What we know about the virus that's spreading across the globe.

Coronavirus

What's ahead in a post-Roe v. Wade world.

Axios Explains: Abortion

The developments that matter in how Americans are paying for drugs, treatment, insurance and more.

Health care costs

Opioids

The developments that matter in the fight over Obama's landmark health care law.

Affordable Care Act

The latest in the debate over whether the U.S. should shift to government-funded health care.

Medicare for All

The developments that matter in the fight over e-cigarette use.

Vaping

The developments that matter on issues that affect our immediate safety and health.

Public health

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

National

5 things serious coffee fans should know

Five things serious coffee fans should know

From how decaf is made to the difference in roasts.

Illustration of a magnifying glass going over a paper coffee cup to reveal the coffee underneath

Coffee

Illustration of a magnifying glass over a coffee cup

Lorna Roxanne Green was sentenced Thursday to five years in prison and three years probation for burning down Wyoming's only abortion clinic.

Driving the news: Green previously admitted to setting fire to the clinic in May 2022. It had been under construction at the time and planned to offer gender-affirming care and abortion procedures. 

Wellspring Health Access Clinic in Casper opened in April after about a year-long delay due to the fire.

Details: The judge handed Green the minimum prison sentence, citing the physical and emotional abuse Green had previously experienced at the hands of her parents, AP reported.

U.S. District Judge Alan Johnson also ordered Green to pay a "very, very substantial" restitution. While the exact amount will be determined at a later date, Johnson said it would likely be more than $280,000.

Green's attorney told the court she had acted alone and accepted responsibility for her actions, and that she hadn't intended to spread fear or make a political statement, per AP.

Background: Green, a 22-year-old mechanical engineering student, was arrested in March and indicted by a federal grand jury in May.

Green pled guilty in July to arson of a building used in interstate commerce.

She was since remanded to the custody of the U.S. Marshals Service.

Of note: In July, a judge in Wyoming temporarily blocked the state's trigger abortion ban, just hours after the law took effect.

Among the health providers that sued the state to challenge the law was the Wellspring Health Access Clinic.

Zoom out: Wyoming became the first state to ban abortion pills earlier this year, but a judge later halted the law from taking effect.

Go deeper: Judge temporarily blocks Wyoming's abortion trigger ban from taking effect

Judge temporarily blocks Wyoming's abortion trigger ban from taking effect

Woman who burned down Wyoming's lone abortion clinic sentenced to 5 years

Lorna Roxanne Green previously admitted to setting fire to the clinic in May 2022.

Abortion rights protesters on June 24, 2022, in Jackson Hole, Wyoming. Photo: Natalie Behring/Getty Images

Abortion

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

Raleigh

Axios Raleigh

The Triangle will get a new children's hospital in the next decade, thanks to $320 million of dedicated funding in the new state budget for UNC Health to build one.

Driving the news: UNC Health said the standalone hospital would cost roughly $2 billion to build, provide medical and behavioral health care for children and adolescents and create thousands of jobs.

The state hopes to open the hospital in the next eight to 10 years.

Yes, but: To reach that deadline, UNC Health will need to raise significant amounts of money via a philanthropic campaign and find property in the region that can handle such a project.

The campus would need to be at least 50 to 70 acres in size and in a highly visible location in the Triangle, UNC Health spokesperson Alan Wolf told Axios.

N.C.'s new budget paves the way for a $2 billion children's hospital

The new children's hospital is expected to open within the decade

Illustration of a giant teddy bear taking up an entire hospital bed. 

Hospitals

News

Development

Politics

Vitals

Axios Vitals

Pregnant veterans will soon have vastly expanded access to so-called maternity care coordinators who provide a range of supportive services, the Department of Veterans Affairs told Axios first.

Why it matters: The announcement is part of the Biden administration's efforts to tackle the country's maternal health crisis and seeks to help a population that may be at heightened risk of pregnancy complications. 

Catch up quick:  Starting Oct. 1, maternity care coordinators will be available to veterans a full year after birth, up from eight weeks currently. 

Since 2012, these coordinators have helped veterans navigate care both inside and outside of the VA system.

Coordinators help connect people to community resources and care, offer support after pregnancy loss and answer medical billing questions. Veterans can receive coordinator services as soon as they have a positive pregnancy test, according to a department spokesperson.

Coordinators touch base with veterans every three months throughout the pregnancy. The new expansion extends the scheduled contacts for another twelve months after delivery. 

