UnitedHealthcare CEO Brian Thompson was shot dead by a masked gunman outside a New York City hotel last week in an apparent assassination that has gripped the public’s imagination.
CCTV footage of the incident in the early hours of December 4 shows the suspect drawing his weapon and firing at least three times at close range. The 50-year-old CEO drops to the floor in the video, later dying from his wounds.
After days of speculation as to the motivation and identity of the gunman, police in the US state of Pennsylvania on Monday arrested 26-year-old Luigi Nicholas Mangione.
Here’s what we know about the man named as a “strong person of interest” in the fatal shooting.
Arrest
New York Police Department (NYPD) Commissioner Jessica Tisch said Mangione was arrested at a McDonald’s restaurant in Altoona, Pennsylvania, after a worker recognised the suspect from police photos and alerted authorities.
Mangione was found sitting at a table looking at a silver laptop and wearing a blue medical mask, according to authorities.
When asked if he had been to New York recently, Mangione “became quiet and started to shake”, according to a criminal complaint.
Mangione was carrying a US passport and multiple fake IDs at the time of his arrest, including one with the name Mark Rosario, which was used to check into a hostel in New York City before the shooting, according to Tisch.
Mangione also had a silencer and a gun “both consistent with the weapon used in the murder”, according to police.
Police suspect the weapon to be a “ghost gun” – one assembled at home without a serial number, possibly made using a 3D printer.
Tisch said Mangione was carrying a “handwritten document” which outlines “both his motivation and mindset” for Thompson’s murder.
Authorities late on Monday charged Mangione with murder, possession of an unlicensed firearm, forgery and providing false identification to police.
Motivation
Police have not publicly released that handwritten note, nor offered details about its contents.
US media, citing unnamed law enforcement sources, reported that the note contained the lines, “These parasites had it coming” and “I do apologise for any strife and trauma, but it had to be done”.
Investigators said last week the words “defend”, “deny” and “depose” were written on the casings of bullets found at the scene of the murder.
Many have interpreted the words as a nod to tactics allegedly used by US health insurance companies to avoid paying claims to patients, speculating that Mangione may have acted in anger against the industry.
Insight into Mangione’s possible worldwide can also be found in a sympathetic review of Industrial Society and Its Future, aka the Unabomber Manifesto, posted from what appears to be his account on the website Goodreads.
The review describes Ted Kaczynski – who was responsible for a decades-long bombing campaign across the US that killed three people and injured 23 others – as an “extreme political revolutionary”.
“It’s easy to quickly and thoughtless write this off as the manifesto of a lunatic, in order to avoid facing some of the uncomfortable problems it identifies. But it’s simply impossible to ignore how prescient many of his predictions about modern society turned out,” the review reads.
The review also states that “violence is necessary to survive” when all other forms of communication fail, calling those who reject this notion “cowards and predators”.
The same Goodreads account also liked a quote by author Kurt Vonnegut reading: “America is the wealthiest nation on Earth, but its people are mainly poor, and poor Americans are urged to hate themselves”.
Mangione was born into a wealthy family in the US state of Maryland, where he graduated from an elite all-boys private institution, the Gilman School, as high school valedictorian in 2016.
Mangione then attended the University of Pennsylvania, graduating from the Ivy League school in 2020 with a bachelor’s and master’s degree in computer science and a minor in mathematics.
Stanford University has confirmed that a person by the same name was employed at the school between May and September of 2019, working as a head counsellor under the Stanford Pre-Collegiate Studies programme.
Mangione, who developed a game app as a teenager, worked as a “data engineer” at a vehicle shopping firm called TrueCar from November 2020, according to his LinkedIn profile. A TrueCar spokesperson said that he had not worked there since 2023.
Mangione lived in Hawaii according to his X account, where he regularly posted about technological advances like artificial intelligence, fitness and healthy living.
The banner on his profile included an X-ray image of a person’s lower back with what appears to be screws and plates inserted into it.
Other reviews found on Mangione’s Goodreads account were related to health and healing back pain, including, Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.
Chinese President Xi Jinping has held his final meeting with his outgoing counterpart in the United States, Democrat Joe Biden.
But Xi’s words on Saturday seemed directed not simply at Biden but at his Republican successor, returning President Donald Trump.
In his encounter with Biden on the sidelines of the Asia-Pacific Economic Cooperation summit in Lima, Peru, Xi emphasised the importance of the US and China maintaining “mutual respect”.
While Xi did not mention Trump by name, he gave a nod to the incoming US president’s victory in the November 5 election.
“The United States has recently concluded its elections. China’s goal of a stable, healthy and sustainable China-US relationship remains unchanged,” Xi said.
But, he warned, “If we take each other as rival or adversary, pursue vicious competition and seek to hurt each other, we would roil the relationship or even set it back.”
Trump, who served as president previously from 2017 to 2021, oversaw a period of heightened tensions with China, including a trade war sparked by his imposition of tariffs on Chinese goods.
On Saturday, Xi appeared to extend a hand of friendship to Trump, encouraging their countries to work together for mutual gain.
“China is ready to work with the new US administration to maintain communication, expand cooperation and manage differences so as to strive for a steady transition of the China-US relationship for the benefit of the two peoples,” he said.
US President Joe Biden and China’s President Xi Jinping attend a bilateral meeting on the sidelines of the APEC Summit in Lima, Peru, on November 16 [Leah Millis/Reuters]
A major campaign theme
Trump has reprised his “America First” philosophy as he prepares to enter the White House for a second time.
China was a repeated feature of the Republican’s campaign speeches, as he led a successful bid for re-election in the 2024 US presidential race.
As part of a pitch to American voters, Trump pledged to protect US manufacturing from Chinese competition.
