The videos are astonishing. In one scene, a senior Chinese woman appears lost in the wilderness of dementia, unable to answer basic questions; in the next, she seems to be lucidly chatting and shucking beans for dinner. By all appearances, years of cognitive decline had been rapidly reversed after the patient underwent an experimental new surgery.

The only problem is: No one is sure if it’s real. 

It’s difficult to take any video at face value in the age of AI, and this experimental procedure happened in China, a country with a recent history of controversial science touting extraordinary but questionable claims. In the past few years, researchers there have published several papers reporting promising results from a procedure that purports to attack Alzheimer’s disease in a peculiar way: by connecting vessels from the lymph nodes in the neck to nearby veins in an attempt to drain the brain of harmful waste. But these have been small studies that did not include a control group. The doctor who first pioneered the surgery there has reportedly been placed under arrest, and the Chinese government has sought to stop most physicians from performing any more of these operations. 

Is that because it’s a scam? Or because it’s dangerous? Or could it be because there have not yet been proper randomized trials, tested against a placebo, to assess the procedure’s safety and efficacy? There are new studies being planned in China to more rigorously evaluate the surgery.

But scientists elsewhere in the world have a lot of questions. And now, a small group of researchers in the US and Europe are endeavoring to find the answers. Within the next few years, we should know whether this surgery really could be the miracle that the viral videos make it appear to be — or another much-hyped treatment that ultimately fizzles out.

Dr. Adnan Siddiqui, a neurosurgeon at the University at Buffalo who is leading an initial US-based study of this procedure, previously helped develop a new treatment for severe stroke patients. This gave doctors a valuable new technique for treating patients during an emergency, and he told me he saw it rapidly change the standard of care around the world. In an interview, he cautioned that a lot more work needs to be done to assess this proposed new Alzheimer’s treatment — but at the same time, he’s optimistic.

“The whole world’s paradigm changed in literally a blink of an eye. It can happen. And I’m hoping this might be that second home run,” he said. In “2027, we’ll start getting clear signals in one direction or the other. By 2028, 2029, we would know whether this is real or not.”

Why this Alzheimer’s surgery really might work

The promise of this controversial new procedure lies in the lymphatic system, which is essentially the body’s drainage system. According to scientists’ best current theories about Alzheimer’s, the brain’s filtration system gets worse as we age, and as a result, plaque made up of amyloid proteins as well as tangles of tau proteins can accumulate in people’s brains and eventually lead to neurological damage, leading to the severe memory loss of Alzheimer’s disease. Researchers have found evidence that those amyloid and tau proteins also accumulate, not just in the brains, but also in the lymph nodes in older people. 

So could a minimally invasive surgery to improve the brain’s drainage have such a dramatic impact on Alzheimer’s disease? 

Siddiqui, who also runs the Jacobs Institute at the University of Buffalo, which is focused on new technology for vascular and neurological disease, had been interested in the lymphatic system’s role in Alzheimer’s before he ever heard about this experimental work out of China from a colleague years ago. The colleague had gone to see Dr. Qingping Xie, the surgeon who started performing lymphatic surgery on Alzheimer’s patients about six years ago. To investigate further for himself, Siddiqui went to South Korea to meet a plastic surgeon, Dr. Joon Pio Hong, who was performing a new “more refined” version of the same basic procedure, as Siddiqui put it. But as in China, these were not proper randomized experiments. There was no placebo.

So Siddiqui wanted to see if he could test it himself. After performing proof of concept operations in 2025 with a new microrobotic tool (for a rare disorder involving constricted blood vessels in the brain), he and his colleagues decided to take an even bigger swing: testing this new technology to perform the lymphatic surgery for Alzheimer’s.

The researchers applied to the US Food and Drug Administration and received approval late last year for five initial procedures; over the summer, they got the green light to perform the procedure on 15 patients. Several operations have already been performed, and Siddiqui told me he had four more lined up next week.

The mechanism makes superficial sense: If Alzheimer’s is the byproduct of amyloid and tau building up in the brain because the body gets worse at filtering them out, bypassing a clogged “drain” in the lymphatic system could help to clear the proteins and relieve symptoms. It is, by a different method, the same therapeutic target as recent breakthrough drugs that slow down the cognitive decline of an Alzheimer’s patient.

But instead of an injection, the procedure involves a small incision in the neck, allowing surgeons to connect lymph nodes to a vein. The hope is that creating this new drainage route will help the brain clear amyloid and tau more effectively and “hopefully bypass whatever plugs that might be there in the system,” Siddiqui said.

This first round of US surgeries are part of what’s called an early feasibility study. “You’re just trying to prove that it’s definitely safe and definitely doable and maybe effective,” Siddiqui said. They’re measuring not only the patients’ cognitive performance but other data points — such as changes to their gait — for any sign of benefit or harm.

If results are promising, a second feasibility study will involve a larger number of patients — 50 or so. After that, if the evidence suggests they should move forward, the scientists would start to introduce placebos. In the case of surgery, that means some patients would receive “sham” surgeries that wouldn’t actually do anything. Then investigators would compare the experiences of the two groups: the people who received the fake surgery and the people who got the real thing.

If the latter group improves significantly more than the former, that would allow scientists to say definitively: Yes, this surgery actually works to treat Alzheimer’s.

“Obviously, this is exactly the kind of disease where there’s so much hype and so much hope,” Siddiqui told me. So it is essential to build out the careful research to substantiate it.

But let’s not get ahead of the science

Siddiqui has been in this position before — and he’s seen it go both ways. There was the new stroke treatment that proved successful and has since become the standard around the world. But he was also an early investigator of a multiple sclerosis treatment, somewhat similar to the Alzheimer’s surgery. After initial promise, it failed when the randomized trials began.

“I wouldn’t be a neurosurgeon if I was not an eternal optimist,” he said. “However, I’m a clinical trialist, and I always respect placebo.”

Placebos are essential, but they are also tricky. If somebody thinks they have received an active treatment in a study, they tend to think they’re going to benefit. This goes for surgical treatments as well. So following patients’ and their symptoms after the intervention is essential to seeing just how much of the effects can be attributed to the treatment and how much could be placebo effect. The latter of which could also be reinforced by loved ones who are desperate to see their parent or spouse get better. 

Alzheimer’s is also a complicated disease that we still don’t totally understand. While scientists think there is a relationship between amyloid and tau proteins and Alzheimer’s disease, other factors, such as inflammation and vascular health, could also have a role. Some prior drug candidates have successfully cleared amyloid plaque, but patients didn’t get better. Some people have amyloid build-up in their brains but never develop Alzheimer’s disease.

Dr. Bohdan Pomahac, division chief of plastic and reconstructive surgery at Yale School of Medicine, is overseeing studies designed to establish more of the basics of how these proteins pass through the lymphatic system. This research includes investigating whether obstruction actually occurs in Alzheimer’s patients, and if so, where exactly those blockages usually are. Only after they do this work, he said, would his team be comfortable proposing surgeries to relieve the blockage and see if that helps improve Alzheimer’s patients’ symptoms.

He told me about having seen Xie, the procedure-pioneering Chinese surgeon, speak during a plastic surgery conference a few years ago. (Plastic surgeons are experts in the kind of microsurgery necessary for the procedure, and several are involved in the ongoing Alzheimer’s trials.) 

“I think most people, including myself at the time, dismissed it as, ‘This is some sort of a charlatan.’” Pomahac said. “But he kept coming back to conferences every year and started to show more and more videos. We were not sure. Is it actors? You couldn’t tell what’s going on.”

Which is why he is dedicated to doing more of the foundational research to understand Alzheimer’s first. “Rushing to the operating room makes no sense in my mind at this point,” Pomahac said. “I think there’s a lot of work that needs to be done to really identify the site of surgery and what type of intervention would be most effective.”

Even if you set this surgery aside, this is an exciting moment for Alzheimer’s science. And although waiting any longer is excruciating for those watching loved ones with the disease progress, progress’ velocity by all accounts is increasing.

“We are finally doing the kinds of rigorous studies that will give us some degree of confidence that there’s something real here or not,” Siddiqui told me. “We’re not quite there yet.” But in just a year or two, we should know much more.

Jonathan Hale was ready to lay down his paint rollers. Hale, a law student turned viral road safety advocate, had run into legal trouble for painting his own DIY crosswalks across some of Los Angeles’s most dangerous intersections. In a meeting with LA Mayor Karen Bass earlier this year, he told her that if the city could commit to making its own streets safer for pedestrians, then he would stop his own vigilante activism. 

“Dude, you’re the mayor. Do something about this. It’s you, dude,” he recalls insisting to Bass — in so many words — after she apologized for his arrest on vandalism charges for a paint job last December. For months, Hale upheld his end of the bargain and stopped painting, believing in her office’s emailed assurances that a new executive order was coming soon. 

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But, eventually, after weeks of unresponsiveness, Hale grew tired of waiting, just as he had the first time he picked up a stencil and a bucket of white paint. “We’re so focused on looking for reasons why we can’t do stuff instead of ways that we can,” he said, “and it’s just paralyzed our institutions.” 

Across the country, such civic paralysis has compelled a legion of guerrilla urbanists to take their city’s matters into their own hands. In Boston, a group of cyclists used strips of green and white duct tape to build a bike lane at an intersection where a truck struck and killed 36-year-old Louisa Gag in July. In Nashville, Kansas City, and across the Bay Area, volunteers have built and installed their own public benches at bus stops where city officials had slowly removed places to sit, after years spent curating increasingly hostile public spaces. 

Every time one of these friendly neighborhood vigilantes paints a crosswalk, fills a pothole, or builds a bench, they remind us that it is not actually that hard — or even that expensive — to do many of the simple things that can make our cities safer and more pleasant places to live. Though our local governments may seem incapable of getting these basic tasks done, they are probably less constrained by money than they are by a sluggish status quo. And in some cases, they’re so afraid of being sued that they’d rather build nothing at all. 

“We see the fear of litigation and liability” so thoroughly sabotaging mundane municipal projects that “a crosswalk takes half-a-million dollars in five years to do when it’s really a bucket of paint in an afternoon,” said Anthony Garcia, a Miami-based urban planner who, with his longtime collaborator Mike Lydon, pioneered the study of tactical urbanism, or low-cost, quick-fix interventions often led by ordinary citizens themselves. Both Garcia and Lydon now advise cities nationally on how to integrate the practices of guerrilla urbanists into the ways they govern and pilot their own new policies. “You don’t have to hold a crosswalk to the same standard that you hold a bridge,” Garcia said.

It can be inspiring when a random citizen feels compelled to pick up a paintbrush and finish what their city can’t seem to start, but it is also an infuriating embodiment of just how stunted some of our most basic systems of governance have become. These industrious urban vigilantes show that making our cities more livable can be an easy, and even joyous practice. But if their work is going to serve as more than mere symbolism, cities themselves will need to learn from their example — or, as some municipalities have recently demonstrated, find new ways to collaborate.

“The point of the crosswalks is the protest. It’s to draw awareness to the issue,” not to create a permanent class of illicit crosswalk painters, Hale told me. “We need to hold the government to a higher standard.”

The quasi-legal case for taking your street into your own hands

While there are some reasons that a municipality would take longer to install a bench or paint a crosswalk than a crew of local residents — compliance with regulations and the installation of proper signage comes to mind — they rarely need to take as long as they often do now.

Take Los Angeles, where even the most basic road safety projects can take years to build, racking up eye-popping bills along the way. Some of these delays have proved deadly. For over a decade, the city sat on funds to improve a perilous intersection in Koreatown, according to Streetsblog, an intersection where, last summer, a drunk driver hit and killed 9-year-old Nadir Gavarrete. 

As the city twiddled its thumbs in the days that followed, the Crosswalk Collective LA — a DIY group that gave Hale his start — started painting. It wasn’t until three months after Gavarrete was killed that the city scrubbed the guerrilla crosswalks, replacing them with “official” crosswalks and a tiny, temporary traffic circle. A permanent solution is supposedly on its way this year.

It shouldn’t take this long, and though cities like LA have the resources and expertise to pull off more permanent and often more effective solutions than a group of vigilantes could, it also shouldn’t take a profound tragedy to convince them to finally act. And just as importantly, they should be capable of also making the sort of small, low-cost, even temporary interventions in the interim, ones that don’t require bespoke planning and a prolonged procurement process.  

As much as Hale has come to enjoy painting crosswalks along with the group he founded, People’s Vision Zero, he does so not as a hobby, but as an expression of discontent with a government that rarely seems to take the safety of his streets as seriously as he’d like them to. Painting a rogue bike lane or giving bus riders a place to sit might not do all that much to fix what’s wrong with our cities directly, but every single DIY urbanist I’ve spoken to has told me that their efforts have helped them reclaim a sense of collective agency over how their cities function, after years of frustration with seemingly impenetrable civic institutions. 

“It’s very easy to feel small, and that nothing that you do matters,” said Carter Lavin, co-founder of the TransBay Coalition, a transit advocacy group with ties to the San Francisco Bay Area Bench Collective, but “one thing about building benches is that every screw you drive, every board you sand makes your neighbor’s life better, and it does it for hundreds of people.”

Unfortunately, getting a city to formalize these often quasi-legal urban interventions is no easy feat, as Pastor Robin Owen, a local nonprofit leader in Nashville who writes a Substack called Jesus Urbanist, knows all too well.

For the past year, Owen has been embroiled in a cat-and-mouse game with the city of Nashville in which she and her growing bunch of bench-building acolytes install a DIY bench that the city later removes, after which they replace it with another bench, which the city will inevitably remove again. For many municipalities, getting rid of useful changes proves far easier than simply implementing them in the first place.

As ill-fated as that dance might seem, it can still feel more meaningful to locals, Owen told me, than the even more hapless task of prodding the government to get something done itself. 

“When you care about a place and want to make it better, you’ve very likely spent hours in meetings or emailing elected officials, and progress is just really complicated and slow,” she told me, “and building a bench and then putting it on a street corner, you actually do something that impacts someone’s life.”

How cities can learn to build the simple stuff quickly

Advocates tell me that in almost every case they would much prefer to work with their city governments than against them. And sometimes they do: For well over a decade, the local transit advocacy group Reconnect Rochester has partnered with Rochester, New York to lay out boxy, brightly colored “bus stop cubes” at transit corridors around the city. Critically, these boxes were permitted.

“If we were to have just kind of gone out there and done this in the dark of night without following any sort of process,” Mary Staropoli, co-executive director of Reconnect Rochester, told me, “I think those bus stop cubes would have been quickly removed.”

Owen has tried for months to convince her city to issue a similar permit for her benches. Nashville happens to boast one of the nation’s only programs dedicated explicitly to facilitating tactical urbanism, which should have made this an unusually straightforward process. And yet, because of a new requirement compelling such projects to pay for liability insurance, she says that she cannot obtain a permit without paying thousands of dollars to protect benches that cost just $35 a pop to build. 

With the exception of some disability protections, cities are indeed far likelier to get sued over the infrastructure they build than over the infrastructure they never bothered to build at all. A crosswalk that never gets painted is one less crosswalk to worry about. A bench that never gets built can’t lead to a lawsuit. But if they never get built at all, then they also have no chance of protecting a pedestrian from a speeding car, or giving an elderly commuter a place to sit. 

“There is this massive moral disconnection where cities are not concerned about liability when it comes to people dying in traffic violence, but are concerned about liability when citizens take action ourselves,” Owen said. “We should be more concerned about our moral liability of people having to suffer as they navigate our cities.” 

Nevertheless, when a citizen paints a crosswalk or builds a bench, whether as a stopgap as an act of protest, it can also exert a sort of “productive tension” on a city, said Lydon, one that can compel a static government to act much more quickly than it would otherwise, even if such changes takes time to materialize.

It wasn’t until a group of local wheelchair users took sledgehammers to sidewalks and began pouring their own cement ramps in the 1970s that Berkeley, California became one of the first cities in the nation to mandate curb cuts, now a hallmark of nationally mandated accessible design that benefit almost everyone at some point: parents pushing strollers, travelers pulling roller bags, and the rest of us in one way or another. 

And in another famous example, a graduate student named Matt Tomasulo zip tied a few dozen wayfinding signs to street poles around Raleigh, North Carolina in 2012, telling passerby how far away various destinations were by walking. While the city initially tore down the signs, they proved popular enough that Raleigh changed course, eventually integrating them into its own planning.

“We’ve documented this over and over,” Lydon said, noting the shift that comes when a city stops fighting a guerrilla intervention and opts to embrace or iterate upon it instead. “You can do these small things, and it can very much lead to transformational change.”

They have fun names like Feel Free, Smurphs, and Hazy Tabz. They come in colorful packages and in gummy form. They’re widely available at gas stations, corner stores, and smoke shops across the country.

They’re also highly addictive, largely unregulated, and in the news after they were found near the bodies of two dead University of Mississippi students.

The drugs are called Kratom and 7-OH. The first, kratom, is derived from the leaves of a coffee-like plant in Southeast Asia. When taken in small doses, kratom causes a low-key buzz. In higher doses, the high is described as euphoric. It operates like an opioid — a chemical in kratom called mitragynine binds to opioid receptors in the brain, which leads to that euphoric high. It also can lead to addiction and overdose. 

Social media is full of videos of people trying to kick the drug, with harrowing stories of dependence and withdrawal. 

7-OH is a highly concentrated compound derived from kratom, which dials up both the high and the danger. The drug has caught the attention of US Health Secretary Robert F. Kennedy Jr., who warned in a press conference last year that 7-OH was “marketed for children.” 

“They’re gummy bears, they’re bright colors, they’re candy-flavored,” Kennedy said. “This is really a sinister, sinister industry.” In August, federal agencies announced they were taking steps to effectively ban 7-OH nationwide. 

To break down the increasing prevalence of both kratom and 7-OH, what the drugs do, and what to do about them, Today, Explained spoke with Mattha Busby, a freelance journalist who covers drugs and drug policy and who wrote about kratom earlier this year. 

As Busby explains, kratom and 7-OH are “definitely in the zeitgeist. It’s in the news and for good reason. To have these 7-OH gummies just in gas stations is a really potentially problematic thing. Without the drug education alongside it, this drug has just popped up out of nowhere.”

Busby also talked with Today, Explained co-host Sean Rameswaram about the business interests behind the drugs, why they’re a complicated topic for the Make America Healthy Again movement, and how industry lobbyists have teamed up with several Trump administration officials to try to sway the results of regulatory decisions. 

Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.

Is there an important distinction between kratom and 7-OH? Is 7-OH found in kratom?

7-OH is found in relatively small quantities within kratom, but this businessman, Vince Saunders, who is the self-styled American shaman out of Kansas City, basically figured out how to extract the 7-OH and blow it up into entire pills.

I’ve never tried 7-OH and I’m not interested, just for the record, since I’ve been talking about how I don’t mind kratom, but these 7-OH tablets are uber, uber strong. I think the large number of people that are taking it are using it instead of opioids. And maybe it’s better, maybe it’s not. 

Is 7-OH something you can also easily find at your neighborhood gas station?

Yeah. It’s much the same as the kratom formulations, so you’re talking gummies, little shots, capsules, and the brand names for the 7-OH companies are perhaps even more kind of out there — 7-OHeaven is one. 

It’s certainly not heaven when you’re going into withdrawals.

And do we know that people are? Are people becoming addicted to 7-OH?

People are becoming addicted to kratom and 7-OH. I think the whole thing, the concern originally sprung up with the Feel Free tonics that are like a mix of kava and kratom. And people just got habituated into drinking several of them per day and realized that it’s very unpleasant if they don’t continue to do that on a daily basis.

We have a federal government that loves to police drugs of all sorts. What are they doing about 7-OH? 

It’s this MAHA dilemma, right? Because their ethos is very “natural medicines and freedom.” The idea that this Feel Free tonic, whose owner JW Ross recently gave, or a company related to him recently gave, like $500,000 to the MAHA PAC, and he’s been photographed next to RFK Jr. — he’s perhaps predictably come out on the side of the kratom industry, which is lobbying for a ban of 7-OH. 

RFK Jr. called it sinister and said that it targets children, which it appears to do in some cases with the gummies. There’s kratom gummies too and clearly gummies are an easier way, especially for older people, to ingest the medicine or substance, so we shouldn’t just blame the gummies here. 

But clearly, when you’ve just got packets of these gummies that are called like 7-OHeaven just on the shelf or indeed behind the counter at the gas station, there’s going to be concern about that. 

There are other MAGA figures like Homeland Security Secretary Markwayne Mullin, who’s got a million-dollar investment in the parent company of Feel Free. There’s definitely this nexus of figures in the government that have got some interest, potentially, or relationships with the kratom industry. And indeed the department when I was writing my Wired story reminded us and readers that everything he’s done is ethical and I’m sure it has been.

We usually think of liberal drug policies as a lefty thing. Markwayne Mullin’s about as right as they come. Are kratom and 7-OH making friends across the political spectrum because there’s a big business opportunity here?

You look at Trump’s executive order on psychedelics and then rescheduling cannabis, and it seems that the right has really seized the mantle and is looking at it from a more libertarian perspective of, “Hey, what happens in a man’s head is his own business.” 

They’re also being probably more business friendly than people on the left would be, so it’s a really interesting moment, especially with RFK Jr. as health secretary.

Trump has spoken at length about the opioid crisis in the United States and how it’s tearing our communities apart and whatnot. Here we have readily accessible opioids at our gas stations. 

Yes, they’re not killing nearly as many people as prescription drugs are. However, they’re a lot easier to get than prescription drugs. Help me understand this administration’s position in relation to what could be a real terror for some people.

They are in the process of banning 7-OH. Last month, the Department of Justice set out an emergency scheduling, so that’s open for comments at the moment. When they ban something, it doesn’t just happen overnight. 

I think by the beginning of next year, it’s quite possible that these 7-OH products won’t be in gas stations and indeed some states have already taken action.

And just to get ahead of any confusion here, 7-OH may be banned from gas stations and probably other convenience stores, but not kratom?

Exactly.

Why one and not the other? Obviously 7-OH is stronger, but you could take a lot of kratom and it might feel like taking a little 7-OH, no?

Absolutely. You just need to take a lot and it’s in powder form. So you need to consume a prodigious quantity of it or drink a bunch of these seltzers. 

I think that they’re not going to ban kratom because there’s an obvious recognition of the good it does for people that are recovering from opiate addictions and that they do have a kind of natural off-ramp, [which] is very unlikely to kill you even though you might take a huge amount. Whereas, if you’re taking like 26 different medications, including a bunch of opioids for your chronic pain, you might die. 

Who do you think wins the argument at the end of the day? We have some strong lobbying forces involved here. You’ve got a lot of people who have come to enjoy or depend on these substances that are, as we’ve established many times now, readily available all over the country. 

