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Trump Aid Cuts End Contraception Access for Millions of Women

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Trump Aid Cuts End Contraception Access for Millions of Women

The United States is ending its financial support for family planning programs in developing countries, cutting nearly 50 million women off from access to contraception.

This policy change has attracted little attention amid the wholesale dismantling of American foreign aid, but it stands to have enormous implications, including more maternal deaths and an overall increase in poverty. It derails an effort that had brought long-acting contraceptives to women in some of the poorest and most isolated parts of the world in recent years.

The United States provided about 40 percent of the funding governments contributed to family planning programs in 31 developing countries, some $600 million, in 2023, the last year for which data is available, according to KFF, a health research organization.

That American funding provided contraceptive devices and the medical services to deliver them to more than 47 million women and couples, which is estimated to have averted 17.1 million unintended pregnancies and 5.2 million unsafe abortions, according to an analysis by the Guttmacher Institute, a sexual health research organization. Without this annual contribution, 34,000 women could die from preventable maternal deaths each year, the Guttmacher calculation concluded.

“The magnitude of the impact is mind-boggling,” said Marie Ba, who leads the coordination team for the Ouagadougou Partnership, an initiative to accelerate investments and access to family planning in nine West African countries.

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The funding has been terminated as part of the Trump administration’s disassembling of the United States Agency for International Development. The State Department, into which the skeletal remains of U.S.A.I.D. was absorbed on Friday, did not reply to a request for comment on the decision to stop funding family planning. Secretary of State Marco Rubio has described the terminated aid projects as wasteful and not aligned with American strategic interest.

Support for family planning in the world’s poorest and most populous countries has been a consistent policy priority for both Democratic and Republican administrations for decades, seen as a bulwark against political instability. It also lowered the number of women seeking abortions.

Among the countries that will be significantly affected by the decision are Afghanistan, Ethiopia, Bangladesh, Yemen and the Democratic Republic of Congo.

The money to support international family planning programs is appropriated by Congress and was extended in the most recent spending bill that keeps the government operating through September. The move by the State Department to cut these and other aid programs is the subject of multiple lawsuits currently before federal courts.

The Trump administration has also terminated American funding for the United Nations’ sexual and reproductive health agency, U.N.F.P.A., which is the world’s largest procurer of contraceptives. The United States was the organization’s largest donor.

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Although the United States was not the sole supplier of contraception in any country, the abrupt termination of American funding has created chaos in the system and has already caused clinics to run out of products.

An estimated $27 million worth of family planning products already procured by U.S.A.I.D. are stuck at different points in the delivery system — on boats, in ports, in warehouses — with no programs or employees left to unload them or hand them over to governments, according to a former U.S.A.I.D. employee who was not authorized to speak to a reporter. One plan proposed by the new U.S.A.I.D. leadership in Washington is for remaining employees to destroy them.

Supply chain management was a major focus for U.S.A.I.D., across all areas of health, and the United States paid to move contraceptive supplies such as hormonal implants, for example, from manufacturers in Thailand to the port in Mombasa, Kenya, from where they were taken by trucks to warehouses across East Africa and then to local clinics.

“To put the pieces back together is going to be very difficult,” said Dr. Natalia Kanem, executive director of U.N.F.P.A. “Already this has had a catastrophic impact — it’s literally affecting millions of women and families. The poorest countries don’t have the resilient buffer.”

The United States also paid for data and information systems that helped governments track what was in stock and what they needed to order. None of those systems have operated since the Trump administration sent a stop-work order to all programs that received U.S.A.I.D. grants.

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Bellington Vwalika, a professor of obstetrics and gynecology at the University of Zambia, said that contraceptives had already begun to run short in some parts of the country, where the United States supplied a quarter of the national family planning budget.

“The affluent can buy the commodity they want — it is the poor people who have to think, ‘Between food and contraception, what should I get?’” he said.

Even before the United States pulled out of family planning programs, surveys found that globally, about 250 million women of reproductive age wished to avoid pregnancy but did not have access to a modern contraceptive method.

At the same time, there had been great progress. Demand for contraception has been rising steadily — with long-acting methods that offer women greater privacy and secure protection — in Africa, the region of the world with the lowest coverage. Supply has improved with better infrastructure that helped get products to rural areas. And “demand creation” projects, of which the United States was a major funder, used advertisements and social media to inform people about the range of contraceptive choices available and the advantages of spacing or delaying pregnancies. Women’s rising levels of education boosted demand, too.

