What has become clear is not just that this voting group supports her — but the intensity of that support. Eighty-two percent of Black women voters had a favorable view of Harris in August, according to the Pew Research Center, up from 67 percent who said the same in May.

Almost 70 percent of this demographic in August also said they were extremely or very motivated to vote, according to Pew, up from 51 percent before she announced her candidacy in July.

Jotaka Eaddy, a political strategist and founder of Win With Black Women, a network of Black women leaders, said the support is leading more younger Black women to register to vote. That could drive turnout and help Democrats. Some 16 million Black women are eligible to vote and 67 percent of them are registered, based on data from Higher Heights, a group focused on mobilizing and electing Black women.

Abortion, IVF: Harris has made abortion access a centerpiece of her presidential campaign. She recently said she would support changing Senate filibuster rules, lowering the threshold to advance a bill from 60 votes to a simple majority, for legislation to protect abortion access.

A number of issues Harris has worked on resonate with Black women voters, as well as women voters overall, Eaddy said, “particularly the issue of reproductive freedom, like IVF, and making decisions about our health care.”

Harris and her running mate, Minnesota Gov. Tim Walz, as well as Republican presidential nominee Donald Trump have vowed to protect in vitro fertilization. In August, Trump said he wants the federal government or insurers to pay for the treatments.

But Trump has struggled with his messaging on abortion, saying decisions about restrictions on the procedure should be left to the states.

Maternal mortality: Harris in 2021 issued a call to action to reduce high U.S. maternal mortality rates, building on her previous work. As a senator from California from 2017 to 2021, she co-sponsored a package of bills to boost maternal health, with a focus on Black women.

The Centers for Disease Control and Prevention says Black women are three times as likely to die of pregnancy-related complications as White women.

Trump in 2018 signed legislation to reduce the maternal mortality rate.

Guns: Harris’s work on reducing gun violence has also found traction with Black women. She is a gun owner but has said she wants to reinstate an assault weapons ban and supports safe storage laws and universal background checks.

Trump is a vocal supporter of gun rights. As president in 2017, he reversed a controversial Obama administration regulation making it harder for people with mental health issues to purchase guns.

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.

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They showed that in 2023, for example, there were four active tuberculosis cases in Clark County, which includes Springfield, up from three in 2022. HIV cases had risen, but sexually transmitted illnesses overall were decreasing.

“I wouldn’t call it skyrocketing,” said Cook, noting that there were 190 active cases in 2023 in all of Ohio. “You hear the rhetoric. But as a whole, reportable infectious diseases to the health department are decreasing.”

Tensions are running high in this industrial town of about 58,000 people. Bomb threats closed schools and public buildings after GOP presidential nominee Donald Trump falsely claimed that Haitian immigrants — who he alleged were there illegally — were stealing and eating household pets. City and county officials disputed the claims the former president levied during his Sept. 10 debate with Vice President Kamala Harris, his Democratic opponent.

Trump was amplifying comments made by Vance that — along with his claims about the immigration status of this population — were broadly panned as false. When asked during a CNN interview about the debunked pet-eating rumor, Vance, a U.S. senator from Ohio, acknowledged that the image he created was based not on facts but on “firsthand accounts from my constituents.” He said he was willing “to create” stories to focus attention on how immigration can overrun communities.

But Ohio Gov. Mike DeWine, also a Republican, has said immigrants have been an economic boon to Springfield. Many began arriving because businesses in the town, which had seen its population decrease, needed labor.

Largely lost in the political rancor is the way Springfield and the surrounding area responded to the influx of Haitian immigrants. Local health institutions tried to address the needs of this new population, which had lacked basic public health care such as immunization and often didn’t understand the U.S. health system.

The town is a microcosm of how immigration is reshaping communities throughout the United States. In the Springfield area, Catholic charities, other philanthropies, volunteers, and county agencies have banded together over the past three to four years to tackle the challenge and connect immigrants who have critical health needs with providers and care.

For instance, a community health center added Haitian Creole interpreters. The county health department opened a refugee health testing clinic to provide immunizations and basic health screenings, operating on such a shoestring budget that it’s open only two days a week.

And a coalition of groups to aid the Haitian community was created about two years ago to identify and respond to immigrant community needs. The group meets once a month with about 55 or 60 participants. On Sept. 18, about a week after Trump ramped up the furor at the debate, a record 138 participants joined in.

“We have all learned the necessity of collaboration,” said Casey Rollins, director of Springfield’s St. Vincent de Paul, a nonprofit Catholic social services organization that has become a lifeline for many of the town’s Haitian immigrants. “There’s a lot of medical need. Many of the people have high blood pressure, or they frequently have diabetes.”

Several factors have led Haitians to leave their Caribbean country for the United States, including a devastating earthquake in 2010, political unrest after the 2021 assassination of Haiti’s president, and ongoing gang violence. Even when health facilities in the country are open, it can be too treacherous for Haitians to travel for treatment.

“The gangs typically leave us alone, but it’s not a guarantee,” said Paul Glover, who helps oversee the St. Vincent’s Center for children with disabilities in Haiti. “We had a 3,000-square-foot clinic. It was destroyed. So was the X-ray machine. People have been putting off health care.”

An estimated 12,000 to 15,000 Haitian immigrants live in Clark County, officials said. About 700,000 Haitian immigrants lived in the United States in 2022, according to U.S. Census data.

Those who have settled in the Springfield area are generally in the country legally under a federal program that lets noncitizens temporarily enter and stay in the United States under certain circumstances, such as for urgent humanitarian reasons, according to city officials.

The influx of immigrants created a learning curve for hospitals and primary care providers in Springfield, as well as for the newcomers themselves. In Haiti, people often go directly to a hospital to receive care for all sorts of maladies, and county officials and advocacy groups said many of the immigrants were unfamiliar with the U.S. system of seeing primary care doctors first or making appointments for treatment.

Many sought care at Rocking Horse Community Health Center, a nonprofit, federally qualified health center that provides mental health, primary, and preventive care to people regardless of their insurance status or ability to pay. Federally qualified health centers serve medically underserved areas and populations.

The center treated 410 patients from Haiti in 2022, up more than 250% from 115 in 2021, according to Nettie Carter-Smith, the center’s director of community relations. Because the patients required interpreters, visits often stretched twice as long.

