1 big thing:

1 big thing: The shame of the Atlanta pen

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2. New lawsuit challenges Georgia abortion ban  

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3. County tells churches they can't host homeschooled students

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4. A poll, hot off the presses

On the job hunt?

5. One photo to go: Whatever you do, do it with style

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It's 🐪 day. How do you plan to conquer it?

⛱ Today's weather: Mostly sunny, with a high near 92. 

Situational awareness: The CEO of Bryan County-based Daniel Defense will be on a panel testifying before the House Oversight Committee this morning about gun manufacturers' role in the country's gun violence. 

Daniel Defense produced the weapon used by the Uvalde shooter, and its marketing techniques have come under scrutiny.

Today's newsletter is 948 words — a 3.5-minute read.

🤓 Thomas is nerding out on the Georgia State University library's Planning Atlanta photography archive.

😍 Kristal wants to add this plant to her growing collection. 

🤤 Emma is pretty excited about Poco Loco & Butter and Cream’s "Choco Loco Taco" reboot. 

Plus: 📚 Churches cited for homeschooling

Atlanta

A daily look at the most significant and interesting stories affecting Atlanta. Written by Emma Hurt, Kristal Dixon and Thomas Wheatley.

Axios Atlanta

National

A group of 20 Republican attorneys general warned CVS and Walgreens on Wednesday that they could face legal consequences if they begin mailing and distributing abortion pills. 

The big picture: Nearly a month after the FDA made a regulatory change allowing retail pharmacies to offer abortion pills, the attorneys general told the big pharmacy chains that selling mifepristone — which is used in medication abortions — is "unsafe and illegal," per a press release.

What they're saying: "[W]e are not dispensing mifepristone at this time," said Walgreens spokesperson Fraser Engerman in an emailed statement.

"We intend to become a certified pharmacy under the program, however we fully understand that we may not be able to dispense mifepristone in all locations if we are certified under the program," Engerman added.

CVS did not immediately respond to a request for comment.

Details: A warning letter led by Missouri Attorney General Andrew Bailey states that "many people are not aware that federal law expressly prohibits using the mail to sent or receive any drug that will 'be used or applied for producing abortion.'"

The attorneys general specifically are referring to the Comstock Act, an 1873 law that made it illegal to send what at the time was deemed to be pornographic publications through the mail. The law also contains language prohibiting the mailing of "any article or thing designed or intended for the prevention of conception or procuring of an abortion."

"Obviously, a federal criminal law — especially one that is, as here, enforceable through a private right of action — deserves serious contemplation," the attorneys general said in the letter.

The letter also noted that certain state laws prohibit the mailing and distribution of abortion pills. However, CVS and Walgreens have already acknowledged that they intend to provide mifepristone where it is legally possible to do so.

State of play: The Justice Department clarified in early January that the Comstock Act does not prohibit the mailing of abortion pills "where the sender lacks the intent that the recipient of the drugs will use them unlawfully." 

The attorneys general argued against the DOJ's interpretation in the letter, saying that "the text, not the Biden administration's view, is what governs."

They warned CVS and Walgreens that "consequences for accepting the Biden administration's reading could come far sooner," adding that civil litigation against the companies could be brought by state attorneys general or private citizens.

Zoom out: At least 19 states have banned or severely restricted the use of telemedicine to access abortion pills, and instead require that patient get the medications from medical facilities in person.

There are currently two lawsuits that argue that states cannot regulate or restrict drugs that are FDA-approved. One lawsuit filed in North Carolina targets the state's restrictions on abortion pills and the another, filed in West Virginia, challenges the state's abortion ban.

These cases could potentially set a precedent that FDA policy preempts state law.

On the other hand, another lawsuit filed by anti-abortion groups argues that the agency did not properly approve mifepristone for terminating pregnancies.

20 GOP attorneys general warn CVS, Walgreens against selling abortion pills

The attorneys general said that CVS and Walgreen would be violating federal law if they distribute abortion pills.

