The federal government on Thursday permanently lifted a major restriction on access to abortion pills. It will allow patients to receive the medication by mail instead of requiring them to obtain the pills in person from specially certified health providers.
The decision, by the Food and Drug Administration, comes as the Supreme Court is considering whether to roll back abortion rights or even overturn its landmark 1973 decision in Roe v. Wade that made abortion legal nationwide.
The F.D.A.’s action means that medication abortion, an increasingly common method authorized in the United States for pregnancies up to 10 weeks’ gestation, will become more available to women who find it difficult to travel to an abortion provider or prefer to terminate a pregnancy in the privacy of their homes. It allows patients to have a telemedicine appointment with a provider who can prescribe abortion pills and send them to the patient by mail.
Earlier this year, for the duration of the pandemic, the F.D.A. temporarily lifted the in-person requirement on mifepristone, the first of two drugs used to end a pregnancy. The decision to make this change permanent is likely to deepen the already polarizing divisions between conservative and liberal states on abortion. In 19 states, mostly in the South and the Midwest, telemedicine visits for medication abortion are banned, and these and other conservative states can be expected to pass other laws to further curtail access to abortion pills.
Yet other states, like California and New York, which have taken steps in recent years to further solidify abortion rights, are expected to increase the availability of the method and provide opportunities for women in states with restrictions to obtain abortion pills by traveling to a state that allows them.
“It’s really significant,” said Mary Ziegler, a law professor at Florida State University. “Telehealth abortions are much easier for both providers and patients, and even in states that want to do it, there have been limits on how available it is.”
So far this year, presumably in anticipation of such a decision, six states banned the mailing of pills, seven states passed laws requiring pills to be obtained in person from a provider, and four states passed laws to set the limit on medication abortion at earlier than 10 weeks’ gestation, said Elizabeth Nash, the interim associate director of state issues for the Guttmacher Institute, a research organization that supports abortion rights.
The current practice is that women who live in states that don’t allow telemedicine for abortion must travel to a state that does — although they don’t have to visit a clinic. They may be in any location within that state for their telehealth visit, even a car, and may receive the pills at any address in the state.
But legal experts said they expected supporters of abortion rights to try to find ways to make the pills available without requiring a patient to travel, including possibly filing legal challenges to state laws banning telemedicine for abortion.
In data released last month by the Centers for Disease Control and Prevention, 42 percent of all abortions — and 54 percent of abortions before 10 weeks — occurred with medication in 2019, the most recent year for which C.D.C. data is available. (The report represents most of the country, but does not include data from California, Maryland and New Hampshire.)
In 2020, some states, including Indiana, Kansas and Minnesota, the method accounts for a majority of abortions, according to state health department reports.
Thursday, December 16, 2021
Omicron’s main threat is its shocking speed, as my colleague Sarah Zhang has reported. In South Africa, every infected person has been passing the virus on to 3–3.5 other people—at least twice the pace at which Delta spread in the summer. Similarly, British data suggest that Omicron is twice as good at spreading within households as Delta. That might be because the new variant is inherently more transmissible than its predecessors, or because it is specifically better at moving through vaccinated populations. Either way, it has already overtaken Delta as the dominant variant in South Africa. Soon, it will likely do the same in Scotland and Denmark. Even the U.S., which has much poorer genomic surveillance than those other countries, has detected Omicron in 35 states. “I think that a large Omicron wave is baked in,” Bedford told me. “That’s going to happen.”
More positively, Omicron cases have thus far been relatively mild. This pattern has fueled the widespread claim that the variant might be less severe, or even that its rapid spread could be a welcome development. “People are saying ‘Let it rip’ and ‘It’ll help us build more immunity,’ that this is the exit wave and everything’s going to be fine and rosy after,” Richard Lessells, an infectious-disease physician at the University of KwaZulu-Natal, in South Africa, told me. “I have no confidence in that.”
To begin with, as he and others told me, that argument overlooks a key dynamic: Omicron might not actually be intrinsically milder. In South Africa and the United Kingdom, it has mostly infected younger people, whose bouts of COVID-19 tend to be less severe. And in places with lots of prior immunity, it might have caused few hospitalizations or deaths simply because it has mostly infected hosts with some protection, as Natalie Dean, a biostatistician at Emory University, explained in a Twitter thread. That pattern could change once it reaches more vulnerable communities. (The widespread notion that viruses naturally evolve to become less virulent is mistaken, as the virologist Andrew Pekosz of Johns Hopkins University clarified in The New York Times.) Also, deaths and hospitalizations are not the only fates that matter. Supposedly “mild” bouts of COVID-19 have led to cases of long COVID, in which people struggle with debilitating symptoms for months (or even years), while struggling to get care or disability benefits.
