Hysterics: Are Hysterectomies Too Common?

Anna Clark

One in three women has a hysterectomy before her sixtieth birthday. Is such major surgery medically necessary for all those women? And if not, how did this procedure become commonplace?

A
lot of women have a lot to say about hysterectomies. It’s the best thing that
ever happened to them; it’s the worst thing that ever happened. They feel
liberated; they feel rage. They wish they’d done it sooner; they wish they hadn’t
been pushed into it. You can get gal-pal advice from the HysterSisters,
or you can get cautionary information from Hysterectomy Educational Resources and
Services
(HERS).

Or,
of course, you can hear directly from women who’ve had the operation. It’s not
difficult to find them; 600,000 women have a hysterectomy each year, says Dr. Jay Goldberg, director of the Jefferson
Fibroid Center
at Jefferson Medical
College in Philadelphia.

Put another way: one in three women has a hysterectomy before her
60th birthday. Yet treatment for life-threatening illnesses — uterine and ovarian
cancers — accounts for only 10% of the procedures.

The other reasons? About 40% of hysterectomies are performed due
to fibroids. Endometriosis, a condition in which uterine tissue grows outside of the uterus, accounts for others. Heavy bleeding, a uterine prolapse (when the
organ slips out of place), a caution against cancer, birth control, and, for
trans men, sexual reassignment surgery, are all among other reasons for
hysterectomies.

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Many who have
the operation are making their best choice, and have never felt better. But
what are the real implications of removing a major reproductive organ from a
woman’s body — even when she doesn’t desire giving birth to children? "In
truth," Natalie Angier writes in Woman:
An Intimate Geography
, "

…we know remarkably little about the purpose of the
various opiates, chemicals, hormones, and hormone precursors that the uterus
secretes with such vigor. We don’t know how important the output is to our
overall health and well-being beyond considerations of reproduction, nor do we
know whether the various secretory skills continue past menopause. … We should
be humbled by the fact that scientists discovered the very dramatic
concentrations of anandamide in the uterus as recently as the late 1990s. And
that humbleness should in turn enhance our vigilance against removing the
uterus in all but the most extreme circumstances.

Women who have a hysterectomy require
six to twelve weeks of recovery time — a testament to the procedure’s gravity. And HERS
chronicles a long list of adverse consequences of the operation that call its
widespread acceptance into question. Among the after-affects reported by women
who had hysterectomies include personality change (79%); profound fatigue (76.9%); diminished or absent sexual desire (75.2%); short term memory loss (66.9%);
insomnia (60.5%); and pain in joints and bones (59.9%). In Woman, Angier reports that hysterectomies — even surgeries that
preserve the ovaries — cause a woman a "heightened risk of high blood pressure
and heart disease … possibly because the extraction of the uterus eliminates
one source of prostaglandins that help protect blood vessels."

Deborah McConnell, a nurse at Boston’s Brigham and Women’s Hospital, said
that hysterectomies that remove the ovaries cause immediate menopause, because
of sudden disappearance of hormones ovaries release. "The sudden drop [in hormones] can have affects on bone health,
heart health and mood effects as well," McConnell says.

So it’s surprising that for illnesses that can be treated less
invasively, alternative treatments aren’t offered more often. And there are
many possible treatments for fibroids, endometriosis, and pain: mymoectomies or
lapatotomies to remove fibroids; uterine fibroid embolization (blocks blood
supply to fibroids for shrinkage); endometrial ablation (uses microwaves to
destroy endometrial lining in a five-minute procedure); pain medications;
hormonal agents; lifestyle changes; a progesterone IUD; medications; and HIFUS
(High Intensity Frequency Ultrasound), which targets fibroids with an
MRI-guided ultrasound system. And Goldberg reports that alternative treatments
for conditions that lead many women to hysterectomies are among the best-funded
research projects, so we can expect still more options soon.

