Five months into her tenure at the Centers for Disease Control and Prevention, Dr. Mandy K. Cohen is trying to put a human face on public health.Dr. Mandy K. Cohen dropped by the Fox affiliate in Dallas in November, just days after the governor of Texas signed a law barring private employers from requiring Covid-19 shots. If she thought promoting vaccination would be a tough sell in a ruby-red state, Dr. Cohen, the new director of the Centers for Disease Control and Prevention, did not give any indication.“I’m not just the C.D.C. director, I’m also a mom,” she said cheerily, noting on live television that her daughters, 9 and 11, had already received the latest Covid and flu shots. She added, “So I wouldn’t recommend something for the American people I wouldn’t recommend for my own family.”It was the kind of stock phrase that Dr. Cohen has repeatedly invoked as she pursues a task that some public health experts fear is impossible: restoring Americans’ faith in public health, and in her battered agency. Five months into her tenure, with the Covid public health emergency officially over, the C.D.C.’s new leader is relentlessly on message.Americans’ trust in the agency, and in science more broadly, was badly damaged by the coronavirus pandemic, and the loss of faith is particularly pronounced among Republicans. In a recent survey by the Pew Research Center, 38 percent of Republicans said they had little or no confidence in scientists to act in the public’s best interests, up from 14 percent in April 2020.At the same time, the C.D.C.’s winter vaccination campaign appears to be falling on deaf ears. On Thursday, the agency issued an alert warning that low vaccination rates for the flu, Covid and respiratory syncytial virus, known as R.S.V., could lead to “severe disease and increased health care capacity strain in the coming weeks.” And partisan divisions over vaccination persist: A KFF poll in September found that seven in 10 Democrats but just a quarter of Republicans planned to get the updated Covid shot.Dr. Cohen preparing for an interview at the Fox affiliate in Dallas. She faces the challenge of restoring Americans’ faith in public health.Desiree Rios for The New York TimesDr. Cohen, whom President Biden selected to succeed Dr. Rochelle P. Walensky, is responding with a nationwide media blitz. Since taking the helm of the C.D.C. in July, she has traveled the country, promoting vaccination in 19 cities in 13 states. She has visited 22 vaccination sites and has participated in dozens of interviews, including an appearance on NBC’s “Today” just before Thanksgiving.She has left a trail of social media posts in her wake, including a series of short videos, called “Check-In With Dr. Cohen,” that typically begin with some variation of the same greeting: “Hi everyone, it’s Mandy Cohen!”In one video recorded on Long Island, Dr. Cohen and a county health official, wearing hard hats and vests, reported on how wastewater can help scientists track viruses and disease. In Dallas, she appeared with another county health official to talk about the importance of data, and with a nurse at a church health fair. And in Chicago, she stood by the president of the American Medical Association as he promoted vaccination.When she speaks to reporters, she frequently brings up her children.“Science is important and yes, the data is important,” Dr. Cohen said in an interview with The New York Times. “But at the end of the day, we’re also all humans. And if we can have a human-to-human conversation about what I would do for my own kids, who I love and I want to be healthy, maybe that can connect us in a different way.”Dr. Cohen is taking over an agency that is in transition. Her predecessor, Dr. Walensky, who began serving at the start of the Biden administration and stepped down in June, commissioned a review of the C.D.C. that identified serious weaknesses in areas ranging from testing to data collection to communications. She then initiated an overhaul of the agency.Dr. Cohen has said she is committed to carrying out that plan, which included setting up a new forecasting and analytics center, as well as structural changes intended to enable the agency to quickly translate its science into coherent policy recommendations. But even her staunchest allies say her top priority must be to change the way the public views her agency.“Restoring trust probably is the No. 1 challenge right now,” said Dr. Judith Monroe, the president and chief executive of the C.D.C. Foundation, an independent nonprofit established by Congress to mobilize private-sector support for the agency’s work. “Because where’s your platform if folks don’t trust what you say?”Experts agree that C.D.C. officials and other public health leaders made serious messaging missteps during the pandemic. Officials bred mistrust by speaking “with certainty when there wasn’t any” and later changing their recommendations, said Brian C. Castrucci, the president and chief executive of the de Beaumont Foundation, a public health nonprofit that is partnering with Frank Luntz, a pollster and political strategist, to study attitudes toward public health.Mr. Luntz, who rose to prominence working for Republicans, said his research had found that a significant portion of the public — as much as 20 or 25 percent — was now unreachable, because public health officials used language that “sounded like it was lecturing, and almost abusive toward people who had legitimate doubts.”Based on Mr. Luntz’s surveys and focus groups, the foundation has developed messaging guidance, including a “communications cheat sheet,” to help public health officials reach Americans of all political stripes. Dr. Tom Frieden, who served as C.D.C. director under President Barack Obama and has participated in the project, said Dr. Cohen’s communications style was in keeping with its findings.“You’re there to empower people with information, not berate people to change their behavior,” he said. “I think Dr. Cohen gets that.”The morning before she was to leave for a two-day, three-city swing through Texas, Dr. Cohen huddled with her top aides and her infectious disease team at the C.D.C. headquarters in Atlanta for an update on the flu, Covid and R.S.V. — which circulate during what the agency now calls the “winter respiratory virus season.” One benefit of that moniker: Winter viruses are less politically toxic than Covid.Dr. Cohen handed out a challenge coin in Dallas, one stop during a two-day, three-city swing through Texas.Desiree Rios for The New York TimesThe news was mixed. Hospitalizations from the flu were up slightly from last year. The rate of Covid vaccination was much lower than that of flu vaccination among health care workers — not a good sign. A new monoclonal antibody shot to prevent R.S.V. in infants was in short supply, but 77,000 more doses had just been released. Texas was seeing an uptick in R.S.V.But there was something else on Dr. Cohen’s mind. During her travels, she had been hearing from people who worried about side effects from vaccination and wanted more information about what federal health officials were doing to monitor vaccine safety. The C.D.C., she told her colleagues, needed to be able to “tell a clear and concise story.”To that end, Dr. Cohen is changing the language that the C.D.C. uses to describe itself. Testifying last month before a House subcommittee in what was her first appearance before Congress in her new post, she described the agency as a “critical national security asset” — a phrase that might have particular appeal to House Republicans, who have proposed cutting the C.D.C.’s funding by $1.6 billion, or roughly one-sixth of its budget.But M. Anthony Mills, a senior fellow at the conservative American Enterprise Institute who studies public trust in science, said the national security frame might not appeal to ordinary Americans who distrust the C.D.C. and other agencies like the National Institutes of Health and the Food and Drug Administration.“For Americans who believe N.I.H. lied about funding research that caused the pandemic, suspect the pharmaceutical industry is in bed with the F.D.A. and see public health efforts as an infringement on their freedom, that constellation of concerns doesn’t have much to do with national security,” he said.Unlike Dr. Walensky, who had no prior government experience and made headlines for seeking out media training, Dr. Cohen is not a stranger to Washington or the spotlight.Dr. Cohen, the former secretary of health and human services in North Carolina, succeeded Dr. Rochelle P. Walensky as C.D.C. director.Desiree Rios for The New York TimesShe was a top official at the Centers for Medicare & Medicaid Services during the Obama administration. Later, as secretary of health and human services in North Carolina, she laid the groundwork for the Republican-controlled legislature to accept an expansion of Medicaid, and she helped steer the state through the pandemic.After news reports that Mr. Biden was planning to pick Dr. Cohen for the director’s post, more than two dozen congressional Republicans signed a letter accusing her of politicizing science. They cited her tenure in North Carolina, where she called for students and staff members in K-8 schools to wear masks and threatened legal action against a school district over its Covid policies.But while her relationships with Republicans in North Carolina may have been tense, they never veered into vitriol, said State Representative Donny Lambeth, a Republican and a chair of the Health Committee in the North Carolina House of Representatives.“She was cool, calm and collected almost every time we had her in front of us,” Mr. Lambeth said. “She did not get rattled.”There were few fireworks during her congressional testimony last month. When Representative Daniel Crenshaw, Republican of Texas, pushed her to admit that the C.D.C. had been wrong during the pandemic, she politely ignored the request.Representative Jeff Duncan, Republican of South Carolina, wanted to know if she had regrets about Covid restrictions from her time in North Carolina. Dr. Cohen did not admit to any. When he asked her pointedly if she would impose such restrictions today, she ducked the question, telling him instead that she was looking forward to a new chapter at the C.D.C.“The good news,” she said, “is we’re in a new place.”

