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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.

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National

A U.S. District Court judge in Wyoming on Wednesday temporarily blocked a statewide abortion ban that came into effect over the weekend, according to multiple reports.

Driving the news: Judge Melissa Owens granted a restraining order due to a wider lawsuit challenging the state's new law that prohibits abortion at all stages of pregnancy except in cases of rape or incest, or to save a pregnant person's life, and another banning abortion pills that's due to take effect in July, per the New York Times.

The new law that took effect Sunday makes abortions a felony punishable by up to five years in prison and states that "abortion defined in this act is not health care."

Abortion rights groups argue that this violates Wyoming's constitution, which says adults have the right to make their own health care decisions.

What they're saying: "The state cannot legislate away a constitutional right," Owens said, per AP. 

"It’s not clear whether abortion is health care. The court has to then decide that," she added.

What's next: "Now, the medication abortion ban and the overall ban will be considered at a hearing where the plaintiffs will seek an injunction to suspend both laws until the full lawsuit can be heard," the New York Times reports.

Wyoming would be the first U.S. state to ban abortion pills if the law were to go into effect on July 1.

Judge temporarily blocks Wyoming abortion ban

Lawsuit challenging law declaring abortion "not health care" says it violates state constitution.

 Abortion rights protesters during a proteston June 24, 2022 in Jackson Hole, Wyoming. 

Abortion rights protesters during a demonstration in Jackson Hole, Wyoming, last June. Photo: Natalie Behring/Getty Images

Abortion

Politics & Policy

Finish Line

Axios Finish Line

How we carry ourselves doesn't just affect our bodies — it also touches our brains.

Why it matters: Slumped posture isn't just an aesthetic concern. It has wide-ranging effects on our well-being — both physical and mental.

"Bad" posture can look different for different people. Broadly, it refers to when your ears are out of alignment with the center of your body, Healthline notes.

Consider "tech neck" — the new name for when our heads are leaning forward, our necks are bent and our shoulders are slumped, often as a result of hunching over a phone or computer.

The physical effects of poor posture go beyond pain in your neck, back and shoulders. It can even lead to heartburn and slowed digestion, per Harvard Medical School.

The mental effects include a knock to your self-confidence.

Case in point: Ohio State researchers compared subjects who sat up straight to subjects who slumped and found that good posture was linked to higher confidence.

"What you're doing with your body affects how you react to your own thoughts," says Richard Petty, an Ohio State professor and one of the study's co-authors.

Sitting up straight boosted study participants' assuredness in their ideas.

In another study, San Francisco State University researchers tested how posture affected students' feelings about math tests.

The students who were good at math experienced no difference taking the test slouching or sitting up straight.

Students who were anxious about math found the test more manageable when practicing good posture.

The bottom line: Just taking a second to breathe and adjust your posture before a tough conversation with a friend or a big presentation at work could help you navigate important moments with more confidence.

This article originally appeared in Axios Finish Line, our nightly newsletter on life, leadership and wellness. Sign up here.

Finish Line: The link between posture and confidence

How we carry ourselves doesn’t just affect our bodies — it also touches our brains.

Illustration of the "Thinker" statue with an angry spiral over his head.

Illustration: Lindsey Bailey/Axios. Photo: Bettmann/Getty Images

Psychology

Vitals

Axios Vitals

The Biden administration is planning a major revamp of the nation's organ transplant system — including looking to break up the system that historically allocated kidneys, livers and other organs to patients.

Why it matters: Audits and a congressional probe have chronicled problems including long wait times, inequities in allocations, failing IT infrastructure, and even organs lost in transit.

Until now, the non-profit United Network for Organ Sharing (UNOS) had the only contract for managing the system.

The details: The Health Resources and Services Administration (HRSA) announced Wednesday it plans to solicit multiple bids to "foster competition" in managing the Organ Procurement and Transplantation Network.

The agency also plans to build data dashboards detailing individual transplant center data on organ retrieval, waitlist outcomes and transplants and modernize the network's IT system. 

