US election 2020: Democrats respond to Obama’s warning

Bernie Sanders: “When I talk about raising the minimum wage to a living wage, I’m not tearing down the system. We’re fighting for justice.”

Elizabeth Warren (L), Bernie Sanders (C) and Julian Castro (R) are all contending for the Democratic presidential nomination

Elizabeth Warren (L), Bernie Sanders (C) and Julián Castro (R) are all contenders for the Democratic presidential nomination

Democratic presidential candidates have given their reaction to a warning by former President Barack Obama against moving too far left in politics.

Mr Obama’s rare intervention into the Democratic race was a talking point at campaign events on Saturday.

Some Democrats called for unity, while others defended their policy agenda.

Nearly 20 candidates remain in the running and there is much debate over the best approach to taking on President Trump next year.

Speaking at a fundraising forum in Washington, the former president – considered a moderate – cautioned candidates against pursuing polices that were not “rooted in reality”.

Mr Obama, who was in office from 2009 to 2017, said “ordinary Americans” didn’t want to “completely tear down the system”.

“This is still a country that is less revolutionary than it is interested in improvement,” Mr Obama said to an audience of wealthy donors on Friday.

Watch former US President Barack Obama talk about “woke” culture

The remarks represented Mr Obama’s most pointed intervention yet in a crowded race featuring 18 candidates.

Former vice-president Joe Biden and senators Elizabeth Warren and Bernie Sanders are leading the pack, but Mr Obama is yet to publicly back a candidate.

How did candidates respond to Mr Obama?

Although none of the Democratic candidates explicitly rebuked Mr Obama’s comments, Mr Sanders mounted the strongest defence of his policy platform.

Answering questions on a forum aired by Univision, a Spanish-language TV network, he was asked whether Mr Obama was “right” to say voters didn’t want systemic change.

Mr Sanders, who describes himself as a democratic socialist and progressive, laughed and said: “Well, it depends on what you mean by tear down the system.”

Democratic presidential hopeful, Vermont Senator, Bernie Sanders speaks at the California Democratic Party 2019 Senator Bernie Sanders insisted that he was “fighting for justice”, not seeking to tear down the system

“The agenda that we have is an agenda supported by the vast majority of working people,” he said. “When I talk about raising the minimum wage to a living wage, I’m not tearing down the system. We’re fighting for justice.”

Elizabeth Warren, another left-leaning frontrunner, struck a more conciliatory tone, choosing to praise Mr Obama’s trademark health care policy, the Affordable Care Act.

“I so admire what President Obama did,” Ms Warren said at a campaign event in Iowa, the New York Times reported.

“He is the one who led the way on health care and got health care coverage for tens of millions of Americans when nobody thought that was possible.”

Senator Elizabeth Warren speaks at the Holiday Inn in Concord, New HampshireElizabeth Warren said she admired Barack Obama’s health care achievements

New Jersey Senator Cory Booker said the party ought to be focusing its energy on defeating Republican President Donald Trump, not internal political squabbles.

“Let’s stop tearing each other down, let’s stop drawing artificial lines,” he said.

Unlike Mr Obama, Julián Castro, a former mayor of San Antonio, Texas, said he was confident any Democratic candidate would beat President Trump, regardless of their political persuasion.

Democratic presidential candidate Julian Castro speaks at the Liberty and Justice Celebration at the Wells Fargo ArenaJulián Castro said he was confident any Democratic candidate would beat Donald Trump

“Their vision for the future of the country is much better and will be more popular than Donald Trump’s,” Mr Castro, former housing secretary in the Obama administration, said.

10 things the Trump administration did in 2018 that you may have missed

From limiting the number of refugees welcomed to the US to cutting aid to Pakistan, here are some things Trump did in 2018 that you may have missed.

Trump listens during a signing ceremony for criminal justice reform legislation in the Oval Office of the White House, Friday, Dec. 21, 2018, in Washington [Evan Vucci/AP Photo]
Trump listens during a signing ceremony for criminal justice reform legislation in the Oval Office of the White House, Friday, Dec. 21, 2018, in Washington [Evan Vucci/AP Photo]

Washington, DC – This year was full of a lot of surprises from US President Donald Trump and his administration

From a number of high-level departures to his recent decision to pull US troops out of Syria, despite opposition from many within his own party and inner circle, Trump never ceased to abruptly interrupt the news cycle with a new development or announcement.

But it’s also the things that didn’t make the front page or the lead story, they may also have you surprised.

Here are 10 things the Trump administration did that you may have missed this year:

1. Fewer Refugees

In 2018, fewer refugees made it into the US than any time during the previous 40 years. That’s because the Trump administration followed a campaign promise to cap the number of people coming to the United States.

In September, the Trump administration reduced that limit again from 45,000 to 30,000. The year 2019 could see the lowest number of refugee admissions in US history.

READ MORE

‘Shameful’: US slashes number of refugees it will admit to 30,000

The move follows remarks the president made throughout 2018 aimed at immigrants and refugees. In one closed-door White House meeting, according to the Washington Post and Democratic Senator Dick Durbin, Trump referred to Haiti, African countries and some Latin American countries as “s***holes” and wondered aloud why the US was letting anyone in from those regions.

His administration has also sought to put limits on who can request asylum. This month, the Supreme Court dealt a blow to the Trump, refusing to allow the administration to implement new rules prohibiting asylum for people who cross the US border between official ports of entry. A lower court has also blocked policies put in place by former Attorney General Jeff Sessions earlier this year that made it harder for individuals fleeing domestic violence and gang violence to claim asylum.

2. Trump cuts Pakistan aid

In a New Year’s Day tweet, Trump took aim at Pakistan arguing, “the United States has foolishly given Pakistan more than 33 billion dollars in aid over the last 15 years.” He vowed that would end. And, it did. In September, during the Labor Day holiday, military assistance to Pakistan ended. The $300m, according to a Pentagon spokesperson, would be “reprogrammed” for “other urgent priorities”.

READ MORE

Pentagon to cancel $300m in Pakistan aid over armed groups

The US military has accused Pakistan of giving safe haven to groups that target US soldiers in Afghanistan. Islamabad has persistently denied the charges even though al-Qaeda leader Osama bin Laden was killed by US forces in Abbottabad in 2011, less than a mile from a Pakistani military training academy.

3. Possible sexual assault rule change at US colleges

In November, while Washington, DC, was distracted with Jim Acosta’s White House credentials and the Russia investigation, Trump’s Education Secretary Betsy DeVos issued a Friday proposal to alter the rules when it comes to how sexual assaults and harassment are handled on school campuses.

Although DeVos said the changes were designed to make reporting “more transparent, consistent, and reliable in their processes and outcomes,” groups advocating on behalf of sexual assault survivors decried it as an attempt to give more power to the accused and lessen the legal burden on schools.

One controversial provision allows the person who is accused to cross-examine the accuser through representatives.

“If these draft rules become law,” said Sage Carson, manager for Know Your Title IX, “more survivors will be forced out of school by harassment, assault, and their schools’ indifference to their complaints.”

