Almost 1,500 school book bans were put into place around the U.S. in the first half of the current academic year, according to PEN America.
An analysis from the group released Thursday found 1,477 book bans were implemented in the first half of the 2022-2023 school year, affecting 874 unique books. In the six months prior, from January to June 2022, there were 1,149 instances of book bans found by the free speech organization.
How does a bill with no enemies fail to move? That question should trouble anyone who cares about Medicare, about rural health care, and about whether Congress can still do straightforward things.
In plain terms, the CONNECT Act would permanently end the outdated rule that limits Medicare telehealth to patients in rural areas who travel to an approved facility. It would make the patient's home a covered site of care. It would protect audio-only services, critical for seniors without broadband or smartphones, especially for behavioral health. It would ensure that Federally Qualified Health Centers can be reimbursed for telehealth, and it would lock in the pandemic-era flexibilities that Congress has been extending on a temporary basis since 2020. In short, it would turn five years of emergency workarounds into permanent, accountable policy.
The real obstacles have nothing to do with evidence or ideology. The first is cost scoring. The Congressional Budget Office has not yet scored the 2025 version of the bill, but projections typically show increased Medicare spending, perhaps $200 or more per beneficiary per year, because patients who would not have sought in-person care now access services remotely. That projected increase frightens budget hawks in both parties, regardless of whether those members have cosponsored the bill. Until a CBO score exists, no financing solution can be designed, and without one, the Senate Finance Committee has little reason to schedule a markup.
The second obstacle is structural. The CONNECT Act sits in three committees simultaneously: the Senate Finance, House Energy and Commerce, and House Ways and Means. No single committee chair owns it. That fragmentation creates a coordination problem that no amount of lobbying has solved, despite the healthcare sector spending a record $867.5 million on federal lobbying in 2025. On top of that, each short-term extension of telehealth flexibilities reduces the political urgency for permanent reform. The most recent extension, through the Consolidated Appropriations Act of 2026, pushed the deadline to December 31, 2027, giving every member of Congress permission to wait another 21 months. The pattern is familiar: extend, delay, repeat.
Pennsylvania illustrates what is at stake when Congress delays. In 2024, the Commonwealth passed Act 42, a strong telehealth parity law that requires private insurers and Medicaid managed care organizations to cover telehealth at the same standard as in-person care. It passed the state Senate 49 to 1. But Act 42 has a fundamental limitation: it does not — and cannot — cover Medicare. Pennsylvania has roughly 2.8 million Medicare beneficiaries, and not one of them is protected by the state's own telehealth law. Meanwhile, the state faces a projected shortage of more than 6,300 mental health professionals by 2026. For rural seniors in Pennsylvania, telehealth is not a convenience; for many, particularly those relying on audio-only phone calls for behavioral health visits, it is the only realistic way to see a provider. Without permanent
Medicare telehealth coverage, that lifeline, depends on whether Congress remembers to renew it every couple of years.
The stakes go beyond individual patients. In late 2025, Governor Shapiro's administration secured $193 million from CMS as the first tranche of Pennsylvania's Rural Health Transformation Plan, a program designed to build broadband-connected telehealth infrastructure across rural hospitals and clinics, expand remote psychiatric consultations, and create maternal health telehealth hubs. Those investments are built on an assumption: that Medicare will reimburse the telehealth services delivered from those new sites. If Congress does not pass the CONNECT Act, a significant portion of that $193 million will be effectively stranded, and infrastructure built for a reimbursement framework may never be delivered. Pennsylvania is not the only state in this position, but it is a vivid example of how federal inaction can undermine state investment.
The CONNECT Act's problem is not the evidence; rather, the clinical data on telehealth equivalency are mature and broadly accepted. It is not an ideology. The bill has genuine bipartisan support that crosses every conventional political line. The problem is process and path: an unscored bill, fragmented committee jurisdiction, and a Congress that finds it easier to extend than to reform. None of these are reasons to let 2.8 million Pennsylvanians, and tens of millions of Medicare beneficiaries nationally, live with permanent uncertainty about whether their telehealth access will survive the next appropriations cycle. Congress, particularly Pennsylvania's delegation, should push the CONNECT Act to markup and vote well before the December 2027 cliff. The votes are there. The evidence is there. What is missing is the will to use them.
