A new episode of The Josh Marshall Podcast is live! This week, Josh and Kate discuss DeSantis Descending: Josh and Kate discuss the continued flailing of the Ron DeSantis campaign and some last minute chaos around Hunter Biden’s plea deal.
You can listen to the new episode of The Josh Marshall Podcast here.
The Republican National Committee’s effort to pivot from spreading false conspiracy theories about mailed ballots, “ballot harvesting” and early voting to encouraging supporters to use these very techniques got a boost from the biggest election conspiracist of them all on Wednesday.
Continue reading “‘Rigged!’: Trump Tries To Have It Both Ways As He Boosts RNC’s ‘Ballot Harvesting’ Initiative”This articles first appeared at ProPublica. ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
Since the Supreme Court overturned Roe v. Wade last year, doctors have warned that limiting abortion care will make pregnancy more dangerous in a country that already has the highest maternal mortality rate among industrialized nations.
The case of Mylissa Farmer, a Missouri woman, is one example. Last August, her water broke less than 18 weeks into her pregnancy, when her fetus was not viable. She was at risk for developing a life-threatening infection if she continued the pregnancy. Yet during three separate visits to emergency rooms, she was denied abortion care because her fetus still had a heartbeat. Doctors specifically cited the state’s new abortion law in her medical records and said they could not intervene until her condition worsened. She eventually traveled to Illinois for care.
Even for people who don’t develop sudden life-threatening complications, doctors note that carrying a pregnancy to term is inherently risky because rapid physical and hormonal changes can exacerbate chronic health conditions and trigger new complications. If more people are forced to continue unwanted pregnancies, there are bound to be more pregnancy-related deaths: A study by the University of Colorado estimates a 24% increase in maternal deaths if the United States bans abortion federally. They predicted the increase would be even higher for Black patients, at 39%. Currently, 14 states have total abortion bans.
Additionally, when abortion is illegal, it makes the procedure more dangerous for those who still try to terminate their pregnancies. The World Health Organization found that unsafe or illegal abortions account for up to 10% of maternal deaths worldwide.
As the United States enters its second post-Roe year, advocates say it’s important to gather data on the impact abortion bans are having on the health of pregnant people to help both policy makers and voters understand the life-or-death consequences of the restrictions. Without such accounting, they say, the public may remain ignorant of the toll. Maternal mortality rates would be a crucial gauge of impact.
Despite the stakes, experts say, at least in the short term, it may be difficult or impossible to track the number of lives lost due to limits on abortion access.
ProPublica spoke to four members of state maternal mortality review committees. Here are some of the challenges they see to drawing any clear conclusions from maternal mortality data in the near future.
Each state has its own system for compiling the data maternal mortality researchers work with. The quality of the data varies vastly by state. It can involve comparing birth and fetal death records, scanning through obituaries, and sometimes begging coroner’s offices to send death records. Many states are still working toward a complete system.
“It really depends on the rigor of the contributing entities,” said Dr. Michelle Owens, a maternal-fetal medicine specialist and the clinical chair for Mississippi’s maternal mortality review committee. “We rely so heavily upon the information we glean from these sources, and if that information is not as reliable … it will definitely have a negative impact on our work and understanding of what the contributing things may have been and what the gaps are.”
All the maternal mortality experts that ProPublica spoke with noted issues with the “pregnancy check box” used in death certificates to denote whether a patient was pregnant at the time of death or within the previous year. In Florida, Dr. Karen Harris, an OB-GYN and a member of Florida’s maternal mortality review committee, has observed the check box “overselect some patients who were never pregnant, or not pregnant in the last year, and it underselects patients who were pregnant.”
Sometimes the check box is wrong because of clerical errors, the researchers said. Other times, it’s simply not filled out because no autopsy was performed to verify whether the person was pregnant. That information could be important in measuring deaths that happen early in pregnancy — including murders. Homicide is a leading cause of death for pregnant or recently pregnant Americans, and researchers also would like to measure how abortion bans, which could force people in abusive relationships to carry unwanted pregnancies, affect those numbers.
Studying pregnancy-associated deaths within a year of pregnancy helps researchers account for any additional factors like substance abuse, unstable housing, suicide or mental health problems. These could be important in identifying deaths connected to continuing an undesired pregnancy.
