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With Carmen Paun and Dan Goldberg

OHIO DELIVERS BIG WIN FOR ABORTION RIGHTS — Ohio voted overwhelmingly on Tuesday to enshrine protections for reproductive health services, including abortion, in the state constitution — the latest in a post-Roe streak of ballot-box wins for the abortion-rights movement.

The results follow a long, bitter and expensive campaign that shows the continuing resonance of the issue more than a year after Roe v. Wade was overturned and the strength of ballot measures as a tool for advancing abortion rights in GOP-dominated states.

Why Ohio matters: It’s another red state that voted decisively to protect abortion rights, following Kansas and Kentucky in 2022. The campaign in Ohio is likely to boost efforts to put the issue on the ballot in other states where abortion is prohibited, such as Florida and Arizona, and will almost certainly shape Democratic messaging in 2024.

What we learned: A popular anti-abortion governor didn’t help. Republican Gov. Mike DeWine signed legislation in 2019 prohibiting abortion — with no exceptions for rape or incest — after six weeks. That law took effect shortly after the Supreme Court overturned Roe, and DeWine won reelection a few months later. It was one of the few bright spots for Republicans in 2022 and held up as proof that abortion wasn’t always a millstone for Republicans.

DeWine was one of several Republican officials in the state who campaigned forcefully against the referendum. He cut ads for the “No” campaign, calling the ballot measure “extreme,” and suggested he would push the legislature to add rape and incest exemptions to the state’s six-week ban if the referendum were defeated. Despite those efforts, the race was called with 57 percent of Ohioans voting to protect abortion rights, roughly the same percentage as in Michigan last year, where Gov. Gretchen Whitmer, a Democratic abortion rights supporter, campaigned for the measure.

What else happened? Gov. Andy Beshear’s reelection in Kentucky will also validate Democrats’ extensive focus on abortion. Beshear launched a series of ads throughout the campaign going after state Attorney General Daniel Cameron for the state’s near-total abortion ban, which doesn’t include exemptions for cases of rape or incest. While it wasn’t among the primary issues in Democratic advertising, according to data from AdImpact, advertising hammering Cameron over abortion was a notable part of Beshear’s advertising mix — and those ads ran statewide, not just in liberal-leaning Louisville.

Virginia Democrats won full control of the state legislature despite attacks from Republican Gov. Glenn Youngkin accusing them of being “extreme” on abortion. Youngkin pledged to enact a 15-week ban with exceptions for rape, incest and the life of the pregnant person.

And in Pennsylvania, Democratic Superior Court Judge Daniel McCaffery defeated Republican Carolyn Carluccio, a Montgomery County Court of Common Pleas judge, for a seat on the state Supreme Court, expanding the Democrats’ majority. Planned Parenthood supported McCaffery as this turned into another proxy fight over abortion rights.

WELCOME TO WEDNESDAY PULSE. Ben got a glimpse of emerging health technologies at the White House’s Office of Science and Technology Policy’s “demo day” Tuesday, which included 3D bioprinting, organs on a chip, robotic exoskeletons for veterans and “high-function” prosthetic arms.

Send your invention ideas, scoops and feedback to [email protected] and [email protected] and follow along @ChelseaCirruzzo and @_BenLeonard_.

TODAY ON OUR PULSE CHECK PODCAST, host Ruth Reader talks with POLITICO health care reporter Maya Kaufman, who talks through New York’s new legislation that makes it easier for state residents to find doulas to provide nonmedical support during pregnancy, labor and beyond and who’ve been shown to improve health outcomes and combat racial inequities in maternal mortality and morbidity.

NIH GETS DIRECTOR — The Senate voted 62-36 on Tuesday to confirm Dr. Monica Bertagnolli to lead the National Institutes of Health, POLITICO’s Erin Schumaker and Kelly Hooper report.

Nearly every Democrat joined 13 Republicans in filling the post responsible for overseeing billions in federal research grants, which has been vacant since Dr. Francis Collins left nearly two years ago.

While Bertagnolli won confirmation with ease, her road there was rocky. After President Joe Biden tapped her to lead NIH in May, Sen. Bernie Sanders (I-Vt.) held up her nomination for months in an effort to extract a comprehensive plan to lower drug prices from the White House.

He and Pennsylvania Sen. John Fetterman were the only members of the Democratic caucus to vote against confirmation. Thirty-four Republicans also voted no.