“I charged China hundreds of billions of dollars in taxes and tariffs. They paid us,” Trump boasted at his final campaign rally in Grand Rapids, Michigan, on November 4.
“And you know what? We’re going to get along great with China. We’re going to get along good. I want to get along with them. President Xi was great until COVID came. Then, I wasn’t so thrilled with him.”
During the height of the COVID-19 pandemic, Trump blamed the Chinese leader for letting the virus spread by “allowing flights to leave China and infect the world”. He also repeatedly called COVID-19 the “China virus”.
Despite their rocky history, Xi called to congratulate Trump on his second term the day after the election, on November 6.
Xi has led the Chinese government since 2013, and under his authority, the two-term limit was abolished for presidents.
Trump has expressed admiration for Xi’s authority over the Chinese government, which some critics compare with authoritarian rule.
“I got along very well with President Xi. He’s a great guy. He wrote me a beautiful note the other day when he heard about what happened,” Trump said after the assassination attempt on him in July. “It’s a good thing to get along, not a bad thing.”
Goodbye to Biden
Xi and Biden have had their own rocky history, with incidents like the 2023 downing of an alleged Chinese “spy” balloon fuelling spikes in tensions.
China maintained that the balloon was a civilian aircraft collecting weather data, and it denounced the US’s decision to shoot it down with a missile after it passed over sensitive US military installations.
Biden, who turns 82 on Wednesday, exchanged some banter with his Chinese counterpart as they spoke to reporters in their final meeting.
“Can you put on your earpiece? We have simultaneous interpreting,” Xi asked Biden at their afternoon news conference.
Biden responded with a joke. “I’ve learned to speak Chinese,” he said with a chuckle.
The US president continued by acknowledging that relations have not always been smooth between their two countries.
“We haven’t always agreed, but our conversations have always been candid and always been frank. We have never kidded one another. We’ve been level with one another. And I think that’s vital,” Biden said, pointing across the table as he read from prepared remarks.
“These conversations prevent miscalculations, and they ensure the competition between our two countries will not veer into conflict.”
He used his final encounter as president with Xi to push several US priorities. In a readout released by the White House, Biden reportedly pushed for greater law enforcement cooperation to stem the flow of synthetic drugs to the US.
He and Xi also spoke about the emerging challenges posed by artificial intelligence (AI), including with regards to its use with nuclear weapons.
“The two leaders affirmed the need to maintain human control over the decision to use nuclear weapons,” the readout explained.
“The two leaders also stressed the need to consider carefully the potential risks and develop AI technology in the military field in a prudent and responsible manner.”
Biden also confirmed that the US’s “one China policy” remained “unchanged”: The US acknowledges the government in Beijing as the sole government of China. It does not have formal diplomatic relations with the self-governing island of Taiwan, which China considers its territory.
China has called acknowledging Taiwan’s sovereignty a “red line” in its relationship with the US.
While Biden has previously pledged to protect Taiwan should it ever face attack, on Saturday, he struck a note of peace, calling for a continuation of the status quo.
“He reiterated that the United States opposes any unilateral changes to the status quo from either side, that we expect cross-Strait differences to be resolved by peaceful means, and that the world has an interest in peace and stability in the Taiwan Strait,” the White House readout said.
But, it added, Biden also “called for an end to destabilizing PRC [People’s Republic of China] military activity around Taiwan”.
Trump’s victory was as much about the political context as it was about the media moment.
Donald Trump’s shock victory in the United States election this week revealed fundamental flaws with the Democratic Party establishment, the news outlets in its corner and how they approach the voting public.
Contributors:
Adolfo Franco – Republican Strategist Natasha Lennard – Columnist, The Intercept Omar Baddar – Political Analyst Osita Nwanevu – Contributing Editor, The New Republic
On our radar
As Israel continues its campaign of mass killing and ethnic cleansing in northern Gaza, Israeli correspondents there have exposed the army’s intentions. Tariq Nafi has been tracking their reporting.
The Kenyan ‘manosphere’
Populated by loudmouths, shock artists and unapologetic chauvinists, the Kenyan “manosphere” is promoting an influential – and at times dangerous – take on modern masculinity.
Featuring:
Audrey Mugeni – Co-Founder, Femicide Count Kenya Awino Okech – Professor of Feminist & Security Studies, SOAS Onyango Otieno – Mental Health Coach & Writer
US Vice President Kamala Harris delivered a televised concession speech to the nation after a whirlwind campaign that failed to stop Republican Donald Trump’s return to the White House.
“While I concede this election, I do not concede the fight that fuelled this campaign,” she told supporters on Wednesday at her alma mater, Howard University, a historically Black college.
Harris pledged to continue fighting for women’s rights and against gun violence and to “fight for the dignity that all people deserve”.
Harris addressed a crowd that included former House Speaker Nancy Pelosi, aides in President Joe Biden’s White House, and thousands of fans who listened to a soundtrack that included Beyonce’s Run the World (Girls) and Tye Tribbett’s We Gon’ Be Alright.
Her running mate, Minnesota Governor Tim Walz, also joined the crowd.
Harris rose to the top of the Democratic ticket in July after Biden stepped aside and brought new-found enthusiasm and cash to the Democratic ticket, but struggled to overcome voters’ concerns about the economy and immigration.
She was handed a resounding loss, with Trump winning a greater share of votes across most of the country compared with his performance in 2020, and Democrats failing to secure key battleground states that decide elections.
Thousands had gathered at Howard University on Tuesday night for what they hoped would be a historic victory for the first woman to become president. They came back on Wednesday to show their support after her.
