

Es probable, sin embargo, que los republicanos presenten las opiniones de Harris sobre el aborto como extremistas. Durante el debate presidencial contra Biden, Trump afirmó falsamente que los demócratas apoyan los abortos tardíos en el embarazo, “incluso después del nacimiento”.

Poco después que se diera la noticia de que Biden había respaldado a Harris, Susan B. Anthony Pro-Life America emitió un comunicado criticando el historial de Harris y ofreciendo una muestra de lo que está por venir. “Mientras Joe Biden tiene problemas para decir la palabra aborto, Kamala Harris la grita”, dijo Marjorie Dannenfelser, presidenta del grupo.

Algunos encuestadores han dicho que Harris tendrá que hacer más que simplemente hacer campaña contra los esfuerzos republicanos para revertir el acceso al aborto para realmente motivar a los votantes: temas como la inflación, la economía y la inmigración, están compitiendo por atención.

“Tiene que decir que está luchando por una ley federal que restablezca Roe vs. Wade”, dijo Robert Blendon, profesor emérito de salud pública en la Universidad de Harvard. “Necesita algo muy específico y claro”.

La elevación de Harris a la cima de la candidatura llegaría en un momento crítico en la lucha por los derechos reproductivos.

La Corte Suprema escuchó dos casos de aborto en el término que acaba de finalizar. Pero los jueces no abordaron los méritos de los temas en ninguno de los casos, fallando en su lugar sobre cuestiones técnicas. Se espera que ambos regresen a la Corte Suprema tan pronto como el próximo año.

Harris también tendría una considerable libertad para hablar sobre lo que se considera los principales logros de la política de salud de la administración Biden.

Estos incluyen mejores subsidios en la Ley de Cuidado de Salud a Bajo precio (ACA) destinados a ayudar a los consumidores a obtener seguro de salud, que se extendieron, a través de la Ley de Reducción de la Inflación, hasta 2025, el límite mensual de $35 en copagos que algunos pacientes pagan por la insulina, y la negociación de precios de medicamentos en Medicare.

“Creo que está bien posicionada. Harris es parte central de la administración y podrá atribuirse el mérito de esas cosas”, dijo Dan Mendelson, CEO de Morgan Health, una subsidiaria de J.P. Morgan Chase.

Dicho esto, puede ser difícil para cualquier candidato lograr que los votantes se enfoquen en algunos de esos logros, especialmente en los esfuerzos relacionados con los precios de los medicamentos.

Aunque la administración ha tomado algunos pasos importantes, “nuevos medicamentos costosos siguen saliendo al mercado”, dijo Mendelson. “Así que si miras la percepción de los consumidores, no creen que el costo de los medicamentos esté bajando”.

Joseph Antos, del American Enterprise Institute, dijo que es probable que Harris diga que la administración Biden-Harris “ya le está ahorrando dinero a la gente” en insulina. Pero tendrá que ir más allá de estos logros y redoblar sus esfuerzos en los precios de los medicamentos y otros temas de costo, no hablar únicamente sobre derechos reproductivos.

“Tiene que concentrarse, si quiere ganar, en temas que tengan un amplio atractivo”, dijo Antos. “El costo es uno y el acceso a tratamientos es otro gran tema”.

Samantha Young de KFF Health News contribuyó con este informe.

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Now, as Democrats rebuild their presidential ticket just a few months before Election Day, Harris would widely be expected to take an aggressive stance in support of abortion access if she became the party’s new presumptive nominee — hitting former President Donald Trump on an issue that could undermine his chances of victory. Biden endorsed Harris on Sunday when he announced his decision to leave the race.

While Biden sought to keep abortion center stage in his reelection bid, abortion advocates had harbored doubts that the president — a practicing Catholic who has said he is not “big on abortion” — could be an effective standard-bearer as Republican efforts erode access to abortion and other women’s health care around the country.

Harris, on the other hand, became the first vice president to visit a clinic run by the Planned Parenthood Federation of America. She undertook a nationwide tour focused on reproductive rights. And when Sen. JD Vance of Ohio was named Trump’s running mate, Harris used her next campaign appearance to criticize him for blocking protections for in vitro fertilization.

“Most significantly, Harris would be the face of the drive to protect abortion rights,” Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News, said in an interview before Biden stepped aside. “Abortion access would likely be front and center in her campaign.”