If there are so many options for women, and so much about the
uterus still a mystery, then how did we get here, with hysterectomies the
second most common operation that American women undergo?

How Did We Get Here?

After conversations with people who had, and chose not to have,
hysterectomies, and with people who perform the operation and who counsel for
alternatives, some explanations stand out.

1) Habit. As Goldberg points out, many doctors — especially
older ones — are accustomed to prescribing hysterectomies for women who don’t
intend to have more (or any) children and who suffer from reproductive system
troubles. "There’s an older, paternalistic attitude," Goldberg explains. "’If
you’re done having kids, let’s take the uterus out.’ [Other doctors] will bring
up alternatives to hysterectomies, and older doctors will scoff at you a little
bit, like, why would you suggest anything else?"

The habits of individual doctors aggregate into regional and demographic patterns. The Agency for Healthcare
Research and Quality reports that "women who live in the Southern and
Midwestern areas of the United States, African-American women, and women who
have male gynecologists are more likely to undergo hysterectomies."

2) Lack of information. The doctor may not be aware of
alternatives that might allow a woman to avoid a hysterectomy while relieving
her symptoms. Or the doctor might not know how to do a procedure. "In Philadelphia,
the doctor gets paid about $1200 for a hysterectomy," Goldberg says. "There’s
an alternative treatment, an embolization, that needs to be performed by a
radiologist. So it can come down to economics: if you refer the patient to a
radiologist, you lose the financial reimbursement."

Women often lack the information themselves. Judy Norsigian, executive director of Our Bodies Ourselves, says there’s
"no question that women aren’t always getting good information about the
implications of a huge surgery."

To explore alternatives and their
consequences, however, takes time. Many women are not willing, or able, to give
that time — especially when they feel the urgency of their symptoms.

3) Imbalance of authority between doctors and patients. Dr. Clarissa
Pinkola Estés’s experience illustrates an extreme case. She had a hysterectomy
at age 33; she’s now 62. "I remember asking, ‘Please, please, help me save my
body, so I can have more children," Pinkola Estés says. "I remember as though
it happened yesterday, the male doctor literally shouted: ‘You will not dictate
to me on matters of medical importance.’"

In less dramatic ways, many of us defer
to medical professionals. Goldberg says "a lot of patients don’t want to insult
the doctor with questions," but with information increasingly accessible
online, many people are able empower themselves.

4) It’s self-referential. With hysterectomies so common,
the operation gains a whiff of normalcy, or is even seen as a rite of passage.
Most of us know many people who had a hysterectomy. This, then, comes to seem
the sensible alternative if we find ourselves suffering from bleeding, pain, or
other symptoms.

Questions about hysterectomies don’t exist in a vacuum. There’s no
doubt that we are informed by an ancient history of valuing women for their
ability to bear (male) children. That is, a woman’s body, and particularly her
reproductive organs, had utilitarian worth and little more. But as Angier
reminds us, the uterus may offer countless health benefits to women beyond its essential
role in bearing children.

It’s foolish to believe that we’ve overthrown millennia-worth of
such sexism in a couple decades. The living legacy of a utilitarian view of
women’s reproductive organs is apparent in the arguments those who oppose abortion
and contraception, where primacy is given to zygotes over the woman they exist
within.

We also cannot forget that our country has a chilling history of abuse
of women’s reproductive systems. Dorothy Roberts has detailed the history of
coercive or forced sterilization, often including hysterectomy, of women of color, indigent, and "mentally deficient" women in Killing the Black Body. She writes,

During the 1970s sterilization
became the most rapidly growing form of birth control in the United States,
rising from 200,000 cases in 1970 to over 700,000 in 1980. It was a common belief among Blacks in the
South that Black women were routinely sterilized without the informed consent
and for no valid medical reason.
Teaching hospitals performed unnecessary hysterectomies on poor Black
women as practice for their medical residents.
This sort of abuse was so widespread in the South that these operations
came to be known as "Mississippi
appendectomies."

