WOMEN’S HEALTH: Reproductive Health

CAPITOL WEEKLY PODCAST: This Special Episode of the Capitol Weekly Podcast was recorded live at Capitol Weekly’s Conference on Women’s Health which was held on Thursday, September 28, 2023

This is Panel 1 – REPRODUCTIVE HEALTH

PANELISTS: Sen. Nancy Skinner; Liz Lawler, California Republican Party delegate; Amy Moy, Essential Access; Julia Spiegel, Deputy Legal Affairs Secretary, Governor’s Office

Moderated by Mackenzie Mays, Los Angeles Times

This transcript has been edited for clarity.

Mackenzie Mays: Hi everyone, and thank you for being here. Thank you, Capitol Weekly. Yeah, so it’s been more than a year since Roe vs. Wade was overturned. And we are going to talk about where California is, where it’s going, and how we compare to the rest of the nation. And we have a group of panelists here today who know about women’s health, they are all women themselves, and they know about the access.

So, we are actually waiting still for the lawmaker to come on, but we will start with Amy Moy. She is the co-CEO of Essential Access, which is a reproductive health equity organization. We have Julia Spiegel, she is an attorney who serves as Deputy Legal Affairs secretary for Governor Gavin Newsom, and she focuses on reproductive rights. Liz Lawler, a delegate of the California Republican Party. She was an Assembly candidate last year, she’s also served on the city council of Monte Sereno. And we will have the Senator joining us soon. But while she is running late, we will hop right in.

I think I wanna start with Amy, because as Tim mentioned, just yesterday, we have a new law in California, and so the laws we saw yesterday signed were about not just helping patients here in California and patients out of-state seeking abortions because they can’t get the care in their states, but also helping healthcare providers. We know that now OBGYNs are worried that they can’t get the training that they say that they need, not just for abortion, but for other sorts of care regarding miscarriages.

Can you sort of look into your crystal ball, and I know you know a lot about this, so it might not take a lot of guessing, but what is the next big issue? We know that legislation was just signed, but what do we still need? What are you sort of advocating for right now.

Amy Moy: Thank you. Well, first, it’s a pleasure to be with all of you and be able to talk about these important issues and also great timing to be together today on the heels of Governor Newsom signing another kind of historic nation-leading package of bills. Yesterday he signed nine bills that will again serve as models for other safe haven states to be able to do a number of things, including, as you mentioned, have enhanced protections for patients and providers, help expand our reproductive healthcare workforce and some other critical components that continue to make California a real leader when it comes to being a reproductive freedom state.

And so I think that what we’re seeing now and what we’ve continued to see with some lived experience… We started a group called the California Future of Abortion Council right after Texas Senate Bill 8 was enacted. Speaking of tea leaves, we knew that the writing was on the wall, that Texas was just the kind of first, it feels a little glib to say, but shoe to drop, right before the whole nationwide nightmare scenario that we’ve been seeing has come into fruition with more than a half of states having abortion bans or severe restrictions.

And so after the first… That first year, the group… The Future of Abortion Council came together and thought, what are some of the things that we know are gaps that we have still here in California, for people in California that still face barriers to accessing this essential health care, and what do we think is needed to bolster protections for California to be a helper for people who are forced to travel from out of state?

And so we have really looked at, in that initial package that was signed by Governor Newsom, including $200 million of an historic investment in new programs to be able to make access more of a reality through training providers by enhancing our infrastructure, by providing a no-cost care, as well as providing the practical supports that make access to care possible, like transportation, lodging, etc. And so we’ve made great strides this year. This package again looks at another year of lived experience, what else was needed, looking at, again, being able to bolster the healthcare workforce as well as protecting patient privacy and digital privacy. And I think as we look forward, we have to continue to make sure that the resources that were made available initially continue and are made relatively permanent.

We know that this is a marathon, unfortunately, and not a sprint. So that initial investment that was made in establishing new programs for folks to be able to get the care that they want and need with dignity and respect, the patients here in California and those forced to come here have that in the foreseeable future and don’t have to worry about those resources winding down.

So I think looking at how we continue the work that has already been done and making sure that there is stability and security in that. I think another component that we need to do is make sure that folks who are in these ban states know that California is here for them, that we can be here for them as a safe haven. We have seen an increase in patients from out of state, certainly, and I think that as folks know that resources are available on the ground to give them… To support them… we’ll be seeing more… Even more of an uptick here. And then I think we just have to keep being nimble and emerging and listen to patients, listen to providers to see what still needs to be done, and also prepare for the future.

I think that as we look to the future and think about what’s possible on the national level, we did pass Proposition 1 here in California to establish the constitutional right to abortion and contraceptive care here. And I think that that’s something that we have to continue to do and to anticipate any additional attacks on reproductive health and freedom that might come down the pike.

MM: Amy, do we have any sort of concern about Californians themselves struggling to get care because of an unexpected influx of patients? I think there’s some sort of balancing act that people are concerned about, can we serve everyone here while also serving other states? What have we figured out about that by now… or nothing? [chuckle]

AM: Well, I think first off, the historic investments that have been made for no-cost care and practical support were established to be made available for Californians who still face barriers to care, as well as folks who are forced to travel out of state to be able to get the care that they want and need. And so Essential Access has had the privilege to be able to administer three particular programs that the state established.