Do you think we see fewer or more kratom products in our gas stations and convenience stores in the years to come?

The kratom advocates are a lot more eloquent and suited and booted than the 7-OH folks. What I see is that 7-OH will be forced underground and that kratom will continue its long and illustrious ascent in American culture. 

We do really have a gas station culture in this country, and I wonder if these substances being so available in them is a particularly American thing. You live in the UK. Are gas station drugs a US thing?

It’s an American thing for sure. But you guys take a lot of drugs!

Most of America’s major cities have made little to no progress reducing racial segregation in their public schools over recent decades. Many have slid backward, and are more polarized today than they were at the turn of the century.

These challenges were highlighted in Nikole Hannah-Jones’s wrenching New York Times Magazine piece in September about her experience sending her daughter to poor, intensely segregated public schools in New York City as part of a campaign to fix them — only for her child to fall behind in her education and demand a change to a more selective school with few Black and Hispanic students. The essay ends with both the writer and subject frustrated: Hannah-Jones with the seemingly insurmountable barriers to improving and integrating schools, and her daughter, with the burden of confronting these structural barriers on her own. 

But Washington, DC, the city I’ve called home on and off for most of my adult life, is one of the few standout exceptions to these trends. 

During the 2000s and 2010s, its public schools underwent a dramatic set of reforms that helped improve teaching and student achievement. At the same time, the number of white students leapt up, and the share of schools that had been almost uniformly Black or Hispanic plummeted by about 20 percentage points, the largest drop among the country’s 50 biggest cities.

Recently, I called Kaya Henderson, DC’s former top schools official, to ask about that era of progress, and whether she thought the policies she implemented had helped encourage integration. If not, what had? Her answer surprised me a bit: It simply wasn’t a question she had ever really pondered. 

“For me, integration was never the point,” Henderson said. “Giving our citizens of the district, no matter where they come from or what they look like, a high-quality school system, that was the point.” 

It’s always perilous to read too much into a single example of success in education. Each state and school district is different, and seemingly small differences in how reforms are implemented can make or break them. 

Each state and school district is different, and seemingly small differences in how reforms are implemented can make or break them.

But I think DC’s story is an instructive and hopeful counterpoint to the pessimism that seemed to pervade Hannah-Jones’s discourse-devouring essay. Having witnessed the dysfunction of these schools firsthand and concluding she was wrong to sacrifice her daughter’s education in a noble attempt to address it, Hannah-Jones doesn’t offer any explicit solutions. But she does seem to suggest that we won’t be able to fix the deep-seated problems in our education system unless we find a way to end de facto segregation, which she has long argued is a critical prerequisite to improving school quality for historically disadvantaged minority students. In her media tour, she has been more explicit, calling for New York City Mayor Zohran Mamdani to produce “a plan to address and dismantle school segregation in the city.” 

“Nothing can help the working class change its material condition more than actually having access to an equal and quality education,” she told radio host Brian Lehrer.

I agree with much of that sentiment. But I can’t help but feel like Hannah-Jones is reversing the order of operations. As DC’s example suggests, the most realistic way to desegregate our schools today might actually be to focus on improving their results first. We don’t need to wait. And while Hannah-Jones famously sought to do that by rallying better-off parents to enroll and advocate for their children on a school-by-school basis, DC shows that, with the right plan, school administrators and teachers can deliver gains as well. 

Integrating schools is hard

One of the many reasons integrating public schools has proven so historically difficult is that most modern-day segregation is driven by differences between districts, rather than within them. Well-to-do and white families decamp to wealthy suburbs when it’s time for kindergarten or middle school, while Black and Hispanic families remain within city limits, or in working-class suburbs.  

Overcoming municipal boundaries tends to be an insurmountable challenge, both politically and legally. Forced bussing was never popular, and in 1974, the Supreme Court ruled that court-issued integration orders that required swapping students between districts were effectively unconstitutional, taking away one of the few tools activists thought they had to break through borders. 

Today, ideas like redrawing school boundaries to make them more diverse poll well when Americans are asked about them in the abstract, but it’s at best unclear how many suburbanites would tolerate such a thing if it was proposed in their town. 

Those sorts of options were never available to DC, anyway. It’s a politically isolated city bordered by neighbor-state suburbs like Arlington, Virginia, and Montgomery County, Maryland, where the region’s well-off professionals have long moved for the school systems. The only way to meaningfully integrate its own schools racially and economically was to lure more white or high-earning families into the district and keep them there. 

How DC saw a major drop in segregated schools

And that is in fact what happened. 

Starting in the early 2000s, DC’s population started to balloon with Gen X and millennial professionals of all races, which had the net effect of raising the overall share of white residents. Many flocked to the city after the financial crisis and Great Recession, since Washington was one of the few places where jobs remained plentiful. And they eventually set down roots. Public school enrollment — including both charters and traditional schools — grew alongside the city’s population, and the share of those students who were white jumped from 3.9 percent in 2000 to 13.7 percent in 2023. 

The influx led to a large drop in the number of what the Civil Rights Project at UCLA has defined as “intensely segregated” schools — where fewer than one in 10 students are white. In 2000, 90 percent of DC’s traditional public and charter schools fell into that category, the most of any district covering the country’s 50 largest cities, according to data from the Segregation Tracking Project at Stanford’s Educational Opportunity Project. By 2023, it had fallen to 69 percent, leaving it in the middle of the pack. 

Over that same period, only five of the 50 largest saw any decline at all. 

I don’t want to oversell DC’s progress. It went from among the worst in the country on this measure to looking more like a typical urban school district — similar to New York City today, where 71 percent of schools remain “intensely segregated.” I doubt many are satisfied with that status quo. There are also obvious downsides to the kind of gentrification that made these gains possible — the city lost thousands of Black families during the 21st century to rising housing prices (though the decline was even larger in the ’80s and ’90s, as its economy was in collapse). 

DC’s white students still tend to cluster in public schools serving affluent neighborhoods, such as Capitol Hill or the famously leafy areas west of Rock Creek Park, and there are vanishingly few white families in the city’s poorest wards, east of the Anacostia River. Using the Segregation Tracking Project’s “normalized exposure” index, I found that there were only three other large cities where white students were spread less evenly across their school district. But because white enrollment grew so much, it still spilled out of those enclaves, and helped diversify schools that had previously been overwhelmingly low-income, Black, and Hispanic. As a result, the city became a rare example of progress on one of America’s most stubborn social ills. 

The city’s school performance improved

During the same period in which its schools became less segregated, DC was also embarking on a high-profile education reform effort.

That drive began with the arrival of charter schools in the late 1990s, which put new competitive pressure on the district’s traditional public schools; today the charter sector teaches almost half of the city’s students. But the pace of reforms hastened after 2007 when then-Mayor Adrian Fenty took control of the city’s schools. His major changes included a controversial pay-for-performance system for teachers known as IMPACT, as well as stronger curriculum standards tied to the Common Core. Later leaders adopted more rigorous standardized tests that allowed parents to easily compare results between schools, a single citywide school lottery, and the city’s much celebrated universal pre-K program.

These changes did not work miracles — but they did lead to a major rise in students’ reading and math scores. DC became the fastest-improving large urban school district in the country on the National Assessment of Educational Progress (NAEP), considered the gold standard for measuring learning gains, with both Black and white students seeing significant progress. Again, this was largely a game of catchup: Washington went from among the very worst performing urban school districts on the NAEP to matching the large city average. But it led to a broad sense that schools were on the upswing. 

It’s difficult, and maybe impossible, to say how much any one of the reform policies actually affected parents’ decisions to stay in the city, or helped reduce segregation in schools. Some have had an obvious impact: DC’s universal pre-K program, which began in 2008, anchors professional families here when their children are young, then acts as a funnel into the public school system. Others are probably less consequential on their own: Studies have found that centralized lotteries like the one DC adopted have only small impacts on integration. 

Regardless, the total package seems to have worked. It’s theoretically possible that the army of Sweetgreen-chomping, DC-Brau-chugging millennials who showed up to DC in the Obama era would have decided to raise their kids here no matter what the state of the city’s schools had been. The more reasonable reading, however, is that DC created a virtuous cycle, by taking steps to improve its K-12 system just as its economy was attracting a new influx of relatively well-off transplants. One telling fact: While the number of white children in DC roughly doubled in this time, the number in public and charter schools more than quadrupled, meaning parents were choosing to send them at higher rates. 

Still, it’s a model, one that shows how a city can change the makeup of its school system when it realistically can’t just make kids commute in from the suburbs. 

It seems telling that one of the only other cities to see similar declines in segregation, Atlanta, put a similar emphasis on education reform early in the century. Although those efforts were eventually sidetracked by a cheating scandal in which schools and teachers were caught faking standardized test scores, it did notch real improvements, as shown on the NAEP. 

Some will ask how much of a model DC can really be, given the uniqueness of its circumstances — not every city will have a chance to capitalize on a boom in young professionals. Still, it’s a model, one that shows how a city can change the makeup of its school system when it realistically can’t just make kids commute in from the suburbs. 

What Henderson, who served as DC schools chancellor between 2010 and 2016, emphasized to me was that insofar as DC has succeeded more than other cities at integrating in its schools, it was at best a side effect of education reform policies, rather than an explicit goal. At one point in our chat, I started reading a few of the stats I had dug up about the decline in “intense” segregation before she stopped me.

“I don’t even know if people collected that kind of data,” she said. “We prided ourselves on ‘what gets measured, gets done.’ If integration was a goal, that would have showed up on some of my [performance indicators]. And we just literally never had that conversation.” I suspect she was exaggerating slightly — Henderson and her deputy celebrated DC’s increase in white enrollment back in 2011. But it’s hard to think of a deeper contrast with Hannah-Jones’s view — where unless cities take politically implausible steps to desegregate, we’re doomed to failing children.

A woman’s death last week near a Russian facility studying the plague immediately put the world on alert. This is the plague, after all, responsible for the deaths of some half of the humans in Europe during the worst outbreak in the 1300s. And it happened in Russia, a country with a long history of bioweapon experimentation.

After the Covid-19 pandemic — which many people, including many scientists, genuinely believe started with the virus escaping from a Chinese laboratory — the worst-case scenario was obvious: What if this is another lab leak that seeds a global outbreak?

That’s not likely, for a number of reasons (the facility is very isolated, plague is not nearly as infectious as Covid, it’s easily treated if caught early). But that doesn’t mean our work with such dangerous pathogens has gotten any safer; in fact, it may be getting less so. The anxiety about the Russian outbreak is a window into two trend lines that do worry global health experts: In the six years since the Covid-19 outbreak, the world has been building even more bioresearch facilities, some in places where that kind of work has never been done before; meanwhile oversight of the science and the security measures at those facilities is struggling to keep up.

Every day, humanity is playing with fire, studying and tinkering with deadly viruses, bacteria, and parasites in laboratories all over the world. And despite the recent debates over rogue AIs or AI-assisted humans intentionally developing bioweapons to wipe out humanity, the Russian incident is a reminder that a simple accident — human error — could pose as much of a threat as malice. While it is hard to confirm the details, local reporting suggests the worker may have been infected after breaking a test tube. And if that’s true, this would, of course, not be the first time that a mistake at a highly secure lab has put people’s lives at risk.

“We are rolling back any progress we made post-Covid, in ways that are going to have long-term effects on our ability to respond to any kind of outbreak.”

Gregory Koblentz, co-founded the Global BioLabs project

Since the pandemic, there has been a dramatic uptick in facilities being built to handle some of the most dangerous pathogens in existence. At the same time, there is still no global authority in charge of oversight for these sites. The US, once the world’s public health leader, has pulled out of the World Health Organization, which issues security guidance for labs around the world and helps coordinate a response when there is a possible emergency, and cut funding for the federal agencies responsible for overseeing US biosecurity facilities. And even after something as global as Covid, the world is still struggling to cooperate and rapidly share information during a health crisis; even now, it can be hard to be sure what is happening in Siberia. Our only sources of information are a Russian government prone to withholding and distorting information, and local news reports that are difficult to verify.

Even if this Russian plague threat fizzles out as expected, one day, we may not be so lucky. 

“We are rolling back any progress we made post-Covid, in ways that are going to have long-term effects on our ability to respond to any kind of outbreak, whether it’s natural or deliberate or an accident,” Gregory Koblentz, who studies global biosecurity at George Mason University and co-founded the Global BioLabs project, told me. 

But there are clear things that can be done, before our luck runs out. 

Countries are building more high-level biolabs, but oversight is falling behind

One of the side effects of the pandemic was a biological laboratory building boom that followed in its wake. Global BioLabs, the research initiative Koblentz helps run, has sought to create a comprehensive survey of high-level labs around the world. Take Biosafety Lab, Level 4 facilities, for example; these are built to handle the most dangerous pathogens in existence, like ebola and smallpox. Global BioLabs noted in its 2023 report that “the number of BSL4 labs is rapidly increasing.” 

This is not the first time that a public health emergency has led to a biolab buildout: The post-9/11 anthrax scares and the first SARS outbreak in the early 2000s both led to countries constructing new facilities. In the late 1990s, there were fewer than 10 BSL4 labs in the world; by the late 2010s, there were almost 40. 

But the pandemic accelerated construction once again. In 2021, there were 59 BSL4 labs either in operation, under construction or actively being planned worldwide; by 2023, 10 more facilities had been completed or were in the works, according to Global BioLabs.

Part of the reason for the buildout is a harsh lesson of the pandemic: Developing countries realized they could not depend on wealthier countries to also prioritize their needs during a serious crisis. So they wanted the capacity to handle deadly biological material themselves in case, for instance, they have a local outbreak and want to be able to safely identify the cause. India alone is planning four new BSL4 facilities; at least five countries — including Brazil, Kazakhstan, Saudi Arabia, Singapore, and Spain— have started building or recently opened their first BSL4 lab. As a result, this construction is happening in places with less institutional experience doing this kind of work, where government oversight and stability have been weaker. 

“The more facilities that are working on this raises concerns about whether all this work is necessary,” Koblentz said. “And do they have the appropriate biosafety and biosecurity management systems in place?” 

That could raise the risks of unsound safety protocols — and ultimately of more high-stakes accidents. On top of that, according to the 2023 Global BioLabs report, about 75 percent of the existing operational BSL4 labs in the world are located in city centers, having at least 50,000 people living within 2.5 miles of the lab, “where dense populations could exacerbate the impact of an accidental release.”

And yet, even as lab construction takes off, national and international standards for governing these facilities and the research conducted there remain lax. There is no global organization that inspects or regulates these sites. One key voluntary group — the International Experts Group of Biosafety and Biosecurity Regulators — has actually gone defunct in recent years, Koblentz said. And national laws are patchy: Only one of the 27 countries with a BSL4 lab has comprehensive national legislation regulating “dual-use” gain-of-function research, in which scientists can tinker with pathogens to make them more transmissible or more virulent — and better understand how they work.

The WHO’s pandemic treaty initially included stronger biosecurity protections, but those were watered down during the debate over the document  — and either way, the treaty has still not been finalized. The US has of course also withdrawn from that and other international efforts to improve pandemic preparedness, further examples of the failure to forge more global cooperation in the wake of Covid. 

We need a more transparent approach to dangerous — but potentially life-saving — science

It could be easy to say we should simply stop studying dangerous viruses or enhancing them, even in highly controlled laboratory settings — but the situation is not that simple. Scientists do this kind of work to prepare for the next pandemic, to better understand how the viruses and bacteria that pose the biggest threat to humanity actually function, so that we can beat them back as quickly as possible. 

If you told somebody on the street that scientists are tinkering with a virus to see how it could become more dangerous, they would probably want the scientists to stop. But if you told them those scientists are doing work that could lead to faster therapeutics or vaccines during the next pandemic and avoid the need for lockdown and save millions of lives, they might be more open to this kind of research.

“The real question is: ‘What are the risks and what are the benefits?’” Beth Cameron, senior adviser to the Brown Pandemic Center at Brown University, told me. “We need to have a more rational conversation about what we’re actually talking about,” she said about these sorts of threats that are poised to have, as she puts it, “large-scale societal consequences.” 

And some of those are still circulating today. The reason Russia has this Siberian lab dedicated to plague research is because plague is still endemic in Russia.

“The dangerous pathogens are there already,” Koblentz said. The question is, he said: “How do you do it safely and securely?”

A starting point would be individual labs adopting new safety protocols, such as those from the International Organization for Standardization that were introduced shortly before the pandemic, Koblentz said. Additionally, as countries are building out their lab facilities, they need to develop strong oversight standards at the same time; the buildings may be flashy and have state-of-the-art equipment, but governments also need to address the mundane work of how to inspect and maintain safety once work begins as an equally important part of the process.

“If this is their first lab, in some cases, they don’t have very strong national legal and regulatory mechanisms for biosafety and biosecurity. They might not have the human capital,” Koblentz said. The regulatory side of the project unfortunately gets “short shrift,” he said.

Ideally, the world would have an international mechanism for auditing these sites, Koblentz said, something like an International Atomic Energy Agency but for biosecurity. There would be more transparent debates about what kind of research is done at high-security labs and whether it is truly important.

Better worldwide biosecurity will also likely require the US once again becoming a global health leader. The withdrawal from multinational groups like the WHO and cuts to government science funding have left everyone more vulnerable. Politics has consequences — including for our risks of a biosecurity catastrophe.

“Our level of preparedness for an outbreak, whether it is a lab accident or a natural outbreak of plague or anything else has been dramatically reduced in the last two years,” Koblentz said. “We’ve got a whole lot of problems that are self-inflicted at this point because of what the Trump administration is doing.”

The pandemic should have been a lesson in how important biosecurity really is. Instead, we’re unlearning its lessons in less than a decade. The Russian plague incident could be an essential wake-up call.

There’s no place like Kansas, a state whose howling winds are so fierce that in the 1800s, the roaring soundscape drove local farmers into madness. It is so windy in Kansas that every so often, trains get swept off their tracks or trampolines get hurled into the air and flung into neighbors’ trees. 

But today, the same gusts that whisked away Dorothy’s home have made Kansas the third-most wind-powered place in the country, its great plains dotted with thousands of twirling turbines responsible for generating over half of the state’s energy. 

And for years, Kansas has been trying to share. 

But that’s easier said than done in the US, where building power lines across state borders can be an onerous, litigious, and bureaucratic slog. The Grain Belt Express, a proposed 800-mile high-voltage line carrying Kansas’s windy riches across Missouri, Illinois, and Indiana, has been trying to get built for the past 16 years. When completed, it will allow Kansas to pump five times as much wind power into Missouri as it does now. But though the project received its first approval in 2013, it will likely not open until 2029 at the earliest, beset by regulatory hurdles across multiple jurisdictions and an endless stream of legal challenges that immediately halt progress every time a new injunction is filed. Alas, the express — which only broke ground this year — was forced to run oh so local. 

But other projects like it might soon enjoy far more reasonable timelines. On Wednesday, a bipartisan group of Senators announced a deal called the Bipartisan American Affordability and Jobs Act, or BAAJA — an acronym that’s led to a slew of cringeworthy euphoric Baja Blast references from abundance Democrats, clean energy advocates, and oil industry lobbyists alike. If passed, it would significantly curtail Americans’ ability to endlessly litigate against energy projects they don’t like, and empower the federal government to push critical multistate projects forward even if one state or municipality drags its feet. That could remake the way the nation’s energy infrastructure gets built, including its interstate transmission lines, for decades to come. 

But the bill also suggests that easing the way for clean energy in the US may require simultaneously creating the conditions for more oil and gas infrastructure in a country that already has a lot of it. It would also mean defanging some of the landmark regulatory norms that for decades have, for example, given Americans a say over developments that could contaminate their drinking water and helped tribes protect sacred heritage sites. These laws were necessary in the first place because prior to the 1970s, American communities frequently found themselves both literally and figuratively steamrolled  by developers singularly focused on building things quickly with little regard for the oil spills, river fires, and bifurcated neighborhoods they left in their wake.

And yet today, half a century later, that same dilemma has, in some ways, turned on its head. America builds things too slowly, and in particular, it builds the kind of infrastructure desperately needed to usher in a transition to clean energy with little of the urgency you’d expect from a world in the throes of climate change-related disaster. Exasperatingly, some of the same protections that have played a critical role in making this nation safer may also be standing in the way of building a nation that is more affordable and sustainable in the long run.

There are still plenty of reasons to feel hopeful about the world’s transition away from fossil fuels, even in the US, which has lagged behind our peers while still building an extraordinary number of solar and wind farms, particularly in Republican-led states like Kansas and Texas. And yet, many of these projects have languished in never-ending Ticketmaster-esque queues to connect to the nation’s decrepit power grid, a direct result of the permitting hellscape that prevents much-needed high-voltage cables like the Grain Belt Express from coming online.      

This new bill aims to ease many of the bottlenecks that stymie clean energy, but it also throws a bone to fossil fuels, which, like renewables, would benefit from less onerous environmental reviews and quicker permissions. This is, after all, a bipartisan bill in a Congress that, at least for now, remains Republican-led, under the tutelage of an aggrieved president who has sabotaged some of the nation’s most promising clean energy projects with an often petty and relentless fervor. Some Democrats in Congress, along with other environmentalists, have raised serious concerns about the bill. Those initial objections may prophesize an uphill battle for it when it comes to a vote, likely after the November midterms. 

Even so, with American electricity bills spiking to frightening new heights, and a data center buildout that could all but snap the power grid in half, this ambitious deal is, at the very least, an indication that some of the nation’s representatives are finally listening. And if it passes into law in the months to come, it could very well remake how Americans get their energy for a generation. 

So why are environmentalists mad?

By most accounts, the Bipartisan American Affordability and Jobs Act almost didn’t happen. 

For months, the proposed permitting deal has been stalled by the Trump administration’s failure to assure Democrats that the president would lay off his attacks on “windmills” and other clean energy projects. But in recent days, lawmakers appear to have come close to a fragile détente on the back of a “very reasonable opening proposal” from the White House, according to Sen. Sheldon Whitehouse (D-RI), the ranking member of the Environment and Public Works Committee. 

If the BAAJA is passed, it will codify new protections that legally prevent presidents like Trump from meddling with already-permitted energy projects or singling out specific forms of energy, a prohibition that will also apply if a Democratic president attempts to halt an approved gas line or a petroleum refinery. The Biden administration’s freeze on approvals for new natural gas export plants, for example, would not be allowed. 

It’s this element of the proposed bill that worries many environmentalists most. According to a transcript obtained by Punchbowl News, during a coalition call on Thursday, dozens of advocates from prominent environmental groups — including the Sierra Club, the National Wildlife Federation, and the Environmental Law & Policy Center — expressed their misgivings about the bill and strategized about how to lobby Democrats against it.