Rocking Horse hired patient navigators fluent in Haitian Creole, one of the two official languages of Haiti. Its roving purple bus provides on-site health screenings, vaccinations, and management of chronic conditions. And this school year, it’s operating a $2 million health clinic at Springfield High.

Many Haitians in Springfield have reported threats since Trump and Vance made their town a focus of the campaign. Community organizations were unable to identify any immigrants willing to be interviewed for this story.

Hospitals have also felt the impact. Mercy Health’s Springfield Regional Medical Center also saw a rapid influx of patients, spokesperson Jennifer Robinson said, with high utilization of emergency, primary care, and women’s health services.

This year, hospitals also have seen several readmissions for newborns struggling to thrive as some new mothers have trouble breastfeeding or getting supplemental formula, county officials said. One reason: New Haitian immigrants must wait six to eight weeks to get into a program that provides supplemental food for low-income pregnant, breastfeeding, or non-breastfeeding postpartum women, as well as for children and infants.

At Kettering Health Springfield, Haitian immigrants come to the emergency department for nonemergency care. Nurses are working on two related projects, one focusing on cultural awareness for staff and another exploring ways to improve communication with Haitian immigrants during discharge and in scheduling follow-up appointments.

Many of the immigrants are able to get health insurance. Haitian entrants generally qualify for Medicaid, the state-federal program for the low-income and disabled. For hospitals, that means lower reimbursement rates than with traditional insurance.

During 2023, 60,494 people in Clark County were enrolled in Medicaid, about 25% of whom were Black, according to state data. That’s up from 50,112 in 2017, when 17% of the enrollees were Black. That increase coincides with the rise of the Haitian population.

In September, DeWine pledged $2.5 million to help health centers and the county health department meet the Haitian and broader community’s needs. The Republican governor has pushed back on the recent national focus on the town, saying the spread of false rumors has been hurtful for the community.

Ken Gordon, a spokesperson for the Ohio Department of Health, acknowledged the difficulties Springfield’s health systems have faced and said the department is monitoring to avert potential outbreaks of measles, whooping cough, and even polio.

People diagnosed with HIV in the county increased from 142 residents in 2018 to 178 to 2022, according to state health department data. Cook, the Clark County health commissioner, said the data lags by about 1.5 years.

But Cook said, “as a whole, all reportable infections to the health department are not increasing.” Last year, he said, no one died of tuberculosis. “But 42 people died of covid.”

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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 voters 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 says 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.”

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When Harris was California’s attorney general, she joined cases that resulted in almost $7.2 billion (about $22 per person in the United States) in fines for drug companies. In that role, she was an aggressive regulator of the drug industry. In her current position, she cast the tiebreaking Senate vote in 2022 for legislation that allows Medicare to negotiate drug prices for its more than 60 million beneficiaries.

As president, Trump also was willing to challenge GOP orthodoxy by taking action to combat high drug costs. His administration sought to lower the prices Medicare pays for drugs through a proposal that the PwC Health Research Institute estimated would cost five drugmakers as much as $500 million a year. What was known as the “most favored nation” interim final rule was blocked because of legal challenges and rescinded by the Biden administration.

In addition, Trump issued a rule setting up a path to import drugs from Canada and other countries, with Florida this year becoming the first state to get federal approval to do so.

If elected, the Harris-Walz ticket appears more likely to be successful on drug pricing than Trump, whose policies were more disjointed, said Sergio Jose Gutierrez, a political strategist who has worked primarily with Democrats.

“His efforts were largely fragmented and faced resistance from both the industry and lawmakers,” Gutierrez said.For example, he said Trump promoted the executive order on international prices to tie certain Medicare drug costs to their prices overseas. But the final rule spurred four industry lawsuits and never went into effect.

The Biden administration successfully implemented a strategy of negotiating prices for top-selling Medicare drugs, even as lawsuits have been filed to stop the program.

Another shift in the pharmaceutical industry is emerging in its political contributions. An industry that gave three or four times as much to GOP candidates as to Democrats in the 1990s and early 2000s is now hedging its bets. So far in the 2024 cycle, drug companies have given $4.89 million to Democrats and $4.35 million to Republicans, according to OpenSecrets, a nonpartisan research group.

Harris has received $518,571 from the industry, and Trump has received $204,748.

Catherine Hill, a spokeswoman for Pharmaceutical Research and Manufacturers of America, or PhRMA, said the industry trade group looks forward to collaborating with any future presidential administration.

She criticized the Biden administration’s plan for Medicare price negotiation and Trump’s plan to align U.S. prices with those in foreign countries. Last month, the Biden administration announced new, reduced prices for 10 drugs in the program following negotiations between the federal government and drugmakers. The lower costs take effect in 2026.

“Previous price controls adopted by the Biden administration threaten to stifle that innovation,” Hill said. “Undermining intellectual property protections and borrowing other countries’ price controls will further undercut innovation and threaten patients’ access to medicine.”

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Harris cast the tie-breaking Senate vote in 2022 for legislation that allows Medicare to negotiate drug prices for its more than 60 million beneficiaries. Before that, she was an aggressive regulator of the drug industry as California attorney general.

As president, Trump would likely retain Medicare price negotiations unless the pharmaceutical industry can come up with something more compelling that they’d put on the table, people close to him say. In his first term, he proposed various policies aimed at reducing prescription costs but had limited success with their implementation.

The drug industry could benefit, though, if Trump remains unable to advance such proposals.

“His efforts were largely fragmented and faced resistance from both the industry and lawmakers,” said Sergio Jose Gutierrez, a political strategist who has primarily worked with Democrats in the U.S. “The lack of a cohesive strategy and the limited ability to implement significant changes made his approach less effective compared to what a Harris-Walz administration could offer.”

The industry is increasingly under attack by lawmakers from both parties for drug prices most Americans regard as unreasonable, according to KFF polling, so the election outcome could be pivotal to drug companies’ fortunes. Their predicament is a sharp reversal from years past, when the firms enjoyed a reputation as being almost untouchable. For more than a decade, manufacturers successfully fended off proposals to let Medicare negotiate lower drug prices before losing the battle two years ago.