Thelma Sibanda, a 27-year-old engineering graduate who lives in a low-income community on the edge of the Zimbabwean capital, Harare, two weeks ago received a hormonal implant that will prevent pregnancy for five years, at a free pop-up clinic run by Population Services Zimbabwe, which had a multiyear U.S.A.I.D. grant to deliver free family planning services.

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Ms. Sibanda has a 2-year-old son and says she cannot afford more children: She can’t find a job in Zimbabwe’s fractured economy, and neither can her husband. They subsist on the $150 he earns each month from a vegetable stand. She had been relying on “hope and faith and natural methods” to prevent another pregnancy since her son was born, Ms. Sibanda said, and had wished for something more reliable, but it simply wasn’t possible in her family’s budget — until the free clinic came to her neighborhood.

With its U.S.A.I.D. funding, the Zimbabwean organization that provided her implant last year was able to buy six sturdy Toyota vehicles and camping equipment so that an outreach team could travel to the most remote regions of the country, delivering vasectomies and IUDs in pop-up clinics. Since the Trump executive order, they have had to stop using all of that equipment.

The Zimbabwean organization is a branch of the international nonprofit MSI Reproductive Choices, which has stepped in with temporary funds so the teams can continue to provide free care for the women they can reach, such as Ms. Sibanda. MSI can cover the costs only until September.

Ms. Sibanda said her priority was providing the best possible education for her son, and because school fees are costly, that means no more children. But many African women have no way to make this kind of choice. In Uganda, while the national fertility rate is 4.5 children per woman, it’s not unusual to meet women in rural areas with limited education who have eight or 10 children, said Dr. Justine Bukenya, a lecturer in community health and behavioral science at Makerere University in Kampala. These women become pregnant for the first time as teenagers and have little space between pregnancies.

“By the time they are 30 they could have their 10th pregnancy — and these are the women who will be affected,” she said. “We are losing the opportunity to make progress with them. The United States was doing a very strong job here of creating demand for contraception with these women, and mobilizing young men and women to go for family planning.”

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Some women who have relied on free or low-cost service through public health systems may now try to buy contraceptives in the private market. But prices of pills, IUDs and other devices will most likely rise significantly without the guaranteed, large-volume purchases from the United States.

“As a result, women who previously relied on free or affordable options through public health systems may now be forced to turn to private sector sources — at prices they cannot afford,” said Karen Hong, chief of U.N.F.P.A.’s supply chain unit.

The next largest donors to family planning after the United States are the Netherlands, which provided about 17 percent of donor government funding in 2023, and Britain, with 13 percent. Both countries recently announced plans to cut their aid budgets by a third or more.

Ms. Ba said the focus in the West African countries where she works was mobilizing domestic resources and figuring out how governments can try to reallocate money to cover what the United States was supplying. Philanthropies such as the Gates Foundation and financial institutions including the World Bank, which are already significant contributors to family planning, may offer additional funding to try to keep products moving into countries.

“We were getting so optimistic — even with all the political instability in our region, we were adding millions more women using modern methods in the last few years,” Ms. Ba said. “And now all of it, the U.S. support, the policies, it’s all completely gone. The gaps are just too huge to fill.”

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Video: Democrats Press Noem on Harsh Immigration Tactics

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Video: Democrats Press Noem on Harsh Immigration Tactics

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Democrats Press Noem on Harsh Immigration Tactics

Some Democratic lawmakers pressed Homeland Security Secretary Kristi Noem on the Trump administration’s aggressive immigration enforcement tactics during a hearing on Thursday.

“Madam Secretary, your incompetence and your inability to truthfully carry out your duties of secretary of Homeland Security — if you’re not fired, will you resign?” “Sir, I will consider your asking me to resign as an endorsement of my work. Thank you very much.” “Secretary Noem, Trump administration — you’re going after the worst of the worst criminals, and we agree with you. The problem is, 70 percent of the people you’ve arrested have no criminal record. You’re going after noncriminal immigrants, U.S. citizens and permanent legal residents.” “Madam Secretary, you and the gentleman from N.C.T.C. referenced the unfortunate accident that occurred with National Guardsmen being killed.” “Do you think that was an unfortunate accident?” “I mean —” “It was a terrorist attack.” “Wait, wait. Look, I’ll get it straight. Then you can —” “He shot our National Guardsmen in the head.” “It was an unfortunate situation, but you blamed it solely on Joe Biden. Trump administration, D.H.S., your D.H.S. approved the asylum application.”

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Some Democratic lawmakers pressed Homeland Security Secretary Kristi Noem on the Trump administration’s aggressive immigration enforcement tactics during a hearing on Thursday.