Akshaya Sahasra Ganji is a student at Penn State.
Voters line up at the Oak Lawn Branch Library voting center on Primary Election Day in Dallas on March 3, 2026. Republicans' decision to hold a split primary from the Democrats and to eliminate countywide voting forced Dallas County voters to cast ballots at assigned neighborhood precincts, leading to confusion. Republicans have now decided to use countywide polling locations for the May 26 runoff election.
Dallas County Republicans will agree to allow voters to cast ballots at countywide voting sites for the May 26 runoff election after a switch to precinct-based voting sites caused chaos, the county party chair said Tuesday.
Dallas County Republican Chairman Allen West supported the use of precinct-based sites earlier this month, but said using precincts again for the runoff would expose the county party to “increased risk and voter confusion” because the county is planning to use countywide sites for upcoming municipal elections and early voting.
“To then shift for the one day runoff election to precincts would bring about large scale disruption,” West said in a statement.
That’s what critics say resulted from the Dallas GOP’s decision to use precinct sites on Election Day for the primary on March 3.
Under Texas state law, county political parties have the authority to choose how they administer their elections. During the primary, Dallas County Republicans wouldn’t agree to participate in the countywide polling place program, which the county has used for years.
Because both parties must agree in order for countywide sites to be used, both Democrats and Republicans in the county instead had to cast ballots at assigned neighborhood precincts on the day of the election, though the county was still able to offer countywide sites during the early voting period.
Experts and election officials warned the change was likely to confuse voters, and on Election Day, hundreds, potentially thousands, of voters had to be redirected after finding out they were at the wrong polling locations. As polling hours were extended in the wake of the confusion, at least 1,756 Democratic primary voters in Dallas cast late ballots that ultimately weren’t counted. It’s not clear how many Republican primary voters were impacted by the shift. West did not immediately respond to a request for comment.
Republicans still want a separate primary — which means the parties won’t share poll workers and voting equipment — so runoff voters will likely still see separate lines for Republicans and Democrats, according to West’s statement. West said he plans to sign a contract with the county elections department this week to make the change official. He also signaled it isn’t permanent, saying the party successfully executed the primary and can assess lessons learned “and improve upon the process and procedures for March 2028.”
The move by Dallas Republicans and other county parties to eliminate the countywide polling place program for the primary follows a years-long push by Republicans to ditch it entirely.
Republican critics of countywide voting claim it makes elections less secure because it could allow people “to double or triple vote,” though there’s no evidence that countywide voting is less secure. In addition, Texas election officials have procedures in place to prevent double voting, including the use of technology that helps officials know in real time who has voted and where.
The countywide voting program, which has been in use in Texas for more than 20 years, has allowed counties to save money by using fewer polling locations (and fewer workers and equipment) that are centralized for all voters to use.
Dallas County GOP Will Agree To Use Countywide Voting Sites for May 26 Runoff Election was originally published by Votebeat Texas and is republished with permission.
Natalia Contreras is a reporter for Votebeat in partnership with The Texas Tribune. She is based in Corpus Christi. Contact Natalia at ncontreras@votebeat.org.
Close-up of American Dollar banknotes with stethoscope
The U.S. is entirely alone among major developed countries, its healthcare system functioning like a business.
Profit maximization has become a dominant organizing principle in U.S. health care.
A stunning 77% of Americans believe it is harder now than a generation ago to maintain a middle-class lifestyle, and 65% are so pessimistic that they believe a middle-class lifestyle is “out of reach for most people,” and the American Dream is dead. These grim sentiments primarily reflect the nearly half-century-long stagnation of inflation-adjusted wages and benefits for 111 million working- and middle-class employees - stagnation that has sharply redistributed incomes upward. It has caused the middle class to shrink from 61% of all families in 1971 to just 51% in 2023, while the share of upper-income households nearly doubled from 11% to 19%. Some 30% of all American households are now considered low income, with America’s income disparity more severe even than Russia.
