March marks International Women’s Month, and we celebrate this by recounting how California has, through implementation of the Affordable Care Act and Medi-Cal, protected and expanded health care access for women in spite of the Trump administration’s attacks against women’s health care.
Medi-Cal is a program that benefits women (by women, we mean an inclusive definition of the words “women” and “female,” including trans women, genderqueer women, and non-binary people who are significantly female-identified). More than a third of Medi-Cal enrollees are women above the age of 15, and of these, 63 percent are of reproductive age. Medi-Cal also finances more than half of all births, 83 percent of publicly funded family planning services, and 50 percent of abortions in California.
With extensive coverage, comprehensive family planning services programs, and state funded abortion care, California has some of the strongest protections for reproductive health services in the country. These achievements are the result of the tireless work of state advocates who have applied a reproductive justice lens in their strategies – believing that all people should have the social, political, and economic power and resources to make healthy decisions about their gender, bodies, sexuality, and families.
Last year, California joined the fight to save the ACA, which has benefited women in the state, in particular from communities of color, through increased enrollment figures and other protections. California was also among the states to codify provisions that this federal administration is striving to eliminate like the freedom of choice protection in family planning.
California continues this leadership role in 2018.The California Coalition for Reproductive Freedom is seeking to expand reproductive health services. One proposal (SB 1023) would clarify that health care service plans, health insurers, and Medi-Cal managed care plans may cover sexual and reproductive health services that are provided appropriately through telehealth. The legislation would benefit Medi-Cal patients who do not have immediate access to a reproductive and sexual health care provider.
California also stands in stark contrast to the slew of states who are (illegally) trying to impose work requirements as a condition of Medicaid eligibility through Sec.1115 waiver projects. While the state has not sought such a Medicaid waiver, a current proposal (SB 1108) would prohibit the state from seeking or obtaining a Medi-Cal waiver to require work, community engagement activities, and other eligibility barriers as a condition of Medi-Cal eligibility or coverage. As evidenced by a recent study, the effect of a work requirement on the actual incidence of work over a five-year period among cash assistance recipients in Riverside was minimal. The impact of such a requirement on California women who must return to work upon the end of their postpartum period would be cruel, and would be harmful for women as well as their newborns and other relatives. Furthermore, seeking to impose a Medi-Cal work requirement on the one in five women in California who experience prenatal or postpartum depression would be even more damaging.
California advocates are also seeking justice for the more than 20,000 Californians who were sterilized between 1909 and 1979 through programs authorized under the state’s eugenic laws. Senate Bill 1190 would provide compensation to any survivors of these initiatives. The bill also acknowledges two additional known periods of coerced sterilizations: women of Mexican origin who delivered babies at USC/LA County Hospitals 1965-1975 and female inmates in California state prisons who were sterilized without proper authorization from 2006 to 2010. While monetary compensation does not address the harm suffered by sterilization survivors and their families, SB 1190 recognizes the dark history of California reproductive health laws and sends a message that such programs cannot be allowed again.
California is also considering whether health centers of public universities can provide students with access to medication abortion. The proposal (SB 320) would be the first of its kind. Finally, in response to a national and state outcry on gender discrimination, the California legislature is introducing a package of bills to achieve equality for women. One of these bills (SB 1150) requires all state agencies to conduct an evaluation of their own departments to ensure that California does not discriminate against women through the allocation of funding and the delivery of services.
As the Trump administration and congressional Republicans continue their war on women’s health care, California is taking the lead to resist and fight back with initiatives and legislation to expand and protect health care coverage for women.