One is in LA County specifically to make LA County a safe haven for care. Funding that has been distributed, more than $6 million so far, to be able to enhance the abortion care infrastructure in Los Angeles, which we anticipated and have seen as a hub for folks not only traveling here, but just due to the population of LA County. Knowing that there were still barriers that remain, so enhancing that abortion care infrastructure to make sure that we can reduce wait times for folks in their local communities to get care, as we anticipate people traveling outside of state here.

We also are administering the Uncompensated Care Fund, which provides providers with grants to offer no cost abortion and birth control care. And again, that’s for folks in California who might not have coverage for whatever reason still, and not be able to afford the out-of-pocket costs for abortion and birth control, as well as for folks traveling to California who would face affordability concerns and who don’t have coverage that travels with them.

So, we know, for example, we’ve… So far, it’s incredible. We’ve been able to distribute more than $20 million for uncompensated care to providers across the state, including the far north, which is an example of an area that may not be seeing an influx of patients from out of-state, but really being able to utilize those costs for their local community. As well as more than $4 million distributed for practical support, which again is to help make care possible, like transportation, lodging, childcare.

Those funds have been distributed across the state, again, including to groups like, in the rural north, where we know that transportation to their local provider because of significant abortion deserts that remain in California have been really significant to be able to help bridge the gap for many to get care in California. And one of our grantees for practical support, one of the lead abortion funds in California, while they’ve seen a surge in callers seeking their support and resources to help get the practical support they need to get abortion services from out of-state, there’s still… The majority of their callers are coming from California. So we have been able to make these funds work for folks in California as well as those forced to travel here.

“To my best of my knowledge, I’m the only senior advisor on reproductive rights in any governor’s office in the country, and that is because this governor is so committed to the issue.” – Julia Spiegel

MM: Thank you. And Julia, I wanna talk about Prop 1, and I think you’re the best person to talk with us about it. We know that when this decision happened, state officials in California reassured everyone that California would be safe as far as abortion access. We know that voters approved enshrining that in the state constitution, but we still hear nationwide uncertainty about the future of abortion even now. Can you sort of talk about, is California safe in regards to protecting that access no matter what? Or why are we still hearing uncertainty even though we do have Prop 1?

Julia Spiegel: Thank you, Mackenzie and thank you to Capitol Weekly and Open California for putting this together. For better, for worse, this is really timely, and we need to continue having these conversations, so thank you.

Prop 1, as you’ve mentioned Mackenzie, was overwhelmingly supported by Californians in enshrining the right to choose to have or not to have an abortion and to choose to have or not to have contraception in the constitution. And that was a very intentional effort to enshrine the right in the constitution, so that even if we have a different court down the line in California, if we have different politicians down the line, it’s up to the people to change that if they would like to, and otherwise it is at the supreme status in terms of the law and the state. But to your point, Mackenzie, that’s not everything, right? So first of all, there’s the law on the books versus the reality on the ground, and then there are broader set of dynamics at play that affect the whole nation, and so one piece of litigation that I’m sure most folks joining us today are aware of is the challenge to Mifepristone, one of the key abortion medication pills.

“I think this is a losing issue for the Republicans, it is a losing issue. Across the country, Americans believe that women have this right.” – Sen. Nancy Skinner

And while I think there has maybe been a sense of complacency and some blue states or some pockets across the country, that at least if we have constitutional rights in this state or we have statutory rights in this other state, that we’re protected. That is not necessarily the case in terms of actual access. So what this lawsuit that’s now out of the Fifth Circuit and then a cert petition has been filed to the Supreme Court, is challenging the availability of that critical medication abortion drug. Now, California has been very clear, we have a stock pile of alternative medication that can be used, and we will do everything we can to make sure that people have access to the healthcare that they need and deserve, but that does not mean that the threats don’t continue and that we don’t have to keep fighting to get out in front and ensure that we are prepared for all the different assaults that even in states like California are very real.

MM: Do you feel like we were prepared, in your work, especially, do you feel like this is something that the governor’s office or leaders in other states were preparing for a long time that this might happen one day, depending on the composition of the court?

JS: Look, the anti-abortion movement has been organized for decades upon decades, we all know that, and I think on this side of the ledger, we’re now getting much more prepared. We obviously did see the Dobbs decision coming down the pike, and the governor could not be more committed to this issue. So for example, to my best of my knowledge, I’m the only senior advisor on reproductive rights in any governor’s office in the country, and that is because this governor is so committed to the issue.

He also, dating way back to February, launched a Reproductive Freedom Alliance that now has 22 governors in it, and the nexus of that, the very import of that, is to allow for much more affirmative work and collective work across the country, so that we can build firewalls and increase access, broadly speaking, and be much more organized and prepared and affirmative as opposed to sort of being on the defense whenever a new assault is coming. So, the candid answer is, we’re playing a little bit of catch up, but we’re getting there and we are ready for this fight now and doing everything we can to prepare across the country.

MM: Thank you. We have Senator Nancy Skinner has joined us. She is the Chair of the Legislative Women’s Caucus and actually just authored some bills that were signed into law yesterday about abortion access. Senator, we discussed some of the new bills and how they compare to last year’s package as far as filling what officials like yourself say are big gaps in health care. I know that you were focusing on shielding providers too… And data privacy as well. Can you discuss that aspect of this? I think you’re on mute too, Senator.

