California Moms and Children Receive Boost from Legislature

Amie Newman

Two bills with the power to significantly improve the health and lives of California's women and children await Governor Schwarzenegger's signing in the final days of the state's legislative session.

Governor Schwarzenegger holds the power to improve access to maternity care coverage for all women in his state and ensure equitable coverage for children with pre-existing conditions. Last week, the California Legislature passed two bills which will significantly impact the health and lives of women and children. From Mercurynews.com:

The bills approved Wednesday would phase in coverage before they are replaced by the new federal health care law in 2014.

The first bill, AB1825, would require maternity coverage in basic plans sold on the individual market. The federal government already requires coverage by employers, and state law requires coverage by HMOs, but residents who buy their own insurance currently don’t get the same coverage.

The second bill, AB2244, would prohibit insurers from refusing coverage to children simply because they have a pre-existing medical condition.

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Maternity care, as defined by the bill, includes “prenatal care, ambulatory care maternity services, involuntary complications of pregnancy, neonatal care, and inpatient hospital maternity care, including labor and delivery and postpartum care.”

As the California Progress Report notes, this mandate will go a long way towards not only ensuring equity of coverage options for women on the individual and group markets, but will relieve financial strain on the state’s public health programs, and “crucially provides the public health benefit of getting babies the prenatal and early care coverage needed to live healthy and productive lives.”

Six years ago, 82 percent of health plans in the individual market, in California, offered maternity coverage. Now? Only nineteen percent of plans offer the coverage.

The second bill not only mimics federal health reform by barring insurance carriers from denying coverage to children based on a pre-existing health condition but also limits the amount insurers can charge to cover those children.

Governor Schwarzenegger has vetoed the bill twice already, over the last two years, and seems unlikely to sign this most recent proposal. But, as the Ms. Magazine blog reports,

In an effort to get the governor’s support, “There’s been some discussion about inserting an exclusionary period during which time pregnancy is not covered,” said McGovern [Beth McGovern is the legislative director for the California Commission on the Status of Women]. This is similar to other exclusions for pre-existing conditions and may be offered in the Senate. This isn’t an ideal solution but  would offer women some coverage.

It’s up to the small-business-friendly governor. He’s just made a cameo appearance in Sylvester Stallone’s new action film, The Expendables, playing a mercenary named “Trench” who’s hired as part of a hit squad. Before he leaves state government, he should prove he hasn’t been bought and paid for by the health-insurance industry to become one of their hit men, bent on proving that women are expendable. He needs to make women’s health a priority before he returns to Hollywood full time. What’s he got to lose?

Governor Schwarzenegger has until September 30th to either sign or veto the bill.

News Law and Policy

California Takes Steps to Repeal ‘Unfair’ Welfare Rule Affecting 130,000 Children

Nicole Knight Shine

Known as the Maximum Family Grant Rule, the provision bars low-income women and families who have another child from receiving increases in welfare benefits under the state program CalWORKs.

A California family-benefit rule that critics have long denounced as racist and sexist would be repealed under a 2016 budget deal reached Thursday by Gov. Jerry Brown (D) and key Democratic lawmakers.

Known as the Maximum Family Grant Rule (MFG), the provision bars low-income women and families who have another child from receiving increases in welfare benefits under the state program CalWORKs.

Critics have argued the rule denied much-needed assistance to approximately 130,000 of the state’s most vulnerable children. The repeal would cost the state $100 million in the first year, as the Sacramento Bee reported.

“CalWORKs was a critical program that helped stabilize our family on solid ground while I made that tough climb [toward self-sufficiency and empowerment],” said Bethany Renfree, former CalWORKs recipient and policy director of the State Commission on the Status of Women and Girls, in an online statement. “Repeal of this unfair rule will have deeply felt implications for all of the families who might have been denied help.”

The additional benefit for each child is an estimated $130 per month.

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Some 16 states have some form of the MFG rule on the books to deny increased benefits to growing families—often those of color.

California, where the rule has been in place since 1994, uniquely allows exceptions to the rule in cases of contraceptive failure. The exception applies only if recipients were using “approved” long-acting birth control—a provision critics have called an invasion of privacy.

As Jamelle Bouie of Slate reported in 2014, family caps—another name for these policies that deny families additional benefits if they have more children—were designed to combat the myth of the “welfare queen,” welfare recipients who bear more children to receive more aid.

Research has disproven this premise and also has suggested that family cap rules push families deeper into poverty.

