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Kenya’s pursuit of universal health coverage has evolved over three decades through incremental reforms. But by far the boldest step taken so far was in 2022 when the government embarked on an overhaul of the healthcare system under President William Ruto’s economic transformation agenda.

The new Social Health Insurance Fund – implemented across the country from October 2024 – replaces the 58-year-old National Health Insurance Fund and aims to provide all Kenyans with quality healthcare. Under the Social Health Insurance Act, passed in 2023, the new scheme mandates health coverage for all. It is backed up with regulations requiring the mandatory registration of all residents of Kenya.

The new healthcare system introduces the Primary Health Fund for basic care at local clinics, the Social Health Insurance Fund for advanced services at larger hospitals, and the Emergency, Chronic and Critical Illness Fund to cover emergency and long-term treatments.

The transition from the old system to the new marks a significant milestone in Kenya’s efforts towards universal health coverage. It’s the first time the government is fully overhauling the country’s health insurance system and addressing its perennial issues of inefficiency, corruption and service delivery head on. Previous efforts have opted for piecemeal reforms.

But the transition from the National Health Insurance Fund is facing serious challenges. These include financing gaps, reimbursement delays and infrastructure constraints that affect service delivery. In addition, the changes are being met with public resistance, low registration rates and concerns about the new member contribution model.

Read more:
Kenya introduced free maternal health services a decade ago – it’s been a success, saving lives

I am a health economist and policy specialist with close to 15 years of experience studying African health systems. In my view, Kenya’s new approach brings challenges that demand strategic management, adequate funding and close collaboration with key stakeholders.

Implementing health reforms is no easy task. Unpredictable forces – such as political interests, economic limitations, stakeholder influence and public opinion – interact in unseen ways. This makes outcomes difficult to predict and control.

To succeed, the Kenyan government must focus on transparent communication, strategic partnerships and efficient reimbursement to build a sustainable health system. It would do well to learn from other countries’ journeys with universal health coverage, like Ghana, South Africa and India.

Kenya’s health reforms

In 2004, the government proposed a national health insurance scheme aimed at providing financial protection. But political and economic issues delayed its rollout.

In 2010, new reforms were introduced. These included a specialised scheme for civil servants, a health subsidy for the poor and revised member contribution rates with expanded benefits. The country then decentralised health services in 2013. This made health service delivery the responsibility of the country’s 47 regional governments. The national government retained policy functions.

Free maternity care was launched in 2013 and expanded in 2016.

In 2018, a pilot universal healthcare programme was launched to strengthen healthcare delivery and access under the then Uhuru Kenyatta regime.

In 2022, the Ruto government embarked on an overhaul of the healthcare system, which led to the Social Health Insurance Fund under the Social Health Insurance Act.

Financing gaps

The transition to the new system has brought several financing issues to the forefront.

Firstly, reimbursement delays from the National Health Insurance Fund have left many health facilities in financial distress. Some facilities are still waiting to be paid for services rendered. The health ministry has been slow in releasing funds. These delays have caused financial strain, preventing facilities from operating efficiently and leading some to refuse to join the new system until their debts are settled. This has affected access to care.

Secondly, due to inadequate public awareness, many patients have incurred out-of-pocket expenses during the transition, particularly those needing long-term treatments like dialysis and cancer care. This is despite the fact that the Social Health Authority – which will administer the new scheme – has offered to reimburse patients who paid for services.

Thirdly, concerns about the sustainability of Kenya’s new healthcare scheme are significant. The projected cost of full implementation is Ksh168 billion (US$1.3 billion). However, the country’s 2024-25 budget allocated Ksh127 billion (US$982 million) for the entire health sector and Ksh6.1 billion (US$47 million) for the Social Health Authority. This is significantly below the required amount.

The government plans to seek development partners’ support and contributions from all eligible Kenyans and foreigners (who have lived in the country for more than a year) to bridge the financing gap. This raises questions about the long-term viability of this approach.

Fourthly, there have been delays in establishing contracts between the Social Health Authority and healthcare providers. This has caused some facilities to turn away patients.

Public resistance and lack of awareness

Public resistance and a lack of awareness are hurdles in the transition. As of October 2024, only 1.9 million Kenyans had voluntarily registered for the new scheme. This is well below the health ministry’s target of registering 12 million households (around 38 million people) by the onset of the programme.

About 10 million National Health Insurance Fund members were transferred to the new scheme automatically. However, issues with data accuracy mean only 70% of the information was transferred correctly.

Read more:
South Africa’s National Health Insurance bill has noble aims but leaves too much uncertain: it needs more work

Concerns over the new contribution structure have also fuelled resistance. Salaried workers now contribute 2.75% of their income. This is higher than the National Hospital Insurance Fund’s flat rate. It has prompted calls for refining the system to ensure fairer contributions, particularly for low-income households.

Another concern is that the new system offers limited coverage, fewer services and lower reimbursement rates for specialised treatments than the National Hospital Insurance Fund. This may increase patients’ out-of-pocket costs and reduce care quality.

Digitalisation is another challenge. Since July 2024, citizens have registered for Social Health Authority services using various methods, including USSD codes and online platforms. However, participation has been slower than expected, partly due to limited awareness and infrastructure challenges. There have also been concerns over data ownership and security.

What can the government do?

To successfully transition from the National Hospital Insurance Fund to the Social Health Insurance Fund and achieve universal health coverage, Kenya must prioritise clear communication, robust digital systems, sufficient funding and efficient reimbursement processes – without corruption.

Learning from other countries like Ghana, which emphasised transparent communication to build trust, could help Kenya ensure effective public engagement.

Partnerships with technology providers could also be enhanced by drawing lessons from Tanzania’s integrated health insurance systems, which improved data management and accountability.

Ensuring financial sustainability, as seen in India’s approach, is crucial for bridging budget deficits and securing long-term funding.

Reimbursement delays must be addressed. South Africa’s National Health Insurance pilot showed the importance of clear payment timelines and strategic purchasing to maintain provider trust and service efficiency.

By adopting these strategies, Kenya can manage the transition challenges effectively and strengthen its healthcare system. Läs mer…

A week after the opening of their solo exhibition So She Was Turned To a Pillar of Salt at The Project Room in Windhoek, Jo Rogge also facilitated a workshop for aspiring female artists at the gallery. Squeezing in a workshop in the few days they were in Namibia is an affirmation of their commitment to the advancement of art in the country. This is despite having been forced out of Namibia in 2016 when, after 30 years of living and working there, Rogge’s work permit was not renewed. They relocated to neighbouring South Africa.

Portrait of the artist.

Rogge is a cultural worker who wears many hats – artist, curator, activist, educator and mentor. They have founded some of the nation’s most thriving art institutions.

For the new show, Rogge tackles burning issues by employing diverse media and forms including paintings, drawings, sculptures from found materials and text-based textiles. In one colourful, confrontational painting called The Lady Chatelaine was Always Going to be a Prince, Rogge addresses the reality of homophobic hate killings in Namibia. This is done by humanising the mutilated figure of Sexy Fredericks lying on a bed of roses. The transgender woman was murdered earlier this year.