4. Climate change report buried

Normally, US administrations use the day after the Thanksgiving holiday (a Friday) to bury uncomfortable news.

READ MORE

Trump says he doesn’t believe his administration’s climate report

In 2018, that news came in the form of an annual government report on climate change. Since his election to office, Trump has repeatedly questioned whether climate change is real.

“Whatever happened to Global Warming?” he tweeted in November after a spate of cold weather hit the US. That thinking may have guided the decision to bury the report, released the day after Thanksgiving when most Americans weren’t paying attention, by the National Oceanic and Atmospheric Administration (NOAA). It not only declares climate change is real but it is getting worse, threatening coastal communities in the US.

“The severity of future impacts will depend largely on actions taken to reduce greenhouse gas emissions and to adapt to the changes that will occur,” the report states. In 2017, Trump pulled out of the Paris climate accord, a historic international agreement on climate change aimed at reducing greenhouse gas emissions.

5. The election was rigged … or not

Just three days into 2018, Trump quietly got rid of a commission ending a taxpayer-funded venture that many people considered a waste of time and money. The Presidential Advisory Commission on Election Integrity was formed in May 2017 to investigate one of Trump’s main claims about the 2016 Presidential contest: it was rigged.

READ MORE

‘Sickening’: New anti-immigrant Trump campaign ad stokes outrage

Although Trump won the election, his Democratic opponent, Hillary Clinton, earned nearly three million more votes. Under the American electoral college system, the popular vote does not guarantee victory. Nevertheless, Trump disliked the idea that more people wanted Clinton to be president. The commission’s official mandate was to “study vulnerabilities in voting systems used for federal elections that could lead to improper voter registrations, improper voting, fraudulent voter registrations, and fraudulent voting”. It was created around Trump’s unfounded claim that millions of people voted illegally for Clinton in 2016.

However, the commission was marred with infighting and legal battles and, in the end, found zero evidence of voter fraud. After it disbanded, the commission’s vice-chair, former Kansas Secretary of State Kris Kobach, was found in contempt of court by a federal judge in a voter suppression case.

6. National debt soars

As a businessman-candidate, Trump ran for president on the premise he knows how to save money and cut waste. More importantly, he promised to get rid of the US national debt, a sore spot for many Republican legislators for many years.

As president, the debt has continued to inflate under Trump. As of mid-December, US national debt was roughly $21.8 trillion. When Trump took office in January, 2017, it was $19.9 trillion. Spending on the military and programmes like social security and Medicare increased in 2018 and there is no indication Trump will take any significant action to reduce it. According to the Congressional Budget Office, interest on the debt is one of the fastest growing payments in the annual budget. They also project overall spending to increase by 5.5 percent a year over the next 10 years.

Ironically, Trump’s Republican Party made spending controls its signature issue throughout the administration of President Barack Obama and orchestrated a partial government down in 2013 as a result of it.

7. Endangered species under attack?

Ever since Trump took over, environmentalists and animal-rights activists have warned that protections for wildlife are on his target list. The president has persistently criticised government regulations that get in the way of big business. In July, the administration announced a proposal to strip the Endangered Species Act (ESA) of some key provisions.

READ MORE

Climate change could cost US billions, worsen disasters: report

While only a proposal, the request has set off alarm bells within some of the biggest environmental organisations. The Sierra Club, which boasts 3.5 million members, bluntly warned the law is “under attack”. If implemented, the Sierra Club argues, the regulation changes would loosen protections for certain animals and fish like the gray wolf, right whale and sage-grouse. In a Washington Post op-ed in August, Interior deputy secretary David Bernhardt called aspects of the ESA an “unnecessary regulatory burden”.

8. Trump boosts overseas military spending

In August, Trump signed off on one of the largest budgets for the US military in history. At a whopping $717bn, the 2019 American defence budget is bigger than that of China, India, the UK, France and Russia combined. “We are going to strengthen our military like never ever before,” the president boasted after authorising the spending during a ceremony at Fort Drum in New York. Within that budget is money for the same overseas military spending Trump once criticised his predecessors. Trump has consistently wondered aloud why Presidents George W Bush and Barack Obama spent trillions of dollars in Iraq and Afghanistan. In his 2019 budget, Trump increased military spending in both countries.

9. Calls to end chain migration … except for Trump family

Trump hates chain migration. He has said it many times. “Under the current broken system, a single immigrant can bring in virtually unlimited numbers of distant relatives,” Trump told Americans in his annual state of the union address in January. “Under our plan, we focus on the immediate family by limiting sponsorships to spouses and minor children.”

READ MORE

US: ‘Chain migration’ grants Melania Trump’s parents citizenship

This apparent distaste, however, did not apply to his own family. In August, Amalja and Viktor Knav, the parents of First Lady Melania Trump, walked into a New York government building and took their oath to become American citizens. They are both from Slovenia. How did they get their citizenship? Through their daughter’s marriage to Trump or, put another way, chain migration. When asked whether the Knavs’ case was a textbook example of the practice, their own lawyer replied, “I suppose so.”

10. Trump poses in photo with conspiracy theorist

There’s no doubt the current occupant of the White House sometimes traffics in falsehoods. He has claimed, then retracted, his belief former US President Barack Obama wiretapped him, said people were rioting in California over sanctuary cities and suggested midterm election voters put on disguises so they could cast ballots multiple times. All those claims are incorrect.

READ MORE

Hate before the vote: Pipe bombs, shootings, incitement

So, in August, when Trump posed for a photo in the Oval Office with the proponent of a conspiracy theory, he seemed to be taking his false assertions to a new level. The visitor, Lionel Lebron, is one of the biggest advocates for a theory that gained significant traction in 2018.

Known as “QAnon” or “Q”, it’s a conspiracy pushed primarily by pro-Trump social mediastars and makes all sorts of unfounded claims about the president’s opponents, centring around a fictitious belief that prominent Democrats are running a paedophile ring. In August, “Q” posters and t-shirts followed the president everywhere. Lebron later tweeted that he never brought up QAnon with Trump.

 

SOURCE: AL JAZEERA NEWS

Five big things from Trump’s head-spinning week

Donald Trump folds his arms

This week in Washington has distilled all the chaos, upheaval, drama and conflict of the first two years of the Donald Trump presidency down to its purest form.

It’s been a bungee jump from high to low, then careening everywhere in between – and it’s not altogether clear that it won’t end with the loud and final thud of an impact on the ground.

Here’s a look at the crises – plural – that have unfolded in the past few days.

Most, if not all, are of the president’s own making. Mr Trump campaigned as a disrupter, and this week has been disruption in the extreme.

The shutdown fight

At the end of last week it appeared that Congress was on a glide path toward avoiding a partial shutdown of the federal government.

Then, on Thursday, everything went haywire. After the White House had signalled it would support the stopgap funding measure, hard-core conservative media outlets and politicians demanded the president draw a line in the sand over building his much-promised border wall.