The data can also be slow — some states, like Florida, provide data to the committee for the past year right away. But others are years behind. Currently, many states have only released data through 2019.
One of the thorniest questions facing maternal mortality experts: How can they determine if abortion access was a factor?
Dr. Lynlee Wolfe, an assistant professor at the University of Tennessee Medical Center and a member of the state’s maternal mortality review committee, wishes maternal mortality review reports could include a check box for the question, “Did inability to get an abortion play a role?”
“But you often can’t dig that out of notes,” she said. “I think what we’re asking is kind of an untrackable number.”
The experts said they could look into causes of death that may be linked to a patient’s inability to get an abortion when they’re having an emergency pregnancy complication: Sepsis, hemorrhage and heart issues, for example, are all worth studying to see if medical records might indicate if doctors delayed ending the pregnancy because the fetus still had a heartbeat.
But beyond that, when the pregnancy was unwanted or exacerbated broader health concerns, it could prove very difficult to determine if abortion access was a factor in the patient’s decision-making.
For example, if a patient had a heart condition that carried a 50% chance of death in pregnancy, researchers would like to see whether the patient was counseled about the risk and offered a termination.
But in a state that had criminalized abortion, “no one’s going to write that down,” said Harris, the Florida doctor. “So we won’t be able to know in the in-depth review if this was a patient choice — or if it was something that was forced upon her.”
Researchers might be able to learn more about the patient’s state of mind and whether the pregnancy was desired or not from interviews with family members and social service records, Owens, the Mississippi doctor, said. But there’s no guarantee they would have discussed their feelings about the pregnancy with family members either.
“With stigma and controversy surrounding conversations and considerations around abortions, people are hesitant to share those thoughts and feelings outside a very small circle of trust,” she said.
Maternal mortality review committees are funded by their states, and some are overseen by state legislatures.
The maternal mortality review members ProPublica spoke with said they did not anticipate interference with their report findings, even if they found examples where abortion access was a factor in a maternal death.
But some maternal care advocates worry such committees are vulnerable to political interference and manipulation. Last year, the Texas Department of State Health Services announced it was delaying its 2019 maternal mortality review report, originally scheduled for September 2022, until mid 2023.
Some saw the delay as a way to keep negative numbers out of the public eye during election season and postpone their release until after the 2023 legislative session had ended. A member of the review committee said she believed there was no legitimate need for the delay and that it was “dishonorably burying these women.” ProPublica reached out to the committee and the Texas health agency to ask about these concerns, but did not receive any response.
After pushback, the report was partially released in December 2022. It found persistent disparities affecting Black mothers and showed that the childbirth complication rate had risen 28% since 2018.
In July, Idaho disbanded its maternal mortality review committee, making it the only state without one. Lawmakers cited the costs of operating the committee — though members said operating costs were about $15,000 a year and covered by a federal grant. The decision came after a lobbying group argued that the committee was a “vehicle to promote more government intervention in health care” and opposed its recommendation to extend Medicaid coverage to mothers for 12 months postpartum.
Maternal mortality rates in the U.S. are higher than in other wealthy countries and have been rising in recent years, so many resources are devoted to studying root causes of the trend and possible strategies for reversing it. But the actual number of deaths is statistically small: In 2021, the U.S. saw an estimated 32.9 deaths per 100,000 births, or 1,205 total pregnancy-related deaths, according to the Centers for Disease Control and Prevention.
This makes it difficult to draw conclusions that are rigorous by epidemiological standards, said Dr. Elliot Main, a Stanford professor and the former medical director for the California Maternal Quality Care Collaborative.
While researchers may learn of individual cases where it’s clear that abortion access was an issue in the patient’s outcome, it could take years to have a data set large enough to reveal a clear picture.
Main also pointed out that many other factors influence maternal mortality rates, which muddles the picture. “Maternal deaths are so rare and often complicated in their underlying causes,” he said. “If you see a trend over time, we have to break it down to see what’s really causing that.”
Before the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization struck down federal protections for abortion rights, U.S. maternal mortality rates were already rising. Influences include COVID-19, the opioid crisis and people having children at older ages, when they are at higher risk for complications. The U.S. also has long-standing racial and socioeconomic health care disparities affecting quality prenatal care — more than half of Georgia’s counties have no OB-GYN, for example. That can mean more patients go into pregnancy with undiagnosed health conditions and may be at higher risk for life-threatening complications.