By Jorge Mitssunaga

December 11, 2025

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The Speaker’s Lobby: What Congress’ December script means for healthcare next year

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The Speaker’s Lobby: What Congress’ December script means for healthcare next year

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This December on Capitol Hill appears to follow a familiar script.

There’s a deadline for Congress to act on (insert issue here). And if lawmakers don’t move by Jan. 1, then (insert consequence here). So, everyone on Capitol Hill clamors over pathways to finish (given issue). Lawmakers and staff are at the end of their wits. Everyone is worried about Congress successfully fixing the problem and getting everyone home for the holidays.

There’s always the concern that Congress will emerge as The Grinch, pilfering Whoville of Christmas toys.

But lawmakers often wind up toiling with the diligence and efficiency of Santa’s elves, plowing through late-night, overnight and weekend sessions, usually finishing (insert issue here) in the St. Nick of time.

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THE HITCHHIKER’S GUIDE TO THURSDAY’S BIG SENATE VOTES ON HEALTHCARE

This pattern is always the same. With few variations.

This parliamentary dance of the sugar plum fairies frequently centers on deadlines for government funding, the debt ceiling and tax policy. Such was the case when the Senate passed the first version of Obamacare on Christmas Eve morning in 2009. Republicans skated on thin ice to finish their tax reform package in December 2017.

Lawmakers moved expeditiously to approve a defense policy bill in late 2020, then made sure they had just enough time on the calendar to override President Trump’s veto of the legislation before the very end of the 116th Congress in early January 2021.

The deadlines sometimes veer into the political. There was a crush to finish articles of impeachment on the House floor for both presidents Clinton and Trump in December 1998 and December 2019, respectively.

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And, so, after everyone got this fall’s government shutdown worked out of their systems, lawmakers were far from prepared to address its root cause. Democrats refused to fund the government unless Congress addressed spiking healthcare premiums. Those premiums shoot up on Jan. 1. And no one has built enough consensus to pass a bill before the end of the year.

Yet.

This December is playing out like many others on Capitol Hill. (Celal Gunes/Anadolu via Getty Images)

But it’s only mid-December. And everyone knows that the congressional Christmas legislative spirit can be slow to take hold. Some of that holiday magic may have officially arrived Thursday afternoon after the Senate incinerated competing Republican and Democratic healthcare plans.

Senate Minority Leader Chuck Schumer, D-N.Y., pushed a three-year extension of the current Obamacare subsidies with no built-in reforms.

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“This is going to require that Democrats come off a position they know is an untenable one and sit down in a serious way and work with Republicans,” Senate Majority Leader John Thune, R-S.D., said of the Democratic proposal.

Thune characterized the Democrats’ gambit as “a political messaging exercise.”

MODERATE REPUBLICANS STAGE OBAMACARE REBELLION AS HEALTH COST FRUSTRATIONS ERUPT IN HOUSE

Republicans even mulled not putting forth a healthcare plan at all. It was the group of Senate Democrats who ultimately helped break a filibuster to reopen the government last month that demanded a healthcare-related vote (not a fix, but a vote) in December. So, that’s all Thune would commit to.

“If Republicans just vote no on a Democrat proposal, we’ll let the premiums go up and Republicans don’t offer anything. What message is that going to send?” asked Sen. Josh Hawley, R-Mo. “I know what people in Missouri will think. They’ll look at that, and they’ll say, ‘Well, you guys don’t do anything. You’ve just let my premiums go up.’”

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It may yet come to that.

Sen. Josh Hawley, R-Mo., questioned what message “no” votes by his party would send. (Valerie Plesch/Bloomberg via Getty Images)

So, there’s a holiday healthcare affordability crisis.

“People are looking now at exactly what’s ahead for them, and they’re very, very frightened,” said Sen. Ron Wyden, D-Ore., the top Democrat on the Senate Finance Committee.

But most Senate Republicans coalesced around a plan drafted by Senate Finance Committee Chairman Michael Crapo, R-Idaho, and Senate Health Committee Chairman Bill Cassidy, R-La. The bill would not renew Obamacare subsidies. Instead, it would allow people to deposit money into a healthcare savings account and shop around for coverage.

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“Our plan will reduce premiums by 1% and save taxpayers money,” boasted Crapo. “In contrast, the Democrats’ temporary COVID bonuses do not lower costs or premiums at all.”

With skyrocketing prices, Republicans are desperate to do something, even if it’s a figgy pudding leaf, as they face competitive races next year.

COLLINS, MORENO UNVEIL OBAMACARE PLAN AS REPUBLICANS SEARCH FOR SOLUTION TO EXPIRING SUBSIDIES

“It has nothing to do with me. It has everything to do with people in Ohio and across America who need to be able to afford access to healthcare,” said Sen. Jon Husted, R-Ohio.