A strong stance on abortion is not the only major contrast to the GOP that Harris offers: She is well versed in health policy. As a child, Harris often accompanied her mother to work on the weekends, visiting the lab where she was studying breast cancer.

While running for president in 2019, she backed “Medicare for All,” a single-payer insurance proposal that established her bona fides as a more progressive voice on health policy. And as California’s attorney general, she fought against consolidation in the health industry over concerns it would drive up prices. 

She stumped for a Biden administration rule setting minimum staffing levels at federally funded nursing homes in April.

“She deserves credit, she’s talked about them on the campaign trail. I don’t see any change there in the priorities on what Democrats want to do on health care if she becomes the nominee,” said Debbie Curtis, vice president at McDermott + Consulting. 

An intensified focus on women’s health and abortion could help galvanize Democratic voters in the final sprint to the election. Since the three Supreme Court justices named by Trump helped overturn Roe v. Wade in 2022, public opinion has turned against Republicans on abortion, even contributing to an unexpectedly poor showing in the 2022 midterm elections.

Thirty-two percent of voters said they would vote only for a candidate for a major office who shares their views on abortion, according to a Gallup Poll conducted in May. That’s a record high since Gallup first asked the question in 1992. Nearly twice as many voters who support abortion, compared with those who oppose abortion, hold that view. 

Sixty-three percent of adults said abortion should be legal in all or most cases, based on a poll conducted in April by Pew Research Center. Thirty-six percent said it should be illegal in all or most cases.

Republicans, in turn, have been eager to distance themselves from their own victory on the issue. Trump angered some members of his base by saying he would leave decisions on abortion to the states.

Regardless, advocates caution that the GOP’s new moderation-by-omission on the issue masks their actual, more extreme stance. Vance has been clear in the past about his support for a national abortion ban. And while the GOP platform adopted during the party’s convention last week may not explicitly call for a nationwide ban on abortion, party leaders’ recognition of “fetal personhood,” the idea that as soon as an egg is fertilized it becomes a person with full legal rights, would create such a ban automatically if the Supreme Court found it constitutional.

Those views stand in contrast to those of many Republicans, especially women. About half of Republican women voters think abortion should be legal in all or most cases, according to a recent national survey by KFF. And majorities of women who vote Republican believe abortion should be legal in cases of rape, incest, or a pregnancy emergency.

If Harris heads the ticket, she would be expected to hammer on those issues in the coming months. 

“It’s been one of if not the main issue she’s emphasized in the last year or two,” said Matthew Baum, Marvin Kalb professor of global communications at Harvard University. “Clearly the Republicans are trying to defang the issue. It’s been a disaster for them.”

It is likely, though, that Republicans would paint Harris’ views on abortion as extremist. During the presidential debate against Biden, Trump falsely claimed Democrats support abortions late in pregnancy, “even after birth.”

Shortly after news broke that Biden had endorsed Harris, Susan B. Anthony Pro-Life America issued a statement calling out Harris’ record and offering evidence of what is to come. “While Joe Biden has trouble saying the word abortion, Kamala Harris shouts it,” said Marjorie Dannenfelser, the group’s president.

Some pollsters have said Harris would have to do more than just campaign against Republican efforts to roll back abortion access to truly motivate voters because so many issues, such as inflation, the economy, and immigration, are competing for attention.

“She has to say she is running for a federal law that will bring back Roe v. Wade,” said Robert Blendon, an emeritus public health professor at Harvard University. “She needs something very specific and clear.”

Harris’ elevation to the top of the ticket would come at a critical juncture in the fight over reproductive rights.

The Supreme Court heard two abortion cases in the term that ended this month. But the justices did not address the merits of the issues in either case, ruling instead on technicalities. Both are expected to return to the high court as soon as next year.

In one case, challenging the FDA’s 2000 approval of the abortion pill mifepristone, the justices ruled that the group of anti-abortion medical professionals who challenged the drug lacked standing to sue because they failed to show they were personally injured by its availability. 

The other abortion-related case pitted a federal law requiring hospitals to provide emergency care against Idaho’s strict ban, which allows abortions when a pregnant patient’s life is in danger — but not in cases in which it is necessary to protect her health, including future fertility.