Main and other researchers suggested that studying data on childbirth complications may provide more avenues for understanding the effects of abortion bans, because those are more common and would provide a larger data set to study.
One reason the impact of Dobbs on maternal mortality rates could remain limited even in states that have banned abortion is that some people who want to terminate their pregnancy are still able to do so, either by traveling or by ordering abortion medication in the mail.
It’s impossible to know the full picture of how many are able to jump through the hoops and obtain abortions even when there are no legal options nearby. But WeCount, a research project led by the Society of Family Planning that has been collecting data from abortion providers, estimates that in the six months following Dobbs, about 35,000 people in abortion-ban states were able to get abortions in other states — just over half of the people estimated to have sought abortions in those states, based on numbers from the same time period the previous year. It’s unclear what happened to the other half. Some may have continued their pregnancies, others may have ordered abortion pills in the mail, which could be sent by organizations based in Europe and Mexico and not be recorded in any database.
Still, having to travel out of state to a limited number of abortion providers meant more patients were forced to wait until their second trimester, researchers said, when an abortion can be more complicated.
And while abortion pills are considered an exceedingly safe method of terminating a pregnancy through the first 10 weeks, according to the Food and Drug Administration and leading medical organizations, patients should still have the option to take them with the instruction and care of a medical provider, advocates say.
In today’s episode of the ongoing collapse of the DeSantis campaign, we have a new moment which we might see as the severed segments of Dead Bounce Ron roiling and twitching around, much like a worm that has been cut into pieces but continues to wiggle and move about almost as if nothing had happened. Yesterday in response to a question about ersatz candidate Robert F. Kennedy Jr., DeSantis said that while he wouldn’t choose Kennedy as his vice president, he would consider him to run the FDA or CDC.
This is of course a ridiculously inane suggestion. But the key is that it was immediately attacked even by many of DeSantis’s erstwhile allies or the kinds of Republicans he needs to gain the support of to remain in the race.
There are two issues to discuss.
Continue reading “GOPers Hit Half-Drowned Ron with Their Paddles as He Struggles to Climb Back in the Campaign Boat”TPM Reader OM responds to my post on the running constitutional crisis in Israel …
Continue reading “A Breaking Point”One question you discuss is whether the protests are trying to block an elected gov’t from doing what it was elected to do. The campaign that Netanyahu and his far-right allies ran was focused heavily on two things: (1) soaring cost of living, and (2) rising crime, especially in the Arab sector of Israeli society. They promised to crack down on crime, return a sense of security, the usual thing right-wing parties promise. They said not a word about “judicial reform” (i.e., the anti democratic regime change).
The key paragraphs come 215 pages into the behemoth Financial Services and General Government appropriations bill, and they’re eye-glazing.
Continue reading “House Republicans Are Quietly Using A Spending Bill To Pick An Extremely Specific DC Abortion Fight”A lot of things happened. Here are some of the things. This is TPM’s Morning Memo. Sign up for the email version.
The risk of Donald Trump being elected President again and abusing the powers of the office to exact revenge and secure retribution against his perceived enemies is already having profound effects on the rule of law.
Yesterday’s highly unusual collapse of the Hunter Biden plea agreement was directly related to the menace Trump poses if he retakes the office he was already twice impeached for abusing.
What stands out most about the awkward and bizarre proceedings in Delaware yesterday is that Hunter Biden’s legal team and federal prosecutors were trying to arrive at a workaround that would prevent him from being targeted by a future Trump White House.
At issue initially was how far-reaching is the immunity Hunter Biden would receive under the deal. Prosecutors and Hunter Biden’s team disagreed about what they had originally negotiated. Plea hearings are usually routine, and it is not common at all for defendants and prosecutors to arrive in court with this kind of misunderstanding not already resolved. That was odd enough.
But in reviewing the reports on the hearing and the transcript it’s clear that what ultimately held things up was the judge’s concerns about the framework of the agreement that was clearly designed to provide Hunter Biden with some protection from a future Trump presidency and a subsequent DOJ run amok. (For a deeper summary, I’d recommend Joyce Vance.)