The artist’s doilies series has a piece titled Filastin expressing their solidarity with Palestinians in the country’s conflict with Israel. Others engage the issues with a dash of humour (Red Hot Resibian takes a dig at Namibia’s founding president’s pronunciation of the word “lesbian”.)

Read more:
Being queer in Africa: the state of LGBTIQ+ rights across the continent

I’ve encountered Jo Rogge’s legacy over and over again in my studies on artists and artistic practices across the region. The core of my research is about salvaging the stories of sidelined artists, often only recognised after their deaths.

Rogge works to make marginalised people visible. A big part of that work is to mentor artists and cultural workers, who are often underfunded and whose voices are not heard.

Working for the marginalised

Rogge’s practice riffs on themes like belonging, alienation and exclusion. At the time of their 2021 exhibition Normal NOT Normal, the artist said

For me, being queer, being non-binary, I am considered not normal by many.

The show grappled with issues of identity in Namibia, a country whose courts only recently overturned colonial era sodomy laws. As in many other African countries, the lesbian, gay, bisexual, intersex and queer (LGBTIQ+) community often faces homophobia and exclusion.

The Day We Took the Boat Out.

In Rogge’s 2018 exhibition Always in a Holding Pattern, the artist presented paintings in which “ships, boats and life rafts” were a recurring theme – the show explored migration. The artist’s own father migrated from Europe and settled in Namibia. Rogge discovered that the village he came from in then East Prussia no longer existed.

As the curator for the Unmourned Bodies exhibition in South Africa in 2023, Rogge invited 18 Namibian artists to choose an artwork that resonated with them from the collection of the Namibian Art Association and Namibian Arts Heritage Trust. Rogge included “works by artists of Ju/’hoansi origins – a population of Khoisan-speaking hunter-gatherers residing in north-eastern Namibia and the north-western region of Botswana. This was to make visible the ”absences and erasures of San artistic contributions to the art historical canon”.

Consistently on the side of the marginalised and vulnerable, Rogge has often grappled with queer invisibility, hate killings, women’s rights and similar issues. The artist has always held the view that human beings are different and so the best way to attain harmony in the world would be to embrace these differences and try to find common ground.

Institution builder

With very little or no government support in most African countries, artists often organise themselves. They build institutions and sustain them. Over the years, Rogge has initiated several institutions and projects that have been central to the development of Namibia’s art world. Many are still thriving today. Among them was the John Muafangejo Art Centre, which accommodated and mentored artists who had no access to university education and funding.

Your Mother’s Doily.

Rogge co-founded the Tulipamwe International Artists Workshop which ran from 1994 to 2003 as part of the broader Triangle Network initiative. This gave Namibian artists the opportunity to learn from and exchange ideas with artists from the region and beyond.

The So Namibia Collective was co-founded by Rogge in 2016 to counter the marginalisation experienced by many women artists in Namibia by government-run art institutions.

As early as 1989, at the dawn of Namibia’s independence, Rogge co-founded Sister Namibia, advocating for women candidates in the nation’s first administration. The publication remains committed to the plight of women and the LGBTIQ+ community.

Read more:
John Hlatywayo: remembering a great Zimbabwean artist who was woefully neglected by history

Rogge also served as a lecturer of art and graphic design in Namibia and in various capacities at the National Art Gallery of Namibia and the Namibian Arts Association.

The future of Namibian art

Rogge’s vision – which must be celebrated in their lifetime – has been to give voice to silenced communities and to unlock the potential of emerging artists.

These Are a Few of My Favorite Things.

Rogge believes that there is a gap in the region – talented young artists are organising themselves because they don’t have the necessary support structures. If all sectors of society, including the state, were to join their efforts, they believe that Namibian art will flourish in future.

Highlighting Rogge reminds us that there are unsung artists engaging key contemporary issues and subjects we cannot just afford to ignore if we are to build inclusive and progressive societies in southern Africa.

So She Was Turned to a Pillar of Salt is on in Windhoek until 12 October. Läs mer…

The Conservative party leadership ballot is a private affair. The MPs don’t have to reveal who they voted for if they don’t want to. And given how badly they appear to have bungled their final round of voting in this contest, it seems unlikely we’ll ever know what really happened.

James Cleverly was the firm favourite among MPs, and yet an attempt to manoeuvre him into the final two against the candidate his supporters felt most sure of beating in the final run-off, when party members vote, seems to have backfired.

It would appear Cleverly and his supporters forgot Lyndon B. Johnson’s first rule of politics – learn to count. As a result, party members now have a choice between two rightwing candidates, Robert Jenrick and Kemi Badenoch. Both are popular among members but less electable and palatable for the wider public. The debacle has exposed (not for the first time) the problems with the electoral system.

Cleverly was seen as the unifier of the party, with the ministerial experience and communication skills to help with a transformation. He had wowed party conference with a well-calibrated speech hinting that the party needed to “normalise” to regain trust. Yet his record leaves questions as to exactly how good his communication skills are in reality. He had made several “jokes”, which were not jokes at all – just offensive comments – and reportedly described his own government’s immigration policy as “batshit”.

A Telegraph article just before his shock loss in the parliamentary party vote feared he would “sign the death warrant” of the party as a “middle-of-the-road bluffer who tickles the tummies of members of the parliamentary party by flattering them that their historic defeat was not so bad after all”. Yet judging by the audible gasps when the result was announced, Tory MPs were shocked at how they had messed the vote up. Both the Liberal Democrats and Labour reacted with glee at the news.

Tory MPs react to the news that they’ve inadvertently knocked out their favourite candidate.

The final two

Badenoch has less ministerial experience than Cleverly but is loved by the Tory party as a battler and is now the favourite to win. The same “death warrant” article called Badenoch a “Warrior Queen”, but that cuts both ways. Badenoch, by channelling her inner Thatcher, is pitching herself as a fighter taking on the forces of reaction within and without. But, to quote another Tory, the Duke Of Wellington, Thatcher would only fight battles she knew she could win. Badenoch’s battle seem rather less focused, and her war on the forces of woke now includes new mothers and civil servants (10% of whom, in her view, should be in prison).

Another recent article, this time in the Guardian spoke of how “she often finds it hard to get through an interview without patronising or arguing with the presenter in a manner that reinforces claims she’s divisive and abrasive”. At the same time, her attempt to tell “hard truths” saw her publishing a lengthy pamphlet featuring some triangles – seemingly explaining electoral realignment – which no one could understand. Not ideal attributes for a leader.

So far in this contest, Jenrick’s most notable interventions have been to grandstand about the European Court of Human Rights (ECHR), compete to be toughest on immigration, and (and we need to follow the logic slowly here) argue that the ECHR is causing UK special forces to kill instead of capture terrorists. Jenrick is the living embodiment of the old Groucho Marx joke “those are my principles, and if you don’t like them…well, I have others”. He has made either a Damascene or cynical journey from squishy centre to hard right just ahead of this contest. What does he really believe? No one is sure.

The reasons for the Tories’ recent catastrophic election loss are in plain sight. Voters saw the Conservative governments as a toxic combination of poor delivery, scandals and being out of touch. The 2024 defeat was a combination of Boris Johnson’s immorality and Liz Truss’s incompetence. Rishi Sunak then finally fractured his own coalition with a self-defeating immigration policy. None of the candidates have addressed the reasons for the loss and the final two are evidently still in denial.