Mississippi has long had high childhood immunization rates, but a federal judge has ordered the state to allow parents to opt out on religious grounds.For more than 40 years, Mississippi had one of the strictest school vaccination requirements in the nation, and its high childhood immunization rates have been a source of pride. But in July, the state began excusing children from vaccination if their parents cited religious objections, after a federal judge sided with a “medical freedom” group.Today, 2,100 Mississippi schoolchildren are officially exempt from vaccination on religious grounds. Five hundred more are exempt because their health precludes vaccination. Dr. Daniel P. Edney, the state health officer, warns that if the total number of exemptions climbs above 3,000, Mississippi will once again face the risk of deadly diseases that are now just a memory.“For the last 40 years, our main goal has been to protect those children at highest risk of measles, mumps, rubella, polio,” Dr. Edney said in an interview, “and that’s those children that have chronic illnesses that make them more vulnerable.” He called the ruling “a very bitter pill for me to swallow.”Mississippi is not an isolated case. Buoyed by their success at overturning coronavirus mandates, medical and religious freedom groups are taking aim at a new target: childhood school vaccine mandates, long considered the foundation of the nation’s defense against infectious disease.Until the Mississippi ruling, the state was one of only six that refused to excuse students from vaccination for religious or philosophical reasons. Similar legal challenges have been filed in the five remaining states: California, Connecticut, Maine, New York and West Virginia. The ultimate goal, according to advocates behind the lawsuits, is to undo vaccine mandates entirely, by getting the issue before a Supreme Court that is increasingly sympathetic to religious freedom arguments.No major religions, including Roman Catholicism, which strongly opposes abortion, have objected to vaccination. But the plaintiffs in these cases say their religious objections stem in part from the use of fetal tissue in vaccine development. A few childhood vaccines, including those that protect against chickenpox and rubella, were developed with cells obtained from aborted fetuses in the early 1960s. Those cells continue to grow in laboratories today.The legal push comes as childhood vaccine exemptions have reached a new high in the United States, according to a report released last month by the Centers for Disease Control and Prevention. Three percent of children who entered kindergarten last year received an exemption, the C.D.C. said, up from 1.6 percent in the 2011-12 school year.Idaho had the highest rate of exemptions, at 12.1 percent, while West Virginia had the lowest, at less than one-tenth of 1 percent. Mississippi’s rate was nearly as low, at two-tenths of 1 percent. At the time, Mississippi allowed exemptions for medical reasons, as all states do, but it did not yet allow parents to opt out on religious grounds.A broad majority of Americans continue to believe in the value of childhood vaccines. But in a Pew Research Center survey conducted in March, 28 percent of respondents said that parents should be able to choose not to vaccinate their children, up 12 percentage points from four years ago.In California, a group of parents backed by Advocates for Faith & Freedom, a nonprofit group devoted to religious liberty, filed suit in federal court in October seeking to restore the state’s “philosophical” exemption, which was eliminated after a measles outbreak in 2015. A federal judge recently allowed a similar case to go forward in Maine, which ended its religious exemption in 2021.Connecticut, which also did away with its religious exemption in 2021, has faced legal challenges backed by We the Patriots USA, a group based in Idaho. In August, a divided federal appeals court rejected a constitutional challenge to the state law, and on Friday, a federal judge dismissed a second lawsuit. Brian Festa, a founder of We the Patriots, said in an interview that his group would ask the Supreme Court to take up the question.“We’re looking for a broader ruling from the high court that says all children in the United States should be allowed exemptions to childhood vaccinations,” Mr. Festa said, adding that allowing exemptions for medical but not religious reasons was “a major constitutional problem.”MaryJo Perry said that her path into advocacy began after her youngest son, now 20, experienced seizures following routine vaccination.Imani Khayyam for The New York TimesPreventing DeathsPublic health experts regard vaccination as a singular triumph. The World Health Organization says up to five million deaths worldwide are prevented each year by vaccines for diseases like diphtheria, tetanus, pertussis, influenza and measles. In the United States, measles alone once killed 400 to 500 people each year and whooping cough deaths numbered in the thousands, while polio left more than 15,000 paralyzed, according to the C.D.C.If vaccination rates dip much below 95 percent, public health experts warn, those diseases will become more than just a memory.“It’s a dangerous game we’re playing,” said Dr. Paul A. Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “If we eliminate school vaccine mandates, measles will be the first vaccine-preventable disease to come back, and it will come roaring back. Why would we want to put children in harm’s way again?”The Mississippi case offers a window into the political forces shaping these trends. The plaintiffs in the case included members of Mississippi Parents for Vaccine Rights, a group founded in 2012 by MaryJo Perry, who said in an interview that her path into advocacy began after her youngest son, now 20, experienced seizures following routine vaccination.Seizures are a rare occurrence after vaccination. A large-scale study of more than 265,000 children identified 383 who had vaccine-related seizures, or less than two-tenths of 1 percent. Nearly all children who have post-vaccination seizures recover completely.Ms. Perry said that while her son had not had ongoing issues, the experience was terrifying. She said her son’s pediatrician repeatedly requested a medical exemption from the state health department but was refused. (Dr. Edney said that Mississippi’s current practice was to grant a medical exemption if a doctor requested one.)“I felt like it was a nightmare, like I was being terrorized by my own government,” Ms. Perry said.“About 99 percent of our kindergartners have been fully vaccinated, and Mississippi has not seen a case of measles in over 30 years,” said Dr. Anita S. Henderson, a pediatrician in Hattiesburg, Miss.Imani Khayyam for The New York TimesYears of ActivismMississippi had a religious exemption until the state’s Supreme Court struck it down in 1979, reasoning that protecting Mississippi schoolchildren “against the horrors of crippling and death” from polio and other infectious diseases superseded religious claims. The state has had high childhood vaccination rates as a result.