Early voting is under way across the United States ahead of Tuesday’s presidential election. Republican candidate Donald Trump and Democratic candidate Kamala Harris have both made last-minute efforts to court union voters – a core voting bloc, especially in swing states like Michigan, where groups like the United Auto Workers (UAW) have significant sway among the electorate.
Vice President Harris has garnered endorsements from important unions across the country, including the UAW, AFL-CIO and Service Employees International Union.
Harris also has the support of the International Association of Machinists and Aerospace Workers, the union behind the latest Boeing strike, which is now entering its eighth week. Boeing picketers say that if she hits the picket line with them, it could help her win more votes.
Meanwhile, former President Trump has also solidified union support, limited though it may be. Members of the Teamsters union have shown stronger support for the Republican nominee. Although the International Brotherhood of Teamsters opted not to endorse either candidate, the union’s president, Sean O’Brien, has campaigned with Trump and appeared on conservative-friendly media outlets in support.
Trump also received an endorsement from the International Union of Police Associations. It comes despite Trump’s false claims about the high rate of crime in American cities, his 34 felony convictions and his campaign owing cities across the US hundreds of thousands of dollars, much of it for police overtime pay.
While Harris has wider support among union members – a 7 percent lead on Trump as 50 percent of union members say they believe Harris’s policies would be better for unions than Trump’s – the latter has garnered support among union members by tapping into issues that are top of mind for the broader electorate like immigration.
“Union members who are likely or could support Donald Trump are really not focused on collective bargaining or economic power but issues that have to do with immigration, issues that have to do with a sense of danger because of levels of crime,” Bob Bruno, professor of labour and employment at the University of Illinois Urbana-Champaign, told Al Jazeera.
Despite Trump’s success in stoking fear about “migrant crime”, violent crime in the US has steadily declined during the administration of President Joe Biden. The most recent FBI data shows a 10.3 percent decline in reported violent crime compared with last year.
Al Jazeera analysed where the candidates stand on key issues important to union workers like collective bargaining and wages. Here’s what we found:
On organising
Harris has a pretty consistent record of being pro-union and was an original co-sponsor of a key workers rights bill – Protecting the Right to Organize (PRO) Act.
The PRO Act, which originally was proposed in 2019, would prevent employers from interfering with union elections, allow for the National Labor Relations Board to hand out financial penalties to companies that violate labour laws and expedite reinstatement of work if workers lose their jobs as a result of a strike.
The bill was reintroduced in 2023 but has not passed the US Congress. Harris said she would sign it into law if elected.
“The Harris campaign is by far the more supportive of organised labour and collective bargaining, and the Trump campaign is outwardly hostile to the idea,” Bruno said.
JD Vance, Trump’s running mate, voted against the PRO Act and has been a vocal critic of the legislation. Vance also rejected several Biden administration nominees to the National Labor Relations Board. In 2020, then-President Trump threatened to veto the PRO Act if it made it to his desk.
The Trump White House also made it harder for workers to organise, including in 2019 when it got rid of a protection implemented during Barack Obama’s presidency that allowed workers to use company email to organise.
“When it comes to Trump, his presidency was an absolute disaster for working people and for union members. His entire term was doing the bidding of corporate CEOs and big corporations from the massive tax giveaways that he bestowed upon them to making it more difficult for workers to organise as a union,” Steven Smith, deputy director of public affairs for the AFL-CIO, told Al Jazeera.
In her capacity as vice president in the Biden administration, Harris spearheaded the White House Task Force on Worker Organizing and Empowerment, which aimed to help better communicate workers rights throughout federal agencies.
On the other hand, Trump has been openly hostile towards workers who are pushing for better working conditions.
In a recent interview with billionaire supporter Elon Musk on X, the social media platform Musk owns, Trump floated the idea of firing workers who are on strike, which would violate federal labour law.
The claim led the UAW to launch a formal complaint with the National Labor Relations Board to investigate Trump and Musk for interfering with workers rights.
On wages
Harris has said that if elected, she would try to raise the federal minimum wage to $15 per hour – an important issue for workers in the service industry and their respective unions because the minimum wage has been stuck at $7.25 an hour since 2009. Since then, its purchasing power has declined by almost 30 percent.
Republican presidential candidate Donald Trump works behind the counter during a visit to a McDonald’s restaurant in Feasterville-Trevose, Pennsylvania [File: Doug Mills/Pool via Reuters]
When he was asked about whether he would raise the minimum wage at a campaign event at a Pennsylvania McDonald’s franchise, Trump dodged the question.
In 2020, he said he would prefer minimum wages to be decided by the states.
“I think it should be a state option. Alabama is different than New York. New York is different from Vermont. Every state is different. It should be a state option,” Trump said at the time.
Thirty-four of the 50 US states have raised their minimum wages above the federal minimum.
That means the remaining 16 still have a minimum wage of $7.25 an hour. So for people who work full time at 40 hours per week at those wages, their annual pay would be only $20 higher than the poverty line for a single person household.
When Biden first took office, he pledged to raise the federal minimum wage for all workers. But his efforts to get Congress to pass the legislation were blocked by Republicans and a handful of Democrats. However, Biden did what the administration could do unilaterally and raised the federal minimum wage for federal workers.
Both Trump and Harris have pledged to end income taxes on tips if elected.
Harris has long fought to improve wages across the economy. During her time as attorney general in California, she launched a task force that was intended to crack down on wage theft in the state.
However, it’s not clear how well those efforts performed. By 2022, it was reported that even when workers won wage theft cases against their employers, only one out of seven were paid out those lost wages within five years.
Trump, however, has repeatedly argued against raising wages.
In 2015, he said wages were “too high”. During that time, he also said auto manufacturers should move operations to the southern part of the US to “lower-wage states”.