The shift in their political standing shows up in pharmaceutical companies’ contributions to candidates. An industry that gave three or four times as much to GOP candidates as to Democrats in the 1990s and early 2000s is now hedging its bets. So far in the 2024 cycle, drug companies have given $4.89 million to Democrats and $4.35 million to Republicans, according to OpenSecrets, a nonpartisan research group.

Harris has received $518,571 from the industry and Trump has received $204,748.

At the Democratic National Convention in Chicago last week, Harris and fellow Democrats touted their records on curbing drug prices. Harris supporters point to her past and present.

While she was California’s attorney general, she joined cases that resulted in nearly $7.2 billion (about $22 per person in the U.S.) in fines for drug companies.

Her vote to pass President Joe Biden’s Inflation Reduction Act paved the way not only for Medicare price negotiation but also an annual $2,000 cap on Medicare beneficiaries’ total drug spending and a $35 cap on their monthly insulin supplies.

“In the United States of America, no senior should have to choose between either filling their prescription or paying their rent,” Harris said Aug. 15 in her first joint appearance with Biden since he exited the presidential race.

She has promised to extend both the annual drug spending cap and the insulin price cap to all Americans with insurance, not just those on Medicare, if elected president.

Harris also backed a contentious policy that, in some instances, would empower the federal government to inject more competition into the marketplace by seizing the patents on some high-cost drugs developed with federal funds.

Doug Hart, 77, of Tempe, Arizona, has been spending about $7,000 annually on prescription drugs. A drug he takes to prevent blood clots will cost less under the Medicare price negotiations. The retired labor union president said the decrease will be considerable and it is one reason he backs Harris.

“The Republicans all voted against Medicare negotiation. Harris broke the tie in the Senate to allow it,” said Hart, who is a board member for the Arizona Alliance for Retired Americans, which works to mobilize returned union members and activists on progressive issues.

While Republicans as a party remain more friendly to the pharmaceutical industry, Trump has been willing to challenge GOP orthodoxy by taking action to combat high drug costs.

He sought during his administration to tie drug prices in Medicare to lower international prices, a proposal that the PricewaterhouseCoopers health research institute estimated would cost five drugmakers as much as $500 million a year. What was known as the “most favored nation” interim final rule was blocked because of legal challenges and later rescinded by the Biden administration.

Trump issued a rule setting up a path to import drugs from Canada and other countries, with Florida this year becoming the first state to get federal approval to import some prescriptions from Canada. But the state has been stymied by pushback from Health Canada, the Canadian government department responsible for national health policy.

And on his campaign website, Trump posted a video in which he questioned whether childhood health problems are the result of “overprescription” of medications.

“Too often, our public health establishment is too close to Big Pharma — they make a lot of money, Big Pharma — big corporations, and other special interests, and does not want to ask the tough questions about what is happening to our children’s health,” he said. “If Big Pharma defrauds American patients and taxpayers or puts profits above people, they must be investigated and held accountable.”

Trump hasn’t said much about drug prices in his 2024 campaign, but allies and former advisers say he remains committed to knocking down prescription prices if reelected.

He would likely focus on increasing generic and biosimilar competition, importing drugs made in the U.S. but sold overseas back to the U.S., and capping out-of-pocket insulin costs, according to former Trump administration officials. Other goals may be lowering prices for drugs in the Medicare 340B program, which requires drugmakers to provide outpatient drugs at reduced prices to eligible health organizations that serve lower-income and uninsured patients.

“The No. 1 issue he cared about while I was in the White House, and I continue to hear him talk about, is lowering drug prices,” said Theo Merkel, a senior research fellow at conservative think tanks Paragon Health Institute and the Manhattan Institute. Merkel was also a special assistant in the Trump White House. “I’m confident that will be at the top of the agenda,” he added.

Catherine Hill, a spokesperson for Pharmaceutical Research and Manufacturers of America, or PhRMA, said the industry trade group looks forward to collaborating with any future presidential administration.

She criticized the Biden administration’s plan for Medicare price negotiation as well as Trump’s plan to align U.S. prices with those in foreign countries. This month, the administration announced new, reduced prices for 10 drugs in the program following negotiations between the federal government and drugmakers. The lower costs take effect in 2026.

“Previous price controls adopted by the Biden administration threaten to stifle that innovation,” Hill said. “Undermining intellectual property protections and borrowing other countries’ price controls will further undercut innovation and threaten patients’ access to medicine.”

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En 2022, Harris emitió el voto de desempate en el Senado para aprobar una ley que permite a Medicare negociar los precios de los medicamentos para sus más de 60 millones de beneficiarios. Antes, como fiscal general de California, fue una reguladora agresiva de la industria farmacéutica.

Como presidente, Trump probablemente mantendría las negociaciones de precios de Medicare a menos que la industria farmacéutica pudiera ofrecer algo más convincente. Según personas de su círculo, en su primer mandato propuso varias políticas destinadas a reducir los costos de los medicamentos recetados, pero tuvo un éxito limitado en su implementación.

La industria farmacéutica podría beneficiarse si Trump sigue sin poder avanzar con tales propuestas.

“Sus esfuerzos fueron en gran parte fragmentados y enfrentaron resistencia tanto de la industria como de los legisladores”, dijo Sergio José Gutiérrez, estratega político que ha trabajado principalmente con demócratas. “La falta de una estrategia consolidada y la capacidad limitada para implementar cambios significativos hizo que su enfoque fuera menos efectivo en comparación con lo que una administración Harris-Walz podría ofrecer”.

Legisladores de ambos partidos atacan cada vez más a la industria, por los precios de los medicamentos que la mayoría de los estadounidenses consideran irrazonables, según encuestas de KFF. El resultado de la elección podría ser crucial para la suerte de las farmacéuticas.

La situación actual de la industria contrasta fuertemente con años anteriores, cuando gozaban de una reputación de ser casi intocables. Durante más de una década, rechazaron propuestas para permitir que Medicare negociara precios más bajos de medicamentos antes de perder la batalla hace dos años.

El cambio en su posición política se refleja en las contribuciones de las compañías farmacéuticas a los candidatos. Una industria que en los años 90 y principios de los 2000 daba tres o cuatro veces más a los candidatos republicanos que a los demócratas, ahora está repartiendo de forma distinta sus apuestas. Hasta ahora, en el ciclo de 2024, las compañías farmacéuticas han dado $4,89 millones a los demócratas y $4,35 millones a los republicanos, según OpenSecrets, un grupo de investigación no partidista.