Abortion

A group of 20 Republican attorneys general warned <a class="gtmContentClick" data-vars-link-text="CVS" data-vars-click-url="https://ago.mo.gov/docs/default-source/press-releases/2023-02-01-fda-rule---cvs-letter-tom-moriarty.pdf?sfvrsn=d42cfc2b_2" data-vars-content-id="714b660d-116f-479c-a725-2ed16f577d27" data-vars-headline="20 GOP attorneys general warn CVS, Walgreens against selling abortion pills" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://ago.mo.gov/docs/default-source/press-releases/2023-02-01-fda-rule---cvs-letter-tom-moriarty.pdf?sfvrsn=d42cfc2b_2" target="_blank">CVS</a> and <a class="gtmContentClick" data-vars-link-text="Walgreens" data-vars-click-url="https://ago.mo.gov/docs/default-source/press-releases/2023-02-01-fda-rule---walgreens-letter-danielle-gray.pdf?sfvrsn=ff1e6652_2" data-vars-content-id="714b660d-116f-479c-a725-2ed16f577d27" data-vars-headline="20 GOP attorneys general warn CVS, Walgreens against selling abortion pills" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://ago.mo.gov/docs/default-source/press-releases/2023-02-01-fda-rule---walgreens-letter-danielle-gray.pdf?sfvrsn=ff1e6652_2" target="_blank">Walgreens</a> on Wednesday that they could face legal consequences <a class="gtmContentClick" data-vars-link-text="if they begin mailing and distributing abortion pills" data-vars-click-url="https://www.axios.com/2023/01/04/walgreens-abortion-pills-fda-regulation-roe" data-vars-content-id="714b660d-116f-479c-a725-2ed16f577d27" data-vars-headline="20 GOP attorneys general warn CVS, Walgreens against selling abortion pills" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/01/04/walgreens-abortion-pills-fda-regulation-roe" target="_self">if they begin mailing and distributing abortion pills</a>. The big picture: Nearly a month after the FDA made a regulatory change <a class="gtmContentClick" data-vars-link-text="allowing retail pharmacies to offer abortion pills" data-vars-click-url="https://www.axios.com/2023/01/04/fda-abortion-pills-pharmacies-roe-wade" data-vars-content-id="714b660d-116f-479c-a725-2ed16f577d27" data-vars-headline="20 GOP attorneys general warn CVS, Walgreens against selling abortion pills" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/01/04/fda-abortion-pills-pharmacies-roe-wade" target="_self">allowing retail pharmacies to offer abortion pills</a>, the attorneys general told the big pharmacy chains that selling mifepristone — which is used in medication abortions — is &quot;unsafe and illegal,&quot; per a <a class="gtmContentClick" data-vars-link-text="press release" data-vars-click-url="https://ago.mo.gov/home/news/2023/02/01/attorney-general-bailey-directs-letter-to-cvs-and-walgreens-over-distribution-of-abortion-pills" data-vars-content-id="714b660d-116f-479c-a725-2ed16f577d27" data-vars-headline="20 GOP attorneys general warn CVS, Walgreens against selling abortion pills" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://ago.mo.gov/home/news/2023/02/01/attorney-general-bailey-directs-letter-to-cvs-and-walgreens-over-distribution-of-abortion-pills" target="_blank">press release</a>.

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

President Biden has made the COVID-19 crisis and a post-Trump return to national unity and traditional democratic ideals his top priorities. From vaccinations to stimulus to schools, Biden is seeking bipartisan compromise while showing a willingness to use executive authority and bare Democratic majorities in the U.S. House and Senate to implement his policies. Republican leaders are navigating deep party divisions over if and how to move beyond former President Trump.

Politics & Policy

Doctors and scientists are urging the Food and Drug Administration to convene an expert panel to review safety concerns around an Alzheimer's drug that won fast-track approval in January.

The big picture: It's the latest concern over whether the FDA is cutting corners evaluating Alzheimer's drugs, prompted by its controversial 2021 approval of Biogen's Aduhelm, which came over the objections of an advisory panel and without evidence the drug actually slowed the decline of memory and brain function. 

Some health experts now say that the agency isn't doing enough to address questions about Eisai's lecanemab — including three patient deaths during clinical trials that scientists connected to the drug.

The FDA didn't follow its customary process and convene an advisory panel before green-lighting the accelerated approval last month.

Accelerated approvals are based on variables that suggest a drug probably works, instead of real-world clinical results.

Congress late last year gave the FDA more authority over confirmatory trials that are supposed to prove the drugs work. 

At a recent National Academies of Sciences, Engineering, and Medicine workshop, FDA officials were told they should more transparent about the rationale for using the fast-track process in new areas beyond cancer drugs and infectious diseases, per a Cowen policy note.    

What's happening: Some health experts believe the agency should next convene a public discussion on Eisai's drug, which would cost $26,500 per year for the average patient, before deciding whether it should get a full approval based on its actual clinical benefit.

