“It’s all gas, no brakes.” For David Hogg, a vice chair of the Democratic National Committee, there’s little time away from politics right now, especially considering his $20 million campaign to disrupt his own party.  Hogg, a survivor of the 2018 mass shooting in Parkland, Florida, and gun control advocate, is looking to oust what he calls “asleep at the wheel” incumbents in primaries around the US through his political action committee, Leaders We Deserve. It’s a strategy that has won him admirers and detractors, especially from the Democratic establishment, who say he shouldn’t be meddling in primaries, considering he’s now a party boss. So far, Hogg isn’t backing down. But he argues that it might get him kicked out of the DNC altogether. The party is set to vote June 9 to decide whether to redo Hogg’s election. Just seven years ago, Hogg was a high school senior in Parkland, taking speech and debate classes and prepping for college. But all that changed when a former student entered his building and committed the largest mass shooting at a US high school. Hogg quickly co-founded the student-led organization March For Our Lives and became one of the nation’s most prominent gun control activists. Today, he’s the first member of Gen Z to be a vice chair at the DNC and, through Leaders We Deserve, is aggressively challenging the party’s status quo to generate “an attitudinal shift.” “What we’re trying to do is say, across the board, Democrats need to stand up and fight harder,” says Hogg, whose PAC is trying to recruit a fresh slate of young candidates. “And if there’s somebody that feels nervous about potentially being challenged as a member of Congress, they should ask themselves why that is ultimately.” On this week’s More To The Story, Hogg discusses why he’s ruled out running for office himself and how the anger he felt after the shooting in Parkland still drives him today. Subscribe to Mother Jones podcasts on Apple Podcasts or your favorite podcast app. Find More To The Story on Apple Podcasts, Spotify, iHeartRadio, Pandora, or your favorite podcast app, and don’t forget to subscribe.

For over a decade, Americans with private health insurance have enjoyed free access to dozens of types of preventive healthcare: cholesterol medication, prenatal care, and many types of cancer screenings, as well as pre-exposure prophylaxis (PrEP), the “miracle drug” that prevents HIV infection. But on Monday, the US Supreme Court heard oral arguments in a case that could gut the part of the Affordable Care Act that requires insurers to cover these services at zero cost to patients.  Kennedy v. Braidwood Management is at least the eighth time the Supreme Court has weighed in on a major element of the ACA since the health law was passed during the Obama administration in 2010. The lawsuit—filed by a group of Christian businesses and individuals who object to PrEP on religious grounds and Obamacare on ideological ones—takes aim at the US Preventive Services Task Force, a panel of independent, volunteer experts who rate the effectiveness of different types of preventive care. The ACA requires insurers to fully cover services rated “A” or “B” by the task force. Currently, members of the task force are appointed by the Secretary of Health and Human Services. But the case being heard by the Supreme Court argues that the Constitution requires officials who wield that level of power to be nominated by the president and confirmed by the Senate. The legal argument is highly technical, and oral arguments on Monday barely touched on the case’s potentially vast consequences for public health. If the justices agree with the plaintiffs, the task force and its recommendations for the last 15 years could be thrown out, and insurers could start denying coverage or imposing out-of-pocket costs on dozens of currently free preventive screenings and services—meaning many fewer patients would choose to get them. “The people who are going to be hurt most are the people who can’t just pull out a credit card and pay full cost for a service, or pay a $50 co-pay or an $80 co-pay,” says Wayne Turner, senior attorney at the National Health Law Program. “It is a literal lifesaver for people to be able to have some early detection.”  > “The people who are going to be hurt most are the people who can’t just pull > out a credit card and pay full cost for a service, or pay a $50 co-pay or an > $80 co-pay.” Among the threatened services are free HIV screenings for all, and PrEP for those at increased risk of contracting the virus. While HIV has become much less deadly since the mid-1990s, when more than 40,000 people in the United States were dying of related causes annually, there are still nearly 32,000 new infections and 8,000 HIV-linked deaths in the US every year, according to the health policy think tank KFF. PrEP—first approved by the FDA as a daily pill in 2012—lowers the risk of acquiring HIV through sex by 99 percent, and through injection drug use by 74 percent.  But the drug can cost up to $1,800 per month, so when the Preventive Services Task Force gave it an “A” rating in 2019, making it 100% covered by insurance, use of the drug appears to have soared. In 2015, 3 percent of people recommended for a PrEP prescription got one; in 2022, 31 percent did, according to the HIV and Hepatitis Policy Institute. Kennedy v. Braidwood threatens to reverse this progress. At the center of the lawsuit are a trio of Texans who have become conservative heroes in the culture wars against LGBTQ and reproductive rights: A powerful anti-LGBTQ activist, a lawyer known for masterminding Texas’ abortion vigilante law, and the judge they like to bring their cases to. The lead plaintiff, Braidwood Management, is owned by 74-year-old doctor Steven Hotze, a Houston-area alternative medicine guru, conservative powerbroker, far-right activist, and Republican megadonor. As my Mother Jones colleague Tim Murphy has written, Hotze—a former anti-abortion lobbyist—has a history of being very publicly anti-gay going back to at least the 1980s, when he campaigned to make it legal to discriminate against queer people in housing and employment.  