What States Can and Can't Do When Banning Abortion

What States Can and Can't Do When Banning Abortion

For more information about your reproductive health rights and related federal resources, you can visit the US government's

Reproductive Rights

site.

Whether someone can get an abortion or related medical procedure mostly hinges on which state they live in after the Supreme Court overturned Roe v. Wade last month and ended the constitutional right to abortion. But the switch from federal protection to state law isn't straightforward and has led to confusion and misinformation on what pregnant patients and physicians can do.

In this still developing landscape, how confident can people be that their treatment is still legal?

"The answer to all your questions is 'Who the heck knows,'" said Dr. Louise Perkins King, a surgeon and bioethicist at Harvard Medical School. "And that's the problem."

The US Department of Health and Human Services issued guidance on July 11 reminding physicians of their responsibilities under the existing Emergency Medical Treatment and Labor Act, or EMTLA, which supports the need to treat and stabilize patients in an emergency, including pregnant patients who may require an abortion. Days later, Texas sued the Biden administration over the law, which allows for medical assistance to save the life of the mother, because, Texas Attorney General Ken Paxton said, it "seeks to transform every emergency room in the country into a walk-in abortion clinic." 

On Tuesday, a judge in Texas blocked the EMTLA guidance, so physicians in that state may no longer be protected by federal law if they perform an abortion when they deem it medically necessary but it falls outside of Texas' interpretation of a life-endangering pregnancy. Physicians nationwide who are members of the American Association of Pro-Life Gynecologists and Obstetricians or the Christian Medical and Dental Association are also exempt -- a total of about 18,000 health care providers, according to the court document.

Texas' new trigger law -- which will be in effect on Aug. 25 -- bans all abortions except when the pregnancy puts the mother "at risk of death or poses a serious risk of substantial impairment of a major bodily function." Physicians who perform an illegal abortion will be committing a felony. It doesn't make exceptions for rape, incest or fetal abnormalities, and it also doesn't make an exception for when the pregnant person's risk of death would come from a "claim or diagnosis" that they'll be hurt or might die in the future. (This could be interpreted to mean a doctor can't provide an abortion if a woman threatens to die by suicide because she has depression.) All abortions are currently banned in Texas after the state's Supreme Court ruled that a law from the 1920s could stand.

Legal battles within some states will continue to shape post-Roe America, with the landscape changing by the day. And lawsuits like the one in Texas clarify the country's stance on whether state law preempts federal rule on abortion or reproductive health care. Basically, can federal regulations trump state law? 

"There's going to be cases that are going to have to determine this question," I. Glenn Cohen, a professor and bioethicist at Harvard Law School, said. 

The argument over medication abortion access -- which is banned or restricted in many states but still available to people if they order it (not without risk) online -- will likely also be one of the first big court cases post-Roe, Cohen said. Questions of whether federal regulations on medication abortion conflict directly enough with state restrictions will continue to be center stage.

Medication abortion, for use in early pregnancy, accounts for more than half of abortions in the US. Restricting the pills is the new frontier of abortion bans.

Robyn Beck/Getty Images

Other federal guidance issued by the Biden administration includes a reminder to pharmacists that they are required to fill medication and birth control prescriptions for patients. Failing to do so is discrimination based on pregnancy status. This was in response to the many reports of women having treatment delayed or prescriptions denied while health care workers try to  navigate around new state laws.

Here's what we know today.

Can states ban abortion pills? Not completely, but some are trying. 

Any state with a current total ban on abortion -- including Texas, Oklahoma, South Dakota, Alabama, Arkansas, Mississippi, Missouri and Wisconsin -- also bans medication abortion. Heavy restrictions in other states, including Tennessee and South Carolina, which ban abortion after about six weeks, also extend to medication abortion. This means providers can't prescribe the medication in those states and patients can't fill prescriptions at pharmacies.  

"If a state law bans abortion broadly, that includes medication abortions," Elisabeth Smith, director of state policy and advocacy at the Center for Reproductive Rights, told MedPage Today.

But abortion bans and state laws seek to punish abortion providers or people who assist them, not the person seeking the abortion (there's reason to believe this might change in the future). For now, people living in the most restrictive states can still order pills from an overseas pharmacy, including Aid Access. However, the pills could take awhile to arrive and potentially put the person past the point of pregnancy for which the medication is safe and effective (about 10 weeks).

Peter Dazeley/Getty Images

The fate of medication abortion pills in Republican-leaning states centers on mifepristone, the first pill given in the two-dose regimen of medication abortion. Because the US Food and Drug Administration approved mifepristone as a safe and effective way to end a pregnancy over 20 years ago, states shouldn't be able to restrict it, the US attorney general's office argued the same day Roe was overturned. (Misoprostol, the second pill, is used off-label for abortion and miscarriage treatment. It's also used to treat health conditions such as stomach ulcers.) 

Whether this federal regulation (and the FDA's stamp of approval) supersedes state laws will need to be decided. Cohen said this is likely to be determined by the Supreme Court as "one of the first post-Dobbs cases."

"It's unclear whether that's going to be a winner of an argument, to be perfectly honest," Cohen said.

Last year, the FDA extended a pandemic-era rule that allowed patients to get medication abortion pills through the mail, instead of requiring them to be prescribed in person. This was seen as a victory for the American College of Obstetricians and Gynecologists and other medical groups, which viewed the in-person requirement as unnecessary for a medication that's safe and effective in early pregnancy.   

But states have their own requirements for medication abortion, and providers licensed in Montana can't prescribe pills to patients who travel over from a restrictive state like South Dakota, NPR reported.

Read more: Worries About Post-Roe Data Privacy Put Spotlight on Period Apps  

Ectopic pregnancies can't result in a delivery and require medical treatment. Symptoms can start with typical pregnancy signs, including a missed period, but can progress to abdominal or pelvic pain, vaginal bleeding, weakness and more. 

Svetlana Gustova/Getty Images

Can states ban treatment for high risk pregnancies? The HHS says no, but doctors say state laws are restricting care.  

Even though the most restrictive states banning abortions leave room for some degree of medical emergency, practicing physicians need to decide where the medical emergency line is – and risk prosecution if a state sees it differently. 

This month, the story of a 10-year-old girl who was raped and pregnant and who traveled to Indiana from Ohio, where abortion is banned around six weeks without exception for rape or incest, made headlines. Not only was the physician publicly questioned by Indiana's attorney general on whether she followed state law, but Ohio Attorney General Dave Yost said in the aftermath that the girl should've been able to legally get an abortion under the state law's medical emergency exemption. Ohio's OB-GYNs disagreed. 

"It states specifically 'medically diagnosed condition,' and as far as I can tell, adolescent pregnancy is not a medically diagnosed condition that's listed," Dr. Jason Sayat, a Columbus OB-GYN, told the Ohio Capital Journal. 

The Department of Health and Human Services reminded physicians and hospitals that if they want to keep their Medicare agreement and avoid "civil penalties," they must treat pregnant patients and provide abortions if necessary as required under the 1986 Emergency Medical Treatment and Labor Act. The EMTLA, now blocked in Texas, outlines certain life-endangering pregnancies that doctors must treat regardless of state law, including ectopic pregnancies, preeclampsia and complications of pregnancy loss.

But that narrow line of abortion exceptions for medical emergencies given by states like Wisconsin is what's troubling Dr. Jennifer McIntosh, a maternal-fetal medicine physician practicing in the state. While Wisconsin's attorney general said he wouldn't enforce a ban, physicians there stopped performing abortions because the state has a pre-Roe criminal statute that prohibits most abortions. The "save the life of the mother" abortion exception language in that law can leave out health conditions which may not be an immediate emergency but can become one down the line. 