Postpartum care is crucial: More than half of pregnancy-related deaths happen between one day and one year after giving birth. About 1 in 8 happen after six weeks postpartum, according to a 2019 study.

By the numbers: Pregnancies among women using VA care reached 12,524 in 2022, up more than 80% since 2014. 

In 2015, the maternity care coordinator program served 957 pregnant veterans.

What they're saying: "Extending postpartum care coordination up to one year allows VA maternity care coordinators the ability to double the amount of contact with their patients," Sally Haskell, acting chief officer for the VA Office of Women's Health, said in a statement. 

The extended service could especially help veterans living in areas lacking sufficient maternity care resources, a VA spokesperson noted. 

March of Dimes has classified 36% of counties as maternity care deserts.

Context: A two-year-old law aimed at supporting pregnant veterans included $15 million for maternity care coordinators. 

The law, known as the Protecting Moms Who Served Act, also required the government to conduct a comprehensive study of pregnancy complications among women veterans.

Veterans to get extended postpartum care services

Maternity care coordinators will be available to veterans a full year after birth, up from eight weeks currently.

Illustration of military camouflage with patterns in the shape of reaching hands

Veterans

Blue cities that have taken the most progressive — and often controversial — steps to tackle the nation's drug crisis are beginning to question those strategies amid rising political backlash. 

Why it matters: Public health experts emphasize policies that prioritize saving the lives of drug users — like so-called safe injection sites — but the worsening fentanyl problem is testing the patience of even the seemingly most tolerant cities. 

Driving the news: The Philadelphia City Council appears ready to override the mayor's veto of its ban on supervised consumption sites where people can take drugs under the watch of health workers. San Francisco Mayor London Breed proposed drug testing for welfare recipients this week, and New York City is reeling from the suspected fatal fentanyl poisoning of a 1-year-old in day care. 

These cities are among those that have most embraced "harm reduction" measures, which attempt to thwart the harms of drug use rather than punish it. 

New York has the nation's only supervised drug consumption sites, although Rhode Island is planning to open one next year and a nonprofit in Philadelphia has been trying to open one. The Justice Department has long opposed these sites, but the Biden administration signaled it may soften federal opposition to them, according to the AP.  

Other states, particularly those on the West Coast, have adopted measures that decriminalize drug possession and focus instead on treatment, but those efforts are also being second-guessed.

"I get a feeling that the fever has broken," said Keith Humphreys, a drug policy expert at Stanford University. "I think the pushback in New York is really just the tip of the iceberg. It's emblematic of what's going on all over the country."

The big picture: Those efforts in blue cities stand in contrast to the dozens of states that have enacted tougher fentanyl crime laws and laws that allow people who supply drugs that lead to fatal overdoses to be charged with homicide.

Fentanyl has rocketed to political prominence as it and other powerful synthetic opioids now account for more than two-thirds of fatal drug overdoses, which top 100,000 per year.  

Republicans frequently — and sometimes inaccurately — tie fentanyl's proliferation to the country's migration crisis.

Many of the local policy changes are being driven by Democrats who are under pressure from constituents concerned about a drug crisis that's increasingly visible on their streets.

Both parties are "starting to really come around to, in some ways, [positions] similar to the '90s, where they were kind of trying to out-punish and [compete for] who's the more punitive party. And that's definitely visible," said Leo Beletsky, a professor at Northeastern University who studies the public health impact of laws.

"The sort of mainstream voters see this problem and they just don't want to see it," he added. "Maybe they've given up on it being solved, but they definitely don't want to see." 

What they're saying: Measures now facing scrutiny are being unfairly blamed for the worsening drug problem, some experts say.

"Overdoses are up everywhere. Homelessness is up everywhere. Yes, it seems like those things seem to be getting worse in states like Oregon that have these drug reforms. They're also getting worse in states that didn't do anything at all or passed tougher drug laws," said Corey Davis, a professor at the NYU Grossman School of Medicine.

"We're seeing that our society has a lot of challenges, but it becomes much easier to blame specific drugs or efforts to address or help people for the problems rather than thinking about those structural drivers, the root causes of what's behind homelessness and overdose," Beletsky said. 

Others also expressed sympathy for people concerned about drug use in their neighborhoods. 

"It's not that people hate people who use drugs, but they want to be able to just walk their kids to school and to park their cars and not be robbed," said Humphreys, the Stanford expert. "When they can't, they get upset, and it's right to get upset."