Cleverly, pictured, praying for his colleagues not to do anything batshit when they vote.
EPA

But it is the Tory members who are voting here. Their version of events is that disunity and a failure to deliver on immigration lost them power. Members may well be torn, as political scientist Tim Bale points out, between values and electability – though with Cleverly out, this latter may be a problem.

Peering through the fog of the contest, there are two things which are very likely. First, Johnson’s shifting of the party to the right, and his closer alignment of the Tory party with the remnants of UKIP is now more evident, and will be further deepened by whoever wins. While Badenoch and Jenrick differ on whether they should beat or join Reform, the Tory party is now on the latter’s territory. There is unlikely to be any Tory “hard truths” to address the electorate’s loss of trust in the party, but instead the talking points will be culture wars, immigration, and leaving the ECHR.

Second, as a result, the party will move further from the centre ground, and away from the average voter, and their concerns. The mess the parliamentary party has made of the contest and the long shadow of dysfunctional leadership have served only to remind voters of the reasons why the party was thrown out of office in July. Peering through his snazzy new glasses, Starmer can see his bad week just got a lot better. Läs mer…

The 67 million Americans eligible for Medicare make an important decision every October: Should they make changes in their Medicare health insurance plans for the next calendar year?

The decision is complicated. Medicare has an enormous variety of coverage options, with large and varying implications for people’s health and finances, both as beneficiaries and taxpayers. And the decision is consequential – some choices lock beneficiaries out of traditional Medicare.

Beneficiaries choose an insurance plan when they turn 65 or become eligible based on qualifying chronic conditions or disabilities. After the initial sign-up, most beneficiaries can make changes only during the open enrollment period each fall.

The 2024 open enrollment period, which runs from Oct. 14 to Dec. 7, marks an opportunity to reassess options. Given the complicated nature of Medicare and the scarcity of unbiased advisers, however, finding reliable information and understanding the options available can be challenging.

We are health care policy experts who study Medicare, and even we find it complicated. One of us recently helped a relative enroll in Medicare for the first time. She’s healthy, has access to health insurance through her employer and doesn’t regularly take prescription drugs. Even in this straightforward scenario, the number of choices were overwhelming.

The stakes of these choices are even higher for people managing multiple chronic conditions. There is help available for beneficiaries, but we have found that there is considerable room for improvement – especially in making help available for everyone who needs it.

The choice is complex, especially when you are signing up for the first time and if you are eligible for both Medicare and Medicaid. Insurers often engage in aggressive and sometimes deceptive advertising and outreach through brokers and agents. Choose unbiased resources to guide you through the process, like www.shiphelp.org. Make sure to start before your 65th birthday for initial sign-up, look out for yearly plan changes, and start well before the Dec. 7 deadline for any plan changes.

2 paths with many decisions

Within Medicare, beneficiaries have a choice between two very different programs. They can enroll in either traditional Medicare, which is administered by the government, or one of the Medicare Advantage plans offered by private insurance companies.

Within each program are dozens of further choices.

Traditional Medicare is a nationally uniform cost-sharing plan for medical services that allows people to choose their providers for most types of medical care, usually without prior authorization. Deductibles for 2024 are US$1,632 for hospital costs and $240 for outpatient and medical costs. Patients also have to chip in starting on Day 61 for a hospital stay and Day 21 for a skilled nursing facility stay. This percentage is known as coinsurance. After the yearly deductible, Medicare pays 80% of outpatient and medical costs, leaving the person with a 20% copayment. Traditional Medicare’s basic plan, known as Part A and Part B, also has no out-of-pocket maximum.

Traditional Medicare starts with Medicare parts A and B.
Bill Oxford/iStock via Getty Images

People enrolled in traditional Medicare can also purchase supplemental coverage from a private insurance company, known as Part D, for drugs. And they can purchase supplemental coverage, known as Medigap, to lower or eliminate their deductibles, coinsurance and copayments, cap costs for Parts A and B, and add an emergency foreign travel benefit.

Part D plans cover prescription drug costs for about $0 to $100 a month. People with lower incomes may get extra financial help by signing up for the Medicare program Part D Extra Help or state-sponsored pharmaceutical assistance programs.

There are 10 standardized Medigap plans, also known as Medicare supplement plans. Depending on the plan, and the person’s gender, location and smoking status, Medigap typically costs from about $30 to $400 a month when a beneficiary first enrolls in Medicare.

The Medicare Advantage program allows private insurers to bundle everything together and offers many enrollment options. Compared with traditional Medicare, Medicare Advantage plans typically offer lower out-of-pocket costs. They often bundle supplemental coverage for hearing, vision and dental, which is not part of traditional Medicare.

But Medicare Advantage plans also limit provider networks, meaning that people who are enrolled in them can see only certain providers without paying extra. In comparison to traditional Medicare, Medicare Advantage enrollees on average go to lower-quality hospitals, nursing facilities, and home health agencies but see higher-quality primary care doctors.

Medicare Advantage plans also often require prior authorization – often for important services such as stays at skilled nursing facilities, home health services and dialysis.

Choice overload

Understanding the tradeoffs between premiums, health care access and out-of-pocket health care costs can be overwhelming.

Turning 65 begins the process of taking one of two major paths, which each have a thicket of health care choices.
Rika Kanaoka/USC Schaeffer Center for Health Policy & Economics

Though options vary by county, the typical Medicare beneficiary can choose between as many as 10 Medigap plans and 21 standalone Part D plans, or an average of 43 Medicare Advantage plans. People who are eligible for both Medicare and Medicaid, or have certain chronic conditions, or are in a long-term care facility have additional types of Medicare Advantage plans known as Special Needs Plans to choose among.

Medicare Advantage plans can vary in terms of networks, benefits and use of prior authorization.

Different Medicare Advantage plans have varying and large impacts on enrollee health, including dramatic differences in mortality rates. Researchers found a 16% difference per year between the best and worst Medicare Advantage plans, meaning that for every 100 people in the worst plans who die within a year, they would expect only 84 people to die within that year if all had been enrolled in the best plans instead. They also found plans that cost more had lower mortality rates, but plans that had higher federal quality ratings – known as “star ratings” – did not necessarily have lower mortality rates.

The quality of different Medicare Advantage plans, however, can be difficult for potential enrollees to assess. The federal plan finder website lists available plans and publishes a quality rating of one to five stars for each plan. But in practice, these star ratings don’t necessarily correspond to better enrollee experiences or meaningful differences in quality.

Online provider networks can also contain errors or include providers who are no longer seeing new patients, making it hard for people to choose plans that give them access to the providers they prefer.

While many Medicare Advantage plans boast about their supplemental benefits , such as vision and dental coverage, it’s often difficult to understand how generous this supplemental coverage is. For instance, while most Medicare Advantage plans offer supplemental dental benefits, cost-sharing and coverage can vary. Some plans don’t cover services such as extractions and endodontics, which includes root canals. Most plans that cover these more extensive dental services require some combination of coinsurance, copayments and annual limits.

Even when information is fully available, mistakes are likely.