Most environmentalists acknowledge, however, that we need to spruce up the power grid and fix how permitting works for clean energy projects and transmission lines. As clean energy advocates know all too well, the projects they support are, paradoxically, more likely to be hampered by environmental reviews than fossil fuel projects are, because renewables usually require more space and represent the bulk of new energy developments. But many advocates understandably take issue with the idea that reforming this overcomplicated process may require weakening the right to challenge other projects, a right affirmed by the National Environmental Policy Act, the Clean Water Act, the Endangered Species Act, and the National Historic Preservation Act. 

The bill’s fate may ultimately depend on whether this trade-off is worth it. The BAAJA still does leave some room for court challenges if they’re filed within 150 days of an approval. But it will still place a much larger burden for determining these damage thresholds on federal agencies, which are, of course, currently controlled by Trump.

“The question’s not whether that would be a good idea — it’s one of the basic building blocks for converting more of our energy system to renewables,” the environmentalist Bill McKibben wrote of grid expansion and permitting reform on his Substack this week. “It’s how many pounds of flesh the fossil fuel industry would demand in return, and how close to vital organs that flesh would be located.”

The problem is, no matter how many Congressional seats Democrats seem poised to scoop up in November, they will still need to get Republicans on board if they want Americans to be able to really see the benefits of solar, the cheapest energy source of all time, reflected on their power bill. And for most of the nation, if not Earth itself, that transition can’t come soon enough. 

In October 2024, students at Cornell University received a campus crime alert about a reported sexual assault. At the time, it was just a campus story. Nearly two years later, on September 16, the victim, known only as “Jane Doe,” filed a civil lawsuit that brought national attention to her story. People across the country are asking what happened and why criminal charges never followed. 

Doe alleges that seven men drugged and sexually assaulted her at the Chi Phi fraternity house two years ago. Her lawsuit also accuses the university, fraternity and sorority organizations, and a local bar of failing to protect her. 

The lawyers for several of the men have denied the allegations and any wrongdoing. Cornell says its disciplinary actions led to suspensions and expulsions for some of the young men, and that the Chi Phi fraternity remains barred from campus. 

Doe went to campus police in November 2024, and the district attorney’s office reviewed her account and declined to bring charges. Tompkins County District Attorney Matthew Van Houten has said that what she described to Cornell police didn’t meet the state’s requirements for criminal charges. 

Van Houten reopened the investigation late last month while continuing to defend his original decision to not pursue charges, but it’s now out of his hands: On Thursday, New York Gov. Kathy Hochul named the state attorney general, Letitia James, as special prosecutor to investigate the allegations, saying she had “lost faith” in Van Houten. 

To break down why Van Houten didn’t pursue the case at the time and what should have happened instead, Today, Explained co-host Noel King spoke with Lauren Hersh, a former Brooklyn prosecutor who led the office’s sex trafficking unit and CEO of World Without Exploitation, about how authorities handled Jane Doe’s allegations, the limits of New York’s consent laws, and what needs to change. 

Hersh also explains where she believes the case should go next and what a special prosecutor can do to investigate (the interview took place prior to James’s appointment). 

Below is an excerpt of Hersh’s conversation with Noel edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.

I want to start with what we know in 2024. A young woman who we know as “Jane Doe” goes to the Cornell campus police and says she had gone to a frat house while under the influence of alcohol. 

At the frat house, she was given more alcohol and ketamine. Several men had sex with her while she was intoxicated. This is what she tells Cornell campus police. What, in your view, is supposed to happen next? 

There are a number of things that could happen. What I would say about these cases is there is no perfect scenario of what is supposed to happen, because what is critically important is we listen to the desire of the survivor. 

We want to take this at her pace. We want to be guided by her wishes. We want her to decide if she is ready to go forward, if she wants to speak to campus police, the Title IX office, if she wants to speak to the local law enforcement. There are a lot of variables here, but for me, what is critically important is that we’re listening to the survivor and what she ultimately wants to happen. 

In the present day, the district attorney who was involved has said that his office reviewed Jane Doe’s statement at the time and found at the time that what she described didn’t meet the legal definition of a crime. 

I think people want to understand, Lauren, how is that possible? 

To be really candid with you, Noel, this is an area that seems super unclear to me because the role of the district attorney in that moment is to investigate. 

When you first get a case file, you first get a victim statement, and especially with facts as horrific as these facts are, or our understanding of this six-page document that the DA read — I would never say that this is a clear-cut case where there’ll be a conviction at the end. We never know that. 

What I can say with 100 percent certainty is if you get a document like that, as a prosecutor, that is a significant investigative lead. And so, as a prosecutor, what I believe to be good practice is starting to pull the layers back, trying to understand what transpired here. Interviewing the victim. That feels critical. That never happened. We now know that there are all these text messages that were shared between these boys, and the prosecutor’s now saying, “I didn’t know about the text messages.” 

It’s my understanding that there were a lot of boys on that particular text thread. And so a good investigator would have gone to that fraternity house and tried to interview some of those boys, tried to understand what were the contemporaneous statements made at that time. Were there any text messages? Was there any social media activity? And I believe that had they done that in a timely fashion, they likely would have come up with these text messages at that time and not two years later.

What you’re saying is interesting because the DA has come out publicly and defended himself by saying, essentially, the details of this lawsuit, which was filed in September of this year, are different from the details in the young woman’s 2024 statement to the police. 

He has used that in his defense, right? “Here’s what I knew at the time versus what this young woman is saying today.” I think I hear you saying that maybe that’s not an excuse?

You’re asking about the inconsistent statements, and I find it troubling that the DA is leading with this notion that the victim has inconsistent statements because that feels to me like here we are making excuses and blaming the victim. 

To my knowledge, the DA has not yet interviewed this victim. Perhaps he’s talking about the civil complaint, which I would think is written in a way where she has worked with her lawyer to put this together. And the initial statement, the initial six-page document that the DA read, my understanding is that it is basically a summary of a conversation. 

Inconsistencies come in all shapes and sizes, so it’s hard to know exactly what we’re talking about here, but it is very common for there to be some inconsistencies. That is not a dealbreaker, despite the fact that this prosecutor wants the public to believe that it is. 

What do you make of the prosecutor speaking publicly in the way that he is at this moment?

I find it rather confusing. I’m not really understanding why he is doing a media tour rather than sitting in his office doing the work, interviewing this particular victim, interviewing witnesses, seeing what evidence actually exists.

It seems to me that the DA has gotten to a conclusion before he’s done the work in actually investigating the case, and it is deeply troubling. And I think the governor should consider appointing a special prosecutor because I am not certain, based on this media tour, that this DA is able to give this particular survivor a full and fair investigation of the facts. 

Drugs and alcohol are central to this case, right? The young woman admits she had been drinking and she was using ketamine. Under New York law, how does that affect whether or not someone is believed to be capable of consenting to sex? 

New York law is actually really problematic here. It’s a place where I believe we are desperate for a legislative fix. I think that there have been a lot of advocates who’ve been championing a correction to this voluntary intoxication loophole for a lot of years, and we’ve not been able to get it. 

New York law makes it very, very hard to prosecute a person when the victim is voluntarily intoxicated, but not unconscious, and this new law would allow the prosecutors the ability to bring cases when the victim is so severely intoxicated but not physically helpless and where a reasonable person should have known the victim’s condition. 

In this particular case, based on what we’re hearing, she was in a condition where a reasonable person should have known her condition. And so in this particular instance, the DA is right. This is a very, very hard case to prove in this moment, but I’m a big believer. We don’t not prosecute cases because they’re hard cases. But at the same time, we know that a change to the law is critically important. 

You clearly want more investigation here. What questions do you want asked? Who do you want to be [interviewed]? 

Before I say who and how and what that investigation looks like, I think it’s really important to say that when two years have passed and the DA did not investigate these cases immediately, we have a big problem on our hands.

The fact that the DA did not investigate this from the moment he found out about this, it’s really problematic because as we know, evidence disappears, memories fade. When you’re dealing on a college campus with a specific culture, there may be a narrative that takes hold. And so it’s important to talk about the time lapse and how that harms the case. 

That said, I still believe that the investigation is critically important. I don’t believe that this DA is the right person to do the investigation. I think a special prosecutor should be appointed. And then I think that the prosecutor and law enforcement should be interviewing everybody who was in that fraternity on that night. Anybody who saw this victim before, saw this victim after. Were there any statements in the immediate aftermath of her leaving that fraternity? Was there an outcry witness? We know that some text messages have come to light. Are there other text messages? I suspect that there are. 

I’d want to interview as many of those boys as possible to understand what was going on because some of those text messages that have come to light — one says, “Free pussy” — don’t sound like a mindset that is engaging in consensual sex. 

I think it is critically important that we understand all of the correspondence of that night. I think we want to see what is out there that helps us get closer to understanding what transpired that night. 

I’ve seen two lines of thinking about this. One is that this is a horrific incident that never should have happened, but it is in some ways singular. But I’ve seen another line of thinking that says, “No, this is a systemic failure. This kind of thing goes on on college campuses, and the steps that follow the outcomes are often the same.”

I wonder if you think this is a systemic failure, and if you think it is, what would need to be done to fix this problem? 

That’s a big question. I do think it’s a systemic failure. I also think it’s a cultural failure. And the reason that I would say this is because I don’t think this is isolated to this specific college campus. I think that sexual assault is happening across the country on college campuses everywhere.

In terms of additional systemic failures, I’ve been working with the Epstein survivors for the last year and a half, so I’ve seen so many systemic failures, so many prosecutorial failures, so much failure with law enforcement. I think that this is yet another example of prosecutorial failure. 

I think the law enforcement failed this young person — the fact that there’s no investigation that happened immediately in the aftermath of this incident, no investigation. We just continue to fail survivors all over the place, and we have to start doing better.

“In what world,” New York Gov. Kathy Hochul asked on Friday, “would the police learn from a victim that she’d been literally gang raped while she was intoxicated by five men in a fraternity house and not elevate those allegations to the district attorney?” 

Hochul was speaking about the case of a former Cornell student who said she was raped by several members of the university’s Chi Phi fraternity in 2024. At the time, the district attorney filed no criminal charges.

The case has rocked the nation and forced a renewed reckoning over how sexual assault is dealt with in higher education. While the district attorney has defended his handling of the case, many politicians and legal experts are now examining whether certain details of the alleged victim’s account were neglected, and prosecutors have reopened the case.

Amy Wang is a staff reporter at the Washington Post who’s been covering the story over the past week. She spoke with Today, Explained co-host Noel King about what allegedly happened on the night in question, what happened afterward, and what we still don’t know. 

Since the two spoke, New York state Attorney General Letitia James has also been assigned to oversee the case and said it is now “an active criminal investigation.” As new information comes to light, further legal action could be taken. 

Below is an excerpt of the conversation between King and Wang, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.

In October of 2024, a young woman went to a fraternity house near Cornell University’s campus. Who is this young woman, and why did she go to the frat house that night?

The young woman is only identified in documents as Jane Doe, so we don’t know her name. She was, at the time, 20 years old. She was a sophomore at Cornell. And around 11 pm on the night of October 19, 2024, this Jane Doe goes to a bar on campus, and then, after that, goes to the Chi Phi fraternity house to hang out with a friend. 

She said that she was already pretty intoxicated at that point, and she’d had maybe 10 drinks in about three hours. Her friend at the fraternity house hands her a beer. After that is where she alleges that another member of the fraternity pressured her into taking drugs, specifically ketamine and marijuana, and drinking more alcohol. She alleges that two members of the fraternity assaulted her, and that one of them later sent a Snapchat message out to active Chi Phi members. The message is pretty graphic, but essentially invites them to join in, and several did.

In about three weeks, this young woman was going to go to the Cornell campus police and report what happened that night. But in the interim, what was going on? What was happening?

We now know, based on reporting by the New York Times and CBS News, this young woman was a member of a campus sorority, so she went to a member of her sorority and was trying to make sense of what happened. She was still processing it in real time. She wasn’t using, according to their reporting, the word “rape” or “assault.” And she was also seeing rumors circulating around campus about what had taken place at the fraternity house and was growing concerned about how they portrayed her. 

She, in the interim, also received a text message from one of the seven men at the fraternity essentially apologizing for how things went down the other night. She is not yet accusing them of assault, but is chatting, even seeks to reassure him in that first message. 

On October 22, she then makes an appointment at the campus health clinic because she had what she thought was a UTI and wanted to be tested because she told the doctor that she had gone through a traumatic experience. 

According to the New York Times reporting, you could see her thinking about what happened kind of evolve over those few weeks. She at some point says that this is starting to ruin her life, and she’s sleeping and crying and she’s feeling ashamed. She’s just really grappling with what had taken place, trying to make sense of it. By November 3 is when, according to these investigative documents that were obtained by the Times, she kind of comes to this conclusion that what happened at the party at Chi Phi was assault. 

She texts one of the seven fraternity members and says, “This was not consensual. I was given more ketamine than I can remember,” and that she was uncomfortable. A few days later, November 7th, 2024, according to these documents, she goes to the ER and asks for a rape kit. And the following day is when she goes to Cornell University Police.

When she goes to the police, how does she characterize what happened to the police? What does she tell them?

What she tells the police is that she believes she was assaulted, and she tells the police that it had started out as something that was consensual. And then at the end she says, “I can say with 100 percent confidence I was raped.” She tells police she was extremely uncomfortable and that she kept taking ketamine in part because she thought she might black out and pass out. She had thought of at least two of the men as her friends. After the events of that night, she is then confronted with rumors that were spreading across campus, sort of depicting her as loose and blaming her essentially.

What happens after Jane Doe talks to the police? What do they do?

When she talks to Cornell University Police, they summarize what she said in a six-page statement that she then signs. And that is the statement that is submitted to the Tompkins County district attorney. 

And the district attorney would be the person who would bring charges or decide not to bring charges. What does he decide? 

Yes, so the district attorney decides not to bring charges in 2024 based on, he has said, the sworn statement that she signs to police. 

The DA says no charges for the seven men. Were they disciplined in any way?

We don’t know exactly how each of the men were disciplined. Cornell has said that they faced a range of disciplinary measures, including expulsions and suspensions. One of the details that had gone particularly viral about this is that the disciplinary measures included for some of the students to write essays. Cornell has not denied that, but it has specifically denied that the students only had to write essays as a disciplinary measure. The university has cited privacy laws and said it really can’t release any more specifics about how individual students were punished or not punished. 

What did Jane Doe do after first talking to the police and then learning the DA wasn’t going to press charges?

After she goes to police, we know she remains on campus and she has to continue seeing some of these men. And she also participates in the school’s Title IX investigation, which takes place over several months and concludes at some point in 2025.

I want to ask you about the DA. He is out in public defending his decision to not press charges in 2024. How is he defending himself?

The DA is a big part of the story. This is the Tompkins County District Attorney. His name is Matthew Van Houten. And he has said that in 2024, based on the written statement from Jane Doe, they did not have what they needed to press criminal charges. 

It’s important to note that we, as in the public, we’ve not actually seen a copy of Jane Doe’s sworn statement. The DA issued a press release in which he summarizes that statement. And in that summary, he describes her characterization of this as voluntary and conscious and consensual. That is at odds with some of the investigative documents that we’ve seen reported since then, including that transcript of Jane Doe’s interview with Cornell Police in which she very confidently says that she believes she was raped and even says that she was physically hit during that night.

The DA said that he did not see, before the lawsuit, the screenshot of the Snapchat message where the frat members are talking pretty crudely about the situation, and he also says he didn’t see the transcript of the interview between Jane Doe and police.

We now know the names of the seven men who were there that night. Have they said anything?

The seven men themselves have not publicly said anything, and the lawyers for three of those seven men have publicly denied the allegations. One of them says that his client went into the room, but immediately left and didn’t participate in the assault.

This is a story that is developing very quickly, and it seems like new information is coming out just about every day. What do we know about what happens next?

So there’s at least two things going on here. There is the reopened criminal investigation. 

Separately, there’s the civil lawsuit that Jane Doe filed last month, and that is not dependent in any way on how the criminal investigation goes, but that will also proceed against the university, the seven fraternity members, and the fraternity itself.

There’s a lot to be anxious about as AI agents and bots get more integrated into every aspect of our lives. Meta, which recently agreed to pay over $17 billion to settle a lawsuit related to harming kids, now wants you to hand over all your online accounts to an inexplicably cute “agent” named Muse that might give a stranger your home address. OpenAI just introduced little blobs called Dots that can supposedly automate routine tasks, like planning dinner and ordering it from your favorite neighborhood spot. AI companies don’t just want you to talk to their chatbots; they want their agents to be an indispensable part of your daily routine.

As a parent, however, I think that perhaps the worst thing AI could do is be my kid’s friend. 

AI companions have been around longer than ChatGPT, and they’re growing in popularity with young users. More than half of teens have interacted with AI companions at least a few times a month, and one in three decided to talk about a serious issue with AI companions instead of real people, according to a Common Sense Media survey conducted last year. In certain groups and situations, a chatbot could offer some benefit — a lifeline for, say, LGBTQ youth who don’t have any in-person support networks, one study found. But even so, there are important caveats and risks.

Meanwhile, other experts are telling parents never to let their kids access AI companions, warning them that these chatbots have a history of offering dangerous advice and engaging in sexualized conversations. Sixteen-year-old Adam Raine died by suicide last April after developing a relationship and discussing his plans with ChatGPT.

If you have kids, these are horrifying stories to hear. It’s reasonable to wonder how widespread the issues are, and who they are affecting most. As of right now, the majority of younger kids aren’t using AI for companionship (phew!). But for those who are, where do the issues arise? And how do they go from using ChatGPT for help with their homework to opening up to it about their problems to preferring it to their human friends? 

Some answers are starting to emerge from research. 

For even young adolescents, there’s a direct link between AI companion use and mental health issues, according to a new study by researchers at the University of North Carolina at Chapel Hill. Their paper, which is still under review, is the first longitudinal study in the US that has looked at the bidirectional association between AI companionship in adolescents and mental health issues, according to one of the researchers. It charted AI use among 2,300 middle schoolers and found that about one in five used AI for emotional companionship. Those who used AI more reported higher levels of loneliness.

“It’s not just that the lonely kids are using AI, and they’re otherwise unharmed,” said Anne Maheux, an assistant professor of psychology and neuroscience at UNC Chapel Hill and the lead author on the study. “It is that using AI comes first, and middle school students are increasing their sense of loneliness following the use of AI.”

I recently spoke to Maheux about her research and the role of technology in young people’s lives. We discussed how much parents and teachers know about what is going on, what kids get out of human relationships that AI can’t provide, and whether she’d let a child under her care use an AI chatbot. While she said there is a lot to be scared of right now, there is some evidence that, when designed with the intention of promoting child learning and development and under the supervision of a caring adult, AI can offer some benefits, and, ultimately, she’s optimistic that we can design a better future for kids. 

The conversation below has been lightly edited for length and clarity.

How do so many kids end up with an AI companion? Do kids start using AI for homework help and end up in an emotional relationship with the technology? 

At a high level, AI companions — in our darkest vision of what that might look like — would be a kid calling an AI chatbot their best friend. That phenomenon is still quite rare. There are certainly plenty of kids who are experiencing that, but it’s not to say that it’s all kids or even most kids. I think that’s good news. 

But it’s also true that the line between opening up AI to ask a question about your homework and a full-blown AI companionship relationship involves a lot of gray areas. There’s evidence, mostly preliminary and anecdotal evidence, to suggest that very few people open up to AI with the primary initial goal of developing an intimate friendship or relationship. 

Most people open it out of a curiosity, sense of novelty, or seeking an answer to a question that’s very pragmatic. Then that can potentially evolve into something more akin to seeking personal advice or help making a decision or help making sense of one’s recent experiences with other humans. And that can potentially evolve to something that’s a bit more emotional.

What did your latest study on adolescents, AI companions, and mental health reveal?

Some kids seek out AI for certain purposes in different ways than other kids. For some kids, AI companionship is particularly attractive, especially the kids who maybe don’t have close friends or social networks in their offline life and who are already lonely. 

It’s a chicken-and-egg problem. Is it that these kids are seeking out AI companions or is it that having an AI companion is exacerbating those potential vulnerabilities or exacerbating risk for mental health problems? What we found is that interacting with an AI companion in a way that’s akin to emotional intimacy among middle school students is longitudinally associated with increases over time in loneliness. So the kids who are seeking out these companions, who are presumably already lonely, are also experiencing an increase in loneliness over time. 

There is this potential directionality question that we’re starting to answer here: It’s not just that the lonely kids are using AI, and they’re otherwise unharmed. It is that using AI comes first, and middle school students are increasing their sense of loneliness following the use of AI. In other words, middle school students using AI for emotional intimacy and companionship developed greater loneliness over time.

Do you have a sense of how often these kids are using the chatbots? 

In our sample — so again, these are US middle school kids — about 15 to 20 percent say that they’re using it at least a few times a week for any purpose. We don’t have specific rates of use for companionship because the questions that we asked were just not framed in a frequency measure, but more in how emotionally intimate they felt with the chatbot.

What else could have been causing that loneliness?

There are almost definitely many causes, and I think that our data suggests that AI companionship may be one cause. It certainly isn’t definitive. Obviously, I have to say that. I’m a scientist and trying to be hesitant about these things, but the reality is that whether or not AI use causes loneliness in this particular case, there are definitely other things that are also causing loneliness. 

That could be a myriad of things about the kid, maybe they have a lot of social anxiety, maybe they struggle with social skills, maybe the kid has had struggles in their family life and doesn’t have a strong sense of connection and belonging at home. It could be structural things. The kid just doesn’t have enough access to appropriate resources. So certainly there’s other things that are at play here, and typically technology use is one of many factors that can influence a kid’s mental health. 

And how much do you think that parents and teachers know about what’s going on, and how well-equipped do you think they are to intervene or to just be more involved in how these kids are using this technology? 

It’s a very slippery technology. The way kids are using it has changed rapidly in just the last year or two years. I would expect that parents, teachers, people who care about kids are probably struggling with the rapidity of change. But it’s also true that all the things that we have known for a long time about supporting kids and helping them thrive, those things are still true and they’ll be true with whatever technology comes after AI that kids are exploring. 

Those things include being curious, asking kids questions about their lived experiences online and offline, having conversations with kids so that they can understand the implications of different technology use. They can understand how, for example, AI is embedded within a broader system of social and political and economic factors, including the fact that many companies are trying to exploit kids’ attention in order to make money, which many kids are quite interested to hear about. 

Supporting kids also means providing a warm and supportive space for them to learn, to make mistakes, to be kids in the offline world, to have the frictionful, challenging, awkward conversations and first dates and all of the things that parents are sometimes trying to protect kids from by providing a safe container for them to explore those things. All of that can also provide avenues for kids to learn what they need to learn and develop — all the resources for a long life of thriving, even in the context of AI or other new technologies. 