The prevalence of unwanted hysterectomies led many Black women, in
activist Frances Beal’s words, to be "afraid to permit any kind of necessary
surgery because they know from bitter experience that they are more likely than
not to come out of the hospital without their insides."

Sterilization wasn’t just used to control African-Americans, but
also Native Americans.

"Even the word (‘hysterectomy’) just scares me so much and brings
up all of these memories," says KL Pereira, a 27-year-old Native woman living
in Cambridge, MA, citing a history of doctors using forced
sterilization on Native women after difficult births and abortions. Pereira’s aunt went in
for a D&C treatment for her endometriosis. She expected superfluous tissue
to be scraped away; she came out of the operation with a hysterectomy that her
doctor decided that she needed.

"Especially for a young girl who was really just learning about
her body and the medicalization of it, I felt like I would never trust doctors
or hospitals. And I honestly still don’t," she says.

This is the context we’re in today: a history of coerced and
forced hysterectomies is one part of why — it bears repeating — hysterectomies have
become the second most frequent operation performed on women.

Truly Free Medical Choices

There is no doubt that a good portion of those operations are
performed on women who diligently researched, explored alternatives, and
partnered with her doctor to come to a mutual decision that a hysterectomy was
her best option. There is no doubt that hysterectomies save the lives of many
women.

Steve Wilson of Long
Beach, CA, considers
herself one of them.

"I was totally comfortable having the complete hysterectomy, and
haven’t been sorry since I did it," Wilson
said. "The pathology report came back as pre-cancerous — was relieved."

Who could blame her? But while we may cheer Wilson for her choice,
we must be quite aware that many other women aren’t making free choices — free,
in that it is unadulterated by an imbalance of power in the doctor-patient relationship,
that the patient has complete and clear information about all options and their
consequences, that her doctors are in no way biased towards her because of her
color, class, marital status, and interest in bearing children, and that
ability to pay in no way limits her options.

Dr. Lori Warren, a gynecologic surgeon in Louisville, KY,
is
pushing for genuine medical choices for women with her website, BetterHysterectomy.com. Says Dr. Warren: "I truly believe that biggest changes will come through patient
education and for women to be empowered to ask for a better, less invasive
surgery."

Perhaps the frequency with which hysterectomies are performed is
symptomatic of the constrained options women, and all individuals, have
in
our country’s broken health care system. We must expect more from our
medical providers. And we can act on those high expectations with
persistent questioning, self-education, and a thorough exploration of
all treatments.

There’s really no other option. Our very bodies are at stake.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

Roundups Politics

Campaign Week in Review: Trump Selects Indiana Gov. Mike Pence to Join His Ticket

Ally Boguhn

And in other news, Donald Trump suggested that he can relate to Black people who are discriminated against because the system has been rigged against him, too. But he stopped short of saying he understood the experiences of Black Americans.

Donald Trump announced this week that he had selected Indiana Gov. Mike Pence (R) to join him as his vice presidential candidate on the Republican ticket, and earlier in the week, the presumptive presidential nominee suggested to Fox News that he could relate to Black Americans because the “system is rigged” against him too.

Pence Selected to Join the GOP Ticket 

After weeks of speculation over who the presumptive nominee would chose as his vice presidential candidate, Trump announced Friday that he had chosen Pence.

“I am pleased to announce that I have chosen Governor Mike Pence as my Vice Presidential running mate,” Trump tweeted Friday morning, adding that he will make the official announcement on Saturday during a news conference.

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The presumptive Republican nominee was originally slated to host the news conference Friday, but postponed in response to Thursday’s terrorist attack in Nice, France. As late as Thursday evening, Trump told Fox News that he had not made a final decision on who would join his ticket—even as news reports came in that he had already selected Pence for the position.