Gov. Mike DeWine, R-Ohio, appointed Husted to succeed Vice President Vance after he left the Senate. So, 2026 will be Husted’s first time on the ballot for the Senate.

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There was some chatter that Republicans might allow for a limited extension of the Obamacare aid so long as Democrats agreed to abortion restrictions in exchange.

“Off the table. They know it damn well,” thundered Schumer.

Senate Minority Leader Chuck Schumer, D-N.Y., said abortion restrictions in exchange for a limited extension are “off the table.” (Tom Williams/CQ-Roll Call, Inc via Getty Images)

So, the competing plans needed 60 yeas to clear a procedural hurdle. But that also meant that both plans were destined to fail without solving the problem before the end of the year.

“We have to have something viable to vote on before we get out of here,” lamented Sen. Thom Tillis, R-N.C.

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That’s why some Christmas congressional calendar magic often compels lawmakers to find a last-minute solution.

“Every legislator up here would like to be home for Christmas,” said Sen. Roger Marshall, R-Kan. “That pressure is what forces us to come together.”

CONGRESS FACES HOLIDAY CRUNCH AS HEALTH CARE FIX COLLIDES WITH SHRINKING CALENDAR

We’ll know soon if everyone buckles down to harness soaring premiums after days of political posturing.

“This should have been done in July or August. So, we are up against a deadline,” said Hawley.

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And procrastination by lawmakers may yet do them in.

“Healthcare is unbelievably complicated,” said Rep. Dusty Johnson, R-S.D. “You’re not going to reform it and bring down costs overnight.”

House Speaker Mike Johnson, R-La., is promising a separate healthcare bill. (J. Scott Applewhite/AP Photo)

House Speaker Mike Johnson, R-La., is now promising a separate, still unwritten healthcare bill for the floor in the coming days.

“You’re going to see a package come together that will be on the floor next week that will actually reduce premiums for 100% of Americans,” said Johnson.

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But it’s unclear if Congress can pass anything.

“I think there’s a fear of working with Democrats. There’s a fear (of) taking action without the blessing of the President,” said Rep. Susie Lee, D-Nev.

GOP WRESTLES WITH OBAMACARE FIX AS TRUMP LOOMS OVER SUBSIDY FIGHT

That’s why it’s possible Congress could skip town for the holidays without solving the problem.

“It will be used like a sledgehammer on us a year from now,” said Rep. Don Bacon, R-Neb.

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Not a great message for Republicans — especially on affordability — before the midterms.

“If there’s no vote, that’ll run contrary to what the majority of the House wants and what the vast majority of the American people want,” said Rep. Kevin Kiley, R-Calif.

Rep. Kevin Kiley said a no vote runs contrary to the will of the American people. (Scott Strazzante/Pool/Getty Images)

That political concern may be just enough to force the sides to find some Christmas magic and address the issue before the holidays.

That’s one Yuletide script in Congress.

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But there’s a script to not fixing things, too.

If Congress leaves town, every communications director on Capitol Hill will author a press release accusing the other side of channeling Ebenezer Scrooge, declaring “Bah humbug!” or dumping a lump of coal in the stockings of voters on Christmas.

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That’s the script.

And every year, it sleighs me.

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Commentary: The U.S. Senate is a mess. He wants to fix it, from the inside

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Commentary: The U.S. Senate is a mess. He wants to fix it, from the inside

To say the U.S. Senate has grown dysfunctional is like suggesting water is wet or the nighttime sky is dark.

The institution that fancies itself “the world’s greatest deliberative body” is supposed to serve as a cooling saucer that tempers the more hotheaded House, applying weight and wisdom as it addresses the Great Issues of Our Time. Instead, it’s devolved into an unsightly mess of gridlock and partisan hackery.

Part of that is owing to the filibuster, one of the Senate’s most distinctive features, which over roughly the last decade has been abused and misused to a point it’s become, in the words of congressional scholar Norman J. Ornstein, a singular “weapon of mass obstruction.”

Democrat Jeff Merkley, the junior U.S. senator from Oregon, has spent years on a mostly one-man crusade aimed at reforming the filibuster and restoring a bit of sunlight and self-discipline to the chamber.

In 2022, Merkley and his allies came within two votes of modifying the filibuster for voting rights legislation. He continues scouring for support for a broader overhaul.

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“This is essential for people to see what their representatives are debating and then have the opportunity to weigh in,” said Merkley, speaking from the Capitol after a vote on the Senate floor.