Between the lines: Some experts say that the way drug use and addiction is talked about has changed, but the country's approach hasn't fundamentally shifted much.

"Ten years ago, you didn't hear police chiefs and sheriffs saying things like, 'We can't arrest our way out of the problem.' And they do say those things these days. And there were some relatively modest changes," Davis said. "But from my vantage point, there never was a real sea change."

Davis was the senior author on a study published this week that found when Oregon and Washington lowered criminal charges for drug crimes, there was no effect on overdose deaths.

Yes, but: Some harm reduction measures — particularly the use of medication-assisted treatment — are much less controversial and have garnered widespread bipartisan support over the last several years.

"I think the things that are generating a lot of pushback are accepting open-air drug scenes, so accepting public drug use, accepting public drug dealing," Humphreys said. 

"And there's some pushback to decriminalization. Particularly families don't buy the idea that you have to wait for someone to realize they're not self-actualizing and to walk into treatment."

Blue cities rethink their embrace of progressive drug policies

Political backlash has leaders rethinking drug policy as the overdose crisis worsens.

A small memorial outside a Bronx day care center where a 1-year-old child died and three other children were injured after alleged exposure to fentanyl. Photo: Spencer Platt/Getty Images

Drug overdoses

San Francisco

Starting in October, San Francisco will implement a new civil court process aimed at helping people with untreated schizophrenia or other psychotic disorders get off of the streets.

Driving the news: CARE court — the result of legislation championed by California Gov. Gavin Newsom — will allow first responders, family members, behavioral health providers and others to directly petition the court for behavioral health services.

How it works: If the court determines that the subject of the petition meets the threshold to qualify for the program, it will order an individualized treatment plan that includes medication, housing placements and wraparound services.

Participants who accept the supervised plan would remain under the purview of CARE court until the case can be dismissed.

If they refuse, they'll have access to a public defender and can opt out, though a CARE court judge could still refer them for a conservatorship — in which another person is appointed to make decisions for them — to force compliance.

What they're saying: Right now, "it's a fail-first system, not a care-first system, which means you have to end up in the criminal justice system before finally someone provides support and a bed and a solution," Newsom said in a Sunday appearance on CBS News' "60 Minutes."

This program will "direct access for people to get connected to services and for them to be referred to that care by those who know them best," Mayor London Breed said in a press release Wednesday.

Yes, but: Concerns remain about the level of resources needed to adequately run the program — and the possibility of civil liberties violations, which rights groups like the ACLU and Disability Rights California have raised.

San Francisco social worker Charlie Berman also told KQED in June that the city could barely manage its current caseload for people with severe mental illness.

What to watch: San Francisco is one of seven counties launching CARE court in October. Its rollout and results will inform the way remaining counties establish their own court before the state's deadline of December 2024.

San Francisco to roll out mental illness court next week

First responders, family members and more will be able to petition the court for treatment for someone with severe mental illness.

Photo of a person sitting on a sidewalk outside a tent in a homeless encampment

A homeless encampment in San Francisco on Aug. 28. Photo: Tayfun Coskun/Anadolu Agency via Getty Images

Mental health

Des Moines

Axios Des Moines

Around 37.4% of Iowa adults were considered obese in 2022 — up from 36.4% the previous year, according to a report by non-partisan health advocacy group Trust for America's Health.

Why it matters: Iowa's obesity rates have trended upward for the last decade and underscore a host of complicated issues, such as eating and sleep patterns, lack of activity, genetics and environmental factors.

Rural Iowans, as well as Black and Latino Iowans, experience higher rates of obesity, according to the report.

These populations are also more likely to endure food insecurity, transportation barriers and lower access to medical and nutritional care.

State of play: Iowa is tied with Arkansas as the 12th most obese state in the country.

All of Iowa's neighbors are ranked lower.

The intrigue: SNAP, the federal program that can help lower-income families afford more nutritional food, is one way that helps populations more prone to obesity.

Yes, but: The study points out that Iowa passed legislation this year tightening its rules on SNAP and requiring asset tests, potentially kicking off thousands of recipients.

Iowa ranked 12th most obese state in 2022

The state's obesity rate continues to tick up.

Illustration of measuring tape draped around a caution street sign.

Axios Des Moines, anchored by Jason Clayworth and Linh Ta, is here to help readers get smarter, faster on the most consequential news and developments unfolding in their own backyard.