As Rewire Editor in Chief Jodi Jacobson explained in a Thursday commentary, Pence “has problems with the truth, isn’t inclined to rely on facts, has little to no concern for the health and welfare of the poorest, doesn’t understand health care, and bases his decisions on discriminatory beliefs.” Jacobson further explained: 

He has, for example, eagerly signed laws aimed at criminalizing abortion, forcing women to undergo unnecessary ultrasounds, banning coverage for abortion care in private insurance plans, and forcing doctors performing abortions to seek admitting privileges at hospitals (a requirement the Supreme Court recently struck down as medically unnecessary in the Whole Woman’s Health v. Hellerstedt case). He signed a ‘religious freedom’ law that would have legalized discrimination against LGBTQ persons and only ‘amended’ it after a national outcry. Because Pence has guided public health policy based on his ‘conservative values,’ rather than on evidence and best practices in public health, he presided over one of the fastest growing outbreaks of HIV infection in rural areas in the United States.

Trump Suggests He Can Relate to Black Americans Because “Even Against Me the System Is Rigged”

Trump suggested to Fox News’ Bill O’Reilly that he could relate to the discrimination Black Americans face since “the system [was] rigged” against him when he began his run for president.

When asked during a Tuesday appearance on The O’Reilly Factor what he would say to those “who believe that the system is biased against them” because they are Black, Trump leaped to highlight what he deemed to be discrimination he had faced. “I have been saying even against me the system is rigged. When I ran … for president, I mean, I could see what was going on with the system, and the system is rigged,” Trump responded.

“What I’m saying [is] they are not necessarily wrong,” Trump went on. “I mean, there are certain people where unfortunately that comes into play,” he said, concluding that he could “relate it, really, very much to myself.”

When O’Reilly asked Trump to specify whether he truly understood the “experience” of Black Americans, Trump said that he couldn’t, necessarily. 

“I would like to say yes, but you really can’t unless you are African American,” said Trump. “I would like to say yes, however.”

Trump has consistently struggled to connect with Black voters during his 2016 presidential run. Despite claiming to have “a great relationship with the blacks,” the presumptive Republican nominee has come under intense scrutiny for using inflammatory rhetoric and initially failing to condemn white supremacists who offered him their support.

According to a recent NBC News/Wall Street Journal/Marist poll released Tuesday, Trump is polling at 0 percent among Black voters in the key swing states of Ohio and Pennsylvania.

What Else We’re Reading

Newt Gingrich, who was one of Trump’s finalists for the vice presidential spot, reacted to the terrorist attack in Nice, France, by calling for all those in the United States with a “Muslim background” to face a test to determine if they “believe in sharia” and should be deported.

Presumptive Democratic nominee Hillary Clinton threw her support behind a public option for health insurance.

Bloomberg Politics’ Greg Stohr reports that election-related cases—including those involving voter-identification requirements and Ohio’s early-voting period—are moving toward the Supreme Court, where they are “risking deadlocks.”

According to a Reuters review of GOP-backed changes to North Carolina’s voting rules, “as many as 29,000 votes might not be counted in this year’s Nov. 8 presidential election if a federal appeals court upholds” a 2013 law that bans voters from casting ballots outside of their assigned precincts.

The Wall Street Journal reported on the election goals and strategies of anti-choice organization Susan B. Anthony List, explaining that the organization plans to work to ensure that policy goals such as a 20-week abortion ban and defunding Planned Parenthood “are the key issues that it will use to rally support for its congressional and White House candidates this fall, following recent setbacks in the courts.”

Multiple “dark money” nonprofits once connected to the Koch brothers’ network were fined by the Federal Election Commission (FEC) this week after hiding funding sources for 2010 political ads. They will now be required to “amend past FEC filings to disclose who provided their funding,” according to the Center for Responsive Politics. 

Politico’s Matthew Nussbaum and Ben Weyl explain how Trump’s budget would end up “making the deficit great again.”

“The 2016 Democratic platform has the strongest language on voting rights in the party’s history,” according to the Nation’s Ari Berman.