In 1985, he endorsed a mayoral candidate who said that the best way to fight the AIDS epidemic was to “shoot the queers.” Years later, Hotze crusaded against same-sex marriage, backing Texas’ statewide ban in 2005 and filing a Supreme Court brief in 2015 arguing that gay marriage was “against the Bible.” (Hotze did not respond to a request for comment.) In 2020, Hotze—who had reportedly become fond of Covid conspiracies and QAnon slogans—allegedly paid a former Houston police captain over $260,000 to conduct a private investigation into voter fraud in Harris County. The investigator pursued the outlandish theory that an air conditioner repairman was using his truck to transport more than 750,000 forged mail ballots signed by undocumented Hispanic children, per a lawsuit filed by the repairman. So the investigator ran the repairman’s truck off the road, then held him at gunpoint while an associate searched the truck, which contained only air conditioner parts. Hotze was charged with aggravated assault with a deadly weapon, among other crimes, for his alleged role in commissioning the private investigation and knowledge of the ex-cop’s plan to confront the repairman. He has pleaded not guilty and says the prosecution is part of a conspiracy against him. Now, he’s at the center of a case that could dismantle a key part of the ACA. Hotze has sued over Obamacare before, challenging the law in 2013 on the grounds that taxation bills must originate in the House, whereas parts of the ACA were first introduced in the Senate. (He also released two techno tracks around that time, with lyrics like: “What would Davey Crockett do? I know what I’m going to do. I’m going to fight Obamacare.”) But lower court judges threw out the case, and in 2016 the Supreme Court declined to hear his appeal. In 2020, Braidwood Management and other plaintiffs sued over the ACA again, this time claiming their religious freedom was being violated by the law’s zero-cost preventive services requirement. Hotze specifically objected to mandatory insurance coverage for PrEP medications, which the lawsuit claimed “facilitate behaviors such as homosexual sodomy, prostitution, and intravenous drug use, which are contrary to Dr. Hotze’s sincere religious beliefs.” > “Our first and most immediate goal is to save this Affordable Care Act > provision, which is so important for so many people.” Representing Hotze and the other plaintiffs was none other than Jonathan Mitchell, the legal strategist and former Texas solicitor general known for crafting Texas’s “bounty hunter” anti-abortion law, SB 8, which cut off most abortion access in his state even before the fall of Roe v. Wade. Last year, Mitchell served as President Donald Trump‘s lawyer in front of the Supreme Court, arguing (successfully) against Colorado’s attempt to exclude Trump from the 2024 ballot. Mitchell has represented Braidwood Management before, in a case claiming that Title VII, the federal law banning discrimination in employment, violated Hotze’s religious beliefs. In both that case, and in the current ACA one, Mitchell filed the lawsuit in the Northern District of Texas, where it was duly assigned to yet another Texas conservative hero, federal Judge Reed O’Connor. In a 2018 ruling involving the constitutionality of the ACA’s individual mandate, O’Connor had already proved willing to strike down the law altogether. The 2018 decision was ultimately overturned by the Supreme Court, which said that O’Connor should have dismissed the case from the get-go. In the Braidwood case, O’Connor handed Mitchell and Hotze a partial win—ruling that the PrEP insurance mandate violated Hotze’s religious freedom, and exempting Braidwood Management from that requirement. Crucially, he also sided with them on an additional, more technical claim that members of the US Preventive Services Task Force are improperly appointed.  It’s that second argument that the Biden administration appealed, and the Supreme Court is now reviewing. Turner, the health policy attorney, says the case comes down to a line in the law that created the task force, declaring it “independent and, to the extent practicable, not subject to political pressure.” Braidwood Management argues that that line makes the task force too unaccountable. (Vaccines and birth control aren’t threatened by this case, since those recommendations are made by other entities—though powerful conservative activists are currently targeting the leading medical group that makes contraception coverage recommendations, as Susan Rinkunas recently reported at Jezebel.) To the surprise of patient advocacy groups, the Trump administration decided earlier this year to fight back against Braidwood’s challenge. Trump, in the past, has tried to repeal the healthcare law. But now, his administration argues that the task force is indeed accountable to Trump’s Senate-confirmed Secretary of Health and Human Services, Robert F. Kennedy Jr. During oral arguments on Monday, the administration’s lawyer claimed the secretary has the power to both appoint and remove members at will, and could use those powers to influence task force recommendations.  Turner says it’s a “real concern” that the Trump administration will eventually attempt to exert greater political control over the task force and its recommendations. “We’ve seen the administration do this in other parts of the federal government and other parts of HHS—purge the current leadership, purge the current members, and fill it with cronies who are going to be rubber stamping,” he says. But says it’s a risk worth taking:  “In my view, our first and most immediate goal is to save this Affordable Care Act provision, which is so important for so many people.” After oral arguments on Monday, court observers predicted that the justices would ultimately reject Hotze and Mitchell’s challenge to Obamacare. The ruling is expected by this summer.