Dallas

Axios Dallas

Dallas will be one of the three main sites of the newest federal agency, the Advanced Research Projects Agency for Health (ARPA-H).

Why it matters: President Biden created the $2.5 billion agency with the aim of making breakthroughs in cancer, Alzheimer's and other diseases.

Several regions across the country were lobbying to get an ARPA-H hub.

Dallas' recent selection as a customer experience hub will create new jobs and allow Fort Worth and other Texas cities to be part of ARPA-H's research.

The big picture: "For years, when you mentioned bio life sciences and health research, people mentioned Boston and Silicon Valley. Now they'll mention Dallas in the same breath. All of a sudden we're in a different category, in a different league," says Tom Luce, who was part of the Texas team lobbying for ARPA-H.

Between the lines: Texas leaders across party lines lobbied for almost two years to get an ARPA-H site. Some were skeptical that the Biden administration would choose a Republican state in an election year, Luce tells Axios.

But Texas' diversity is hard to ignore because the U.S. is becoming more like the state.

"They needed to succeed in Texas if ARPA-H was going to succeed because the population reflects the country in terms of our diversity. We're young, we're old, we're a diverse population," Luce says.

What's happening: Dallas' Pegasus Park will house the ARPA-H hub, managed by South Carolina-based Advanced Technology International.

The agency's administrative operations will be based in the Washington, D.C., region to be near its parent agency, the U.S. Department of Health and Human Services.

Another site in Cambridge, Massachusetts, will house the investor catalyst hub, helping ARPA-H programs deal with red tape and bring innovative ideas to market.

Private, public, and nonprofit organizations can apply to be the hub's "spokes."

Zoom in: Dallas' two major airports, its central location in the country and its respectable hospital and research institutions add to its desirability for ARPA-H.

The city's customer experience hub will help ARPA-H develop "accessible, needed and readily adopted" health solutions, with a focus on "equitable health outcomes for all," the agency says.

What they're saying: "Americans can be assured that Texas will continue to pave the way for critical healthcare research and comprehensive support for years to come," Gov. Greg Abbott said in a news release, calling Dallas-Fort Worth the "ideal location" for ARPA-H.

What's next: Pegasus Park, a 26-acre life science campus, is ready for ARPA-H's launch, and the agency is in the process of identifying its spokes and hub workers, Luce says.

Dallas will be a federal health innovation hub

Illustration of the Reunion Tower as a caduceus.

Dallas + science = big things happening. Illustration: Allie Carl/Axios

Boston

Axios Boston

While hospitals struggle with nursing shortages, a Massachusetts startup is preparing to train hundreds of foreign-born students to fill those roles.

Driving the news: Boston-based InSpring plans to admit its first cohort of 20-30 international students with bachelor's degrees in the U.S. and other countries this winter, co-founder and CEO Chris Hoehn-Saric tells Axios.

The group will enter an accelerated bachelor of nursing program at the MGH Institute of Health Professions, Mass General Brigham's graduate school.

Why it matters: The nationwide nursing shortage has hit Massachusetts hard. Nurse vacancy rates in the state's hospitals doubled from 6.4% in 2019 to 13.5% in 2022, according to the Health Policy Commission report published in March.

Industry leaders believe a national shortage will persist for years.

Threat level: Without enough staff, patients are receiving delayed care. Mental health patients, for example, have been waiting longer for hospital beds.

Others have had to wait more than a month to be transferred to skilled nursing facilities, per the report.

What they're saying: "We simply don't have the volume or diversity of a domestic labor force to solve for the demands that are happening over the next generation," Hoehn-Saric tells Axios.

"What we know now is that international students not only can do the work and want to do the work, they're historically underutilized."

Zoom in: Employers tend to overlook international job seekers because they're unfamiliar with the immigration process, says Hoehn-Saric, who previously worked for the international student recruiter Shorelight.

International student visas allow them to legally work for one to three years after graduation, depending on their specialty, but they typically need to be sponsored by an employer afterward.

If they don't find work and don't get sponsored in time, they have to return to their home country, making it harder to return for a job in the U.S.

The big picture: Massachusetts is one of several states where business leaders and advocates have urged the state to harness international talent to solve worker shortages.

Boston startup hopes to remedy the nursing shortage with international students

InSpring plans to admit 20-30 international students into its first cohort this winter.