By Chelsea Cirruzzo and Ben Leonard

Anti-Abortion activists, like those in Ohio who supported making it more difficult to amend the state constitution, appear to be fragmented over who to blame for their loss on Tuesday. | Darron Cummings/AP Photo

ANTI-ABORTION FORCES REGROUP POST-OHIO — After a staggering loss in Ohio’s special election this week, anti-abortion activists are grappling with how to forge ahead, POLITICO’s Alice Ollstein reports.

What happened in Ohio? The word “abortion” didn’t appear on Tuesday’s ballot, which asked voters whether the state constitution should be made more difficult to amend. But the race also served as a proxy war because of its implications for a November ballot initiative that would codify protections for abortion into the state constitution.

Has this been a trend? Despite achieving their decadeslong goal of overturning Roe more than a year ago, anti-abortion advocates have continued to clash over the past year as their side lost abortion referendums in six other states and was blamed for a disappointing showing in the 2022 midterms. Far from turning the corner this year, they suffered defeat in a pivotal Wisconsin Supreme Court race and came up short again in Ohio.

How are anti-abortion leaders responding? Some point the finger at stingy donors and disengaged GOP leaders for the anti-abortion side getting massively outspent. Others say anti-abortion advocates need to soften their hardline positions and move away from near-total bans without exemptions to stave off electoral disaster.

And still others argue the results are a rebuke for the leave-abortion-to-the-states argument many conservatives make and a demonstration of why federal restrictions are needed.

While some anti-abortion activists urge a full-scale revamp of their messaging, policies or both, many anti-abortion leaders say they want to stay the course going into November. They insist an up-or-down vote on putting abortion protections in the state constitution would be easier to message than the wonky, structural ballot measure before voters this week.

On one hand: Some anti-abortion activists urge Republicans to embrace a more moderate stance than the near-total bans without exemptions in many states, such as a 15-week law that allows some exceptions.

On the other hand: Not everyone agrees, including Students for Life, which plans to tour dozens of Ohio colleges leading up to the fall vote and is among groups arguing that a 15-week ban would still allow more than 90 percent of abortions to take place and advocating for at least a six-week ban on the procedure.

WELCOME TO THURSDAY PULSE. It’s Chelsea and I’m excited to formally introduce myself as a co-author of Morning Pulse and HHS reporter! Before POLITICO, I authored Axios’ D.C. newsletter and reported on health care policy for Inside Health Policy and U.S. News & World Report. I’m also a cat mom to Cloud, a video game aficionado and a Swiftie.

Help me get acclimated to my new job by sending your tips, scoops and feedback to [email protected] and [email protected] and follow along @_BenLeonard and @ChelseaCirruzzo.

TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with Olivia Olander, who reports on the Equal Employment Opportunity Commission's proposed rules for the Pregnant Workers Fairness Act — which would require employer accommodations for pregnant workers, including those with abortion-related issues — and the ensuing Republican backlash.

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Medicine doesn’t work 5 times better when you take it in a hospital. So why do hospitals charge 5 times what they paid for medicines? These costs leave patients and the rest of the health care system paying more. See the new data.

Abortion rights advocates began a push to ask Arizona voters to create a constitutional right to abortion. | Ross D. Franklin/AP Photo

ABORTION ACTIVISTS EYE ARIZONA — A top progressive group wants to build on the huge success Democrats are having with abortion-related ballot initiatives — this time in Arizona, POLITICO’s Zach Montellaro reports.

Fresh off their 14-point victory in Ohio on Tuesday, progressive groups are eyeing the Southwest battleground state as the next place to ensure abortion rights after the fall of Roe v. Wade. Arizona bans abortion after 15 weeks of pregnancy.

A memo from the progressive organizing group Indivisible to its donors argues that Democrats should continue riding the backlash to the Supreme Court’s 2022 decision in Dobbs into 2024 in key competitive states nationwide. The group hopes an abortion ballot initiative in Arizona would increase the likelihood that abortion-rights voters turn up in a state that could help decide the next presidential election.

What happened last time: Arizonans already tried and failed to get an initiative codifying abortion rights on the ballot after Roe was overturned. But organizers ran out of time ahead of a July deadline to qualify, collecting only about half of the needed signatures.

What’s next: Earlier this week, a coalition of groups — including the state chapters of the ACLU, Planned Parenthood and pro-choice group NARAL — announced it would support a new political committee, Arizona for Abortion Access, to sponsor a ballot initiative campaign for 2024. On Tuesday, activists in Arizona released their proposed constitutional amendment language, which could appear on the November 2024 ballot.