Sen. Nancy Skinner: Certainly, and thank you for holding this panel and happy to see the other panelists. And just before I answer that one, to Julia’s point, once Amy Coney Barrett was approved as a Supreme Court Justice, it was clear that that court was gonna put abortion at risk. We just didn’t know how far they would go. And of course, did we necessarily expect that so many states would so quickly act? I’m sure there are people who did expect that, but I think a lot of us… I came of reproductive age at the point that Roe V Wade was affirmed, so I never had to concern myself with worrying about getting an illegal abortion or getting somebody’s permission, so I was always… I had that reproductive freedom from the point that I’ve came of reproductive age.

I think this is a losing issue for the Republicans, it is a losing issue. Across the country, Americans believe that women have this right. They may not themselves personally support or choose to have an abortion, but they think that this is a right we all should have.

Now, the biggest threat at the moment – the biggest threat, who knows what the biggest threat is – but a really serious threat is the threat to the two-drug regimen, that medication abortion, mife.. and I always forget the second one, but misoprostol and mifepristone. Anyway, those two drugs are so safe, so effective and they are what the majority of people use to have an abortion.

“I’m a pro-choice Republican and there are a lot of us, and we are tired of not being represented.” – Liz Lawler

So this threat to overturn the FDA or make them illegal is real. And I think that one of the things that we’re gonna have to consider, the state of California, if they go so far as that, is there is some rules within FDA approval that if a drug was already approved, that there is a possibility that a state could continue to use it. So we may have to act affirmatively at some point. We haven’t yet because we’ve not had to, but we may have to act to say, forget it… FDA already approved this, our state law is gonna make this… Is going to approve this drug, and we’ll make it available. Now my shield law, SB-345, which the governor just signed yesterday, it’s the first in the country, not the first in the country shield law. Vermont, Massachusetts, New York, a couple other states have it, but it’s the first one that basically offers full legal protections to all of our doctors, nurses, midwives, pharmacists, anyone who provides this kind of care.

But in addition to the reproductive care, it provides this legal protection for gender-affirming care. So that’s the part that’s first in the nation. The second part that’s first in the nation, which gets to your point, is that we saw this horrible circumstance where the mother in Nebraska was just convicted and sentenced to two years. How did they discover this? Because they subpoenaed from Meta, her Facebook records, and they saw that she and her daughter had communicated via Facebook around the use of the drug. And so that’s how they convicted her. The SB-345, which the governor just signed, basically prevents our social media companies, our data companies from cooperating with law enforcement on these issues. So that’s also a first in the country, and I’m really proud of it.

MM: Thank you Senator. Liz, I’d like to toss it to you. As we can see, it’s sort of a natural progression when we talk about this, that it becomes political. It’s one of the most emotional debates of our time. We previously had discussed that there’s a part of your party that wants to move away from their historic opposition to abortion. Can you tell us where you stand on that and what you have heard from your women who are constituents on the campaign about this issue?

Liz Lawler: Great question, and thank you for having me. I am delighted to be here. Actually, I am one of the candidates behind changing the platform and moving us forward into the 21st century. We are supposedly the party of women’s rights and self-determination. We are the party of non-discrimination. So there are some inconsistencies in our old platform that do not apply to modern society. The bulk of Californians, the bulk of Americans, are completely accepting of a women’s right to choose an abortion. Shocker, I’m a pro-choice Republican and there are a lot of us, and we are tired of not being represented. So we are behind this effort to acknowledge reality. This is what Californians want, this is what Americans want, acknowledge reality.

We can still have those beliefs and protect the unborn, but we must support women, we must support women’s health, and we must support a women’s independence and self-determination. So we are trying to remove those inconsistencies in our platform and move the party forward. We have a lot of independence that we’ve lost because of these issues. And we need to have balance in our government. We need to have healthy debate, and we have so many people that aren’t being represented currently by our current platform. So we’re really driving this forward and we really wanna be relevant and embrace really what people want and be the party voters need us to be.

MM: Is it difficult to be a woman who is pro-abortion in your party? Can you sort of discuss the kind of conversations that you have and do you think it’ll be a really heavy lift? Are we talking this will take years to see sort of a gradual shift, or do you think that you’re already there and it just needs to be official?

LL: We need people to stand up and make it happen. I think that there is a fear in some of our leadership that they don’t wanna lose the base. But I believe you can move a mountain, it’s one rock at a time. [laughter] So we will take anything we can that is in the name of progress. I can’t tell you how long it’s gonna be, but there is definitely a shift nationwide, and I am not alone. There are a lot of us in the Republican party who are for women’s right to choose and for gay marriage. I have a gay son who’s married. There’s a lot of us. And so I am not alone. And those folks that you refer to are in the minority, actually. There is a very heated debate, and it’s going to be a knockdown drag out fight this weekend. And we have a very vocal minority that is got this grip on old ideology that does not apply to modern society. And we really need to evolve and adapt.