Part D beneficiaries often fail to accurately evaluate premiums and expected out-of-pocket costs when making their enrollment decisions. Past work suggests that many beneficiaries have difficulty processing the proliferation of options. A person’s relationship with health care providers, financial situation and preferences are key considerations. The consequences of enrolling in one plan or another can be difficult to determine.

The trap: Locked out

At 65, when most beneficiaries first enroll in Medicare, federal regulations guarantee that anyone can get Medigap coverage. During this initial sign-up, beneficiaries can’t be charged a higher premium based on their health.

Older Americans who enroll in a Medicare Advantage plan but then want to switch back to traditional Medicare after more than a year has passed lose that guarantee. This can effectively lock them out of enrolling in supplemental Medigap insurance, making the initial decision a one-way street.

For the initial sign-up, Medigap plans are “guaranteed issue,” meaning the plan must cover preexisting health conditions without a waiting period and must allow anyone to enroll, regardless of health. They also must be “community rated,” meaning that the cost of a plan can’t rise because of age or illness, although it can go up due to other factors such as inflation.

People who enroll in traditional Medicare and a supplemental Medigap plan at 65 can expect to continue paying community-rated premiums as long as they remain enrolled, regardless of what happens to their health.

In most states, however, people who switch from Medicare Advantage to traditional Medicare don’t have as many protections. Most state regulations permit plans to deny coverage, impose waiting periods or charge higher Medigap premiums based on their expected health costs. Only Connecticut, Maine, Massachusetts and New York guarantee that people can get Medigap plans after the initial sign-up period.

Deceptive advertising

Information about Medicare coverage and assistance choosing a plan is available but varies in quality and completeness. Older Americans are bombarded with ads for Medicare Advantage plans that they may not be eligible for and that include misleading statements about benefits.

A November 2022 report from the U.S. Senate Committee on Finance found deceptive and aggressive sales and marketing tactics, including mailed brochures that implied government endorsement, telemarketers who called up to 20 times a day, and salespeople who approached older adults in the grocery store to ask about their insurance coverage.

The Department of Health and Human Services tightened rules for 2024, requiring third-party marketers to include federal resources about Medicare, including the website and toll-free phone number, and limiting the number of contacts from marketers.

Although the government has the authority to review marketing materials, enforcement is partially dependent on whether complaints are filed. Complaints can be filed with the federal government’s Senior Medicare Patrol, a federally funded program that prevents and addresses unethical Medicare activities.

Meanwhile, the number of people enrolled in Medicare Advantage plans has grown rapidly, doubling since 2010 and accounting for more than half of all Medicare beneficiaries by 2023.

Nearly one-third of Medicare beneficiaries seek information from an insurance broker. Brokers sell health insurance plans from multiple companies. However, because they receive payment from plans in exchange for sales, and because they are unlikely to sell every option, a plan recommended by a broker may not meet a person’s needs.

Help is out there − but falls short

An alternative source of information is the federal government. It offers three sources of information to assist people with choosing one of these plans: 1-800-Medicare, medicare.gov and the State Health Insurance Assistance Program, also known as SHIP.

The SHIP program combats misleading Medicare advertising and deceptive brokers by connecting eligible Americans with counselors by phone or in person to help them choose plans. Many people say they prefer meeting in person with a counselor over phone or internet support. SHIP staff say they often help people understand what’s in Medicare Advantage ads and disenroll from plans they were directed to by brokers.

Telephone SHIP services are available nationally, but one of us and our colleagues have found that in-person SHIP services are not available in some areas. We tabulated areas by ZIP code in 27 states and found that although more than half of the locations had a SHIP site within the county, areas without a SHIP site included a larger proportion of people with low incomes.

Virtual services are an option that’s particularly useful in rural areas and for people with limited mobility or little access to transportation, but they require online access. Virtual and in-person services, where both a beneficiary and a counselor can look at the same computer screen, are especially useful for looking through complex coverage options.

We also interviewed SHIP counselors and coordinators from across the U.S.

As one SHIP coordinator noted, many people are not aware of all their coverage options. For instance, one beneficiary told a coordinator, “I’ve been on Medicaid and I’m aging out of Medicaid. And I don’t have a lot of money. And now I have to pay for my insurance?” As it turned out, the beneficiary was eligible for both Medicaid and Medicare because of their income, and so had to pay less than they thought.

The interviews made clear that many people are not aware that Medicare Advantage ads and insurance brokers may be biased. One counselor said, “There’s a lot of backing (beneficiaries) off the ledge, if you will, thanks to those TV commercials.”

Many SHIP staff counselors said they would benefit from additional training on coverage options, including for people who are eligible for both Medicare and Medicaid. The SHIP program relies heavily on volunteers, and there is often greater demand for services than the available volunteers can offer. Additional counselors would help meet needs for complex coverage decisions.

The key to making a good Medicare coverage decision is to use the help available and weigh your costs, access to health providers, current health and medication needs, and also consider how your health and medication needs might change as time goes on.

This article is part of an occasional series examining the U.S. Medicare system.

This story has been updated to remove a graphic that contained incorrect information about SHIP locations. Läs mer…

Mounting pressure to regulate children’s use of technology in the United States raises the question: Is childproofing the internet constitutional?

In response to significant political pressure stemming from alarming revelations about youth experience with digital technologies, a wave of state laws have recently passed across the U.S. They address a variety of online harms affecting children, ranging from exposure to pornography and risky content to manipulative design and social media access.

Meg Leta Jones

Most of the newly passed state laws have already been challenged, and those challenges are working their way up through the appeals process of the court system. In the 2024-25 term, the U.S. Supreme Court will review the constitutionality of a Texas law that obligates porn sites to block underage users in the case Free Speech Coalition v. Paxton.

The controversy found its way to the highest court after a federal district court determined that the law violated the First Amendment but the 5th U.S. Circuit Court of Appeals overturned the lower court decision. The 5th Circuit ruling compared the new law with those banning the sale of pornography magazines to minors in the 1960s, which were ruled constitutional.

Meg Leta Jones

While the court considers the Texas law, the U.S. House will be considering the Kids Online Safety Act, known as KOSA, and the Children and Teens Online Privacy Protection Act, referred to as COPPA 2.0, because it updates the 1998 Children’s Online Privacy Protection Act, COPPA. KOSA addresses addictive design features and parental controls, and COPPA limits data collection and use. Senate leaders merged the two into KOSPA, which passed 91-3.

Age-gating

All these laws demand that platforms treat children differently from adults, and so require platforms to know who is a child and who is an adult. This practice is referred to as age-gating and includes a few methods.

Meg Leta Jones

The old COPPA 1.0 added restrictions, responsibilities and liability for sites directed at kids or sites that had knowledge a user was under 13. Most sites avoid the law’s restrictions and requirements by simply including language in their terms of service forbidding those under 13 from creating an account. Others, like Facebook, eventually went further, asking the user to input their age or date of birth. Kids long ago learned to circumvent the virtually meaningless barrier.

The new wave of laws requires more, using one of two age-gating options: inference and verification. To infer age, the platforms make a good guess by using data generated by the user, either through biometric scans of the face or voice or analysis of the data troves the platforms already collect for targeted advertising. Age verification involves relying on evidence already vetted by another institution such as a government ID or credit card.