"Some of what we do is to prevent emergencies from happening," McIntosh said. "To have to wait for an emergency to actually appear puts your patient's life at risk."

The treatment for an ectopic pregnancy is termination, because terminating the pregnancy is the only safe outcome when an embryo grows outside of the uterus, typically in a fallopian tube. Without treatment, the fallopian tube is likely to rupture, which can lead to internal bleeding and death. But some laws, like one in Texas, specifically restrict medications including methotrexate, which has led to access problems for people who are pregnant as well as people who are taking methotrexate for another health reason. 

Complicating confusion and risk over how abortion bans will affect treatments for ectopic pregnancies is the fact that more rare types of ectopic pregnancies exist, including ones where the pregnancy is growing inside a C-section scar or other area outside the safety of the main cavity of the uterus -- but still technically in the uterus. These rarer kinds of ectopic pregnancies are also life-threatening, and may be more difficult to diagnose and treat as such in a state that bans abortions with an emphasis on the pregnancy being in the uterus.

Saul Loeb/AFP/Getty Images

States are not prosecuting people who have abortions (yet)

Current state laws -- both those in effect and those in limbo in court -- prosecute other people involved in an abortion, not the person who's pregnant. 

But the health impact may be already felt when a doctor is hesitant to treat patients, or pharmacists are reluctant to fill a prescription for mifepristone before interviewing a woman to ascertain whether her pregnancy is already ended and her situation is in line with state law.

"Even in these straightforward cases of basic OB/GYN practice, the laws leave providers questioning and afraid," Dr. Carley Zeal, an OB-GYN in Wisconsin, told The New York Times. "These laws are already hurting my patients."

Aside from hesitancy among health care providers, physicians also fear that worries people have about being prosecuted for having an abortion or miscarriage will stop patients experiencing complications from any kind of pregnancy loss from seeking care. 

That's because it was already happening, before Roe was overturned. According to the National Advocates for Pregnant Women, there were over 1,700 arrests or prosecutions of women from 1973 (when Roe became law) to 2020 where their pregnancies were the focus of the case against them. 

So will doctors report you if they suspect you had an abortion? 

"The vast majority of health care professionals will not do that, because that's not caring for their patients," King said. But, she added, "I'm sure there's a very small, but unfortunately detrimental, minority who might." 

Your current access to birth control shouldn't be impacted by the overturn of Roe v. Wade. However, there's reason to believe that could change in the future.

Carol Yepes/Getty Images

Birth control is still protected under the Affordable Care Act

Right now, IUDs, birth control pills and other birth control methods are legal in all 50 states. And they should also be covered at no out-of-pocket cost for those covered under the Affordable Care Act. The right to birth control is protected under two Supreme Court rulings: Griswold v. Connecticut (1965) and Eisenstadt v. Baird. (Another Supreme Court Case, Burwell v. Hobby Lobby Stores, chipped away a little of that protection, however, finding that some corporations are exempt for religious reasons.) 

Plan B or "morning after pill" brands are also not included in abortion bans, because they will not end an existing pregnancy. Most health plans should also cover them. 

Legislators in Missouri last year voted to block taxpayer funding for IUDs and emergency contraception, casting doubt that all birth control devices will be protected indefinitely, at least in some states. The claims of legislators like Paul Wieland, a Republican state senator in Missouri, are that anything that has the potential to disrupt a fertilized egg's implantation into the uterus is an abortifacient. 

The medical community has been clear that IUDs and emergency contraception do not cause abortions and will not end an existing pregnancy. Copper IUDs work mostly by causing a chemical change in the sperm and egg before they meet, according to the World Health Organization. Hormonal IUDs like Mirena work mostly by thickening cervical mucus so sperm can't reach the egg, and can also prevent ovulation. Plan B and similar pills likely won't work if a person has already ovulated, meaning the chances of it stopping implantation are currently understood to be slim.

Nevertheless, unlikely occurrences or instances where a fertilized egg may be prevented from implanting into a uterus could be called into question in future court cases.

Read more: Could a Post Roe v. Wade World Impact Your Access to Birth Control?   

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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Amid War in Ukraine, Should Ordinary Russians Be Banned From Trading Crypto?

Amid War in Ukraine, Should Ordinary Russians Be Banned From Trading Crypto?

This story is part of War in Ukraine, CNET's coverage of events there and of the wider effects on the world.

As Russia's war on Ukraine intensifies, the US and its allies have continued to increase their economic pressure on the Russian government, to isolate the country further from the global financial system and debilitate its military capacity. Western allies have frozen Russian assets abroad, removed Russian banks from international banking networks and even banned all gas and oil imports, among other unprecedented penalties. But there's still growing concern that Russian President Vladimir Putin and his supporters might turn to cryptocurrencies to avoid economic sanctions.

With their ability to operate as alternatives to the traditional financial system, cryptocurrency exchanges -- digital marketplaces where you can buy and trade digital currencies -- have become an effective option both for Ukraine supporters to raise funds for relief efforts and for ordinary Russians to seek financial shelter from the economic sanctions imposed on their country.

That's why both the Ukrainian government and advocates for even further economic penalties against Russia have become increasingly vocal about the role crypto exchanges can play in the conflict. Hundreds of Western businesses, such as oil companies Shell and BP and tech players Netflix and Microsoft, have scaled back or halted their dealings in Russia since the beginning of the war. And some people argue that similarly stopping crypto operations in the country could significantly weaken Putin's hold on Russia's economy and its citizens.

"I'm asking all major crypto exchanges to block addresses of Russian users," Ukraine's vice prime minister and minister of digital transformation, Mykhailo Fedorov, tweeted Feb. 28. "It's crucial to freeze not only the addresses linked to Russian and Belarusian politicians but also to sabotage ordinary users." 

Fedorov also sent letters to eight cryptocurrency exchanges, including two of the largest by volume, Coinbase and Binance, asking them to stop offering service to Russian users out of concern digital currencies are being used to evade sanctions.

The response was swift. 

"We are not preemptively banning all Russians from using Coinbase," CEO Brian Armstrong tweeted March 3. "We believe everyone deserves access to basic financial services unless the law says otherwise." And hours after getting Fedorov's letter, a Binance spokesperson told CNBC, "We are not going to unilaterally freeze millions of innocent users' accounts. Crypto is meant to provide greater financial freedom for people across the globe. To unilaterally decide to ban people's access to their crypto would fly in the face of the reason why crypto exists."

But the CEOs of several exchanges, including some that got Fedorov's letter, said that though they'll continue to offer access to ordinary Russians, they're complying with US law in regard to sanctions. On March 7, Coinbase reportedly said that to facilitate sanctions enforcement, it had blocked more than 25,000 wallet addresses related to Russian individuals or entities thought to have engaged in illicit activity and had reported them to the US government.

"Some ordinary Russians are using crypto as a lifeline now that their currency has collapsed. Many of them likely oppose what their country is doing, and a ban would hurt them, too."

Coinbase CEO Brian Armstrong

Ukraine's request for an all-out ban on Russian users, and the unequivocal rejection from most regulated crypto exchanges, has sparked a debate about the responsibilities digital currency platforms have in an international conflict. As a growing number of Western companies decide to stop conducting business in Russia, should crypto exchanges follow suit and go beyond what they're required to do by law? And even if they did, would banning all Russian users from crypto exchanges make a difference in slowing down Russia's invasion of Ukraine?

Some crypto specialists interviewed by CNET, including executives from crypto companies and public officials working to prevent Russia from using digital assets to sidestep economic sanctions, said a full Russian ban from crypto platforms could do more harm than good in regard to ordinary Russians. And some said the volume of the whole crypto market is still too small to really help Putin's government counter the impact of Western economic penalties, even if it tried.