Mr Trump abruptly changed course, announcing that “any measure that funds the government must include border security”. The fact he’s stopped calling for a wall and instead asked for border security and “metal slats” – fencing – is a concession that might have meant something if it was made weeks ago, and not under the shadow of a shutdown.

The irony is that the warning was made at a signing ceremony for bipartisan farm legislation, during which the president touted another recently passed bill reforming the criminal justice system. Green shoots of inter-party co-operation appeared this week, only to be met with the herbicide of wall acrimony.

The House of Representatives seems solidly behind including wall funding in any bill. But the Senate, with only 51 Republicans and unified Democratic opposition, is well short of the 60 votes needed to agree to such a measure. And if enough House members change their mind, there’s always the chance that the president will veto a stopgap bill without any funding for the wall.

The dynamic changes considerably on 3 January, when Nancy Pelosi and the Democrats take over the House.

At that point, the door slams shut on wall funding ever being approved in the House. The Senate may very well acquiesce to a new wall-free spending bill and the president becomes the final roadblock.

Would he back down, giving the House Democrats an early win? That may be a bitter pill to swallow.

For Mr Trump, however, the pain he appears to fear from his supporters seems to outweigh in his mind the political discomfort from a shutdown.

Short presentational grey line

The great withdrawal

If Mr Trump’s pivot on budget funding was surprising, his unexpected announcement that he’s pulling the 2,000 US troops out of Syria – and reports of plans for thousands more coming home from Afghanistan – was an electric shock through the US foreign policy establishment.

The fact that the president, who campaigned in part on drawing down US involvement obligations abroad, might contemplate such a move is not unexpected. The manner in which the announcement was made, with little apparent consultation with senior government officials or US allies abroad, is the primary source of upheaval – and the cause for concern among even those who might otherwise support the decision.

Was Trump right to say ISIL is beaten?

Then came the exclamatory punctuation mark at the end of the drawdown drama. Defence Secretary James Mattis, perhaps the most universally respected member of Mr Trump’s Cabinet, announced he was resigning because of differences of opinion he has with the president. In his announcement, he offered full-throated support for the US alliance structure and a warning that the US must serve as a counterweight to authoritarian rivals.

Then came his parting shot.

“Because you have the right to have a Secretary of Defence whose views are better aligned with yours on these and other subjects, I believe it is right for me to step down from my position,” he wrote.

It was one of the most direct suggestions of disapproval from any of Mr Trump’s ever-expanding list of former advisers and Cabinet secretaries.

All of this raises the question, why did the president act now? There has been some speculation that it may be tied the budget fight over the Mexican border wall. If people tell the president there’s not enough money, then he’ll reduce US commitments abroad. Others have suggested the move was a distraction in the midst of an unpleasant news cycle. Or perhaps it was a move to placate Turkey or – an evergreen explanation – Russia.

Whatever the reason, Mr Trump has roiled his supporters in the US Senate at a time when he needs them most. In the past, Republican politicians have managed to walk the line between offering tuts of disapproval for presidential actions they don’t like, while still voting lockstep for conservative policy priorities.

In the coming days, however, this straddling effort will be tested like never before.

Short presentational grey line

Mueller’s circling army

In a recent article in The Atlantic, Benjamin Wittes and Mikhaila Fogel compare Robert Mueller’s special counsel investigation of possible Russian ties to the Trump presidential campaign to a siege on a walled city.

If the investigation is “a campaign of degradation over a substantial period of time”, this week brought a number of new volleys that could hasten the eventual collapse.

There was Michael Flynn’s sentencing fiasco, in which Mr Trump’s former national security adviser admitted in open court that he knowingly lied to the FBI and wasn’t tricked or trapped into it. The judge, Emmet Sullivan, then suggested he sold his country out.

Facing the prospect of an angry judge threatening jail time, Flynn’s lawyers asked for a sentencing delay – dangling the possibility of more co-operation by Flynn and guaranteeing this portion of the Mueller investigation will stretch on until at least March.

Apps on a smartphone

Meanwhile, the Senate released two investigations into Russian social media campaigns to influence the 2016 presidential election.

They indicated the scope of the attack was much wider than previously known. The efforts reached hundreds of millions of people on Facebook, Twitter, Instagram, YouTube and other services, engaging conservatives and discouraging key voting blocs on the left, all in an attempt to help Mr Trump’s presidential bid.

The president and his supporters have dismissed evidence of Russian meddling as blame-shifting by Democrats seeking an excuse for their 2016 defeat. With these reports, that becomes a more difficult case to make.

What’s still not known is if there are any direct links between the Russians and the Trump team. Rumours swirl of new Mueller indictments on the horizon, however, perhaps of Trump confidant Roger Stone, who had contacts with WikiLeaks, the group that released hacked Democratic documents.

Then there’s the NBC News report that Mr Mueller could release his findings and conclusions in mid-February – which, although it seems like an eternity in US politics these days, is just two months away.

The clock is ticking – providing a possible explanation for Mr Trump’s dyspeptic attitude of late.

Short presentational grey line

A crumbling foundation

There was evidence as early as 2016, thanks in large part to the efforts of the Washington Post’s David Fahrenthold, that Donald Trump frequently used his family’s charitable foundation – funded in large part by donations from other people – to settle business lawsuits, buy baubles at auctions and, during the presidential campaign, advance his political interests.

Any of this could qualify as “self-dealing” and put the charity’s tax status at risk.

The controversies swirling around the foundation attracted the attention of the Democrat-run attorney general’s office in New York, which launched an investigation. On Tuesday, they negotiated the dismantling of the charity.

Mr Trump and his lawyers explained that they wanted this all along, and that the entire inquiry was the result of “sleazy Democrats”. But this is another dark cloud that won’t be disappearing anytime soon.

Barbara Underwood, in a statement heralding the action, called the foundation “little more than a chequebook” for the Trumps, with activity that displayed “a shocking pattern of illegality”.

What’s more, she said, the state would continue to seek millions of dollars in back taxes and fines from the Trump Organization, and sanctions against the president and his three oldest children.

During the 2016 campaign, Mr Trump repeatedly criticised Hillary Clinton and her family’s much-larger operating foundation. Two years later, however, it’s the president’s charity that remains in the headlines.

Short presentational grey line

Dow heading down

Mr Trump has spent much of his presidency touting the seemingly endless ascent of the US stock market.

“The Stock Market just reached an All-Time High during my Administration for the 102nd Time, a presidential record, by far, for less than two years,” he tweeted in early October.

Politicians who hitch their star to the stock market, however, can be in for a bumpy ride. Since Mr Trump wrote that tweet, the Dow Jones Industrial Average has fallen more than 4,300 points – a 16% decline.

Due to a combination of rising interest rates, the president’s trade wars, the impending government shutdown and indications of slower economic growth, the now long-in-the-tooth bull market may be coming to an end. December has seen the biggest market decline since the Great Depression and the largest drop in any month since 2009.

Larger economic indicators, such as GDP growth, unemployment and consumer confidence, are still strong. The current economic expansion is now entering its 13th year, however, and no one has yet discovered how to outwit the business cycle.