Harris would also have substantial leeway to talk about what are considered to be the Biden administration’s core health policy accomplishments. These include enhanced Affordable Care Act tax credits aimed at helping consumers get health insurance coverage, which were extended through the Inflation Reduction Act into 2025, the $35 monthly cap on copays some patients pay for insulin, and drug price negotiation in Medicare.

“I think she is well positioned. She is core to the administration and will be able to take credit for those things,” said Dan Mendelson, CEO of Morgan Health, a subsidiary of J.P. Morgan Chase.

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According to the Association of American Medical Colleges, for the second year in a row, students graduating from U.S. medical schools were less likely to apply for residency positions this year in states with abortion bans and other significant abortion restrictions.

In this episode of “The Indicator From Planet Money,” KFF Health News’ chief Washington correspondent, Julie Rovner, reports on how the medical labor force is changing post-Roe v. Wade and why graduating medical students, from OB-GYNs to pediatricians, are avoiding training in states with abortion bans.

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Find more of our abortion coverage here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Customers often don’t discover the changes until they’re denied medical coverage or get stuck with a bill for ACA tax credits they have to repay.

Senate Finance Committee Chair Ron Wyden (D-Ore.) said he’ll propose legislation to allow the Centers for Medicare and Medicaid Services to hold fraudulent brokers “criminally responsible” for their actions. The agency, which oversees the ACA exchanges, can fine individuals up to $250,000 for submitting false information in an application for a health plan, but it hasn’t done so, Wyden said.

“I am disappointed these penalties have not yet been used to hold bad actors accountable,” Wyden wrote last week in a sharply worded letter to CMS Chief Chiquita Brooks-LaSure.

Jimmy Patronis, who oversees agencies including insurance regulators as Florida’s chief financial officer, called on Congress to push CMS to require two-factor authentication on healthcare.gov and related platforms that agents use to sign people up for coverage. According to Patronis, the state has opened more than 900 investigations into problem enrollments.

“It’s far easier to prevent fraud from occurring in the first place than it is to ask state regulators to chase down these bad actors after the fact,” Patronis wrote.

The problem appears concentrated among the 32 states using the federal marketplace — healthcare.gov — because, brokers say, it’s too easy for rogue agents to access policyholder information. All they need is a name, date of birth and state.

States that run their own insurance markets generally have additional security requirements.

CMS tallied 90,000 complaints about unauthorized sign-ups or plan switching in just the first quarter of 2024, out of more than 16 million enrollments.

Jeff Wu, acting director of the Center for Consumer Information and Insurance Oversight at CMS, has said his agency is preparing regulatory and technological fixes, investigating brokers and working to restore consumers to chosen plans.

But even with Wyden’s legislation on the way, Congress looks unlikely to act. Lawmakers are in the middle of an election year in which President Biden is trying to win votes for bolstering enrollment in ACA plans while knocking his opponent, former president Donald Trump, for his unsuccessful attempt to repeal the law.

Sabrina Corlette, who follows the ACA market as co-director of the Center on Health Insurance Reforms at Georgetown University, said the feds can do more, including coordinating better with state investigations.

But states like Florida should also regulate the marketplaces, she said.

“If there’s a lot of bad brokers in Florida, then Florida needs to look inward and maybe do a better job of policing brokers,” she said.

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“Ultimately I shifted my selection pretty drastically,” she said. “I was struggling to find a residency program in the South where I could still get the training I consider fundamental to the skill set needed to be an OB/GYN.” Instead of going home to Georgia, she’s headed to Pittsburgh to start her medical residency this summer. Panakam has plenty of company.

For the second year running, fewer graduating U.S. medical students applied for residency training in states with abortion bans or restrictions than in the previous year, according to data from the Association of American Medical Colleges. (Overall applications were down slightly, because students are being urged to apply to fewer programs, but the decrease was markedly larger in states where abortion is illegal or significantly restricted.)

It’s not just obstetrician-gynecologists; the decline crosses specialties, including those that don’t serve primarily pregnant patients. That could threaten the future of the overall medical workforce in states with bans, because doctors tend to locate permanently where they do residencies.