U.S. District Judge Maryellen Noreika was rightly concerned that the proposed workaround would insert the judicial branch into what is exclusively executive branch territory. That was especially ironic since she had just shot down an attempt by the legislative branch – in the form of the House GOP – to weigh in on the plea agreement.
Noreika, a Trump appointee (but it should be said she conducted the plea hearing carefully, professionally and without any hint of partisanship), declined to ratify the plea agreement and ordered the parties to submit written briefs.
Trump has already injected a curdling effect on the rule of law into the minds of anyone – investigators, partisan foes, public targets of his enmity – likely to be on the receiving end of his abuses of power. But now we see his influence manifesting in ways that are forcing prosecutors and judges to deal with it.
That Trump can have this kind of corrosive effect while out of office is a harbinger of what Trump II would look like.
The election security official who defended the integrity of the 2020 election and was shortly thereafter fired by then-President Donald Trump confirms he has spoken with Special Counsel Jack Smith’s team investigating Jan. 6.
AJC: Republicans behind Giuliani’s Georgia hearings mum on his false statements
Senate Minority Leader Mitch McConnell’s apparent medical episode during a Hill press conference Wednesday revealed a man far more feeble and halting than before his fall, brain injury, and long hospitalization earlier this year:
McConnell had another fall earlier this month while disembarking from an airplane at Reagan National Airport, NBC News is reporting.
Florida’s lone black congressman, the reliably conservative Byron Donalds, was put on full blast by Team DeSantis after he questioned the state’s new African American history curriculum, saying “the attempt to feature the personal benefits of slavery is wrong & needs to be adjusted.” Donalds has endorsed Trump in 2024.
A local GOP official in North Carolina has been accused of assault by a fellow Republican Amy Churchill, a school board member who was censured last month by the county GOP. The alleged incident happened Monday at a meeting of the Buncombe County GOP:
[Buncombe County GOP Chairman Doug] Brown initially told Churchill he was “glad to see you here,” she told Asheville Watchdog in an exclusive interview, and then questioned why she was at the GOP meeting, her first since being censured — a formal expression of the party’s severe disapproval of her actions.
Brown then became “very agitated,” Churchill said, and slammed the door on her when she entered a hallway.
In a complaint she filed with Asheville Police, Churchill wrote, “(I) stated that his behavior was rude, (Brown) stated that he had had enough of me and placed hands forcefully on (my) upper arms, shoulder area and proceeded to forcefully shove (me) multiple times without removing hands and moved (me) backwards.” She said she had to “apply pressure” to her back right heel to keep from falling.
WaPo: Trump needed $225 million. A little-known bank came to the rescue.
Oh, FFS:
The oleaginous Ted Cruz bookends his remarks with “if this is true” – which apparently is enough to just make up whatever you want and insert it between the disclaimers:
ProPublica: How The Ultrawealthy Use Private Foundations To Bank Millions In Tax Deductions While Giving The Public Little In Return
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In his subtle critique of the curriculum, the only Black Republican member of Florida’s congressional delegation gave the DeSantis administration an out.
Continue reading “Where Things Stand: Donalds Softly Suggests DeSantis Maybe Probably Shouldn’t Push Curriculum On The Pros Of Slavery”Senate Minority Leader Mitch McConnell (R-KY) abruptly froze mid-sentence during a Wednesday press conference, falling silent and still soon after he began his remarks.
Continue reading “McConnell Freezes, Is Led Away And Returns During Press Conference”Let’s cut to another scene from the ongoing death rattle of the DeSantis for President campaign. Yesterday, along with firing a third of the staff because it’s running out of money, the DeSantis campaign fired a staffer who made a campaign video, laced it with far right and Nazi imagery and then farmed it out to a fan site to obscure that it was produced by the campaign. Do you remember this story? Didn’t we hear about this a few days ago? About how the crazy ad supposedly made by a fan was actually cut in-house? At first I was confused too. Actually the same thing had happened all over again. A few weeks ago there was that gay and trans-bashing ad that over the weekend we learned from the Times had actually been produced in house by the DeSantis campaign. Then, over the weekend, a now-fired staffer named Nate Hochman produced an aesthetically comparable ad and farmed it out to a DeSantis supporting Twitter account called DeSantiscams so that the campaign could then amplify it.
Continue reading “Crypto-Fascists and Dead Bounce Ron’s Speed Bumps on the Way to Oblivion”