“For many, many years, it was one of the few things that Mississippi has done well,” said Dr. Anita S. Henderson, a pediatrician in Hattiesburg and a past president of the state’s chapter of the American Academy of Pediatrics. “About 99 percent of our kindergartners have been fully vaccinated, and Mississippi has not seen a case of measles in over 30 years.”Ms. Perry and members of her group tried for years to change the law. They marched with signs and empty strollers around the State Capitol and held lobbying days to push Mississippi’s Republican-controlled Legislature to add a “personal belief” exemption to state law. But the legislation never passed.In 2016, Ms. Perry met Del Bigtree, a former television producer who had partnered on a documentary with Andrew Wakefield, the British doctor behind the discredited theory that vaccines are linked to autism. Their film, “Vaxxed,” took aim at the drug industry and was a hit with Ms. Perry’s group. Mr. Bigtree later traveled to Mississippi to testify on behalf of legislation that the organization was supporting to expand vaccine exemptions.In an interview, Mr. Bigtree said the success of the film prompted him to found the Informed Consent Action Network. The group, based in Texas and known by the acronym ICAN, says its mission is to give people “the authority over your health choices and those of your children” and to put an end to “medical coercion.” It funded the Mississippi lawsuit, and tax filings show it spends millions of dollars on legal work.Del Bigtree founded the Informed Consent Action Network, which says its mission is to give people “the authority over your health choices and those of your children.”Desiree Rios for The New York TimesMr. Bigtree says his work is nonpartisan. But on Jan. 6, 2021, he addressed a “medical freedom” rally not far from the pro-Trump crowd that stormed the U.S. Capitol.“I would stand on the stage at the Democratic National Convention if they would allow me,” he said in the interview, adding: “I don’t want mandates. It’s a free country. Everybody should be able to make whatever choice they want.”But public health experts say that the purpose of vaccination is to protect entire communities and that making immunization a personal choice puts vulnerable people, including those who cannot get vaccinated for medical reasons, at risk. Last year, a measles outbreak in Ohio infected 85 children, nearly all of them unvaccinated. No one died, but 36 children were hospitalized.States have long had the legal authority to require vaccination as a condition of school enrollment. As far back as 1905, the Supreme Court ruled in Jacobson v. Massachusetts that a state had the right to “protect itself against an epidemic” by requiring citizens to be vaccinated against smallpox or pay a fine.But the coronavirus pandemic, and in particular the arrival of Justice Amy Coney Barrett on the Supreme Court, brought a “dramatic shift” in public health jurisprudence — especially in cases involving religious liberty, said Wendy E. Parmet, an expert in public health law at Northeastern University.Ms. Perry believes vaccine mandates are a gift to drugmakers.Audra Melton for The New York TimesA Legal VictoryThe Mississippi case was filed last year, and Dr. Edney, the state health officer, was one of the defendants. Ms. Perry was not a plaintiff; her children are grown. But she connected some of her members with Aaron Siri, a New York lawyer who handles much of ICAN’s legal work.During a hearing in April in Federal District Court in Gulfport, Paul Perkins, a Baptist pastor, testified that the state’s vaccination requirement prevented him from enrolling his own daughter in the Christian academy that he runs. Jeana Stanley, a doctor of physical therapy, and Brandi Renfroe, a court reporter, testified that even though they and their husbands worked in Mississippi and considered that state home, they had moved just across the border to Alabama so their unvaccinated children could attend school.“I put my trust in God for healing,” Dr. Stanley wrote in an affidavit, adding that she and her children avoided “physicians, medications (both over the counter and prescription) and vaccines.”The case put Dr. Edney and the Mississippi State Board of Health at odds with the state attorney general, Lynn Fitch, a Republican who argued that an existing religious freedom law required the state to offer religious exemptions.At the hearing in April, the judge, Halil Suleyman Ozerden, an appointee of President George W. Bush, ordered the state to begin accepting requests for religious exemptions, setting a mid-July deadline for Dr. Edney to set up a process for offering them.“Freedom wins again,” Mr. Siri wrote on Twitter.The judge made his ruling final in August, finding that Mississippi’s vaccination requirement had violated the constitutional rights of the plaintiffs, who he said had “sincerely held religious beliefs about vaccination.” Dr. Edney said he decided not to appeal. He said he feared that the case would go to the Supreme Court and that the state’s vaccination requirement would be struck down entirely.Instead, he said, the state is working to ensure that parents seeking exemptions have “deeply held” beliefs, including by requiring them to watch an educational video about “the millions of lives that have been saved and continue to be saved” by vaccination.Mr. Bigtree hailed the suit as a “landmark, historic case.” In the wake of its victory, his group trumpeted its support for similar legal challenges in other states.Ms. Perry said Mississippi Parents for Vaccine Rights was working to elect candidates who are “pro-medical freedom.” She said she saw the court ruling as the culmination of a decade of her hard work, coupled with a new political climate.“We’ve had many parents for years wanting to sue, and it was just not the right time,” she said. “Covid kind of set the stage in the judiciary for it to happen.”

Households may now order another four at-home tests, or eight if they have not placed an order since the program was revived in September.Just in time for the holiday season, the Biden administration is offering Americans a fresh round of free at-home coronavirus tests through the Postal Service.The administration revived the dormant program in September, announcing then that American households could order four free tests through a federal website, covidtests.gov. Beginning Monday, households may order an additional four tests — or eight tests if they had not ordered any in the previous round.Hospitalizations and deaths from Covid-19 are far below what they were during the worst stretches of the pandemic, which has claimed the lives of about 1.1 million people in the United States.Hospital admissions of patients with Covid ticked up this summer, but they began declining slightly in September and have held fairly steady in recent weeks. About 16,000 people were admitted to hospitals with the virus in the week that ended Nov. 11, according to the Centers for Disease Control and Prevention.Private insurers had previously been required to cover up to eight at-home tests per month, but that requirement ended in May with the expiration of the public health emergency for the coronavirus, making it harder for many Americans to get tests without footing the bill.Separately from the Postal Service program, the federal Department of Health and Human Services says it is providing more than four million tests per week to nursing homes, schools, community health centers and food banks.