A policy paper Elena R. Gutiérrez, associate professor at the University of Illinois at Chicago, wrote for the Center on Reproductive Rights and Justice at the University of California at Berkeley debunks the notion that women on welfare have more children than do others. It notes that most CalWORKS families include one or two children, a figure consistent with the state’s overall birthrate. Although one national study suggested a link between family caps and lower birthrates, that effect occurred only in states that provided public funding for abortion care for low-income individuals, according to the paper.

Previous attempts to repeal the rule stalled in the state legislature, as Rewire has reported.

This go-round, the budget deal was backed by more than 130 groups, including ACCESS Women’s Health Justice; the American Civil Liberties Union of California; California Latinas for Reproductive Justice; the Center on Reproductive Rights and Justice; the County Welfare Directors Association of California; the California Partnership; and the Western Center on Law and Poverty.

Last month, petitioners turned over 8,500 signatures to Gov. Brown, urging him to work with lawmakers to repeal the rule.

The budget act must still be voted on by the entire legislature and then signed by the governor.

Commentary Contraception

Zika Threat Shows Urgent Need for Better Contraceptive Access

Julie Rabinovitz

As summer approaches and global officials continue to issue warnings about Zika, U.S. federal and state officials can allocate funds and expand insurance coverage to ensure contraceptive access.

Pressure is mounting on Congress to send President Obama a sufficient spending bill to combat the Zika virus’ spread.

The House and Senate recently passed their own measures, both proposing less than the $1.9 billion the president requested. But now they must work out their differences for the sake of our public health. Currently, none of these proposals include funding for Title X, the federal program that provides low-income people with family planning services, birth control, and other preventive reproductive health services. With the potentially life-changing outcomes that can result from contracting Zika, federal and state action is urgently needed to support prevention efforts and increase access to the full range of contraception available nationwide.

There’s no time to waste. More than 600 people in the continental United States, including at least 150 pregnant women, have already been infected with Zika. This month, a New Jersey infant exposed to Zika was born with the birth defect microcephaly, where a baby’s head is smaller than expected. Many more Americans have been affected in Puerto Rico and other U.S. territories. Local transmission is expected to spike as warmer weather approaches and climate conditions become more favorable to the virus’s primary vector, the Aedes aegypti mosquito.

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The Centers for Disease Control and Prevention (CDC) have reported significant evidence showing links between Zika and adverse pregnancy and birth outcomes, including miscarriage, stillbirth, and fetal abnormalities. Brain damage in Zika-infected babies is proving to be far worse than doctors initially thought. Zika has been found to attack lobes of the fetal brain that control thought, vision, and movement. Exposure to Zika was first considered to be a threat for women in the first trimester only, but there is growing concern about the possibility of maternal-fetal transmission throughout pregnancy.

It has also been discovered that men infected with Zika can transmit the virus to their sexual partners through semen, where the virus is stored much longer than in the blood.

As more individuals learn about the potential health risks linked to the virus, many will want and need services and information to help them effectively avoid or postpone pregnancy. Extensive research already shows the public health value and taxpayer savings associated with preventing unintended pregnancy.

Now with Zika, the stakes are even higher.

Congressional leaders must act without delay to pass a comprehensive Zika funding and preparedness package that includes additional resources for Title X to expand access to reliable birth control, related services, and counseling to low-income and uninsured people. Increased funding for these essential services is needed on the ground now, especially in regions expected to be disproportionately affected by the virus. The threat is particularly worrisome in areas that experience the warmer weather that’s conducive to Zika-carrying mosquitoes.

On the state level, elected leaders across the country should require public and commercial health plans to cover all—not just some—FDA-approved birth control. After the passage of the Affordable Care Act (ACA), California was one of the first states to approve a contraceptive-coverage equity law that codified the spirit of the ACA’s contraceptive mandate, also known as the birth control benefit, by requiring health plans to cover all methods of contraception without cost sharing or restrictions. Maryland recently enacted a similar measure that also requires coverage for vasectomies, and several other states are considering legislation with the same intent. The Zika threat makes passage of these kinds of laws across the country time-sensitive. State Medicaid programs must also adopt reimbursement and coverage policies that break down barriers enrollees may face in accessing the full range of effective contraceptive methods.

Patients must be able to get the method they can use safely and consistently. That means health-care professionals across the country, including those in primary-care settings, must offer all forms of available birth control. Providers need training to support their patients in accessing the contraceptive method that is best suited for their health and reproductive life goals. Even some OB-GYNs can use training on newer methods and updated best practices.

Many unknowns remain regarding the Zika virus, which has quickly become one of the world’s greatest public health challenges. But a concerted and proactive response—that includes improved access to contraception—must be implemented before Zika becomes a national public health crisis here in the United States.