“Every day, patients and families across the United States rely on the Organ Procurement and Transplantation Network to save the lives of their loved ones who experience organ failure,” said Carole Johnson, HRSA administrator in a statement. 

“That is why we are taking action to both bring greater transparency to the system and to reform and modernize the OPTN. The individuals and families that depend on this life-saving work deserve no less.”

The Biden administration is requesting $67 million in the fiscal 2024 budget — which will include organ procurement transplant network contracting and modernization effort — more than double the fiscal 2023 allocation of $36 million. They are also requesting congressional approval for the removal of an appropriations cap on the OPTN contracts.

What they're saying: “For too long it’s been clear that UNOS has fallen short of the requirements for this contract and the expectations of Americans waiting for a transplant," Senate Finance chair Ron Wyden (D-Ore.), said in a statement.

"We welcome a competitive and open bidding process," UNOS said in an emailed statement. "We believe we have the experience and expertise required to best serve the nation’s patients and to help implement HRSA’s proposed initiatives."

Editor's note: This story has been updated with a comment from UNOS.

Biden administration to revamp organ transplant program

The Biden Administration is planning a major revamp of the nation's organ transplant system — including looking to break up the system that historically managed transplant allocation.

Photo: Brendan Smialowski/AFP/GettyImages)

Congress

Health Care Policy

Health Care Policy Thought Bubble

The Biden administration on Tuesday rejected a request to use march-in rights to break the patent of the prostate cancer drug Xtandi as a way to lower the price.

Why it matters: The move is sure to lead to progressive pushback on the Hill. 

"The Biden Administration has missed yet another opportunity to do something meaningful to lower prescription drug costs and protect taxpayer investments," Rep. Lloyd Doggett (D-Texas) said in a statement.

Senate HELP Chair Bernie Sanders (I-Vt.) said he was "extremely disappointed" in the decision, adding the drug was developed with U.S. taxpayer support and can be purchased in Canada for one-fifth the U.S. price.

Yes, but: The administration also announced a new "review" of march-in authority, with an interagency working group to develop criteria, "including price," for using march-in rights.

James Love, a leading advocate for using march-in rights and director of the group Knowledge Ecology International, in an email to Axios dismissed the review as "a way to deflect criticism" of the decision on Xtandi.

What they're saying: The letter from the National Institutes of Health rejecting the request states that Xtandi is "widely available as a prescription drug."

The big picture: While President Biden touts allowing Medicare to negotiate drug prices in the IRA, some progressives want him to go further and act on his own to break patents.

A version of this story was published first on Axios Pro. Get news like this by subscribing. Use code POLICY100 which gives you $100 off.

Biden administration rejects "march-in" request to lower drug price

The Biden administration rejected a request to use march-in rights to break the patent of a prostate cancer drug as a way to lower the price.

Rep. Lloyd Doggett. Photo: Oliver Contreras/Bloomberg via Getty Images

Drug price increases

Republicans itching to probe the pandemic response are already struggling to separate vaccine-related questions that could yield lessons learned from ones that echo theories experts say are debunked by reams of data.

Why it matters: Americans' trust in public health institutions has been shattered over the last few years. Scientists warn that although there's a lot that can be learned from good-faith inquiries, there's nothing positive that can come from using public health to score political points. 

Driving the news: House Republicans have launched several lines of inquiry as part of their pandemic oversight, including into the vaccine approval process.

Experts say elected officials may not be the best equipped people to look back on vaccine policy decisions — particularly if they cross the line into misinformation or conspiracies.

"No major government initiative should ever be out of reach of oversight," said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health. "However, there's ways to do it that are productive and result in positive change ... and then there are ways to do it that undermine not only health and safety in respect to COVID, but sow doubt in respect to all vaccines."

Lockdown policies, vaccine mandates and the role of infection-acquired immunity may be fair game, yet "without facts to stand on, to make groundless insinuations about the safety and efficacy of these vaccines is just irresponsible," she said.