MM: I wanted to ask you too, I spoke to some Republicans in the Capitol recently and some of them said we aren’t opposed to abortion outright, but they have a big issue with the focus on other states, which we were talking about earlier. Where do you stand on that, are you able to… Do you see voters concerned or not all in about helping other states, which we have done with other sort of laws like the Senator mentioned with gender-affirming care. But do you think that’s a hurdle to not only focus on Californians, but to other states that need California’s care?

LL: Well, technically, I do. I think that the bills that have been passed, me personally, I like the privacy protections. I like protecting our practitioners and those seeking abortions in our state. We want Californians to come to our state. I think from a practical standpoint, we have to look at what are the implications of that? What’s going to happen?

For example, look at New York, they’re being overwhelmed. And while we have this funding in this… I think you said $20 million in funding to support travel expenses, is that going to be spent out? Are we anticipating those costs? What’s gonna happen there? And I think particularly from the conservative side, it’s more of… There may be a concern about taxpayer dollars being spent for this. I mean, those are just the concerns I would throw out there, if that answers your question.

MM: Yeah. Senator, do you wanna respond to that? Do we have the infrastructure, which I asked Amy a little bit about already, but do we have the infrastructure and what do you say when you hear these criticisms that say, “Hey, you work for California, what are we doing?”

NS: I’m happy to respond. So look. Given that these other states where even their residents do not support these bans, these other states have acted the way they did, California felt an obligation to offer a lifeline. And additionally, let’s be real, I’m a Californian, yes, whoever, we all live here. However, most of us, many Californians came from somewhere else, and we may go somewhere else to another state to work for two years. I have nephews and nieces that are in school in another state. So I don’t look at it as like, okay, this person is just a resident of this state. No, we’re a very mobile country and we should be providing this right to whoever feels this essential healthcare that is legal in California, we should offer and make legally protected to anyone who needs it. That’s our attitude. So, of course we knew that for some people coming to California was gonna be very cost-prohibitive.

Now, let’s be real. So we funded and put that in the budget, but let’s be real, it is impractical for 90 some odd, 99% probably, of the people who confront a pregnancy that was not planned, was not… Is not practical for them at this moment. It is not practical for them to travel to another state. They have work responsibilities, family responsibilities, any other number of issues, no matter whether we pay them or not, which is why the medication abortion, this safe, completely safe, medically-approved is the way to go. And it’s why our advancement in our laws to protect people so that our healthcare practitioners can continue to provide medication abortion, not only to somebody who’s physically located in California, but to their patients who may be elsewhere.

So that one, I think it was really important for us to advance, in addition to our support for those folks who may need to come to our state. And again, I wanna remind people that somebody who comes to our state, they may have lived here at some point, or they may in fact be moving back here in a few years. They just happen to be, because of work or school or other reasons, caring for a family member in another state, which is why I think it’s a justification for using our taxpayer funds for this purpose.

MM: Yeah, I had an interesting conversation with a doctor recently. One of the bills passed yesterday would allow new doctors, so medical residents, to come to California, train in abortion up to 90 days, be paid for it, like normal residents and then move back if they so wish. And one of the doctors I interviewed is planning to do that. She’s from Georgia and she is really worried about women’s health, especially black women’s health there. She says that people in her hometown travel to Washington DC to get an abortion. And she may not… She doesn’t know if she’ll be able to perform abortions there ever. But she’s getting the training. She’s gonna move back to Georgia in 2025. And one argument in support of that is we have a provider shortage here. And they’re hoping she, while she’s a resident, she can fill in that gap those years she’s here, and then it’ll be up to her to, to go back or maybe move…

NS: So I’m really happy to hear that you talked to a medical resident or a doctor who felt that way and who felt they needed that training. I’m so glad that the Future of Abortion Council and the Women’s Caucus were able to put forward a bill like that and the governor signed it. And we know that all of our medical practitioners need this training. This is essential healthcare. And I think most of us believe that at some point in the future, it will once again be a right of all people in America to use… To have control over their reproductive freedom.

MM: One issue I really wanna talk about today is Crisis Pregnancy Centers. Even in California, they have been nearly impossible to more strictly regulate. There was news last week that the Attorney General is suing a group of Crisis Pregnancy Centers, but even he is not seeking to ban them or shut them down. He’s alleging false advertisement of their services. The Supreme Court overturned a law in California that had sought to more strictly regulate them. Julia, I think I’d like to ask you, because we do get into like legal implications here, and I think people are confused about why this is so difficult for state Democrats to do. Are we talking about religious freedom? Are we talking about constitutional rights? What is sort of the sticking point here with these centers?

JS: Well, so I’ll back up and just explain first what these centers are. So we try to not even call them Crisis Pregnancy Centers because that’s part of what’s false and misleading, right? They are not actually healthcare providers in the vast majority of circumstances. They’re fake clinics that seek to bring in women who are pregnant or other people who are pregnant, provide an ultrasound, tell them how old their fetus is, perhaps accurately, perhaps not, and then convince them to keep the child.

And so part of the challenge is that because they are not actually healthcare facilities, they are not regulated by the state as healthcare facilities, they’re separate entities. So I do think, for example, the lawsuit that you referenced, that Attorney General Bonta just launched against five different clinics for their false and misleading information is really important. He’s going after clinics that are using abortion pill reversal as a methodology that has no backing in the scientific literature whatsoever. And saying, that is false and misleading. You cannot convince people to pursue some sort of method that does not have scientific backing.