“Without the public being able to see the obstruction,” he said, “they [can’t] really respond to it.”

What follows is a discussion of congressional process, but before your eyes glaze over, you should understand that process is what determines the way many things are accomplished — or not — in Washington, D.C.

The filibuster, which has changed over time, involves how long senators are allowed to speak on the Senate floor. Unlike the House, which has rules limiting debate, the Senate has no restrictions, unless a vote is taken to specifically end discussion and bring a matter to resolution. More on that in a moment.

In the broadest sense, the filibuster is a way to protect the interests of a minority of senators, as well as their constituents, by allowing a small but determined number of lawmakers — or even a lone member — to prevent a vote by commanding the floor and talking nonstop.

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Perhaps the most famous, and certainly the most romanticized, version of a filibuster took place in the film “Mr. Smith Goes to Washington.” The fictitious Sen. Jefferson Smith, played by James Stewart, talks to the point of exhausted collapse as a way of garnering national notice and exposing political corruption.

The filibustering James Stewart received an Oscar nomination for lead actor for his portrayal of Sen. Jefferson Smith in the 1939 classic “Mr. Smith Goes to Washington.”

(From the Academy of Motion Picture Arts and Sciences)

In the Frank Capra classic, the good guy wins. (It’s Hollywood, after all.) In real life, the filibuster has often been used for less noble purpose, most notably the decades-long thwarting of civil rights legislation.

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A filibuster used to be a rare thing, its power holstered for all but the most important issues. But in recent years that’s changed, drastically. The filibuster — or, rather, the threat of a filibuster — has become almost routine.

In part, that’s because of how easy it’s become to gum up the Senate.

Members no longer need to hold the floor and talk nonstop, testing not just the power of their argument but their physical mettle and bladder control. These days it’s enough for a lawmaker to simply state their intention to filibuster. Typically, legislation is then laid aside as the Senate moves on to other business.

That pain-free approach has changed the very nature of the filibuster, Ornstein said, and transformed how the Senate operates, much to its detriment.

The burden is “supposed to be on the minority to really put itself … on the line to generate a larger debate” — a la the fictive Jefferson Smith — “and hope during the course of it that they can turn opinions around,” said Ornstein, an emeritus scholar at the American Enterprise Institute. “What’s happened is the burden has shifted to the majority [to break a filibuster], which is a bastardization of what the filibuster is supposed to be about.”

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It takes 60 votes to end a filibuster, by invoking cloture, to use Senate terminology. That means the passage of legislation now effectively requires a supermajority of the 100-member Senate. (There are workarounds, which, for instance, allowed President Trump’s massive tax-and-spending bill to pass on a 51-50 vote, with Vice President JD Vance casting the tie-breaker.)

The filibuster gives outsized power to the minority.

To offer but two examples, there is strong public support for universal background checks for gun buyers and greater transparency in campaign finance. Both issues have majority backing in the Senate. No matter. Legislation to achieve each has repeatedly been filibustered to death.

That’s where Merkley would step in.

He would not eliminate the filibuster, a prerogative jealously guarded by members of both parties. (In a rare show of independence, Republican senators rejected President Trump’s call to scrap the filibuster to end the recent government shutdown.)

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Rather, Merkley would eliminate what’s come to be called “the silent filibuster” and force lawmakers to actually take the floor and publicly press their case until they prevail, give up or physically give out. “My reform is based on the premise that the minority should have a voice,” he said, “but not a veto.”

Forcing senators to stand and deliver would make it more difficult to filibuster, ending its promiscuous overuse, Merkley suggested, and — ideally— engaging the public in a way privately messaging fellow senators — I dissent! — does not.

“Because it’s so visible publicly,” Merkley said, “the American citizens get to weigh in, and there’s consequences. They may frame you as a hero for your obstruction, or a bum, and that has a reflection in the next election.”

The power to repair itself rests entirely within the Senate, where lawmakers set their own rules and can change them as they see fit. (Nice work, if you can get it.)

The filibuster has been tweaked before. In 1917, senators adopted the rule allowing cloture if a two-thirds majority voted to end debate. In 1975, the Senate reduced that number to three-fifths of the Senate, or 60 members.

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More recently, Democrats changed the rules to prevent filibustering most presidential nominations. Republicans extended that to include Supreme Court nominees.

Reforming the filibuster is hardly a cure-all. The Senate has debased itself by ceding much of its authority and becoming little more than an arm of the Trump White House. Fixing that requires more than a procedural revamp.

But forcing lawmakers to stand their ground, argue their case and seek to rally voters instead of lifting a pinkie and grinding the Senate to a halt? That’s something worth talking about.

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