Harris ha recibido $518.571 de la industria, y Trump $204.748.

En la Convención Nacional Demócrata en Chicago, Harris y otros promocionaron sus antecedentes en la reducción de los precios de los medicamentos. Los partidarios de Harris señalan su pasado y presente.

Mientras fue fiscal general de California, Harris tuvo causas que resultaron en casi $7.200 millones (alrededor de $22 por persona en Estados Unidos) en multas para las farmacéuticas.

Su voto para aprobar la Ley de Reducción de la Inflación del presidente Joe Biden allanó el camino no solo para la negociación de precios de Medicare, sino también para un límite anual de $2.000 en el gasto total en medicamentos de los beneficiarios de Medicare y un límite de $35 en sus suministros mensuales de insulina.

“En los Estados Unidos de América, ningún adulto mayor debería tener que elegir entre llenar su receta o pagar su alquiler”, dijo Harris el 15 de agosto en su primera aparición conjunta con Biden desde que el presidente  abandonara la carrera por la reelección.

Si es elegida presidenta, ha prometido extender tanto el límite anual de gastos en medicamentos como el límite del precio de la insulina a todos los estadounidenses con seguro, no solo a aquellos con Medicare.

Harris también respaldó una política polémica que, en algunos casos, permitiría al gobierno federal inyectar más competencia en el mercado al incautar las patentes de algunos medicamentos costosos desarrollados con fondos federales.

Doug Hart, de 77 años, de Tempe, Arizona, ha estado gastando alrededor de $7.000 anuales en medicamentos recetados. Un medicamento que toma para prevenir coágulos de sangre costará menos bajo las negociaciones de precios de Medicare. El presidente retirado de un sindicato dijo que la disminución será considerable y es una de las razones por las que apoya a Harris.

“Los republicanos votaron en contra de la negociación de precios de Medicare. Harris rompió el empate en el Senado para permitirlo”, dijo Hart, quien es miembro de la junta de la Alianza de Jubilados de Arizona, que trabaja para movilizar a miembros y sindicalistas retirados en temas progresistas.

Si bien como partido los republicanos siguen siendo más favorables a la industria farmacéutica, Trump ha estado dispuesto a desafiar la ortodoxia del GOP tomando medidas para combatir los altos costos de los medicamentos.

Durante su administración, trató de vincular los precios de los medicamentos en Medicare con los precios internacionales más bajos, una propuesta que el instituto de investigación de salud de PricewaterhouseCoopers estimó que costaría a cinco fabricantes de medicamentos hasta $500 millones de dólares al año.

Lo que se conocía como la regla final interina de “nación más favorecida” fue bloqueada debido a desafíos legales y luego fue rescindida por la administración de Biden.

Trump emitió una regla que establecía un camino para importar medicamentos de Canadá y otros países, con Florida convirtiéndose este año en el primer estado en obtener la aprobación federal para importar algunas recetas de Canadá. Pero las acciones del estado se frustraron por la resistencia de Health Canada, el departamento del gobierno canadiense responsable de la política de salud nacional.

Y en su sitio web de campaña, Trump publicó un video en el que cuestionaba si los problemas de salud infantil son el resultado de la “sobre recetar” medicamentos.

“Con demasiada frecuencia, nuestro establishment de salud pública está demasiado cerca de Big Pharma; ganan mucho dinero, Big Pharma, las grandes corporaciones y otros intereses especiales, y no quieren hacer las preguntas difíciles sobre lo que está sucediendo con la salud de nuestros hijos”, dijo. “Si Big Pharma engaña a los pacientes y contribuyentes estadounidenses o antepone las ganancias a las personas, se los debe investigar y responsabilizar”, agregó.

Trump no ha dicho mucho sobre los precios de los medicamentos en su campaña de 2024, pero sus aliados y ex asesores dicen que sigue comprometido a reducir los precios de las recetas, si es reelegido.

Probablemente, Trump se enfocaría en aumentar la competencia de genéricos y biosimilares, importar medicamentos fabricados, pero que en la actualidad se venden en el extranjero, y limitar los costos de bolsillo de la insulina, según ex funcionarios de su administración.

Otros objetivos podrían ser reducir los precios de los medicamentos en el programa 340B de Medicare, que requiere que los fabricantes proporcionen fármacos para pacientes ambulatorios a precios reducidos a organizaciones de salud elegibles que atienden a pacientes de bajos ingresos y sin seguro.

“El tema número 1 que le importaba mientras estaba en la Casa Blanca, y sigo escuchándolo hablar, es reducir los precios de los medicamentos”, dijo Theo Merkel, investigador senior en los think tanks conservadores Paragon Health Institute y Manhattan Institute. Merkel también fue asistente especial de Trump en la Casa Blanca. “Estoy seguro de que estará arriba en la agenda”, agregó.

Catherine Hill, vocera de la Asociación de Investigación y Fabricantes Farmacéuticos de América, o PhRMA, dijo que el grupo comercial de la industria espera colaborar con cualquier futura administración presidencial.

Criticó el plan de negociación de precios de Medicare de la administración Biden, así como el plan de Trump de alinear los precios con los de otros países. Este mes, la administración anunció nuevos precios reducidos para 10 medicamentos en el programa tras negociaciones entre el gobierno federal y las farmacéuticas. Los costos más bajos entrarán en vigencia en 2026.

“Los controles de precios anteriores adoptados por la administración Biden amenazan con frenar esa innovación”, dijo Hill. “Socavar las protecciones de la propiedad intelectual y tomar ‘prestados’ los controles de precios de otros países subestimará aún más la innovación y amenazará el acceso de los pacientes a los medicamentos”.

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That vision is outlined in the Project 2025 “Mandate for Leadership,” a 900-page blueprint produced by the conservative Heritage Foundation and other conservative organizations as a guide for the next administration.

Although Trump has repeatedly said Project 2025 has no place in his campaign, Democrats keep bringing it up. On each night of the Democratic National Convention so far, speakers have invoked Project 2025, with Sen. Bernie Sanders (I-Vt.) calling it “radical”; Colorado Gov. Jared Polis (D) holding up a bound copy of the “Mandate for Leadership” and calling it Trump’s “road map to ban abortion in all 50 states”; and comedian Kenan Thompson highlighting its call to use the 19th-century Comstock Act to block the mailing of abortion pills.