The experts point to a congressional probe into the Aduhelm case that found that the FDA did not follow its own guidance and practices during that approval process.

As we wrote during the Aduhelm controversy, the underlying concern is the FDA's decisions could undermine medical standards and give millions of patients false hope, because greenlighting more drugs just because they might work could unleash perverse incentives.

Catch up quick: The FDA in early January granted accelerated approval to Eisai's lecanemab — marketed at Leqembi — which has shown in large clinical trial results published in the New England Journal of Medicine that it can slow the progression of the disease by 27%, as well as slow the rate of cognitive decline over 18 months.

The study showed that patients who took lecanemab presented more adverse effects than those given a placebo.

Eisai reported 13 deaths out of the nearly 1,800 participants in the trial. However, the company has not released any details on the deaths, so scientists have been unable to independently determine whether lecanemab had anything to do with them, Science reports.

What they're saying: "[C]ritical questions remain as to whether the benefits outweigh the risks reported of brain swelling, brain bleeding and death among patients who received this drug," the independent advocacy group Doctors for America said in a statement. 

"As physicians, we vow to 'do no harm' in treating our patients and look to the FDA to provide unbiased, independent guidance to signal through their approval decisions that the authorized treatment's benefits truly outweigh its risks," they added.

Between the lines: Eisai researchers have suggested that Alzheimer's patients are willing to take a drug with health risks if it could slow the progression of the condition: "They are willing to risk a brain hemorrhage," Sharon Cohen, one of the principal investigators, said in November.

"I don't really see this as much different than cancer drugs," said Howard Fillit, co-founder and chief science officer of the Alzheimer's Drug Discovery Foundation, adding that those drugs are approved even if they have side effects that can reduce quality of life, because "they might extend life by six months or a year or 18 months."

"We are seeing an extension of cognitive life expectancy, the ability of people to be able to think and drive and do other things ... and for elderly people, I think this is critical," Fillit added.

State of play: A report in Nature Reviews Neurology found that while the lecanemab trial represents "an important milestone," there's still a need for "a thorough appraisal of the data" to indicate whether the results are clinically meaningful.

Alzheimer's disease "is a very slowly progressive condition without treatment. And so, you add a treatment that slows it a little bit more," but "it's really not perceptible day-to-day to the patients and the families," said Constantine Lyketsos, an Alzheimer's researcher at Johns Hopkins School of Medicine.

Details: Lecanemab targets amyloid plaques, proteins in the brain that are believed to contribute to the development of Alzheimer's.

The accelerated approval was not based on the NEJM study but on a Phase II trial that looked at patients' cognitive scores as the primary clinical endpoint. The drug actually failed to meet the required scores on the primary endpoint and the approval was granted instead based on a surrogate endpoint, or variable, that indicated the reduction of amyloid plaques.

Zoom in: The presence of amyloids is measured through PET scans. However, there is no conclusive evidence that PET amyloid-beta scans are "reasonable and necessary" for the diagnosis or treatment of Alzheimer's, per the Centers for Medicare and Medicaid Services.

An independent panel needs to meet to discuss the use of beta amyloid PET scans to support a drug's accelerated approval, which is of "tremendous public health urgency," said Jason Karlawish, a professor at the University of Pennsylvania Perelman School of Medicine.

Lecanemab is the third drug that FDA has used beta amyloid PET scans "to decide whether they're going to grant accelerated approval, and yet we've never had a public discussion of the data to support the use of that endpoint," Karlawish added.

Of note: In the FDA's summary for accelerated approval, the agency says that while "not yet submitted to the agency for review," the NEJM study appears to support the drug's clinical benefit.

"Kind of jumping the gun a little bit by talking about the clinical trial data that they have yet to review was alarming to see," said Reshma Ramachandran, an assistant professor at the Yale School of Medicine.

Don't forget: The FDA has so far evaluated three Alzheimer's drugs that are based on the amyloid hypothesis and are measured by the beta amyloid PET scans: Aduhelm, lecanemab and Eli Lily's donanemab — the last of which did not receive FDA accelerated approval.

What we're watching: Some FDA advisers believe that an expert panel meeting is not necessary.

"I think this data doesn't require it," said Liana Apostolova, a neurologist at the Indiana University School of Medicine and member of the FDA's Peripheral and Central Nervous System Drugs Advisory Committee.

"Very positive results in the trial on multiple outcomes and biomarkers don't historically go to an advisory committee," she added. 

Apostolova told Axios that she has worked as a consultant for Eisai on lecanemab, and said that if an advisory meeting is called, she would not participate as a result.

