Keeping abortion rights off the ballot

Dec 18, 2023

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With Erin Schumaker

Driving The Day

Anti-abortion activists participate in a Celebrate Life Day Rally at the Lincoln Memorial on June 24, 2023, in Washington, D.C.

Anti-abortion activists participate in a Celebrate Life Day Rally at the Lincoln Memorial on June 24 in Washington, D.C. | Anna Rose Layden/Getty Images

NEW ABORTION TACTICS — After a series of high-profile defeats, many conservatives no longer want to see abortion on the ballot.

The new strategy: In Arizona, Florida, Nevada and other states, several anti-abortion groups are buying TV and digital ads, knocking on doors and holding events to persuade people against signing petitions to put the issue before voters in November, POLITICO’s Alice Miranda Ollstein and Megan Messerly report.

Republicans are also appealing to state courts to keep referendums off the ballot, while GOP lawmakers in states including Missouri and Oklahoma are pushing to raise the threshold for an amendment to pass or to make it on the ballot in the first place.

“All options should be on the table,” said Steven Aden, the chief legal officer of the anti-abortion group Americans United for Life. “Because we believe that abortion is truly about the right to life of human individuals in the womb, we don't believe those rights should be subjected to majority vote.”

Why it matters: The strategy aims to prevent abortion-rights groups from notching their third, and largest, set of ballot measure victories since Roe v. Wade was overturned.

How we got here: Abortion-rights wins in Kansas, Kentucky, Michigan and Ohio, underscore abortion opponents fears’ that their monumental victory overturning Roe is being undone one state at a time.

In Missouri, a Republican lawmaker has filed legislation for the new session, which begins next month, that would require constitutional amendments to pass with a statewide majority and a majority in more than half of the state’s eight congressional districts.

It is one of several GOP proposals around the country that would undermine efforts to approve abortion protections at the ballot in 2024 — though changes to the initiative process would need to be approved by voters.

Anti-abortion advocates and Republican state attorneys general in states like Florida, Missouri and Nevada are challenging initiatives in court as unconstitutionally vague, confusing or misleading.

Progressives are bracing for efforts from conservatives to prevent abortion-related measures from being voted on in November, and say the opposition campaigns prove that abortion rights remain so popular that they can only be defeated through subterfuge.

“What we have learned from this growing drumbeat of opposition to citizen-initiated ballot measures from elected officials is that they continue to innovate, they continue to get more creative at how they want to deny voters the opportunity to vote on these questions,” said Kelly Hall, executive director of the progressive ballot measure group the Fairness Project.

WELCOME TO MONDAY PULSE. I’m still tired from the gauntlet of holiday parties. I got a new candle in a White Elephant exchange, though. Help us finish out the year strong and send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.

TODAY ON OUR PULSE CHECK PODCAST, host Kelly Hooper talks with E&E News public health reporter Ariel Wittenberg, who breaks down her investigation into the heat-related illnesses — and one fatality — afflicting letter carriers and how the U.S. Postal Service allegedly falsified heat-safety training records at the risk of endangering workers' health.

Listen to today’s Pulse Check podcast

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Congress

TAKING ON HEALTH TRANSPARENCY — Congress is continuing its work on health transparency, with new bipartisan legislation in the Senate that would require insurers, hospitals and other health facilities to disclose more pricing information, POLITICO’s Megan R. Wilson reports.

It follows on the heels of a recent House vote that advanced a health package that included similar provisions, known as the Lower Costs More Transparency Act. Sen. Mike Braun (R-Ind.) introduced the measure with Senate HELP Chair Bernie Sanders (I-Vt.). Sen. Tina Smith (D-Minn.) is also an original co-sponsor.

Megan got hold of the text, which hasn’t yet been posted online. While it has similar disclosure requirements to its House counterpart, the Senate version appears to be more stringent in some areas — including requiring hospitals to post the actual cash prices for a service, and rather than allowing providers to offer a median price.