But other experts on the role the private sector can play in global conflicts said bringing the Russian economy to a standstill is the one nonmilitary way to thwart Putin's advance on Ukraine, and that crypto exchanges can contribute to that only if they stop operating in Russia altogether. 

Cryptocurrencies are digital assets that are recorded on a blockchain, a distributed digital ledger that can't be altered. They usually aren't backed by an underlying asset, such as fiat currency. That's why they could be an ideal safe haven amid a wave of economic sanctions. 

Why crypto exchanges won't budge on Russia

In refusing to kick ordinary Russians off their platforms, cryptocurrency exchanges argue that the move would further hurt Russian citizens who are suffering from the economic impact of the war and who might consider buying cryptocurrencies as a way to protect their financial standing.

"We all saw those photos of runs on ATMs from Russian citizens -- lines around the block in Moscow," said Todd Conklin, counselor to the deputy secretary of the US Treasury Department. "One would suspect ordinary citizens may have been looking for an alternative to the ruble." Conklin made the remarks during a March 4 webinar hosted by blockchain analytics company TRM Labs about the possibility Russia could use cryptocurrencies to avoid economic sanctions. 

The ruble, Russia's national currency, has lost nearly 50% of its value against the US dollar since the start of the year, according to Reuters. Other parts of Russia's financial system have also been impacted by the West's pressure on the country to stop its aggression on Ukraine. Digital payment services such as Apple Pay, Google Pay and Samsung Pay aren't available in Russia any longer. Visa, Mastercard and PayPal also halted operations in the country. Ordinary Russian citizens, worried that economic sanctions will devastate the Russian economy even further, have flocked to ATMs and banks, seeking to withdraw as much cash as possible before it might be too late. 

"Some ordinary Russians are using crypto as a lifeline now that their currency has collapsed," Armstrong, the Coinbase CEO, tweeted. "Many of them likely oppose what their country is doing, and a ban would hurt them, too."

As long as US crypto businesses are complying with US laws in ensuring that sanctioned individuals or entities aren't using their platforms, "crypto could be a vital lifeline for ordinary Russians to preserve their savings [and] receive familial remittances," Michael Parker said in an email. Parker is a former federal prosecutor who's now head of anti-money laundering and sanctions practice at Ferrari & Associates, a Washington, DC-based law firm.

Jesse Powell, co-founder and CEO of Kraken Exchange, another crypto platform, tweeted that though he understood the rationale behind Ukraine's request to remove all Russians from crypto exchanges, Kraken "cannot freeze the accounts of our Russian clients without a legal requirement to do so." 

"I would guess that the vast majority of crypto holders on @krakenfx are anti-war," Powell tweeted. "#Bitcoin is the embodiment of libertarian values, which strongly favor individualism and human rights."

Given the anti-authority libertarian streak that fuels so much of the cryptocurrency sector, the refusal from crypto exchange executives to stop operations in Russia isn't surprising, said Yale University professor Jeffrey Sonnenfeld, who's the president of the Chief Executive Leadership Institute, a nonprofit focused on CEO leadership and corporate governance.

Crypto executives don't like "being told what to do," Sonnenfeld said. "And yet, there's a striking naivete [in] that they are working in support of [Putin], the greatest autocrat alive today, the most restricted world leader, [who] they are tacitly supporting by enabling a bypass, if it's even for the cognoscenti, for elites and for oligarchs, if it was as limited as some claim."

Sonnenfeld said that the reason more than 300 Western companies have pulled out of Russia so far isn't that the government told them to do so. "It's the maverick streak of these CEOs who pulled out and started this thundering herd," he said, "courageous CEOs who had the moral character to pull out."

What a full ban on Russia would and wouldn't do

Some specialists said that blocking all Russians from crypto would not only potentially inflict damage on millions of innocent citizens, but it would also do little to amplify the West's sanctions on Russia's economy. The reason? Russia doesn't have the digital infrastructure to tap into crypto assets at a level required to outmaneuver the economic penalties already imposed by the US and its allies.

"You can't flip a switch overnight and run a G20 economy on cryptocurrency," Conklin said during the webinar hosted by blockchain intelligence company TRM. He explained that in recent years, Russia has worked to bolster the ruble and build up its reserves, instead of laying the rails needed to support crypto. That's why US economic sanctions have been focused on preventing Russia from accessing the reserves it keeps overseas. "Big banks in an economy need real liquidity," Conklin said. "Conducting large-scale transactions in virtual currency is likely to be slow and expensive."

Anthony Citrano, founder of Los Angeles-based NFT platform Acquicent, pointed to crypto prices as a clue to what's going on. "If the Russian government really were using crypto as a major piece of their international finance strategy, you'd expect to see absolutely explosive growth in prices of major crypto [currencies]," he said, "which we have not seen. Time will tell, but for now there is zero evidence this is happening."

"If you can show [Putin] to be truly impotent over the economy, that he doesn't have control over civil society, then he and the oligarchs fall flat on their face, and that's what cryptocurrency mavericks can do."

Yale University professor Jeffrey Sonnenfeld

Former federal prosecutor Ari Redbord, who's now head of legal and government affairs at TRM, said the economic sanctions levied so far have been so "serious and so draconian in their measures" that Russia would need much more than crypto assets to counterbalance them. "We're talking about [the] potential loss of, or no access to, hundreds of billions of dollars in frozen [Russian] Central Bank assets. We're talking about $1.5 trillion in potential trade losses," he said. "The entire crypto market cap doesn't approach what ultimately Russia would need to prop up a G20 [economy] government and fight what is going to become a more and more costly war."

But that doesn't mean the Russian government or Putin's supporters won't try to use crypto to circumvent economic sanctions. "Russian actors are very adept at money laundering and have been for a long time," Redbord said. In the case of crypto, they'll be looking for "noncompliant exchanges in order to move those funds." 

Such exchanges include platforms like Suex, which was blacklisted by the Biden administration in September for allegedly helping launder ransomware payments. TRM has identified about 340 exchanges that are either in Russia or Russia-related and don't have compliance controls in place, "and that is where illicit actors will look to move on as on-ramps and off-ramps for crypto," Redbord said.

Those digital platforms are already operating outside the law, though. For any US business, including businesses in the crypto industry, "there is still a full compliance obligation to not deal with sanctioned parties or interests in blocked property," said Parker, from Ferrari & Associates. "US crypto businesses must, and largely do, institute robust compliance programs, including advanced analytics software, to ensure legal compliance with US sanctions."

Bringing Russia to a standstill

Yale's Sonnenfeld argues that it's beside the point whether Putin and his supporters can actually get their hands on enough digital assets to offset the impact of Western sanctions. He said that by halting all operations in Russia, crypto exchanges could contribute to putting even more pressure on Putin's government, until it reaches a tipping point.

"Government-ordered sanctions have limits," Sonnenfeld said, even if they're a coordinated effort between multiple international actors, including the US, the EU, the UK, Australia, Japan and the UN. "They work best when voluntary efforts of the private sector rally."

That's what happened in South Africa in the late 1980s, Sonnenfeld said, when international pressure contributed to putting an end to apartheid, a system of institutionalized racial segregation that had ruled the country for more than 40 years. Economic sanctions imposed by the US government had an effect only when dozens of major private companies joined in. "It brought civil society to a stop/standstill," he said.

Sonnenfeld and his research team at Yale compiled a list of companies that continued operating in Russia following its invasion of Ukraine. After the publication of a Washington Post story that mentioned that McDonald's and Starbucks were on the list, both chains announced plans to stop operating in Russia. Since the list was created and made public, it now shows "over 330 companies [that] have announced their withdrawal from Russia in protest" of the Ukraine war.