Health experts want FDA safety review of fast-tracked Alzheimer's drug

Health experts worry that the FDA has not properly evaluated the risks and benefits of Eisai's lecanemab.

Alzheimer's Association

Doctors and scientists are urging the Food and Drug Administration to convene an expert panel to review <a class="gtmContentClick" data-vars-link-text="safety concerns" data-vars-click-url="https://www.axios.com/2022/11/29/alzheimers-treatment-fda-safety-deaths" data-vars-content-id="98b89c27-6346-48e2-b700-a052ddb7ce47" data-vars-headline="Health experts want FDA safety review of fast-tracked Alzheimer&#x27;s drug" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/11/29/alzheimers-treatment-fda-safety-deaths" target="_self">safety concerns</a> around an Alzheimer&#x27;s drug that won fast-track approval in January.The big picture: It&#x27;s the latest concern over whether the FDA is cutting corners evaluating Alzheimer&#x27;s drugs, prompted by its controversial 2021 <a class="gtmContentClick" data-vars-link-text="approval of Biogen&#x27;s Aduhelm" data-vars-click-url="https://www.axios.com/2021/06/07/fda-alzheimers-drug-biogen" data-vars-content-id="98b89c27-6346-48e2-b700-a052ddb7ce47" data-vars-headline="Health experts want FDA safety review of fast-tracked Alzheimer&#x27;s drug" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2021/06/07/fda-alzheimers-drug-biogen" target="_self">approval of Biogen&#x27;s Aduhelm</a>, which came over the objections of an advisory panel and without evidence the drug actually slowed the decline of memory and brain function.

The Biden administration on Monday moved to reverse a Trump-era policy that made it easier for employers to refuse to offer birth control coverage in company-sponsored health plans.

The big picture: The Trump administration's rollback of the Affordable Care Act's contraceptive mandate allowed organizations to opt out of coverage, citing moral objections. Before that, exemptions were limited to religious grounds.

The Trump administration rule was challenged in court on the grounds it could cause irreversible harm to women but took effect in 2018.

Driving the news: The new rule — proposed by the Health and Human Services, Treasury and Labor departments — would get rid of the "moral" exemption and retain the "religious" one.

It would also create an "independent pathway" for people who have insurers with religious exemptions to access birth control through a "willing contraceptive provider" at no cost, according to an HHS press release.

What they're saying: "If this rule is finalized, individuals who have health plans that would otherwise be subject to the ACA preventive services requirements but have not covered contraceptive services because of a moral or religious objection, would now have access," said Chiquila Brooks-LaSure, administrator for the Centers for Medicare and Medicaid Services.

By the numbers: HHS estimates that the proposal could affect over 100 employers and 125,000 workers, CNN reports.

What's next: The public has a 60-day window to comment on the rule.

Biden administration proposes strengthening health law's contraception mandate

The proposed rule reversed a Trump-era policy that rolled back the ACA.

Birth

The Biden administration on Monday moved to reverse a Trump-era policy that made it easier for employers to refuse to offer birth control coverage in company-sponsored health plans.The big picture: The Trump administration&#x27;s rollback of the <a class="gtmContentClick" data-vars-link-text="Affordable Care Act&#x27;s contraceptive mandate" data-vars-click-url="https://www.axios.com/2017/12/15/trump-administration-rolls-back-aca-contraception-mandate-1513306016" data-vars-content-id="b3d6a664-38af-4dcb-8137-accb3663f0ed" data-vars-headline="Biden administration proposes strengthening health law&#x27;s contraception mandate" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2017/12/15/trump-administration-rolls-back-aca-contraception-mandate-1513306016" target="_self">Affordable Care Act&#x27;s contraceptive mandate</a> allowed organizations to opt out of coverage, citing moral objections. Before that, exemptions were limited to religious grounds.

The Biden administration is weighing additional actions to help people access abortions, which may include a public health emergency declaration.

The big picture: Both abortion rights advocates and Democratic lawmakers have urged the Department of Health and Human Services and President Biden to take such a step in response to the overturning of Roe v. Wade, which they say has created a "full-scale reproductive health crisis" across the U.S.

The lawmakers argued that such a move would allow the administration to help support states that protect abortion, deploy Public Health Services Corps teams and give the government "the ability to accelerate access to new medications authorized for abortion."

What he's saying: "There are discussions on a wide range of measures ... that we can take to try to protect people's rights," HHS Secretary Xavier Becerra told Axios during a pair of Monday public events that touched on reproductive health access.  