So I do think that’s really important in terms of getting at one of the tactics employed by these fake clinics. There’s another bill that I wanna highlight as well though, AB 1720, which was brought by assembly member Rebecca Bauer-Kahan. This is a bill that is part of our broader effort to do everything we can to ensure that people get the care that they need, the reproductive healthcare they need in the appropriate settings. And so what AB 1720 does is say if you are gonna utilize an ultrasound, a medical device or something similar, some other medical imaging device for some sort of medical or diagnostic purpose, it must be in a healthcare setting or provided by a licensed professional.

“So here, even in California, the number of these fake clinics actually outnumbers the number of real reproductive health and abortion providers.” – Amy Moy

And so, again, this is a very important way to make sure that medical information and technicians and procedures are not being used to essentially hoodwink people into taking courses of action or going to places that are not actually there to provide them healthcare. So I think these are really important… And that’s nation leading. This is a first in the country type of effort to regulate the use of ultrasounds in that way, and I think it will have a really significant impact.

MM: Abortion pill reversal, is not backed by science, by top medical organizations, but it is practiced across the state. And actually some of those clinics are licensed by the state. And so I think that’s why people are confused or sort of maybe even frustrated with the state for not figuring out a way to… They feel like,’ how can they have a right to a medical procedure that could be unsafe?’ I don’t know if the senator or Amy wanted to talk about the role of Crisis Pregnancy Centers or anti-abortion centers. Everything’s loaded. But the role of them in the anti-abortion movement… In the role of this abortion pill reversal.

NS: Amy, please go ahead.

AM: Oh, thanks Senator. And thank you senator for your leadership. And congratulations on getting some of your authored bills signed yesterday. We’re so grateful. I’m really happy that we’re having an opportunity though to talk about these fake clinics because it is a remaining issue that we do need to address. We talked earlier about some of the tea leaves of some of the remaining gaps and things that are left to do. And I think addressing the pervasiveness and the growth of these fake clinics is something that we have to take very seriously. So here, even in California, the number of these fake clinics actually outnumbers the number of real reproductive health and abortion providers. And so one thing that we have to make sure we do is in actually, which ’cause we talked about some of those strategies, some things that have already been in place, but to actually increase the number of health settings and healthcare providers that do offer this essential fundamental healthcare.

So increase pathways to real care that patients want and need. So some of the funding and grant programs that we talked about will help with that by expand… To helps expand the healthcare workforce, get folks trained up, be able to enhance their funding for infrastructure and provide uncompensated care. We’ve also, in California, taken a great step forward to support primary care providers like federally qualified health centers to be able to offer abortion services by allowing them to bill for abortion care outside of their kind of community health center codes. So doing a number… And we also are training providers at Essential Access to be able to offer and integrate abortion services into diverse health settings, including – thanks to California’s SB 24 – on campus health centers, we have now trained up all of the UC and CSU campus health centers to be able to provide abortion care as well as looking at primary care settings, both public and private.

So I think that that’s a key issue we have to keep looking at, is expanding access points. And that’s something that we’ve made progress on and have to continue to do so. But Mackenzie, you did lift up something that I also wanted to elevate, which is some of these fake clinics are getting licensed as health centers. And we do… That is something that we have to look into it because they are not providing comprehensive healthcare. They are offering services, as the AG has exposed, that are not real. They have deceptive and misleading tactics and should not have added credibility from the state by being licensed as healthcare providers. They all… Some of them also receive Medi-Cal and Family PACT reimbursement for some of the services that they claim to offer. And so that’s something that I think we also have to look at. I don’t think one state dollar should be going to supporting these fake clinics.

I think also looking at continued education, some of the new funding, like the Reproductive Justice Fund is to help counter some of the misinformation and misleading tactics of these fake clinics. But they are growing. And if you look at the areas where they are growing, they are in communities that are… Have lower income households, that are in communities of color. And so their strategies do need to be exposed and countered.

So increased public awareness to let folks know, to not be fooled, to not be… To be aware of the deceptive tactics that these folks are putting out there so that they don’t have the care that they want and need delayed when they see a sign, “pregnant, need help, we are here for you.” We also know that people will go there and then, like Julia mentioned, kind of get biased counseling and get dissuaded from the care that they want and need from people who have an agenda and not their best interest in mind. So I think that we also do need to have a greater public awareness about the strategies and tactics of these fake clinics.

MM: Julia, the state is doing something about as far as awareness, right? We have a website now, correct?

JS: Exactly. It’s abortion.CA.gov. And this was again a nation-leading website that we launched. we had legislation last year. Thank you, Senator. And it’s extraordinary. I mean we worked with a wide group of stakeholders to develop it. It lays out very clearly what are your rights, what are the available resources to help you in accessing those rights.

“I think we all know that in 1967, with the Therapeutic Abortion Act, Reagan legalized abortion because he wanted to protect women and young women from dying from back alley abortions.” – Liz Lawler

We know rights only mean so much on paper, but you have to actually be able to avail yourself of those rights. And in addition, we’re very clear on this website that anyone’s information is protected. So we are not tracking individuals, we are not keeping their IP addresses. There are many other websites where that is not the case. And so we wanted to be very clear that this is a resource that anyone can use without fear of what may happen to them, like the mom in Nebraska and elsewhere. And so that was really of paramount importance to us.