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TRIALS SPIKE FOR GENE THERAPIES — Clinical trials for cell and gene therapies are surging, according to the latest data from the Alliance for Regenerative Medicine, Ben reports.

About 1,000 trials were conducted in 2018, but this year, there are more than 1,600, the organization said, reflecting growing investment in the sector. The FDA could approve up to nine such therapies this year, which would be an all-time high.

View from Congress: The growth comes as Congress weighs allowing the expansion of value-based purchasing agreements between states and drugmakers through the MVP Act, which the industry has backed. Critics have charged it could become a loophole for pharma to pay lower rebates to states.

The legislation’s path forward is unclear, with Democrats divided over the bill. Just three Democrats supported it in a House Energy and Commerce Committee markup in May.

HHS OFFICIALS APPEAL SOCIAL MEDIA STAY — Oral arguments are scheduled today in an unusual social media censorship case at the U.S. Court of Appeals for the Fifth Circuit.

The Biden administration is appealing a paused July 4 federal order barring federal officials, including high-profile health officials, from having any contact with social media firms.

The suit: The appeal concerns a suit filed by the attorneys general of Missouri and Louisiana, who allege the Biden administration pressured social media companies to censor posts that contained disinformation on Covid-19 and elections. Among the officials named in the suit were Surgeon General Vivek Murthy and Health and Human Services Secretary Xavier Becerra.

On July 4, a federal Louisiana judge wrote in his order that the administration had likely violated the First Amendment, calling their efforts “Orwellian.” A federal appeals court has temporarily put that order on hold.

The White House’s take: The Justice Department has said officials didn’t threaten or coerce companies to de-platform certain speech but simply encouraged them to police their platforms in light of health disinformation, which includes anti-masking and anti-vaccines, POLITICO’s Matt Berg and Josh Gerstein previously reported.

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MA PLANS GET BONUSES — Federal spending on Medicare Advantage bonus payments has skyrocketed since 2015, per a new KFF report, as enrollment in these plans continues to grow.

The bonuses are based on the star rating system, a system that the Medicare Payment Advisory Commission recommended overhauling in 2020, arguing that the system doesn’t adequately measure plan quality.

Medical Advantage bonus payments are on track to reach at least $12.8 billion this year, a 30 percent increase from 2022 and more than quadrupled since 2015, KFF says. Meanwhile, 26 million, or 85 percent, of Medicare Advantage enrollees in 2023 were in plans that received bonuses.

HITTING YOUR INBOX AUGUST 14—CALIFORNIA CLIMATE: Climate change isn’t just about the weather. It's also about how we do business and create new policies, especially in California. So we have something cool for you: A brand-new California Climate newsletter. It's not just climate or science chat, it's your daily cheat sheet to understanding how the legislative landscape around climate change is shaking up industries across the Golden State. Cut through the jargon and get the latest developments in California as lawmakers and industry leaders adapt to the changing climate. Subscribe now to California Climate to keep up with the changes.

CDC SAYS COVID SHOTS LIKELY COMING IN THE FALL — CDC Director Mandy Cohen says updated Covid-19 shots against XBB.1.5, a subvariant of Omicron, are likely to become available by mid-September once manufacturers receive FDA authorization. The CDC will also issue its own recommendations.

“We are likely to see this be — and again, I don’t want to get ahead of the scientists that are going to do their work in the next few weeks — but we are likely to see this as a recommendation as an annual Covid shot, just like we have an annual flu shot,” Cohen told Andy Slavitt, President Joe Biden’s former senior adviser for the Covid response, Wednesday on his podcast “In the Bubble with Andy Slavitt.”

What to watch: Moderna, Pfizer and Novavax have all filed their updated shots to the FDA for authorization after the agency recommended in June that they tailor their shots against the XBB.1.5 strain.

And while another Omicron subvariant, EG.5, or “Eris,” has gained traction in recent months, experts tell POLITICO’s Andrew Zhang that currently available vaccines are still likely to be effective.

Dr. Steven Barnard has been named chief technology officer of biotech company Illumina.

Dr. José Romero, head of the National Center for Immunization and Respiratory Diseases for the past 14 months, is leaving the CDC. He will be replaced by Dr. Demetre Daskalakis, who was deputy director of the White House’s mpox response team, STAT reports.

POLITICO’s Ashleigh Furlong reports on calls from the World Health Organization for mosquito nets to combat mosquito-borne illnesses in Europe.

Muck Rock reports on criticisms that the NIH’s long Covid initiative has failed to test meaningful treatments in more than two years.

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Five times more. That’s how much more a hospital can charge you for a medicine compared to what they paid for it. And this massive markup winds up creating a significant financial burden for patients and the health care system in general. Learn more.

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