What do kids learn from having these kinds of conversations with other humans that they can’t get from AI? 

Kids need to engage with other people, period. That’s true for all of us. We’re an incredibly social species. Simply being around other people and talking to strangers, let alone having strong social bonds, is really good for us. And all those things are uniquely important during adolescence, when kids have this neurobiological sensitivity to social information and reward. That’s when kids learn how to engage in conversation, they learn how to maintain eye contact, how to read body language, how to read emotions and perceive the world from the lens of someone else, to take their perspective. That’s not to mention other things, like being a member of one’s culture, what is valued, and what is expected. All of that is learned in the context of other human social relationships or relationships with broader social groups that a kid might be a member of. 

AI obviously can’t and never will be able to offer some of those things. It can’t actually experience empathy or care. It can’t engage in a true mutual human relationship. It may be able to simulate some of those things, and there’s some evidence that it can serve as a source of social practice. It can help kids work through the potential for difficult conversations and then serve as a bridge to engaging with other people. But there are aspects of AI that just simply can never replace the core sacred aspects of humans. 

Can you be more specific? What is it about human relationships that can’t AI simulate?

The way that AI systems are currently designed, which is not an inherent feature, but is a design choice, is to be sycophantic, highly agreeable, anthropomorphized, and all of those things can lead to kids developing expectations or understandings of interactive relationships that are actually fundamentally at odds with a normal human relationship. Some of the most consistent things that I’ve seen in the educated hypotheses on this topic and also in the emerging empirical research is that people need the friction that comes with human relationships. 

Human relationships are just hard and messy, and they’re also really beautiful. They’re what make so much of human life valuable and worth living. And with AI that’s always agreeable, that’s always available, that has no needs of its own, that can’t care or be cared for, it just doesn’t serve the same context to help kids learn things like conflict resolution or negotiation, being pro-social or caring for someone else who has needs. So many of those aspects that can feel uncomfortable in the moment, dealing with another person or a person who’s not responding right away, those things are actually important in the building blocks of developing the skills and capacities to be a functioning and thriving person in the social adult world. 

This is a problem with AI in general, isn’t it? It makes things effortless, but if you choose this path of least resistance, you’ll avoid the friction that causes you to learn and develop and build skills you need to exist in the world. 

Absolutely. And I think that all these things are connected too. AI offers this effortless, frictionless solution to our day-to-day problems, whether they’re social problems, whether they’re problems doing our homework, and those immediate solutions feel really good in the moment, so they’re quite tempting to keep coming back to. But there’s this real possibility that in the long term, that erodes our capacity for not only social relationships or cognitive skills, but just a general ability to withstand the momentary day-to-day distress of being a person living a normal life. And so I think every domain of human psychology comes together at that point, whether it’s social, emotional, mental health, or cognitive. 

Do you think that there are interventions that legislators could make or even that tech companies could make that would improve outcomes for kids, maybe make them a little less lonely? 

There are a million specific design changes that I would recommend. I think at a very minimum, AI systems can afford a pretty phenomenal amount of access to information, but there’s been no benefits that I’ve seen of them acting as friends. Kids need other human friends, full stop. Designing systems that are intended to exploit kids’ vulnerability or sensitivity to human social information and relationships, I think, is bad for kids. 

At the federal level, it seems that regulation is not coming, but at the state level, there have been many state regulations intended to protect kids, intended to create safer systems, to put in guardrails, to modulate different aspects of the models, the design, the user interface. These things could potentially make a real difference, I think.

What do you recommend parents do with regard to AI and their kids? Should they let them use chatbots? 

In short, no. But I am not a parent, and it’s much easier to dole out advice than it is to enact it. Parenting decisions about technology are not one-size-fits-all. Kids, parents, family dynamics, technology, and the context in which it is used differ, and in so many cases are personal choices (parents must weigh various potential opportunities and risks). Decades of research indicate what conditions a child needs to thrive. Extremely minimal research addresses the effects of AI on youth, and what we have so far suggests that the risks outweigh the benefits. 

I would not give a child under my care AI chatbots of any kind to use without me or another trusted adult present. I would talk to them openly about AI and its risks and benefits, but to me AI, like all technology, should be a tool used to promote human thriving, and when the evidence is unclear or suggestive of harms, I think it’s best not to experiment on kids. Currently, the off-the-shelf AI chatbots most kids are using appears more likely to undermine well-being for vulnerable users, especially children. 

Well, as a father of two daughters, I’m definitely terrified of what’s to come in the next few years. 

There’s a lot to be scared of, but there’s a lot to be hopeful of too. I think that everyone wants kids to thrive. Some of us are under different incentives, and some of those incentives might be perverse. But most of us are working really hard to design a better world for kids. 

This story was originally published in The Highlight. To get access to member-exclusive stories like this every month, become a Vox Member today.

In the moody alcoves of a lobby bar in Chicago in 2021 over French 75s, Dr. Louise King, a gynecologic surgeon, and Katie L. Watson, a bioethics professor, found themselves in conversation about a topic that had long frustrated them both: Female surgeons are consistently underpaid compared to male surgeons, even after accounting for specialty, rank, age, and other factors. 

What troubled them even more was how the pay gap compounded in King’s own field. Surgeons who perform procedures that are specifically for women, like gynecological surgeries, are paid less for their services than surgeons who perform comparable surgeries for the male anatomy. Gynecologic surgeons are also predominantly women. Over the course of the conversation, Watson termed this situation “double discrimination,” a phrase that captures the overlapping dilemma of lower pay for surgeries in a specialty that is overwhelmingly female and also serves a primarily female patient population.

That term, which has since entered the medical literature, stuck because the problem it describes has been well documented for decades. In 1997, a group of gynecologic surgeons published a paper in the journal Gynecologic Oncology with a title that gets straight to it — “Is Adam worth more than Eve?” Dr. Barbara A. Goff, now chair of Obstetrics and Gynecology at University of Washington Medicine, and colleagues found that doctors are paid around 44 percent more for performing male-specific procedures than analogous female-specific ones. 

In the three decades since, the problem hasn’t been fixed. To the contrary, it has been effectively institutionalized, built into the systems and codes that determine how surgeons bill for procedures of all kinds. Today, gynecologic or female-specific procedures are in large part still reimbursed at lower rates than male-specific procedures even when they take similar time and skill.

Those disparities have consequences that extend beyond the compensation of individual doctors. When gynecological procedures don’t bring in as much money to hospitals, those same hospitals are disincentivised to offer women’s health services. That can lead to worse care for women and, crucially, fewer training opportunities for the surgeons who do that work. 

But this historically persistent inequality is not a foregone conclusion.

How healthcare services are billed changes all the time as procedures get reevaluated, new ones get added, and medical societies and experts push for revisions. In fact, one of the biggest changes in how maternity care is billed and reimbursed is set to take effect early next year, splitting up services for prenatal care, delivery, postpartum care, and more. While this is a long-overdue fix for obstetrics, gynecologic surgery — which covers most of a woman’s life outside of childbearing years — continues to be left out of the conversation. 

And although real change will require concerted efforts, King and Watson — and other advocates who have spent years documenting this disparity — have a fairly clear sense of how to start fixing it.  

How surgical procedures are valued

The work of deciding how much a medical procedure is worth starts well above the head of any given doctor, medical practice, or hospital. In the United States, the Centers for Medicare and Medicaid Services, a federal agency that administers healthcare and health insurance policies, sets rates for different procedures based on a metric called relative value units (RVUs). An RVU is supposed to take into account how long a procedure takes, the skill it requires, and the intensity of work it demands. Both Medicare and private insurers consider these figures when they’re settling on reimbursement levels. If a procedure has a higher RVU, it is valued more highly, and makes more money.

In a recent study, cheekily titled “Price and Prejudice,” researchers from the Mount Sinai Health System found that out of 55 pairs of sex-specific procedures that they evaluated in 2023, 75 percent had lower RVUs for procedures on female patients. On average, RVUs for male-specific procedures were 30 percent higher, and when those procedures were performed in a hospital or surgical center, surgeons were paid around 26 percent more.

For example, doctors will often perform biopsies — taking a small sample of tissues, cells, or fluids — on both male and female genitalia to diagnose problems. In 2023, researchers found that Medicare’s standard national rate for reimbursing surgeons was $121.32 for a penile biopsy but only $65.74 for a vaginal biopsy. 

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King, the director of reproductive bioethics at Harvard Medical School Center for Bioethics and a contributor on the study, believes that when the RVU system was created back in the 1990s, gynecological services were largely ignored, leaving the specialty undervalued from the start. While Medicare and Medicaid Services have undertaken some efforts to make RVUs more equitable across specialties over the years, that undervaluation has persisted. 

That problem may come down to how those values are determined in the first place — and who determines them. RVUs are set by a committee of doctors convened by the American Medical Association (AMA), with most of the seats allocated to members of major medical societies. The committee surveys different doctors on the time and skill required for procedures in their specialties. Based on these responses, the committee recommends values for each service to the federal government, which has historically accepted nearly 90 percent of them.

While the data quality of the underlying surveys has improved over the years, it is still not very high, said Dr. Miriam Laugesen, a tenured associate professor of health policy and management at Columbia University Mailman School of Public Health. Because the committee’s process isn’t transparent, it is often unclear what evidence its valuations rest on. This leads to distortions of all kinds, she said.

“It’s not a government process; It’s not a federal advisory committee,” Laugesen said. “It’s just a committee that was put together by the [AMA]. It’s pretty unusual in terms of how policy is made.”

In particular, King said that the surveys have a very low response rate from some specialties and are only sent to a small subset of doctors. She has never received a committee survey in the 17 years that she has practiced. 

The American College of Obstetricians and Gynecologists (ACOG) has a core seat on the committee that determines RVUs. But most ACOG members are general OB-GYNs, who split their time between obstetrics and gynecology and typically operate relatively rarely. The surgeons who perform the bulk of gynecologic operations are subspecialists – gynecologic oncologists, urogynecologists, and minimally invasive gynecologic surgeons — who complete an additional fellowship after residency. They mainly belong to their own societies and don’t have a seat at the table when RVUs are being determined. 

“From a purely cynical or economic standpoint, [ACOG] has no reason to advance billing for gynecology. It doesn’t represent a large portion of the practices of their members,” said King, adding that ACOG has been heroic in its efforts to obtain reimbursement equity for its own members. (One unintended possible result of that advocacy is that pushing for a smaller pay gap for services related to pregnancy has in turn sent the message that women’s bodies are literally worth less, and are less deserving of care when they’re not engaged in the god-given duty of reproduction.)

The result is that doctors in specialties like OB-GYN who operate infrequently are answering the surveys about complicated surgical procedures that gynecologic surgeons perform more frequently. King said that her surgical schedule aligned more closely with those of general surgeons. For example, she operates two to three times a week whereas, according to her, an average OB-GYN will likely operate once a month. 

“So they’re not the right people to be answering these surveys. They [the survey committee and ACOG] don’t target the surveys to people who operate a lot,” she said. 

Part of the problem with using surveys to determine a key foundation of medical reimbursements is that the data is self-reported by doctors. This is especially relevant when more objective avenues may be available. One of those avenues is the American College of Surgeons’ National Surgical Quality Improvement Program, which is an initiative that collects and manages key surgical data to track quality and improvement in surgical fields, including the actual time spent performing surgical procedures, making it a more definitive measure than self-reported surveys.

Dr. Shitanshu Uppal, a gynecologic oncologist and division chief for gynecology oncology services at the University of Michigan, and his colleagues analyzed 901,917 surgeries using both the National Surgical Quality Improvement Program as well as the self-reported surveys used to determine RVUs. They found that median RVUs per hour vary widely between specialties. Gynecology had the third-lowest median RVUs per hour of all the specialties studied. In effect, that means that gynecological surgeons are paid less for every hour that they work. 

The researchers also found that compared to the operating times logged for real surgeries in the Surgical Quality Improvement Program, surgeons in certain specialties tended to report longer procedure times in the self-reported surveys sent out by the RVUs committee. Specialties that reported longer operating times were more likely to be awarded higher RVUs, leading to greater hourly rates of reimbursement.

According to Uppal’s analysis, urologists — a profession most often associated with procedures on men because their work routinely concerns the prostate and the testicles — reported times that exceeded the baseline data by a median of 20 minutes. By contrast, estimates from gynecologists only exceeded the actual time by a median of five minutes, meaning that urologists tended to overestimate their time spent in surgery by four times as many minutes. Generally, urologists earn much more than general OB-GYNs, who in turn earn more than other subspecialties like gynecologic surgery. Despite having access to reliable electronic records of operating time, Uppal and his colleagues note, the AMA committee still continues to use self-reported operating times, which influences their RVU recommendations, ultimately cementing disparities in female-specific procedures. 

“The system that they have now developed over time,” King said, “now creates discrimination because of its complexity.” She added that this is how systemic discrimination is perpetuated, even if systems or rules appear seemingly neutral.

How low reimbursement rates make women’s lives worse

The US healthcare system has never been especially good at putting its money where its mouth is when it comes to women’s health. Experts have been sounding the alarm on sex-based disparities in medical billing for a long time — long enough that governing authorities like the committee responsible for RVUs and ACOG have had time to respond to the concerns. 

Over the years, the gap between male-specific procedure reimbursements and female-specific reimbursements has decreased slightly. But researchers of the Price and Prejudice study showed that between 2003 and 2023, there were no statistically significant improvements to the pay disparities. Comparing a smaller set of procedures across 1997, 2015, and 2023, they found that the gap had narrowed only minimally.

One common justification that ACOG provides for the pay gap is that obstetrics and gynecologic services see a higher-than-average share of patients on Medicaid, which pays doctors less than other insurers. King agreed this is a real factor, but it doesn’t explain why Medicare itself values procedures on women lower in the first place. And as her account of double discrimination makes clear, undervaluing gynecology ultimately affects women everywhere for the worse.

“I have patients who are waiting for surgery with me for a year at a time. I mean, that’s crazy.”

Dr. Louise King

Lower reimbursements in gynecologic surgery disproportionately affect female surgeons because they represent a majority of this specialty. It’s not just the surgeons’ salaries that are affected. Hospitals and facilities work on a revenue-based model — if gynecologic surgeries are not bringing in enough money, institutions tend to allocate fewer resources to those procedures. That, in turn, can limit access to operating rooms, surgical staff, and operating times. 

“I have patients who are waiting for surgery with me for a year at a time. I mean, that’s crazy,” King said. As a minimally invasive gynecologic surgeon, she surgically treats women with endometriosis, fibroids, cysts, or other such conditions.

It also affects the training that gynecologic surgeons receive. When there aren’t enough resources to operate regularly, opportunities to train residents are rarer than they should be. The result is that low reimbursement rates have contributed to a workforce of low-volume gynecologic surgeons who are sometimes not as well-trained as other surgeons who operate frequently.

The relationship between volume of surgeries performed and patient outcomes is well-documented in other fields. Research shows that surgeons who operate infrequently have worse outcomes, including more complications before, after, and during surgeries, compared to surgeons who operate regularly. 

Low-volume gynecologic surgeons — who perform a particular procedure less than 12 times a year — have significantly higher rates of causing bowel and urinary tract injuries in their patients. Especially in benign gynecological surgery (procedures not related to cancer), having surgeons who operate frequently also increases the number of minimally invasive procedures performed, which is related to better patient outcomes. 

Payment reform is an uphill battle, but not a lost cause

It takes multiple years and pressure from different entities to update or add new RVUs for procedures — but crucially, it is not impossible. The first few steps to creating a sustainable system might look like submitting gynecology-related procedure codes for reevaluation to the AMA committee or prompting a congressional report on the matter. 

For example, for years there has only been one billing code for endometriosis, regardless of the complexity of surgery or technique used. This disincentivizes surgeons from taking on complicated surgical cases of endometriosis because of the low reimbursement rate. Reevaluating that rate or diversifying the various surgical approaches that different cases require would help affected women get the care they deserve.

Medicare’s payment system also has what’s called a budget neutrality rule, which dictates that significantly increased payments for any given procedure must be offset by cuts elsewhere. The AMA itself believes that reforming this rule would make it easier to work toward reimbursement equity for female-specific procedures.  

Experts have suggested creating gynecology-specific conversion factors to bring parity to a system that naturally undervalues these procedures, while others think that eliminating sex-specific billing codes whenever possible is the right move. For example, the code for genitalia biopsies is different for men and women. This means that those procedures can be reimbursed differently even though they are essentially similar. Adopting one sex-neutral code for any genitalia biopsies would avoid this. While the reform required for this would be substantial, researchers believe that it would narrow the billing gap significantly.     

Authorities often justify lower RVUs for female-specific procedures by pointing to training: Gynecologists spend fewer years learning to operate than urologists and other higher-paid surgical specialists, according to King.

Historically, surgeons who operated on the female pelvis trained in ways that were more closely aligned with general surgeons than OB-GYNs. When obstetrics and gynecology merged into one specialty in the 1900s, the training for gynecologic surgery was truncated. 

“General OB-GYNs will train for four years and of that four years about 18 months is devoted to surgical training in gynecology,” said King, contrasting the new training period to those of general surgeons, which is in years. 

She believes that training periods should be increased for gynecologic surgeons. That change would secure better reimbursement for the speciality, while also producing better trained surgeons who would be more attuned to advances in minimally invasive surgery that will ultimately improve the outcomes for their female patients. In some cases, the experience gained during a two-year fellowship in gynecologic surgery was equivalent to 19 years in practice.  

In their initial work on double discrimination, Watson and King argued that failing to implement solutions for parity is tantamount to saying that female patients deserve less well-trained surgeons than male patients.  

As with most women’s health issues, it is unclear if this systemic disparity in medical reimbursement is the result of conscious misogyny or a by-product of ignorance. But that question of origins matters little when its consequences have been enshrined in medical policy, with lasting consequences for the practice of medicine more generally. We have allowed this wage gap to persist, even as many have sounded the alarm for decades. It is long past time to heed their warnings.

October 7, 2026, 5:50 pm ET: This story was originally published on October 2 and has been updated to include the sourcing on the RVU gap resulting from training for gynecologic surgery.  

Buried beneath every American city is a mysterious jumble of cables, pipes, and gas lines, entangled like a pair of wired headphones the moment you pull them out of your pocket. Every time a contractor sticks a shovel in the asphalt, they embark on a high-risk excavate-by-dots obstacle course, dodging color-coded clusters of spaghetti-like power lines, gas mains, sewers, and fiber-optic cables. A line of blue spray paint means water. Red means power. Yellow is gas. Orange is telecom. 

About 700,000 times a year — that’s once every 47 seconds — something goes wrong. 

A backhoe slices into a cable and cuts off a 911 call center, or a woman comes home to find her dryer and hot water heater on fire after a contractor pierced her electrical line. Just last week, a contractor accidentally severed a single telecommunication cable that proved critical enough to ground flights at some of the nation’s largest airports on the eve of the UN General Assembly, ensnaring even world leaders like Canadian Prime Minister Mark Carney in delays. 

The ground beneath our city streets has never been so crowded, driven by a furious race to lay fiber optic cables carrying the data that fills your social media feeds and transmits your ChatGPT queries. Nor have the systems we use to find out where it’s safe to dig — namely, a hotline and all that colorful spray paint — ever felt so catastrophically insufficient. 

“If the locator mismarked the line, if the line wasn’t marked, if there was no map that even said the line was there,” said Sarah Magruder Lyle, president of the Common Ground Alliance, a trade association focused on underground damage prevention, “there are a variety of issues that could happen before the excavator even puts a shovel or a backhoe in the ground.”

According to Common Ground, such incidents cost the US about $83.2 billion per year, roughly as much as we invest in public transit annually nationwide. But the actual financial toll may be even higher, because every time a crew stumbles across a mislabeled power line or a gas pipe everyone else forgot about, it can delay construction for months on end. As Magruder Lyle put it, “if they get out there and they find something that they’re not supposed to, you have to go back and reengineer the whole project.” 

Such surprises can also lead to tragedy. A 5-year-old named Alistair Lamb was killed in Missouri last spring after a contractor drilled into a gas line near his home, spewing fumes that leveled his house when his unsuspecting father flipped a light switch. And just this May, another unmarked gas line killed three people when contractors struck it, leading an apartment complex in Dallas to explode.

Yet the messy underbelly of our cities remains largely invisible, with accountability for issues foisted upon and at times evaded by a hodgepodge of finger-pointing private utility companies, agencies, and contractors. And that’s a shame because there is, in fact, a better way to bury the cables and pipelines that our modern lives depend on, and a multitude of better ways that we can find the ones we’ve already buried. 

What Disney World gets right about the stuff we bury

To understand one utopian vision for how all this could work, look no further than the happiest place on Earth. That’s a moniker Disney World has earned, in my mind, not for its Mickey Mouse waffles (though my niece may disagree), but for its world-class utility corridors, also known as utilidors.

Directly beneath the Magic Kingdom is a sprawling network of tunnels. Initially designed to shepherd around Mickey and his friends, the system now also serves as one of the largest utility corridors ever created. Unlike the rest of America, where cables are typically dumped in ditches before being covered with dirt, the electrical lines that power Cinderella’s castle quite literally get the princess treatment. 

Alongside water pipes, sewers, and animatronic control systems, these power lines lace the walls and ceilings of the utilidors, meaning they’re protected from weather and changes in the soil. They are also easy to monitor, catalog, and access if something needs fixing. While the cost of building a controlled system like this is much higher upfront than burying directly in the ground, the practice virtually eliminates the risk of accidentally rupturing a gas main or slicing a fiber optic cable during routine maintenance. Once they’re built, they can also drastically reduce costs in the long run because you no longer need to tear up a street every time a utility needs fixing. 

“Obviously, it’s expensive,” said Debra Laefer, a professor of civil and urban engineering at New York University, “but in the long term, it would be hugely cheaper,” especially “in areas where we are digging all the time, there’s a direct business case for moving towards these utilidors.”

As fantastical as Disney World’s imagineered system may seem — and it was, to be clear, predicated on a not-easily-reproducible master plan — the idea of storing utility lines in easy-to-access tunnels is not just for amusement parks. It is possible even in places where most of those lines are currently lying in the dirt, as Prague proved back in the 1970s, when the city decided it was fed up with destroying its precious cobblestone streets every time a buried pipe or cable needed fixing. The city now boasts a sprawling utility tunnel network, occasionally patrolled, evidently, by a couple of robot dogs tasked with mapping out every cable. 

Singapore has also spent years building out walkable utility corridors that operate much like the Magic Kingdom’s, transmitting water, data, and energy from the safety of well-organized underground tunnels. Some of Tokyo’s largest districts store their cables and gas lines in huge concrete utility ducts, and many Parisian water lines and fiber optics are kept across the city’s centuries-old sewer system, a catacombs of waste made easily navigable by blue-and-white street signs that correspond to the avenues above. Many university campuses across the US also boast their own sprawling utilidors.