Despite these policy positions, Trump won the union-heavy state of Michigan in 2016. Biden won the state by 2.8 percentage points over Trump in 2020, and now it’s a dead heat between Harris and Trump in the state. An aggregate of political polls compiled by the poll-tracking website FiveThirtyEight shows Harris has a small lead in Michigan but well within the margin of error.
The Biden administration, however, has fought to improve wages for middle class workers. In several job creation programmes, the administration included a prevailing wage clause that requires companies bidding for contracts to pay a living wage to their employees.
“The middle class is going to earn prevailing wage on all of those construction and factory-related jobs that come with that large federal subsidy,” Bruno said.
On overtime pay
At the end of Obama’s second term, the Department of Labor said any full-time workers making less than $47,476 qualified for automatic overtime pay.
A judge in Texas blocked the rule before it could take effect. When the plan threshold came up for re-evaluation in 2019, the Trump administration slashed it. The cuts meant employers only needed to pay overtime for salaried workers making $35,358 a year or less.
When the rule was up for reconsideration again this year, the Biden-Harris administration raised the threshold to $43,888 on July 1. It will increase again on January 1 to $58,656. The plan will likely continue if Harris is elected next week.
As for Trump, his allies at the Heritage Foundation think tank want him, if he wins, to reverse the rule.
Trump has a long history of failing to pay overtime during his time in the private sector. A 2016 report from USA Today found that his companies violated overtime and minimum wage laws 24 times.
He echoed that sentiment in a campaign speech this month. The Republican nominee told supporters in Michigan he “used to hate to pay overtime”.
“People are shocked and they’re scared because if Trump takes away their overtime, they’re not going to be able to make their rent at the end of the month. That’s the kind of thing that’s at stake here,” Smith said.
Trump, however, has said he wants to end taxes on overtime pay as part of a bigger tax plan if he is re-elected.
“It’s time for the working man and woman to finally catch a break, and that’s what we are doing because this is a good one,” Trump said at a campaign rally in Arizona in September.
Neither campaign replied to Al Jazeera’s requests for comment.
Ottawa says the close ally of India’s PM is involved in an intimidation campaign against Sikh separatists on Canadian soil. Indian sources call the allegations ‘flimsy’.
Canada has accused Indian Minister of Home Affairs Amit Shah of being behind a campaign of violence and intimidation targeting Sikh activists, in a move likely to extend a recent diplomatic spat between Ottawa and New Delhi.
Deputy Foreign Affairs Minister David Morrison confirmed to the members of the national security committee late on Tuesday that the government considers Shah – considered India’s second-highest leader and a close ally of Prime Minister Narendra Modi – the architect of the campaign against Sikh separatists in Canada, which has included the assassination of an activist.
India has not so far responded, however, Reuters news agency reported on Wednesday that government officials had rejected the accusation.
Morrison told committee members that he had confirmed Shah’s name to The Washington Post, which had earlier reported the allegations.
“The journalist called me and asked if it was that person. I confirmed it was that person,” Morrison told the committee. He did not reveal the evidence behind Canada’s allegation.
Prime Minister Justin Trudeau has previously said Canada has credible evidence that agents of the Indian government were involved in the murder of Canadian Sikh activist Hardeep Singh Nijjar in British Columbia in June 2023.
The assassination and aftermath have caused a diplomatic spat between the two countries.
Canada expelled Indian diplomats that it linked to the campaign it claims has targeted Sikhs. India responded with its own expulsion of Canadian officials.
The United States also charged a former Indian intelligence officer, Vikash Yadav, for allegedly directing a foiled plot to murder Sikh separatist leader Gurpatwant Singh Pannun, a dual US-Canadian citizen and Indian critic in New York City.
Nathalie Drouin, Trudeau’s national security adviser, told the security committee on Tuesday that Canada had evidence the Indian government had been gathering information on Indian nationals and Canadian citizens in Canada through diplomatic channels and proxies.
‘Flimsy’
Canadian authorities have in the past said that they have shared evidence with India, but officials in New Delhi have repeatedly denied that and called the allegations absurd.
India did not immediately comment on the accusation against Shah. However, Reuters quoted unnamed government sources who said that New Delhi considers Canada’s evidence to be “very weak” and “flimsy” and that it does not expect it to cause any trouble for the powerful interior minister.
Modi’s government has branded Sikh separatists “terrorists” and threats to its security. The activists demand an independent homeland, known as Khalistan, to be carved out of India.
An armed rebellion during the 1980s and 1990s killed tens of thousands. In 1984, anti-Sikh riots killed thousands following the assassination of then-Prime Minister Indira Gandhi by her Sikh bodyguards after she ordered security forces to storm the holiest Sikh temple to flush out Sikh separatists.
The US election campaign is in its final weeks with voters heading to the polls on November 5 to elect the next president.
Early voting is already taking place in a number of states, including in battlegrounds such as North Carolina and Georgia.
With less than three weeks to go until the election, Democratic Vice President Kamala Harris and Republican former President Donald Trump are battling it out to sway undecided voters.
However, the popular vote does not decide the winner. Instead, it determines which electors will represent each state in the Electoral College, which does pick the president.
To win, a candidate needs to secure 270 of the 538 electoral votes up for grabs. Electoral College votes are distributed across states according to their relative populations.
In July, President Joe Biden, a Democrat, exited the presidential race and endorsed Harris as his replacement. Since then, the vice president’s ratings have risen from what had been lower numbers under Biden.
But the race is still tight. FiveThirtyEight’s election forecast suggests that Harris is favoured to win 54 times out of 100 while Trump wins 46 times out of 100.
Which states could swing the presidential election?
Swing states, also known as battleground states, can sway the outcome of a national election.
One of the defining characteristics of a swing state is its ambiguous political leanings where no party has overwhelming support.