"There are certain criteria that you look for to be able to declare a public health emergency. That's typically done by scientists and those that are professionals in those fields who will tell us whether we are in a state of emergency and based on that, I have the ability to make a declaration," Becerra added, when asked about a public health emergency declaration on abortion.

He said that there hasn't been a "full assessment" on what a declaration on abortion would look like and whether conditions merit it, but there's still "an evaluation" on the topic.

Don't forget: "We are constantly exploring additional actions we can take to protect and expand access to reproductive health care, including abortion care, and are prioritizing the actions that can give us the highest impact and most durable solutions," an HHS spokesperson told Axios.

Since Roe v. Wade was overturned, HHS has taken steps to protect reproductive health access, including issuing guidance saying that abortion care is protected in emergency situations and stating that birth control insurance coverage is guaranteed under federal law.

Of note: The White House has previously said that declaring a public health emergency did not "seem like a great option." 

But HHS has the authority when the secretary determines that a "disease or disorder presents a public health emergency." 

The designation has been broadly used to respond to natural disasters, the opioid crisis, as well as diseases like the coronavirus, per a report from the Network for Public Health Law. 

How it works: An emergency declaration "would potentially make it easier for people who need to travel out-of-state to get abortions or to get abortion medication. It would make available funding that wouldn't otherwise be there to address those unmet needs," said Mary Ziegler, a professor of law the University of California, Davis, who specializes in abortion issues. 

Zoom in: It's possible that an emergency declaration would make abortion medication more widely available.

They could be considered as a "countermeasure needed to mitigate the effects of a health crisis resulting from abortion bans" under federal law, Rachel Rebouché, a professor of law at Temple University, told Ms. Magazine.

"Providers offering medication abortion as a countermeasure could be shielded from liability and states would be preempted from applying their own laws to the actions of these providers working under a public health emergency," Rebouché added.

What we're watching: The declaration likely would be challenged in court. 

"It would be hard to imagine a federal court challenge to that ... ending well for the administration, but by the same token, it might have some value in the short term," Ziegler told Axios.

Editor's note: This story and headline has been corrected to reflect that HHS is weighing several potential actions on abortion access, which may include a public health emergency.

HHS weighs abortion access actions, including possible health emergency declaration

Democratic lawmakers have urged the Biden administration to declare a Public Health Emergency on abortion.

Illustration of a red cross floating in a life preserver.

Top Stories

The Biden administration is weighing additional actions to help people access abortions, which may include a public health emergency declaration.The big picture: Both abortion rights advocates and <a class="gtmContentClick" data-vars-link-text="Democratic lawmakers" data-vars-click-url="https://www.axios.com/2022/07/13/house-letter-biden-abortion-emergency" data-vars-content-id="fa93712f-38c3-4389-a055-766036ab9d2a" data-vars-headline="HHS weighs abortion access actions, including possible health emergency declaration" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/07/13/house-letter-biden-abortion-emergency" target="_self">Democratic lawmakers</a> have urged the Department of Health and Human Services and President Biden to take such a step in response to the overturning of Roe v. Wade, which they say has created a &quot;full-scale reproductive health crisis&quot; across the U.S.

Data: Guttmacher Institute; Table: Alice Feng/Axios

About a quarter of U.S. states have banned or restricted abortion since Roe v. Wade was overturned. But elsewhere, lawmakers are moving to ensure that access to the procedure remains guaranteed, and to accommodate out-of-state providers and patients.

The big picture: There are currently at least 25 states and Washington, D.C., which have measures in place to protect abortion access.

Some are weighing steps to expand access and prepare for a likely influx of out-of-state patients seeking care.

In 2022, a total of 364 bills and executive orders were introduced to protect abortion access in 33 states and Washington, D.C., according to data from the Guttmacher Institute provided to Axios.

State of play: Voters in California, Vermont and Michigan in November adopted amendments to enshrine abortion protections into their respective state constitutions.

Michigan is the only one that previously lacked state laws in support of abortion access.

More states are expected to advance similar measures, because constitutional protections are considered the most ironclad and are "very hard to amend," Jessica Arons, senior policy counsel for the American Civil Liberties Union, told Axios.

"You can pass a bill that codifies abortion rights ... but if a future election changes the political makeup of the legislature and who's in the governor's office, then they could repeal the statute," Arons added.

Additionally, Arons explained that courts can "invalidate" a state law, but not a constitutional amendment because they are "bound" by that document.

