Cynthia H. Chuang, Penn State and Carol S. Weisman, Penn State

On June 24, 2022, the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization eliminated a nearly 50-year constitutional right to abortion and returned the authority to regulate abortion to the states.

The Dobbs ruling, which overturned Roe v. Wade, has vastly reshaped the national abortion landscape. Three years on, many states have severely restricted access to abortion care. But the decision has also had a less well-recognized outcome: It is increasingly jeopardizing access to contraception.

We are a physician scientist and a sociologist and health services researcher studying women’s health care and policy, including access to contraception. We see a worrisome situation emerging.

Even while the growing limits on abortion in the U.S. heighten the need for effective contraception, family planning providers are less available in many states, and health insurance coverage of some of the most effective types of contraception is at risk.

A growing demand for contraception

Abortion restrictions have proliferated around the country since the Dobbs decision. As of June 2025, 12 states have near-total abortion bans and 10 states ban abortion before 23 or 24 weeks of gestation, which is when a fetus is generally deemed viable. Of the remaining states, 19 restrict abortion after viability and nine states and Washington have no gestational limits.

It’s no surprise that women living in states that ban or severely restrict abortion may be especially motivated to avoid unintended pregnancy. Even planned pregnancies have grown riskier, with health care providers fearing legal repercussions for treating pregnancy-related medical emergencies such as miscarriages. Such concerns may in part explain emerging research that suggests the use of long-acting contraception such as intrauterine devices, or IUDs, and permanent contraception – namely, sterilization – are on the rise.

A national survey conducted in 2024 asked women ages 18 to 49 if they have changed their contraception practices “as a result of the Supreme Court overturning Roe v. Wade.” It found that close to 1 in 5 women began using contraception for the first time, switched to a more effective contraceptive method, received a sterilization procedure or purchased emergency contraception to keep on hand.

A study in Ohio hospitals found a nearly 16% increase in women choosing long-acting contraception methods or sterilization in the six months after the Dobbs decision, and a 33% jump in men receiving vasectomies. Another study, which looked at both female and male sterilization in academic medical centers across the country, also reported an uptick in sterilization procedures for young adults ages 18 to 30 after the Dobbs decision, through 2023.

A loss of contraception providers

Ironically, banning or severely restricting abortion statewide may also diminish capacity to provide contraception.

To date, there is no compelling evidence that OB-GYN doctors are leaving states with strict abortion laws in significant numbers. One study found that states with severe abortion restrictions saw a 4.2% decrease in such practitioners compared with states without abortion restrictions.

However, the Association of American Medical Colleges reports declining applications to residency training programs located in states that have abortion bans – not just for OB-GYN training programs, but for residency training of all specialties. This drop suggests that doctors may be overall less likely to train in states that restrict medical practice. And given that physicians often stay on to practice in the states where they do their training, it may point to a long-term decline in physicians in those states.

But the most significant drop in contraceptive services likely comes from the closure of abortion clinics in states with the most restrictive abortion policies. That’s because such clinics generally provide a wide range of reproductive services, including contraception. The 12 states with near-total abortion bans had 57 abortion clinics in 2020, all of which were closed as of March 2024. One study reported a 4.1% decline in oral contraceptives dispensed in those states.

Contraception under threat

The Dobbs decision has also encouraged ongoing efforts to incorrectly redefine some of the most effective contraceptives as medications that cause abortion. These efforts target emergency contraceptive pills, known as Plan B over-the-counter and Ella by prescription, as well as certain IUDs. Emergency contraceptive pills are up to 98% effective at preventing pregnancy after unprotected sex, and IUDs are 99% effective.

Neither method terminates a pregnancy, which by definition begins when a fertilized egg implants in the uterus. Instead, emergency contraceptive pills prevent an egg from being released from the ovaries, while IUDs, depending on the type, prevent sperm from fertilizing an egg or prevent an egg from implanting in the uterus.