In August 1981, then-President Ronald Reagan signed a bill into law that allowed the development of state-level programs to help disabled people live outside institutions like nursing homes. Known as Home and Community-Based Services (HCBS) waivers, the programs—now in their fourth decade—are funded by Medicaid and run by each individual state. With potential cuts to Medicaid a priority for the Trump administration, the future of HCBS remains in limbo. Donald Trump’s recently confirmed Treasury Secretary Scott Bessent has refused to directly answer questions about whether he’d fall in line with attacks fielded by Republican politicians and Project 2025 by offering a recommendation to cut Medicaid. Reagan couldn’t be described as an advocate for disabled people’s rights—just over a year into his first term, 130,500 people had already been dropped from Social Security Disability Insurance, then and now a lifeline for millions. Like Donald Trump, Reagan wanted to slash government spending at the expense of Americans’ wellbeing. But while the politics of the time forced Reagan’s GOP to field a compromise with some benefits for disabled people—which yielded HCBS—the Trump White House hopes to gut even that, leaving hundreds of thousands of people, if not millions, without the option of community care. > 4.5 million people rely on Medicaid HCBS to avoid institutionalization. Today, roughly 4.5 million people use Medicaid-funded HCBS as an alternative to institutionalization; the waivers help pay for home healthcare workers, durable medical equipment, career coaching, case management and other services. No one claims that the program is perfect—but most criticism has come on the basis of shortfalls, not overspending. More than half a million disabled people remain on waitlists for HCBS, often waiting years for a waiver, and inconsistent requirements across states can make the process confusing and challenging. “It’s a bit of a mix between racism and ableism that believes that certain types of people are undeserving of assistance,” said Mia Ives-Rublee, senior director of the Center for American Progress’ disability justice initiatives, of ongoing attacks on Medicaid. Ives-Rublee said that Project 2025 includes a push to end Medicaid exception waivers—programs that allow states to modify and add to standard Medicaid services, which “specifically implies HCBS funding”—on the grounds that the government is spending too much money on them. About half of disabled children in the United States currently rely on Medicaid, says Jenny McLelland, director of HCBS policy for Little Lobbyists, an organization that advocates for kids with complex health needs. That includes McLelland’s son James, who spent the first year of his life in an institution; the private insurance McLelland’s family then had, like many plans, did not cover long-term home-based care. Only a Medicaid waiver allowed him to go home. McLelland’s HCBS waiver “pays for a nurse who manages his ventilator and breathing while he’s asleep or while we are away from the house to work,” she said. “Medicaid home and community-based services make it possible for my son to have an integrated, joyful life,” taking part in school theater and bringing home straight-A grades. > Cuts will “result in more people either ending up in institutions or ending up > dead,” one expert says. Advocates are worried about the fate of HCBS, which would be relatively easy for states to abandon under the new administration—and which helps millions of people stay out of hospitals, nursing homes, and group homes, which McLelland says frequently deliver “lower-quality care, often at a higher cost.” The GOP has put forth several proposals promoting Medicaid per-capita spending, which would change current spending practices by limiting funds through a formula that doesn’t take into consideration the needs of disabled people. Nicole Jorwic, Caring Across Generations‘ chief of advocacy and campaigns, said that what such changes “would ultimately do is cut the amount of money that the federal government is sending to states per person…just on the consumer price index.” Changes to Medicaid per-capita spending, Jorwic says, “means waiting lists would grow” and that “the types of services being offered are going to narrow” as funding is reduced or withdrawn. Given that federal Medicaid funds already make up, on average, one-third of state budgets, Jorwic believes that state governments coughing up the extra cost “is never going to happen.” She notes that health funding is a popular target even in blue states like Maryland, where a $3 billion state funding shortfall has put hundreds of millions of dollars in funding for its human services department funds—where Medicaid is housed—on the chopping block. Another attack on Medicaid incorporated into Project 2025 has involved lifetime caps on the support of people on Medicaid—caps that many disabled people may hit at a young age. “A state will have to take up the rest of that spending,” said Ives-Rublee, “or they will reduce the coverage of an individual, either by saying we won’t cover these services or by saying we won’t cover you at all.” McLelland is also concerned that attacks on the Affordable Care Act could lead to further damage: disabled people who qualify for Medicaid only due to ACA expansions could be kicked off HCBS as a result. There’s “no ethical way” to deprive people of Medicaid, McLelland says. An ulterior motivation for Republicans’ push to cut Medicaid, Jorwic says, is the Trump administration’s need to cut costs in order to finance an extension—or expansion—of Trump’s first-term tax cuts for the richest Americans and corporations, which Jorwic finds “even more upsetting and ableist.” Ives-Rublee also foresees bleak outcomes if HCBS waivers are defunded or dropped: “That’s going to result in more people either ending up in institutions or ending up dead.”