“The geographic misalignment between where the needs are and where people are choosing to go is really problematic,” said Debra Stulberg, who chairs the Department of Family Medicine at the University of Chicago. “We don’t need people further concentrating in urban areas where there’s already good access.”

The concerns of graduating medical students extend beyond their ability to practice medicine; they’re also worried about their own health, or that of their partners. “People don’t feel safe potentially having their own pregnancies living in those states,” Stulberg said.

Some students say it’s a hard decision.

“I feel some guilt and sadness leaving a situation where I feel like I could be of some help,” said new medical school graduate Hannah Light-Olson, who will leave Nashville for OB/GYN training at the University of California at San Francisco this summer. “I feel deeply indebted to the program that trained me, and to the patients of Tennessee.”

It’s not that residency programs are going unfilled. There are still more graduating students from medical schools both in the United States and abroad than there are residency slots. But Beverly Gray, an associate professor of obstetrics and gynecology at Duke University School of Medicine, worries that abortion restrictions impact “whether we have the best and brightest coming to North Carolina.”

Residents in states where abortion is banned will still get training in abortion techniques, which are also used for miscarriages and other conditions. But to train on the procedures they’ll have to leave the state. And some students worry the training won’t be sufficient.

“I would rather have not become an OB/GYN than not be trained as a good one,” said Laura Potter, who is moving from medical school at the University of California at Davis to residency at Mass General Brigham in Boston.

But there are students choosing to train in states with abortion restrictions to make sure patients there get the care they need. And others hope to relocate to those parts of the country after their training — including Panakam.

“Long term, I still hope to practice in the South,” she said. “But at this point in my professional journey, it’s a little too early for me to restrict my training in any meaningful way.”

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Blum turned to programs mostly in states where abortion access — and, by extension, abortion training — is likely to remain protected, like California, Colorado, and New Mexico. Arizona has enacted a law banning most abortions after 15 weeks.

“I would really like to have all the training possible,” she said, “so of course that would have still been a limitation.”

In June, she will start her residency at Swedish Cherry Hill hospital in Seattle.

According to new statistics from the Association of American Medical Colleges, for the second year in a row, students graduating from U.S. medical schools were less likely to apply this year for residency positions in states with abortion bans and other significant abortion restrictions.

Since the Supreme Court in 2022 overturned the constitutional right to an abortion, state fights over abortion access have created plenty of uncertainty for pregnant patients and their doctors. But that uncertainty has also bled into the world of medical education, forcing some new doctors to factor state abortion laws into their decisions about where to begin their careers.

Fourteen states, primarily in the Midwest and South, have banned nearly all abortions. The new analysis by the AAMC — a preliminary copy of which was exclusively reviewed by KFF Health News before its public release — found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2%, compared with a 0.6% drop in states where abortion remains legal.

Notably, the AAMC’s findings illuminate the broader problems abortion bans can create for a state’s medical community, particularly in an era of provider shortages: The organization tracked a larger decrease in interest in residencies in states with abortion restrictions not only among those in specialties most likely to treat pregnant patients, like OB-GYNs and emergency room doctors, but also among aspiring doctors in other specialties.

“It should be concerning for states with severe restrictions on reproductive rights that so many new physicians — across specialties — are choosing to apply to other states for training instead,” wrote Atul Grover, executive director of the AAMC’s Research and Action Institute.

The AAMC analysis found the number of applicants to OB-GYN residency programs in abortion ban states dropped by 6.7%, compared with a 0.4% increase in states where abortion remains legal. For internal medicine, the drop observed in abortion ban states was over five times as much as in states where abortion is legal.

In its analysis, the AAMC said an ongoing decline in interest in ban states among new doctors ultimately “may negatively affect access to care in those states.”

Jack Resneck Jr., immediate past president of the American Medical Association, said the data demonstrates yet another consequence of the post-Roe v. Wade era.

The AAMC analysis notes that even in states with abortion bans, residency programs are filling their positions — mostly because there are more graduating medical students in the U.S. and abroad than there are residency slots.

Still, Resneck said, “we’re extraordinarily worried.” For example, physicians without adequate abortion training may not be able to manage miscarriages, ectopic pregnancies, or potential complications such as infection or hemorrhaging that could stem from pregnancy loss.