Details: A recent letter to the FDA by Republicans on the House's Select Committee on the Coronavirus Pandemic questioned the Biden administration's approval process for COVID vaccines, alleging that "this effort may not have been to save lives but concernedly to provide cover for implementing and enforcing vaccine mandates around the country."

The letter also raised concerns with the administration's booster shot approval process and references the departure of two top FDA vaccine officials who, according to Endpoints, said they were leaving their positions at least in part because they felt like the FDA was being sidelined.

Scientists have raised wonky questions about booster policies and what the data best supports and say there's room for debate on the subject.

Yes, but: Some Republicans are veering well beyond questions of whether vaccine decisions were driven by politics or adequately backed by data. They're instead raising concerns about vaccine safety and whether the entire process was tainted by cover-ups. 

Possibly the highest profile among this group is Florida Gov. Ron DeSantis, whose administration has issued a health alert on mRNA vaccine safety that was strongly rebuked by FDA commissioner Robert Califf and CDC cirector Rochelle Walensky.

But DeSantis has gone even further. In a successful petition for a statewide grand jury, DeSantis questioned whether the vaccine makers — perhaps criminally — misrepresented information about the shots' safety and efficacy.

"An investigation is warranted to determine whether the pharmaceutical industry has engaged in fraudulent practices. The people of Florida deserve to know the truth," DeSantis wrote in the petition. 

Pfizer in response reiterated the scientific rigor of its process.

The big picture: Republicans have been emboldened by recent studies and reports that they say prove they were right all along about matters like the value of infection-derived immunity and the legitimacy of the theory that COVID originated with a lab leak. Scientists say the reality is more complicated, in large part because knowledge changed as more data became available.

Some Republicans say they're angry with what they view as public health officials' reluctance to update policy as new information came in, including vaccine policy. 

One commonly-cited sore spot is early-on messaging that the vaccines prevented transmission, which was used as a justification for mandates. At the time, clinical trial data suggested that Pfizer and Moderna's vaccines were extremely effective at preventing people from becoming sick with the virus, let alone being hospitalized and dying.

But several months after the vaccines became available, it became clear that breakthrough infections were more common than previously expected and that the vaccines' effectiveness faded over time. Paired with the rise of the omicron variant, it meant the vaccines have had a much lower real-world effectiveness than they did in the original clinical trials. 

This was a pivotal change that led to growing vaccine skepticism on the right. A recent survey by Surgo Health obtained by Vanity Fair found that Republicans are now 2.4 times more likely than Democrats or independents to believe that COVID-19 vaccines are unsafe.

The intrigue: Even supporters of vaccine oversight are wary of members who they think will take it too far. 

"There's a lot to dig in to that is worthy of investigation: Did FDA listen to its outside experts after the original vaccines or rush the updates through because of Biden political demands? But you can also go too far and question the underlying value of vaccines, which is leading to record lows in routine vaccinations for curable diseases like polio, MMR, and more," said a former GOP staff director who worked on COVID-related issues and recently left the Hill. 

The person added that he thinks Republicans are running the risk of having legitimate oversight get subsumed by misinformation and conspiracies. 

What they're saying: "Differences of opinion about who needs a booster when — that’s a straw man," said Cornell virologist John Moore. "That is not pandering to the anti-vaxxers. That is a legitimate discussion among public health officials."

"There's no decisions taken by humans that couldn't be revisited if your agenda is genuinely to find improvements for the future and if you have the appropriately qualified people doing it," he added. "But that's not what we're seeing here. We're seeing exercises in political point-scoring."

If the conversations lead to further mistrust of the COVID vaccines, "there is a risk that it has spillover effects to other vaccines that were not previously in question," Brown's Nuzzo said. 

The other side: Some Republicans argued that it's the Biden administration and public health officials who brought problems on themselves, including through bad policy.

"The way the CDC, the way Dr. Fauci handled this, it just exacerbated the anti-vaxxers. The last thing the anti-vaxxers want to be told is to shut up and take this shot, when all along this had not been studied long-term, we didn't know the long-term complications," said Kansas Sen. Roger Marshall said in an interview.

