This week, a colleague asked me to explain the tone we might use for a new project in a slide with a few bullets and a lot of pictures. As you can imagine, I prefer words. Sure, a picture is worth 1,000 words, but I’d prefer to write 2,174 words so I can prove my point my way, rather than leave it up to interpretation. But they didn’t want a dissertation. They wanted a mood board, and I obliged. I’m not saying I caught the bug, but when I sat down to write this week’s first article on the states with the highest STI rates, it occurred to me that a series of maps might, in fact, be worth 2,174 words.
Read on. Or is that look on?
The States with the Most STIs Have A Lot of Other Things In Common
U.S. News and World Report recently published a list of the states with the highest STI rates. To be fair, unlike its annual list of the best colleges which is based on a complicated algorithm of graduation rates, student/faculty ratios, and whether the dining hall’s scrambled eggs are edible, this is just CDC data ranked. Specifically, the news outlet (are there even magazines anymore?) took the cumulative rates of gonorrhea, chlamydia, and syphilis per 100,000 residents and ranked them highest to lowest. The top 10 made a list that no state tourism board will want to advertise.
These states have a lot of things in common, most of which are also things the tourism boards probably aren’t putting in their tri-fold brochures. The overlap is not perfect but check out these other maps.
They are among the poorest states.
They did not expand Medicaid, leaving fewer people in the state with access to health care.
They had the strictest abortion laws ready to go when Roe was overturned or have passed them since.
If sex education is taught at all, it must tell young people that sex is only appropriate in marriage.
They’re waging war against vulnerable young people by passing bans on gender affirming care for trans kids
They won’t say gay.
I know very well that correlation is not causation (that’s not how it f**king works) and that it takes real research, not just some fun with a free online mapmaker to explain the interconnection of poverty, education, and health outcomes. I also know that institutional racism runs through all of it.
Still, my colorful maps (all of which are linked back to the original sources because I don’t get research credit here) paint portraits of states that are struggling to meet the health needs of their citizens. In many cases, it is for lack of trying: these states keep putting politics above the health needs of both young people and adults.
I blame elected officials who are pushing a conservative agenda that lacks empathy and leaves their constituents vulnerable. In this case it’s vulnerable to chlamydia, gonorrhea, and syphilis. The most alarming statistic in STIs today involves congenital syphilis—infections passed from mother to infant during pregnancy or birth. Cases of this have gone up 750% since 2012. Congenital syphilis can lead to miscarriage, stillbirth, prematurity, low birth weight, and death shortly after birth. Each of the nearly 3,000 cases in 2021 represented not just a failure of STI prevention but a failure of prenatal health care.
While I don’t blame the residents of these states for their presence on so many top 10 lists, I do get confused when I look at one more map.
They keep voting against their own best interests.
Covering Contraception: Will We Have to Pay for OTC Birth Control?
Opill is coming over the counter soon, but we still don’t know who is going to pay for it. This is the question that the Biden administration is asking right now, and they’re looking for public feedback.
In my days of taking the birth control pill (or should I say in my decades of taking the birth control pill because my love affair with oral contraception started in the late 80s and ended around this time last year), we had to pay for the precious pack even if we had insurance. I honestly don’t remember what it cost, but I think it was $30 to $50 or so each month. Then came the Affordable Care Act which said that prescription contraceptive methods had to be covered by insurers at no cost to the consumer. Those precious pill packs were suddenly free. Yay.
This mandate—which has been challenged numerous times in court because nuns and craft store owners don’t want you to have free birth control—was part of an overall push to cover preventative medicine but only applies to things prescribed by a health care provider. That wasn’t an issue in birth control until now because other than condoms which are pretty cheap, there were no over-the-counter options. (There is also emergency contraception, but that’s kind of a category of its own since it’s not meant to be a regular method of birth control. EC is usually paid for out of pocket and costs about $50 a pack.)
The Biden Administration’s current Request for Information (RFI) also covers tobacco smoking cessation products, folic acid used during pregnancy, and breast-feeding supplies. It notes that some of these items are already paid for under the ACA’s preventative care mandate but still only when prescribed by a provider.
Of course if we make that rule for Opill, we’ve basically defeated the purpose of making it available over the counter.
The price of birth control is an important factor in getting people to use it. A KFF study found that among females of reproductive age who report being likely to use OTC birth control pills, 39% would be willing and able to pay $1-$10 per month for them, 34% would pay $11-20 a month, and just 16% said they would be willing and able to pay more than $20 per month. Even at $1 a month, it would be more expensive for many people with health insurance to get Opill than it is for them to keep getting refills of Loloestrin or Yaz or whatever prescription pill pack they prefer. You really can’t beat free. (Thanks, Obama! No really, thank you.)
There’s also a process question here. Insurance companies seem to thrive on paperwork. Getting them to cover Opill without a prescription for free would be great, but would you still have to go the pharmacy to get it rather than just plucking it off the shelves? Have you seen the line at my CVS lately?
We’re in a pill paying pickle, and HHS would like of our help figuring it out.
MAGA Logic: Let’s Blow Up a School to Save the Children
Erin Reed, who reports on trans issues in another great Substack, Erin in the Morning, recently wrote about an elementary school in Highland Park, Illinois that was evacuated for several days because it had received bomb threats.
Why threaten second graders, you ask? Well, a few days earlier, Libs of TikTok had posted a picture of a classic elementary school classroom complete with tables, book bins, a colorful rug for circle time, and a pride flag. “Libs” questioned why children should learn under a massive “progress pride flag.” (Progress is good people, we like progress.)
The TikTok got over 580,000 views and those who commented started calling the teachers groomers and pedophiles. Then the bomb threats started rolling in, and staff decided that the elementary school kids weren’t safe in their own school. (It’s worth noting that this town was the site of a mass shooting during its 2022 Independence Day parade which killed 7 people and injured 48 others.)
The hypocrisy here—which really does boil down top let’s blow up a school or at least say we’re going to in order to save the children from gay peole—is mind boggling but no longer surprising. Libs of TikTok has a history of saying just this. As Reed explains, the account has been tied to 66 separate threat events including ones against hospitals across the country that provide gender affirming care.
The person behind the account, Chaya Raichik, remained anonymous until she did a “face reveal” on Tucker Carlson’s Fox News show back when Tucker Carlson still had a Fox News show. But if you were worried about her safety, you can relax, Ron DeSantis offered her sanctuary in the governor’s mansion in case any actual liberals of TikTok tried to make threats against her.
Real libs don’t do that. But we do eat quiche.
Wow! Very impressed by your use of the all those maps. They really say it about as clearly as you can