Dr. Monica M. Bertagnolli won bipartisan approval despite opposition from Senator Bernie Sanders, the chairman of the Senate health committee.The Senate on Tuesday confirmed Dr. Monica M. Bertagnolli, a cancer surgeon who currently leads the National Cancer Institute, as the next director of the National Institutes of Health, overriding the objections of Senator Bernie Sanders of Vermont, the chairman of the Senate health committee.The vote was 62 to 36. In a statement last month, Mr. Sanders said that while Dr. Bertagnolli was an “intelligent and caring person,” he would vote against her because she “has not convinced me that she is prepared to take on the greed and power of the drug companies and health care industry.”Dr. Bertagnolli will become only the second woman to lead the N.I.H. on a permanent basis, after Dr. Bernadine P. Healy, who served under President George H.W. Bush. She will take over an agency that has been the target of political attacks by Republicans, who have accused its scientists of intentionally downplaying the possibility that Covid-19 was the result of a laboratory leak.“I think no one wants to know what the true origin of the last Covid pandemic was more than the biomedical research community,” Dr. Bertagnolli told Senator Bill Cassidy of Louisiana, the top Republican on the health committee, during her confirmation hearing last month.“And how will you accomplish that?” asked Mr. Cassidy, who is a medical doctor. Dr. Bertagnolli promised she would make any data on the subject “available, public and accountable to the American people.”President Biden announced in May that he would nominate Dr. Bertagnolli to lead the N.I.H., the world’s premier medical research agency, which has an annual budget of more than $47 billion and occupies a sprawling campus in Bethesda, Md. It has been without a permanent director since Dr. Francis S. Collins stepped down nearly two years ago.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.We are confirming your access to this article, this will take just a moment. However, if you are using Reader mode please log in, subscribe, or exit Reader mode since we are unable to verify access in that state.Confirming article access.If you are a subscriber, please 

The institute founded by President George W. Bush issued an urgent call on Wednesday for Congress to renew the global AIDS program known as PEPFAR, a centerpiece of Mr. Bush’s foreign policy legacy that has become a victim of abortion politics on Capitol Hill.PEPFAR — the President’s Emergency Plan for AIDS Relief — has saved an estimated 25 million lives since Mr. Bush founded it 20 years ago. The $6.9 billion program, which must be reauthorized by Congress every five years, has long had bipartisan support and is often cited as a powerful example of America’s moral leadership in the world.But it faces an uncertain future. The legislation authorizing the program lapsed on Sept. 30 after some House Republicans claimed, without evidence, that the Biden administration was using it to promote abortion overseas. Those Republicans want to attach abortion-related restrictions to PEPFAR that would doom its reauthorization in the Democratic-controlled Senate.The Bush Institute, which is nonpartisan, has thus far been reluctant to step into the debate.But in a bipartisan letter signed by more than 30 retired ambassadors, foreign policy luminaries and organizations — including the Carter Center, founded by former President Jimmy Carter — the institute pleaded with Congress to reauthorize the program. It argued that in addition to saving lives, PEPFAR was countering the rising influence of Russia and China and burnishing America’s reputation as a global leader.“PEPFAR is a model of United States leadership and a source of great national pride,”the letter said. “It is one of the most successful international development programs since World War II. Abandoning it abruptly now would send a bleak message, suggesting we are no longer able to set aside our politics for the betterment of democracies and the world.”For now, at least, PEPFAR is continuing to operate. But advocates fear that, without the underlying authorization, the program will be subject to budget cuts or even elimination in the future. And they say the program is weaker without the bipartisan imprimatur of Congress.“The classic conservative talking point is that we don’t want to fund programs that aren’t authorized,” said Keifer Buckingham, the advocacy director at the Open Society Foundations and a longtime PEPFAR supporter. “It’s also fair to say that in global health and global health politics, optics matter,” she added.Mr. Bush himself did not sign the institute’s letter; people close to him have said he is trying to use his voice judiciously. The lead individual signer is Dr. Deborah L. Birx, a senior fellow at the Bush Institute who ran PEPFAR under Presidents Barack Obama and Donald J. Trump, and also served as Mr. Trump’s coronavirus response coordinator. But Mr. Bush has made no secret that he wants the program reauthorized. Over the summer, he discussed its future with Representative Michael McCaul, a Texas Republican and the chairman of the House Foreign Affairs Committee, over lunch at the Bush family compound in Maine. In mid-September, he published an opinion piece in The Washington Post urging Congress to save it.At that time, PEPFAR’s supporters on Capitol Hill thought they were making progress toward breaking the logjam. Representative Barbara Lee, a California Democrat who is a leading proponent of the program, said in an interview then that she was working with a freshman Republican, Representative John James of Michigan, on a bipartisan reauthorization bill.But the effort was put on hold last month in the face of a threatened government shutdown, and it remains stalled because the House is in a state of dysfunction with Republicans unable to choose a speaker.

The Biden administration is restarting a program to provide free rapid tests through the mail.The Biden administration, looking ahead to a possible winter surge of Covid-19, announced on Wednesday that it was reviving its program of offering Americans free coronavirus tests through the mail and would spend more than $600 million to buy tests from a dozen domestic manufacturers.The website for the program, covidtests.gov, will begin accepting orders on Monday, and households will be able to receive four tests. Dawn O’Connell, the assistant secretary for preparedness and response at the Health and Human Services Department, said the money would fund the purchase of 200 million tests to replenish the nation’s stockpile as tests are sent out.But a byproduct of the program, Ms. O’Connell said, is that it will shore up domestic manufacturing capacity in the event of another serious coronavirus surge. Coronavirus hospitalizations have been on the rise in the United States, though they remain low compared with earlier stretches of the pandemic, and free tests are now harder to come by for many Americans. While private insurers had previously been required to cover up to eight at-home tests per month, that requirement ended when the Biden administration allowed the public health emergency for the coronavirus to expire in May.