"If there's people who are skeptics that have a thorough hearing out, maybe that'll do something about the anti-vaccine sentiment," said Sen. Bill Cassidy of Louisiana. "But anti-vaccine sentiment is thoroughly embedded in our society.”

The bottom line: Many experts feel that the conversations emerging are not the helpful kind.

"It just feels like the intention of these hearings is just to set fire to things as opposed to trying to improve the functioning of government for future crises," Nuzzo said.

Republicans' COVID vaccine tightrope

Experts say there's a fine line between responsibly scrutinizing policy and fueling misinformation.

Coronavirus vaccines

Nonprofit and public hospitals charged commercially insured patients up to 25% more for brain scans with an MRI than for-profit facilities, a new JAMA analysis found.

Why it matters: It's one of the first comparisons using data from a Trump-era hospital price transparency law to show variations in what facilities negotiate with insurers for common services. 

"This one service gives us a lens to observe hospital's strategic pricing behavior because this is a lever they can pull to make money," Ge Bai, a Johns Hopkins professor and study co-author, told Axios.

What they found: Non-profits, teaching hospitals and hospitals in more affluent areas tended to have higher markups, a lower proportion of Medicare patients and a higher likelihood of employing clinicians in MRI departments.

The median commercial price of an MRI brain scan for all hospitals is $1,900, the study found. 

For-profit hospitals in the study charged a median price of $1,509, while nonprofit and government hospitals charged a median $1,938 and $2,149, respectively. Medicare pays $400 or less for the procedure, depending on the facility type.

Rural hospitals charged more for brain MRIs than urban hospitals in the same health system by $363.

The findings suggest that hospitals negotiate higher prices with commercial payers when they have market power in a region or area.

Nonprofit, government hospitals charge more than for-profit facilities for brain imaging: study

A new JAMA analysis found that nonprofit and government hospitals charge more for brain MRI scans than for-profit hospitals in the same state or region.

Illustration of a hundred dollar bill with a brain in place of Benjamin Franklin

Health insurance

The Department of Homeland Security announced Tuesday night it's stepping up efforts to combat fentanyl trafficking across the Southern border with the launch of a major new, multi-agency operation.

Driving the news: "Operation Blue Lotus" has already "stopped more than 900 pounds of fentanyl from coming into the United States in its first week," per a DHS statement.

A screenshot of a DHS tweet announcing a new fentanyl  trafficking crackdown, Operation Blue Lotus, "has led to:    ✔️ 18 seizures  ✔️ 16 federal arrests  ✔️ 2 state arrests."

The "coordinated surge operation" that launched on March 13 includes "an increase in targeted inspections" by Customs and Border Patrol officers and Homeland Security Investigations agents, canine units and advanced technology at locations along the border, per the DHS.

Why it matters: Fentanyl is much more potent than prescription opioids and it's been linked to an increase in drug overdose deaths in the U.S. in recent years, per the National Institutes of Health.

A record 107,622 people died from overdosing in the U.S. in 2021 and the vast majority was caused by fentanyl, according to the latest available data from the Centers for Disease Control and Prevention. 

"President Biden's Republican critics blame his border policies for the crisis, saying U.S. authorities are too busy to stop illegal drugs from entering the United States because they're contending with record numbers of migrants," the Washington Post notes.

Details: Homeland Security Secretary Alejandro Mayorkas announced the new operation following a meeting with CBP officials at the Mariposa Port of Entry in Nogales, Arizona, after touring the border with state Gov. Katie Hobbs (D) on Tuesday.

Mayorkas said in a statement it's part of the Biden administration's "multi-pronged strategy to combat the scourge of fentanyl that is devastating communities across the United States" and noted that the DHS has in the past two years "seized more fentanyl than the previous five years combined."

He said during a news conference that "Operation Blue Lotus" marked a "monumental shift" and an example of how the Biden administration is "taking it to the cartels, to the traffickers and we will not stop."