Among Project 2025’s proposals are plans for federal health policy.

For instance, the Department of Health and Human Services would adopt a staunch antiabortion stance, and federal approval for one commonly used abortion drug could be revisited and potentially withdrawn.

“Abortion,” “reproductive health” and any other term “used to deprive Americans of their First Amendment rights” would be removed from every federal rule, regulation, grant or piece of legislation.

The Centers for Disease Control and Prevention would research abortion risks and complications. And HHS would be recast as the Department of Life, underscoring a new Christian nationalist focus.

Although Trump has repeatedly denied that the document will inform his White House if he wins in November, Democrats’ focus on Project 2025 will probably continue beyond the convention, in part because some of its proposals, including abortion restrictions, poll poorly for him and other Republican candidates.

Support for abortion access is growing. Sixty-one percent of adults want their state to allow legal abortion for any reason, according to a poll conducted in June by the Associated Press and the University of Chicago’s NORC, which provides social research.

Vice President Kamala Harris’s campaign says Project 2025 shows “they’ll implement a 50-state ‘backdoor ban’ on abortion — without Congress — and jail health care providers.”

Abortion rights groups are also using Project 2025 to say Trump would endanger access to abortion. The former president has said abortion issues should be decided by states.

“We’re so focused on educating voters about 2025. It’s an extreme ban,” said Julie Lewis, director of public policy at Planned Parenthood Votes, a super PAC affiliated with Planned Parenthood Federation of America.

The Heritage report, a version of which has been produced roughly every four years since the 1980s, has had considerable sway on GOP presidents. Former president Ronald Reagan adopted about 60 percent of the recommendations in a Heritage guide. Trump did the same in his presidency.

As Election Day approaches, Trump continues to try to distance himself from the document, and its authors say he wasn’t involved. A number of high-ranking officials from his administration, though, were. His running mate, Sen. JD Vance of Ohio, wrote the foreword to a yet-to-be-released book by Kevin Roberts, who is president of Heritage.

Roger Severino, vice president of domestic policy at Heritage, who wrote the HHS chapter in the Project 2025 blueprint, ran the agency’s Office for Civil Rights during Trump’s presidency.

Severino pushed back on Democratic claims that the document would ban medication abortion: “It’s a lie, plain and simple,” he said.

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Walz, un ex profesor de secundaria y entrenador de fútbol de 60 años, tiene un historial de apoyo a iniciativas de atención médica de izquierda durante sus dos mandatos como gobernador y mientras fue representante en la Cámara de Representantes de Estados Unidos de 2007 a 2019.

También lidera un estado central para la industria de la salud: Minnesota es el hogar tanto de la mayor aseguradora de salud del país, UnitedHealth Group, como de uno de sus sistemas hospitalarios más prestigiosos, la Clínica Mayo.

Los republicanos han aprovechado su historial para definir a la fórmula Harris-Walz como extrema en atención médica, mientras que los demócratas dicen que los esfuerzos de Walz para reducir los costos de los medicamentos y preservar el acceso al aborto son posiciones centrales que atraen a los votantes indecisos.

En cualquier caso, su elección pone la atención médica en el centro de la escena como un tema electoral, resaltando la importancia de la batalla del país sobre el acceso al aborto, así como la profunda angustia de los votantes por el aumento de los costos de salud.

Muchas de las posturas de Walz coinciden con las de Harris.

Ha luchado por el acceso al aborto, firmando una legislación para codificar los derechos al aborto en el estado, y en marzo recorrió una clínica de Planned Parenthood con la vicepresidenta.

Apoyó la legislación del Congreso que dio facultades al gobierno federal para negociar los precios de los medicamentos en Medicare, el programa de seguro de salud para personas mayores y discapacitadas. El 15 de agosto, la administración Biden publicó nuevos precios reducidos para 10 medicamentos en el programa que derivan de las negociaciones entre el gobierno y las farmacéuticas. Los costos más bajos entrarán en vigencia en 2026.

Como gobernador, Walz firmó en 2020 una ley para limitar los gastos de bolsillo de la insulina a $35 al mes para los residentes elegibles con una necesidad urgente del medicamento. Dos años después, el presidente Joe Biden hizo lo mismo para todos los pacientes de Medicare.

A principios de la pandemia de covid-19, Walz ordenó que se usaran máscaras en la mayoría de los espacios públicos cerrados. Extendió una orden ejecutiva de quedarse en casa en 2020, lo que llevó al ex presidente Donald Trump a publicar “¡LIBEREN A MINNESOTA!” en X, en aquel entonces todavía Twitter.

“Tiene sentido común cuando se trata de problemas y políticas”, dijo Andy Slavitt,  ex  ejecutivo de UnitedHealth y ex administrador de los Centros de Servicios de Medicare y Medicaid (CMS). “No es un ideólogo. Es un pensador independiente que se preocupa por las personas que no tienen recursos”, agregó Slavitt, quien se desempeñó como asesor principal del equipo de respuesta al covid de la administración Biden.

Walz también ha defendido los tratamientos de fertilidad (FIV), compartiendo su historia personal de cómo él y su esposa, Gwen, dependieron de ellos para concebir. Debido a que la fertilización in vitro está bajo una amenaza creciente por parte de algunos opositores al aborto, a pesar de su amplia popularidad, su conocimiento de primera mano sobre los desafíos de fertilidad le agrega fuerza política.

“Walz ha sido articulado y apasionado sobre su experiencia con la FIV, y eso conecta con personas de ambos lados de la calle”, dijo Christoper Sheeron, fundador y presidente de Action for Health, una organización nacional de defensa sin fines de lucro.

Los republicanos en Minnesota dicen que las posiciones de Walz sobre atención médica se volverán en contra de la fórmula demócrata. Critican el requisito que estableció en 2021 sobre la vacunación contra covid o las pruebas regulares para empleados estatales, su apoyo a la legislación para codificar los derechos al aborto, su respaldo a la legalización de la marihuana recreativa y una ley que firmó para expandir la cobertura de salud pública a ciertos inmigrantes sin residencia legal.

