Bauer-Kahan on a mission to improve menopause education

Any person with ovaries who lives long enough will go through it. Menopause. They can look forward to the possibility of hot flashes, brain fog, urinary issues, sexual dysfunction, mood swings, memory decline and that’s just naming a few.

Historically, women have often been understudied and undertreated in health science, and menopause is no exception. Studies show that women feel like they do not receive the proper menopausal care due to a knowledge gap among their healthcare professionals.

Driven by personal experience, Assemblymember Rebecca Bauer-Kahan (D-Orinda) introduced AB 432 this session, her second effort to address the gaps in care as the buzz around menopause gains national attention.

“I found in my own experience that most doctors don’t know what the standard of care is. They don’t. They’re not trained adequately on how to treat menopause care. And so we’ve expanded upon [that] this year, because that seems to be also a really huge stumbling block for women,” Bauer-Kahan said.

AB 432 is a bipartisan attempt to shore up physician education through Continuing Medical Education (CME) and expanded insurance coverage. It’s backed by the California Women’s Legislative Caucus, California Commission on the Status of Women and Girls (CCSWG), National Women’s Political Caucus of California and Black Women for Wellness Action Project.

“I found in my own experience that most doctors don’t know what the standard of care is. They don’t. They’re not trained adequately on how to treat menopause care.”

The bill would amend the law to require health insurers and health care service plans to cover evaluation and treatment options for perimenopause and menopause without Utilization Management (UM). Insurers and health plan service providers rely on UM to determine necessary patient care on a case-by-case basis. UM is also a cost-saving measure that can lead to barriers to receiving recommended treatment from physicians.

“Insurance companies should not dictate the order of treatments based on their own metrics and prior authorization policies. Appeals severely limit treatment options and burden both patients and providers, leading to barriers to drug access and coverage inequities,” Dr. Rajita Patil, an assistant clinical professor in the UCLA Department of Obstetrics and Gynecology, a certified menopause expert, and the founder and director of the UCLA Comprehensive Menopause Program, said during her testimony in support of the bill at the Health Committee hearing.

Bauer-Kahan introduced AB 2467 last year, which had similar language to this year’s bill. It died on Gov. Gavin Newsom’s desk. In his veto, he called the bill “too far-reaching,” with its insurance coverage mandates and “unprecedented” UM ban on non-FDA-approved drugs.

The new legislation does not contain major changes. In fact, Bauer-Kahan said, while it may be the norm to narrow a bill following a veto, she opted instead to add to the bill.

“We’ve doubled down,” Bauer-Kahan said. “What we really need to do is make sure that we’re educating the Executive branch so that they understand the value of this.”

Despite that, she did alter the language to specifically include only FDA-approved treatments that can forgo the UM process, which often slows down or prohibits the treatment of women at any stage of menopause.

The bill’s supporters argue that women do not receive the care they need around menopause, not just because of insurance issues, but also largely due to the lack of education of physicians in their training.

“Fewer than half of those experiencing menopause receive any form of care, and even fewer receive evidence-based holistic treatment,” Patil said. “When left untreated, [it] can lead to workplace absenteeism, presenteeism, strained relationships, diminished well-being and actually can lead to chronic disease in the long term.”

When first introduced in February, the bill required all physicians with a patient population of 25 percent or more women to complete a CME course. It’s now been amended to narrow the list of physicians needing to take the mandated course. That language around CME is where the opposition comes in.

Every two years, licensed physicians and surgeons must complete at least 50 hours of CME. Groups like the American College of Obstetrics and Gynecology (ACOG) offer these courses and emphasize the importance of allowing physicians to choose their own CME paths. Concerned that this mandate will become just another “checkbox,” opponents believe physicians should determine which courses are most relevant to their practice.

While opponents recognize the need to improve physician training, they oppose mandatory CME requirements of any kind. Instead, organizations like ACOG advocate for expanding the number of specialists who can treat menopause or enhancing physicians’ clinical training.

“Let’s focus some of the training on not such acute care, but topics that occur in the outpatient setting,” said Dr. Kelly McCue, immediate past chair for ACOG District IX. “We also advocate for expanding access to high-quality continuing medical education on menopause and encourage its uptake, but not making it mandatory.”

Other bill opponents include the California Medical Association, the California Chapter of the American College of Cardiology, the California Orthopedic Association, the California Rheumatology Alliance and the California Society of Plastic Surgeons.

“Fewer than half of those experiencing menopause receive any form of care, and even fewer receive evidence-based holistic treatment.”

Dr. Elaine Waetjen, a professor of gynecology at UC Davis Medical Center and an obstetrician whose research focuses on the gynecological health of midlife and older women, agrees that physician education around menopause can be lacking due to how they are trained.

“I think that in residency, oftentimes training is really focused on obstetrics and on acute care of women, because acute care is one of those things that people can live or die by,” Waetjen said. “I think most people who gain knowledge about how to function as a menopause practitioner learn it after residency.”

And opponents of the bill would like to keep it that way, despite their support of expanding the uptake of CME courses around menopause.

The Business & Professions and Health Committees have now heard this bill, which passed with all aye votes. The Appropriations Committee will hear it next. According to an analysis by the California Health Benefits Review Program, the bill could raise total premiums by 0.05% in 2026. Cost sharing for covered benefits would rise by about $21 million, while out-of-pocket spending on non-covered services would decrease by approximately $33 million.

“I grew up with a mother who wasn’t supposed to talk about menopause, never got menopause care, and I think we’ve seen a real shift in society,” Bauer-Kahan said. “And I do want people to know the government is here to make sure they are getting the resources and the care they need if they go through this transition that is life changing, but also can be really positive, if we were to treat it the way it should be.”