What goes up eventually comes down (at least a bit), and the timing may not be good for the president.

Obamacare: Texas court rules key health law is unconstitutional

People sign up for health insurance in Miami, Florida. 1 November 2017

A federal judge in the US state of Texas has ruled that a key part of the Affordable Care Act (ACA), better known as Obamacare, is unconstitutional.

Twenty states argued the whole law was invalidated by a change in tax rules last year which eliminated a penalty for not having health insurance.

President Donald Trump said the ruling was great news for America.

The law’s provisions will, however, remain in place until an appeal is heard at the US Supreme Court.

President Trump promised to dismantle Barack Obama’s landmark 2010 healthcarelaw, which was designed to make medical cover affordable for the many Americans who had been priced out of the market.

But despite his Republican Party having majorities in both the House of Representatives and the Senate, the ACA is still operating.

However, in 2017 Congress did repeal the requirement – the so-called individual mandate – that people buy health insurance or pay a tax penalty.

Mr Trump took to Twitter following the judge’s ruling in Texas.

He also urged incoming Democratic Senate minority leader Chuck Schumer and Democratic Speaker of the House Nancy Pelosi to “pass a STRONG law that provides GREAT healthcare”.

The ruling came a day before the deadline for Obamacare enrolment for the coming year.

What does the ruling say?

Two Republicans – Texas Attorney General Ken Paxton and his Wisconsin counterpart Brad Schimel led the legal challenge.

Sitting in Fort Worth, US District Judge Reed O’Connor noted that a $1.5tn tax bill passed by Congress in 2017 eliminated the tax penalties which anyone who failed to obtain health insurance had to pay.

He ruled that the individual mandate was now unconstitutional.

As the individual mandate was an “essential” element of the ACA, the whole of Obamacare was therefore unconstitutional, Judge O’Connor said.

He said his ruling was concerned with the intentions of the 2010 and 2017 Congresses.

“The former enacted the ACA. The latter sawed off the last leg it stood on.”

Protesters hold a small peaceful demonstration in support of health care on September 23, 2017 in Livingston, MontanaHealth care provision in the US has long been a divisive issue

What reaction has there been?

Ms Pelosi described the ruling as “cruel” and “absurd” and said it would be repealed.

She said it exposed “the monstrous endgame of Republicans’ all-out assault on people with pre-existing conditions and Americans’ access to affordable health care”.

Mr Schumer, meanwhile, said the ruling appeared “to be based on faulty legal reasoning and hopefully it will be overturned”.

He said that if it was upheld in the higher courts “it will be a disaster for tens of millions of American families, especially for people with pre-existing conditions”.

What comes next?

The decision is almost certain to be challenged in the US Supreme Court.

White House spokeswoman Sarah Sanders said that the law would remain in place for the time being, pending further legal developments.

‘Trump not thinking about the little people’

Meanwhile, the White House called on Congress to replace Obamacare with an affordable healthcare system which protects people with pre-existing conditions.

But other states have argued that eliminating Obamacare would harm millions of Americans, and pending any appeal the landmark health care law remains in place.

US Senate Democratic leader Chuck Schumer said: “If this awful ruling is upheld in the higher courts, it will be a disaster for tens of millions of American families.”

[If you take much more from us we’ll have to take all of you down.]

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Boston Medical Center Nurse Denied Life Insurance Because She Carries Naloxone

Isela was denied life insurance because her medication list showed a prescription for the opioid-reversal drug naloxone. The Boston Medical Center nurse says she wants to have the drug on hand so she can save others.

Bloodwork was supposed to be the last step in Isela’s application for life insurance. But when she arrived at the lab, her appointment had been canceled.

“That was my first warning,” Isela says. She contacted her insurance agent and was told her application was denied because something on her medication list indicated that Isela uses drugs. Isela, a registered nurse who works in an addiction treatment program at Boston Medical Center, scanned her med list. It showed a prescription for the opioid-reversal drug naloxone — brand name Narcan.

“But I’m a nurse, I use it to help people,” Isela remembers telling her agent. “If there is an overdose, I could save their life.”

That’s a message public health leaders aim to spread far and wide. “BE PREPARED. GET NALOXONE. SAVE A LIFE,” was the message at the top of a summary advisory from the U.S. surgeon general in April.

But some life insurers consider the use of prescription drugs when reviewing policy applicants. And it can be difficult, some say, to tell the difference between someone who carries naloxone to save others and someone who carries naloxone because they are at risk for an overdose.

Primerica is the insurer Isela says turned her down. (NPR has agreed to use just Isela’s first name because she is worried about how this story might affect her ongoing ability to get life insurance.) The company says it can’t discuss individual cases. But in a prepared statement, Primerica notes that naloxone has become increasingly available over the counter.

“Now, if a life insurance applicant has a prescription for naloxone, we request more information about its intended use as part of our underwriting process,” says Keith Hancock, the vice president for corporate communications. “Primerica is supportive of efforts to help turn the tide on the national opioid epidemic.”

After Primerica turned her down, Isela applied to a second life insurer and was again denied coverage. But the second company told her it might reconsider if she obtained a letter from her doctor explaining why she needs naloxone. So, Isela did contact her primary care physician — and then realized that her doctor had not prescribed the drug.

Isela had bought naloxone at a pharmacy. To help reduce overdose deaths, Massachusetts and many other states have established a standing order for naloxone — one prescription that works for everybody. Isela couldn’t just give her insurer that statewide prescription; she had to find the doctor who signed it. As it happens, that physician — Dr. Alex Walley — also works at Boston Medical Center.

Walley is an associate professor of medicine at Boston University; he also works in addiction medicine at Boston Medical Center and is the medical director for the Opioid Overdose Prevention Pilot Program at the Massachusetts Department of Public Health.

“We want naloxone to be available to a wide group of people — people who have an opioid use disorder themselves, but also [those in] their social networks and other people in a position to rescue them,” Walley says.

He says he’s written a half dozen letters for other BMC employees denied life or disability insurance because of naloxone, and that troubles him.

“My biggest concern is that people will be discouraged by this from going to get a naloxone rescue kit at the pharmacy,” Walley says. “So this has been frustrating.”

The life insurance hassle — and threat of being turned to down — has discouraged Isela and some of her fellow nurses. She is not carrying a naloxone kit outside the hospital right now because she doesn’t want it to show up on her active medication list until the life insurance problem is sorted out.

“So if something were to happen on the street, I don’t have one — just because I didn’t want another conflict,” Isela said.

BMC has alerted the state’s Division of Insurance, which has said in a written response that it is reviewing the cases and drafting guidelines for “the reasonable use of drug history information in determining whether to issue a life insurance policy.”

But Isela isn’t a drug user. And yet, she is being penalized as if she were.

Michael Botticelli, who runs the Grayken Center for Addiction Medicine at BMC, says friends and family members of patients with an addiction must be able to carry naloxone without fear that doing so will send them to the insurance reject pile.

“It’s incumbent on all of us to make sure that we try to kind of nip this in the bud,” he says, “before it is any more wide-scale.”