You can also see, and we will update it after the bills that were signed by the Governor yesterday, and thanks to the Senator’s leadership and others, we will update it. But there is also a comprehensive link there that states basically all the key actions that California has taken to protect patients and providers and enhance access in the state all in one place on that website.

AM: And I just want to add how important that is because we’re finding here in California also that just, even though we’ve done such amazing work to enhance protections here, that because the overturning of Roe V Wade has been such a national conversation on all media platforms, that there is confusion even here in California about, is abortion legal here? What are the legal protections? Still confusion or fear of like, oh, maybe that’s something that’s out of reach for me because I can’t get to an abortion provider, or I can’t afford services, or I have confidentiality concerns to be able to utilize my insurance to get this care. So I think that also something like abortion.CA.gov is so important because, again, there is… Not only to counter the misinformation but also to clear up the confusion and increase awareness, as Julia said, about what we do have in California to make access not only a right, but actually available.

NS: Well, the… If you don’t mind me jumping in Mackenzie, the portions of various of the bills that did more to protect one’s privacy either from their use of their cellphone or Internet use or from having our different data collectors not cooperate with law enforcement, that is so important because, yes, if you’re in California, our laws protect you. But these states, some of them are becoming so aggressive. What if you go into another state and this data is on your phone, and while it may have happened prior, if they want to come after you and they are able to get access to data, then another state could potentially prosecute you. I mean these are not out of… We don’t see it happening yet, but it’s… Given the aggression of some of these states in terms of this kind of prosecution. So, these privacy measures are so important. And I’m really happy that the Future of Abortion Council and the members of the Women’s Caucus brought forward more bills to add more protection in that way so that we could…

Now, of course, many, if you’re just a regular California resident, do you know that? And yes, this website is so important to help spread that information, but we also have to spread it other ways. We have to do our best to reassure folks in California that your privacy is protected. You have the right to all of this care, and you can use your Medi-Cal or insurance, and we don’t have restrictions. And we need to get that word out to help people feel safe. Because when they read about things like the Nebraska mother being sentenced to two years, I mean, that’s got to put fear in so many people.

MM: Liz, is this industry something that you’re familiar with, that you talk to people about? I know one of the big arguments from Republicans who support the senator saying we have a right to disagree with abortion just as much as someone has a right to agree with it. And I visited some of these centers recently for a story, and they point to other services. So they point to, ‘we gave away 10,000 diapers or we gave away car seats, and we do have religious freedom and we don’t hide that this is a religious organization.’ But then, of course, you’ve heard that the criticisms of that is that I did see magazines that had false information about cancer links to abortion and things like that. Can you sort of speak about the balance of these two issues?

LL: Sure. Well, I mean, the whole focus is on women’s health care, right? And I think we all know that in 1967, with the Therapeutic Abortion Act, Reagan legalized abortion because he wanted to protect women and young women from dying from back alley abortions. Right. Our focus should be on providing health care for all women and ensuring that they are getting proper and appropriate and safe health care, bar none. So if there is any agency that is operating under false pretenses that is not caring for our women. And while I know that those agencies will claim religious freedom and things like that, but they are doing a huge disservice to our young women and women of all ages if they are not being fully transparent. That is my personal opinion. And I do think that you have a very good argument because it is misinformation, because we are talking about the livelihoods and lives of women and their care and they need proper care before and after procedures.

MM: Liz, remind me, did abortion even come up last night at the GOP debate?

LL: You know what? I have to admit I didn’t watch the whole thing I headed to bed…

MM: I did watch it. I don’t remember catching it. But I’m wondering is this, so have we moved on? I don’t think so but…

LL: But I think I did… If I may, I remember in the first debate, I think Nikki Haley said something really smart, which was, ‘let’s acknowledge Americans are for this. Let’s come to consensus and whatever that consensus is.’ But we all know here in California that abortion is codified. It’s in the constitution. It is secure, it is safe and we are doing everything we can to protect our women.

MM: Senator, I’m going to put you on the spot because the abortion access bills in the Caucus… sponsored by the Caucus easily got Newsom support. They did last year too. That is not a surprise at all. But what has failed to get to his desk are bills about regulating these centers. Is that any sort… Have you had any sort of conversation within the Caucus to maybe come back at it again next year to figure out something to do about that?

“They are coming for our birth control. This is… If you think about a lot of the attacks that are happening now, they are not centered only on abortion. It’s about autonomy.” – Amy Moy

NS: Well, I know that this is something we’re going to continue to work on, and I think Julia pointed out there’s legal issues around some of this, constitutional issues. So we’re going to have to be… We’re going to have to think out of the box and be as clever as possible. I mean, even, for example, my shield law a couple years ago, nobody would have thought, oh, we should… Either that it’s legal or that we should add protections to California providers for health care they might provide to somebody in another geographic location outside of California.