Of note: "Operation Blue Lotus" has also prevented more than 700 pounds of methamphetamines and over 100 pounds of cocaine from entering the U.S., according to the DHS.

DHS launches major border operation targeting fentanyl trafficking

Homeland Security Secretary Alejandro Mayorkas hailed "Operation Blue Lotus" as a "monumental shift" during a visit to the border.

A US Customs and Border Protection agent weighs a package of Fentanyl at the San Ysidro Port of Entry on October 2, 2019 in San Ysidro, California. 

A U.S. Customs and Border Protection agent weighs a package of fentanyl at the San Ysidro Port of Entry in San Ysidro, California, in 2019. Photo: Sandy Huffaker/AFP via Getty Images

Fentanyl

China is becoming the most formidable rival America has faced, and the risk of confrontation with Russia, North Korea or Iran still looms. Authoritarians are rising, the chaotic Afghanistan exit revealed the limits of U.S. power, and the pandemic, climate change and other critical challenges continue to pose grave threats.

World

The Oklahoma Supreme Court ruled 5-4 on Tuesday that the state constitution guarantees a "limited right" to abortion, including in cases where there is a "reasonable" certainty pregnancy threatens a person's life.

Why it matters: Abortion providers filed a lawsuit last year challenging two laws in the state, a pre-Roe ban and another one that the governor signed into law in 2022. The court ultimately ruled that the 2022 ban interfered with the "inherent right to terminate a pregnancy to preserve the woman's life."

Context: Abortion providers had argued that abortion rights are protected by the state constitution, which says: "No person shall be deprived of life, liberty, or property, without due process of law."

The 2022 ban specifically states that a health provider cannot provide an abortion unless a person's life is "endangered by a physical disorder, physical illness or physical injury."

The pre-Roe ban is less strict, allowing abortions when the procedure is "necessary to preserve her life."

Driving the news: In its opinion, the court concluded that the provisions of the 2022 law are "much more invasive to a woman's right to terminate a pregnancy in order to preserve her life." 

The opinion highlights a language discrepancy between "save the life of a pregnant woman" and "preserve her life," both of which are used in different state laws addressing abortion.  

The judges say that the first phrase, "save the life of a pregnant woman,"  limits abortions to a pregnant woman "in a medical emergency" if her life "is endangered."

Details: That portion of the law, the opinion said, requires a woman to be in "actual and present danger" to obtain a "medically necessary abortion." 

"We know of no other law that requires one to wait until there is an actual medical emergency in order to receive treatment when the harmful condition is known or probable to occur in the future," the opinion reads. 

"Requiring one to wait until there is a medical emergency would further endanger the life of the pregnant woman and does not serve a compelling state interest."

What they're saying: "We are disappointed that the Court declined to rule whether the state Constitution also protects the right to abortion outside of these circumstances," said Nancy Northup, president and CEO of the Center for Reproductive Rights, in a statement. 

"The Oklahoma Supreme Court’s own precedent and the plain language of the Oklahoma Constitution guarantee the right to liberty and assure that a broad right to reproductive autonomy exists."

Editor's note: This article has been updated with comment from Nancy Northup, president and CEO of the Center for Reproductive Rights.

Oklahoma Supreme Court: State constitution grants "limited right" to abortion

In its opinion, the court concluded that the provisions of the 2022 law are "much more invasive to a woman's right to terminate a pregnancy in order to preserve her life."

A woman takes part in a nationwide abortion rights protest in New York on March 12, 2023. Photo: Kena Betancur/AFP via Getty Images

Oklahoma

Supplies of some essential drugs used in hospitals are hitting 10-year lows, forcing rationing and pharmacy workarounds.

Driving the news: Drug shortages are the worst they've been in a decade, according to the American Society of Health-System Pharmacists — a sign of how much we rely on low-margin manufacturers with limited capacity for basics like the inhalation drug albuterol and some common cancer treatments.

What they're saying: Quality control issues, selected plant closures and other manufacturing woes have added up, Michael Ganio, senior director of pharmacy, practice and quality at ASHP told Axios.