“Bajo el gobernador Walz, vimos una de las agendas más radicales y de izquierda del país. Mientras los estadounidenses buscan unidad, Walz tiene un historial de implementar políticas extremas que solo nos dividen más”, dijo en un comunicado Mark Johnson, líder republicano del Senado estatal de Minnesota. “Ha puesto a nuestro estado en el camino hacia la atención médica gestionada por el gobierno y ha defendido mandatos restrictivos de atención médica que limitan el acceso de los habitantes de Minnesota a la atención que salva vidas”.

Tracy Mitchell, residente de Minnesota, dijo que antes de la elección de Walz, se inclinaba por apoyar a Trump en noviembre porque creía que haría más para reducir sus costos de atención médica.

El anuncio consolidó su decisión: va a votar por Trump.

“Tengo tres hijos, y la atención médica se vuelve costosa”, dijo Mitchell, de 38 años, de Ham Lake, mientras visitaba Stillwater, Minnesota, con su familia. Es la directora de operaciones de programas de una clínica de salud mental.

“La forma en que manejó covid y en términos de atención médica, creo que es demasiado extremo”, dijo.

Aun así, los demócratas expresan la esperanza de que un mayor enfoque en la atención médica les dará una ventaja en las elecciones, aprovechando las preocupaciones de los votantes sobre temas económicos en los estados indecisos.

El 48% de los republicanos o adultos que se inclinan por los republicanos dijeron que la asequibilidad de la atención médica es un problema muy grande en el país, según una encuesta de mayo del Pew Research Center. El 65% de los demócratas o adultos que se inclinan por los demócratas estuvo de acuerdo.

La preocupación supera a la inmigración ilegal, el déficit presupuestario federal, la violencia armada y las adicciones.

Tres de cada cuatro adultos dijeron que están muy o algo preocupados por poder pagar facturas médicas inesperadas, según una encuesta realizada en enero y febrero por KFF, una organización sin fines de lucro de información sobre salud que incluye a KFF Health News.

“Los republicanos siempre han sufrido porque hablan de la atención médica en términos económicos”, dijo William Pierce, director senior en APCO Worldwide, una firma global de asesoría y defensa, y ex asistente del Congreso republicano. “Los demócratas hablan de ello como un tema personal. La elección de Walz les da una mayor oportunidad de empujar más fuerte”.

El homólogo de Walz en la fórmula republicana, el senador por Ohio JD Vance, tiene menos experiencia en temas de atención médica. Pero ha tratado de mostrar preocupación por el aumento de los costos y las barreras para acceder a la atención.

Durante una visita reciente a Eau Claire, Wisconsin, Vance dijo que el gobierno debe hacer más para preservar el acceso a la atención médica en la América rural.

En una columna de opinión publicada en julio de 2017 en The New York Times, mucho antes de postularse para el Senado como republicano, Vance expresó su apoyo a algunas disposiciones de la Ley de Cuidado de Salud a Bajo Precio (ACA), y criticó el impulso del partido republicano para derogar la ley porque, dijo, la propuesta “retira sus apoyos para los pobres”.

Desde que es candidato a vicepresidente, Vance ha alineado sus puntos de vista con los de Trump sobre ACA, una ley que Trump intentó y no pudo derogar mientras era presidente.

“La diferencia es entre quienes defienden ACA y quienes la derogarían; la elección de Walz hace que ese contraste sea más claro que nunca”, dijo Anthony Wright, director ejecutivo de Families USA, una organización no partidista centrada en el acceso y la asequibilidad de la atención médica.

Vance ha apoyado permitir que el gobierno federal negocie los precios de los medicamentos de Medicare, un particular punto de acuerdo en la política de salud con los demócratas.

Al igual que Trump, se opone a la atención de afirmación de género para menores transgénero. Pero ha tomado posiciones más firmes que el ex presidente sobre el aborto, una vulnerabilidad que los demócratas han tratado de explotar. El apoyo público a los derechos al aborto ha aumentado desde que la Corte Suprema anuló Roe vs. Wade en 2022, y muchos estados liderados por republicanos tomaron acciones para imponer prohibiciones estrictas.

Ambas campañas, demócrata y republicana, están atrayendo un nuevo escrutinio sobre sus posiciones en la atención médica. El super PAC de la vicegobernadora de California, Eleni Kounalakis, Californians for Choice, lanzó un anuncio este mes diciendo que Vance apoya una prohibición nacional del aborto, “despojándonos de nuestra libertad”.

Al igual que Trump, Vance ha dicho recientemente que los estados deberían decidir las políticas específicas sobre el aborto, pero anteriormente apoyaba la prohibición del aborto a nivel nacional.

Mientras tanto, la campaña de Trump ha etiquetado a Walz como “Tampon Tim” debido a una ley estatal que firmó que requiere que los productos menstruales estén disponibles para “todas las estudiantes en los baños que utilizan regularmente en los grados 4 a 12, según un plan desarrollado por el distrito escolar”.

Un anuncio reciente de la campaña de Trump llamó a Walz “demasiado raro. Demasiado radical”.

Pero agregar a Walz a la fórmula electoral ha inyectado energía a los votantes demócratas con preocupaciones de atención médica. Como Angel Palm, de 32 años, entrenadora de vida para personas con discapacidades que vive en Fridley, Minnesota.

“Mi hijo es autista y tiene costos médicos. Es muy importante”, dijo a KFF Health News. “Estoy muy emocionada”.

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Walz, a 60-year-old former high school teacher and football coach, has a record of supporting left-leaning health care initiatives during his two terms as governor and while serving in the U.S. House of Representatives from 2007 to 2019. He also leads a state central to the health care industry: Minnesota is home both to the nation’s largest health insurer, UnitedHealth Group, and one of its most prestigious hospital systems, the Mayo Clinic.

Republicans have seized on his record to portray the Harris-Walz ticket as extreme on health care, while Democrats say Walz’s efforts to lower drug costs and preserve abortion access are mainstream positions that appeal to swing voters. Either way, his selection thrusts health care center stage as an election issue, underscoring the primacy of the nation’s battle over abortion access as well as voters’ deep angst over spiraling health care costs.

Many of Walz’s stances dovetail with those of Harris.

He has fought for abortion access, signing legislation to codify abortion rights in the state, and in March toured a Planned Parenthood clinic with the vice president.