This year, the states being closely watched are Arizona, Georgia, Michigan, Nevada, North Carolina, Pennsylvania and Wisconsin.
In the 2020 presidential election, Georgia flipped from Republican red to Democratic blue after nearly three decades of voting Republican, and in Arizona, the Democrats won by a narrow margin of 0.3 percentage points.
Polls show Trump and Harris in a narrow race in swing states. Polling in these states is more important in determining the winner than national polling because the Electoral College and not the popular vote chooses the president.
What happens if Harris and Trump end in a tie?
There are a total of 538 electoral votes. To win the election, a candidate must get 270.
Given the nature of how electoral votes are distributed, specific combinations of states could lead to a tie of 269 votes. Such a scenario is possible, though not probable.
If no candidate wins at least 270 electoral votes, a contingent election takes place in which the US House of Representatives decides the winner.
Each state’s delegation in the House would cast one vote, and a candidate must receive a majority (26 out of 50) of the state delegation votes to win.
The US Senate would then choose the vice president with each senator casting one vote and a simple majority (51 votes) required to win.
How do polls work?
Election polls predict how the population might vote by surveying a sample of voters. Surveys are most commonly conducted by phone or online. In some cases, it is via post or in person.
Poll trackers, which aggregate a number of polls together, are weighted based on a number of factors, such as the sample size of the poll, the pollster quality, how recently the poll was conducted and the particular methodologies employed.
How accurate are polls?
Polls are never 100 percent accurate. Both the 2016 and 2020 US elections saw opinion polls underestimate the popularity of Republican candidates. Despite polling for the 2022 midterms being more accurate, many still remain sceptical about polling results.
Part of the reason for inaccuracy in polls in recent years is related to the ability to reach voters. Often polls are conducted via telephone surveys; however, fewer people are inclined to answer calls. Nonresponse bias is another reason for inaccuracy – for example, in recent years, Trump voters have chosen not to respond to polls. Additionally, changes in voter turnout have affected the accuracy of polls, for example, in 2020 voter turnout was much higher than expected.
A mathematical margin of error is implicit in polls because they use small, select groups of people to ascertain the choice of a larger population. That margin of error in US polls indicates the range within which the actual result is likely to fall. With a 1,000-person sample size, the margin of error is about plus or minus 3 percent.
Many of the polls conducted before this year’s presidential election have shown the difference in support between Harris and Trump within the margin of error.
In the US, presidential elections are decided by a state-based vote allocation system. Here’s what you need to know.
It’s at the heart of how presidential elections in the United States are decided. But for many, the Electoral College is a mystery, wrapped in a riddle, shrouded in an enigma.
It doesn’t have to be confusing, though.
To understand the Electoral College system, you first have to know that US presidents are not elected by the national popular vote: the total number of votes each candidate receives.
Instead, a group of 538 so-called “electors” select the president. These electors make up the Electoral College.
So who are these electors?
Before the election, the political parties in each state choose a slate of electors: real people who ultimately cast a vote for the president. Very often, the electors are party officials or supporters.
Each state gets the same number of electors as it has representatives in the US House of Representatives and the US Senate.
For example, Michigan gets 15 Electoral College votes. That corresponds to the two senators and 13 House members that represent the state in Congress.
Now that we know who these electors are and how many represent each state, how are their votes allocated? Here’s where it gets fun.
In nearly all the states across the US, the presidential candidate who gets the most votes wins all that state’s electors: It’s a winner-takes-all system. Even if a candidate wins a state narrowly, they still get all the electors.
The outliers are Maine and Nebraska, which allocate their electors based on a more complicated system that reflects the popular vote on the state and congressional district levels.
The District of Columbia — which is not a state but encompasses the country’s capital — also gets three Electoral College votes.
But here is the most important part: To win the White House, a presidential candidate must win the support of a majority of the electors.
So out of a total of 538 Electoral College votes, they need at least 270 to win.
The electors ultimately cast their votes in December, about a month after the election.
Their votes are then certified by Congress in early January, when the president is confirmed and takes office.
So what does this all mean?
Effectively, to win the US presidency, a candidate has to win support in enough key states to reach that magic Electoral College number of 270.
Under this system, a candidate who wins the popular vote — the most votes in total across the US — may not actually win the White House.
One recent example came in 2016, when Democratic presidential candidate Hillary Clinton won the popular vote but lost the election to Republican Donald Trump. His victory was buoyed by wins in states like Florida and Pennsylvania, each of which offered at least 20 Electoral College votes.
The Electoral College system was designed, in effect, to ensure the political power of the states.
Some Americans say the Electoral College should be scrapped in favour of the popular vote. Others argue the system ensures highly populated states do not overshadow smaller ones, thereby encouraging minority representation in US democracy.
Amid fierce debates around abortion and challenges with access to healthcare, women in the United States face another battle: the increasing risk of death associated with pregnancy.
The US has the highest maternal mortality rate of all high-income countries, at 22 deaths per 100,000 live births, according to analysis published by the Commonwealth Fund in June. It based this assessment on data from the US Centers for Disease Control and Prevention (CDC) as well as the Organisation for Economic Co-operation and Development (OECD), of which the US is a member.
Some studies suggest that the high rate of US maternal mortality can be attributed to specific shortcomings in the country’s healthcare system, including one that especially impacts women from minority groups.
So what does the US maternal mortality crisis look like? Is there a way forward? And will abortion bans make it worse?
What is maternal mortality?
Maternal mortality refers to the death of a woman during pregnancy, childbirth or within the “postpartum” period following childbirth or the termination of a pregnancy due to complications or an abortion. These deaths can be caused by conditions such as excessive bleeding or seizures, but are related to or aggravated by pregnancy.
