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How end of Roe v. Wade has changed health care in America

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On the eve of the first anniversary of the Supreme Court’s landmark ruling to overturn Roe v. Wade, federal public officials and local health care providers returned to St. Louis reflecting on the ways that decision has changed America in the past year.Health and Human Services Secretary Xavier Becerra, U.S. Rep. Cori Bush, D-St. Louis County, and representatives from Planned Parenthood of St. Louis and other clinics that provide abortions in Illinois gathered in the same conference room where they first learned of the Dobbs decision.“I remember vividly that moment as we were wrapping up our roundtable and the room got incredibly quiet. Everybody started looking down at their phones, and we knew that the worst-case scenario had become our new reality,” said Yamelsie Rodríguez, president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri.

Brian Munoz

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St. Louis Public RadioMichelle Landeau, board president for the Missouri Abortion Fund, hugs St. Louis Alderwoman Christine Ingrassia after a Supreme Court decision overturned Roe v. Wade on June 24, 2022, after a roundtable at the Planned Parenthood of the St. Louis Region and Southwest Missouri in the Central West End.

Secretary Becerra reflected on the havoc the court’s opinion has wreaked on people across the country, emphasizing the physical, emotional and mental stress many have endured.“It has turned health care for women fundamentally upside down,” he said. “Sometimes you wonder if the nine people sitting in judgment up in Washington DC, in that hallowed building where they write all these decisions are thinking about the trauma that Americans go through.”In one year, the Dobbs decision has had a tangible effect on health care for people across the country, said Admiral Rachel Levine with the United States Public Health Service Commissioned Corps.“The political and legal environment of the state that you live in is now a social determinant of health,” she said. “For reproductive rights, it’s a social determinant of health for women, as well as for other issues such as gender affirming care.”For clinics in the Metro East, where abortion is protected by Illinois state law, the court’s decision has meant many more people from farther away seeking care, said Dr. Colleen McNicholas, chief medical officer at Planned Parenthood of the St. Louis Region & Southwest Missouri.

Christine Tannous

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Pool PhotoFairview Heights’ Planned Parenthood ultrasound technician Nafka Hasic, back, is comforted by lead nurse Wendy Stamilio, front, and director of patient access at the regional logistics center Kawanna Shannon, right, as she becomes emotional Friday at the Planned Parenthood clinic in Fairview Heights. Officials, including Rep. Cori Bush, U.S. Health and Human Services Secretary Xavier Becerra and U.S. Department of Health and Human Services Assistant Secretary for Health Admiral Rachel Levine, visited the Planned Parenthood to meet with employees to discuss their experience working in the past year.

She said the clinic in Fairview Heights has logged a 700% increase in patients from beyond the bi-state, even a recent patient from the U.S. Virgin Islands.“It really speaks to the ripple effect that abortion bans have,” she said. “We saw that coming into the Dobbs decision when Texas eliminated abortion.”McNicholas explained how Texas’ 6-week abortion ban preceding the Dobbs decision meant many people from Oklahoma as well as Texas started traveling to the Metro East clinics because there wasn’t as much access to care.“We’ve seen folks in the last year from 29 states,” she said. “Lots of states that still have access because with fewer people to provide care, there’s longer waiting times and they’re being pushed to later parts in pregnancy.”A few women at this year’s roundtable shared their experiences with how no more Roe v. Wade has affected them personally. Dr. Love Holt, a community engagement manager with Pro Choice Missouri, detailed her own experience with a medication abortion this past January.“Earlier that month my cycle was late and I was thrusted into panic mode,” she said. “Because I know a post Roe world means that abortions are illegal and harder to access where I live.”

Brian Munoz

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St. Louis Public RadioRev. Dr. Love Holt hypes up the crowd on Friday, June 24, 2022, during a demonstration at Planned Parenthood in St. Louis. Thousands marched throughout the country last year after the Supreme Court overturned Roe v. Wade, which largely deals with abortion care, on Friday through the case Dobbs v. Jackson Women’s Health Organization.