In most cases, cities chose not to relocate utilities all at once, a feat that would probably be financially prohibitive and deeply disruptive. Rather, they took advantage of all the times they’ve needed to relocate utility lines anyway, a standard (and expensive) practice for big building projects like the Wallis Annenberg Wildlife Crossing or the Second Avenue Subway, a major transportation project in New York City that’s been consistently delayed by unmapped utility lines. A group of graduate students found that building such a tunnel in parts of NYC would likely cost at least twice as much as dropping a utility line in the ground, but could recoup the costs within 47 years. 

“There are streets in New York City that have been excavated at least once a year, every year for the past 30 years,” Laefer said. If you just prioritize those streets, gathering the piping in a “big concrete box” underground, you could allow workers to complete most repairs without needing to disturb the streets or sidewalks above at all.

But building new utility tunnels would require that we first come to better understand the wires and piping already entangled under our cities, which if you recall, we have only a surprisingly flimsy picture of in most cities today. But if every surprise utility line is an opportunity to move it somewhere better, it is also an opportunity, at the very least, to map out where it is.

To that end, a few years ago, Laefer led a $1.2 million pilot funded by the National Science Foundation to create a test case for 3D-mapping New York City’s underground utilities, a project that’s since been adopted into a citywide initiative. The city says it plans to roll out the spruced up utilities locating system in 2028. The UK debuted a similar digital map of over 3 million kilometers of underground pipes and power, owned by hundreds of utilities and agencies a few years ago. The nation projects that it could help save over $500 million per year by minimizing delays and accidental damage. In places where Singapore has not yet stuffed its utilities into walkable tunnels, the city’s own mapping and utilities coordination has already saved it an estimated $230 million in avoided clashes since 2024. Not bad for an intervention that doesn’t even require any physical rebuilding.

So why hasn’t every American city copied London or Singapore?

Well, US cities tend to be plagued by even more private utilities and patchwork local and state norms and regulations than a nation like the United Kingdom. Getting them to pool together what they often consider proprietary underground data is challenging, and few local officials have opted to prioritize such efforts. But this may well change as more and more fiber optics go into the ground, more flights get canceled, more apartment complexes explode, more power lines flicker off, more sinkholes form, and more Americans come to be all too acquainted with the perils lurking just beneath our feet. 

“I think at this point, it’s more about political will and money than any technical obstacle,” Laefer said. “Technically, we’re there. It’s just a matter of doing it.”

Welcome to The Midterms, Actually. Every week I’ll be writing about two things: one big idea or trend I see forming across the 2026 primaries, and one thing I’m hearing from a voice on the ground. You can sign up here to get it in your inbox every week. Let’s get into it.

One big idea: Democrats’ Laken Riley vote is aging badly

Two things happened this week that reveal how quickly the politics of immigration enforcement are shifting.

First, Republican Sen. Jim Justice of West Virginia, a staunch ally of President Donald Trump, urged the administration to dial back its enforcement push. “Before you know it, you get people that get carried away in their job and whatever it may be, and all of a sudden, then you’re dragging people away that have lived on your street corner for 15 years,” Justice told Politico this week. “I don’t know that we need to be doing that stuff.” And he’s not the only red-state Republican who’s been pushing back on ICE lately, including some facing voters in tough races next month.

The second thing flew under the radar: Sen. Jon Ossoff, the Georgia Democrat running for reelection who has also been floated as a 2028 presidential candidate, struggled to explain himself when a reporter confronted him on camera about his vote for the Laken Riley Act in January 2025. Passed within days of Trump’s inauguration and signed nine days into his second term, the law requires ICE to detain undocumented immigrants who are merely arrested for or charged with theft-related crimes, before any conviction.

In the exchange with a reporter from Drop Site News, Ossoff talked about his Senate work investigating alleged ICE abuses, but didn’t directly address his vote after being asked if he regretted it. “Laken Riley was my constituent and what happened to her should happen to no American, to no person in this world,” Ossoff said. “I think that immigration enforcement should be focused on those who are convicted or charged with serious crimes.” He excused himself to walk into a meeting as the reporter pressed him on whether the law undermined due process. 

In both cases, you see changing winds of electoral politics. Back in 2025, when Ossoff and 11 other Senate Democrats joined Republicans in supporting Trump’s immigration bill, they implicitly validated Trump’s premise on immigration enforcement: that not only was the border out of control, but that there also needed to be new efforts to step up interior enforcement through expanding agencies like ICE. In the year-plus since that vote, Trump has hired more ICE officers, launched sweeping raids in cities like Minneapolis, Chicago, and Los Angeles, and fueled a cauldron of chaos that’s led to shootings across the country. Politically, it has now put Democrats like Ossoff in a pickle, one that will matter more the closer we get to 2028.

How do you explain giving more immigration powers to a Stephen Miller-led White House? How can one argue you couldn’t have seen this coming?

In some ways, you can understand the political logic of the time. Ossoff, who is running in a state Trump carried, and many of the congressional Democrats who supported the Laken Riley law were in competitive races, and Democrats left the 2024 election thinking they had misread the electorate on the issue, particularly after Latino voters swung hard toward the right. But given what’s happened since, it’s clear many congressional Democrats made a familiar mistake: prioritizing political triangulation over standing on their values of protecting marginalized communities.

Take a look at some of the Democrats who have already had to walk back their votes. In the Democratic primary for Minnesota’s open Senate seat, Lt. Gov. Peggy Flanagan made US Rep. Angie Craig’s vote for the law a key focus of her campaign, calling it “disqualifying.” The attacks were so effective that Craig eventually expressed remorse, saying, “I wanted to be honest with the people of Minnesota. I will tell you when I get it wrong, and I got that one wrong.” Craig lost the August 11 primary to Flanagan.

Maryland’s April McClain Delaney, another congressional Democrat, also said she regretted her vote: “I will say that this was in the beginning of my term. And I never thought that ICE immigration and the horror of what has happened would happen.” (She survived her primary, defeating David Trone by 6 points.)

It’s easy to see where the buyer’s remorse is emanating from. Trump’s ICE is broadly unpopular. And as we’ve talked about on this Substack and in our reporting on America, Actually, Trump is doing worse and worse with Latino voters, with both prices and immigration enforcement driving the slide. A Hart Research poll for TelevisaUnivision of 1,500 Latino registered voters in battleground House districts (August 6–17) found 63 percent disapprove of Trump’s job performance and 62 percent disapprove of his handling of immigration enforcement and deportations. Sixty-four percent view ICE unfavorably. 

When I recently talked to Stephanie Valencia of Equis Research, she said this: 

The people who feel most regretful who voted for Trump in 2024 are most regretful because of immigration. They feel like there was a broken promise there. Like, they were told he was gonna focus on the border, which everybody agreed was chaos, and he was gonna focus on violent criminals and serious threats, and at the end of the day, he has not complied with that.

But while the shift in public opinion helps explain the elected officials’ political logic, it doesn’t change the material harm of their votes. Just this week, ICE announced plans to hire 5,000 more employees, most of them deportation officers, by the end of the year as enforcement continues to ramp up.

And these raids have a lasting effect on targeted communities, like in Maine, the Chicago area, and Texas. It’s the No. 1 issue that has come up in my conversations with local reporters. The chief architect of this chaos is the president, but make no mistake: Trump had help from shortsighted Democrats.

One thing I’m hearing 

Maya Miller is a Report for America corps member covering democracy and government for the Gulf States Newsroom, a public radio collaboration that includes Louisiana’s WWNO and WRKF. She’s been reporting on Mississippi’s redistricting fight and what residents are saying about their representation and the upcoming midterms.

You’ve been reporting from redistricting hearings in Mississippi. What are residents most concerned about, and is there a conversation or moment that captures the mood?

Residents are most concerned about their representation. In Mississippi in particular, race and party are strongly intertwined, and Black residents worry that by being drawn into new districts, voters may elect a Republican candidate. There was a bit of secrecy around redistricting earlier this summer, with Gov. Tate Reeves, a Republican, canceling a special session to redraw judicial lines. So advocates created the People’s Hearings, a series of meetings held across the state to voice concerns and create a public record of testimonies from Mississippians. Quickly after, lawmakers decided to host their own public hearings, and at these hearings, hundreds of residents showed up, mostly to urge them not to redistrict.

“It seems to me that the threat of losing representation has made people more aware of the moving parts.”

At one hearing, I spoke to Joyce Arceneaux-Mathis, president of the Natchez NAACP. She’s frustrated that the state is going to spend millions on new maps when people are struggling with day to day expenses. And Ramona Sanders of Meridian, Mississippi, has a lot of concerns on whether mid-decade redistricting is illegal. While it’s not, she says that lawmakers are opening themselves up to legal action. I haven’t heard anything from voter advocacy groups that points to future lawsuits, but only time will tell, if and when lawmakers redraw the maps, if these maps are constitutional or not.

Redistricting is often covered as a fight over which party wins more seats. What would these changes mean for the communities you cover and their ability to have a voice in Congress?

One change that could happen is that residents who are Democrats might lose the state’s only Democrat leader. Out of four congressmen, there’s only one Democrat, Bennie Thompson, who represents District 2. His district spans much of the west, from the capital city of Jackson to most of the Mississippi Delta and southwest Mississippi. It’s a heavily Black district, somewhere around 63 percent Black. He’s held this seat for 33 years and has brought millions to the district for health care, infrastructure, and agriculture. 

So residents are worried that Republicans are trying to edge him out and replace him with a more conservative leader who may not have the same concerns as the community. 

How are these fights affecting people’s interest in the midterms? Are you hearing more determination to vote, more doubt that voting matters, or something else?

People are fired up. They’re incredibly engaged. I’m hearing from a lot of people who are more determined to vote in November than when I covered redistricting in Alabama in 2024. It seems to me that the threat of losing representation has made people more aware of the moving parts. So they’re attending hearings, participating in rallies, registering to vote and checking their registration, phoning a friend and making plans to be at the polls on November 3.

What is the national conversation about redistricting missing that becomes clear when you spend time in these communities?

I think the national conversation is missing the voice of the community. It’s one thing to report on the politics of redistricting, but there’s a layer of real concern from residents that shouldn’t be ignored. They’re worried about hospitals closing. They’re worried about public schools losing funding. They’re worried about the rising cost of groceries and gas. I find that talking to and listening to residents helps me understand a community more than calling up a lawmaker and asking them their thoughts. There’s a place for that side of the conversation, of course, but I’ve always tried to center people who will be most impacted in my reporting, and I feel that leads to a better story for our listeners.

After moving to West Virginia last year, Steve Kuo signed up for a new insurance plan that would cost him $500 a month. But there was one upside: He knew he was entitled to a free preventive visit. He wanted to take advantage of it, so he made an appointment at a clinic near his new home.

But then when he got there, they asked about his medical history and he mentioned prior kidney problems. When he received a bill a few weeks later, he had been charged twice for the same appointment: Once as that free preventive visit, once as an “office sick visit” because of the kidney conversation. He was flummoxed — and very annoyed, as he shared on social media. “No copayment means no copayment, exactly as stated in the insurance guidelines,” Kuo told me over email. “What is written and agreed upon should be honored.”

He is far from alone. On Reddit, I easily found more than a dozen examples in just the past year of people getting a surprise bill for what they thought was going to be a free visit. 

One woman posted a nearly $1,000 bill she’d received for what she thought was going to be a preventive gynecology visit. Another woman said that she ended up facing roughly $3,000 bills because she was given an ultrasound (which she said she didn’t request) at a preventive visit, and then her blood draw was sent to an out-of-network lab. Another person lamented that they had been billed $170 for an office visit because they had briefly mentioned back stiffness.

It’s not supposed to be like this. Americans don’t get much when it comes to our healthcare, but most of us are supposed to be entitled to at least one thing: Once every year, no matter your health insurance, you can go to the doctor with the goal of preventing future health problems by discussing important vaccinations, cancer screenings, and cardiovascular health screenings. The Affordable Care Act made that the law in 2010.

But more than 15 years later, people all over the country are walking into their doctor’s office, thinking they’re entitled to that one free visit every year, and walking out being billed for a sick visit, blood labs, and more. Researchers estimate that Americans spend tens of millions, maybe hundreds of millions of dollars every year on services that are supposed to be free under the ACA.

Dr. Yalda Jabbarpour, a family physician in the Washington, DC, area and medical director of the Robert Graham Center for Policy Studies, told me she still deals all the time with people’s confusion about what a preventive visit really means.

“Every single time I’m in the clinic, this issue comes up with a patient. And it’s sad that it comes up,” Jabbarpour told me. “In my mind, the blame is not to be put on the patient. The blame is not to be put on the physician. Really, this points to a bigger system issue that we need to solve.”

How could a seemingly simple promise of one free annual doctor’s visit result in a situation so convoluted that patients and doctors are still struggling with it nearly two decades later? And how might we fix it?

Patients are getting surprise bills from their doctors — and they’re pissed off

The goal of the ACA was to expand coverage and make sure health insurance would be comprehensive to actually help people stay healthy. As part of that project, the authors of the law added a mandate for insurers to cover those services, including an annual wellness exam. The problem is, they did not define what the parameters of that preventive visit actually were, said Alex Hoagland, a healthcare economist at the University of Toronto. 

“It didn’t establish a clear definition of…all the diagnosis codes and procedure codes and how frequently you get that combination within a year,” he said. “They don’t define what actually is preventive care and what’s not.”

That has left each insurer to define a preventive visit on their own — and that’s where the perverse incentives that leave patients in a lurch begin. Preventive visits are supposed to be reserved strictly for screenings and talking about other preventive measures you can take to protect your long-term health, but you may get billed for an “office visit” or a “sick visit” if you talk about any specific symptom you’re experiencing, the same as if you had come in because you had the flu. 

Health insurers have an incentive to keep the definition of preventive care as narrow as possible, so they have to pay fewer claims without any contribution from the patient. At the same time, doctors want to be paid for the actual services that they are providing. If somebody does bring up a bigger health problem during a preventive visit, then the doctor reasonably wants to be paid accordingly. 

“I know, particularly in the healthcare space, it’s really popular to blame one party or another, and here I don’t think it’s a matter of corporate greed or physician incompetence or whatever,” Hoagland said. “It’s just a natural mismatch of incentives.”

So the reality is that “one free doctor’s visit” sounds straightforward, but, in practice, it’s much more complicated. You as the patient might think of it as one visit, but in our fee-for-service healthcare system, where providers bill based on each specific thing they do, it’s not. The conversation about your vaccination may be free — but asking about your back pain is not. If you get blood tests ordered, that’s another line item. The list goes on. “It’s not like you walk into a doctor’s office and it’s just one thing that happens, right?” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. “It’s multiple different things that are happening when you go into a doctor’s office.”

Part of the problem may be that it’s one free visit. We Americans are consumers at heart: Tell us we’re going to get something for free and we want to take advantage of it. But having just one free visit may also lead to people bringing a laundry list of questions to that preventive visit, because they think of it as their only chance to ask everything of their doctor. 

That makes it easy for the discussion to tip over into a sick visit — and not only does that lead to a surprise bill, it can also crowd out the conversation about prevention that the visit is supposed to be focused on.

“What ends up happening a lot…is that a patient comes in for their annual visit, and in their mind, that is their time to bring up every single thing that’s been happening during the year, because they see it as the free visit to bring up everything that’s happened during the year. For some patients, that takes up the entire visit,” Jabbarpour told me. “They leave, and it’s like, ‘Oh my god, we forgot to do all the screening things: the vaccinations, the cancer screenings, and the cardiovascular risk screening.’ And then something happens down the line because you never address those screenings.”

A 2021 study by Hoagland and Paul Shafer, both of Boston University at the time, estimated that Americans with employer-sponsored insurance had in 2018 alone paid between $75 million and $219 million in medical bills that should have been free. They were more likely to be charged for things like contraception or cholesterol and diabetes screenings, with individuals sometimes paying hundreds of dollars for those services.

Hoagland told me he had been billed for preventive visits because he has type 1 diabetes and the system automatically categorized his appointment as a diabetic visit. Earlier this year, he co-authored a study that found people with chronic conditions were more likely to be charged for preventive care. Corlette said that she too had recently been charged for what was supposed to be a preventive visit after she mentioned an issue as an aside. And these are folks who study health care for a living.

“It was literally maybe a 10-second conversation where I would ask the doctor a question about something,” she said. “And that triggered it.”

Colonoscopies are another dramatic example of how this issue plays out in real life; Corlette told me the procedure was one of the first services where this fuzzy line between prevention and treatment under the ACA became obvious. People go under for what is supposed to be a preventive colonoscopy. But then their doctor finds a polyp and decides to remove it — good clinical practice, but as a result, their patient could end up being charged thousands of dollars because the colonoscopy was no longer preventive once that polyp was snipped.

“All of a sudden, that would trigger what the patient thought was a preventive service into a cost-sharing obligation,” Corlette said. “Colonoscopies can be thousands of dollars. That was when we were first like, ‘Oh, yeah, this is a more complicated area than I think the lawmakers that drafted this provision originally envisioned.’”

How the US could fix our preventive visit headaches

The ACA’s preventive visit promise was clearly well-intentioned and it’s worth remembering that, if you look in the aggregate, more Americans are getting more free preventive care than they did before the law was passed. The problem, as much as anything, is expectations: People think they’re entitled to a free visit and are understandably frustrated when they get billed for it.

“The difference is before the Affordable Care Act, maybe they anticipated some kind of cost-sharing,” Hoagland said. “But after, they expect it to be free.”

It doesn’t have to be this way. Corlette’s team at Georgetown University recently released a proposal that Americans be entitled to three primary care and two urgent care visits every year with no cost-sharing. This approach has two virtues, she told me: It will help people feel like they are actually getting value from their insurance — the very complaint that Steve Kuo raised — and, because we know primary care helps prevent problems down the road, it should also improve people’s health in the long term. Take the pressure off that one free visit and let people see the doctor a few times a year without worrying about being charged.

“In employer-based insurance, a lot of people feel like, ‘What the hell am I getting for my premium each month?’” Corlette said. “We wanted people to feel like they’re getting good value, and we wanted to get to better population health.”

Hoagland also endorsed the idea of at least one free physician’s visit every year, no matter what’s discussed. In the long term, Jabbarpour said she’d like to see copays eliminated entirely for primary care. 

But any payment reforms are not going to happen immediately. What can we do right now?

For one, doctor offices could make an effort to be as transparent as possible. Jabbarpour’s MedStar system has started calling people a couple of days before their appointment with a brief script that tells the patient that they could be charged if the conversation with their doctor touches on additional medical problems. If your doctor’s office doesn’t proactively bring it up, ask when you schedule your appointment or when they call you to confirm it. Worst-case scenario, ask your provider what they consider preventive care when your visit begins. You might also want to educate yourself on what services are generally considered preventive and should be available for free: Your insurer may make that information available on their website, or KFF has a database you can peruse.

It’s not a perfect solution. “What ends up happening is patients come in, and they say, ‘I know I’m not supposed to talk to you about anything else, so I’m not going to tell you about anything else.’ And you don’t want that to happen,” Jabbarpour said. You should ask your doctor directly: What do you consider to be preventive care? Establish boundaries at the start. That way, you can at least be aware if you are going to get charged because the conversation crossed the line to discussing an active health problem.

And if you want to see the underlying laws change, start organizing. Contact your state and federal reps and ask them what they are doing to ensure this stops happening. Things could be different: Jabbarpour said she hopes to one day work in a health system where the cost of a single primary care visit isn’t so high-stakes, where doctors and their patients can manage their health according to their particular needs, rather than worry about how to bill for one specific conversation that covers the whole range of somebody’s health — like primary care is supposed to do.

“I think some patients can be managed by seeing us once every year, once every two years, and some patients need to see us monthly,” Jabbarpour told me. “To put all patients in the same box and say you can only see your primary care physician once a year if you want it paid for, it makes zero sense.”

This story was originally published in The Highlight. To get access to member-exclusive stories like this every month, become a Vox Member today.

The Soviet Union famously churned out tens of thousands of new apartment buildings in the 1960s, ’70s, and ’80s — some assembled in as little as 12 days — together comprising tens of millions of individual apartments. Such speed is not unique to communist command economies, or even to grim concrete mega-blocks. In Sweden and Japan today, modern, high-quality new homes can be factory-built and assembled in a matter of weeks using the same basic method — prefabrication — as the Soviets.

The US, alas, evinces no such urgency to build housing. 

In some of our highest-cost cities — San Francisco, New York, Miami — it takes, somewhat astonishingly, nearly five years to erect a modestly sized apartment building, from the time an application is first submitted to building completion. That was one of the top-line findings of a remarkable new economics working paper on housing construction timelines across 60 US cities. The gaps between the fastest and slowest cities were just as striking: In Raleigh, North Carolina, a builder can complete a 20-unit apartment building in about as much time as it takes just to approve the permit for one in San Francisco, where applications languish for more than a year. In Indianapolis, a single-family home can be built in six months from proposal to completion, less than one-eighth the time it takes in San Francisco.

Such delays have costs — in delayed housing supply at a time when America is millions of homes in the hole, in lost staff time that developers ultimately bake into the cost of the new homes, and in homes that simply never get built because the process is discouraging to anyone but the best-resourced developers. The authors, Leonardo D’Amico, Evan Soltas, and Audrey Wang, found that longer permitting lengths are correlated with higher housing prices and lower rates of housing production, though they don’t claim to have shown that these are causal relationships. The research (which has not yet been through peer review and, like any working paper, may be revised before final publication) represents the first such comprehensive dataset comparing homebuilding timelines across the US. To build it, the researchers assembled 1.1 million permits covering 2.7 million housing units between 2000 and 2025 — about one in 13 new homes permitted nationally over that period, they write. 

It probably won’t come as a shock to you that housing can be built faster in Sioux Falls, South Dakota, than in Los Angeles or pretty much anywhere in California. But perhaps the most notable takeaway (to me, anyway) from the paper was how massively home permitting times have lengthened across the board over the past 25 years. Across the cities in their sample, the researchers estimate that permitting time for a standardized multifamily building rose from 0.6 years in 2000 to 1.5 years in 2023, and, for a single-family home, from 1.6 months in 2000 to 4.9 months in 2023. 

Is there really any good reason why we should take nearly a year longer to approve an apartment building than, Soltas joked in a recent interview, “the barbarians of 2006”? Shouldn’t we be getting faster and more efficient at building housing over time, not slower — especially at a time of acute housing scarcity? 

You would think. So what is going on here?