Conflating contraception and abortion spreads misinformation and causes confusion. People who believe that certain types of contraception cause abortions may be dissuaded from using those methods and rely on less effective methods. What’s more, it may affect health insurance coverage.

Medicaid, which provides health insurance for low-income children and adults, has been required to cover family planning services at no cost to patients since 1972. Since 2012, the Affordable Care Act has required private health insurers to cover certain women’s health preventive services at no cost to patients, including the full-range of contraceptives approved by the Food and Drug Administration.

According to our research, the insurance coverage required by the Affordable Care Act has increased use of IUDs, which can be prohibitively expensive when paid out of pocket. But if IUDs and emergency contraceptive pills were reclassified as interventions that induce abortion, they likely would not be covered by Medicaid or the Affordable Care Act, since neither type of health insurance requires coverage for abortion care. Thus, access to some of the most effective contraceptive methods could be jeopardized at a time when the right to terminate an unintended or nonviable pregnancy has been rolled back in much of the country.

Indeed, Project 2025, the conservative policy agenda that the Trump administration appears to be following, specifically calls for removing Ella from the Affordable Care Act contraception coverage mandate because it is a “potential abortifacient.” And politicians in multiple states have expressed support for the idea of restricting these contraceptive methods, as well as contraception more broadly.

On the third anniversary of the Dobbs decision, it is clear that its ripple effects include threats to contraception. Considering that contraception use is almost universal among women in their reproductive years, in our view these threats should be taken seriously.

Cynthia H. Chuang, Professor of Medicine and Public Health Sciences, Penn State and Carol S. Weisman, Distinguished Professor Emerita of Public Health Sciences, Penn State

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Pooja Shree Chettiar, Texas A&M University and Siddhesh Sabnis, Texas A&M University

Pain is easy to understand until it isn’t. A stubbed toe or sprained ankle hurts, but it makes sense because the cause is clear and the pain fades as you heal.

But what if the pain didn’t go away? What if even a breeze felt like fire, or your leg burned for no reason at all? When pain lingers without a clear cause, that’s neuropathic pain.

We are neuroscientists who study how pain circuits in the brain and spinal cord change over time. Our work focuses on the molecules that quietly reshape how pain is felt and remembered.

We didn’t fully grasp how different neuropathic pain was from injury-related pain until we began working in a lab studying it. Patients spoke of a phantom pain that haunted them daily – unseen, unexplained and life-altering.

These conversations shifted our focus from symptoms to mechanisms. What causes this ghost pain to persist, and how can we intervene at the molecular level to change it?

More than just physical pain

Neuropathic pain stems from damage to or dysfunction in the nervous system itself. The system that was meant to detect pain becomes the source of it, like a fire alarm going off without a fire. Even a soft touch or breeze can feel unbearable.

Neuropathic pain doesn’t just affect the body – it also alters the brain. Chronic pain of this nature often leads to depression, anxiety, social isolation and a deep sense of helplessness. It can make even the most routine tasks feel unbearable.

About 10% of the U.S. population – tens of millions of people – experience neuropathic pain, and cases are rising as the population ages. Complications from diabetes, cancer treatments or spinal cord injuries can lead to this condition. Despite its prevalence, doctors often overlook neuropathic pain because its underlying biology is poorly understood.

There’s also an economic cost to neuropathic pain. This condition contributes to billions of dollars in health care spending, missed workdays and lost productivity. In the search for relief, many turn to opioids, a path that, as seen from the opioid epidemic, can carry its own devastating consequences through addiction.

GluD1: A quiet but crucial player

Finding treatments for neuropathic pain requires answering several questions. Why does the nervous system misfire in this way? What exactly causes it to rewire in ways that increase pain sensitivity or create phantom sensations? And most urgently: Is there a way to reset the system?

This is where our lab’s work and the story of a receptor called GluD1 comes in. Short for glutamate delta-1 receptor, this protein doesn’t usually make headlines. Scientists have long considered GluD1 a biochemical curiosity, part of the glutamate receptor family, but not known to function like its relatives that typically transmit electrical signals in the brain.

