Is second time the charm for Bauer-Kahan’s menopause education bill?

When Assemblymember Rebecca Bauer-Kahan (D-Orinda) began experiencing severe brain fog, she grew frightened about what could be wrong. After three doctors told her she was fine, it was a recommendation from a friend over lunch that led her to a menopause specialist. That specialist finally recognized her symptoms for what they were and provided treatment.

Bauer-Kahan said the experience left her shaken but determined.

This year, she introduced Assembly Bill 432, the Menopause Equity Act, her second attempt to expand insurance coverage with added requirements for more training of physicians and surgeons around menopausal care.

The measure is part of the California Legislative Women’s Caucus’s 11-bill priority package. It has attracted high-profile support, including from actress and activist Halle Berry, who went public last year about her own years-long struggle to get diagnosed with perimenopause.

Berry’s advocacy has helped shine a spotlight on the lack of consistent care and information available for women entering menopause. Supporters say Bauer-Kahan’s legislation is one way to begin closing that gap in California.

Bauer-Kahan’s earlier effort, AB 2467, sought to expand insurance coverage and provider education for menopause treatments but was vetoed by Gov. Gavin Newsom in September 2024. Newsom acknowledged the bill’s intent but raised concerns that its broad coverage mandates and prohibition on utilization management went too far.

This year, supporters like Lourdes Ayon returned to testify. Ayon, a lobbyist for San Diego Gas & Electric, spoke solely as a private citizen, drawing on her personal experience with delayed diagnosis, repeated insurance denials and significant out-of-pocket costs. She also shared her story during hearings on AB 2467 last session.

“I ran into some issues right away—the testosterone was not covered by insurance,” Ayon said. “And when I looked at the price of the testosterone that I would have to get on monthly, [it] was $450.”

Her story mirrors the challenges Bauer-Kahan and others describe—multiple appointments, delayed diagnoses, a lack of clear information from physicians and necessary treatments left uncovered by insurers.

Since clearing the Assembly, AB 432 has been reshaped by amendments to address opposition. Early versions of the bill required mandatory Continuing Medical Education (CME) for doctors on menopause-related topics.

Medical groups, including the California Medical Association and the American College of Obstetricians and Gynecologists, opposed that mandate. In negotiations, Bauer-Kahan agreed to a compromise. Physicians and surgeons who choose to complete CME courses on perimenopause, menopause, or post-menopause will now receive two hours of credit for every hour of coursework.

“The switch we made on incentivizing these classes versus mandating them really turned the tone of physicians, which I think is a positive thing,” Bauer-Kahan said. “I want it to be something that they view as a benefit to them in their education and to their patients.”

Insurance coverage was always expected to be a tougher fight. Back in February, Bauer-Kahan told Capitol Weekly she anticipated pushback from insurers, who would be tasked with expanding what they cover under state law.

Berry’s advocacy has helped shine a spotlight on the lack of consistent care and information available for women entering menopause. Supporters say Bauer-Kahan’s legislation is one way to begin closing that gap in California.

That prediction has proved accurate. As AB 432 moved through Senate hearings, insurers warned that the bill’s broad coverage mandates, limits on utilization management (processes like prior authorization and step therapy) and lack of in-network restrictions could create opportunities for waste, fraud, and abuse.

“Specifically, our concerns are centered around the bill granting the treating provider unfettered authority to determine medical necessity, while also limiting the ability of the plan to employ any utilization management tools,” Steffanie Watkins of the Association of California Life and Health Insurance Companies said at the Senate Health Committee hearing in July. “We believe this bill…will drive up costs for consumers, increase the use of expensive brand-name drugs and ultimately increase the cost of health care for everyone.”

The California Health Benefits Review Program (CHBRP) estimated in its April report that the impact of AB 432 would add roughly $2 million in annual costs across the state’s commercial and public health plans combined.

Amendments to AB 432 now require coverage for FDA-approved treatments for perimenopause and menopause without prior authorization or other utilization management tools, while allowing insurers to review non-FDA-approved treatments. Bauer-Kahan described the change as a middle ground that addresses concerns from Gov. Newsom’s veto of AB 2467, ensuring that licensed physicians prescribing FDA-approved medications can provide necessary care while preserving a layer of oversight for treatments not yet approved by the FDA.

The bill cleared the Senate Appropriations Committee suspense file on August 29^th, though it was amended to exempt Medi-Cal from the proposed new requirements. The full Senate and Assembly both endorsed the revised version and the bill is now headed for Newsom’s desk.

For Bauer-Kahan, the stakes extend beyond her own story. She frames the bill as a generational shift in how medicine treats women.

“I want people to be left with an understanding that this will happen to everyone with ovaries who lives long enough, and that we are building a future for Californians, where, when that happens, you will have a physician who understands it, healthcare that covers it,” she said. “Then at this critical moment, where women are at their peak professional careers, which should be the best time of their lives, as I see it, we’re going to make that a reality.”