For Sonnenfeld, paralyzing Russia's economy is the only nonmilitary option the West has against Putin's advances on Ukraine.

"The humanitarian thing to do is to not go with bombs and bullets, and to strangle civil society" and dissolve Putin's image of being a totalitarian with full control over all sectors, he said. "If you can show him to be truly impotent over the economy, that he doesn't have control over civil society, then he and the oligarchs fall flat on their face, and that's what cryptocurrency mavericks can do" should they decide to halt operations in Russia. "They can be really helpful here." 

Allowing ordinary Russians to have access to digital assets through crypto exchanges is "not doing anything humanitarian," Sonnenfeld said. "People should be thrown out of work, they should be out on the street" due to an economic collapse brought on by government-ordered sanctions and to private companies denying Russian citizens access to services, goods and money. "Is that cruel?" Sonnenfeld said. "No, it is better than shooting them, than bombing them -- and that's the stage we're at right now."

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What has the pandemic changed people have changed since the pandemic how the pandemic has impacted healthcare how the pandemic has impacted healthcare the pandemic changed health care how has the pandemic changed healthcare how has healthcare changed since the pandemic the pandemic the pandemic institute

The pandemic changed health care, and there's no going back

The pandemic changed health care, and there's no going back

This story is part of The Year Ahead, CNET's look at how the world will continue to evolve starting in 2022 and beyond.

If the pandemic has taught us one thing, it's how to take our health into our own hands. 

We've become our own triage nurse, analyzing a sore throat with such urgency that, in another time, would've been considered a little obsessive. We've been asked to monitor our temperatures and even become citizen public health surveyors with the help of at-home COVID-19 tests. But one day (hopefully soon), the consequences of leaving the house with a sore throat won't mean we're risking someone's life. Soon, our physical health will remain a core piece of our well being, but we'll shake the neurosis of a pandemic mindset – hopefully, keeping our newfound sensitivity to public health and a desire to not harm others in the process.

But will our health care system?

"The pandemic accelerated a lot of changes that were kind of percolating in the background," says Matthew Eisenberg, associate professor of health policy and management at Johns Hopkins Bloomberg School of Public Health. Eisenberg studies how neoclassical economics ("supply and demand") applies to health care. While COVID-19 "catalyzed" many of the changes -- and inequities -- already budding in health care, he said, it will be up to policy makers as well as the supply-and-demand cycle of health care to decide what sticks and what doesn't.

Telemedicine: a thing of the past, or the future?

Video-calls-as-doctor's-visit wasn't a tool created because of COVID-19, but the pandemic has transformed it from an obscure practice to the new way to do health care. Importantly, policy changes made during the pandemic helped knock down some barriers for telemedicine access, and helped providers get paid for it.

Private insurance companies as well as public payers (i.e. Medicare) relaxed their policies on telemedicine reimbursement for health care providers because of COVID-19. As more health care providers get paid for telemedicine (which gives them incentive to provide it), the more supply there is for patients, Eisenberg says. 

"Prior to the pandemic, the only way a Medicare provider could be reimbursed for telemedicine would be if a patient was in a rural area where they could not physically travel to a provider," he says. "Even then, they had to go to a specialized facility and do the telemedicine at some out-patient facility's computer." 

Even through a computer screen, there are roadblocks to accessing health care. Before COVID-19, some patients, depending on where they live and what medical condition they have, would need to drive across state lines to access a specialist (which requires an amount of time and money many patients don't have). The loosening of interstate licensure laws during the pandemic has allowed people to connect with a doctor miles away, and even fill a prescription across state lines. 

Dr. Megan Mahoney is a family medicine doctor and the chief of staff at Stanford Health Care. Stanford Health Care, along with many other providers and organizations, have advocated to keep those restrictions loose once COVID-19 is no longer a public emergency, and the emergency rules no longer apply.

"We have noticed that there are states that don't have a single pediatric endocrinologist," says Mahoney. These specialists treat children with diabetes, for example. "We have a whole team of pediatric endocrinologists."

But in order to participate in telemedicine, you need an internet connection. Mahoney called the bipartisan infrastructure bill, which has a $65 billion budget for expanding internet access to rural communities and helping families pay their internet bill, a "tremendous" help in health care access. In the new virtual health landscape, access to broadband is a "social determinant of health," she says. Some policies and benefits put into place during the pandemic to help families access the internet, like the Emergency Broadband Benefit, were temporary. As broadband continues to mold in its form as a public good, its relationship to health care access will only strengthen.

FS Productions/Getty Images

Sliding into your doctor's DMs

In addition to telemedicine, the pandemic also gave us nearly unlimited access to our doctors' inbox through the patient portal. According to a report published in JAMA, which looked at instant messaging data between patients and their providers from March 2020 through June 2021, the number of patient messages increased, despite fewer patients seeking care in some specialties.

"The sheer demand that we're seeing is very much a testament to the patients' desire for this new channel of care," Mahoney says.  

Even older patients, whose relationship with technology sometimes gets a bad rap, are sending their doctors messages and embracing telemedicine, she says. 

"That was what propelled and accelerated the transformation," Mahoney says. When elderly people, who were originally reluctant to use telemedicine, were forced to use it in order to get care during the lockdown, "that helped them get over that hurdle." 

"What I've noticed is the digital divide, while we do need to be aware of it, it can be overcome and sufficiently addressed through additional education," she says. 

Some of that education for patients requires medical assistants to take on tech support roles. In addition to taking blood pressure and temperature when patients come into the room, they also need to make sure patients are comfortable signing into their patient account and feel comfortable with the technology, according to Mahoney. 

That shift in the patient-provider dynamic, and more direct access to care, is necessary to maintain a system Mahoney says can help people get early intervention and, hopefully, prevent visits to the emergency room.

Many of the messages Mahoney receives from patients involve correcting misinformation patients have heard about COVID-19 -- the type of preventative, education-based work that the current health care structure "does not support," she says. For example, sustaining a more thorough patient-doctor messaging system would require providers be paid for their time consulting with patients off-hours. It also requires online communication to be in the patient's language – a barrier for many people in the US who don't speak English or speak it as a second language. 

"I hope that health care can keep up with this cataclysmic shift that's happening," Mahoney said. "It will have to."

There are arguments against telemedicine as the end-all-be-all. Dr. Thomas Nash, an internist in New York City, told The New Yorker in a June 2020 report that though telemedicine is "doable...I worry that it's going to delay a good exam, and get in the way of deeper interactions between people and their doctors." The informal setting of telehealth may also be less likely to pick up on big issues which routine in-person exams would normally detect, such as high blood pressure, California Healthline reported. And it's more difficult to build an open relationship with your doctor through a screen than it is when you're sitting in their office.

But that also assumes people had a relationship to lose in the first place. As of Feb. 2019, one year before the pandemic began, about one fourth of all adults and half of all adults under 30 didn't have an ongoing relationship with a doctor, according to a report from the Kaiser Family Foundation. This is also a group that shows a strong preference for telehealth, and is the target audience for pre-pandemic care-on-demand services, including Nurx, which allows people to get birth control prescriptions and other medications online, sister sites Hims and Hers, Curology and more.