Instead, GluD1 plays a different role. It helps organize synapses, the junctions where neurons connect. Think of it as a construction foreman: It doesn’t send messages itself, but directs where connections form and how strong they become.

This organizing role is critical in shaping the way neural circuits develop and adapt, especially in regions involved in pain and emotion. Our lab’s research suggests that GluD1 acts as a molecular architect of pain circuits, particularly in conditions like neuropathic pain where those circuits misfire or rewire abnormally. In parts of the nervous system crucial for pain processing like the spinal cord and amygdala, GluD1 may shape how people experience pain physically and emotionally.

Fixing the misfire

Across our work, we found that disruptions to GluD1 activity is linked to persistent pain. Restoring GluD1 activity can reduce pain. The question is, how exactly does GluD1 reshape the pain experience?

In our first study, we discovered that GluD1 doesn’t operate solo. It teams up with a protein called cerebellin-1 to form a structure that maintains constant communication between brain cells. This structure, called a trans-synaptic bridge, can be compared to a strong handshake between two neurons. It makes sure that pain signals are appropriately processed and filtered.

But in chronic pain, the bridge between these proteins becomes unstable and starts to fall apart. The result is chaotic. Like a group chat where everyone is talking at once and nobody can be heard clearly, neurons start to misfire and overreact. This synaptic noise turns up the brain’s pain sensitivity, both physically and emotionally. It suggests that GluD1 isn’t just managing pain signals, but also may be shaping how those signals feel.

What if we could restore that broken connection?

In our second study, we injected mice with cerebellin-1 and saw that it reactivated GluD1 activity, easing their chronic pain without producing any side effects. It helped the pain processing system work again without the sedative effects or disruptions to other nerve signals that are common with opioids. Rather than just numbing the body, reactivating GluD1 activity recalibrated how the brain processes pain.

Of course, this research is still in the early stages, far from clinical trials. But the implications are exciting: GluD1 may offer a way to repair the pain processing network itself, with fewer side effects and less risk of addiction than current treatments.

For millions living with chronic pain, this small, peculiar receptor may open the door to a new kind of relief: one that heals the system, not just masks its symptoms.

Pooja Shree Chettiar, Ph.D. Candidate in Medical Sciences, Texas A&M University and Siddhesh Sabnis, Ph.D. Student in Medical Sciences, Texas A&M University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Jennifer D. Oliva, Indiana University

Over the past decade, health insurance companies have increasingly embraced the use of artificial intelligence algorithms. Unlike doctors and hospitals, which use AI to help diagnose and treat patients, health insurers use these algorithms to decide whether to pay for health care treatments and services that are recommended by a given patient’s physicians.

One of the most common examples is prior authorization, which is when your doctor needs to
receive payment approval from your insurance company before providing you care. Many insurers use an algorithm to decide whether the requested care is “medically necessary” and should be covered.

These AI systems also help insurers decide how much care a patient is entitled to — for example, how many days of hospital care a patient can receive after surgery.

If an insurer declines to pay for a treatment your doctor recommends, you usually have three options. You can try to appeal the decision, but that process can take a lot of time, money and expert help. Only 1 in 500 claim denials are appealed. You can agree to a different treatment that your insurer will cover. Or you can pay for the recommended treatment yourself, which is often not realistic because of high health care costs.

As a legal scholar who studies health law and policy, I’m concerned about how insurance algorithms affect people’s health. Like with AI algorithms used by doctors and hospitals, these tools can potentially improve care and reduce costs. Insurers say that AI helps them make quick, safe decisions about what care is necessary and avoids wasteful or harmful treatments.

But there’s strong evidence that the opposite can be true. These systems are sometimes used to delay or deny care that should be covered, all in the name of saving money.

A pattern of withholding care

Presumably, companies feed a patient’s health care records and other relevant information into health care coverage algorithms and compare that information with current medical standards of care to decide whether to cover the patient’s claim. However, insurers have refused to disclose how these algorithms work in making such decisions, so it is impossible to say exactly how they operate in practice.

