By Chelsea Cirruzzo and Ben Leonard

With Daniel Payne

Anti-abortion activists are counting on Ohio voters to end the movement's run of state-level losses. | Alice Miranda Ollstein/POLITICO

ABORTION OPPONENTS EYE OHIO — Ohio voters can decide beginning today whether to enshrine abortion protections into the state constitution or be the first state to reject an abortion-rights ballot measure since the Supreme Court overturned Roe v. Wade, POLITICO’s Alice Miranda Ollstein reports.

And though abortion opponents have lost every state referendum since Roe fell last year, they point to several reasons why they think Ohio will be different — some structural and some based on lessons they’ve learned from those losses that are shaping their tactics on the ground in the Buckeye State.

For instance, unlike in Kansas, Kentucky and Michigan — which held their own abortion referendums last year — Ohio has a popular Republican governor campaigning against the measure and GOP state officials rewrote the summary that will appear on the ballot in a way abortion rights supporters say is misleading.

Conservatives see Ohio’s referendum as a bellwether for 2024 when abortion rights could be on the ballot in Arizona, Florida and Missouri and will feature heavily in Democratic efforts to hold the White House and win a swath of state and federal seats.

The abortion-rights groups see equally high stakes in Ohio but insist the same messaging of freedom from government interference that helped their side win in six states last year will work again.

With a month to go before Election Day, abortion opponents in Ohio are working to target voting blocs they feel their counterparts neglected in other states, including college students, communities of color and people who support abortion rights.

“I know it’s going to help us eat into that base that the Democrats have always felt like they had 100 percent,” said Ruth Edmonds with the Center for Christian Virtue, one of the main groups campaigning against the amendment.

WELCOME TO WEDNESDAY PULSE. More mammals than previously thought glow in the dark, including platypuses, koalas and light-colored cats. Time to take another look at my cat’s white underbelly. Send your tips, scoops and feedback to [email protected] and [email protected] and follow along @_BenLeonard_ and @ChelseaCirruzzo.

TODAY ON OUR PULSE CHECK PODCAST, host Kelly Hooper talks with Kaja Klapsa, a former POLITICO fellow and a reporter for the German newspaper Die WELT, who explores what's behind the gender-affirming care in Europe that many Republicans point to when advocating for restricting such care for minors in the U.S. — and explains how the view on the other side of the Atlantic is more nuanced than portrayed.

A message from Coalition to Protect America’s Health Care:

Access to care is on the line. Congress is considering legislation that would cut billions of dollars in funding for hospitals. No other provider is open 24/7 to all who need care, with the ability to treat sicker and more complicated patients, while still responding to emergencies, natural disasters, and more. It’s time to reject cuts to care and stand up for America’s hospitals.

Sen. Bernie Sanders wants to know why the U.S. pays the highest prices in the world for prescription drugs. | Susan Walsh/AP

SANDERS SETS SIGHTS — Senate HELP Chair Bernie Sanders (I-Vt.) has two new targets now that his package aimed at addressing the workforce shortage and funding community health centers has passed out of committee, he tells Daniel.

“We are going to take a look — return to the pharmaceutical industry and ask why we pay by far the highest prices in the world for prescription drugs,” Sanders said. “We are also going to take a look, down the road, at hospitals and how they function in America as well — especially tax-exempt hospitals.”

The latter is already in motion, with his office releasing a report arguing nonprofit hospitals have failed to hold up their end of the bargain with the federal government.

Democrats on the Health, Education, Labor and Pensions Committee say nonprofit hospitals got big tax breaks — but didn’t significantly use them to provide charity care, a requirement to keep their special status. The report listed several large hospital systems with less than 1 percent of their revenue going to charity care.

The HELP majority argued that Congress should:

— Ensure the size of tax breaks is connected to the level of charity care given

— Create clear standards for financial assistance programs, including requiring hospitals to determine patient eligibility and provide help regardless of patients asking for it

— Require nonprofit hospitals to address concerns from underserved patients as required under the Affordable Care Act

The hospital industry disagrees with the report’s findings.