Sarah Tew/CNET

The great vaccine race 

Scientists impressed the world by moving quickly to develop highly effective COVID-19 vaccines in record time – doses of Pfizer and BioNTech's vaccine, with Moderna's authorized right behind it, were available to the first round of eligible adults in the US less than a year after the the country went into lockdown. According to Nature, the fastest anyone developed a vaccine was for mumps in 1960, and that took four years from development to approval (Pfizer's vaccine for people age 16 and up has full approval by the US Food and Drug Administration, while Moderna and Johnson & Johnson have emergency use authorization). While there's much left to be desired about how the vaccines are distributed and accessed by populations in countries outside the US (only 8.9% of people in low-income countries have had a coronavirus shot), an estimate from the Yale School of Public Health reports the vaccines have saved about 279,000 lives and prevented 1.25 million hospitalizations a s of early July 2021. 

Part of the reason the vaccines were developed so quickly was because research on the technology they use was already underway (the mRNA vaccines were developed using information from HIV research). While the global society has shown we can be very efficient at producing effective and safe vaccines, don't get your hopes up too high that it'll happen that fast again, says Michael Urban, an occupational therapist and program director at the University of New Haven.

"The thing people have to remember is that the federal government pumped tons and tons of money into this development," says Urban. "Globally, not just the United States." 

One reason for that is because COVID-19 had such a prominent impact on our economy. "The fact that this [vaccine] came out is because this is disrupting the fabric of life," Urban says. "How we make money, how we engage with people – how we enjoy our lives."

While it's tempting to hope that because scientists banded together to create a vaccine for COVID-19 and the US government helped fund much of that work it will usher in more resources to find preventative measures and treatments for other diseases, it's unlikely. The incentive for the government to subsidize research and development of treatments for other things that are more individualized, such as cancer or HIV, Urban says, might not be as strong, which leaves it up to the drug companies themselves. And without a public health emergency as transmissible and widespread as COVID-19, it's unlikely drug companies will pour quite as much time and effort into finding treatments.

And when addressing a drug company that profits "billions off of cancer treatments," for example, is it really in the best interest of the company to find an effective preventative measure? 

"If they can do one shot and get rid of cancer, is it really in their best interest?" Urban says. "I hate to say that," says Urban.

Two steps forward, two steps back

In addition to propelling us into trends that've been helpful in health care, the pandemic has magnified our shortcomings and has disproportionately affected the same people who have been mistreated by the medical system for years. Black and Hispanic Americans have been hospitalized with COVID-19, and died from the disease, in much greater numbers compared to white Americans.

Dr. Shantanu Nundy, a primary care physician and author of the book Care After Covid: What the Pandemic Revealed Is Broken in Healthcare and How to Reinvent It, told NPR in a May 2021 report that the pandemic scramble to find a testing site, get a vaccine appointment or access preventative care exposed those who might not have ever experienced it to the perils of health care. 

"The pandemic magnified long-standing cracks in the foundation of the US healthcare system and exposed those cracks to populations that had never witnessed them before," said Nundy in the NPR interview.

Another weak spot exposed because of COVID-19 was the US public health response, and its subsequent communication to the public about what to do when you're sick. When the pandemic struck, public health agencies were relying on "old methodologies" in terms of quarantine requirements and testing rules for COVID-19, Urban says. Compared to other countries, we have issues with containment and quarantine restrictions that don't always prevent people from spreading the virus, he says. The CDC's latest isolation guidance for people who test positive for COVID-19, for example, has been criticized by some for being too relaxed and not requiring a negative test.

In the US, there's a one-and-done mentality. "You do a one-time test, you're cleared," Urban says. "Have a nice day." 

When the next pandemic happens, he says the US is likely still not set up with the structure and tools needed to respond appropriately to a public health emergency. "We didn't learn from the Spanish flu," Urban says. 

An early December report from the Global Health Security Index, an assessment of health security across the globe developed by the Johns Hopkins Center for Health Security and the Economist Impact, backs that up. According to the report, 195 countries across the globe are "dangerously underprepared for future epidemic and pandemic threats, including threats potentially more devastating than COVID-19." 

But importantly, the blame isn't solely on public health agencies, Urban says. The CDC, for example, is "under pressure" to get people back to work and everyday life, Urban says. To do so, the agency has to work within US federal law and the vastly different state and local laws which govern what we can and can't expect people to do.

Looking forward

As we move away from the immediate threat of COVID-19, our appreciation for mental health care is likely to stay. Eisenberg says that we may see specialized mental health services, including some practices that are virtual-only, and some that are a hybrid of in-office and virtual visits. There may also be a shift away from medication treatments for mental health conditions and more provider-focused psychotherapy, Eisenberg finds. 

"It's a small shift, but that could have big implications down the road," he says.

While there are structural and policy changes needed to ensure everyone has autonomy over their health, the pandemic has shifted the way care providers approach health care. Now more than ever, there's an emphasis on public health. 

In an interview with the American Medical Association, Nundy explained the framework he believes is necessary to progress health care after the pandemic. Through the course of the pandemic, Nundy said, doctors "built a muscle" for operating with public health in mind. 

"Let's take that muscle and let's start applying it to diabetes, let's start applying it to mental health," Nundy said. "So much more is possible." 

Correction, Jan. 14: The original version of this story misspelled Shantanu Nundy's last name. 

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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Bear market how long will stocks fall and could it cosmetics bear market how long will stocks fall today bear market how long will stocks fall monday bear market how long will stocks fall again tomorrow bear market definition bear market etf bear market funds bear market consignment

Bear Market: How Long Will Stocks Fall and Could It Cause a Recession?

Bear Market: How Long Will Stocks Fall and Could It Cause a Recession?

What's happening

The S&P 500 has dropped more than 20% from its peak at the start of 2022, resulting in the first bear market since 2020.

Why it matters

A steep decline in a broad stock index suggests a sustained market downturn, seen by many investors as a sign of a possible looming recession.

The stock market took a big hit in June when the S&P 500, an index of 500 leading US publicly traded companies, fell to its lowest level since March 2021.

On June 13, the S&P 500 closed at 3,749.91 points, from a high of 4,818.62 on Jan. 4, representing a drop of 22%. Major players like Amazon, Apple and Meta all took hits to their market value.

As of June 23, the index sat at 3,795.73, still 21.2% below January.

The decline put stocks in bear market territory -- a sustained period of downward price trends -- for the first time since the start of the COVID-19 pandemic. (In contrast, a bull market is when stock prices remain on an upward trajectory.) 

We've had many bear markets in the past, but the current situation is attracting extra attention because of soaring inflation and other factors that have some experts worried about a recession.

Here's what you need to know about bear markets, including why they happen, how long this one could last and what it means for the economy.

What is a bear market?

When a broad stock market index experiences a 20% or more decline from recent highs for at least two months it's considered a bear market. 

Since 1928, the S&P 500 has had 26 bear markets, according to Hartford Funds.

The S&P 500 Index has stayed more than 20% below its January 2022 peak, resulting in the first bear market in two years.

DNY59/Getty Images

The inverse of a bear market is a bull market, when there is a rise of 20% or more in a broad market index like the S&P 500 or Dow Jones Industrial Average over at least a two-month period.

There have also been 27 bull markets since 1928, according to Hartford Funds, averaging 991 days or 2.7 years.

How long does a bear market usually last?

It depends on which formula you use. According to investment analysis firm Seeking Alpha, the average duration of an S&P 500 bear market since the 1920s has been 289 days, or about nine and half months. (The shortest, in March 2020, during the onset of the COVID-19 pandemic in the US, lasted just one month.) On average, the S&P 500 declined about 36% during those bear periods. 

But more recently, the 14 bear markets since World War II have averaged 359 days, or close to a year, according to Bespoke Investment Group.

Analyzing all the bear markets since World War II, Ben Carlson of Ritholtz Wealth Management found it took 12 months to go from "peak to trough," or from the end of a period of growth to hitting rock bottom.