Botticelli says increased access to naloxone across Massachusetts is one of the main reasons overdose deaths are down in the state. The most recent state report shows 20 fewer fatalities this year compared to last.

Botticelli relayed his concerns in a letter to Dr. Jerome Adams, the U.S. surgeon general, who says he contacted the National Association of Insurance Commissioners. That group says it has not heard of any cases of life insurance applicants being denied because they purchased naloxone.

Adams says it’s good to, as Botticelli suggests, nip the problem in the bud.

“Naloxone saves lives,” Adams says, “and it is important that all Americans know about the vital role bystanders can play in preventing opioid overdose deaths when equipped with this lifesaving medication.”

Isela says the second company that rejected her has agreed to let her reapply, in light of Walley’s letter stating that she carries the drug so that she can reverse an overdose. Isela is in the process of reapplying.

This story is part of a reporting partnership with NPR, WBUR and Kaiser Health News.

Medicare for All: As Healthcare Costs Soar, Momentum Grows to Guarantee Healthcare for All Americans. Bernie’s full speech.

NOVEMBER 30, 2018

As Democrats prepare to take control of the House, pressure is growing on the Democratic leadership to embrace Medicare for All. Nearly 50 newly Democratic members of Congress campaigned for Medicare for All. In the last year, 123 incumbent House Democrats also co-sponsored Medicare for All legislation, double the number who supported a Medicare for All bill in the previous legislative session. Meanwhile, pharmaceutical, insurance and hospital companies are paying close attention. As the Intercept’s Lee Fang reports, over the summer the groups formed a partnership to fight the growing support for expanding Medicare.

Full Bernie Sanders Speech on Economic Justice, Healthcare, Opposing Trump & Ending the War in Yemen

Hundreds of international progressive leaders have traveled to Burlington, Vermont for a gathering hosted by the Sanders Institute. Last night, former presidential candidate and independent Vermont Sen. Bernie Sanders kicked the event off with a keynote speech on healthcare, raising the minimum wage and his bipartisan resolution to end military support for the U.S.-backed, Saudi-led bombing of Yemen. He was introduced by Harvard professor Cornel West.

 

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Oh no! They fired that sweet, wealthy, racist pig-fucker, Jefferson Beauregard Sessions III ( you know, Jeff!)

It’s another Sunday morning, true believers, and we’re still here, you and I.

I wanted to scribble something down about the public outcry over the firing of  poor Jeff Sessions, Jefferson Beauregard Sessions III (that noble soul who recused himself from the Mueller investigation into Comrade Trump’s ties to Russia.  The public wailed, as though this was some noble statesman, one of the last in DC willing to follow his conscience over the whims of his authoritarian, immoral boss.  Then, Maine’s own (how embarrassing) rape-apologist, Susan Collins comes out with this statement about how the Senate must do something to protect the investigation into Trumps ties to Russia!  You know, an attempt to win back the support of the moderates and the progressives, the young; let’s not forget, before we go further, that it was Collins (who, let’s face it was “Marcy” to Olympia Snow’s “Peppermint Patty” for years) who introduced Jeff Sessions, the good-ol’ boy from ‘Bama to Congress for approval as Secretary of State.

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What a pair!

Let’s take a quick look back at an oft-told Jeff story.  As the US attorney in Mobile, Alabama, Jeff Sessions was talking over a case one day in the 1980s with two fellow prosecutors.  It involved the kidnap and brutal murder of a young black man  by two members of the Ku Klux Klan.

The sociopathic Klansman, Henry Hayes and Tiger Knowles, slit the guy’s throat and thenhung him from a tree.  The murder was apparently in retribution for a jury acquitting a black man in the slaying  of a white police officer.  As Sessions learned that some members of the Klan had (supposedly) smoked marijuana on the evening of the slaying, he said aloud that he thought the KKK was: “OK until I found out they smoked pot.”  Sessions insists he was joking.

Hah, hah!

Jeff says he’s not a racist, but the Southern Poverty Law Center’s Heidi Beirich, who tracks hate speech, has said that Sessions is a racist, and that his presence in Trump’s inner circle was “a tragedy for American politics.”

Know what his last act as Secretary was?  To limit Federal oversight of State and local law enforcement!  Of course, Betsy Devos, your Secretary of Education is pushing back Obama-era legislation which was passed because of the tendency of Universities in the US to keep reports and punishment of campus rape in-house, instead of reporting it to the Cops.

No, we don’t have time for that today, but, hell, think of your daughters, people!

Back to Jeff, I’m glad that the evil son of a bitch was canned, and I don’t care why.  I lived down south, in places as regressive as Wild New England is progressive; I’ve know plenty of Jeffs, and a slew of Beauregards.

I mean, the guy is against legal immigration!  Google that shit.

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Oh, but Rage, we know that he was bad, but we’re just worried that this new guy will stop the Mueller investigation!

Ninja, please.  I read where some scatterbrained fem-bot compared Sessions dismissal to that of Archibald Cox, special prosecutor in the Watergate investigation, finally fired by one (after several refusals and resignations) of NIxon’s Secretaries of State.

Hardly.

Trump will go only as far as he knows he can; he might be a bad businessman who enjoys watching Russian women urinate on one another, but he’s hardly an idiot when it comes to perceptual manipulation.  I could see him staging a distraction, another “Al Qaeda-Taliban-Isis wants to kill us” Orwellian sort of thing, or another terrorist attack, like the one which was so beneficial for the Bush regime.

Of course, Mueller does have a secret weapon available to him, even if he is dismissed:  the Secret Indictment.

If Mueller decides that he has a strong enough case against Trump, a secret  (or “Sealed”) indictment returned by a grand jury will automatically protect the integrity of his investigation even if he gets fired, while (since it’s secret) it wouldn’t provoke Mr. Trump (the “not-so-slenderman”) into retaliation.

To make this happen, all that Mueller has to do (if he hasn’t already) is to formally request that the already-seated grand jury (the one looking into Russian interference in the last POTUS election) issue criminal charges against Trump.  If they were to find probable cause for the charges to proceed, then a judge would decide whether the indictment could remain secret or not. If the judge were to determine that it could, then the charges would remain hidden from public view.  Well, until the arrest or once his peeps bailed him out.

If Trump were to fire Mueller, an already-filed sealed indictment would remain in force, since a  sealed indictment, you see,  can only be dismissed by a judge.  Trump can’t get rid of the whole mess simply by firing Mueller.  And, with a sealed indictment the statute of limitations for crimes Trump might be charged with wouldn’t expire.  This leaves open the possibility of Trump being tried in the future.

To the Ninth Circle of Hell with Jefferson Beauregard Sessions III; but first, he needs to go back to 1952 where he belongs.  As far as the Klan smoking weed?  I don’t know any stoner (even ignorant racist stoners) who could do anything as horridly, ignorantly, misanthropically and anti-Christian as the Klan did in the above case.  They were drunk, brother-man; you know it.