While the inference method provokes significant privacy concerns, age-gating advocates argue that age verification at the operating system or browser level is effective and doesn’t burden users or put their privacy at risk.

The last time the constitutionality of age-gating the internet came before the Supreme Court, the law did not survive. In 1997, the Supreme Court in Reno v. ACLU invalidated provisions of the Communications Decency Act enacted to protect children from exposure to explicit material online because they lacked the precision required to narrowly target unprotected speech. Congress made some adjustments and tried again with the Children’s Online Protection Act, not to be confused with COPPA, which ultimately failed as well but under a highly fractured court.

Meg Leta Jones

3 questions

While the constitutional analysis, the technology and the associated research are fairly complex, the outcome depends on answers to three main questions.

To limit sharing or accessing content, the government needs to have a good reason. So, the first question to ask is whether the harms to kids are really that bad and whether the challenged law mitigates the harms. Laws sometimes fail this test.

Like in 2011, when the Supreme Court scuttled California’s attempt to prohibit the sale of violent video games to minors, Utah’s efforts to limit children’s access to social media recently stalled after the government could not convince the district court that a compelling link exists between youth mental health problems and social media.

Meg Leta Jones

The second question is whether restrictions and obligations related to children place burdens on speakers and seekers who have legitimate rights to share and access information freely. While the 5th Circuit maneuvered around this question by relying on the constitutionality of laws that require showing an ID to access offline pornography, other courts have gotten technical. For instance, Arkansas’s Social Media Safety Act did not survive because the court determined adults would be deterred from creating accounts if it involved producing an ID or biometric scans.

This question may come down to not only the technical reality or potential of age-gating but also user experience research.

Meg Leta Jones

The third question is whether alternatives, namely parental controls, work better and leave adult access unhindered. Although some parents and policymakers insist parental controls have not worked to protect children, lower courts considering the new wave of age-gating have found that parental controls remain superior options for addressing online harms to children, just like the Supreme Court did two decades ago.

Meg Leta Jones

Nobody knows how the Supreme Court will answer these three questions this time around. So much has changed. The court has changed, the technology has changed, the research has changed, childhood has changed. If age-gating laws are upheld as constitutional, more big changes are likely to follow. Läs mer…

The Biden administration is using tax credits, regulations and federal investments to shift drivers toward electric vehicles. But drivers will make the switch only if they are confident they can find reliable charging when and where they need it.

Over the past four years, the number of public charging ports across the U.S. has doubled. As of August 2024, the nation had 192,000 publicly available charging ports and was adding about 1,000 public chargers weekly. Infrastructure rarely expands at such a fast rate.

Agencies are allocating billions of dollars authorized through the 2021 Bipartisan Infrastructure Law for building charging infrastructure. This expansion is making long-distance EV travel more practical. It also makes EV ownership more feasible for people who can’t charge at home, such as some apartment dwellers.

Charging technology is also improving. Speeds are now reaching up to 350 kilowatts – fast enough to charge a standard electric car in less than 10 minutes. The industry has also begun to shift to a standard called ISO 15118, which governs the interface between EVs and the power grid.

This standard enables a plug-and-charge system: Just plug in the charger and you’re done, without contending with apps or multiple payment systems. Many existing chargers can be retrofitted to it, rather than needing to install totally new chargers.

Tesla’s decision to open its reliable Supercharger network to non-Tesla vehicles promises to further expand access to fast chargers, although this shift is proceeding slowly.

Severed cable on a vandalized EV charger in the Tarzana neighborhood of Los Angeles on May 16, 2024.
Patrick T. Fallon/AFP via Getty Images

As a researcher studying adoption of EVs, I’m encouraged by these advancements. But there’s still a need to make the charging experience more reliable and accessible for everyone. Stories of charging woes abound online and are a popular focus for EV critics. Here are the key issues drivers are confronting.

Broken, slow or inaccessible

Although EV charging infrastructure has improved in the past several years, reliability is still a critical issue. For example, a 2022 study by researchers at the University of California, Berkeley, found that nearly 30% of public non-Tesla fast chargers in the Bay Area didn’t work. A national study in 2023 that used artificial intelligence models to analyze driver reviews of EV charging stations reached a similar result.

These findings highlight the need for more robust maintenance and monitoring systems across charging networks. Federal guidelines require that chargers must have an average annual “uptime,” or functional time, greater than 97%, but this metric is not always as clear-cut as it sounds. While many charging-point operators report high uptime percentages, their figures often exclude factors such as slow charging speeds or incomplete charges that degrade users’ experience.

Cars waiting to charge at a center in San Diego.
Gil Tal, CC BY-ND

Many drivers complain about throttling – chargers that dispense electricity at less than the maximum rate the car is capable of accepting, so the car charges more slowly than expected. Sometimes this is normal: Cars will charge more slowly as their battery gets closer to full in order to avoid damaging the battery. Other factors can include weather conditions and the number of other vehicles simultaneously using the charging station.

Drivers’ issues with chargers involve more than just uptime. Technical barriers, such as payment processing and vehicle-charger communication, sometimes can prevent a charge from starting or completing.

To ensure that all EVs can charge smoothly at any network, groups such as the National Charging Experience Consortium and CharIN are bringing automakers, charging providers and national laboratories together to address these issues.

Other obstacles are more local, such as long lines at charging stations and chargers that are blocked by parked cars, snowbanks or other obstacles. Finding vehicles with internal combustion engines parked in EV charger spots is common enough that it has a name: getting ICEd. There’s a clear need for more comprehensive solutions to help the charging experience keep pace with demand for EVs.

A Wall Street Journal tech columnist finds abundant chargers – with abundant challenges – in Los Angeles.

A street-level view

At the University of California, Davis, we are working with the California Energy Commission to understand the range of charging obstacles that EV drivers face. As part of a three-year study, we are sending undergraduate students out to test thousands of chargers across the entire state of California.

So far, our results show that just over 70% of charge attempts have succeeded. Many issues have caused failed charges, including traffic congestion at charging stations, damaged or offline chargers, difficulty using navigation apps to find charging stations, and malfunctioning chargers.

Quantity and quality both matter

As federal investments continue to pour money into EV charging, our findings indicate that it’s important to use these resources not only to expand the network but also to improve the user experience at every step.

Areas for improvement include stricter oversight of charger maintenance; more robust uptime requirements that reflect real-world performance; and better collaboration between automakers, charging-point operators and software providers to ensure that vehicles and chargers can work together seamlessly.

The future of EV adoption depends not just on how many chargers are available, but on how reliable and easy they are to use. By addressing specific pain points that drivers face, policymakers and industry leaders can create a charging ecosystem that truly supports the needs of all EV drivers. Reliability is key to unlocking widespread confidence in the EV charging infrastructure and ensuring that it can keep pace with the growing number of electric vehicles on the road. Läs mer…

The “Caitlin Clark effect,” or the impact on women’s basketball from a ponytailed rookie phenomenon from America’s heartland, is real: The 2024 WNBA season shattered viewership, attendance and merchandise sales records.

Clark, however, didn’t get a chance to compete for a league title.