That means the current bear market would bottom out at the beginning of 2023, a year after January's peak.

Does a bear market mean a recession is on the way?

A bear market can often, but not always, go hand in hand with a recession. In the 12 recessions since World War II, nine were accompanied by bear markets, Reuters reported.

But there have been 26 bear markets since 1928, and only 15 recessions.

Bear markets tied to a recession are usually longer (495 days compared to 198 days) and more severe (a 35% drop in the S&P 500 versus 28.2%), according to Bespoke Investment Group. 

What causes a bear market?

Numerous factors can fuel a bear market. Ones relevant to our current situation include a weakened economy, and the ongoing invasion of Ukraine and its impact on the geopolitical landscape. 

Chunks of the economy shutting down during the pandemic could also be a factor, as could the Federal Reserve's decision to raise interest rates to curb inflation. After hiking them a quarter of a percentage point in March and a half point in May, the Fed raised interest rates by three-quarters of a point in June.

The average duration of an S&P 500 bear market since the 1920s is about nine and a half months.

ATU Images/Getty Images

Where does the phrase 'bear market' come from?

The terms "bear market" and "bull market" date to the early 1700s in London's Exchange Alley, a precursor to the modern-day London Stock Exchange, but there are several theories about their origins. 

Traders who engaged in naked shorting -- or selling shares that haven't been affirmatively proven to exist -- were called "bear-skin jobbers," and later just "bears." The suggestion was they would sell a bear's hide before they even caught the animal. 

Another explanation holds that the terms are related to how each animal attacks. A bear will swipe its claws downward, a metaphor for a downturn in the market. A bull will thrust its horns upward, suggesting an upward trend in the market.

And yet another theory is that a bear hibernates, similar to how a slumping market has gone to "sleep," Sam Stovall, chief investment strategist at investment research firm CFRA, told the Associated Press.  A surging stock market is a bull market, according to Stovall, because bulls charge at their victims.

The terms first saw print in the 1761 book Every Man His Own Broker, written by economist Thomas Mortimer. 

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5 best online therapy services for 2022 toyota 5 best online therapy services for 2022 5 best online therapy for teens top 5 best online school 5 best online dating sites 5 best online banks 5 best fixed income investments

5 Best Online Therapy Services for 2022

5 Best Online Therapy Services for 2022

The destigmatization of mental health has come leaps and bounds over the years, but access to traditional resources hasn't followed suit. As per a study, up to 70% of the people who need mental health care don't have access to it. Enter online therapy. It helps bridge the gap and offers resources to those who otherwise can't get help, whether because of location, finances or scheduling conflicts. 

There are plenty of reasons traditional therapy may not be the best option for you. The convenience and flexibility of online therapy are quickly making it one of the most popular ways to connect with mental health professionals. If you're considering giving online therapy a try or just interested in learning more, here are our top six choices for the best online therapy. 

But not all online therapy platforms are created equal. Below, a primer on five popular HIPAA-compliant therapy services that only employ licensed and trained mental health professionals. 

Read more: Best Mental Health Apps  

BetterHelp

BetterHelp is one of the largest, reputable online therapy platforms that gives you access to over 12,000 experienced mental health professionals. You can feel confident about the therapist you work with through BetterHelp therapists, thanks to experience requirements and a thorough vetting process. Every therapist has a minimum of three years and 1,000 hours of hands-on experience. 

After you sign up and complete the questionnaire, you'll be matched with a therapist, generally within a day. BetterHelp therapists specialize in various areas, including anxiety, depression, substance abuse and eating disorders. You can message your therapist from anywhere, anytime. However, that doesn't mean you will always get an immediate response. Given they are real people, they aren't available 24/7. 

The cost of online therapy with BetterHelp ranges from $60 to $90/week. You are billed monthly. According to the website, pricing is based on your location, preferences and therapist availability. Some users did note frustrations with customer service and technical issues with the BetterHelp app. 

BetterHelp best features:

• You can participate in video calls, instant messages, text and live therapy sessions with your counselor. 
• On the website, you have access to blog articles and educational content.

Things to consider:

• BetterHelp doesn't accept insurance, so what you see is what you'll pay. Financial assistance may be available through BetterHelp for qualified individuals. The initial questionnaire determines the eligibility for financial assistance, as it asks about employment and financial troubles. 
• You get talk therapy with BetterHelp; counselors do not diagnose or prescribe medication. 

Talkspace

Talkspace is one of the most versatile online therapy platforms with several communication methods, therapy options and price points. With Talkspace, you get message-based therapy that's a great option for those who feel comfortable sharing through video or have a changing schedule that cannot commit to weekly sessions. 

Starting Talkspace is simple. Once you sign up, you complete an assessment that includes the payment plan options. Talkspace has three therapy subscription options. Messaging therapy which includes text, video and audio messaging with a therapist, starts at $69/week. Live therapy starts at $99/week and includes four 45-minute live therapy sessions each month. The last subscription option combines the two. Starting at $129/week, it includes four live sessions and text, video and audio messaging. Talkspace notes that pricing is based on where you live and the network of available therapists. 

After you select which plan you want, a consultation therapist selects a list of matched therapists that you can choose from. 

Talkspace best features:

• Those with an employee assistance program through their employer may have coverage. 
• A psychiatrist through Talkspace Psychiatry has the ability to prescribe medication and help you manage it. These services cost $249 for the initial consultation and $120 for your follow-up sessions. 
• TalkSpace has a network of over 3,000 mental health professionals. 

Things to consider:

• While still more affordable than traditional therapy, Talkspace doesn't offer sliding scale payments. However, Talkspace does offer the occasional discount. 
• Your therapist may not reply immediately to messages; it typically takes a day. 
• Recent user reviews note that customer service and insurance claims with TalkSpace can be frustrating. 

Cerebral

Cerebral takes the spot for the best online therapy platform for medication management, thanks to its all-in-one approach to mental health. You have access to talk therapy and medication with a licensed psychiatrist. Those who manage their prescriptions through Cerebral will be shipped directly to your home. 

There are three membership plans. Medication and care counseling includes evaluation, diagnosis and prescription from a psychiatrist, medication delivery and weekly video/phone sessions. This plan is $85/month. Mediation and therapy costs $325/month and includes everything the first plan does, though you can chat with your therapist anytime. The final is therapy, which does not include any medication though weekly meetings with your therapist. It costs $259/month. 

Cerebral subscriptions are about average compared to competitors for out-of-network providers. However, if you have an insurance plan that Cerebral accepts, the price can be as low as $30/month, plus a copay.

Cerebral best features: 

• Membership plans are FSA/HSA eligible. 
• Cerebral is a one-stop shop that offers therapy, psychiatry and medication management. 
• All therapists and psychiatrists are board-certified and licensed. 

Things to consider:

• Cerebral is not available in all states. Treatment for disorders also varies by state. 
• When signing up, you have to add a payment method before an appointment. This may result in your card being charged if you do not match with a therapist within the time period provided. However, since Cerebral recently started issuing refunds for this. 
• User reviews are typically positive at 4.3 on Google Play and 4.6 on the App Store. 

Amwell

Most online therapy platforms don't accept insurance, making counseling unattainable for many. Amwell is the best online therapy platform that takes insurance because of its large network of accepted health plans. 

After signing up with Amwell, you will choose a licensed therapist and schedule your first session. You can choose your therapist based on what they specialize in, allowing you to find the best fit for your needs. Each therapist has a bio on their profile. 

Amwell offers fewer communication options than competitors because it is not a subscription-based therapy. You only have access to virtual video sessions that you schedule. This tends to be the best for people who only have sessions with a therapist and have a schedule that requires flexibility. Most users comment that while the app may not be the most modern, it is typically easy to use. 