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AS for Susan Collins, you know –  she knows it, unless her meds are disabling; she knows that if she had turned right instead of left at that moment when the World watched, if she could have sacrificed her favor with Mr. Trump and his rich plutocratic cohorts…

Think about it.

She’d have become this shero of the ages, an Oprah favorite, a savior of the GOP.  Hell, you know that Ryan quit his day job and came out against Trump so that he could put himself in position of candidate viability against him in 2020, and you know that Collins, instead of voting for Trump, wrote in Ryan’s name.  If she had stood up for what her own constituents demanded, what the victims of past abuse had demanded, what the young and the moderates had demanded, she could have been Ryan’s running mate.

But that’s not gonna happen, is it, Susan?

No, in 2020, you’ll be running an ill-fated election campaign, and before you know it, even Bruce Poliquin won’t be returning your calls.

She knows this too, everything that I’ve just scribbled, goes over that moment over and over again in her mind.  She could have become a postage stamp, a folk song, a coffee-table book of quotes.  Instead, because in that one instant, she turned left instead of right, she’ll become one more paragraph in history books-to-come about left-over relics from the old-way of doing things who, instead of becoming a timeless hero, became one of history’s fools (at best,) one of her villains, at worst.

So, in closing,  Jefferson Beauregard Sessions III (and I imagine, the second and the first as well) is a racist (we smoked a big ol’ fatty when we heard he was canned.)  George H. W. Bush’s favorite book is “David Cop-a-feel.”  And, I finally quit Facebook last night and hooked back up on Ello.

The lesson.. or, a lesson, but a really important one:

Always try to do the right thing.  You won’t always, but at least try.

And don’t worry about good ol’ Jeff Sessions;

Are you, really?

Forget it, man.  Let’s go bowling.

Love and riots,

Rage

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New Study puts Maine at Number Four in the Nation in Emergency Room Visits per Capita.

(NEWS CENTER Maine) — A new study puts Maine at number four in the country in emergency room visits per capita. A study conducted by the Henry J. Kaiser Family Foundation collected data for community hospitals, representing 85% of all hospitals between the years 2012 and 2016. Not included in the study Federal hospitals, long term care hospitals, psychiatric hospitals and others, according to the study.

The top area listed for ER visits per 1,000 people is Washington D.C. The nation’s capital has the highest percentage due, in part to the increase in crime around the area, according to the website MedicareHealthPlans.

The States with the Most ER Visits

  1. Washington D-C
  2. West Virginia
  3. Mississippi
  4. Maine
  5. Ohio
Maine Hospital Emergency Room Visits per 1,000 People
MAINE US
2016 489 440
2015 725 441
2014 580 428
2013 599 423
2012 595 424

Northern Lights Eastern Maine Medical center says the amount of Emergency Department visitors is similar to the study’s timeframe. Dr. James Jarvis, Sr. Vice President and Sr. Physician Executive, and Dr. Michael Melia, Chief of Emergency Medicine, say there are multiple factors landing Maine in the top 5, but EMMC is actually seeing sicker patients arrive in our emergency department than we would in other parts of the country.

“We are, if not close to the oldest state in the nation, so that already brings unique challenges to us,” said Dr. Jarvis. “We are an underinsured state. The decision was made not to expand Medicaid in the state of Maine. In fact, we actually contracted the number of patients that are covered under Medicaid that would leave us with a number of patients that is either under or uninsured in our state.”

““There is more rural medicine in Maine then if you were in New York City,” said Dr. Melia. “Some people are going to seek care for acute things as opposed to going on long trips to go see a doctor for routine medicine.”

Dr. Jarvis says it is easier for patients to get to the ER than a primary care doctor. Many patients have transportation issues to get to proper care.

“It is easier to call 911 and have an ambulance come to your house than it is to get a taxi cab, a friend or a relative or Uber to come to your house,” said Dr. Jarvis. “For some people it winds up for them being cheaper and they are going to get taken to an emergency room and not a doctor’s office.”

Another concern is what the hospital calls ‘super utilizers.’ Patients that continuously frequent the Emergency Department.

“We do have certain individuals who will seek care at the emergency department hundreds of times a year and that certainly taxes the system,” said Dr. Melia. “We try and put resources for those individuals to find out why are they super utilizers and what resources are necessary in order to keep them away from the ED and get them the care they needed.”

The women looking outside the law for abortions

  • 28 October 2018
Illustration a woman looks for medication onlineImage KATIE HORWICH

Accessing abortion has become increasingly difficult in parts of the US. As a result, a growing number of reproductive rights activists say it is time American women learn the facts about “self-managing abortion” with pills.

Kate could tell something was wrong. She’d been feeling nauseous for days and her body just felt different. The 27-year-old massage school student and her boyfriend were supposed to leave on a short road trip together, but before they hit the highway, she asked him to drive to a local drugstore.

Kate, which is not her real name, bought a pregnancy test and took it in the store bathroom. It was positive.

“I probably lost all my colour,” she recalls. “I was pretty devastated.”

Over the six-hour drive that followed, the young couple wrestled with the decision in front of them – to become parents or not. Kate was open to the idea, but as a full-time student doing odd jobs on the side to make ends meet, she was also broke. Her boyfriend told her he wasn’t ready to become a father.

“I struggle putting food on the table and I’m in debt,” she says. “I just didn’t see how I could justify putting a kid in that situation.”

The nearest abortion clinic was hours away, and the attendant who answered the phone told her that because she was less than 10 weeks along, she could terminate the pregnancy with pills – one dose of the drug mifepristone to take at the clinic, and a second medication, misoprostol, to take at home.

She was also told it would cost nearly $800. Kate was shocked.

“It would have taken everything I have. I don’t know how I would have paid rent.”

So she did what thousands of women around the globe do every year – she decided to try to have an abortion on her own.

Illustration open highway

Despite the fact that abortion is legal in the US, various studies have estimated that hundreds of thousands of Americans have tried to end a pregnancy without the help of a doctor at some point in their lives, whether through medication, herbs, vitamin C, alcohol, drugs or self-harm. Although accurate figures are difficult to come by, one study estimated that in the state of Texas alone, between 100,000 and 240,000 people had attempted a self-induced abortion.

A New York Times analysis of Google data found that in 2015, there were 700,000 searches from the US for information about self-managed abortion – phrases like “how to have a miscarriage,” “how to self-abort” and “buy abortion pills online”.

With the confirmation of Judge Brett Kavanaugh to the US Supreme Court, pro-choice activists are preparing for the possible dismantling of Roe v Wade, the landmark 1973 Supreme Court decision which legalised abortion across the country. In this imagined “post-Roe” United States, some campaigners are making the case that women need to know the facts about how to “self-manage” their own abortions.

“This is the next frontier in abortion access,” says Erin Matson, co-founder of Reproaction, a pro-choice group that has begun hosting public information sessions on self-managed abortion throughout the US. “Everybody has a right to know information about how to safely and effectively end a pregnancy on their own. It’s bigger than this political moment.”

Anti-abortion activists say that even if Roe is overturned, it is unlikely abortion would become illegal across the US, and that it’s a dangerous argument for women managing their own care.