The Connecticut Sun eliminated Clark’s team, the Indiana Fever, in the first round of the playoffs with a two-game sweep, ending her record rookie-of-the-year campaign.

And it may be just the latest chapter in a complicated saga steeped in race.

During the first game of the series, the fingers of Sun guard DiJonai Carrington hit Clark in the eye as Carrington followed through on a block attempt of a Clark shot.

During the next day’s media availability, USA Today columnist Christine Brennan recorded and posted an exchange between herself and Carrington.

In the brief clip, the veteran sports writer asks Carrington, who is Black, if she purposely hit Clark in the eye during the previous night’s game. Though Carrington insisted she didn’t intentionally hit Clark, Brennan persisted, asking the guard if she and a teammate had laughed about the incident. The questions sparked social media outrage, statements from the players union and the league, media personalities weighing in and more.

Hit the pause button here.

As a longtime sports writer who has covered the WNBA – and as a journalism scholar who studies women’s sports and fandom – I’ll concede that Brennan’s line of questioning seems, on its face, like business as usual in sports journalism.

After all, haven’t most baseball fans seen a scribe ask a pitcher if he intentionally beaned a batter?

But Brennan’s questions were not asked in a vacuum. The emergence of a young, white superstar from the heartland has caused many new WNBA fans to pick sides that fall along racial lines. Brennan’s critics claim she was pushing a line of questioning that has dogged Black athletes for decades: that they are aggressive and undisciplined.

Because of that, her defense of her questions – and her unwillingness to acknowledge the complexities – has left this professor disappointed in one of her journalistic heroes.

Brennan and much of the mainstream sports media, particularly those who cover professional women’s basketball, still seem to have a racial blind spot.

The emergence of a Black, queer league

When the WNBA launched in 1997 in the wake of the success of the 1996 Olympic gold-medal-winning U.S. women’s basketball team, it did so under the watch of the NBA.

The NBA set out to market its new product, in part, to a white, heterosexual fan base.

The plan didn’t take hold.

While the league experienced fits and starts in attendance and TV ratings over its lifetime, the demographic makeup of its players is undeniable: The WNBA is, by and large, a Black, queer league.

In 2020, the Women’s National Basketball Players Association reported that 83% of its members were people of color, with 67% self-reporting as “Black/African-American.” While gender and sexual identity hasn’t been officially reported, a “substantial proportion,” the WNBPA reported, identify as LBGTQ+.

In 2020, the league’s diversity was celebrated as players competed in a “bubble” in Bradenton, Florida, due to the COVID-19 pandemic. They protested racial injustice, helped unseat a U.S. senator who also owned Atlanta’s WNBA franchise, and urged voters to oust former President Donald Trump from the White House.

Racial tensions bubble to the surface

In the middle of it all, the WNBA has more eyeballs on it than ever before. And, without mincing words, the fan base has “gotten whiter” since Clark’s debut this past summer, as The Wall Street Journal pointed out in July. Those white viewers of college women’s basketball have emphatically turned their attention to the pro game, in large part due to Clark’s popularity at the University of Iowa.

Money is also pouring into the league through a lucrative media rights deal and new sponsorship partners.

While the rising tide following Clark’s transition to the WNBA is certainly lifting all boats, it is also bringing detritus to the surface in the form of racist jeers from the stands and on social media.

After the Sun dispatched the Fever, All-WNBA forward Alyssa Thomas, who seldom speaks beyond soundbites, said in a postgame news conference: “I think in my 11-year career I’ve never experienced the racial comments from the Indiana Fever fan base. … I’ve never been called the things that I’ve been called on social media, and there’s no place for it.”

Echoes of Bird and Magic

In “Manufacturing Consent,” a seminal work about the U.S. news business, Edward Herman and Noam Chomsky argued that media in capitalist environments do not exist to impartially report the news, but to reinforce dominant narratives of the time, even if they are false. Most journalists, they theorized, work to support the status quo.

In sports, you sometimes see that come to light through what media scholars call “the stereotypical narrative” – a style of reporting and writing that relies on old tropes.

Scholars who study sports media have found that reporters routinely fall back on racial stereotypes. For example, coverage of Black quarterbacks in the NFL as less intelligent and more innately gifted would go on to hinder the progress of Black quarterbacks.

Magic Johnson defends a shot by Larry Bird during the 1985 NBA Finals.
Bob Riha, Jr./Getty Images

In Brennan’s coverage of the Carrington-Clark incident, there appear to be echoes of the way the media covered Los Angeles Lakers point guard Magic Johnson and Boston Celtics forward Larry Bird in the 1980s.

The battles between two of the sport’s greatest players – one Black, the other white – was a windfall for the NBA, lifting the league into financial sustainability.

But to many reporters who leaned on the dominant narrative of the time, the two stars also served as stand-ins for the racial tensions of the post-civil rights era. During the 1980s, Bird and Magic didn’t simply hoop; they were the “embodiments of their races and living symbols of how blacks and whites lived in America,” as scholars Patrick Ferrucci and Earnest Perry wrote.

The media gatekeepers of the Magic-Bird era often relied on racial stereotypes that ultimately distorted both athletes.

For example, early in their careers, Bird and Johnson received different journalistic treatment. In Ferrucci and Perry’s article, they explain how coverage of Bird “fit the dominant narrative of the time perfectly … exhibiting a hardworking and intelligent game that succeeded despite a lack of athletic prowess.” When the “flashy” Lakers and Johnson won, they wrote, it was because of “superior skill.”

When they lost to Bird’s Celtics, they were “outworked.”

Framing matters

Let’s go back to Brennan.

Few have done more for young women in the sports media industry than Brennan. In time, energy and money, she has mentored and supported young women trying to break into the field. She has used her platform to expand the coverage of women’s sports.

Brennan defended herself in a lengthy interview on the podcast “Good Game with Sarah Spain”:

“I think [critics are] missing the fact of what I’m trying to do, what I am doing, what I understand clearly as a journalist, asking questions and putting things out there so that athletes can then have an opportunity to answer issues that are being discussed or out there.”

I don’t think Brennan asking Carrington about the foul was problematic. Persisting with the narrative was.

USA Today sports columnist Christine Brennan accepts an award at The Billies, a ceremony that focused on positive media portrayals of female athletes, in 2006.
Frazer Harrison/Getty Images

Leaning into racial stereotypes is not simply about the language used anymore. Brennan’s video of her persistent line of questioning pitted Carrington against Clark. It could be argued that it used the stereotype of the overly physical, aggressive Black athlete, as well.

At best, Brennan has a blind spot to the strain racism is putting on Black athletes today – particularly in the WNBA. At worst, she is digging in on that tired trope.

A blind spot can be addressed and seen. An unacknowledged racist narrative, however, will persist. Läs mer…

Donald Trump has a particular formula he uses to convey messages to his supporters and opponents alike: He highlights others’ wrongdoings even though he has committed similar acts himself.

On Oct. 3, 2024, Trump accused the Biden administration of spending Federal Emergency Management Agency funds – money meant for disaster relief – on services for immigrants. Biden did no such thing, but Trump did during his time in the White House, including to pay for additional detention space.