The US count includes deaths that occur within up to a year of delivery or termination of a pregnancy. In total, 817 US women in the US died of maternity-related causes in 2022. The country’s maternal mortality ratio that year stood at 22 deaths for every 100,000 live births.
However, this rate varies depending on ethnicity. Black women are more than twice as likely to experience a pregnancy-related death compared to the country’s average. For every 100,000 live births among Black women in 2022, nearly 50 women died within a year of delivery or termination.
What is causing high maternal mortality in the US?
Typically, some of the leading complications associated with maternal deaths have been “obstetric” or directly associated with pregnancy, such as excessive bleeding, placental blockages in the birth canal, and seizures.
However, the type of risks facing pregnant women in the US seem to be changing.
“Over the last two decades, we’re seeing a shift away from the more traditional obstetric risk for dying,” said Alison Gemmill, assistant professor in the department of Population, Family and Reproductive Health at John Hopkins University in the US.
“Now what we’re seeing is that most of the maternal deaths have some kind of underlying cardiovascular condition attached,” she said.
Additionally, a CDC report found that some of the leading causes of maternal death between 2017 and 2019 were mental health and heart conditions (in addition to excessive bleeding).
Pregnancies deemed high-risk from the outset are also becoming more common, according to KS Joseph, a professor at the Department of Obstetrics and Gynaecology at the University of British Columbia in Canada, who studies maternal mortality around the world. Part of this can be attributed to assisted reproductive technologies such as in vitro fertilisation (IVF), which help women with fertility issues related to factors such as age or pre-existing health conditions to conceive.
(Al Jazeera)
Are some ethnic groups affected more than others?
Without universal healthcare, US women – particularly those who are less likely to have health insurance – can lack comprehensive medical support.
Black women are especially at risk. In 2022, for every 100,000 live births, 49.5 Black women died. This was significantly higher than the rates for white (19.0), Hispanic (16.9) and Asian (13.2) women.
This disparity starts with a history of inadequate or inaccessible healthcare, and extends to implicit bias that affects the quality of medical care women receive during pregnancy, according to Melva Craft-Blacksheare, who was an assistant professor at the University of Michigan’s Flint campus until her retirement this year.
“A lot of this [bias] was part of the beginnings of gynaecology, like the idea that Black people don’t feel pain, because OBGYN [obstetrics and gynaecology], started with Dr Marion Sims, the father of OBGYN, working without anaesthesia on Black enslaved women,” she said.
After perfecting his surgical techniques on Black women without anaesthesia, American physician James Marion Sims performed the same procedures on white women who were sedated.
While anaesthesia was not fully integrated into medical practice in the 19th century, several sources have supported the notion that Sims’s decision to not use any kind of numbing technique on Black people was based on the misguided notion that they did not experience pain like white people did.
Craft-Blacksheare added that these misconceptions have been passed down through medical education and training in some form; as a result, Black women often find their concerns being dismissed by medical professionals.
Campaigners and family members believe this was the case in 2016 when 39-year-old Kira Johnson died in a Los Angeles hospital. Johnson, who was scheduled to deliver via Caesarean section, complained of severe pain in her abdomen for 10 hours before being attended to by the medical team. In emergency surgery, after which she died, doctors found that Johnson had been bleeding internally and had three litres of blood in her abdomen.
Research also shows that the chronic stress of experiencing racism can lead to accelerated aging and poorer health outcomes for Black women, putting them at higher risk of conditions like hypertension and pre-eclampsia, a potentially deadly condition if it is not identified, during pregnancy.
Craft-Blacksheare said that social challenges like poverty and domestic abuse, which Black women in the US often face at higher rates than other groups, should be considered by providers when treating pregnant women, as these factors can impact their health or ability to attend appointments.
(Al Jazeera)
Is the way the US monitors maternal mortality to blame?
The US method for recording pregnancy-related deaths is highly debated, and has raised concerns that it obscures the underlying causes of death in some cases.
In 2003, states across the country began adopting a death certificate that included a “pregnancy checkbox”, asking if the deceased was pregnant at the time of death or within the previous year. By 2017, when all states adopted the checkbox, the maternal mortality rate had more than doubled.
The CDC claims this checkbox addressed previous underestimations, but critics argue it is frequently ticked incorrectly, resulting in an overestimation of the number of deaths.
For example, one of the CDC’s own assessments found that in 2013, the checkbox was marked for 147 deceased women above the age of 85. Such findings have resulted in new rules for the checkbox, such as limiting its application to an age range of 10 to 44.
However, experts argue that ticking the checkbox still connects a significant number of deaths to pregnancy, even when that may not have aggravated the person’s demise.
“This overestimation and this lack of specificity with regard to causes of death is hurting the system and we are not able to identify what it is that we need to go after if we want to prevent these deaths,” explained Joseph, pointing to data showing that between 60 to 80 percent of maternal deaths in the US are preventable.
He added that if death certificates clearly outlined how being pregnant played a role, this could help accurately identify and address those preventable or common risk factors associated with pregnancy.
Craft-Blacksheare, who is on Michigan’s maternal mortality review committee, said she believes that the US maternal mortality cases are correct and not overestimated, however.
She explained that the committee not only confirms whether pregnancy was an aggravating factor in the death, but assesses additional factors such as whether the death was preventable or discrimination was involved in care.
Gemmill said that while state-level committees are important, the US needs to invest more in federal infrastructure to investigate the reliability and validity of maternal death reporting – similar to other high-income countries.
“We’ve lagged because we don’t have that kind of national system, that kind of gold standard system,” she said.
What else can be done to improve outcomes for mothers in the US?