Love explained how she needed a procedure to remove tissue from inside her uterus after the medication caused major bleeding for her. The workers at the Catholic hospital she went to kept their faces covered and hardly shared any information with her, Love said.“It was very sketchy because of the laws and all of the fear around what could happen at their hospital, especially a Catholic hospital,” she said. “They hurried me out soon after the procedure. I could have died that day.”Maggie Olivia, another woman at the roundtable, shared how anti-abortion protestors have become more hostile to those seeking abortion care. She said she’s more prepared than most for that kind of harassment, given the nature of her work as a policy manager at Pro Choice Missouri, but it’s still jarring.“There is no preparing the way that it feels to be personally targeted like that,” Olivia said. “I still very much remember the things those protesters said to me that morning.”Afterward, Olivia said she was denied a refill on her mental health medications because there was a note in her medical chart that she had a positive pregnancy test earlier in the year.To Congresswoman Bush, the stories highlighted how decisions around pregnancy are deeply personal. And now, she said, people across the country are living in fear about their own bodies.“The thing that really pisses me off about that is that nobody else has to deal with it,” Bush said. “There is no other person that has to feel what that person feels in their own body.”

Brian Munoz

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St. Louis Public RadioU.S. Rep. Cori Bush (MO-01), D-St. Louis, pauses as Dr. Love Holt tells her post-Roe abortion story on Friday at the Planned Parenthood of the St. Louis Region & Southwest Missouri’s clinic in the Central West End.

Bush was emphatic when she said decisions about pregnancy should not be decided by anyone other than the person who is pregnant.“Shame on Missouri, shame on our former Attorney General,” she said. “Because he has never had to get up and wonder if he was pregnant and what he would have to do with that child.”Along with the harsh reality of a year post Roe v. Wade being overturned, there was also hope about the future. Becerra emphasized how the court did not shake his resolve to push for that kind of health care.“It’s a fight that’s been going on for a long time. It preceded 1973 (when Roe v. Wade was first decided),” Becerra said. “Thank you for letting us come here to St. Louis, to not just remember, but to re-energize because we have so much to do.”Bush agrees.“All they did was ignite us on fire. All they did was give us more fuel,” she said.

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Poll: Support for Missouri abortion rights amendment growing

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A proposed constitutional amendment legalizing abortion in Missouri received support from more than half of respondents in a new poll from St. Louis University and YouGov.That’s a boost from a poll earlier this year, which could mean what’s known as Amendment 3 is in a solid position to pass in November.SLU/YouGov’s poll of 900 likely Missouri voters from Aug. 8-16 found that 52% of respondents would vote for Amendment 3, which would place constitutional protections for abortion up to fetal viability. Thirty-four percent would vote against the measure, while 14% aren’t sure.By comparison, the SLU/YouGov poll from February found that 44% of voters would back the abortion legalization amendment.St. Louis University political science professor Steven Rogers said 32% of Republicans and 53% of independents would vote for the amendment. That’s in addition to nearly 80% of Democratic respondents who would approve the measure. In the previous poll, 24% of Republicans supported the amendment.Rogers noted that neither Amendment 3 nor a separate ballot item raising the state’s minimum wage is helping Democratic candidates. GOP contenders for U.S. Senate, governor, lieutenant governor, treasurer and secretary of state all hold comfortable leads.“We are seeing this kind of crossover voting, a little bit, where there are voters who are basically saying, ‘I am going to the polls and I’m going to support a Republican candidate, but I’m also going to go to the polls and then I’m also going to try to expand abortion access and then raise the minimum wage,’” Rogers said.Republican gubernatorial nominee Mike Kehoe has a 51%-41% lead over Democrat Crystal Quade. And U.S. Sen. Josh Hawley is leading Democrat Lucas Kunce by 53% to 42%. Some GOP candidates for attorney general, secretary of state and treasurer have even larger leads over their Democratic rivals.