This is not the first time he has accused someone of something he had done or would do in the future. In 2016, Trump criticized opponent Hillary Clinton’s use of an unsecured personal email server while secretary of state as “extreme carelessness with classified material.” But once he was elected, Trump continued to use his unsecured personal cellphone while in office. And he has been criminally charged with illegally keeping classified government documents after he left office and storing them in his bedroom, bathroom and other places at his Mar-a-Lago estate.

After complaining about how Hillary Clinton handled classified documents, Donald Trump stored national secrets in a bathroom.
Justice Department via AP

More recently, the Secret Service arrested a man with a rifle who was allegedly planning to shoot Trump during a round of golf. In the wake of this event, Trump accused Democrats of using “inflammatory language” that stokes the fires of political violence. Meanwhile, Trump himself has a long history of making inflammatory remarks that could potentially incite violence.

As a scholar of both politics and psychology, I’m familiar with the psychological strategies candidates use to persuade the public to support them and to cast their rivals in a negative light. This strategy Trump has used repeatedly is called “projection.” It’s a tactic people use to lessen their own faults by calling out these faults in others.

Projection abounds

There are plenty of examples. During his Sept. 10, 2024, debate with Vice President Kamala Harris, Trump claimed that Democrats were responsible for the July 13 assassination attempt against him. “I probably took a bullet to the head because of the things that they say about me,” he declared.

Earlier in the debate he had falsely accused immigrants in Springfield, Ohio, of eating other people’s pets – a statement that sparked bomb threats and prompted the city’s mayor to declare a state of emergency.

Similarly, congressional investigators and federal prosecutors have found that Trump’s remarks called thousands of people to Washington, D.C., on Jan. 6, 2021, encouraging them to violently storm the Capitol in order to stop the counting of electoral votes.

Trump isn’t the only politician who uses projection. His running mate, JD Vance, claimed “the rejection of the American family is perhaps the most pernicious and the most evil thing the left has done in this country.” Critics quickly pointed out that his own family has a history of dysfunction and drug addiction.

Projection happens on both sides of the political aisle. In reference to Trump’s proposed 10% tariff on all imported goods, the Harris campaign launched social media efforts to condemn the so-called “Trump tequila tax.” While Harris frames this proposal as a sales tax that would devastate middle-class families, she deflects from the fact that inflation has made middle-class life more expensive since she and President Joe Biden took office.

How it works

Projection is one example of unconscious psychological processes called defense mechanisms. Some people find it hard to accept criticism or believe information that they wish were not true. So they seek – and then provide – another explanation for the difference between what’s happening in the world and what’s happening in their minds.

In general, this is called “motivated reasoning,” which is an umbrella phrase used to describe the array of mental gymnastics people use to reconcile their views with reality.

Some examples include seeking out information that confirms their beliefs, dismissing factual claims or creating alternate explanations. For example, a smoker might downplay or simply avoid information related to the link between smoking and lung cancer, or perhaps tell themselves that they don’t smoke as much as they actually do.

Motivated reasoning is not unique to politics. It can be a challenging concept to consider because people tend to think they are fully in control of their decision-making abilities and that they are capable of objectively processing political information. The evidence is clear, however, that there are unconscious thought processes at work, too.

Influencing the audience

Audiences are also susceptible to unconscious psychological dynamics. Research has found that over time, people’s minds subconsciously attach emotions to concepts, names or phrases. So someone might have a particular emotional reaction to the words “gun control,” “Ron DeSantis” or “tax relief.”

And people’s minds also unconsciously create defenses for those seemingly automatic emotions. When a person’s emotions and defenses are questioned, a phenomenon called the “backfire effect” can occur, in which the process of controlling, correcting or counteracting mistaken beliefs ends up reinforcing the person’s beliefs rather than changing them.

For instance, some people may find it hard to believe that the candidate they prefer – whom they believe to be the best person for the job – truly lost an election. So they seek another explanation and accept explanations that justify their beliefs. Perhaps they choose to believe, even in the absence of evidence, that the race was rigged or that many fraudulent votes were cast. And when evidence to the contrary is offered, they insist their views are correct.

Vice President Kamala Harris has campaigned with Liz Cheney, right, a prominent Republican who formerly served in Congress.
AP Photo/Mark Schiefelbein

A way out

Fortunately, research shows specific ways to reduce people’s reliance on these automatic psychological processes, including reiterating and providing details of objective facts and – importantly – attempting to correct untruths via a trusted source from the same political party.

For instance, challenges to Democrats’ belief that the Trump-affiliated conservative agenda called Project 2025 is “dangerous” would be more effective coming from a Democrat than from a Republican.

Similarly, a counter to Trump’s claim that the international community is headed toward World War III with Democrats in the White House would be stronger coming from one of Trump’s fellow Republicans. And certainly, statements that Trump “can never be trusted with power again” carries more weight when it comes from the lips of former Republican Vice President Dick Cheney than from any member of the Democratic Party.

Critiques from within a candidate’s own party are not out of the question. But they are certainly improbable given the hotly charged climate that is election season 2024. Läs mer…

Polls show that LGBTQ rights will likely factor into most Americans’ pick for president this November as they choose between former Republican President Donald Trump and Vice President Kamala Harris, a Democrat.

A March 2024 survey by independent pollster PRRI found that 68% of voters will take LGBTQ rights into consideration at the polls. Fully 30% stated that they would vote only for a candidate who shares their views on the issue.

It is no coincidence, then, that LGBTQ rights issues feature prominently in the party platforms.

The Republican Party’s electoral promises include cutting existing federal funding for gender-affirming care and restricting transgender students’ participation in sports. Meanwhile, the Democratic Party platform proposes to outlaw discrimination against LGBTQ people, including passing the Equality Act, which would prohibit discrimination based on sexual orientation and gender identity in housing, health care and public accommodations.

As a legal scholar who has written extensively on the history of LGBTQ rights, I have seen that the clearest indication of how a politician will act once in office is not what they promise on the campaign trail. Instead, it’s what they have done in the past.

Let’s examine their records.

Trump restricted some LGBTQ rights

Trump and his running mate, U.S. Sen. JD Vance of Ohio, are both relatively new to politics, so their records on LGBTQ rights issues are slim.

Trump enacted two policies restricting LGBTQ rights early in his one term in office. The first was his 2017 executive order Promoting Free Speech and Religious Liberty, which reinforced that federal law must respect conscience-based objections to comply with the First Amendment. This order indirectly imperiled LGBTQ rights because many LGBTQ rights battles are fought over whether conservative Christian businesses run afoul of anti-discrimination laws when they refuse to serve same-sex couples.

Trump at an election rally in Ohio on Aug. 4, 2024.
Scott Olson/Getty Images

A few months later, Trump banned transgender individuals from serving in the U.S. armed forces. He ultimately revoked the directive, implementing instead a new policy that allowed existing transgender soldiers to remain in the military but barred new transgender recruits from enlisting.

Vance has opposed trans rights

Vance, a one-term senator, has accrued a record of trying to roll back the rights of transgender Americans during his short time in public office.