Provide better prenatal care
Several key stages of pregnancy require special attention to reduce maternal mortality, experts say. These include medical assessments prior to conception, prenatal care during pregnancy, home visits and regular checkups following delivery.
About one in seven US babies were born to a mother receiving inadequate prenatal care in 2022, according to a study by the March of Dimes, a non-profit organisation dedicated to preventing premature births and birth defects.
Gemmill said that many women do not get treated for underlying conditions such as prediabetes until it is observed in pregnancy-related scans, causing them to miss out on opportunities for early intervention.
Improve postpartum care and expand maternity leave
Data indicates that women’s health is especially neglected in the postpartum period. Sixty-five percent of maternal deaths occur postpartum, with 30 percent occurring between 43 to 365 days after delivery.
Additionally, according to the American College of Obstetricians and Gynecologists, up to 40 percent of women do not attend a postpartum visit, potentially missing opportunities for timely intervention for health risks.
The Commonwealth Fund report also found that an absence of federally mandated paid maternity leave gives women less time to “better manage the physiological and psychological demands of motherhood”.
Overall, experts say that pregnant women need more focused care in clinical settings. “There’s so much emphasis on saving infants’ lives and making sure that infants are healthy. But then that means that the mom is an afterthought in many ways,” said Gemmill.
Focus more on maternal needs and midwifery
Craft-Blacksheare also sees healthcare for pregnant women as an infrastructure issue. “It’s driven by physicians, it’s driven by hospitals and it’s not driven by maternal needs,” she said.
Some suggest that increasing access to midwives can help make maternal healthcare more holistic. This could also compensate for a shortage of obstetricians and gynaecologists in the US, according to the Commonwealth Fund report.
Midwives are health professionals trained to medically and emotionally support women during pregnancy, labour and the postpartum period.
“Midwifery care is a very specialised care that puts the woman and the family in the centre of their care”, says Craft-Blacksheare, adding that midwives should work together with physicians, especially in high-risk situations.
Will US abortion bans make maternal mortality worse?
A study published in the journal Women’s Health Issues by researchers in Boston suggests that abortion bans, several of which have been passed in the US in the past year, will exacerbate maternal mortality, particularly when it comes to racial inequalities in deaths.
When local abortion facilities are unavailable, pregnant women are often forced to travel to other cities, counties or states for the procedure. Black and low-income patients, who frequently already have children, are disproportionately affected and often lack the economic security, social support, and childcare resources needed to take time off work and travel for an abortion.
When women are already at risk of dying due to a pregnancy complication, abortion restrictions force them to carry through with the pregnancy against their will. Once again, the effects of this are expected to be felt most deeply by Black and Hispanic women who lack access to comprehensive healthcare, according to the study.
The bans may also put the US even further behind other high-income countries, which largely allow abortions, in terms of maternal mortality rates.
Gemmill, who is also studying the effect of the abortion restrictions, said that while data is not currently available to draw a conclusion, an increase in maternal complications is possible.
“We’re already seeing stories come out from certain states where people aren’t getting the care that they need and it’s putting their lives at risk,” she said. “So I definitely think we will be seeing an increase because of that.”
It started as a last-minute effort in February: Organisers in Michigan hoped to use the state’s Democratic primary to send a message to President Joe Biden to end his support for Israel’s war in Gaza.
Six months later, Biden is no longer the Democratic presidential candidate. But the US’s “ironclad” support for the war continues. And so has the “uncommitted” movement, the protest effort born in Michigan.
Initially, the aim was to encourage primary voters across the country to cast their “uncommitted” ballots in protest of the war. But now that the primary season is over, the “uncommitted movement” has set its sights on a new platform: the Democratic National Convention.
Next week, 30 delegates from eight states, representing some 700,000 voters who cast “uncommitted” ballots, will be heading to the convention in Chicago. Though they have been denied an official platform to speak at the proceedings, they hope their presence will still send a strong message.
“We’re the first delegation ever to be representing Palestinian human rights. And I think that that’s really important. We’re a small but mighty group,” said Asma Mohammed, who organised for the “uncommitted” movement in advance of Minnesota’s primary.
Mohammed acknowledged the “uncommitted” delegates will be a minority at the convention. Still, she emphasised the voter base they represent could be decisive in November’s general election.
“There’s 30 of us, and there’s over 4,000 delegates nationally. So we’re less than 1 percent of the delegates,” she told Al Jazeera.
“But inside the convention hall, we will be representing the Palestinians that were massacred, representing the almost million voters nationwide who said that they want a ceasefire right now and that they want an arms embargo.”
Activist Natalia Latif tapes a ‘Vote Uncommitted’ sign on the speaker’s podium during an election night gathering in Dearborn, Michigan [File: Rebecca Cook/Reuters]
The group had requested for Dr Tanya Haj-Hassan, a pediatric intensive care physician who has worked in Gaza, to speak at the convention. Their appeal was denied, Mohammed said.
Still, the delegates, under the banner of the Uncommitted National Movement, will hold a programme of events on the sidelines of the convention. There, they will meet with various caucuses and seek to rally other delegates pledged to Kamala Harris, the new Democratic nominee for president.
‘Fighting for human rights’
The Uncommitted National Movement has already used its position to protest against the continuing bloodshed in Gaza, where more than 40,000 Palestinians have been killed.
Earlier this month, Harris was formally designated the Democratic nominee through a virtual roll call — an online vote in which all delegates could take part.
Instead of voting for Harris, the “uncommitted” delegates nominated victims from Gaza. Mohammed was among the delegates who participated in the protest.
“I submitted my vote for Reem Badwan, a three-year-old who was murdered in an Israeli air strike in Gaza,” Mohammed said. “And I made clear my vote [in the general election] was contingent on a ceasefire and an arms embargo.”