One building, very different wait times

Permitting refers to everything that happens after a developer submits an application to build a house or multifamily building, before they’re allowed to break ground. The proposal is then reviewed for compliance with a range of different sets of rules, from building safety and energy codes to plumbing to zoning and, in some places, aesthetic design. Initial applications will often be found noncompliant and then sent back to the builder for revisions, Soltas, an assistant professor of economics at Princeton, told me.  

The gulf between housing starts in California and Texas has become something of a meme in housing abundance circles. But, for all that, we have until now lacked rigorous apples-to-apples comparisons of permitting and building times in different metro areas, Soltas said. That gap in seemingly basic knowledge, what should be “step zero” facts for the national housing reform debate, became apparent to him when he was teaching an urban economics class, which became one of the impetuses for the new paper. “I realized if I needed that information to teach my students, that it might be useful for other people,” he said. 

Rather than merely pulling permits from different cities and comparing how long whatever happened to be built in each city took to approve, the researchers used the data to estimate how long an identical, standardized project would take in each place between 2015 and 2019, keeping constant its size and the density of the surrounding neighborhood. Their uniform archetypes were a 2,800-square-foot detached single-family home on a 0.15-acre lot and a 20-unit multifamily building with 1,200 square feet per apartment.

Cities with longer permitting times also tended to have longer construction periods — the longer it takes to get an application approved, the longer it then takes to do the building itself, which compounds the gap between the fastest- and slowest-building cities (it’s possible that “cities that make the permitting process difficult also put in lots of burdens that slow the construction process,” Soltas said). One advantage of the researchers’ method is that the differences across cities can’t merely be chalked up to something like the complexity of building within already-dense environments like Manhattan — the analysis already controls for that. So the enormous gaps between different places become harder to dismiss as inevitable features of development in big cities.

The study wasn’t designed to answer the “why” of it all — those will be questions for future research. “Our paper doesn’t directly identify any smoking guns,” Soltas said. Still, some of the culprits are likely obvious — California, for example, has long subjected some housing projects to extensive environmental review requirements under the California Environmental Quality Act (CEQA). Apartment buildings, especially larger ones, are more likely to have to go through CEQA review, though they’re more environmentally friendly than single-family homes (recognizing this as an obstacle to housing affordability, California has been moving to exempt many housing projects from such reviews). 

Why are we taking so much longer to permit housing?

But why, as the study finds, is permitting becoming slower across the country, not just in the most regulated cities? “We estimate that, in 2000, our standardized multi-family project had a 71-percent probability of approval within six months of applying for a permit,” the researchers write. “In 2025, that project had a 44-percent approval probability within six months.” Permitting times have come down a bit since 2023, but it’s unclear whether that just represents the reversal of pandemic-era highs, or if it reflects real progress from the pro-housing policies that have been passed in many cities and states in recent years. 

That discovery dovetails with other economics research finding that zoning codes, which were first widely adopted in the US in the early-to-mid 20th century, have continued to become more restrictive even in recent years, making it harder to build housing. 

Without knowing why exactly permitting lengths have ballooned, it’s hard to say whether those increases have occurred for good reasons. At least some of it may have to do with the aforementioned intensification of zoning and other land-use restrictions, which, I can say from having written a lot about zoning, tend to be pretty ill-conceived and hard to justify. 

The slowdown may also be connected to expanding building code requirements. I’ve written at length about that issue, too; although ever-more stringent rules might seem like a great idea — who could be opposed to more safety? — they tend to be biased against multi-family housing and likely inflate the cost of building, all without having to show that the benefits are worth the costs. Particularly the cost in housing supply that never gets built, which has the effect of keeping more Americans living in older housing stock. And do we really think a home built to 2005 standards is dangerously subpar today?  

We might ultimately decide that many of today’s building requirements — particularly ones like stronger energy efficiency standards — are worth it, but first we’d need to determine what their full costs are, which we remain far from doing. 

At a minimum, it seems unlikely that an apartment building that’s okay to build in Grand Rapids today would be unsafe for New York. So what, exactly, is all that extra permitting time buying the city? Now, at least, Mayor Zohran Mamdani can put an exact number on the delay. 

This story appeared in Today, Explained, a daily newsletter that helps you understand the most compelling news and stories of the day. Subscribe here.

Today’s newsletter is a heavy one — so please feel free to skip it if you need to. But as the uproar over an alarming rape allegation at Cornell University from 2024 keeps building, I wanted to take a minute to look at the facts of the case and the wider scourge of campus sexual assault. (We’ll get into that second topic in just a minute.)

You’ve probably read about the case on social media, but if not, let me bring you up to speed. A former Cornell undergraduate student, identified as Jane Doe in a civil lawsuit filed earlier this month, alleges that seven men pressured her into drinking and snorting large amounts of ketamine, an anesthetic that can cause dissociation, before raping her at a campus fraternity house.

At the time, she reported the incident to campus police — but her lawsuit alleges the men were never adequately investigated. Instead, the case was handled through Cornell’s administrative disciplinary system, which meted out noncriminal punishments, such as suspensions and expulsions, and permanently shuttered the fraternity house.

The case and its handling have horrified observers online and in Ithaca, New York, where Cornell is located. In response to that uproar, the Tompkins County district attorney announced on Monday that he was reopening his office’s investigation. A nine-page statement further explained why the DA’s office didn’t file criminal charges two years ago: At the time, the statement says, the woman did not allege that she was incapacitated or that the encounter was nonconsensual. 

For many online, however, that explanation only prompted more questions, such as: Was Jane Doe ever interviewed by a specialist trained to speak to survivors? And what prompted her to go to police in the first place, if she believed the encounter was consensual? The reopened investigation will take time, but should provide some answers.

Go a little deeper

Sexual assault remains appallingly common on college campuses. When I taught an undergraduate writing class in 2024, I assigned my students a personal essay and encouraged them to choose a topic they found weighty or meaningful. In a class of 11 women, two wrote about being assaulted at school. 

That proportion surprised and horrified me, though it shouldn’t have. Surveys have consistently estimated that roughly one in five undergraduate women experiences some form of sexual assault or nonconsensual contact during college. 

Awareness around the issue has grown over the past decade or so, particularly in light of the Me Too movement and after a string of high-profile cases in the mid-2010s. But progress has been more complicated.

First, it’s difficult to know if the situation is improving or worsening, because the data around campus sexual assault is really limited. Federal law has historically required that universities disclose only the incidents reported through official channels — a small minority of all cases. 

In 2022, Congress enacted a requirement directing colleges and universities to begin conducting more comprehensive surveys on campus sexual assault every two years. That would have helped measure the true scope of the problem — arguably, a prerequisite for designing and tracking potential interventions. But the Biden administration never set up that survey, and President Donald Trump has, if anything, rolled back college sexual assault protections and slow-walked Title IX investigations related to sexual harassment and violence.

Just Monday, in fact, Trump’s Department of Education formally rescinded Biden-era rules designed to better hold schools accountable for sexual assault. The department will now revert to rules put in place during Trump’s first term, which defined sexual harassment more narrowly and gave schools more latitude over how they handle allegations. 

It’s an amazing irony, really, that those rollbacks were formalized on the same day that prosecutors reopened the Cornell case. If anything, the outrage over that investigation shows that people want institutions to take sexual assault more seriously. 

One link for later

➨ Make art a little more personal. The average museumgoer looks at any one piece of art for only 27 seconds — maybe because it’s daunting to spend any more time on the task of Serious Art Appreciation. Instead of laboring to interpret a piece the “right” way, try relating it to your personal experience and other cultural objects you know well. This is also a correct and valid way to look at art! As one artist told Vox, “I don’t need the viewer of my paintings to know exactly what I meant…it’s more about an openness to a conversation.” 

Before you go…

• Did you know…that the sun’s magnetic north and south poles reverse roughly every 11 years? It generally doesn’t have much of an impact on Earth, though it can make the auroras more visible. 
• Today’s trivia: The civil rights activist Ruby Bridges became famous at age 6 for doing what? (You can find this and other brain puzzles in Vox’s daily crossword. Look for the answer in tomorrow’s edition.)
• Yesterday’s trivia: We asked you for the name of the unrequited love interest in Victor Hugo’s The Hunchback of Notre Dame. That would be Esmeralda, whose fate was way darker in the 1831 novel than in the Disney movie version. 

To no small extent, Americans have grown accustomed to being watched.

For more than a decade, CCTV cameras have recorded a hefty portion of many people’s public movements, while ubiquitous smartphones have made us all perpetually vulnerable to unsolicited documentation (if not, social media notoriety).

Until recently, however, technical limitations constrained the reach of government surveillance (at least, in the physical realm). Police may have been swimming in CCTV footage. But using such videos to track any given person’s movements was an extremely time-intensive endeavor. To do so, an officer would need to sift through hours of footage captured on many different cameras.

Yet AI is now making it possible for the government to trace ordinary citizens’ movements with unprecedented ease and precision. Or at least, this is what the security firm Flock Safety has effectively promised — and the company’s critics have loudly warned. 

Flock provides police departments with networks of surveillance cameras — primarily, automatic license plate readers (ALPRs) that photograph each vehicle that passes them. 

The firm’s main selling point is also its chief political liability: Its ALPRs log not only license plate numbers, but also generate textual descriptions of all vehicles they detect and store this information in a nationally integrated, searchable database. This makes it technically feasible for police to monitor the travels of most any driver with a few keystrokes. 

Alas, some cops cannot be trusted with that power. In August, the Washington Post reported that at least 50 law enforcement officers had been charged or accused of using license-plate readers for illegitimate purposes, often to stalk their exes or romantic interests. Even more alarmingly, some police departments appear to have used ALPR data to surveil their own critics and protesters. 

These revelations fortified an already growing movement against license plate readers. In August alone, more than 90 cities and counties canceled contracts with Flock. And this backlash has been remarkably bipartisan. Deep blue cities like Los Angeles, Austin, Texas, and Cambridge, Massachusetts, have backed out of partnerships with Flock, while Republicans in Florida have barred local police from installing ALPRs on state highways, and the Texas GOP has paused funding for Flock cameras.

The anti-ALPR movement is responding to real problems with how that technology has been deployed. And yet, according to Flock and many police departments, these cameras are also helping to nab car thieves and locate missing persons.

All this raises the questions: Do ALPRs really have significant public safety benefits? And if so, is there a way to have our license plate surveillance and civil liberties too? 

To find out, I reviewed the latest academic research, dug through the worst horror stories in the news, and reached out to criminologists about the risks and rewards of ALPRs. Although the available evidence is limited, the technology appears to have modest — but genuine — crime-fighting benefits. And while the ALPR databases have been badly misused, this is in part because the tech has gone largely unregulated. With stringent safeguards, there may be a way to make it much harder for creeps and authoritarians to monitor law-abiding citizens’ comings and goings without forfeiting a useful law-enforcement tool.

The case for ALPRs

On a late summer day in Chamblee, Georgia, Leslie Barrera was pushing her 1-year-old son Mateo in a stroller when a car pulled up next to her. A man sprung out of the vehicle, pointed a gun at Barrera, and tried to grab the baby from his carriage. But he’d chosen his victim poorly: Barrera charged him, wrested away his gun, and tried to shoot the kidnapper, only for the firearm to jam. A woman (oddly, disguised as a man) then emerged from the car and snatched the child. The baby-nabbers proceeded to pile back into their vehicle and speed away.

With the aid of surveillance cameras, police quickly identified the car as a maroon Acura SUV. Unfortunately, the abductors had swapped out its valid license plate with a paper dealer tag. Decades earlier, that might have delayed, if not thwarted, the recovery effort. But this was 2020 — and Chamblee police had access to a Flock ALPR system. By searching through its database of vehicle photos, the cops discovered a shot of the same Acura with its registered metal license plate from days earlier. The plate led them to the suspect’s name and address — and thus, within just five hours of his abduction — to Mateo.

Flock has a lot of stories like this. The company boasts that their cameras “supported more than 1 million criminal investigations” and helped locate “more than 10,000 missing persons” last year. 

“Every single day, law enforcement across this country is using FLOCK technology to solve crime and find missing people faster,” Paris Lewbel, a spokesperson for Flock, told me. 

The limited evidence suggests that Flock’s claims about its cameras’ public safety benefits are overhyped.

But Flock’s colorful anecdotes and raw tallies tell us only so much. A Flock camera can be used in an investigation without making a decisive difference in its outcome. Without ALPR photos, Chamblee police may still have been able to tie the maroon Acura to Mateo’s kidnappers. 

To gauge Flock’s actual impact on public safety, we need (at a minimum) some quasi-experiments: When jurisdictions deploy advanced ALPR systems, do they see lower crime or higher clearance rates — both compared to their own past record and to simultaneous trends in Flock-less places?

There has been remarkably little research into these questions. But a recent study from the University of South Carolina’s Ian Adams and Scott Mourtgos sheds some light into them. 

Drawing on Flock’s installation records, the criminologists identified the month that 216 law enforcement agencies activated their first camera. They found that during the first year after Flock deployment, these areas saw an 11 percent decline in motor vehicle theft, relative to similar places that remained un-Flocked. Jurisdictions that put up the ALPRs also saw the success rate of their car theft investigations rise by 16 percent. 

These findings should be taken with a few grains of salt. For one thing, police departments will be more likely to invest in an ALPR system if they’ve got a serious stolen vehicle problem. And if car thefts in an area spike, they are liable to regress back toward historically typical levels, no matter what the local police department does. 

What’s more, agencies will often install ALPRs as part of broader anti-vehicle theft efforts, which may include deploying more officers to high-crime areas, among other things. Adams and Mourtgos’s data suggests that such simultaneous actions may be responsible for a portion of their results: Although Flock adopters solved stolen car cases at a higher rate after putting up the cameras, this rise tended to begin before the ALPRs were installed.

Nevertheless, the working paper indicates that Flock cameras do make some difference. “We’re not talking huge numbers here,” Mourtgos told me, “but it’s not nothing either.”

And there is reason to think that ALPRs have greater potential to deter and solve crimes than existing results suggest, as police departments may be deploying them in suboptimal ways. 

Consider a 2025 study of Atlantic City’s ALPR rollout. On paper, the municipality was an ideal candidate for the technology: As a barrier island, Atlantic City has only eight access points, so an ALPR network could easily capture every car entering and exiting the city. 

As one would hope, the research found that car theft declined after the cameras were erected, although the authors could not rule out other explanations. Perhaps more significantly, however, they discovered that the cameras produced vastly more leads than the department was capable of logging or investigating. Between November 2022 and November 2024, the city’s ALPRs issued 12,384 stolen vehicle alerts, virtually all of which went unnoticed or ignored by department personnel; over the studied period, the ALPR system prompted only 72 vehicle stops, of which just 52 concerned stolen cars. 

“In an ideal world, someone would be monitoring the alerts in real time and dispatching an officer, who would successfully make a traffic stop,” the paper’s co-author, Rowan University criminologist John Shjarback, told me. “But yeah, that kind of rarely happened.” 

Shjarback concludes that the department lacked enough patrol officers to respond to a significant portion of alerts, while its civilian surveillance center monitors appeared to simply miss a large proportion of serious hits. “They have a lot to do in that real-time crime center,” Shjarback said. “There’s a relatively high amount of crime and gun violence and whatnot in Atlantic City. One or two retired officers on duty just weren’t enough to do the live monitoring.” 

Similar operational flaws and resource constraints may have limited the efficacy of Flock systems in at least some of the areas analyzed by Adams and Mourtgos. Indeed, Mourtgos noted that many departments in his study lacked enough ALPRs to cover most significant thoroughfares. “Even in jurisdictions that are at the higher end on cameras, you’re still covering an extremely small minority of these roadway structures,” Mourtgos said. “So, that’s probably another reason why we see only modest effects.”

Taken together, the limited evidence suggests that Flock’s claims about its cameras’ public safety benefits are overhyped; its ALPR networks do not appear to be the “single greatest change” in policing tech “since DNA,” as the company touts on its website. But, as common sense might suggest, automatically logging all license plates on major highways and intersections seems to make it at least a bit harder to get away with stealing cars (and perhaps, babies).

Mass surveillance has its downsides

Of course, the fact that ALPRs offer some benefits to public safety does not mean that they’re necessarily worthwhile. Sewing a GPS chip into every American’s forearm would surely make crimes easier to solve and less tempting to commit. But most would regard such trackers as dystopian infringements on privacy and invitations to authoritarian control. 

And Flock’s ALPRS are much the same, in the view of their staunchest critics.

The “DeFlock” movement’s fundamental argument is that the cameras give police departments more information than they can be trusted with. One danger is that wayward cops can exploit the data to stalk their exes. The more profound threat, however, is that police agencies will use ALPR systems to deter or punish lawful dissent. 

And that hazard is not entirely hypothetical. After a writer named Canyen Ashworth published an op-ed criticizing local police in Lenexa, Kansas, that town’s police began tracking his movements with its ALPRs (apparently, because Ashworth’s column led the police chief to conclude, incorrectly, that he must have been the dastardly perp behind a recent spree of…unpermitted poster-hanging incidents).

More broadly, a 2025 investigation from the Electronic Frontier Foundation (EFF) found that more than 50 federal, state, and local agencies had run hundreds of searches related to protests or activist groups through Flock’s ALPR system. It’s not clear how many of these queries were motivated by an illiberal desire to monitor dissenters. In theory, a police officer could search for, say, “red sedan at No Kings protest” because a car of that description tried to run over protesters or committed some other criminal offense in the demonstration’s vicinity. And some of the searches tallied by EFF appear to fall into that category. But many others had no discernible purpose beyond the surveillance of activists.

We need to watch the watchmen

All this is unquestionably alarming. And if widespread misuse of ALPR networks were inevitable, then their costs to civil liberties would likely outweigh their modest (and as yet, not wholly certain) benefits for public safety.

But this probably isn’t the case. Rather, governments can likely limit ALPR’s downsides — while preserving their utility to law enforcement — by more stringently regulating the technology.

“In something like half of the states, there is no regulation. Virtually none, in our view, have adequate regulation.”

Barry Friedman, founding director of NYU School of Law’s Policing Project

Until recently, legislatures had placed scant guardrails on ALPRs. As the Congressional Research Service noted in 2024, there is “no specific federal legislative framework” governing law enforcement’s use of such cameras. And most states have no comprehensive ALPR regulations. Thus, if we’re failing to prevent police departments from misusing these cameras, it may be because most state and local governments haven’t actually tried. 

“In something like half of the states, there is no regulation,” Barry Friedman, the founding director of NYU School of Law’s Policing Project, told me. “Virtually none, in our view, have adequate regulation. The police decided to do this on their own. Them and their vendors made the decision and didn’t disclose what was happening.”

Fortunately, there is a long list of ways for policymakers to constrain abuse of ALPR data. To name just a few, governments could:

• Require police departments to delete logged location records after three weeks (or less), unless they are connected to a specific investigation (thereby leaving would-be stalkers and tyrants with less surveillance data to sift through). 
• Permit ALPR searches for only an enumerated set of law enforcement purposes, such as tracking stolen vehicles or suspected violent offenders. 
• Create an audit trail for every query documenting who searched for what, when, and under what justification.
• Mandate the use of software that automatically flags suspicious queries — such as someone searching for the same license plate over and over, without attaching an actual case number — and that temporarily locks out users who appear to be misusing the database. (Flock currently offers software with similar features, but most police departments with ALPRs are not legally required to adopt such systems.)
• Expressly forbid the use of the ALPR system for tracking people on the basis of protected speech.
• Punish intentional, unauthorized searches of the database with jail time.

Virginia’s recently enacted ALPR law includes many of these provisions, while several other states have embraced a subset of these policies.

Some may still want to get de-Flocked

To be sure, for some, even heavily regulated ALPR systems will entail intolerable costs to privacy and unacceptable risks of authoritarian misuse. The American Civil Liberties Union (ACLU) supports efforts to regulate license plate readers, but only as a second-best alternative to banning the technology outright. 

“No guardrails can completely address the chilling effect of mass surveillance,” Chad Marlow, senior policy counsel at the ACLU, said. “When people know that they are being surveilled all the time, they may not intellectually dig into the, ‘Well, what exactly is happening with this data? What’s it being collected for? How long is it being stored?’ The average person isn’t going to go through all those steps.” 

Rather, Marlow argues, many will simply see cameras and fear that they’re being watched — and fearful of those doing the watching. 

“Someone who is an alcoholic and wants to go to an AA meeting — but doesn’t want the public or any of their insurance companies or the government knowing they’re an alcoholic — and knows there’s a camera outside of the church that hosts the meeting may just say, ‘You know what? It’s really important for me to keep this struggle private. And so I can’t go to that AA meeting,’” he said. 

These are legitimate concerns, although there is little hard evidence that license-plate readers have a chilling effect on protests or personal behavior. And given how much sensitive information people publicly share on social media — or willingly generate, through their internet activity — there’s some reason to doubt that many will refrain from lawful activity, merely because they spotted an ALPR by the side of the road. In fact, license plate readers have actually been in wide use for more than a decade and, until recently, few seemed to register their existence, much less, reorganize their lives around avoiding the cameras’ gaze. 

Still, reasonable people can disagree about how to weigh ALPRs’ trade-offs. My point here is merely that governments may be able to secure modest but meaningful public safety benefits from the cameras — while greatly reducing their misuse — by giving regulation a chance. Using the ALPRs of 2026 probably doesn’t require accepting the authoritarian nightmares of 1984.

This story was originally published in The Highlight. To get access to member-exclusive stories like this every month, become a Vox Member today.

Todd Waller wasn’t expecting to spend the latter half of his 30s living with roommates. But in late 2022, following a breakup with his girlfriend, he needed to find a new place to live, quickly. 

A social worker based in the Atlanta metro, Waller started googling “efficiency apartments” and stumbled onto an ad for PadSplit, a company founded in 2017 that lets property owners rent out individual furnished bedrooms in single-family homes by the week. “It said I could get approved right away and move in tomorrow,” he recalled. There was no security deposit required.

All of a sudden, Waller found himself living with six other people and able to save a lot of money. His rent was just $180 per week, or less than $800 per month. Though he earned a decent salary, he never really had anything left over after all his bills were paid, and the new financial breathing room made the tradeoff of housemates feel worth it.

After a while, Waller decided he would be willing to upgrade to a nicer PadSplit unit, one with more amenities but still with roommates. Now he pays $1,250 a month to live on one side of a 2,000-square-foot home, with access to his own private bathroom, a private entrance, and a renovated kitchen. Three other people live on the other side of the house, and he rarely interacts with them.

“My house is awesome; I pay $500 less a month than I would if I were renting [a place of my own] without roommates, and I just was able to buy a new car,” he told me. He knows one day he’ll move somewhere else and perhaps even buy his own home, but he likes that he feels he can make that decision comfortably at his own pace.