And even if Omicron is milder, greater transmissibility will likely trump that reduced virulence. Omicron is spreading so quickly that a small proportion of severe cases could still flood hospitals. To avert that scenario, the variant would need to be substantially milder than Delta—especially because hospitals are already at a breaking point. Two years of trauma have pushed droves of health-care workers, including many of the most experienced and committed, to quit their job. The remaining staff is ever more exhausted and demoralized, and “exceptionally high numbers” can’t work because they got breakthrough Delta infections and had to be separated from vulnerable patients, John Lowe told me. This pattern will only worsen as Omicron spreads, if the large clusters among South African health-care workers are any indication. “In the West, we’ve painted ourselves into a corner because most countries have huge Delta waves and most of them are stretched to the limit of their health-care systems,” Emma Hodcroft, an epidemiologist at the University of Bern, in Switzerland, told me. “What happens if those waves get even bigger with Omicron?”
The Omicron wave won’t completely topple America’s wall of immunity but will seep into its many cracks and weaknesses. It will find the 39 percent of Americans who are still not fully vaccinated (including 28 percent of adults and 13 percent of over-65s). It will find other biologically vulnerable people, including elderly and immunocompromised individuals whose immune systems weren’t sufficiently girded by the vaccines. It will find the socially vulnerable people who face repeated exposures, either because their “essential” jobs leave them with no choice or because they live in epidemic-prone settings, such as prisons and nursing homes. Omicron is poised to speedily recap all the inequities that the U.S. has experienced in the pandemic thus far.
Here, then, is the problem: People who are unlikely to be hospitalized by Omicron might still feel reasonably protected, but they can spread the virus to those who are more vulnerable, quickly enough to seriously batter an already collapsing health-care system that will then struggle to care for anyone—vaccinated, boosted, or otherwise. The collective threat is substantially greater than the individual one. And the U.S. is ill-poised to meet it.
Sen. Kyrsten Sinema (D-Ariz.) is doubling down on her support for the 60-vote legislative filibuster, throwing a wrench into a frantic, last-ditch effort to get a deal to change the Senate's rules before the end of the year.
Her statement on the topic comes as a group of Democratic negotiators tasked with leading the discussions have been holding a flurry of behind-the-scenes talks about how to change the rules and break the stalemate on long-stalled voting rights legislation.
But while Sinema is making it clear that she supports voting and election reform bills that have been blocked by GOP senators, she is also standing by her support for keeping the 60-vote legislative filibuster and warning against a carve-out from the rule for voting rights.
John LaBombard, a spokesman for Sinema, said that she "continues to support the Senate's 60-vote threshold" which she believes would "protect the country from repeated radical reversals in federal policy which would cement uncertainty, deepen divisions, and further erode Americans’ confidence in our government."
"Senator Sinema has asked those who want to weaken or eliminate the filibuster to pass voting rights legislation which she supports, if it would be good for our country to do so," LaBombard said, if a weakened filibuster was then used to pass "nationwide voter-ID law, nationwide restrictions on vote-by-mail, or other voting restrictions currently passing in some states extended nationwide."
Sinema's statement comes as Sens. Tim Kaine (D-Va.), Jon Tester (D-Mont.) and Angus King (I-Maine), who is a member of the Democratic caucus, have been holding talks for weeks to try to come up with a plan to change the Senate's rules that could win over all 50 Senate Democrats.
The discussions have hit new urgency as Democrats are facing the growing chance that they reach the end of the year with President Biden's Build Back Better (BBB) bill in limbo, and without a clear path forward on voting rights legislation, despite activists and many senators viewing it as a top priority.
Majority Leader Charles Schumer (D-N.Y.) is also getting pressure from within the caucus to move voting rights legislation. But because 10 GOP senators are not expected to support a bill, the only way for it to get through the Senate is with a rules change on the filibuster.
I repeat…— Pam Keith, Esq. (@PamKeithFL) December 16, 2021
the games being played by Sinema & Manchin are only viable in a scenario where defection to the GOP is an option.
If the GOP was in serious legal jeopardy, w/cascading indictments & a serious hit to their fundraising,
defection wouldn’t be a threat. S&M would chill
- Broward County, Florida's Parkland school district has reached a $26 million settlement with the victims and families of the 17 killed at Marjory Stoneman Douglas High School in February 2018.
- The House Transportation committee has found that Donald Trump's multi-million dollar loan from the federal government to buy the now sold DC Old Post Office was a massive mess.
- Canada is the latest country to issue international travel warnings as COVID Omicron continues to spread across the globe.
- Sen. Ron Wyden has blocked legislation to ban US imports of Chinese goods made with Uyghur detainee labor after Sen. Marco Rubio objected to Wyden' child tax credit amendment.
- Internet security experts are scrambling to plug a major exploit in the latest patch of logging utility Log4J, used by thousands of companies on the internet.