Those who work with students and residents say their observations support the AAMC’s findings. “People don’t want to go to a place where evidence-based practice and human rights in general are curtailed,” said Beverly Gray, an associate professor of obstetrics and gynecology at Duke University School of Medicine.

Abortion in North Carolina is banned in nearly all cases after 12 weeks. Women who experience unexpected complications or discover their baby has potentially fatal birth defects later in pregnancy may not be able to receive care there.

Gray said she worries that even though Duke is a highly sought training destination for medical residents, the abortion ban “impacts whether we have the best and brightest coming to North Carolina.”

Rohini Kousalya Siva will start her obstetrics and gynecology residency at MedStar Washington Hospital Center in Washington, D.C., this year. She said she did not consider programs in states that have banned or severely restricted abortion, applying instead to programs in Maryland, New Hampshire, New York, and Washington, D.C.

“We’re physicians,” said Kousalya Siva, who attended medical school in Virginia and was previously president of the American Medical Student Association. “We’re supposed to be giving the best evidence-based care to our patients, and we can’t do that if we haven’t been given abortion training.”

Another consideration: Most graduating medical students are in their 20s, “the age when people are starting to think about putting down roots and starting families,” said Gray, who added that she is noticing many more students ask about politics during their residency interviews.

And because most young doctors make their careers in the state where they do their residencies, “people don’t feel safe potentially having their own pregnancies living in those states” with severe restrictions, said Debra Stulberg, chair of the Department of Family Medicine at the University of Chicago.

Stulberg and others worry that this self-selection away from states with abortion restrictions will exacerbate the shortages of physicians in rural and underserved areas.

“The geographic misalignment between where the needs are and where people are choosing to go is really problematic,” she said. “We don’t need people further concentrating in urban areas where there’s already good access.”

After attending medical school in Tennessee, which has adopted one of the most sweeping abortion bans in the nation, Hannah Light-Olson will start her OB-GYN residency at the University of California-San Francisco this summer.

It was not an easy decision, she said. “I feel some guilt and sadness leaving a situation where I feel like I could be of some help,” she said. “I feel deeply indebted to the program that trained me, and to the patients of Tennessee.”

Light-Olson said some of her fellow students applied to programs in abortion ban states “because they think we need pro-choice providers in restrictive states now more than ever.” In fact, she said, she also applied to programs in ban states when she was confident the program had a way to provide abortion training.

“I felt like there was no perfect, 100% guarantee; we’ve seen how fast things can change,” she said. “I don’t feel particularly confident that California and New York aren’t going to be under threat, too.”

As a condition of a scholarship she received for medical school, Blum said, she will have to return to Arizona to practice, and it is unclear what abortion access will look like then. But she is worried about long-term impacts.

“Residents, if they can’t get the training in the state, then they’re probably less likely to settle down and work in the state as well,” she said.

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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A new regulation out this month allows states to include adult dental care as a benefit that health insurers must cover under the Affordable Care Act. Following record ACA enrollment this year, the proposal represents an election-year aspiration for the future of Obamacare: It doesn’t require states to do anything, even as it shows off President Biden’s intention to make the ACA a more robust safety net.

“It’s huge, really significant,” said Colin Reusch, director of policy at Community Catalyst, a health coverage advocacy group. He said the new Biden administration rule represents “one of the first real changes” to coverage provisions of the law since it passed in 2010.

But like so much in health care, expanding access to dental services is a lot more complicated than it sounds.

An estimated 68.5 million U.S. adults lacked dental insurance in 2023, according to the nonprofit CareQuest Institute for Oral Health. That’s more than 2.5 times the roughly 26 million Americans of all ages who lack health insurance.

And millions of Americans lost dental coverage in the past year as part of the Medicaid “unwinding” that dropped low-income people who had been covered by the program during the pandemic.

At the same time, untreated dental disease is estimated to cost the United States more than $45 billion in lost productivity annually, according to the Centers for Disease Control and Prevention, and it’s linked to a long list of even more serious health problems, including heart disease and diabetes.

Still, efforts to expand U.S. dental coverage have long foundered on the shoals of cost. When people have dental insurance, they tend to use it. So including the coverage in a health insurance policy can raise overall premiums.

That’s one reason traditional Medicare coverage explicitly excludes most dental care. (Many private Medicare Advantage plans offer some dental coverage as an enticement for seniors to join.)