With rents outpacing wages in most of the country, legislators are increasingly looking at co-living — sometimes called house-sharing or adult dorm rooms — as an overlooked piece of America’s housing stock. Zillow counts roughly 21 million “empty nest households” — or homes where older residents living with no children have at least two extra bedrooms. Some lawmakers want to make it easier for those homeowners to rent them out, which could put workers closer to their jobs and help seniors stay in houses they can no longer afford alone. Others are eyeing a different kind of vacancy: Post-pandemic remote work has left about a fifth of American office space empty, and there’s growing interest in turning some of it into apartments. 

Many advocates for people experiencing homelessness also argue that co-living is a needed solution, something that could help people going through emergencies avoid the scary slide into shelter living, especially models where you can move in almost immediately and without a deposit. PadSplit surveyed its renters in December and found a population that mostly works (83 percent were employed) and mostly hadn’t been to college. The median income was $32,500.

That co-living needs advocates at all is a legacy of the last century. Renting a single room in a boarding house or residential hotel was once an ordinary way to live in an American city, but in the decades after World War II those rooms became shorthand for poverty and vice, and cities responded by banning new ones and paying landlords to get rid of the old. Half a century later, many people still see sharing space with strangers as a last resort, or feel embarrassed about having roommates past a certain age. And discriminatory zoning codes written in that era are still on the books in most communities, enforcing traditional nuclear family arrangements when it comes to single-family housing, by defining “family” as people related by blood, marriage, or adoption. Those rules can be wielded against home-sharing, and against specific renters neighbors want to keep out.

But these longstanding barriers are starting to finally give. Doubling up with people you aren’t related to is less unusual than it used to be. Between 2017 and 2022, the number of households sharing space with nonrelatives grew by more than 500,000. Lawmakers desperate for anything that adds more housing supply also seem less picky about where it comes from. Companies like PadSplit are putting private capital behind the model, and a wave of new laws and litigation — much of it led by conservative legal groups arguing on property-rights grounds — is making it harder for cities to tell homeowners who can and cannot sleep in their spare rooms. 

For the first time since cities banned cheap rooms, the people trying to bring them back have the momentum, and the next couple of years will go a long way toward deciding whether co-living stays a niche workaround for people like Waller or becomes something a lot more people are able to consider.

The return of SROs

At the turn of the 20th century, as American cities swelled, immigrants, day laborers, and factory workers crowded into downtowns looking for somewhere cheap and temporary to sleep. A small room could be rented by the day, the week, or however long someone needed it. Some “boarded” in private homes while others took beds in bottom-rung hotels known as flophouses. These arrangements varied widely, but became broadly known as single-room occupancies (SROs).

The turn against them came after World War II, as middle-class white families decamped for roomy new houses in the suburbs, and SROs grew more closely associated with shoddy housing for the poor and the deviant. New York and other cities started banning SRO construction in the 1950s. By the 1970s, SROs were a regular media villain, even as they still housed hundreds of thousands of people, including the mentally ill who had been turned out by the closing of state asylums. Cities started to offer landlords incentives to convert their SROs into luxury rentals. Between the mid-1970s and the 1990s, roughly a million of these affordable market-rate units disappeared from the market across the country.

The idea that perhaps cities made a mistake in banning these lower-cost housing options has been simmering in urbanist policy circles for the last 15 years, particularly as the homelessness crisis has gotten worse. The Furman Center at NYU argued in 2018 that reintroducing SROs could help address the housing shortage. The architecture critic Karrie Jacobs argued in 2021 that cities had blamed a kind of housing for problems that belonged to the people living in it. “The notion took hold that if you eliminated the housing, the marginal people would simply vanish,” she wrote in Curbed.

Still, lawmakers have dragged their feet on actually making it easier to rent these kinds of units again, and until recently the people pushing for it had little to show beyond op-eds and white papers. What’s different now is that the fight has moved out of the world of policy papers and into places where it can produce actual results, including a lawsuit that could reach the Supreme Court.

Suing over who counts as family

In early 2022, a home-sharing startup called HomeRoom was renting out two houses in Shawnee, Kansas, a suburb of Kansas City. The company rented rooms one at a time to unrelated adults who wanted cheaper housing, and at a local city council meeting that year, Shawnee’s community development director asked whether the city should support such arrangements in single-family neighborhoods at all. Two months later, the council passed an ordinance banning “co-living groups,” which it defined as four or more unrelated adults sharing a home. 

Under the ordinance, if even one adult in a house wasn’t related to the others by blood, marriage, or adoption, the whole household counted as unrelated.

While the new law forced HomeRoom to evict its tenants, it also put Val French, a Shawnee homeowner, in a bad situation. She lived with her husband, their two adult sons, and one son’s girlfriend. Because the girlfriend was related to no one, the house was now deemed in violation of the city’s occupancy rules. Her son and his girlfriend had to move out, and French couldn’t rent the empty room to anyone else.

French and HomeRoom sued in federal court in May 2023, with assistance from the libertarian Pacific Legal Foundation. They argued that their right to choose who they live with is protected under the 14th Amendment, but they ran into legal precedent from a 1974 Supreme Court case, Village of Belle Terre v. Boraas, which upheld a Long Island village’s nearly identical rule against six college students sharing a house.

The decision came down in the same years cities were clearing out their SROs, and it has given local governments cover to decide who counts as a family ever since.

A federal judge dismissed the Shawnee suit in September 2023, citing Belle Terre, and this past April the US Court of Appeals for the 10th Circuit upheld the dismissal. A few months later, the Pacific Legal Foundation (PLF) petitioned the US Supreme Court to hear the case and reconsider Belle Terre once and for all. The precedent has already frayed in places — state courts in California, Michigan, New Jersey, and New York have struck down local “unrelated occupants” limits under their own laws — but it still governs everywhere else. 

There is “a fundamental liberty right to choose household living companions — whether as an articulation of the right of intimate association or independently — that is deeply rooted in American history and tradition,” PLF’s lead attorney on the case, David Deerson, told me. 

The Supreme Court hears only about 1 percent of the cases it’s asked to take, and even if it took this one, the plaintiffs would be asking a conservative majority to recognize a new constitutional right, which that majority has spent the past few years insisting courts should almost never do. 

Deerson’s argument is aimed at that skepticism, though. When the Supreme Court overturned Roe v. Wade in 2022, it held that an unwritten right counts only if it is “deeply rooted in history and tradition.” Deerson and his allies are arguing that living with people you aren’t related to qualifies as such because, for most of American history, boarding houses and lodgers were typical staples of family life. Belle Terre is also a short opinion written by William O. Douglas, a liberal justice whose legacy has little connection to today’s conservative justices. 

The legislative front

A Supreme Court reversal would be the cleanest fix for co-living, but advocates aren’t waiting on it. State legislatures have already shown they’ll act: Iowa barred cities from enforcing relationship-based occupancy limits in 2017, Oregon and Washington followed in 2021, and in 2024, Colorado lawmakers passed a law prohibiting cities from restricting how many unrelated roommates can live under one roof absent a clear health or safety reason. 

The Pacific Legal Foundation worked on that last bill too, and has since turned it into model legislation for other states. They colloquially call it the “Golden Girls bill” since occupancy caps like these would have prevented the four unrelated women of the hit 1980s sitcom from sharing a house. 

This year Pennsylvania lawmakers introduced their own version, with supporters citing not private property rights but the potential to ease the state’s affordable housing shortage. As legislators considered the proposal, Pacific Legal Foundation published research showing that nine of the 10 most populous cities in Pennsylvania capped the number of unrelated adults who could live together. The state House passed the Golden Girls bill this summer, though the Pennsylvania Senate version has not yet received a vote. 

The objection lawmakers hear most is the same one that animated Belle Terre — that lifting occupancy caps could turn quiet, orderly, neighborhood homes into de facto frat houses. That college partying concern killed Connecticut’s proposed Golden Girls bill this year. While the bill cleared the state Senate, it never got a vote in the House, amid reported concerns from the speaker about college students moving into wealthy neighborhoods. “What if a neighbor is unhappy about four unrelated people who are 19 years old or 22 years old living in the house?” state House Speaker Matt Ritter asked in an interview with the Connecticut Mirror. 

Pennsylvania’s sponsors tried to head off those fears by amending the bill to exclude protections where someone is enrolled at a college or university. In other words, the law would have covered Blanche, Dorothy, Rose, and Sophia from Golden Girls unless one of them signed up for a class at their community college.

Nevertheless, advocates are expanding their push. Jim Manley, state policy director for the Pacific Legal Foundation, told me he expects Texas, Florida, Pennsylvania, North Carolina, Rhode Island and Utah to take up new versions of the legislation in 2027.

And occupancy caps aren’t the only co-living target. Sam Hooper, a lawyer who has been lobbying state legislatures to re-legalize SROs, and his former colleagues at the Institute for Justice are now focused on the ROOM Act, model legislation that would bar cities from restricting SROs and other co-living arrangements, including rules that make it hard to convert offices into apartments. A version was first introduced in Rhode Island earlier this year. 

For Meagan Forbes, Institute for Justice’s director of legislation, the goal is for co-living to be treated like any other form of housing. “Other local laws can regulate things like noise and fire safety, but current regulations just go way too overboard in preventing this kind of housing,” she told me. 

Hooper, who drafted the ROOM Act, says he wanted to “take a massive sledgehammer” to existing restrictions. The resistance he runs into isn’t only the frat-house worry, but older cultural fears that SROs would recreate the poor tenement conditions of the early 20th century. “I think there’s this real problem of letting the perfect be the enemy of the good in housing policy,” he told me. “People accuse us of wanting people to live in undignified housing, but they just struggle to understand that it can be a perfectly fine option for many people at different points in their life.” Hooper credits his own London co-living experience in his 20s with introducing him to some of his best friends and his wife. 

Even so, he cited a broad political coalition backing him up, from property rights champions in conservative states to Democrats and progressive YIMBYs drawn to the housing justice and homelessness angles. There are business leaders interested in workforce housing, he said, and he noted that the AARP testified for the ROOM Act in Rhode Island. “I’m hopeful we’ll be able to keep this bipartisan coalition that hasn’t succumbed to the culture wars,” Hooper added.

Not every co-living proposal is about removing rules. DC’s Senior Co-Living Program Establishment Act, also nicknamed the Golden Girls bill, would pay senior homeowners $300 a month to rent a room to another senior, plus up to $2,500 for home modifications. 

The 21st Century ROAD to Housing Act, the federal housing package that became law in July, doesn’t touch occupancy rules. But it does fund a pilot program for converting vacant commercial buildings into housing, which could make adult dorm office conversions easier.

The demand question

While momentum for co-living is real, demand is also complicated. Americans are doubling up more than they were before the pandemic — about 8.2 million households in 2024, up 4.3 percent since 2019, according to analysis shared by Zillow. Yet the share made up of unrelated adults living together actually fell slightly, by roughly 50,000 households, while homes shared with couples or families grew by nearly 400,000. In other words, when Americans need to save on rent, they still mostly turn to people they already know.

PadSplit is betting that changes. Atticus LeBlanc recently announced his company is expanding into New York, Chicago, and San Francisco, three of the most expensive rental markets in the country.

“Does that mean things have gotten more desperate, that it’s forcing this cultural acceptance?” he asked me in an interview. “I think there’s certainly an argument to be made there. But you could just as easily make the argument that, holy cow, we are really, really wasteful with space.”

Six months ago, first lady Melania Trump walked into a White House education summit next to a faceless robot powered by artificial intelligence, which she said could one day give children personalized instruction.

“Imagine a humanoid educator named ‘Plato,’” she said. “Access to the classical studies is now instantaneous…humanity’s entire corpus of information is available in the comfort of your home.” 

Weeks earlier, her guest at the State of the Union had been a 10-year-old from Alpha School, a fast-growing private school network where children learn reading and math from AI software for two hours a day, and spend the rest of their time on workshops and projects overseen by adults the school calls “guides” rather than teachers.

The Trump administration had chosen AI as the future of American schooling, and wanted everyone to know it. But they picked a bad year to ask Americans to trust the technology with their kids.

Earlier this month, top leaders at Anthropic, OpenAI, and Google DeepMind publicly urged for an AI development slowdown, warning that companies racing to build ever more powerful systems could lose control of them, threatening not only large swaths of infrastructure but even humanity itself. Trump responded by calling the panic a “hoax” and said the US would not “hinder or stifle” the industry, because “whoever wins AI wins.” This “let them cook” mantra has met nearly every AI fear this year, from job loss to data center construction.

Yet the public is not convinced, and parents perhaps least of all. Efforts to bring AI into classrooms have run into organized opposition, and much of it is coming from inside Trump’s own coalition, setting up a fight between the administration’s pro-tech allies and conservatives who think screens have already done enough damage to kids.

In the nation’s two largest school districts, New York City has recently pulled student-facing generative AI from classrooms through eighth grade and Los Angeles blocked it on all student devices. But it’s not just Democratic-run cities that are pushing back. Earlier this year Utah barred students from using generative AI on assignments without a teacher’s say-so, and required schools to notify parents when it’s used in class. Oklahoma followed suit with a law, passed without a single “no” vote, that requires districts to tell parents which AI tools they use and what data they collect, and lets families opt out. Florida went further last week, when its Board of Education adopted rules for parents to opt their children in before they use AI at school, guaranteeing non-AI alternatives, and banning “companion” chatbots outright. 

Even at the Heritage Foundation, a conservative think tank with close ties to Trump, leaders are warning about the risks of AI in the classroom. In a March report, Heritage officials cautioned that AI tools built with addictive design features can harm children’s attention, mental health, and learning, and said schools should set limits rather than assume the technology will regulate itself. In July, the Manhattan Institute, another conservative think tank, recommended New York State bar students from using AI until third grade and keep it out of tests at every grade.

All the while, the Trump administration continues to push in the opposite direction, casting the wider AI race as one the US cannot afford to lose to China. Last year, Trump signed an executive order creating a White House task force to bring AI into K-12 classrooms, train teachers to use it, and build an “AI-ready workforce” to keep America as the global leader.

Polling data released in August found voters across the political spectrum concerned about AI in classrooms, with 85 percent worried about students using it to finish assignments without learning anything. Republicans were, if anything, slightly more eager than Democrats for government guardrails, 80 percent to 76 percent. Put differently, Republican voters appear closer to the Heritage Foundation than to the White House, which points to a coming clash inside the GOP over parental rights, innovation, and whether schools that take public money should have to prove their tactics work.

Up to this point much of the AI backlash has focused on regulating the tech in public schools, while some of its most ambitious boosters have concentrated on building private schools and developing new tools. A state can cap screen time in its elementary classrooms and let another family down the road pay thousands of dollars for Alpha, and everyone can call it a win for parent choice.

That peace may start to fray though as more public money comes on the table. Texas recently expanded vouchers to Alpha network schools and the company has also sought to open publicly funded charter schools. Other states are likely to confront these issues as well, meaning the AI education fight on the right may soon be unavoidable — and would land before an electorate whose patience for the tech, in schools and increasingly everywhere else, has been running thin all year. 

The Trump administration’s AI bet

The AI-in-schools executive order came just three months into Trump’s second term, and called for AI education to begin as early as kindergarten. Within five months, Education Secretary Linda McMahon was touring Alpha School’s Austin campus, describing it as “the most exciting thing” she’d seen in education in a long time. 

Alpha is hardly the first education company to promise a shiny new school model, but it has quickly become an influential player in the growing national debate around AI in schools. Its story so far reflects many of the big questions around AI in the classroom, including how to determine if the tech is helping or hurting kids, who is profiting, and what role governments should play in facilitating its adoption.

Alpha had been a small operation for most of its existence. MacKenzie Price, a Stanford graduate, co-founded it in 2014 after her second-grade daughter complained that school was boring. The tech billionaire Joe Liemandt became Price’s partner and the school’s principal financial backer. As recently as 2024 it served about 300 students across three campuses. 

Growth exploded in summer 2025, when Alpha took over campuses from a shuttered Montessori chain and announced plans for 10 new schools. This August it announced plans for 27 more.

Behind the school’s growth is its claim that students enrolled can cover a full day’s worth of academics in just two hours with AI, learning twice as fast as they would at a traditional school. Alpha can “enable the increase in human intelligence,” Price declared on a panel in Washington, DC, earlier this month, because “our academics can be delivered so much more efficiently and effectively.” 

Alpha says results from MAP tests, a widely used measure of academic growth, show its students learning 2.6 times faster on average than similar students at other schools. But no outside researcher has audited or independently verified those results.

That may soon change. MIT’s Blueprint Labs, the group behind some of the most rigorous charter school research in the country, told Vox it is designing pilot studies to measure the effects of the school’s programs on achievement and engagement, using experimental designs. Alpha is paying for the research; the lab says its own researchers will set the questions and methods. Harvard’s Human Flourishing Program is separately planning to study students’ life skills and well-being via a longitudinal study during the next academic year, Christina Hinton, who is involved with the research, told me. For now, Alpha’s academic claims remain its own.

Meanwhile, scrutiny of Alpha has grown. A Wired investigation last year described the school’s surveillance system as capable of recording students’ screens, keystrokes, and mouse activity and potentially tracking their eye movements. A 404 Media report published this winter claimed Alpha’s own internal documents said its AI-generated lessons sometimes did “more harm than good.” Alpha has disputed both reports, saying they relied on cherry-picked examples and accounts from fired employees, and provided me with an open letter it says every current family at the Brownsville campus signed, stating that the school Wired described doesn’t resemble theirs.

But education officials are still wary. This month, ProPublica and the Texas Tribune reported that at least nine states, Texas among them, had turned down Alpha’s bids to open publicly funded charter schools, with officials repeatedly pointing out that the model had only been tested on affluent students. (Tuition varies based on location, ranging from $10,000 a year at its Brownsville campus to $75,000 at its most expensive California schools.) Where Alpha had worked with lower-income students, ProPublica and the Texas Tribune found, it either hadn’t released enough data to back its claims of student growth or state test scores fell well short of what its leaders had predicted. 

After the Texas State Board of Education rejected Alpha’s charter bid in the summer of 2025, Alpha didn’t reapply. While policy advocacy was “frustratingly slow,” Price wrote, Alpha’s goal was “for students everywhere at every income level to be able to use this model of learning.” They turned instead to Texas’s new voucher program, which lets families spend public money at private schools. Unlike a charter, a private school in the program doesn’t have to give state tests or show anyone how its students perform. The comptroller, which runs the Texas Education Freedom Accounts (TEFA), approved most of Alpha’s Texas schools, which, counting virtual programs and specialty academies, now number more than 30.

None of the concerns that Texas’s State Board of Education had raised about Alpha’s test scores, missing data, or AI applied. “That wasn’t relevant,” Travis Pillow, a spokesperson for the TEFA voucher program, told ProPublica. “Our role is to make sure that a school meets the requirements in the law.” 

The five most expensive Alpha schools in Texas opted to leave the voucher program earlier this month, but many Alpha network schools are still participating, including Texas Sports Academy, Montessorium, NextGen Academy, Nova Academy, and Waypoint Academy. TEFA confirmed to me that students are attending Alpha affiliates via vouchers this year. 

Anna Davlantes, a spokesperson for Alpha, told me that in lieu of vouchers for their most expensive campuses, her network is offering families financial aid. 

The conservative revolt

Despite Alpha’s enthusiastic embrace in the White House, the introduction of AI in schools is increasingly challenged by forces on the right, from grassroots MAGA parents to social conservatives and technocrats.

The new AI rules in Florida, Oklahoma, and Utah, for example, grew out of a broader conservative push against screens in classrooms that predated the rise of chatbots and was turbocharged by parents’ frustrations with virtual learning during the pandemic.

Earlier this year Iowa capped elementary school screen time at an hour a day in a bill Gov. Kim Reynolds signed with Health and Human Services Secretary Robert F. Kennedy Jr. at her side. Tennessee passed a weakened version of a bill that would have banned devices in elementary schools outright, while similar bills in Missouri and Kansas died after school districts and teachers unions objected.

Uniting these efforts is a growing conviction that the last 15 years of education technology has failed most kids. The sponsor of Kansas’s bill used to sit on his state’s board of education and remembers thinking that ed tech held such promise. “What we found out is that not only is it not the education of the future, but it is destroying the education of the past,” he told Education Week. A growing number of lawmakers and parents have been citing The Digital Delusion, a book self-published in 2025 by neuroscientist Jared Cooney Horvath, that blames the proliferation of screens for declining student achievement. In January Sen. Ted Cruz (R-TX), who is otherwise one of the Senate’s leading opponents of AI regulation, invited Horvath to testify about the harms of AI on student learning and mental health.

The screen skeptics overlap with a more traditionalist wing of the GOP that objects to classroom technology on principle. Missouri’s original bill would have required cursive and kept 70 percent of student work on paper. The classical education movement, which holds up teachers as a moral example, has grown fast on the right. (Of the 895 identified classical schools nationwide, roughly one-third opened or converted to the model between 2020 and 2024, according to a Heritage Foundation tracker.)

The strand of conservatism that cuts closest to Alpha School comes from a third group, the school choice advocates. On paper, Alpha sounds like what the school reformers have wanted for years: It can offer an alternative to underperforming local public schools, its AI programs can theoretically compensate for inconsistent teacher quality, it provides personalized instruction, and it checks mastery on every lesson, so families can easily know whether their child is learning. Those are problems the education reform movement was launched to solve, and Alpha claims to fix them all.

The reformers, though, want proof. Mike Petrilli, who runs the conservative Thomas B. Fordham Institute think tank and has spent decades advocating for charter schools, wrote recently on his Substack that parents who want to pay for Alpha out-of-pocket should be able to, but “that doesn’t mean the rest of us shouldn’t be skeptical, or that we shouldn’t worry about fraud, or that we should allow public funding to flow to these school.”

This split was on display in DC this month at the education conference where Price appeared. Molly Hart, who runs Utah’s public schools and calls herself a school choice supporter, argued that once a school takes taxpayer money, “the game changes,” and parents can’t make a real choice without data about how it performs. Erika Donalds, who chairs the education center at the America First Policy Institute and is one of the Trump administration’s closest allies on schools, said parents, not the government, should decide which results matter. Donalds compared the choice to picking a restaurant on Yelp. 

The evidence has started to catch up with parental concern. In a randomized trial involving nearly 1,000 students at a Turkish high school, those given access to a GPT-based math tutor that readily supplied answers scored 17 percent lower on a subsequent exam taken without it. A version designed to withhold answers eliminated that penalty but produced no statistically significant learning gain. A newer working paper tracking nearly 27,000 Chinese students found that adopting AI raised homework scores by 18 percent but lowered monthly exam scores by 20 percent within six months.

Alpha School is working to add more detail to that pile, and other studies will surely follow. It’s at least possible that some aspects of AI in education prove more promising with further study. But public skepticism will remain a major barrier, either way. On an issue where parties are still sorting themselves out, the White House and its allies are swimming against a growing anti-tech tide that extends far beyond just AI or even schools. That’s unlikely to change before 2028, and whoever wants the Republican nomination will have to say which parents they’re listening to.