“All overturning Roe v Wade would do is give the question back to the states and allow the states to legislate the procedure,” says Dr Ingrid Skop, an obstetrician-gynecologist in San Antonio, Texas, and a board member of the American Association of Pro-Life OB-GYNs.

“I think that even if restrictions were put in place so that more women could not access the procedure, that many more women would carry their pregnancies to term and probably many of these women would find that what began as an unintended pregnancy would become a desired pregnancy and a desired child.”

Though the phrase “self-managed abortion” conjures images of coat hangers and disreputable, back-alley abortionists, campaigners say that is not the world we live in anymore, in large part thanks to the development of abortion with pills, which can be used with about 95% effectiveness until 10 weeks into a pregnancy.

“A third of all abortions now, you go to the clinic and get pills and go home and do the abortion,” says Dr Beverly Winikoff, founder and president of Gynuity Health Project. “Doing an abortion now means swallowing a pill.”

The Pink House: The last abortion clinic in Mississippi

Such was the case for Kate, who quickly found online pharmacies who could ship her mifepristone and misoprostol from India for half the cost. However, she didn’t like the look of the websites or trust that the medication would be genuine. That’s when she came across a new site called Aid Access, which quietly came online earlier this spring.

The reproductive rights advocates behind websites like Women Help Women, Safe2Choose and Women on Web have been sending abortion pills by mail to countries where abortion is illegal or severely restricted for over a decade.

One study found that of 1,000 Irish women who received pills by mail using the Women on Web service, 95% ended their pregnancies successfully. But until very recently, none of these services would ship to the US – a wealthy, first-world country where abortion is legal, and the anti-abortion movement is politically powerful and litigious.

That changed this spring, when Dr Rebecca Gomperts, the Dutch physician behind Women on Web, founded Aid Access. She publicly announced its existence earlier this month, though she estimates she’s already sent 600 mifepristone-misoprostol kits to the US since April.

Dr Gomperts says that after reading email pleas for help from all over the US and watching how many restrictions states have placed on abortion services over the last 10 years, she decided something had to be done.

“It is especially the really poor women who are affected by obstacles that have been put in place in the last years,” she says. “The need is growing and it’s super desperate.”

When Kate got to Aid Access, she filled out a short survey that asked about the length of her pregnancy, her medical history and her reasons for needing help. She was approved, paid a $95 fee (women too poor to pay can still receive the medication) and gave Aid Access her address. Dr Gomperts wrote Kate the prescription from her private practice in Europe.

After the little brown box arrived in the mail (from a pharmacy in India that Dr Gomperts declines to name), Kate took the medication as instructed, and says that after a sleepless night of painful cramps, diarrhea and vomiting, she began to bleed. By morning, it was over.

“I felt a real sense of relief two days later,” she says. “I’d been so miserable for what seemed like forever.”

Illustration a package from India

Aid Access is just the newest way American women can get their hands directly on medication without going through a doctor. Online pharmacies – many located in India – will sell the drugs without a prescription (one research group bought 22 such products online and received 20, and although some of the blister packs were damaged, 72% contained enough of the drug to be effective).

Misoprostol – which is less effective than mifepristone but can be used on its own to induce a miscarriage – is sold over the counter in Mexico and has been found for sale at US flea markets near the border.

Some activists believe that with accurate information about how to take the medication and when to seek help, abortions can easily be done at home.

“We can trust women to make decisions and to manage their own abortions,” says Dr Gomperts. “Women have a human right to health.”

Obtaining abortion drugs in the US without a prescription is against the law. The US Food and Drug Administration has placed mifepristone under a Risk Evaluation and Mitigation Strategy, which is a special restriction on distribution for medications that may have serious risks associated with their use. The opioid fentanyl is also under a REMS, for example. Mifepristone can only be distributed in a doctor’s office or hospital.

In a statement to the BBC, the FDA said it is looking into Aid Access: “The agency takes the allegations related to the sale of mifepristone in the US through online distribution channels very seriously and is evaluating the allegations to assess potential violations of US law.”

However, many doctors believe that the REMS on mifepristone is unnecessary, and both the American Medical Association, and the American College of Obstetricians and Gynecologists have recommended that the restriction be lifted.

“To date, 19 deaths have been reported to the FDA among the more than three million women in the United States who have used [mifepristone],” one working group of doctors wrote in 2017 in the New England Journal of Medicine. “Pregnancy-related death… is 14 times higher.”

Mifepristone, the first of two drugs typically prescribed for a medication abortionMifepristone, the first of two drugs typically prescribed for a medication abortion

Anti-abortion organisations, like the Family Research Council, argue that the medication is not safe enough to be provided over the counter, and that circumventing FDA regulations is even riskier. Women who have an ectopic pregnancy, who have an intrauterine device or who have a history of adrenal health problems are not advised to take mifepristone. Rare complications include sepsis or haemorrhage, which could be life threatening.

“Just sort of violating the law and the distribution requirements – there are reasons these things are in place,” says Chris Gacek, a senior fellow on regulatory affairs at the Family Research Council. “Regardless of your views on abortion, I just don’t think this is good medicine.”

There are other, legal attempts to remove obstacles between patients and medication. Planned Parenthood currently runs telemedicine programmes in 14 states, where a doctor consults with the patient online or via telephone at a clinic that is convenient for her, and if the doctor determines she is eligible for medication abortion, he or she unlocks a drawer containing the pills remotely. Researchers at Gynuity Health Projects are currently running a study that’s been filed with the FDA, in which women are directly mailed the drugs after consultation with a physician.

However, 19 other states have a ban on abortion drugs being dispensed by telemedicine, and since the medications are not obtainable without a prescription in the US, any pregnant person trying to obtain the pills without a doctor’s help is operating in risky legal territory.

“I would never encourage anyone to do that,” says Tara Kepler, an attorney of counsel at Bryan Cave Leighton Paisner and a telemedicine legal expert. “There’s no way to get it without a prescription unless you’re violating the law.”

At the same time, Kepler says that she’s never heard of legal action being taken against a patient for ordering a prescription online. Activists say that since women will continue trying to self-induce abortion regardless of the legal risks, it is their responsibility to put out helpful, accurate information.

“What we know is people were managing their abortions before Roe, and have and will continue to do so without Roe,” says Pamela Merritt, co-founder of Reproaction.

A sign that reads "Reproaction's self-managed abortion forum"

On a balmy Sunday afternoon, less than 24 hours after the confirmation of Justice Kavanaugh, a small group gathered in the brightly lit basement of an old union hall in St Louis, Missouri. A handwritten sign hung on the door read, “Self-Managed Abortion Forum”.

Attendance was modest – 10 men and women in total – and the bags of crisps and fruit salad sat untouched. Organisers wondered if the event might inspire protest, but none materialised. Nevertheless, the sense of urgency in the room was palpable.

Several people declined to provide their names, and said that they intentionally did not RSVP to the event on Facebook.

“It could be traced back if [abortion] gets criminalised,” said one.

“I’m a pharmacist,” another said. “That could be bad for me.”