An effort to add a dental benefit to Medicare was stripped from Biden’s “Build Back Better” legislation before it was passed in 2022 as the Inflation Reduction Act. Instead, the administration clarified and expanded the limited circumstances in which Medicare can cover dental care. Any progress on oral health — including giving states the option to require coverage for adults — is seen by advocates as a victory. Dental coverage for children is already an essential benefit under the ACA.

But whether they actually get coverage depends on states affirmatively adding dental benefits to benchmark plans in the ACA’s insurance marketplaces. Those plans not only determine what services Affordable Care Act insurance has to cover, but also set parameters for state-employee and many private-employer health plans.

Reusch said a few states are considering the change, but it will be a while until anything is certain. States have until May 2025 to decide whether to add dental care to benchmark ACA plans; the benefit wouldn’t be effective until the 2027 plan year.

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Algorithms make it possible for companies to fix prices without explicitly coordinating with one another, posing a new test for regulators policing the market, said Lina Khan, chair of the Federal Trade Commission, during a media event hosted by KFF.

“I think we could be entering a somewhat novel era of pricing,” Khan told reporters.

Khan is regarded as one of the most aggressive antitrust regulators in recent U.S. history, and she has paid particular attention to the harm that technological advances can pose to consumers. Antitrust regulators at the FTC and the Justice Department set a record for merger challenges in the fiscal year that ended Sept. 30, 2022, according to Bloomberg News.

Last year, the FTC successfully blocked biotech company Illumina’s over $7 billion acquisition of cancer-screening company Grail. The FTC, Justice Department, and Health and Human Services Department launched a website on April 18, healthycompetition.gov, to make it easier for people to report suspected anticompetitive behavior in the health care industry.

The American Hospital Association, the industry’s largest trade group, has often criticized the Biden administration’s approach to antitrust enforcement. In comments in September on proposed guidance the FTC and Justice Department published for companies, the AHA said that “the guidelines reflect a fundamental hostility to mergers.”

Price fixing removes competition from the market and generally makes goods and services more expensive. The agency has argued in court filings that price fixing “is still illegal even if you are achieving it through an algorithm,” Khan said. “There’s no kind of algorithmic exemption to the antitrust laws.”

By simply using the same algorithms to set prices, companies can effectively charge the same “even if they’re not, you know, getting in a back room and kind of shaking hands and setting a price,” Khan said, using the example of residential property managers.

Khan said the commission is also scrutinizing the use of artificial intelligence and algorithms to set prices for individual consumers “based on all of this particular behavioral data about you: the websites you visited, you know, who you had lunch with, where you live.”

And as health care companies change the way they structure their businesses to maximize profits, the FTC is changing the way it analyzes behavior that could hurt consumers, Khan said.

Hiring people who can “help us look under the hood” of some inscrutable algorithms was a priority, Khan said. She said it’s already paid off in the form of legal actions “that are only possible because we had technologists on the team helping us figure out what are these algorithms doing.”

Traditionally, the FTC has policed health care by challenging local or regional hospital mergers that have the potential to reduce competition and raise prices. But consolidation in health care has evolved, Khan said.

Mergers of systems that don’t overlap geographically are increasing, she said. In addition, hospitals now often buy doctor practices, while pharmacy benefit managers start their own insurance companies or mail-order pharmacies — or vice versa — pursuing “vertical integration” that can hurt consumers, she said.

The FTC is hearing increasing complaints “about how these firms are using their monopoly power” and “exercising it in ways that’s resulting in higher prices for patients, less service, as well as worse conditions for health care workers,” Khan said.

Policing Noncompetes

Khan said she was surprised at how many health care workers responded to the commission’s recent proposal to ban “noncompete” clauses — agreements that can prevent employees from moving to new jobs. The FTC issued its final rule banning the practice on Tuesday. She said the ban was aimed at low-wage industries like fast food but that many of the comments in favor of the FTC’s plan came from health professions.

Health workers say noncompete agreements are “both personally devastating and also impeded patient care,” Khan said.

In some cases, doctors wrote that their patients “got really upset because they wanted to stick with me, but my hospital was saying I couldn’t,” Khan said. Some doctors ended up commuting long distances to prevent the rest of their families from having to move after they changed jobs, she said.

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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