The AI freakout of the past few weeks has centered on nothing less than the risk of human extinction — on the possibility that artificial intelligence could wipe us all out. But the reality is, AI programs are already having a direct and sinister effect on people’s physical health: UnitedHealth Group, the largest health insurer in the US, has been accused of using AI programs to deny payments to people, despite their doctors saying the care was necessary, and is facing a class-action lawsuit. 

Humana and Cigna are facing their own litigation over similar allegations. Meanwhile, Medicare has launched its own AI tool that will help the government determine whether to approve prior authorizations, and doctors are sending the federal government reports of patients at their offices who are in tears because they can’t get the medicine to manage their chronic pain.   

The claims in the legal complaints are harrowing: Families are desperate for an elderly loved one who recently experienced a serious fall to be allowed to stay in a nursing home. Doctors are flummoxed when a patient who may need months of rehab is cut off by an algorithm after a couple of weeks. 

This is AI’s threat to people’s health right now. 

While the current conversation may be fixated on something more Hollywood, private insurers and the Trump administration are already deploying AI programs to vet people’s health insurance claims — and the evidence is growing that these programs are not always doing a good job and are instead putting people’s health at risk. Until these lawsuits are settled or policymakers can figure out a way to regulate how insurers use this new technology, it will be up to each of us to make sure that an AI program isn’t being used to cheat us out of insurance benefits that we’re entitled to.

“The type of care that clinicians deliver is very sensitive to the patient’s unique circumstances. That may not really show up as a number. There’s not a numeric value that tells you the completeness and connection of a patient’s social network,” said Mika Hamer, a health services researcher at the University of Maryland. “There really are a lot of factors that really can’t be quantified and so aren’t really suitable to go into these models. If we start to rely exclusively on the models, I think we run the risk of losing that human touch.”

Patients say private health insurers are using AI to deny claims

Insurers and patients fighting over medical claims is nothing new: Policyholders want the most coverage they can get and payers have a business incentive to pay as little as they can. Health insurers have also used algorithms for decades: Plug in somebody’s age, their weight, whether or not they smoke, and one of the old-fashioned algorithms could spit out a rough estimate of how much medical care they would need before they died. Simple — and comparatively transparent. 

When you submitted a claim or sought prior authorization, there was supposed to be a human doctor who could review all of the relevant information on behalf of the insurer and make the final decision, in theory with the patient’s best interests in mind. It didn’t always work that way in practice, of course, but that was the idea.

What’s different right now, according to Daniel Schwarcz, a law professor at the University of Minnesota who has looked at health insurers’ AI use, is that these newer programs can make very specific predictions about someone’s future health based on the information that’s fed into them, and those predictions are being used in the process of approving or denying medical claims. And exactly what went into making those predictions — and whether it is the AI or the human who ultimately holds the final authority — is often opaque from the outside.

“The reason we want human review is we want human substantive judgment. We want AI to be supporting that,” Schwarcz said. “But the difficulty is distinguishing between AI supporting meaningful human processing and AI basically replacing the human with the human just passively defaulting to the AI judgment. It’s just incredibly hard to distinguish between those two in practice, particularly in rules or regulations.”

And those questions are at the heart of the lawsuits brought against three major insurers in the past few years about their use of AI in processing claims.

In May 2022, Gene Lokken, then 91 years old, fell in his home. He was taken to the nearby hospital in Tomahawk, Wisconsin, and treated for a broken leg and a broken ankle. Less than a week later, he was placed in the health system’s hospice care because, according to the lawsuit filed by his family, he was “very weak, not communicative, and in constant pain.”

But a month later, after receiving skilled nursing care, Lokken started to improve. By late June, his doctor had removed his splint and placed his leg in a removable boot. In July, he started physical therapy to get up and walk again. And for a while, his Medicare Advantage plan sold by UnitedHealth covered all of the services he needed.

Until July 20. Around that time, according to the lawsuit, UnitedHealth denied any more services at the nursing facility where Lokken had been for the past two months. It insisted that he could be safely discharged and more time at the nursing care facility “was not medically necessary.”

The insurer’s decision left Lokken and his physician “dumbfounded.” The physical therapist notes from the time said Lokken was still suffering paralysis and weakness after only a couple weeks of rehab. His family appealed, but UnitedHealth continued to deny the claims, asserting that because Lokken could feed himself and did not require help to clean himself, he did not need nursing care and could go home. 

From July 2022 to July 2023, Lokken remained at the nursing home, but his family had to pay between $12,000 and $14,000 monthly to keep him there. And on July 17, 2023, Lokken died — having never left the facility.

The lawsuit alleges that the decision to stop covering Lokken’s nursing-home stay was largely made by an AI algorithm, called nH Predict, which UnitedHealth follows so unquestioningly that employees were allegedly at risk of being disciplined or fired if their claims decisions went against the AI’s projections. The complaint alleges that the AI model would typically start denying claims after two weeks of nursing home care — and the attorneys have more examples than Lokken.

Glennette Kell required emergency surgery after a fall in late August 2023 and was referred to a nursing home rehab center. By mid-September, UnitedHealth was denying her claims for nursing care, despite the fact that, according to the lawsuit, she still could not walk. Kell had to pay $10,000 of her own money to cover the rest of her bills. Darlene Buckner suffered a heart attack in October 2023 and underwent triple-bypass surgery. She was readmitted to the hospital in late November because she was experiencing complications, but less than two weeks later, UnitedHealth allegedly denied any further treatment at the hospital because it was deemed medically unnecessary. At the time, according to the class-action lawsuit, Buckner was experiencing “an open infected wound near her heart from the open-heart surgery, she was on blood thinners, and was receiving antibiotics through an IV.” 

UnitedHealth, in its responses to the plaintiffs, has asserted that federal laws and regulations already require all claims decisions ultimately be made by a human doctor, not an AI program, and raised several other technical legal objections (such as saying the plaintiffs have not fully exhausted their administrative appeal options). The plaintiffs, however, allege that UnitedHealth employees “are instructed not to deviate” from the AI model’s projections, and then tell patients the AI-generated information is proprietary when they or their doctor try to inquire about why their claims are being denied. 

And, to be clear, UnitedHealth is not the only insurer being sued for using AI programs to deny claims. Humana is facing its own lawsuit brought by other Medicare Advantage patients who allege the same nH Predict program also led to their claims being wrongfully denied. Joanne Barrows, then 86, fell in November 2021 and went to a rehab nursing facility after her hospital stay. And just two weeks later, Humana began denying her claims for further care, according to the complaint, leaving her and her doctor “bewildered” because she was under doctor’s orders not to put any weight on her leg.

And the third lawsuit, filed against Cigna, alleges the company used a different AI algorithm that allowed its doctors to deny claims in huge batches — hundreds or thousands at a time — if they did not meet certain predetermined criteria. One patient, Suzanne Kisting-Leung, had claims denied for two ultrasounds done by her doctor to check for ovarian cancer, putting her on the hook for more than $700 in medical bills because, the lawsuit alleges, Cigna’s AI program determined that the scans were not medically necessary. The plaintiffs say that their claims were instantly rejected, without their medical files ever being opened. As for the law that human doctors have to make the final call? According to the lawsuit, the algorithm “enable[s] its doctors to automatically deny payments in batches of hundreds or thousands at a time for treatments that do not match certain pre-set criteria, thereby evading the legally required individual physician review process.”

These people, many of them elderly, had no idea AI was being used to make decisions about their coverage — until it was too late.

“From their perspective, you might as well have been speaking Esperanto. They just had no idea what it was that was being said to them when they were being told. They usually heard about it for the first time when they were being told that they needed to leave,” Glenn Danas, one of the attorneys in the class-action litigation against United, Humana, and Cigna, told me. “They just had no idea what was going on or why this was being done to them.”

AI is now making decisions for traditional Medicare claims too

It’s not just private insurers either. The Trump administration is now pushing traditional Medicare and Medicaid to use AI to adjudicate insurance claims too. In June 2025, nearly two years after those lawsuits had been filed against Cigna, Humana, and UnitedHealth, the US Department of Health and Human Services announced it would deploy a new program called the WISeR (Wasteful and Inappropriate Service Reduction) model to make prior authorization decisions for about a dozen procedures for the people on traditional Medicare in six states — “leveraging enhanced technologies, such as Artificial Intelligence (AI) and Machine Learning (ML), along with human clinical review to ensure timely and appropriate Medicare payment for select items and services.” It would be a pilot program, before federal officials decide whether to take the program nationwide.

It was a quiet, massive change for traditional Medicare, which covers about half of the 66 million Americans on the program. (Medicare Advantage plans, in which private companies administer Medicare benefits under slightly different parameters and which were the subject of the earlier AI-related class-action litigation, cover the rest.) People on traditional Medicare had historically not been required to get prior authorization for most services; now they would be, and a novel AI program would play a significant role in which claims get approved and which ones don’t.

From the start, physician and patient advocates warned about the potentially adverse consequences of the WISeR program; the Center for Medicare Advocacy said the program would likely “complicate, delay and even outright deny necessary care.” According to media reports and internal government documents, that’s exactly what has happened since the model went live in January. 

The Washington Post first reported in March that physicians and their patients were experiencing approval delays or denials for medical services that should have been covered. One glitch led to a denial of payment for services that had been approved. Doctors noticed that certain procedures seemed to give the AI model problems — such as two competing treatments for incontinence — and were weighing whether or not to stop offering one of those services altogether. The Post reported on one Arizona patient who had been receiving steroid injections for chronic back pain before being denied multiple times after the AI program’s launch. The pain became so severe, he said, that he could not exercise at all.

Then this month, the Electronic Frontier Foundation released a trove of documents it received in response to a Freedom of Information Act lawsuit related to the WISeR model. The documents revealed aggressive denials — one company using the AI model had actually denied more prior authorization requests than it had approved — and there were delays even when the care was ultimately approved. One review took 83 days when the model was supposed to make a decision within 72 hours.

The direct feedback from doctors in the federal documents obtained by EFF was devastating.

“We have patients calling our offices crying in pain because their procedures are being delayed while awaiting approvals or guidance tied to this model,” one doctor wrote. “A 3-4 day delay for necessary pain procedures is already difficult for vulnerable patients, but when providers cannot obtain answers for weeks, the situation becomes unacceptable.”

According to the federal documents, the Trump administration was already discussing ways to expand the program. Despite the outcry from doctors and patients, and growing concern among their representatives in Congress, it doesn’t look like WISeR is going away.

How can we make sure AI doesn’t take over insurance claims?

AI is becoming a part of healthcare — it is already happening. And many of those uses could be truly beneficial. Anthropic recently announced an initiative to apply the theoretical findings of its AI models to real-life lab work that could lead to new drugs being developed in the future. In terms of scientific discovery and the potential to translate it into new treatments, the excitement among clinicians about its potential is palpable.

And nobody denies that health insurance administration is chaotic and burdensome and would benefit from being made more efficient and streamlined — tasks which AI is at least superficially well-suited for.

But as the past few years have already shown, rushed and sloppy deployment of AI to take responsibility for approving or denying payment for people’s medical care has created serious problems. The issue is that this technology is being adopted more quickly than any regulator can oversee it. We don’t really know how health insurers are using AI tools. We don’t have a good framework for what keeping a “human in the loop” of insurance decisions — which is what people want — would really mean, Schwarcz said. 

“I think everyone agrees at a high level of generality, ‘Yes, AI should be used to enhance human review and not to replace it,’ but no one actually knows how to write rules to enforce it,” he told me. “I don’t think that there’s anything I’ve seen that has effectively defined what it means for a human to be meaningfully in the loop in the sense of retaining independent judgment as opposed to just reviewing and deferring. It is incredibly hard to specify in rules or regulations a standard that is verifiable and enforceable. That is still, as far as I know, an unsolved problem.”

Some states have started adopting rules requiring transparency for AI use in insurance claims, and lawmakers in Congress have put forward proposals requiring human involvement, including the bipartisan Protecting Patients from Automated Denials Act. But these technologies are so ubiquitous and so flexible that rigorously regulating their use is going to be difficult. Meanwhile, the profit incentive for companies to adopt these tools and deploy them widely is extremely strong. We don’t even know how widespread their use really is.

Danas said he and his clients hoped their litigation would help with “putting the brakes” on AI’s use in insurance. Until we figure out what to do from a policy perspective, what can each of us do in the meantime? Hamer told me that the old advice is still the best advice: If your claim is denied, appeal it. An enormous number of denied claims end up getting overturned on appeal. 

“You do not necessarily have to accept that the first answer from your insurance company is the final determination,” she said.

Welcome to The Midterms, Actually. Every week I’ll be writing about two things: one big idea or trend I see forming across the 2026 primaries, and one thing I’m hearing from a voice on the ground. Let’s get into it. You can sign up here to get it in your inbox every week. Let’s get into it.

One big idea: Latinos didn’t come home. They’re just in motion.

In the last presidential election, President Donald Trump’s strong support with Latino voters ended up one of the biggest stories of the night. After years of Democrats telling themselves that the growing number of Hispanic Americans would help lead to a permanent liberal majority, their dreams were first dashed in 2016 (when many of those voters stayed home) and then buried in 2024 (when they, and other nonwhite voters, swung toward Trump).

But just as Democrats have at times been too confident that minority voters would fall in line, it now seems Republicans have replicated their mistake. Poll after poll shows a historic reversal among Latino voters in Trump’s second term, and these days even Republican members of Congress are beginning to call Trump out on his deportation efforts. 

Why? It comes back to the numbers.

As Nate Cohn observed in the New York Times this week, Democrats now lead Republicans among Hispanic likely voters by 35 percentage points on the generic congressional ballot, 64-29 — a 28-point swing from 2024, when Kamala Harris carried Hispanic voters by just 7 points. The shift is a big reason the polling has Democrats in “blue wave” territory this November.

Last week on America, Actually I explored this shift in detail — by talking to Stephanie Valencia, co-founder and president of Equis, the research firm that has spent a decade digging into the Latino electorate. And the first thing she wanted us all to know: Get rid of the idea that Latinos will ever be permanently Democratic or permanently Republican. Part of the electoral power is that a larger section of the electorate defines itself more independently.

“Latinos often get given the title, the sleeping giant, which I just want to rid that out of everybody’s vocabulary. We should be called the swinging giant based on how much shift we have seen election to election. A third of Latinos consider themselves kind of independent or apolitical nonpartisan, and that’s that swinging middle that really is deciding every single election.”

Here are three more trends Valencia pointed out, which help explain why this all-important voting group has done such a drastic 180 on Trump in his second term.

1. It’s the economy (again)

As with all things in Trump’s second term, it starts with the fundamental problem of his second term: He has not delivered on lower prices. Equis found that Trump’s net approval with Latinos on cost of living sits at -52 — and his number on the economy (-45) is worse than his overall approval with the group (-31). Both are dramatically worse than where he sits with non-Latinos, who put him at -39 on cost of living and -25 on the economy. Among Latino men 18 to 39, cost of living hits a stunning -63.

Here’s what Valencia said:

“Latinos make up more of the wage workforce than any other racial subgroup. And so what that means is when wages are down and inflation is high, Latinos feel it more. We have less savings. We have less rates of home ownership. So the kind of safety nets that other people might have, we just don’t have.”

She also pointed this out:

“In Trump 1.0, his approval on the economy and the cost of living was actually better than his everyday approval… And he has been underwater with Latinos almost this entire term so far on the cost of living and the economy. It’s almost been a complete and total reversal.”

One of the arguments Trump made to Hispanic communities (and other groups also) was that he’d economically empower them, and that this was more important than prioritizing social causes that didn’t have a material benefit. That’s also been his fundamental flaw. From tariffs to rising gas prices, he has not only not delivered — people also feel worse off than before.

2. The immigration backlash

Valencia’s data was undeniable: More and more Latinos turned on Trump as he broadened his deportation efforts, which were broadly unpopular. But what I didn’t understand is why it took until Trump’s second term for people to realize those threats were legitimate, considering they were so front and center during his campaign. (They held up “Mass Deportation Now!” signs at the Republican National Convention!)

Here’s what Valencia said:

“I think this is really important for us as avid news consumers to understand what it is that the average voter, and especially that voter who’s coming in and out of elections, the kind of news they’re consuming. What they were seeing on mainstream media, perhaps even Fox News at the time, was a focus on Trump surrogates who said he’s gonna focus on serious criminals, securing the border, and violent criminals. And so that’s what people bought.”

“Fast-forward to 2026, the people who feel most regretful who voted for Trump in 2024 are most regretful because of immigration. They feel like there was a broken promise there. Like, they were told he was gonna focus on the border, which everybody agreed was chaos, and he was gonna focus on violent criminals and serious threats, and at the end of the day, he has not complied with that.”

There’s also an element of disbelief. When Trump said he would deport “bad people,” a lot of people thought he was only talking about people in other communities — or immigrants with criminal legal histories — not the more far-reaching immigration sweeps we’ve seen since he’s been in office. A striking ad from Rep. María Elvira Salazar (R-FL) this week where she directly criticizes Trump’s immigration policy explicitly made this distinction. 

The Equis numbers track that shift almost perfectly. In December 2024, 65 percent of Latino Trump voters believed he would target only criminals and recent arrivals. Today, 62 percent of Latinos overall say he’s going after undocumented immigrants broadly — and among his own Latino voters, the share who say that has jumped from 26 percent to 37 percent. That perception is the whole ballgame: Latino Trump voters who still believe he’s targeting only criminals give him +84 net approval. Among those who’ve concluded he’s targeting everyone, it collapses to +31.

The backlash isn’t about the border. It’s about what’s happening in the interior — the raids, the family separations, the citizens and legal residents swept up. 

Equis finds 68 percent of Latinos say Republicans promised to deport criminals and deported hardworking people instead — and 67 percent say Democrats promise immigration reform and never deliver. Forty-two percent say both parties broke their promises.

“I think it is a huge mistake for Democrats to assume or to rest on their laurels and think that because of what people are feeling around Trump and Republicans and the sense of disappointment and broken promises, that that is automatically going to translate to them as a party and as a brand. Right now, the Democratic brand has suffered a repeated set of blows among Latino voters. 20 years of comprehensive immigration reform that hasn’t been delivered. It’s a thing that comes up in almost every focus group.”

3. Meeting voters where they are

The third trend isn’t about persuasion at all. It’s about the fact that a lot of campaigns are still bad at the mechanics of reaching this electorate — and Valencia’s examples were almost comically basic.

Their testing found that more than 70 percent of Latinos who see an ad in Spanish come away thinking that candidate or party cares more about Latinos. That’s not a persuasion effect. That’s a respect effect, and it’s enormous for the price of one ad buy.

So how do campaigns blow it? Some examples, according to Valencia: translating English ads directly into Spanish, rather than tailoring them to the language and culture; and assuming English speakers and Spanish speakers are separate categories when voters often shift between media in both languages. 

The deeper error is the monolith problem — the group is still treated as a voting bloc that moves in unison, rather than a diverse set of people from varying countries of origin and contexts. And the fastest-moving division isn’t the country of origin at all. It’s age — an electorate replenishing itself faster than either party’s model of it.

“There are a million Latinos who turn 18 every single year, and an 18-year-old who turns 18 this year and will vote in this year’s election was born the year Barack Obama was elected president. … The era of politics for an 18-year-old today is chaos, Covid, and corruption. They do not remember the hopium of Obama and the beautiful coalition that we built. That is all ancient history to them.”

A million new voters a year, completely up for grabs. Nobody is inheriting these voters. Neither party owns them. Because as Valencia put it: Demographics have proven not to be destiny — effort and intention matter more.

What I’m hearing

This week I called Matthew Eadie, a reporter at Evanston Now, who has been covering an ICE stop in Evanston, Illinois that has since attracted national attention. On the morning of Sunday, September 20, federal agents stopped a man walking on Howard Street. He turned out to be a US citizen, and not the person they were looking for. Agents reportedly left him on the ground with injuries to his head, neck, and teeth. DHS says he “refused to identify himself. Now the community is demanding answers.”

What’s the community reaction been?

People are really furious. If you remember the fall here — Operation Midway Blitz, the heightened Border Patrol enforcement across the Chicago area, Gregory Bovino parading around the streets with camera crews, the protests at the Broadview processing center — people here were very aware of how impactful it was. It was also happening around the elections, so it was prominent news everywhere and everybody was talking about it.

Over the summer it really died down, and I don’t think people have paid much attention since. ICE has been around all year, but they haven’t been as flashy about it, which has been talked about nationally too. This was a flare-up, and it’s a reminder that it’s still going on even after Bovino left. There have been protests at Broadview this week unrelated to the Evanston incident. So either people are starting to pay more attention as the election gets closer, or the incidents are actually picking up again.

What are the unanswered questions you’re still chasing?

Who were they looking for? Were they actually looking for somebody? That’s been their story — a specific individual — and a lot of people I’ve talked to are really skeptical that’s the case. One witness at the scene told me he felt like they just picked him and drove up on him. Essentially what’s been called a “Kavanaugh stop” — if they’re suspicious of you, they can pretty much find a reason to detain you. And then they dropped it once they realized either that he was a US citizen, which he says he is, or that there were too many people around taking videos for it to be worth their time.

So: What happened in the lead-up, and who specifically were they looking for? 

Afterward, the agents talked to Evanston police — that’s an Evanston police policy; they’re supposed to try to get information from ICE officers. I’ve FOIAed all the body cam footage. I want to see what those conversations were like, and what exactly the agents told police officers when they talked privately.

Part of what we’re trying to do is see the issues that play out from the bottom up rather than the way they get framed nationally. Beyond immigration, is there anything in your coverage that’s shaping local politics more than the national conversation reflects?

The national issues matter to everybody, but they hit communities in completely different ways. Evanston is affluent — college town, Northwestern, wealthier than most suburbs. Affordability is a buzzword that comes up everywhere, but people here talk about it differently.

This is an overwhelmingly progressive Democratic city. Some people in Evanston certainly need it to be more affordable for themselves. But you also have progressive voters saying we want to make Evanston more affordable and more inclusive for other people. Sometimes the affordability conversation gets framed as “life is too expensive for me and we need to make it cheaper for me,” which is true in a lot of places. In somewhere like Evanston, where there are a lot of affluent people who are also very progressive voters, it’s more: If we actually want to say we’re a progressive community, we have to show it. And showing it maybe means building affordable housing.

It’s also a city that passed reparations, which the federal government is challenging right now. That’s going to be a federal court case through the end of this year and probably into next year — the feds challenging the city’s reparations program. That’s something the city prides itself on. Those are big issues here that come out of the national conversation but sound different than how we hear them in national media.