Zoom in: Blue states started enacting protective laws even before the Supreme Court's Dobbs decision that overturned Roe. 

Several — such as Colorado, Connecticut, New Jersey, New York and Washington state — adopted new bills after Texas' six week ban took effect and after the Supreme Court leak came out.

What else is happening: Governors in California, Colorado, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Nevada, North Carolina, New Mexico, Pennsylvania, Rhode Island and Washington have issued executive orders to add more protections to abortion providers and patients in their states.

Other types of laws: Other states — like Maryland, Washington and Delaware — have moved to loosen restrictions on who can provide and abortion and who can prescribe medication to end a pregnancy.

Four states — Colorado, Massachusetts, Montana and Maine — have laws that establish a "bubble zone" that limits protests near the doors of any clinic.

States are also considering bills that would require most insurers in a state to provide abortion coverage.

Between the lines: In states like New Mexico, Kansas, Montana, Alaska, Florida and Minnesota, the right to an abortion is protected by a state Supreme Court precedent, according to the Center for Reproductive Rights.

However, those rights could be challenged in court in states where there is an anti-abortion majority of lawmakers. 

Approximately six in 10 U.S. adults (61%) believe abortion should be legal in "all or most cases," according to a survey from the Pew Research Center.

What they're saying: "As most states return for their first legislative sessions since the Dobbs decision and the midterm elections, there's no doubt that abortion will be front of mind for lawmakers — just as it is for their constituents.," said Alexis McGill Johnson, president of Planned Parenthood Action Fund, in a written statement.

McGill Johnson said that while more abortion restrictions are expected to be introduced in states, Planned Parenthood also expects "renewed efforts to restore, protect, and expand reproductive freedom."

Below is a summary of the most recent laws protecting or expanding abortion access. 

Abortion protections that have been enacted

Minnesota: Gov. Tim Walz (D) signed into law a bill to guarantee the right to an abortion in the state, which is now considered to be a haven for abortion access in the upper midwest. 

Minnesota is the first state since the fall of Roe to enact a protective law.

Michigan: Constituents voted in support of a constitutional amendment to create a right to "reproductive freedom," which includes the ability to get an abortion. 

The petition to add the amendment to the November ballot got the most signatures of any ballot initiative in state history.

California: Voters in the state adopted a constitutional amendment that creates a "fundamental right to choose to have an abortion."

Gov. Gavin Newsom (D) last year also signed into law a bill to protect abortion providers and patients from bans, lawsuits and penalties in other states, such as the restrictive laws in Texas and Oklahoma. The bill is in effect.

Vermont: Voters overwhelmingly backed adding a constitutional amendment that protects abortion access and creates an "individual’s right to personal reproductive autonomy," which includes the choice to get an abortion.

Massachusetts: Ex-Gov. Charlie Baker (R) signed into law a bill to expand protections to reproductive health care and gender-affirming care. 

The legislation also prohibits state agencies from assisting with other out-of-state investigations or legal proceedings on health care services that might be restricted in other states.

Abortion protections that have passed both chambers in the state legislature

New York: Lawmakers officially passed a bill to add an amendment conferring the right to get an abortion into the state's constitution. Voters will get to decide on the addition during the 2024 elections. 

Go deeper: Where abortion has been banned now that Roe v. Wade is overturned

Where abortion access is protected without Roe v. Wade

Over 360 provisions were introduced to protect abortion access in 2022.

Axios Explains: Abortion

About a quarter of U.S. states <a class="gtmContentClick" data-vars-link-text="have banned or restricted abortion" data-vars-click-url="https://www.axios.com/2022/06/25/abortion-illegal-7-states-more-bans-coming" data-vars-item="in_content_link" href="https://www.axios.com/2022/06/25/abortion-illegal-7-states-more-bans-coming" target="_self">have banned or restricted abortion</a> since Roe v. Wade was overturned. But elsewhere, lawmakers are moving to ensure that access to the procedure remains guaranteed, and to accommodate out-of-state providers and patients.The big picture: There are currently at least 25 states and Washington, D.C., which have measures in place to protect abortion access.

Oriana Gonzalez

Stories

Health experts want FDA safety review of fast-tracked Alzheimer's drug

20 GOP attorneys general warn CVS, Walgreens against selling abortion pills

Where abortion access is protected without Roe v. Wade

HHS weighs abortion access actions, including possible health emergency declaration

Biden administration proposes strengthening health law's contraception mandate

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