Between the lines: Oncology drugs have been hit particularly hard in recent months, putting experts on high alert. 

Those in short supply include methotrexate, an injectable chemotherapy drug, and one of several generics produced by Illinois-based Akorn Pharmaceuticals, which shuttered operations last month due to bankruptcy.

Manufacturing delays and increased demand have also led to shortages of the cancer treatments cisplatin, and fluorouracil, per ASHP.

Pluvicto — used to extend survival among patients with metastatic prostate cancer — will take months to be made available to patients again, the Wall Street Journal reports.

"People will die from this shortage, for sure," Jonathan McConathy, director of the division of molecular imaging and therapeutics at the University of Alabama, told WSJ.

A survey of health systems conducted by the group End Drug Shortages Alliance found the injectable  Bacillus Calmette-Guerin (BCG), used for treating bladder cancer, was being rationed or was not available for use at all. 

"This is a terrible crisis. We should be doing everything we can to give every single one of these patients the best chance of survival," Laura Bray, a board member of the alliance, told CNN.

Between the lines: Manufacturing delays and quality problems are blamed for the shortages. But that's often because there aren't many alternative sites to pick up the slack in the system due to the challenging economics of the market, experts say.

"These are really low-margin businesses. These companies, particularly the ones that are making some of these sterile products relied upon so heavily by hospitals, really have little play in the supply they are able to offer," Hilary Marston, the FDA's chief medical officer told Axios.

The agency works with manufacturers as much as it can, such as quickly approving acceptable workarounds, she said. "But the underlying reality of this market remains what it is," Marston said.

When it comes to oncology drugs, the FDA said it is doing what it can to help companies meet the demand, but it has special challenges.

"Those are absolutely critical. They need to be made on very specialized manufacturing lines due to the nature of the manufacturing," Valerie Jensen, associate director of the FDA's Drug Shortage Staff, told Axios.

"We're working with those companies to not only increase production but also working with them qualify additional suppliers and sites and anything else they can do to increase supply."

Be smart: In most cases, health system pharmacists can find a workaround by either compounding or repacking medications into different doses.

"We'll MacGyver a way to get the right dose to the right patient," Ganio said.

However, as he points out, that's far from ideal, particularly as it adds to the workload in a workforce environment where burnout is already high. It can also increase the risk of a medication error, he said.

A 2019 study by group purchaser Vizient found managing drug shortages cost U.S. hospitals about $360 million a year.

The big picture: These problems within America's drug supply chain are also impacting consumer access at the pharmacy counter — most notably with the ADHD medication Adderall, as well as its generic alternatives.

The FDA told the Washington Post the problem started with manufacturing delays but is now being driven by consumer demand.

The bottom line: For Ganio, the overall lackluster response to Akorn's closure should be more on par with the collective national worry over Silicon Valley Bank's failure.

"We have life-saving drugs being produced by this manufacturer," Ganio said. "We certainly need to take that kind of look at our health care infrastructure and treat the drug supply chain as critical infrastructure."

Drug shortages upend hospitals care, cancer treatments

Many of the drugs American hospitals rely on are in short supply — and the problem is only expected to get worse.

Illustration of 5 vaccine bottles, 4 are empty. 

Drugs

An emerging fungal infection that can prove fatal in communal health settings spread further and became more drug-resistant during the pandemic, a Centers for Disease Control review of surveillance data found.

Why it matters: The timing suggests the spread of Candida auris could have been exacerbated by COVID-related stresses like staff and equipment shortages, increased antimicrobial use and changes in patient movement.

The increase in cases underscores the importance of infection control in hospitals and long-term care facilities, researchers said.

What they found: The number of C. auris clinical cases tripled from 2019 to 2021, to 1,471 in 2021.

Most U.S. cases are found in post–acute settings, especially long-term acute care hospitals.

Drug-resistant fungus gained strength during pandemic: CDC

An emerging fungal infection that can prove fatal in communal health settings spread further and became more drug-resistant during the pandemic.

Health

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