During her confirmation hearing last month, Sanders and ranking member Bill Cassidy (R-La.) pressed Bertagnolli on her approach to drug pricing and whether she’d add reasonable pricing clauses to NIH contracts. She told both members she couldn’t commit to any particular drug pricing policy.

LACKING TRIAL DIVERSITY — Few clinical trials report the race and ethnicity of their participants in their study results, reports the Milken Institute.

Why it matters: During her HELP Committee hearing last month, Bertagnolli pledged to make clinical trials, which are registered by the NIH, more inclusive.

But among more than 21,000 clinical trials registered with ClinicalTrials.gov as of May 2022 that have reported results, race was reported only half of the time and ethnicity only a quarter of the time. Most studies reported gender.

The gaps, the researchers said, could lead to disparities in quality of care because therapies have been based on incomplete information for understudied groups.

Among the clinical trials that reported demographic information, including trials that haven’t yet posted results, researchers found:

— 52.4 percent were women.

— 30.2 percent were Hispanic and 69.8 percent were non-Hispanic, with some variation depending on the type of trial.

— 75.1 percent were white, 16.6 percent were Black, 6 percent were Asian and 2.2 percent were listed as another race.

PEPFAR HOLD-UP — State Department officials warn that questions from Congress regarding abortion as a method of family planning — sent in response to congressional notifications for 2024 global HIV spending — are holding up funding for AIDS relief and that the delay could harm efforts to fight the disease, Carmen reports.

But the department has been unclear in correspondence with Congress, seen by POLITICO, about when it needs the funds appropriated for the President’s Emergency Plan for AIDS Relief released to avoid those harms.

Emails from State Department officials to the House Foreign Affairs Committee in September didn’t specify a deadline, and John Nkengasong, U.S. global AIDS coordinator, didn’t provide one during a panel discussion at the Milken Future of Health Summit in Washington on Tuesday.

“We don’t have a fixed deadline for that, but we were supposed to have moved those monies to the field so that they meet the needs,” Nkengasong said.

The State Department didn’t immediately respond to a request for comment.

How we got here: House Foreign Affairs Chair Michael McCaul (R-Texas) and the State Department have blamed each other for a delay in dispensing $2 billion in funding to international groups fighting HIV and AIDS.

McCaul’s staff has asked for revisions to program documents to indicate that PEPFAR doesn’t fund programs that promote abortion as a family-planning method.

SOCIAL MEDIA UNDER SCRUTINY — The Senate Judiciary Committee heard testimony Tuesday from another Meta whistleblower and former employee. Arturo Béjar, a former director of engineering and a consultant at Meta, provided evidence that the company was aware children were being harmed on Instagram and refused to make changes to make the platform safer, POLITICO’s Rebecca Kern and Ruth Reader report.

Béjar is the second ex-employee to come forward in the past two years to say the platform was aware teenagers were exposed to harmful content.

Documents provided by Béjar revealed that more than a quarter of 13- to 15-year-olds reported receiving sexual advances on Instagram, and about as many reported being bullied or threatened. He also showed that Meta responded to only 2 percent of related content complaints.

“Instagram is a product, like ice cream or a toy,” said Béjar. “How many kids need to get sick from a batch of ice cream? Or be hurt by a car before there’s all manners of investigations.”

The committee has advanced six bipartisan bills on online child sexual exploitation that await a Senate vote.

Meta has pushed back against Béjar’s claims. Spokesperson Andy Stone said in a statement that the company has rolled out new features as a result of the types of survey results that Bejar flagged, including notifications to users whose comments were reported for abusive content.

Meanwhile, Sens. Richard Blumenthal (D-Conn.) and Marsha Blackburn (R-Tenn.) continue to advocate for the Kids Online Safety Act, which would give children and parents the option to control what they see online. The bipartisan bill, which has more than 50 co-sponsors, failed to pass last year, and senators on the committee are skeptical it will pass before the end of this year.

Janet Trautwein, former CEO of the National Association of Benefits and Insurance Professionals, is a compliance and government affairs executive at Warner Pacific, a leading health insurance general agency that supports health care brokers in several states.

Colonel (Ret.) Vic Suarez has joined the Securing America’s Medicines and Supply coalition as a senior adviser. He previously served as commander of the 6th Medical Logistics Management Center.

POLITICO’s Alice Miranda Ollstein reports on the steep rise in congenital syphilis.

The Associated Press reports on the use of ketamine as a pain treatment despite few studies and little regulation.