But given the, again, very mobile society and the growth of telehealth and so many other… I mean, if I were a doctor, I could have a patient that started with me while they were in California and is either permanently or temporarily in another state. So all this makes a lot of sense. It’s just that we had… Neither did our laws really capture it before nor did we fully understand how to do it in a way that was legally viable. So it took a lot of lawyers sitting down and really thinking it through to construct the law in a way. And fortunately states like Mass and New York had acted so there was some models, but again, to construct the law in a way that we felt would withstand challenges in court.

So that’s a similar thing that we have to do around these fake clinics – because they are fake, and I completely agree with Amy, they should not be getting a dime of our Medi-Cal reimbursements or any of our other funding. They’re fake. So we really need to think thoroughly about what ways we can limit them and limit their licenses. And I’m really proud of the Attorney General for taking the… Initiating the lawsuit that he initiated last week.

MM: We’re going to take some questions from the audience, but before we do, sort of quick fire here, women’s health care and reproductive health care isn’t just about abortion. It is the issue of the year. But I’ll open this up to anybody. But what do you think is the next big… What should we be paying attention to women’s health wise? We talk about family planning. We talk about paid leave. Should we be worried about birth control access? Not sure who wants to weigh in for…

NS: I’ll jump in.

Almost all of the laws we’ve done have not covered only abortion. They’ve also covered contraception. Because we know that there are some People who even want to put that at risk. And when I say some people, some of the anti-abortion forces. So we were careful and the Future of Abortion Council was very wise in directing that almost all of the protections, including our constitutional Prop 1 that Senator Atkins authored, included protections for access to contraception. But I think… We’re talking abortion and we, all of us here who’ve been speaking agree that women have the right to control their reproductive functions and their choices. However, we also know that we want to be… That for those of us who want to have family and want to have… Bear children and such, whatever point we decide that, we want to have the best health care possible. And the reality is that if you’re Black, especially if you’re black and a birthing person or a little less but still factor Latino, or Native American, your outcomes, both your outcomes as the mother, as the pregnant person and the infant are much worse.

The infant mortality is far higher and maternal mortality, and many people you remember reading about Beyonce and the complications in her pregnancy or our tennis star, blanking the name right now. I’ve got jet-lag, so…

MM: Serena.

NS: Yes, Serena. These things they’re… It’s across socio-economic status and even education status, if you are a black birthing person. So we need to do much more about improving the health care, especially the maternal and infant health care for our women of color, our Black people birthing.

“This is a health care issue, and the assault that we see has ripple effects and consequences on the health of people of reproductive age and after. And so I think we do have to take a holistic approach to tackling it.” – Julia Spiegel

AM: Yeah, absolutely. Senator, I was going to also echo some of the things that you said, but I would say they… A few things. One is they are coming for our birth control. This is… If you think about a lot of the attacks that are happening now, they are not centered only on abortion. It’s about autonomy. And that’s a connection and a through line across whether it’s abortion, birth control, gender-affirming care, our autonomy to have control over, and our own destinies and our bodies. And that’s a through line of the attacks that we’re seeing. And so also really proud of the effort and the Senator’s bill that includes gender-affirming care and abortion. And I think that as we move forward, looking at how we have to look at these intersecting issues together.

Also, I think that while we’ve been talking about California being a reproductive freedom state, I think we also have to make sure California is a reproductive justice state. And we’re really lucky here in California to have an amazing group of reproductive justice leaders that aren’t represented here today, but want to give them a shout-out and to say, in addition to looking at Black infant health mortality disparities, we also have to make sure that the right to have children is honored and accessible and available for all.

We talk about being pro-choice. Well, for some folks, maybe they don’t have a choice for many reasons. And so, looking at also the right to have children equity in fertility treatment, and care, and coverage. I also think that we have to make sure… Again, you mentioned, Mackenzie, paid leave. We have to… Looking at things like our minimum wage, worker… all of these things are so interconnected because when we think about reproductive health and our reproductive lives, it’s connected to our economic security, our families. We need universal pre-k for children who we have here in California to be able to thrive across the board.

And just going back to Essential Access Health administers the Title 10 federal family planning program in California and we have for the last 50 years. And we see… Liz and I were talking earlier about when she was talking about trying to remove the anti-abortion position from the Republican Party platform. But in California, the Republican Party platform does have support for family planning services, which is a great step forward because the national platform is anti-family planning.

And we see that play out in… At the national level with whenever the… One side of Congress is controlled by Republicans that they zero out Title 10 federal family planning funds, which have been level-funded for the last almost 10 years as the need for care has gone up and as the cost of providing care has increased. And so I think in California, continuing to look at how we fill the gap potentially in funding from the federal government to support family planning services. California did that once when we had a 40% cut from the federal government in Title 10 funding, as well as looking at how with a demonstration waiver that’s now being considered at the federal level to bolster family planning services and access.

So continuing to look at how not only in our rights but also in making access equitable that we look at contraceptive care and access as well as continuing to look at sex education. We’ve passed some really great laws, but the consistency of provision of care and accountability of what actual sex education is being offered in our schools across the state is inconsistent and accountability is inadequate.

MM: Thanks. Liz, I know you want to weigh in here.

LL: Yeah, I wanted to weigh in, just a question to Amy.