Brian Munoz

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St. Louis Public RadioHundreds of demonstrators pack into a parking lot at Planned Parenthood of St. Louis and Southwest Missouri on June 24, 2022, during a demonstration following the Supreme Court’s reversal of a case that guaranteed the constitutional right to an abortion.

One of the biggest challenges for foes of Amendment 3 could be financial.Typically, Missouri ballot initiatives with well-funded and well-organized campaigns have a better chance of passing — especially if the opposition is underfunded and disorganized. Since the end of July, the campaign committee formed to pass Amendment 3 received more than $3 million in donations of $5,000 or more.That money could be used for television advertisements to improve the proposal’s standing further, Rogers said, as well as point out that Missouri’s current abortion ban doesn’t allow the procedure in the case of rape or incest.“Meanwhile, the anti side won’t have those resources to kind of try to make that counter argument as strongly, and they don’t have public opinion as strongly on their side,” Rogers said.There is precedent of a well-funded initiative almost failing due to opposition from socially conservative voters.In 2006, a measure providing constitutional protections for embryonic stem cell research nearly failed — even though a campaign committee aimed at passing it had a commanding financial advantage.Former state Sen. Bob Onder was part of the opposition campaign to that measure. He said earlier this month it is possible to create a similar dynamic in 2024 against Amendment 3, if social conservatives who oppose abortion rights can band together.“This is not about reproductive rights or care for miscarriages or IVF or anything else,” said Onder, the GOP nominee for Missouri’s 3rd Congressional District seat. “Missourians will learn that out-of-state special interests and dark money from out of state is lying to them and they will reject this amendment.”Quade said earlier this month that Missourians of all political ideologies are ready to roll back the state’s abortion ban.“Regardless of political party, we hear from folks who are tired of politicians being in their doctor’s offices,” Quade said. “They want politicians to mind their own business. So this is going to excite folks all across the political spectrum.”

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Democrat Mark Osmack makes his case for Missouri treasurer

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Mark Osmack has been out of the electoral fray for awhile, but he never completely abandoned his passion for Missouri politics.Osmack, a Valley Park native and U.S. Army veteran, previously ran for Missouri’s 2nd Congressional District seat and for state Senate. Now he’s the Democratic nominee for state treasurer after receiving a phone call from Missouri Democratic Party Chairman Russ Carnahan asking him to run.“There’s a lot of decision making and processing and evaluation that goes into it, which is something I am very passionate and interested in,” Osmack said this week on an episode of Politically Speaking.Osmack is squaring off against state Treasurer Vivek Malek, who was able to easily win a crowded GOP primary against several veteran lawmakers including House Budget Chairman Cody Smith and state Sen. Andrew Koenig.While Malek was able to attract big donations to his political action committee and pour his own money into the campaign, Osmack isn’t worried that he won’t be able to compete in November. Since Malek was appointed to his post, Osmack contends he hasn’t proven that he’s a formidable opponent in a general election.“His actions and his decision making so far in his roughly two year tenure in that office have been questionable,” Osmack said.Among other things, Osmack was critical of Malek for placing unclaimed property notices on video gaming machines which are usually found in gas stations or convenience stores. The legality of the machines has been questioned for some time.As Malek explained on his own episode of Politically Speaking, he wanted to make sure the unclaimed property program was as widely advertised as possible. But he acknowledged it was a mistake to put the decals close to the machines and ultimately decided to remove them.Osmack said: “This doesn’t even pass the common sense sniff test of, ‘Hey, should I put state stickers claiming you might have a billion dollars on a gambling machine that is not registered with the state of Missouri?’ If we’re gonna give kudos for him acknowledging the wrong thing, it never should have been done in the first place.”Osmack’s platform includes supporting programs providing school meals using Missouri agriculture products and making child care more accessible for the working class.He said the fact that Missouri has such a large surplus shows that it’s possible to create programs to make child care within reach for parents.“It is quite audacious for [Republicans] to brag about $8 billion, with a B, dollars in state surplus, while we offer next to no social services to include pre-K, daycare, or child care,” Osmack said.Here’s are some other topics Osmack discussed on the show:How he would handle managing the state’s pension systems and approving low-income housing tax credits. The state treasurer’s office is on boards overseeing both of those programs.Malek’s decision to cut off investments from Chinese companies. Osmack said that Missouri needs to be cautious about abandoning China as a business partner, especially since they’re a major consumer of the state’s agriculture products. “There’s a way to make this work where we are not supporting communist nations to the detriment of the United States or our allies, while also maintaining strong economic ties that benefit Missouri farmers,” he said.What it was like to witness the skirmish at the Missouri State Fair between U.S. Sen. Josh Hawley and Democratic challenger Lucas Kunce.Whether Kunce can get the support of influential groups like the Democratic Senatorial Campaign Committee, which often channels money and staff to states with competitive Senate elections.