The crux of the measure involves hospitals to be more specific about how much their services cost and insurers to disclose negotiated rates for services and the maximum allowed for providers that aren't in network. Like the House bill, it also extends transparency requirements to clinical labs, imaging centers and other facilities.

Public Health

Dr. Vivek Murthy, who has been nominated to be U.S. Surgeon General, speaks during an event.

U.S. Surgeon General Vivek Murthy has crisscrossed the country on his social connection tour. | Susan Walsh/AP

ON THE ROAD WITH MURTHY — U.S. Surgeon General Vivek Murthy's been busy this fall, crisscrossing the country on his multi-state social connection tour for college students, Erin reports.

"We Are Made to Connect" builds on the public health advisory Murthy issued earlier this year, which warned that loneliness and isolation are linked to a greater risk of cardiovascular disease, dementia, stroke, depression and anxiety, as well as suicide.

"This is really one of the defining issues of our time," Murthy told the crowd during a tour stop in Brooklyn. Grim statistics took a backseat to upbeat programming that night, which featured dancing unicorns, a drum line, grammy-winning musician Jon Batiste on the piano, and a 45-second exercise Murthy says anyone can try to feel less lonely.

Afterward, Erin sat down with Murthy for a conversation about loneliness, the surgeon general's affection for health challenges and how technology doesn’t have to destroy human connection.

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Medicaid

BOOSTING MATERNAL HEALTH — CMS is willing to give states extra money and flexibility to strengthen maternal health access, including by boosting access to doulas and midwives, POLITICO’s Robert King reports.

The agency released a new voluntary payment model on Friday that aims to partner with state Medicaid agencies. The goal is to lower maternal mortality rates that are higher than any other high-income country, despite high spending in the U.S.

States that sign up under the Transforming Maternal Health model will get extra help for targeting better maternal health access. States could use the money to boost access to providers such as midwives, freestanding birth centers and doulas.

States can also work with their local hospitals to earn a “birthing friendly” designation from CMS for meeting certain quality measures.

The model is the latest effort by the Biden administration to combat the problem. The most recent data available from 2021 shows that the U.S. maternal mortality rate was 32.9 deaths per 100,000 live births.

In the Courts

ILLUMINA CASE BACK TO FTC — A federal court late Friday agreed with the Federal Trade Commission that Illumina’s takeover of multi-cancer testing company Grail was anticompetitive, but overturned the agency’s ruling saying that it did not properly consider the company’s settlement offer.

Why it matters: The case, which was sent back to the FTC for further proceedings, represents the first time in decades that a federal court validated U.S. antitrust regulators’ concerns about vertical mergers, POLITICO’s David Lim and Josh Sisco report.

The argument: The U.S. Court of Appeals for the Fifth Circuit agreed that the FTC demonstrated the merger “is likely to substantially lessen competition” in the multi-cancer early detection market. The three judge panel also found that Illumina did not show that the Grail deal would result in efficiencies that offset the anticompetitive effects of the merger. The court also rejected the company’s constitutional challenges to the agency’s administrative litigation process.

However, the Fifth Circuit held that the FTC incorrectly required Illumina to demonstrate that its “open offer” to competitors that aimed to address antitrust concerns would restore a pre-merger level of competition — a standard described as a “legal error.” The offer was meant to make Illumina’s gene sequencing technology available to competitors on fair terms.

“The 5th Circuit’s opinion is an important victory for antitrust enforcement because it clearly recognizes how vertical mergers can threaten competition," said FTC spokesperson Douglas Farrar. "As a result, this decision marks a pivotal moment for those who want to protect open, competitive markets, and a huge win for consumers in the modern economy.”

Illumina spokesperson David McAlpine said the company is reviewing the decision.

What’s next: The FTC commissioners will now reconsider the settlement offer under the parameters set out by court.

WHAT WE'RE READING

POLITICO’s Sarah Grace Taylor reports on California Gov. Gavin Newsom blaming local counties for not moving fast enough on mental health reform.

The New York Times reports on an effort in New York City to offer free online therapy to teens.

The Washington Post reports on rampant disease in the Gaza Strip.

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