Using AI to review coverage saves insurers time and resources, especially because it means fewer medical professionals are needed to review each case. But the financial benefit to insurers doesn’t stop there. If an AI system quickly denies a valid claim, and the patient appeals, that appeal process can take years. If the patient is seriously ill and expected to die soon, the insurance company might save money simply by dragging out the process in the hope that the patient dies before the case is resolved.

This creates the disturbing possibility that insurers might use algorithms to withhold care for expensive, long-term or terminal health problems , such as chronic or other debilitating disabilities. One reporter put it bluntly: “Many older adults who spent their lives paying into Medicare now face amputation or cancer and are forced to either pay for care themselves or go without.”

Research supports this concern – patients with chronic illnesses are more likely to be denied coverage and suffer as a result. In addition, Black and Hispanic people and those of other nonwhite ethnicities, as well as people who identify as lesbian, gay, bisexual or transgender, are more likely to experience claims denials. Some evidence also suggests that prior authorization may increase rather than decrease health care system costs.

Insurers argue that patients can always pay for any treatment themselves, so they’re not really being denied care. But this argument ignores reality. These decisions have serious health consequences, especially when people can’t afford the care they need.

Moving toward regulation

Unlike medical algorithms, insurance AI tools are largely unregulated. They don’t have to go through Food and Drug Administration review, and insurance companies often say their algorithms are trade secrets.

That means there’s no public information about how these tools make decisions, and there’s no outside testing to see whether they’re safe, fair or effective. No peer-reviewed studies exist to show how well they actually work in the real world.

There does seem to be some momentum for change. The Centers for Medicare & Medicaid Services, or CMS, which is the federal agency in charge of Medicare and Medicaid, recently announced that insurers in Medicare Advantage plans must base decisions on the needs of individual patients – not just on generic criteria. But these rules still let insurers create their own decision-making standards, and they still don’t require any outside testing to prove their systems work before using them. Plus, federal rules can only regulate federal public health programs like Medicare. They do not apply to private insurers who do not provide federal health program coverage.

Some states, including Colorado, Georgia, Florida, Maine and Texas, have proposed laws to rein in insurance AI. A few have passed new laws, including a 2024 California statute that requires a licensed physician to supervise the use of insurance coverage algorithms.

But most state laws suffer from the same weaknesses as the new CMS rule. They leave too much control in the hands of insurers to decide how to define “medical necessity” and in what contexts to use algorithms for coverage decisions. They also don’t require those algorithms to be reviewed by neutral experts before use. And even strong state laws wouldn’t be enough, because states generally can’t regulate Medicare or insurers that operate outside their borders.

A role for the FDA

In the view of many health law experts, the gap between insurers’ actions and patient needs has become so wide that regulating health care coverage algorithms is now imperative. As I argue in an essay to be published in the Indiana Law Journal, the FDA is well positioned to do so.

The FDA is staffed with medical experts who have the capability to evaluate insurance algorithms before they are used to make coverage decisions. The agency already reviews many medical AI tools for safety and effectiveness. FDA oversight would also provide a uniform, national regulatory scheme instead of a patchwork of rules across the country.

Some people argue that the FDA’s power here is limited. For the purposes of FDA regulation, a medical device is defined as an instrument “intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease.” Because health insurance algorithms are not used to diagnose, treat or prevent disease, Congress may need to amend the definition of a medical device before the FDA can regulate those algorithms.

If the FDA’s current authority isn’t enough to cover insurance algorithms, Congress could change the law to give it that power. Meanwhile, CMS and state governments could require independent testing of these algorithms for safety, accuracy and fairness. That might also push insurers to support a single national standard – like FDA regulation – instead of facing a patchwork of rules across the country.

The move toward regulating how health insurers use AI in determining coverage has clearly begun, but it is still awaiting a robust push. Patients’ lives are literally on the line.

Jennifer D. Oliva, Professor of Law, Indiana University

This article is republished from The Conversation under a Creative Commons license. Read the original article.