The cost of your sessions is based on the therapist or psychiatrist and their experience level. Typically, sessions cost between $109 to $129. Your health insurance plan will determine how much you pay out of pocket.

Amwell's best features:

• You can schedule a session with a psychiatrist for medication.
• Amwell accepts many types of insurance providers. 
• Amwell also offers a variety of services competitors don't have, like breastfeeding support or stress management. 

Things to consider:

• Amwell doesn't do subscription plans; you are charged by session. 
• Since it doesn't have messaging or phone call options, Amwell is not a good choice for crisis situations. 

Pride Counseling

The LGBTQIA+ community struggles with mental health issues at a disproportionately high rate. And traditional counseling options aren't always helpful. A survey of LBGTQ+ people found that 50% had experienced harsh language, scapegoating problems on their sexual orientation or outright denial of care. 

Pride Counseling, a subsidiary of BetterHelp, offers inclusive and accessible virtual counseling specialized for the LGBTQIA+ community to address struggles like gender identity, stigma, eating disorders and stress. Every therapist you encounter when using Pride Counseling has extensive experience working with the LGBTQIA+ community. 

At the start, you are asked several questions, including your pronouns, how you identify and your sexual orientation, to ensure you at matched with the best therapist. Pride Counseling also has taken steps to ensure security and anonymity are valued -- you can pick a "nickname" instead of your full name. 

You have unlimited messaging to contact your therapist at any time. Unlike other options, your counselor cannot diagnose conditions or prescribe medication. Costs range from $60 to $90/week with a billing cycle of every four weeks.  

Pride Counseling's best features:

• All therapists have experience working with the LGBTQIA+ community. Requirements are at least three years and 1,000 hours of experience to become a Pride Counseling therapist.
• Price Counseling has positive reviews from users, with a 4.5 on Google Play and 4.6 on the App Store. 

Things to consider:

• Unfortunately, Pride Counseling does not accept insurance. 
• Pride Counseling is only for adults. 
• The website, while straightforward, doesn't offer any additional resources like blog articles for those seeking an answer to a specific question. 

ReGain

ReGain, a sister site to BetterHelp, is a virtual therapy platform with experts specializing in relationships, intimacy and family issues. That's why it's our choice for the best online therapy for couples counseling. All therapists through ReGain are licensed and hold titles like licensed marriage and family therapists or clinical social workers.  

The sign-up process is similar to the other options on the list -- you fill out a questionnaire and are matched with a therapist. You can have both couples sessions and individual sessions with your therapist. You have access to 24/7 chat messaging, phone and video sessions. Unique to ReGain, there is a one-week free trial when you sign up.  

Another benefit that ReGain offers that alternatives do not is the wealth of educational information available on the website. ReGain offers dozens of articles and advice on relationships, regardless if you are signed up. This is not a standard feature in the virtual therapy space. 

ReGain online therapy costs between $60 to $90/week; you'll be billed every four weeks.  

ReGain's best features:

• You don't have to pay double for having both partners in the session. 
• All therapists through ReGain specialize in relationships and family issues.
• ReGain has a 4.5 rating on Google Play and 4.8 on the App Store. User reviews are generally positive.  

Things to consider:

• ReGain doesn't support three-way video conferencing; you and your partner have to be in the same room for your video sessions. 
• Typically it is not covered by insurance. 

How we chose the best online therapy platforms

Many criteria were considered when choosing the best online therapy platforms. The most important being the therapist's qualifications and credibility, pricing, ease of use, customer reviews, accessibility and insurance coverage. 

All of the selections on the list have positive user reviews, are easy to use and more affordable than traditional therapy. 

What is online therapy?

Online therapy brings the expertise of mental health professionals to the comfort of your home through phone calls, messages and video conferencing. Each online mental health service will vary in what they offer. For example, some services won't be able to diagnose or prescribe medication as a traditional therapy option could. 

Online therapy isn't for everyone. But it's a good option for people who have inconsistent schedules, tight budgets or aren't comfortable meeting with a therapist face to face. Research has shown that virtual therapy can be as effective as in-office meetings for some. 

Online therapy benefits: 

• Virtual therapy is more affordable and accessible than traditional therapy options. However, not all platforms accept insurance. 
• It's convenient. You can schedule your sessions around work, childcare or other life events that may get in the way.
• Being at your home when you're working in sessions can be more comfortable than going into an office. 

Read more: Tips to Find the Right Therapist For You

Is online therapy secure?

Privacy is one of the most important concerns when seeking online therapy. The American Psychological Association provides specific guidelines that therapists should follow for virtual sessions. One of the most important guidelines states that all online therapy platforms must comply with the Health Insurance Portability and Accountability Act (HIPAA). Whether through video or chat or text, all communication is covered under HIPAA. 

Some virtual counseling platforms take extra levels of precaution and allow you to delete messages after reading. It's important to read the privacy policies of each platform before signing up. This information is often found in the frequently asked questions section of the website. 

How to choose the best online therapy

Finding your ideal match can be difficult with so many options available to you. All platforms will vary in strengths and weaknesses, so it's important to know what your most important needs are. When you're looking for the best online therapy, you'll want to keep a few things in mind:

• Your goal: The first thing you want to check is that the platform includes the issue you want help with. Some platforms are specialized, like in the case of ReGain and couples counseling. 
• The therapists' credentials: You should be able to find the credentials and experience requirements for the platform's therapist. This is often located in the FAQ section of the website. You typically also want a service that allows you to change therapists. 
• User reviews: User reviews can serve as a gauge of the satisfaction of the platform. Did people find the website or app easy to use? What were their favorite features? Were there any pain points you need to watch for?
• Your budget and insurance: The unfortunate truth is that money is one of the main reasons people do not get the help they need. The subscription options and cost should be clearly stated on the website. You also should be able to find insurance coverage. 

Read more: How Cognitive Behavioral Therapy Can Reshape the Way You Think

More support for your mental health

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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How Much Cheaper Are Store-Brand Groceries Than Name Brands?

How Much Cheaper Are Store-Brand Groceries Than Name Brands?

This story is part of Home Tips, CNET's collection of practical advice for getting the most out of your home, inside and out.

Store-brand groceries might not have all the flashy packaging and advertising oomph of your favorite cereal, seltzer and snacks. If you can grin and bear a cheesy knockoff in place of those name-brand products, though, you can save a bunch on your monthly food spending.

In a summerlong series on saving money to combat inflation, we've calculated whether it's cheaper to buy groceries online or in person and laid out some strategies for saving at Whole Foods. But it turns out one of the most surefire ways to save at the supermarket is by letting some of that brand loyalty go by the wayside. 

If you're curious about exactly how much you can save buying store-brand groceries, I've done the math and the final figures are pretty shocking. On average, it's about 40% in total savings across various grocery categories. I compared the cost difference for buying name brands versus store-brand products at two popular grocery stores. Read on for a full savings breakdown in case you decide to make the switch. 

Read more: Is Grocery Shopping Online Cheaper Than at the Store? I Did the Math

Who makes store-brand products?

First things first, it's well documented that most major food manufacturers label their products under a number of different brands, including generic or store brands. According to recent statistics captured by the Private Label Manufacturing Association, one in five store-brand products is manufactured by a private label manufacturer. It makes sense: Those manufacturers can then appeal to people who are paying at either price. But they want you to go for the brand name price, rather than the store brand. That's why advertising exists; to make you believe that brand name products are somehow better, when the truth is that identical products are often going down parallel conveyor belts, getting two different labels at the end of the production line. 

This store-brand toasted cereal retails for around $2. A box of General Mills Cheerios is more like $5.