“I’m clergy,” added a third.

Next to the fruit salad was a stack of fact-sheets which laid out how a regimen of 12 tablets of misoprostol taken four at a time over the course of nine hours can induce an abortion.

“Misoprostol is typically used within the first 12 weeks of pregnancy and is about 85 percent effective,” the card read, next to a cartoon of a woman with four pills under her tongue.

Pamela Merritt, one of three panellists at the front of the room, said that to her knowledge, hers is the only group actively promoting information on self-managed abortion. Her co-director Erin Matson acknowledged merely hosting the discussion is “radical”. Still, they believe the need for these conversations is clear.

“The Supreme Court has solidified a 5-4 conservative majority for the foreseeable future,” said Merritt. “We now must proceed in a way that protects access to care and protects people who are most vulnerable to reproductive oppression.”

The self-managed abortion forum in St Louis, Missouri
The self-managed abortion forum in St Louis, Missouri

Still, the activists have to be careful. Reproaction’s panellists never explain how to obtain the pills. Instead, they refer the audience to links online with more information.

“It’s actually not that complex, how to use these pills to end a pregnancy. What’s complex is how to talk about it in a way that doesn’t expose people to legal liability,” says Matson. “We are not providing advice. We are not coaching people who are self-managing their abortions through the process. We are sharing the World Health Organization’s protocol.”

According to the WHO, “where mifepristone is unavailable” misoprostol – the second drug prescribed for a medication abortion – is the “recommended method of medical abortion”. The drug was developed for the treatment of stomach ulcers, but researchers soon discovered it also causes miscarriage.

Misoprostol is cheaper and less highly regulated than mifepristone, and there are no tests that would detect it in the blood stream. It is less effective than taking misoprostol together with mifepristone, but in absence of other options, World Health Organization reports say that the regimen is safe and effective at ending pregnancy.

In St Louis, one of the panellists was Dr Colleen McNicholas, an obstetrician-gynecologist who – until just the week prior – provided abortion services at clinics in Columbia and Kansas City, Missouri. Newly enforced state regulations revoked her admitting privileges, meaning she can only do abortions at a single clinic located in St Louis. Missouri now joins the ranks of one-clinic states like North Dakota, West Virginia and Kentucky.

Information about misoprostol

“If we get to a place where there are states or large portions of the country where there is no access to abortion, I think self-managed abortion will fill at least part of that gap whether we like it or not,” says Dr McNicholas. “I have both a clinical and moral obligation to help women do the safest thing that they can to achieve the outcome they want. Whether I’m able to actually provide the care is irrelevant.”

The number of clinics in the Midwest has dropped 22% over the last five years, and the state of Texas alone has shuttered 32 clinics. Thirty-three states have passed laws to limit or restrict patient access to abortion over the past decade. For instance, in Missouri, women must wait 72 hours after their initial doctor visit to get the abortion, a significant obstacle for those who are driving long distances, and may have jobs and need childcare.

Merritt says that in places like Missouri, women are already living in the equivalent of a post-Roe world.

“For a lot of people abortion access is a right in name only – particularly for people experiencing financial difficulties,” she says.

At the St Louis discussion, audience members asked questions about legal exposure, and what someone ought to do if she took misoprostol but then needed to go to a hospital with complications.

“They should say they’re pregnant and bleeding,” said Dr McNicholas. “That’s all the information that needs to be given.”

Dr Colleen McNicholas
Dr Colleen McNicholas

Self-inducing an abortion with pills carries legal risk. Although no one has ever been prosecuted directly for purchasing abortion drugs online, the act of buying pills has been used as evidence for criminal charges, including murder. The most famous case was Purvi Patel, who was sentenced to 20 years in prison under Indiana’s feticide law before her conviction was overturned. Similar cases have played out in Idaho, Virginia and Georgia. In some of these cases, it was a doctor or hospital employee where the woman sought help who contacted police.

Dr Skop, the anti-abortion obstetrician-gynecologist in San Antonio, says that if a woman does not tell her doctor that she has tried to self-induce an abortion with misoprostol, she puts her doctor at a disadvantage in her treatment. She adds that she would never turn a woman over to authorities if she found out she’d tried to end her own pregnancy.

“I would care for her. I think that most OBGYNs would,” she says.

At the end of the session in St Louis, some swapped stories about how they were preparing for the end of Roe. Two said they’d been stockpiling doses of Plan B, the so-called “morning after pill”, just in case that medication were also discontinued or even criminalised.

“We have to protect each other,” said one woman. “The system is not going to save us.”

Illustration drug store sign

The day after Kate took her pills, her morning sickness was gone and she was able to eat normally for the first time in weeks. The day after that, she was back at work. She says she is no longer pregnant, and confident that she made the right decision.

“I’m grateful that I was able to access the medication because I think it’s better than the alternative,” she says. “I didn’t understand why it was that expensive, not to mention the drive both ways, and missing work for me. I wouldn’t have done it another way.”

At the same time, she stresses that her experience was difficult. Her first shipment of medication got stuck in somewhere in customs and she had to send frantic emails requesting another shipment, which she got free of charge. The delay was extremely stressful and although she knows this is not everyone’s experience with the medication, she found the process very physically painful.

“I don’t want it to seem like it was easy, because really, it’s not,” she says. “It was pretty traumatic, the whole thing.”

Otto, another person who used Aid Access, says the package arrived without incident and that though there were intense, painful cramps and vomiting, the experience was positive one. As someone who identifies as gender-fluid and finds doctor visits of any kind uncomfortable, Otto was relieved to do the procedure at home with supportive roommates, instead of hours away, alone in a hotel room.

“I was, kind of, I don’t know – really proud of myself for how far I’d come in my understanding of my own body and the politics of my own body,” Otto says. “I was just excited.”

Kate also says she has no regrets, and the fact that she might be breaking the law didn’t scare her or impact her decision to seek out the medication on her own. She’s nearly finished with school, and is eager to start a career in massage working specifically with cancer patients.

She hopes that by speaking out about her experience, other women in similar situations will do whatever they feel is best for them.

“If you end up having to take things in your own hands, it is your body, it’s your life,” she says. “I think everybody should have that right.”

To protect their anonymity, the BBC has changed some names and omitted identifying information.

Congress OKs Record Military Funds in $1.3T Spending Bill (Remember the warnings of Eisenhower, right?)

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Congress approved a $1.3 trillion spending bill early this morning—averting what would have been the third government shutdown of the year, less than a day before it was set to take effect. The bill won bipartisan support in both houses, clearing the Senate on a 65-32 vote just after 1 a.m., after more than two-thirds of House lawmakers approved it earlier in the day. President Trump has signaled he will sign the bill, which will boost spending on weapons and war to an all-time high, while increasing funding for a U.S.-Mexico border wall. It does not address the plight of immigrants brought to the U.S. as children—so called DREAMers—a key demand of immigrant rights groups and some Democrats. The bill also contains modest gun control measures, including tightening a background check measure known as “NICS”—but does not provide for universal background checks for prospective gun buyers.