Coupled with inflation, the struggle to achieve a middle-class lifestyle has made affordability a major household concern, especially the cost of health care. Kaiser polling finds that 36% of Americans delayed or skipped needed health care in 2025 due to high costs. And at least before the Iran war spiked gasoline prices, 66% consider health costs more concerning than groceries, housing, or gasoline.
Health care is expensive – embarrassingly expensive. The U.S. is an international outlier. At $14,885 per capita (2024), it is by far the most expensive care on earth, double the $7,371 average of the next 14 richest nations like Australia, Canada, Japan, France, and Germany. Its high cost reflects high prices, not better care – American patients actually average shorter hospital stays and fewer physician visits per capita than abroad.
The U.S. has a few strengths, such as medical research. Yet, despite spending twice as much, the U.S. rationed health care implicitly by cost, resulting in mediocre national outcomes. It is 47th in life expectancy, nearly 4 years shorter on average than other rich nations.
Strong Democracies = Strong Health Systems
While foreign health systems vary in structure, all provide relatively inexpensive, generally high-quality, near-universal public health care. Their lower costs and superior outcomes reflect four seminal differences with America: they do not ration health care by price, they do not trust profit-maximizing firms to supply health care, they have uniform, rigorous regulation of health providers, and their public policies treat health care as a basic human right akin to safe food and water or fire stations. These four differences are a consequence of the higher quality of their democracies - higher quality because their political systems respond effectively to public desires.
In contrast, donor-dominated pay-to-play American politics means policy goals of wealthy elites unsympathetic to workers or government are disproportionately reflected in law. Unlike other rich nations, pay-to-play tarnishes the U.S. as a low-quality, faux democracy on a par with India, Oman, Panama, or Namibia. It is what economists call a Functional Oligarchy.
Opposition from wealthy conservatives, health care providers, and the Republican Party is why America rations health care – why it does not acknowledge health care as a basic human right. This is why 26 million Americans lack health insurance at any point in time, and 100 million lack it at some point every year. That same market ideology is why weakly regulated profit-maximizing corporations provide a majority of America’s health care. It also explains why Republicans fetishize abolishing Obamacare, reject Medicaid expansion at the state level in ten states, are privatizing swaths of the Veterans Administration, and are loosening antimonopoly laws in health care.
Profits over Patients
Profit-maximizing American health providers exhibit behaviors not found in superior health care systems. American providers and insurers, for instance, can profit by overbilling, by refusing claims and pre-authorizations for insubstantial reasons, by charging administrative costs five times higher per capita than in Europe, and by paying executive compensation fourfold higher than in Europe. And they exploit weak regulations to commit fraud and seek oligopoly power to create scarcity.
As the Brookings Institution notes, these rent-seeking, monopoly power, and other flaws in America’s health care markets “have contributed to rapidly rising costs in recent decades.”
In the hospital sector, horizontal consolidation of hospitals has been rapid, raising prices without improving the quality of care. Mega hospital systems now control over 90% of all U.S. hospital beds and 68% of local community hospitals. A 2025 Federal analysis found that such mergers resulted in lower wages for nurses and skilled workers but raised prices from 6% to 65%.
Vertical mergers are also commonplace, with hospitals and insurance companies like UnitedHealth acquiring physicians’ practices. The General Accountability Office (GAO) found that such mergers increased the share of doctors working for hospitals from 30% in 2012 to 47% in 2024. And such consolidation increased physicians’ service fees by 14% on average after acquisition.
Mergers have also created vast hospital deserts. Some 81% of all American counties are officially designated health professional shortage areas, with their 120 million inhabitants lacking proximity or “proper access” to health care providers.
Moreover, America has just 2.7 practicing physicians per 1,000 population compared to an average of 3.8 in Europe. The reason is a residency requirement bottleneck created by law in 1997 that constricts the number of new doctors (while raising their compensation). These pressures are predicted to persist, with estimates of a nationwide doctor shortage within the next decade ranging upward from 86,000.