David Watsky/CNET

Now, this doesn't necessarily mean that all store-brand, O-shaped, toasted oat cereals are actually General Mills Cheerios in disguise, but it stands to reason that for a lot of store-brand products, the quality or flavor is potentially equal to their name- counterpart. And considering the opportunity for savings, they're certainly worth a taste test. While some brand-name products are unlikely to have a generic equivalent, (like, is anyone really seeking off-brand Cool Ranch Doritos?) commodity items like canned beans or rice would seem especially safe bets in the store-brand category.

Trader Joe's beloved pepita salsa is just one example of a store-brand item that's gained fandom and loyalty all its own.

Trader Joe's

Here's how much you can save buying store brand: Wegmans vs. Stop & Shop

I chose both Wegmans and Stop & Shop to represent high-end and average grocery store chains, using Instacart to generate current prices. 

Discount grocery stores such as Trader Joe's and Aldi keep their costs low because they deal primarily in their own brands. Wegmans is an interesting example since it has a lot of its own brand loyalty, not only as a grocery store chain, but also for its Wegmans label. (Seriously, I know people who would cross state lines to stock up on its flavored seltzers. Take that, LaCroix.) Stop & Shop is generally perceived as a midrange grocery chain, with good selection and good quality, and not considered expensive, but neither is it revered for its generic brand, which is simply called SB or Store Brand. 

Despite perceptions, however, both Wegmans and Stop & Shop are relatively aligned on prices, for both national and store-brand products. Wegmans came out a little ahead in price for name-brand products, in fact: The whole order was about $2 less than Stop & Shop's. Store-brand prices were within 20 cents of each other for the full list at both stores.

Cost of store brand versus name brand

	Wegmans	Wegmans store brand	Stop & Shop	Stop & Shop store brand
Goya chick peas, 16 ounces	$1.49	$1.09	$1.19	$1.09
Barilla thin spaghetti, 16 ounces	$2.29	$1.19	$2.49	$1.49
Arnold whole wheat bread, 24 ounces	$4.99	$3.49	$5.69	$2.69
Bird's Eye frozen broccoli florets, 12 ounces	$3.29	$1.79	$3.39	$3.29
Skippy creamy peanut butter, 16 ounces	$4.29	$2.69	$3.49	$2.89
Honey Nut Cheerios, 10 ounces*	$4.39	$2.29	$6.49	$2.79
Organic Valley/Horizon reduced fat organic milk, half-gallon	$6.39	$5.09	$6.29	$5.19
FAGE nonfat Greek yogurt, plain, 32 ounces	$7.49	$4.99	$7.89	$5.79
Bonne Maman strawberry preserves, 13 ounces*	$6.39	$4.09	$6.99	$4.19
Mission flour tortillas, soft taco size, 10-pack	$3.49	$1.79	$4.49	$2.59
Rao's homemade marinara, 24 ounces	$9.19	$1.19	$9.79	$1.99
Finlandia/Sargento sliced swiss cheese, 7 ounces*	$6.89	$3.09	$5.79	$3.69
Starbucks Breakfast Blend ground coffee, 12 ounces	$12.69	$7.49	$12.69	$5.19
Smithfield thick cut bacon, 16 ounces	$9.79	$7.89	$9.49	$7.99
Heinz Original tomato ketchup, 20 ounces	$3.49	$2.09	$3.19	$2.89
Lay's Classic potato chips, 8 ounces	$4.59	$2.69	$5.29	$2.39
LaCroix sparkling water, 12-pack	$6.89	$4.09	$7.39	$4.69
Swanson chicken broth, 32 ounces	$4.59	$3.79	$3.49	$2.79
Colavita extra virgin olive oil, 17 ounces	$13.79	$8.09	$12.49	$5.79
Hellman's mayonnaise, 30 ounces	$6.89	$4.89	$6.99	$4.19
	$123.30	$73.80	$125.00	$73.60
*Indicates store-brand item whose quantity was greater for listed price

Buying store brand can mean huge savings

For both Wegmans and Stop & Shop, the huge savings in buying generic products can't be denied. The original shopping list of 20 staple items amounted to about $125 in both locations, with the store-brand version of the list coming to just under $75. That's an average of 40% savings over the whole list. 

Granted, this doesn't represent a complete shopping list, since certain grocery categories were excluded intentionally. Some of these items, such as condiments, are products that you might shop for once in a while, rather than weekly. Regardless, the math is clear: Store-brand products are significant potential savings in your grocery shopping experience.

Certain grocery stores including Trader Joe's and Wegmans have managed to cultivate cult-like fandom for their own brands.

Wegmans

How I evaluated name brands vs. store brands

Using grocery shopping list templates available online, I generated a list of 20 common staple ingredients from the pantry, bakery, dairy, deli and freezer sections, covering a variety of prices. Items such as whole fruits and vegetables and butchered meats aren't typically subject to brand (or they're rarely revealed) and I discluded them for the purposes of this investigation. For each of the items I selected, I compared prices between national, well-known brands and the store brand of the same item, at roughly the same size, using Instacart. If there's a discrepancy in size, I've noted that with an asterisk, but did not adjust the price accordingly, since I wanted to reflect an accurate total of what you'd pay for a grocery list's worth of either name-brand or store-brand products. 

In most cases, the store-brand model was the larger size of the two items anyway, meaning even more savings if you factor in its relative value. For example, at Wegmans, Bonne Maman Strawberry Preserves are $6.39 for 13 ounces, whereas Wegmans brand Strawberry Preserves are only $4.09 for a full 18 ounces, nearly 50% more product. The savings on your grocery receipt will amount to $2.30, but if you scale up the Bonne Maman price to match the same amount of store-brand product, its price would become $8.85, representing a savings of $4.76, or over 50%, for the Wegmans brand.

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Certain upscale and imported goods like Bonne Maman preserves will cost you significantly more than store brand. 

Bonne Maman

Where are the biggest savings on store-brand items?

Between both Wegmans and Stop & Shop, the more the brand-name item cost, the more savings were typically available, not only in terms of pure dollars and cents but also as percentage savings between the brand name and store brand. Brand-name items above $5 tended to result in the largest percentage discount, with bigger-ticket items such as olive oil, coffee and spaghetti sauce pushing 50% off or more for their generic or store-brand counterparts. 

Pricier items such as olive oil and marinara sauce are where you're likely to see bigger savings if you opt for store brand.

Colavita

Less expensive items, especially those under $2 to begin with, may offer only 10% to 30% savings overall. For example, approximately 17 ounces of Colavita Extra virgin olive oil costs $12.79 at Stop & Shop, whereas the equivalent store-brand olive oil costs only $5.79, which amounts to over 55% off the name-brand price. 

On the other hand, 16 ounces of Goya chickpeas are only $1.19 to begin with. With the store brand being only 10 cents less, the savings only amount to 8%. Olive oil, however, is more likely to be subject to quality and flavor nuance, so while the savings can be much larger, it may be a matter of personal preference if the savings are worth it. Chickpeas are generally less subject to flavor or texture scrutiny.

Costco's Kirkland is another budget store brand that has garnered its own customer loyalty. 

Costco

Does every grocery store have its own brand?

While store brands are growing, not every grocery store has its own brand, and many just carry no-name or generic brands in addition to name-brand products. Among store brands, there are those that carry the name of the store in its proprietary label, such as Wegmans, Publix, Kroger and others that have a separate label for store-brand products, such as Stop & Shop's SB, Walmart's Great Value and Costco's Kirkland Signature. Whichever the case, it's worth getting to know your local grocer's store-brand products, to see where you may be able to generate huge savings in your grocery bill.

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