He supported congressional legislation empowering the federal government to negotiate drug prices in Medicare, a health insurance program for seniors and the disabled. The Biden administration on Aug. 15 released new, reduced prices for 10 drugs in the program that stem from the negotiations between the government and drugmakers. The lower costs will kick in in 2026.

As governor, Walz signed legislation in 2020 to cap out-of-pocket insulin costs to $35 a month for eligible residents with an urgent need for the medication. Two years later, President Joe Biden did the same for all Medicare patients.

Early in the covid-19 pandemic, Walz mandated that masks be worn in most indoor public spaces. He extended an executive stay-at-home order in 2020, which led former President Donald Trump to post “LIBERATE MINNESOTA!” on X, the social platform then called Twitter.

“He has common sense when it comes to issues and policy,” said Andy Slavitt, a former UnitedHealth executive and former administrator of the Centers for Medicare & Medicaid Services. “He’s not an ideologue. He’s an independent thinker who cares about people who don’t have resources,” said Slavitt, who served as a senior adviser to the Biden administration’s covid response team.

Walz also has championed fertility treatments, sharing his personal story of how he and his wife, Gwen, relied on them to conceive. Because in vitro fertilization is under increasing threat by some abortion opponents, despite its broad popularity, his firsthand knowledge of fertility challenges is adding political muscle.

“Walz has been articulate and passionate about his experience with IVF, and that connects with people on both sides of the aisle,” said Christoper Sheeron, founder and president of Action for Health, a national nonprofit advocacy organization.

Republicans in Minnesota say Walz’s health care positions will work against the Democratic ticket. They criticize his 2021 covid vaccination or regular testing requirement for state employees, his support of legislation codifying abortion rights, his backing of recreational marijuana legalization, and a bill he signed to expand public health coverage to some immigrants lacking legal residency.

“Under Gov. Walz, we saw one of the most radical, far-left agendas in the country. While Americans are searching for unity, Walz has a record of implementing extreme policies that only divide us further,” the Republican leader of Minnesota’s state Senate, Mark Johnson, said in a statement. “He has put our state on a path to government-run health care and championed restrictive health care mandates that limit Minnesotans’ access to life-saving care.”

Minnesotan Tracy Mitchell said that before Walz’s selection she was leaning toward backing former President Donald Trump in November because she believed he would do more to lower her health care costs.

The announcement cemented her decision: She’s voting for Trump.

“I have three kids, and health care gets expensive,” Mitchell, 38, of Ham Lake, said while visiting Stillwater, Minnesota, with her family. She is the director of program operations for a mental health care clinic.

“The way he handled covid, and in terms of health care, I think he is too extreme,” she said.

Still, Democrats express hope that a greater focus on health care will give them an advantage in the election, tapping into voter concerns about pocketbook issues in swing states.

Forty-eight percent of Republicans or adults who lean Republican said health care affordability is a very big problem in the country, according to a May poll by the Pew Research Center. Sixty-five percent of Democrats or adults who lean Democratic agreed.

The concern tops illegal immigration, the federal budget deficit, gun violence, and drug addiction.

Three in 4 adults said they are very or somewhat worried about being able to afford unexpected medical bills, based on a poll done in January and February by KFF, a health information nonprofit that includes KFF Health News.

“Republicans have always suffered because they talk about health care in economic terms,” said William Pierce, who is a senior director at APCO Worldwide, a global advisory and advocacy firm, and a former GOP congressional aide. “Democrats talk about it as a personal issue. The selection of Walz gives them a greater opportunity to push it harder.”

Walz’s counterpart on the GOP ticket, Ohio Sen. JD Vance, has less experience with health care issues. But he has sought to show concern about rising costs and barriers to care.

During a recent visit in Eau Claire, Wisconsin, Vance said the government must do more to preserve health care access in rural America.

In a July 2017 op-ed published by The New York Times, well before he ran for the Senate as a Republican, Vance expressed support for some provisions of the Affordable Care Act and criticized the GOP push to repeal the law because, he said, the proposal “withdraws its supports for the poor.”

Since joining Trump’s ticket, Vance has aligned his views with Trump’s on the ACA — a law Trump tried and failed to repeal while president.

“The difference is between those defending the ACA and those who would repeal it; the choice of Walz makes that contrast as clear as ever,” said Anthony Wright, the executive director of Families USA, a nonpartisan organization focused on health care access and affordability.

Vance has backed letting the federal government negotiate Medicare drug prices — a rare point of agreement on health policy with Democrats.

Like Trump, he opposes gender-affirming care for transgender minors. But he has taken firmer positions than the former president on abortion — a vulnerability Democrats have sought to exploit. Public support of abortion rights has increased since the Supreme Court struck down Roe v. Wade in 2022 and many Republican-led states moved to impose strict bans.

Both the Democratic and Republican campaigns are drawing fresh scrutiny of their positions on health care. California Lt. Gov. Eleni Kounalakis’ super PAC, Californians for Choice, released an ad this month saying Vance supports a nationwide abortion ban, “stripping away our freedom.”

Like Trump, Vance has recently said states should decide specific abortion policies, but he previously supported outlawing abortion nationwide.

Trump’s campaign, meanwhile, has labeled Walz “Tampon Tim” because of a state law he signed requiring menstrual products to be available to “all menstruating students in restrooms regularly used by students in grades 4 to 12, according to a plan developed by the school district.”

A recent Trump campaign ad called Walz “too weird. Too radical.”

But Walz’s addition to the ticket has energized Democratic voters with health care concerns such as Angel Palm, 32, a life coach for people with disabilities who lives in Fridley, Minnesota.

“My son is autistic and has medical costs. It’s so important,” she told KFF Health News. “I’m so stoked.”

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After President Donald Trump left office, Severino helped the conservative Heritage Foundation develop a plan to expand that conservative stamp to the broader department, recasting HHS with a focus on traditional marriage and family.

The vision is outlined in the Project 2025 “Mandate for Leadership,” a blueprint by the foundation and allied groups intended to guide the next presidential administration. It has emerged as a political flash point, as Democrats portray the 900-page document as promoting an authoritarian power grab by extreme conservatives.

Severino, the lead architect of the project’s section on HHS, has won praise from conservatives and criticism from LGBTQ+ and other liberal advocacy groups who say he poses a threat to reproductive rights and gender-affirming care.