Ahmad Awad, an “uncommitted” delegate from New Jersey, said the effort was a “symbolic way to highlight the many victims of the war”. The 29-year-old lawyer nominated Abdul Rahman Manhal, a 14-year-old killed in Gaza’s Nuseirat refugee camp in November.
“The districts that I’m representing as an ‘uncommitted’ delegate encompasses Paterson and Clifton, New Jersey, which are home to a large Palestinian American community. It’s basically little Ramallah,” Awad said, drawing an analogy to the West Bank city.
Awad explained that his participation in the “uncommitted” movement stems from a family history of fighting and surviving human rights abuses.
“Fighting for human rights is something that’s really ingrained in my DNA,” he told Al Jazeera.
“On my father’s side, both of my grandparents were born in Palestine prior to 1948. My mother’s side is Polish. My grandfather is a survivor of Nazi slave labour camps.”
‘Resolute is the best word’
In Harris’s abrupt entrance into the presidential race, activists have seen a potential opening for a course change in US policy towards Israel.
Harris became the Democratic nominee after Biden withdrew from the race on July 21, amid concerns about his age and capacity to lead.
Whereas Biden has advanced a policy of “bear-hug diplomacy” towards Israel, some observers believe Harris has signalled her intention to take a tougher stance.
Shortly after entering the presidential race, Harris pledged to denounce the suffering of Palestinian civilians. “I will not be silent,” she said, shortly after meeting Israeli Prime Minister Benjamin Netanyahu.
In a brief exchange with two “uncommitted” leaders — Layla Elabed and Abbas Alawieh — at a campaign stop in Detroit this month, she also said she would speak with the group.
But her campaign has not set a date for the meeting, and a Harris campaign adviser doused hopes that she would support a full arms embargo on Israel.
Michael Berg, a 49-year-old uncommitted delegate from Missouri, said there had been some positive signs from Harris, although he had tempered his expectations.
“It’s hard to know where things are going,” said Berg, who named two-year-old Gaza victim Jihad Khaled Abu Amer as his vote during the virtual roll call. “I’m hoping that Vice President Harris is not as dug in on positions as President Biden seems to be.”
Still, Berg explained he and the other “uncommitted” delegates are steadfast in their mission to advocate for a ceasefire at the Democratic National Convention.
“So we are, I guess, resolute is the best word. We are going to the convention because we have a very clear mandate and mission from the people, and we’re going to do what we can.”
‘Standing with my fellow Kentuckians’
In the lead-up to the convention, the “uncommitted” movement has added delegates to its group.
Violet Olds, for instance, applied to represent the “uncommitted” segment of voters in Kentucky but was not initially involved in the movement.
Olds, a digital project manager, said that after she was selected by the party to represent uncommitted voters, she was approached by her local Democratic Socialists of America chapter, which connected her to the national protest movement.
“I actually reached out and found ways to communicate with other Kentucky voters to find out why they voted uncommitted and how I can represent their voices at the convention,” the 41-year-old told Al Jazeera.
“And it all comes down to basically Gaza and Palestine. So I’m standing with my fellow Kentuckians and with Palestinians.”
During the roll call, Olds named Mohammad Bhar, a 24-year-old Palestinian man with Down syndrome who died after being mauled by an Israeli military dog in his home in Shujayea in Gaza.
“I am autistic, and so that means that I represent a whole different class of people than I think the Democratic Party is usually used to representing, and my son is autistic, as well,” Olds said. “So when I heard Mohammad’s story, it really, really, really hit home.”
Asma Mohammed, an activist with Uncommitted Minnesota, addresses media in Minneapolis, Minnesota [Stephen Maturen/AFP]
Others, like Inga Gibson, a delegate from Hawaii, have long been part of the Palestinian solidarity movement. Nearly 30 percent of voters in Hawaii’s Democratic primary cast their ballot for “uncommitted”, the largest proportion of any state. Seven of the island state’s 22 delegates are “uncommitted”.
Gibson attributed the turnout to Hawaii’s “own history of settler colonialism”.
“A lot of native Hawaiians within the Palestinian freedom movement have drawn on that parallel,” she explained.
Gibson, a 52-year-old environmental policy consultant, said that the relatively small size of the “uncommitted” delegation does not reflect wider sentiment against US support for Israel.
Polls have repeatedly shown widespread disapproval of Israel’s actions among Democrats. Experts say the support for Israel could disadvantage Democrats in several key battleground states, including Michigan and Pennsylvania.
“I do not feel that our movement, by any means, is in the minority, even if our delegates are, per se, in the minority compared to 4,000 others,” said Gibson. She named Gaza victim Ruba Yasser Nawas, a 22-year-old software engineer, during the roll call vote.
“Everything that we are asking for is completely mainstream.”
‘Cannot just make this week a celebration’
June Rose, the sole “uncommitted” delegate from Rhode Island, also said it was incorrect to assume the delegation members come from the fringes of the Democratic Party.
“We are Democratic professionals. I’m the chief of staff of the Providence City Council. I’ve made my career helping to elect Democrats and defeat Republicans who pose incredible risk to the future of our country,” the 29-year-old told Al Jazeera.
“But my relationship with the party will never supersede my relationship with my values, and in this case, my values and my party are in direct conflict.”
Rose named Eileen Abu Odeh, a toddler killed with her family in an Israeli air raid in Gaza, during the roll call. They explained the delegation’s presence at the Democratic National Convention can serve as a gut check for the party, as it prepares to chart a course forward on foreign policy.
“Our party cannot just make this week a celebration, and I think that that’s the tone that many in our party want to take,” Rose said. “But that celebration would be on the graves of innocent children who’ve been slaughtered.”