Between 2023 and 2024, Vance introduced or sponsored five bills opposing trans rights. One seeks to restrict gender-affirming care for minors by imposing criminal sanctions on doctors who perform such surgeries; another aims to do the same by exposing physicians to civil liability for either prescribing gender affirming hormones or performing surgeries.

JD Vance has made rolling back the rights of transgender Americans a centerpiece of his short congressional career.
Christian Monterrosa/AFP via Getty Images

Another Vance bill would expand health care workers’ ability to make conscience-based objections to transgender rights. One more would amend Title IX, which prohibits discrimination based on sex in education, to limit transgender student participation in athletics.

Vance has also tried to pass legislation that would stop the Department of State from issuing passports with an unspecified “X” gender designation, a policy that launched in 2021. Gender-neutral passports allow transgender, intersex and nonbinary individuals to carry identity documents that reflect their gender identity and avoid what can be significant problems getting through airport security with misgendered IDs.

Congress has not voted on any of these proposals.

A ‘legislative priority’ for Harris

Harris and her vice presidential pick, Minnesota Gov. Tim Walz, have both made LGBTQ rights a legislative priority throughout their long political careers.

Vice President Kamala Harris at a Pride Celebration on June 28, 2023, in Washington, D.C.
Tasos Katopodis/Getty Images for GLAAD

Harris initially took public office in 2003 as San Francisco’s district attorney. In that role, she established a hate crimes unit that prosecuted violence against LGBTQ youth in schools. She also trained prosecutors nationwide to counter the “gay panic” and “trans panic” defenses in court, which is when lawyers attempt to justify violence as a fear-based reaction to the victim’s sexual orientation or gender identity.

Harris was elected California’s attorney general in 2011 and declined to defend the state’s ban on same-sex marriage when opponents challenged the law’s constitutionality before the U.S. Supreme Court. She also joined amicus briefs supporting transgender bathroom access after North Carolina barred transgender people from using bathrooms that did not match the gender on their ID.

Harris, however, did not unequivocally champion LGBTQ rights. In 2015, she opposed two prisoners’ request for urgent gender-confirmation surgery. She has since called for a “better understanding” of transgender health needs.

As a U.S. senator from 2017 to 2021, Harris sponsored bills proposing to better address distinct LGBTQ issues in health care and the criminal justice system. She also sponsored five Senate bills to prohibit discrimination based on sexual orientation and gender identity in employment, housing and public accommodations. Other bills she sponsored focused on LGBTQ youth, aiming to prohibit discrimination in child welfare programs and barring federal funds from supporting so-called conversion therapy of LGBTQ teens.

The Senate did not vote on any of these bills.

As vice president, Harris has been part of what advocates describe as the most pro-LGBTQ administration in U.S. history.

Since 2021, President Joe Biden has issued multiple executive orders to combat discrimination against the LGBTQ community, including by eliminating the Trump-era restrictions on transgender military service. Biden also signed into law the Respect for Marriage Act, which changed the federal definition of marriage from “a man and a woman” to “two individuals.” The statute ensures that the federal government would continue to recognize same-sex unions if the Supreme Court ever reversed its decision to legalize marriage equality.

Walz: Ally in the statehouse

Harris’ vice-presidential pick has a similarly extensive record backing LGBTQ rights.

As a U.S. representative from 2007 to 2019, Walz supported efforts to grant federal benefits to same-sex couples before marriage equality became federal law. He also co-sponsored many of the House versions of the same bills as Harris.

As Minnesota’s governor, Walz has issued several executive orders promoting LGBTQ inclusion and equity and banned conversion therapy for minors. He also declared Minnesota as a “trans refuge state” that will not enforce laws interfering with children’s access to gender-affirming care.

Walz signs a law in 2023 that declares Minnesota to be a refuge for people traveling for gender-affirming medical care.
Glen Stubbe/Star Tribune via Getty Images)

Starkly different records

If elected, Trump has promised to cut federal funds for public schools that “push … gender ideology” and “keep men out of women’s sports.” Harris pledges to “defend the freedom to love who you love openly and with pride.”

As citizens head to the polls in November, they can be confident that, on this topic at least, the candidates mean what they say. Läs mer…

A sculpture of the Virgin Mary showing her giving birth to Jesus was recently attacked and beheaded. Called “Crowning” by the artist Esther Strauss, the sculpture had been part of a temporary exhibition of art outside the Catholic St. Mary Cathedral in Linz, Austria.

The sculpture was controversial for its explicit depiction of birth; an online petition seeking its removal received more than 12,000 signatures. Strauss’ work was part of a project that sought to look at gender equality and the role of women, designed to honor the 100th anniversary of the cathedral’s consecration to the Virgin Mary. The exhibition opened on June 27, 2024, and the statue was vandalized a few days later.

My research as a historian of art has shown me that there has never been only one way of depicting the birth of Christ.

Depiction of birth in early texts

Early Christian writings reveal that the birth of Christ was of keen interest and reflected ideas of the day.

A widely read text from the mid-second century, called the The Protoevangelium of James, gives details about the life of the Virgin and infancy of Christ. As women of that time gave birth with the aid of midwives, the text explained that the Mother of God also was helped in her labor. Sections 19-20 of the text give details about Joseph contacting two midwives.

One woman is said to have doubted the virgin birth. After she inserted her finger into Mary’s vagina, her hands withered. An illustration in a French prayer book from Paris dating to about 1490-1500 shows the midwife with missing hands. The story explained that her hands grew back after she touched the child Christ.

Menologion of Basil II, an 11th-century illuminated Byzantine manuscript with 430 miniatures depicting the Nativity of Christ, now in the Vatican library.
Via Wikimedia Commons

The representation of midwives, as seen in an 11th-century manuscript from Constantinople, is still common in the Eastern church.

Ideas change over time and place

New modes of spirituality in later centuries brought changes in art. St. Bridget of Sweden, who founded a new order of nuns, left a large body or writing, including what she believed were revelations from God. One of her revelations included a vision of Christ’s birth she experienced in Bethlehem in 1371–72.

Although Bridget had given birth eight times, she described Mary’s delivery as “in the twinkling of any eye.” Bridget said she “was unable to notice or discern how or in what member (Mary) was giving birth.” By “member” she may have meant that she did not know through what part of Mary’s body Jesus emerged. Many paintings between the 15th and 16th centuries adopted her vision and showed the child surrounded by light and the Virgin calmly worshipping him.

Hugo van der Goes’ ‘The Adoration of the Shepherds,’ 1476-79.
Florence Galleria degli Uffizi, Florence

A painting by Belgian artist Hugo van der Goes, in about 1475, follows Bridget’s vision of the birth. Instead of being “wrapped in swaddling clothes,” Christ lies naked, perfectly clean, in the “great and ineffable light” that Bridget described.

Each era and community produces art that speaks to its own priorities. Fifteenth-century Italy introduced traditions of a miraculous childbirth that were different from a realistic tradition cherished by early Christians of the second century. I would argue that “Crowning” is but one more example of such cultural change. Here, Mary is an inspiration for other women, physically strong and capable even in the difficult process of giving birth.

The sculpture, when intact, was barely 15 inches tall, a clear indication that it was not made for large-scale public veneration. It was a meditative image designed for a one-on-one encounter – for those who decided to engage. Läs mer…