MM: I actually have a question from the audience for you too…

LL: Okay. I’ll be super quick, Amy I’m sorry, I misspoke. We don’t explicitly say we support family planning, but we don’t not say it. In other words, we’re acknowledging that that’s here and we’re acknowledging the support of adoptive families as well. So I just wanted to clarify that. But also in terms of women’s health, we’re always talking about reproductive health, which of course is super important, but we’re not talking about aging as well, the diseases and the things that impact older women when we go through menopause. Things like osteoporosis and other things. And I think that we would really be smart and helpful to prioritize these things for our aging women population because these are real, and these are not getting the attention it deserves. So I’d really like to see something like that happen as well.

MM: Liz, a question from the audience: “Even if California’s Republican Party does step away from this opposition, they ask what would removing that plank from this party achieve if, like Amy mentioned, the national party is not moving in that direction?”

LL: Well, you know, the saying what happens in California happens in the rest of the country. We are the largest state party in the country. And if we’re going to drive innovation and drive this conversation, it has to start somewhere. And there’s already national recognition that abortion really should not be an issue that we… The hill that we die on, right? Because the Democrats bludgeon it with… Us with it every single time so. And it’s a reality. I mean let’s…

NS: Legitimately.

LL: Legitimately. Yes. So, and there’s a lot of us, like I said, that support a woman’s right to choose. So let’s just remove that from the conversation altogether.

MM: Julia, I know you want to weigh in. I think there’s a question from the audience that you might be best to answer, maybe the Senator too. But they ask: “Mexico recently decriminalized abortion, and would that have an impact on Americans who live in anti-abortion states? Like, could they travel to Mexico for an abortion?” I know it’s a little outside of the California law conversation we’re having here but…

JS: I’m not here to give legal advice to anyone. I’ll just be clear about that. But I wanted to weigh in just in terms of the priorities. I mean, I really want to echo what Amy and the Senator and Liz said just about holistically looking at health. This is a health care issue, and the assault that we see has ripple effects and consequences on the health of people of reproductive age and after. And so I think we do have to take a holistic approach to tackling it. That is why, when the Governor launched the Reproductive Freedom Alliance, he chose that terminology,… You can’t have reproductive freedom unless you have reproductive justice, to Amy’s point. You can’t have reproductive freedom unless you have reproductive access, so you can actually avail yourself of that. So that is what freedom truly means. That’s what the autonomy to make those healthcare decisions mean. And so we feel very strongly that we have to take a holistic approach in ensuring that that freedom is available to everyone in this state and anyone who needs to travel to this state for care.

I also want to note, contraception is absolutely next on the chopping block, to Amy’s point, so is potentially fertility treatment, right? What may happen to those embryos that have been fertilized for individuals who are struggling to have children through ordinary means and need fertility treatment, that too may be challenged. So the whole spectrum of reproductive health care, I really do think is at risk, and we have to be really comprehensive in our approach.

I also just want to note that data of all kinds, to Senator Skinner’s earlier point about the mom in Nebraska, all kinds of data is at risk. And one of the bills that the governor signed yesterday protects electronic health records, where there was a loophole that if you traveled from Texas to California for care and you went back to Texas and both providers use the same health care system, health care record system, your records could be vulnerable and accessible in Texas. That is no longer going to be the case for California, which is huge. But we have all kinds of data, all of us, all of the time. And so I think we really do have to take a broader look at that approach.

In terms of Mexico, I was not getting a complete dodge in terms saying I’m not here to give legal counsel. I don’t think there’s anything to say. You may not travel to Mexico if you’d like to travel to Mexico and do what you’d like to do in Mexico, but I do think that’s a really sad reflection of where we are as a country, if that’s what’s happening, if that’s what’s required. Who even has the resources and time and means to travel to Mexico for care that they can’t receive in their own state?

NS: There’s already news reports of clinics in Mexico indicating they’re having a large uptick of Americans going to Mexico. We’ve so much been talking about your reproductive choices, but for many birthing people, this is life or death. Their health, they’re at risk of dying if they carry out a pregnancy. And so this, again, when we speak about essential health care, I just want to reiterate that point, it is essential healthcare. That, for some number of people, is a matter of life or death.

And I mentioned before about, and other of our panelists talked about it also, about this real discrepancy in the outcomes of if you’re a birthing person who is Black or Native American or Latino. And so I was really, really proud. And the governor signed it to do the Momnibus bill a couple of years back. And that bill is allowing for Medi-Cal to support things like doula care, both postpartum and pre, during pregnancy, much more extensive services. So, we’re really… California is taking a very comprehensive approach. Is there more to do? Yes, but we’re taking a very comprehensive approach.

MM: All right, that’s it. Thank you everyone for joining us, for watching, and to our panelists. We have another panel coming up right now, so you can join that one. Thank you so much.

Julia Spiegel: Thank you.

Amy Moy: Thank you.

Tim Foster: Thanks everyone. Thanks for tuning in…

Thanks to our Women’s Health sponsors: THE CALIFORNIA HEALTH CARE FOUNDATION, THE TRIBAL ALLIANCE OF SOVEREIGN INDIAN NATIONS, WESTERN STATES PETROLEUM ASSOCIATION, KP PUBLIC AFFAIRS, PERRY COMMUNICATIONS, CAPITOL ADVOCACY, LUCAS PUBLIC AFFAIRS, THE WEIDEMAN GROUP and CALIFORNIA PROFESSIONAL FIREFIGHTERS