One by one, doctors who handle high-risk pregnancies are disappearing from Idaho — part of a wave of obstetricians fleeing restrictive abortion laws and a hostile state legislature. Dr. Caitlin Gustafson, a family doctor who also delivers babies in the tiny mountain town of McCall, is among those left behind, facing a lonely and uncertain future.When caring for patients with pregnancy complications, Dr. Gustafson seeks counsel from maternal-fetal medicine specialists in Boise, the state capital two hours away. But two of the experts she relied on as backup have packed up their young families and moved away, one to Minnesota and the other to Colorado.All told, more than a dozen labor and delivery doctors — including five of Idaho’s nine longtime maternal-fetal experts — will have either left or retired by the end of this year. Dr. Gustafson says the departures have made a bad situation worse, depriving both patients and doctors of moral support and medical advice.“I wanted to work in a small family town and deliver babies,” she said. “I was living my dream — until all of this.”Idaho’s obstetrics exodus is not happening in isolation. Across the country, in red states like Texas, Oklahoma and Tennessee, obstetricians — including highly skilled doctors who specialize in handling complex and risky pregnancies — are leaving their practices. Some newly minted doctors are avoiding states like Idaho.The departures may result in new maternity care deserts, or areas that lack any maternity care, and they are placing strains on physicians like Dr. Gustafson who are left behind. The effects are particularly pronounced in rural areas, where many hospitals are shuttering obstetrics units for economic reasons. Restrictive abortion laws, experts say, are making that problem much worse.“This isn’t an issue about abortion,” said Dr. Stella Dantas, the president-elect of the American College of Obstetricians and Gynecologists. “This is an issue about access to comprehensive obstetric and gynecologic care. When you restrict access to care that is based in science, that everybody should have access to — that has a ripple effect.”Idaho doctors operate under a web of abortion laws, including a 2020 “trigger law” that went into effect after the Supreme Court eliminated the constitutional right to abortion by overturning Roe v. Wade last year. Together, they create one of the strictest abortion bans in the nation. Doctors who primarily provide abortion care are not the only medical professionals affected; the laws are also impinging on doctors whose primary work is to care for expectant mothers and babies, and who may be called upon to terminate a pregnancy for complications or other reasons.Idaho bars abortion at any point in a pregnancy with just two exceptions: when it is necessary to save the life of the mother and in certain cases of rape or incest, though the victim must provide a police report. A temporary order issued by a federal judge also permits abortion in some circumstances when a woman’s health is at risk. Doctors convicted of violating the ban face two to five years in prison.Dr. Gustafson, 51, has so far decided to stick it out in Idaho. She has been practicing in the state for 20 years, 17 of them in McCall, a stunning lakeside town of about 3,700 people.Dr. Gustafson, a family doctor who also delivers babies, has been practicing in Idaho for 20 years. Angie Smith for The New York TimesShe sees patients at the Payette Lakes Medical Clinic, a low-slung building that evokes the feeling of a mountain lodge, tucked into a grove of tall spruces and pines. It is affiliated with St. Luke’s Health System, the largest health system in the state.On a recent morning, she was awakened at 5 a.m. by a call from a hospital nurse. A pregnant woman, two months shy of her due date, had a ruptured membrane. In common parlance, the patient’s water had broken, putting the mother and baby at risk for preterm delivery and other complications.Dr. Gustafson threw on her light blue scrubs and her pink Crocs and rushed to the hospital to arrange for a helicopter to take the woman to Boise. She called the maternal-fetal specialty practice at St. Luke’s Boise Medical Center, the group she has worked with for years. She did not know the doctor who was to receive the patient. He had been in Idaho for only one week.“Welcome to Idaho,” she told him.In rural states, strong medical networks are critical to patients’ well-being. Doctors are not interchangeable widgets; they build up experience and a comfort level in working with one another and within their health care systems. Ordinarily, Dr. Gustafson might have found herself talking to Dr. Kylie Cooper or Dr. Lauren Miller on that day.But Dr. Cooper left St. Luke’s in April for Minnesota. After “many agonizing months of discussion,” she said, she concluded that “the risk was too big for me and my family.”Dr. Miller, who had founded the Idaho Coalition for Safe Reproductive Health Care, an advocacy group, moved to Colorado. It is one thing to pay for medical malpractice insurance, she said, but quite another to worry about criminal prosecution.“I was always one of those people who had been super calm in emergencies,” Dr. Miller said. “But I was finding that I felt very anxious being on the labor unit, just not knowing if somebody else was going to second-guess my decision. That’s not how you want to go to work every day.”The vacancies have been tough to fill. Dr. James Souza, the chief physician executive for St. Luke’s Health System, said the state’s laws had “had a profound chilling effect on recruitment and retention.” He is relying in part on temporary, roving doctors known as locums — short for the Latin phrase locum tenens, which means to stand in place of.He likens labor and delivery care to a pyramid, supported by nurses, midwives and doctors, with maternal-fetal specialists at its apex. He worries the system will collapse.In rural states like Idaho, strong medical networks are critical to patients’ well-being. Angie Smith for The New York Times“The loss of the top of a clinical pyramid means the pyramid falls apart,” Dr. Souza said.Some smaller hospitals in Idaho have been unable to withstand the strain. Two closed their labor and delivery units this year; one of them, Bonner General Health, a 25-bed hospital in Sandpoint, in northern Idaho, cited the state’s “legal and political climate” and the departure of “highly respected, talented physicians” as factors that contributed to its decision.Other states are also seeing obstetricians leave. In Oklahoma, where more than half of the state’s counties are considered maternity care deserts, three-quarters of obstetrician-gynecologists who responded to a recent survey said they were either planning to leave, considering leaving or would leave if they could, said Dr. Angela Hawkins, the chair of the Oklahoma section of the American College of Obstetricians and Gynecologists.The previous chair, Dr. Kate Arnold, and her wife, also an obstetrician, moved to Washington, D.C., after the Supreme Court overturned Roe in Dobbs v. Jackson Women’s Health Organization. “Before the change in political climate, we had no plans on leaving,” Dr. Arnold said.In Tennessee, where one-third of counties are considered maternity care deserts, Dr. Leilah Zahedi-Spung, a maternal-fetal specialist, decided to move to Colorado not long after the Dobbs ruling. She grew up in the South and felt guilty about leaving, she said.Tennessee’s abortion ban, which was softened slightly this year, initially required an “affirmative defense,” meaning that doctors faced the burden of proving that an abortion they had performed was medically necessary — akin to the way a defendant in a homicide case might have to prove he or she acted in self-defense. Dr. Zahedi-Spung felt as if she had “quite the target on my back,” she said — so much so that she hired her own criminal defense lawyer.“The majority of patients who came to me had highly wanted, highly desired pregnancies,” she said. “They had names, they had baby showers, they had nurseries. And I told them something awful about their pregnancy that made sure they were never going to take home that child — or that they would be sacrificing their lives to do that. I sent everybody out of state. I was unwilling to put myself at risk.”Dr. Leilah Zahedi-Spung, a maternal-fetal specialist, decided to move from Tennessee to Colorado not long after the Supreme Court overturned Roe v. Wade.Joanna Kulesza for The New York TimesPerhaps nowhere has the departure of obstetricians been as pronounced as in Idaho, where Dr. Gustafson has been helping to lead an organized — but only minimally successful — effort to change the state’s abortion laws, which have convinced her that state legislators do not care what doctors think. “Many of us feel like our opinion is being discounted,” she said.Dr. Gustafson worked one day a month at a Planned Parenthood clinic in a Boise suburb until Idaho imposed its near-total abortion ban; she now has a similar arrangement with Planned Parenthood in Oregon, where some Idahoans travel for abortion care. She has been a plaintiff in several lawsuits challenging Idaho’s abortion policies. Earlier this year, she spoke at an abortion rights rally in front of the State Capitol.In interviews, two Republican state lawmakers — Representatives Megan Blanksma, the House majority leader, and John Vander Woude, the chair of the House Health and Welfare Committee — said they were trying to address doctors’ concerns. Mr. Vander Woude acknowledged that Idaho’s trigger law, written before Roe fell, had affected everyday medical practice in a way that lawmakers had not anticipated.“We never looked that close, and what exactly that bill said and how it was written and language that was in it,” he said. “We did that thinking Roe v. Wade was never going to get overturned. And then when it got overturned, we said, ‘OK, now we have to take a really close look at the definitions.’”Mr. Vander Woude also dismissed doctors’ fears that they would be prosecuted, and he expressed doubt that obstetricians were really leaving the state. “I don’t see any doctor ever getting prosecuted,” he said, adding, “Show me the doctors that have left.”During its 2023 session, the Legislature clarified that terminating an ectopic pregnancy or a molar pregnancy, a rare complication, would not be defined as abortion — a move that codified an Idaho Supreme Court ruling. Lawmakers also eliminated an affirmative defense provision.But lawmakers refused to extend the tenure of the state’s Maternal Mortality Review Committee, an expert panel on which Dr. Gustafson served that investigated pregnancy-related deaths. The Idaho Freedom Foundation, a conservative group, testified against it and later called it an “unnecessary waste of tax dollars” — even though the annual cost, about $15,000, was picked up by the federal government.That was a bridge too far for Dr. Amelia Huntsberger, the Idaho obstetrician who helped lead a push to create the panel in 2019. She recently moved to Oregon. “Idaho calls itself a quote ‘pro-life state,’ but the Idaho Legislature doesn’t care about the death of moms,” she said.Most significantly, the Legislature rejected a top priority of Dr. Gustafson and others in her field: amending state law so that doctors would be able to perform abortions when the health — not just the life — of the mother is at risk. It was almost too much for Dr. Gustafson. She loves living in Idaho, she said. But when asked if she had thought about leaving, her answer was quick: “Every day.”