Private Equity: Buy and Bust
The combination of robust profits on offer and weak regulation has led to a surge in private equity (PE) buyouts in health care. PE firms have been aggressively acquiring hospitals, emergency rooms, physician practices, nursing homes, and hospices, but also less prominent sectors, including veterinary practices and even funeral parlors.
The PE business model focuses on immediately improving profit margins following debt-heavy acquisitions. It prioritizes rapidly compensating limited partners by cost-cutting, reducing staffing, and quickly shedding or mortgaging acquired assets. Critics label the model “Buy and Bust” because acquisitions are typically downsized, dissolved, or rapidly resold – diminishing the quality of patient care in the process. The median holding period for physician practices acquired by PEs is three years.
Analyses find that when the local market share for physician specialties owned by a single PE tops 30%, prices increase an average of 18% for gastroenterology procedures, 13% for dermatology, and 16% for obstetrics and gynecology. And a JAMA article by Harvard and University of Chicago physicians found that hospitals purchased by PEs experienced a 25.4% increase in hospital-acquired adverse medical events (falls, infections), “suggesting poorer quality of inpatient care.”
The elections of 2026 and 2028
The American Health industry delivers inadequate care at exorbitant prices. That extra cost reflects its profit-maximization ethos, fundamentally at odds with superior systems abroad. Those foreign systems (and Medicare) provide lessons for reform. But first, the barrier posed by America’s pay-for-play politics must be overcome – an issue that can only be addressed at the ballot box. Americans are frustrated with their health care system. But reform hinges on the Democratic Party effectively translating that sentiment at the polls in 2026 and 2028.
George Tyler is a former deputy assistant treasury secretary and World Bank official. He is the author of books including Billionaire Democracy and What Went Wrong.
U.S. President Donald Trump speaks to reporters before boarding Air Force One at Palm Beach International Airport on March 23, 2026 in West Palm Beach, Florida.
WASHINGTON – Independent journalist Georgia Fort filmed federal agents outside of her home on Jan. 30. They were coming to arrest her in connection with reporting and filming at an anti-ICE protest in Minneapolis, Minn., almost two weeks prior.
“I don’t feel like I have my First Amendment right as a member of the press,” said Fort in video footage shared with CNN.
She added that “it’s hard to understand how we have a Constitution, constitutional rights, when you can just be arrested for being a member of the press.”
Don Lemon, a former CNN host, was arrested in late January in connection with the same protest. Junn Bollman, an independent photographer, was also arrested in Los Angeles on Feb. 27, according to reporting by the Committee to Protect Journalists.
Arresting journalists escalated the Trump administration’s consistent attacks against the media. Experts warn that these attacks could have a chilling effect on the press, which the public relies on for information and to hold government officials accountable.
“You need the press to find out about your neighbors being abducted if it doesn't happen in front of your eyes, and it usually won't happen in front of your eyes,” said Seth Stern, chief of advocacy at the Freedom of the Press Foundation. “Whatever it is that you are most concerned about and that you want to resist during this administration, you know you're going to need a free press to give you the information you need in order to advocate effectively for your priorities.”
THE PRESIDENT AND THE PRESS
The executive branch needs some amount of secrecy, which means the president and the press have “always been at odds with each other,” said Matt Carlson, professor at the University of Minnesota’s Hubbard School of Journalism and Mass Communication.
“Journalists' job is to bring all these things into the public eye,” said Carlson. “Even presidents who seem supportive of the press are always unhappy when what they're doing is reported into everyone's living rooms or everyone's computers or everyone's newspapers.”
Historian Harold Hozner said Trump is not the first president to criticize the media.
“The first president who talked about fake news was the first president, George Washington,” Hozner said.
Other presidents, including Abraham Lincoln, Woodrow Wilson, and Franklin Delano Roosevelt, attempted to limit the freedom of the press. However, Hozner noted that previous administrations implemented restrictions during genuine national emergencies.
“The difference is that Donald Trump has done this without a national emergency,” Hozner said. “There has been no declaration of war. There has been no insurrection, except when Donald Trump was leaving the presidency in 2021.”
Since Trump became the Republican presidential nominee in 2016, he has regularly attacked journalists, Carlson said.