His proposals smack of some of the most heated culture war conflicts shaping the election, from gay rights to gender identity to contraception. They would likely find support under a conservative administration.

Under Severino’s vision for HHS, federal approval of one commonly used abortion drug, mifepristone, could be revisited and potentially withdrawn. Health agencies would promote “fertility awareness” as an “unsurpassed” method of contraception. Medicaid, the public health insurance program that covers more than 75 million low-income and disabled people, could be converted into block grants that Democrats say would result in far lower funding and enrollment.

HHS itself would be known as the Department of Life, underscoring a new focus on opposing abortion.

Severino declined to comment extensively on Project 2025, but he pushed back in an interview on assertions that it would ban access to medication abortion.

“When the Biden-Harris administration says [the document] would ban all chemical abortion nationally, it’s a lie, plain and simple,” he said.

Trump, again the GOP’s presidential nominee, has taken increasingly aggressive steps to distance himself from Project 2025 as it has become central to his opponents’ attacks. Heritage on July 30 said that Paul Dans, who directed the initiative, would step down from his role. The same day, Trump’s campaign managers, Susie Wiles and Chris LaCivita, denounced the document.

“Project 2025 had nothing to do with the campaign, did not speak for the campaign, and should not be associated with the campaign or the President in any way,” Wiles and LaCivita said in a statement.

But the campaign’s message is undermined by the document’s authorship; its contributors include a number of high-ranking officials from Trump’s first administration, including former White House adviser Peter Navarro; Christopher Miller, whose positions included acting secretary of defense; and Trump’s secretary of Housing and Urban Development, Ben Carson.

Project 2025’s passages on abortion, in particular, depart significantly from what Trump has said about the issue on the campaign trail. He has said he wants abortion policy made in states, not at the federal level, and that he wouldn’t support a national ban or taking mifepristone off the market. He refashioned the official GOP platform to make scant mention of abortion, recognizing the political peril the issue posed for his campaign.

Support for abortion access is growing. Sixty-one percent of adults want their state to allow legal abortion for any reason, according to a poll conducted in June by The Associated Press and the University of Chicago’s NORC, which conducts social research.

The Heritage Foundation’s policy proposals, published roughly every four years since the 1980s, have had considerable sway on GOP presidents. Former presidents Ronald Reagan and Trump each adopted about 60% or more of the recommendations produced in earlier Heritage guides, the group says.

Severino was a trial attorney for seven years in the U.S. Department of Justice’s Civil Rights Division under former presidents George W. Bush and Barack Obama. He joined Heritage in 2015 and garnered acclaim from conservatives in part because of articles he published while he was there.

In one, for example, he said a proposal by Obama to include gender identity in Affordable Care Act provisions prohibiting discrimination would penalize medical professionals and health care organizations that, as a matter of faith, believe “maleness and femaleness are biological realities” to be “affirmed” rather than “treated as diseases.”

He was tapped to run the HHS Office for Civil Rights in 2017.

There, he created a new Division of Conscience and Religious Freedom because, he said, protections for people with deeply held religious beliefs had been underenforced.

The proposals for HHS laid out in Project 2025 have alarmed LGBTQ+ advocacy groups as well as some researchers.

“It could promote stigma and discrimination,” said Lindsey Dawson, director of LGBTQ Health Policy at KFF, a health information nonprofit that includes KFF Health News.

President Joe Biden and the Democratic Party’s new presumptive presidential nominee, Vice President Kamala Harris, have repeatedly urged voters to read the document themselves.

In one of her first speeches after taking over the top spot on the Democratic ticket, Harris said Project 2025 would “treat health care as only a privilege for the wealthy instead of what we all know it should be, which is a right for every American.”

Conservatives say Democrats are lying about what Project 2025’s proposals would do and are incorrectly attributing the ideas to Trump for political gain.

Spokespeople for the Trump and Harris campaigns didn’t respond to requests for comment.

The blueprint’s foreword espouses what it calls an anti-“woke” mentality, proposing to delete from every federal regulation words such as diversity, equity, inclusion, “and any other term used to deprive Americans of their First Amendment rights.”

HHS would revisit a rule that prohibits discrimination in health programs and extends those protections to people based on their sexual orientation and gender identity. The document says that definition “created special privileges for new classes of people, defined in ways that are highly ideological and unscientific,” and should be reversed.

The Centers for Disease Control and Prevention would cease collecting data on gender identity because, the Project 2025 report says, it “legitimizes the unscientific notion that men can become women (and vice versa),” and health agencies would study the “negative effects of cross-sex interventions” such as puberty blockers.

“Families comprised of a married mother, father, and their children are the foundation of a well-ordered nation and healthy society,” according to the document.

The road map would roll back years of hard-fought gains for people who are LGBTQ+, their advocates say.

“This is a fantasy reality, like watching ‘Leave it to Beaver,’” said David Stacy, vice president of government affairs at the Human Rights Campaign, an LGBTQ+ advocacy group.

The concepts may appeal to many in Trump’s conservative base, however. Nine in 10 U.S. adults say a husband and wife raising children together is completely acceptable, according to a 2023 poll by the Pew Research Center. Fewer than half say the same about a married gay or lesbian couple raising children together.

Nine in 10 Trump supporters and about 4 in 10 Biden supporters say sex at birth determines if someone is a man or a woman, according to an April Pew poll.

Project 2025 risks GOP voter support over its anti-abortion stance, according to some political analysts. Its foreword also calls for removing from grants, regulations, and legislation words such as abortion, reproductive health, reproductive rights, and any other term “used to deprive Americans of their First Amendment rights.”

The proposal urges that the CDC fund research into abortion risks and complications and that HHS cut federal funding for states that don’t provide data such as the number of abortions performed within their borders.

Project 2025 calls for revisiting approval of the abortion pill mifepristone. It could potentially lose FDA authorization and be subject to new dispensing requirements — such as barring distribution by mail, based on an 1873 law known as the Comstock Act — before that step.

The proposal’s authors say misoprostol, a medication approved to treat ulcers but also used for abortion, would not be affected.

“If the FDA were to reconsider mifepristone because of legal or safety concerns, at most, it would put doctors back in the process without limiting their ability to prescribe other chemical abortion drugs off-label,” Severino said.

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