A decades-old program created by President George W. Bush to combat AIDS around the world is at risk of being sucked into a partisan dispute over abortion, with some Republicans threatening to block its renewal.Nancy Pelosi, the Democratic former House speaker, and George W. Bush, the Republican former president, do not agree on much. But earlier this year, they joined a high-powered gathering in Washington — with the Irish rock star Bono on video from Dublin — to mark the 20th anniversary of America’s biggest and, arguably, most successful foreign aid program.Mr. Bush created that program, the President’s Emergency Program for AIDS Relief, in 2003. In the two decades since, PEPFAR, as it is known, has saved 25 million lives and served as a powerful tool for soft diplomacy, a symbol of America’s moral leadership in the world. It has had extraordinary support from a bipartisan coalition of liberals and Christian conservatives.But now PEPFAR is in danger of becoming a victim of abortion politics — just as the State Department is reorganizing to make the program permanent.The program is set to expire at the end of September. But House Republicans are not moving forward with a bill to reauthorize it for another five years, because abortion opponents — led by a G.O.P. congressman who has long been a supporter of PEPFAR — are insisting on adding abortion-related restrictions.The stalemate is the latest example of how Republicans are using their majority in the House of Representatives to impose their conservative views on social policy throughout the federal government. They have focused in particular on abortion, a year after the Supreme Court overturned Roe v. Wade and, with it, the right to legal abortion. Earlier this summer, House Republicans loaded up the annual military policy bill that has long been bipartisan with provisions to limit abortion access and transgender care.The fight over PEPFAR, a $7 billion-a-year program that operates in more than 50 countries, is similar, because it is a broadly bipartisan program that now appears at risk of being sucked into a partisan fight over cultural and social issues.PEPFAR continues to have wide support, including from Representative Michael McCaul of Texas, the Republican chairman of the Foreign Affairs Committee, which oversees the program and approve the reauthorization legislation. But so far, Mr. McCaul has not advanced it because of the objections of abortion foes, including his Republican colleague, Representative Christopher H. Smith of New Jersey, one of the leading anti-abortion voices in Congress who also helped draft the legislation creating PEPFAR.Representative Christopher H. Smith of New Jersey wants PEPFAR funding to include restrictions barring the program from partnering with organizations that provide abortion services.Pool photo by Ken CedenoMr. Smith now says he will not agree to renew the program unless it is subject to the so-called Mexico City policy — enacted by Republican presidents but lifted by Democrats, including President Biden — that would bar the program from partnering with any organization that provides abortion services, no matter the source of the funding.That is a non-starter for Democrats, who are demanding a “clean” five-year reauthorization — one with no added policy restrictions.“We’ve done clean reauthorizations for 20 years,” said Representative Barbara Lee, Democratic of California and a chief sponsor of PEPFAR.But there is a substantial stumbling block: Three influential outside groups that oppose abortion — the Family Research Council, the Heritage Foundation’s political action arm and Susan B. Anthony Pro-Life America — have sided with Mr. Smith and intend to “score” the vote when they compile their annual ratings of members of Congress. A vote for renewing PEPFAR without the anti-abortion language would be counted as a demerit, making it politically toxic for most Republicans.The situation has alarmed champions of the program. In an email, Bono called the impasse “madness,” and called on Congress to “protect the bipartisan commitment to keeping politics out of PEPFAR.”Mr. McCaul said he is “talking to supporters both inside and outside the government, and working with my colleagues on both sides of the aisle in the House and the Senate” to resolve the dispute. He has also been texting with Bono, who in turn has been in touch with congressional leaders on the matter.A senior White House official, speaking on the condition of anonymity to describe the negotiations, said on Thursday that the White House was “engaging closely with Congress at senior levels” in pursuit of a straight five-year reauthorization.The program is an important legacy for Mr. Bush and other Republicans of his era, including Bill Frist, the former Senate majority leader, and Rick Santorum, a former senator from Pennsylvania.President George W. Bush at the White House in 2003 with a choir from Uganda made up of children who had been orphaned by H.I.V., AIDS or conflict.Doug Mills/The New York Times“I look back on the things I did as a member of Congress, and feel like I was able, as the pro-life warrior in the United States Senate, to forge a compromise to get conservatives to support this,” Mr. Santorum said in an interview. “It’s been a great thing for our country, and it’s been a great thing for humanity.”Last week, Mr. Santorum publicly pleaded for a “five-year, clean extension” in an opinion essay in the conservative outlet Newsmax. He said he intended to use Congress’s upcoming August recess to try to forge a compromise.But in recent months, Mr. Smith, the New Jersey Republican, and right-wing groups have begun accusing the Biden administration of injecting progressive politics into the program.In late May, a Heritage Foundation scholar published an essay in The Hill arguing that PEPFAR had become “increasingly politicized” and needed an overhaul. Mr. Smith followed in early June with “Dear Colleague” letter asserting that Mr. Biden had “hijacked PEPFAR.”In an interview, he pointed to new language in a PEPFAR country and regional operational plan calling for the program to partner with organizations that advocate for “institutional reforms in law and policy regarding sexual, reproductive and economic rights of women.” He argued that was code for a plan to “integrate abortion with H.I.V./AIDS work.”The document also says PEPFAR programs should “advance human rights and decriminalization for lesbian, gay, bisexual, transgender, queer, and intersex (L.G.B.T.Q.I.+) communities.” That did not sit well with the Family Research Council, whose chief lobbyist, Travis Weber, recently called PEPFAR “a massive slush fund for abortion and L.G.B.T. advocacy.” In an interview, he said he stood by those words.The senior White House official said that the “intentional focus on health equity is new” and that it came in response to requests from local communities for PEPFAR to “address barriers to health for children, adolescent girls and young women, and key populations.” The mention of women’s rights refers to ensuring that adolescent girls have access to schools, the official said.The Biden administration has added a footnote to the document clarifying that PEPFAR does not fund abortions, an assertion that Mr. Smith called “meaningless.”There is no evidence that PEPFAR or its foreign partners have used federal tax dollars to promote or perform abortions; U.S. law does not allow it. But some PEPFAR grantees, such as Population Services International, a global health nonprofit based in Washington, do provide abortion-related services with money from other sources.