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As Illinois receives praise for its cannabis equity efforts, stakeholders work on system’s flaws

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Medical marijuana patients can now purchase cannabis grown by small businesses as part of their allotment, Illinois’ top cannabis regulator said, but smaller, newly licensed cannabis growers are still seeking greater access to the state’s medical marijuana customers.Illinois legalized medicinal marijuana beginning in 2014, then legalized it for recreational use in 2020. While the 2020 law legalized cannabis use for any adult age 21 or older, it did not expand licensing for medical dispensaries.Patients can purchase marijuana as part of the medical cannabis program at dual-purpose dispensaries, which are licensed to serve both medical and recreational customers. But dual-purpose dispensaries are greatly outnumbered by dispensaries only licensed to sell recreationally, and there are no medical-only dispensaries in the state.As another part of the adult-use legalization law, lawmakers created a “craft grow” license category that was designed to give more opportunities to Illinoisans hoping to legally grow and sell marijuana. The smaller-scale grow operations were part of the 2020 law’s efforts to diversify the cannabis industry in Illinois.Prior to that, all cultivation centers in Illinois were large-scale operations dominated by large multi-state operators. The existing cultivators, mostly in operation since 2014, were allowed to grow recreational cannabis beginning in 2019.Until recently, dual-purpose dispensaries have been unsure as to whether craft-grown products, made by social equity licensees — those who have lived in a disproportionately impacted area or have been historically impacted by the war on drugs — can be sold medicinally as part of a patient’s medical allotment.Erin Johnson, the state’s cannabis regulation oversight officer, told Capitol News Illinois last month that her office has “been telling dispensaries, as they have been asking us” they can now sell craft-grown products to medical patients.“There was just a track and trace issue on our end, but never anything statutorily,” she said.

Dilpreet Raju

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Capitol News IllinoisThe graphic shows how cannabis grown in Illinois gets from cultivation centers to customers.