“Today’s report is totally off base and does not fully account for the wide range of community benefits that hospitals provide,” American Hospital Association President Rick Pollack said in a statement. “This tunnel-visioned ‘research’ neglects to consider that under the law community benefit is defined by much more than charity care and includes patient financial aid, health education programs and housing assistance, just to name a few. 

The AHA released its own report Tuesday highlighting the benefit provided by their members. The group argued nearly 7 percent of nonprofit hospitals’ expenses went toward financial assistance for patients.

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W&M EYES HSA PACKAGE — House Ways and Means Committee Republicans look to move to the floor a package of bills the panel approved earlier this year to boost high-deductible health plans and the tax-free savings accounts that come with them, according to two lobbyists familiar with the discussions, Ben reports.

The committee aims to combine the four bills it approved in June and September into one bill so the plans are more enticing for consumers. But the package, and a floor vote on it, is on hold due to the absence of a permanent House speaker, said the lobbyists, who were granted anonymity to discuss the talks. It’s unclear how a new speaker would impact the legislation.

The legislation would let the plans cover telehealth and chronic care services pre-deductible, include the direct primary care payment model and offer on-site health clinics. The bill would also increase the amount of money people could contribute to health savings accounts.

The original bills advanced in committee markups but faced significant Democratic opposition over concerns about who stands to benefit from the changes. The updated package has good odds of passing the Republican-controlled House but could face longer ones in the Democrat-controlled Senate, where advocates hope to appeal to Senate Finance Chair Ron Wyden (D-Ore.).

A Ways and Means Committee GOP spokesperson didn’t respond to requests for comment.

A message from Coalition to Protect America’s Health Care:

TARGETING NONMEDICAL HEALTH FACTORS — HHS awarded $16.7 million in grant awards to support community-based economic development projects, with most jobs created by the grants reserved for low-income people.

Background: The program is part of the White House’s Justice40 initiative, which HHS joined last June. As part of the initiative, the White House directed federal agencies to invest in disadvantaged communities. HHS programs covered under the initiative include a CDC program to help 11 jurisdictions develop climate-resiliency plans and federal assistance toward low-income homes to manage energy costs like heating and cooling.

Why it matters: The social determinants of health, which include housing, economic conditions and transportation, are drivers of health disparities. Last year, HHS Secretary Xavier Becerra said the agency was putting equity “at the core of everything we do."

The agency said the grants, awarded Tuesday, will create 575 full-time jobs in 26 states, with the goal of expanding opportunities for low-income people in communities with high poverty and unemployment. Grant recipients, which are creating the jobs, will also provide transportation, childcare, financial literacy and other support services to keep new employees at work.

A NEW POLITICO PODCAST: POLITICO Tech is an authoritative insider briefing on the politics and policy of technology. From crypto and the metaverse to cybersecurity and AI, we explore the who, what and how of policy shaping future industries. We’re kicking off with a series exploring darknet marketplaces, the virtual platforms that enable actors from all corners of the online world to traffic illicit goods. As malware and cybercrime attacks become increasingly frequent, regulators and law enforcement agencies work different angles to shut these platforms down, but new, often more unassailable marketplaces pop up. SUBSCRIBE AND START LISTENING TODAY.

AdvaMed has launched a new digital health tech division with Shaye Mandle as its executive director. Mandle previously was president and CEO of the Medical Alley Association. Taha Kass-Hout, chief technology officer of GE Healthcare, has been named chair of the division’s board of directors.

ABC News reports that overwhelmed mental health hotlines have been forced to restrict some callers.

Axios reports that Weight Watchers and other weight-loss companies are embracing weight-loss drugs.

POLITICO’s Ashleigh Furlong reports that the European Parliament is close to a deal allowing patients to opt out of sharing their health data.

A message from Coalition to Protect America’s Health Care:

When it matters most, will the care be there? Hospitals are the cornerstones of our communities, but supply chain challenges, high inflation, and workforce shortages have pushed them to the brink – especially those in rural and underserved communities. Now, some in Congress are proposing billions of dollars in cuts to hospital-based care. Nowhere else do patients have access to quality, around-the-clock care, regardless of their ability to pay. America’s hospitals and hospital systems care for sicker patients, provide more complex procedures, are ready on standby during emergencies, and, for many, are the only trauma care centers for miles. Protect care for all to ensure it is there, when it matters most.

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