“The assertion is made by critics is that organizations like P.S.I. are working with U.S. money and involved in abortion — and shouldn’t that be illegal?” said Karl Hofmann, the group’s president and chief executive. “I guess my answer is, those two facts are true, and it’s not illegal.”Ms. Lee, the California Democrat, said she is working to “clarify this misrepresentation” being made by Mr. Smith.But the prospects for a five-year extension seem bleak.“We are in a very precarious place,” said Shepherd Smith, an evangelical Christian and a co-founder of Childrens AIDS Fund International, a nonprofit. He has organized other faith-based groups to issue a letter in support of reauthorization.Christopher H. Smith, the New Jersey congressman, has proposed an alternative: He persuaded fellow Republicans to insert language into a State Department spending bill that would allow PEPFAR to keep operating for a year without a new authorization, but subject to the anti-abortion restrictions. But even if that were to pass, certain programs — including one devoted to orphans and vulnerable children — would lapse after Sept. 30.And the symbolism of such a move would be devastating, PEPFAR’s backers say — a signal to other nations that the United States is abandoning its bipartisan commitment to end the AIDS epidemic by 2030, and that Washington is truly broken. It would also be a setback for global health; PEPFAR has created an infrastructure of clinics in poor nations that provide other services, including Covid-19 testing and vaccines.“This is not an issue that at all involves abortion — it’s about having health care facilities in countries to deal with pandemic type of challenges,” said Senator Benjamin L. Cardin, Democrat of Maryland. He called PEPFAR’s creation “one of the great moments in American foreign policy.”A man receives a Covid-19 vaccine in Kathantha, Sierra Leone. PEPFAR has created an infrastructure of clinics in poor nations that provide other services, including Covid-19 testing and vaccines.Finbarr O’Reilly for The New York TimesAs the debate plays out on Capitol Hill, the State Department official who oversees PEPFAR, Dr. John N. Nkengasong, is about to get a big promotion. On Tuesday, Secretary of State Antony J. Blinken is expected to announce the establishment of a new Bureau of Global Health Security and Diplomacy, to be led by Dr. Nkengasong. The idea is to integrate PEPFAR into the department’s broader global health work and to transition it out of emergency status.Since its inception, the program has invested more than $100 billion in fighting the global AIDS crisis. Independent analyses by K.F.F., formerly the Kaiser Family Foundation, have found that PEPFAR has helped improve maternal and child health and is “associated with large, significant declines in mortality” in countries where it has operated.Backers of the program are hoping that Mr. Bush will weigh in. Earlier this year, Emily Bass, an author and activist, sent the former president a signed copy of her book, “To End a Plague: America’s Fight to Defeat AIDS in Africa,” which chronicles the PEPFAR story.A few weeks ago, Ms. Bass said, Mr. Bush sent a letter thanking her.“Laura and I will remain invested in this mission for the rest of our lives,” he wrote.

The NewsPresident Biden has picked Dr. Paul Friedrichs, a military combat surgeon and retired Air Force major general who helped lead the Covid-19 response at the Pentagon, to head a new White House office created by Congress to prepare for and manage future biological threats.The White House said that it would announce the appointment on Friday and that it would take effect on Aug. 7. It will then be up to Dr. Friedrichs to set up the new office, the Office of Pandemic Preparedness and Response Policy, although the administration has christened it with a shorter Washington acronym: O.P.P.R.The appointment comes after a lengthy search for a director that ended where it began — at the White House, where Dr. Friedrichs recently joined the staff of the National Security Council as the senior director for global health security and biodefense. Before that, he served as the Joint Staff surgeon at the Pentagon, providing medical advice to the chairman of the Joint Chiefs of Staff. His planned selection was reported last week by The Washington Post.Dr. Paul Friedrichs at the Pentagon in 2021. He retired from the Air Force as a major general and recently joined the staff of the National Security Council.Alex Brandon/Associated PressWhy It Matters: Future health threats loom.The coronavirus pandemic has often been described as the worst public health crisis in a century. But experts agree that given current migration patterns and the way humans intersect with animal life, it will not be a century — and it might not even be a decade — before the next pandemic arrives.The era of Covid “czars” is over. Mr. Biden’s first White House coronavirus response coordinator, Jeffrey D. Zients, is now the White House chief of staff. The second coordinator, Dr. Ashish K. Jha, has gone back to his position as dean of the Brown University School of Public Health. Mr. Zients praised Dr. Friedrichs for his work on the pandemic, saying he would “lead the charge to ensure that never happens again.”Covid-19 made clear that a biological health threat does not respect boundaries — including the boundaries that divide federal agencies. The appointment of Dr. Friedrichs signals a more permanent and coordinated effort to prepare for and respond to pandemics — one that will last beyond the Biden administration and will be centralized within the White House.Background: Dr. Friedrichs served decades in the Air Force.In a February speech, Dr. Friedrichs reflected on his 37-year career in the Air Force and shared a bit about himself. His father served in the Navy at the end of World War II, and his mother was a Hungarian freedom fighter whose parents were killed by the Russians. His wife was an Army doctor when they met.He also reflected on the role of the military in fighting Covid-19, an effort that included helping to develop and distribute vaccines and providing medical support to struggling hospitals. “The military health system became the pinch-hitter that stepped in to help our civilian partners as we collectively struggled to work through that pandemic,” he said.What’s Next: The job will focus on preparedness.Dr. Friedrich’s new position gives him authority to oversee domestic biosecurity preparedness. He will need to work on the development of next-generation vaccines, ensure adequate supplies in the Strategic National Stockpile and ramp up surveillance to monitor for new biological threats. He will also have to work with Congress to secure funding for preparedness efforts.