According to Reporters without Borders, in the two months before the 2024 presidential election, Trump verbally attacked the media over 100 times, not including social media posts. Trump has also insulted female reporters using sexist language and demeaning comments, while others in his administration have publicly argued with journalists.
Carlson said Trump has challenged the legitimacy of journalism as a whole.
“It tears down confidence in the press as an honest broker in seeking the truth. And I think that's the goal,” said Hozner. “I think it's a very purposeful, long-range way to tear down the reputation of the press.”
ESCALATION AFTER ESCALATION
In addition to verbal attacks on the media, the Trump administration has tried to restrict reporting.
In the first few months of the second administration, the White House took over deciding who would make up the press pool, a job previously handled by the White House Correspondents Association.
The Trump administration tried to ban the Associated Press from White House coverage after the publication refused to change its style guide on the Gulf of Mexico to the Gulf of America. The Pentagon also restricted access to only allow journalists who agreed to various reporting restrictions. On Wednesday, they also banned press photographers from briefings on the Iran War.
The administration’s actions against the press have escalated in recent months, with the arrests of three journalists in connection with their reporting at a protest in Minnesota and the raid of a Washington Post journalist’s home.
Previous presidents, including former President Barack Obama, have used tools like the Espionage Act to go after sources that leaked confidential information, said Gabe Rottman, the vice president of policy at the Reporters Committee for Freedom of the Press.
Arresting journalists for their work at protests is an attempt to “criminalize very routine newsgathering practices,” Stern said.
Fort, Pullman, and Lemon were each charged with two crimes. The first was conspiring to deprive people of their civil rights, and the second was violating the Freedom of Access to Clinic Entrances (FACE) Act, which prohibits interfering with access to reproductive health clinics and places of worship.
The journalists’ arrests were "unprecedented" and a “really dramatic overcharge,” Rottman said.
Charges are usually brought at the local or state level, and it is very rare for journalists to be charged, let alone convicted, for covering a protest, Rottman said.
In January, FBI agents executed a search warrant on Washington Post reporter Hannah Natson’s home. Her phone, a watch, a personal laptop, and a work computer were seized. Natson was not the target of the investigation. Authorities were investigating a government contractor accused of possessing classified documents.
Prior to the raid, journalists had some assurance they could publish leaks without retribution, Stern said.
“Now, any journalist who wants to publish a government leak has to consider the possibility that their home might be raided,” Stern said.
Stern added that government leaks have been crucial to some of the most important news in American history.
“If you see these instances in isolation, you can point to precedent for them under administrations of both parties,” said Rottman. “When you put them all together, it's escalation after escalation.”
A CHILLING EFFECT
By going after independent journalists, the Trump administration is trying to “intimidate” reporters everywhere, Stern said. He added that it makes journalists “second-guess whether they can safely do their jobs without getting arrested” and creates a landscape where people are unsure how laws are enforced.
“Nobody knows what routine conduct the administration is going to figure out a way to go after next,” Stern said. “The only discernible rule that you can figure out if you're a journalist trying not to be targeted by this administration is to self-censor, to not report things that the administration doesn't want you to report.”
Stern added that people do not always know when publications are self-censoring.
“We will never know how many stories we didn't read about because a journalist decided to self-censor, or a news outlet decided to self-censor,” Stern said. “We know what news we do read. We don't know what we don't know. So it's entirely possible that some really significant news has not come across our radars because of fear of retribution.”
Despite the Trump administration’s wide variety of attacks, great journalism and reporting critical of the administration has still continued, Stern said.
“From the most powerful to, you could argue, the most vulnerable, the administration is coming up with tactics to suppress news gathering and chill reporting,” Stern said. “The media hasn't rolled over and died.”
According to reporting by PBS, after Lemon’s arrest, he said he would continue reporting.
"I have spent my entire career covering the news. I will not stop now,” Lemon said. “In fact, there is no more important time than right now, this very moment, for a free and independent media that shines a light on the truth and holds those in power accountable."
Marissa Fernandez covers politics for Medill on the Hill.