No notice has been posted, but Johnson’s verbal guidance comes almost two years after the first craft grow business went online in Illinois.It allows roughly 150,000 medical patients, who dispensary owners say are the most consistent purchasers of marijuana, to buy products made by social equity businesses without paying recreational taxes. However — even as more dispensaries open — the number available to medical patients has not increased since 2018, something the Cannabis Regulation Oversight Office “desperately” wants to see changed. Johnson said Illinois is a limited license state, meaning “there are caps on everything” to help control the relatively new market.Berwyn Thompkins, who operates two cannabis businesses, said the rules limited options for patients and small businesses.“It’s about access,” Thompkins said. “Why wouldn’t we want all the patients — which the (adult-use) program was initially built around — why wouldn’t we want them to have access? They should have access to any dispensary.”Customers with a medical marijuana card pay a 1% tax on all marijuana products, whereas recreational customers pay retail taxes between roughly 20 and 40% on a given cannabis product, when accounting for local taxes.While Illinois has received praise for its equity-focused cannabis law, including through an independent study that showed more people of color own cannabis licenses than in any other state, some industry operators say they’ve experienced many unnecessary hurdles getting their businesses up and running.The state, in fact, announced last month that it had opened its 100th social equity dispensary.But Steve Olson, purchasing manager at a pair of dispensaries (including one dual-purpose dispensary) near Rockford, said small specialty license holders have been left in the lurch since the first craft grower opened in October 2022.“You would think that this would be something they’re (the government) trying to help out these social equity companies with, but they’re putting handcuffs on them in so many different spots,” he said. “One of them being this medical thing.”Olson said he contacted state agencies, including the Department of Financial and Professional Regulation, months ago about whether craft products can be sold to medical patients at their retail tax rate, but only heard one response: “They all say it was an oversight.”This potentially hurt social equity companies because they sell wholesale to dispensaries and may have been missing out on a consistent customer base through those medical dispensaries.Olson said the state’s attempts to provide licensees with a path to a successful business over the years, such as with corrective lotteries that granted more social equity licenses, have come up short.“It’s like they almost set up the social equity thing to fail so the big guys could come in and swoop up all these licenses,” Olson said. “I hate to feel like that but, if you look at it, it’s pretty black and white.”Olson said craft companies benefit from any type of retail sale.“If we sell it to medical patients or not, it’s a matter of, ‘Are we collecting the proper taxes?’ That’s all it is,” he said.State revenue from cannabis taxes, licensing costs and other fees goes into the Cannabis Regulation Fund, which is used to fund a host of programs, including cannabis offense expungement, the general revenue fund, and the R3 campaign aiming to uplift disinvested communities.For fiscal year 2024, nearly $256 million was paid out from Cannabis Regulation Fund for related initiatives, which includes almost $89 million transferred to the state’s general revenue fund and more than $20 million distributed to local governments, according to the Illinois Department of Revenue.Medical access still limitedThe state’s 55 medical dispensaries that predate the 2020 legalization law, mostly owned by publicly traded multistate operators that had been operating in Illinois since 2014 under the state’s medical marijuana program, were automatically granted a right to licenses to sell recreationally in January 2020. That gave them a dual-purpose license that no new entrants into the market can receive under current law.Since expanding their clientele in 2020, Illinois dispensaries have sold more than $6 billion worth of cannabis products through recreational transactions alone.Nearly two-thirds of dispensaries licensed to sell to medical patients are in the northeast counties of Cook, DuPage, Kane, Lake and Will. Dual-purpose dispensaries only represent about 20 percent of the state’s dispensaries.While the state began offering recreational dispensary licenses since the adult-use legalization law passed, it has not granted a new medical dispensary license since 2018. That has allowed the established players to continue to corner the market on the state’s nearly 150,000 medical marijuana patients.But social equity licensees and advocates say there are more ways to level the playing field, including expanding access to medical sales.Johnson, who became the state’s top cannabis regulator in late 2022, expressed hope for movement during the fall veto session on House Bill 2911, which would expand medical access to all Illinois dispensaries.“We would like every single dispensary in Illinois to be able to serve medical patients,” Johnson said. “It’s something that medical patients have been asking for, for years.”Johnson said the bill would benefit patients and small businesses.“It’s something we desperately want to happen as a state system, because we want to make sure that medical patients are able to easily access what they need,” she said. “We also think it’s good for our social equity dispensaries, as they’re opening, to be able to serve medical patients.”Rep. Bob Morgan, D-Deerfield, who was the first statewide project coordinator for Illinois’ medical cannabis program prior to joining the legislature, wrote in an email to Capitol News Illinois that the state needs to be doing more for its patients.“Illinois is failing the state’s 150,000 medical cannabis patients with debilitating conditions. Too many are still denied the patient protections they deserve, including access to their medicine,” Morgan wrote, adding he would continue to work with stakeholders on further legislation.Capitol News Illinois is a nonprofit, nonpartisan news service covering state government. It is distributed to hundreds of newspapers, radio and TV stations statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation, along with major contributions from the Illinois Broadcasters Foundation and Southern Illinois Editorial Association.

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