After Justice Clarence Thomas cast doubt on the Supreme Court decision that established a right to contraception, reproductive rights advocates are pressing for new protections at the state level.One year after Justice Clarence Thomas said the Supreme Court should reconsider whether the Constitution affords Americans a right to birth control, Democrats and reproductive rights advocates are laying the groundwork for state-by-state battles over access to contraception — an issue they hope to turn against Republicans in 2024.The justice’s argument in Dobbs v. Jackson Women’s Health Organization, the case that overturned Roe v. Wade and the right to abortion, galvanized the reproductive rights movement. House Democrats, joined by eight Republicans, promptly passed legislation that would have created a national right to contraception. Republicans blocked a companion bill in the Senate.Now, reproductive rights advocates are pressing their case in the states. Even before Dobbs, some states had taken steps to protect the right to contraception, by either statute or constitutional amendment; 13 states and the District of Columbia currently have such protections, according to KFF, a health policy research organization.This month, the movement scored an important but little-noticed victory in Nevada, where the Democratic-controlled Legislature passed a bill, inspired by the defeated federal measure, that would guarantee a right to contraception. Gov. Joe Lombardo, a Republican, has not said whether he will sign it, and a spokeswoman said she could not speak to his views. Proponents of codifying such a right see Nevada as a test case.“It’s going to be up to Republicans to choose whether they want to protect the right to contraception,” Senator Edward J. Markey, Democrat of Massachusetts and the sponsor of the failed Senate bill, said in an interview. He called the Dobbs decision “a preview of coming atrocities.”On Wednesday, Mr. Markey and Representative Kathy Manning, Democrat of North Carolina, reintroduced legislation to create a national right to contraception. With the House now controlled by Republicans and Senate Democrats well short of the 60 votes needed to break a filibuster, the legislation is most likely dead on arrival in Washington.Polls have consistently shown broad bipartisan support for access to contraception, and while Republicans may not be eager to enshrine a right to it in federal law, neither do they generally want to ban it. Still, some opposition to birth control does exist.The Roman Catholic Church opposes any form of artificial birth control, arguing that some contraceptives “can cause early abortions.” Some abortion foes claim that two common methods of preventing pregnancy — intrauterine devices and emergency contraception, also known as the morning-after pill and marketed as Plan B — are “abortifacients” that prevent a fertilized egg from implanting in a woman’s uterus.But the American College of Obstetricians and Gynecologists says intrauterine devices work “mainly by preventing fertilization of an egg by sperm.” And the Food and Drug Administration said last year that Plan B does not prevent a fertilized egg from implanting in the womb and cannot be considered an abortion pill.Critics of codifying a right to contraception say such legislation amounts to a solution without a problem — or is purely a political gesture meant to put Republicans in a difficult spot and spur voters into rejecting them at the ballot box.“Most Republicans saw that as a political vote, not really a serious vote,” John Feehery, a Republican strategist, said of the vote on the House bill last year. “In the Republican coalition, there is a small but vocal element that is anti-contraception, but the vast majority of Republicans don’t have any interest in making contraception illegal.”Since the Dobbs decision, debates over birth control have also become increasingly tied up with abortion. Some Republicans who voted against the House bill complained that it would have sent more money to Planned Parenthood, an organization that is a target for many in the party because it is a major provider of abortions. Representative Cathy McMorris Rodgers, Republican of Washington, described the bill as a “Trojan horse for more abortions.”Writing for the majority in the Dobbs case, Justice Samuel A. Alito Jr. stressed that the ruling “concerns the constitutional right to abortion and no other right.” But in a concurring opinion, Justice Thomas said the Supreme Court should reconsider other rulings, including Griswold v. Connecticut, a 1965 decision that established the right of married couples to use contraception. He said the logic of the majority opinion in Dobbs undermined Griswold.Justice Clarence Thomas said the Supreme Court should reconsider Griswold v. Connecticut, a 1965 decision that established the right of married couples to use contraception.Allison V. Smith for The New York Times“For years, we asked elected officials around the country to pay more attention to the conflation of abortion and contraception,” said Clare Coleman, the president and chief executive of the National Family Planning & Reproductive Health Association, which represents health providers. “We shouldn’t have to answer the ‘Why are we worried?’ question anymore.”Ms. Coleman and her allies in the movement say that complacency is what cost American women the right to abortion. They also see what they regard as worrisome efforts to restrict access to birth control.In 2021, Republicans in Missouri tried to ban taxpayer funding for intrauterine devices and emergency contraception. Missouri is one of four states — the others are Arkansas, Mississippi and Texas — that have ejected Planned Parenthood, a major provider of birth control, from their Medicaid programs.At the same time, the federal family planning program known as Title X is being challenged in Texas, where a federal judge ruled late last year that it violated parents’ constitutional rights by permitting clinics to provide birth control to teenagers without parental consent. If the ruling is upheld, it could threaten access to contraceptives for minors nationwide.So far, though, the Dobbs case has not spawned the kind of widespread attacks on birth control that advocates feared. In fact, access to contraception has been expanded in a handful of red states, according to the Guttmacher Institute, which tracks reproductive health measures.In Indiana, Gov. Eric Holcomb signed legislation allowing pharmacists to prescribe birth control. In West Virginia, Gov. Jim Justice signed a bill requiring insurance plans to cover 12-month supplies of contraceptives from pharmacies. In Arkansas, Gov. Sarah Huckabee Sanders signed legislation requiring Medicaid to cover intrauterine devices and other long-acting reversible contraceptives for women who have just given birth. All are Republicans.The push for laws declaring a right to contraception comes as the F.D.A. is considering allowing birth control pills to be sold over the counter for the first time. A panel of advisers to the agency said last month that the benefits of over-the-counter contraception outweighed the risks. In anticipation of possible action by the F.D.A., Senate Democrats recently reintroduced legislation that would require insurers to cover over-the-counter contraception.But Senator Catherine Cortez-Masto, Democrat of Nevada and one of the bill’s chief sponsors, said she did not know if the measure’s backers could get any Republican support in the current post-Dobbs climate. “We think that we should,” she said, “but, you know, it’s a different and challenging time right now.”In North Carolina, the Dobbs case and abortion politics doomed a bill to affirm a right to contraception, said State Senator Lisa Grafstein, a Democrat who introduced the measure. Ms. Grafstein said in an interview that she had spoken to at least one Republican who was interested in becoming a co-sponsor.But that was before lawmakers in the state moved to ban most abortions after 12 weeks.State Senator Lisa Grafstein, a Democrat in North Carolina, introduced a contraception bill that was doomed by abortion politics.Kate Medley for The New York Times“Once the abortion debate took off, there wasn’t any more discussion of these kinds of issues,” Ms. Grafstein said. “The tenor of things has really changed a lot in terms of whether a conversation like that would even be possible at this point.”Even in Nevada — a state where voters codified a right to abortion through a referendum more than three decades ago, in 1990 — it was tough for the bill’s backers to get Republican support. Ultimately, a handful of Republicans voted for the measure. Its chief sponsor, Assemblywoman Selena Torres, a Democrat, said she was hopeful that the governor would sign it.“This was a very separate topic from abortion,” Ms. Torres said. “But I do think that the Dobbs decision is ultimately what drives this conversation.”Supporters of codifying a right to contraception are hoping Nevada will serve as a model for other states and will also put pressure on Republicans in Congress. Americans for Contraception, an advocacy group that has orchestrated the state-by-state strategy, ran attack ads last year against Republicans who voted against the House bill.The group says it has lined up Democratic state legislators in five more states — Arizona, Mississippi, Tennessee, Virginia and Wisconsin — to introduce bills next year to guarantee a right to contraception.“Last year, 195 House Republicans tried to get away with opposing the right to contraception by voting against a straightforward bill,” said Dana Singiser, a senior adviser to the group. “Nevada demonstrates that some of their colleagues at the state level recognize that supporting the right to contraception is a policy and a political no-brainer.”In Washington, there is a ready explanation for why so many Republicans voted against the House bill: Susan B. Anthony Pro-Life America, an anti-abortion group, decided to include the vote in its scorecard for lawmakers.The organization derided the measure as the “Payouts for Planned Parenthood Act” and said it would “trample conscience rights” in states that allow health providers or pharmacists to refuse to provide birth control. The group asserted that the bill’s definition of contraceptives — “any drug, device or biological product intended for use in the prevention of pregnancy” — was overly broad and could be construed to include abortion pills.“If you’re a Republican, you want to be seen as pro-life, and the Susan B. Anthony group, they help define who’s pro-life,” said Mr. Feehery, the Republican strategist, adding, “I think most Republicans would much rather be on the side of Susan B. Anthony than on the side of Planned Parenthood.”