Op-Ed: We need two laws to ensure reproductive choice for all Californians

The U.S. Supreme Court just gave Texas the green light to ban abortion before most people even know they’re pregnant. With access to reproductive healthcare under attack across the country, many Californians are asking what they can do to help.

In addition to supporting advocates and providers in Texas and other states with limited services, we need to do everything we can to expand access to the full range of reproductive healthcare here in California. We must continue to set the example for what evidence-based healthcare looks like.

As a gynecologist, I know very well the critical role that contraception and abortion play in my patients’ lives, allowing them to plan if and when they will have children and giving them more control over their lives.

I also know from my practice that not every contraceptive method is right for every person, and people have individual preferences about what features of a birth control method are important to them.

A bill introduced in the state Legislature this year, SB 523 by Sen. Connie Leyva (D-Chino), addresses important shortcomings of existing law, including the Affordable Care Act, by mandating coverage for the full range of contraceptive options, including vasectomy and over-the-counter methods. We know that certain populations — especially Black, Indigenous and other people of color, as well as those living on low incomes — continue to face barriers obtaining the birth control they want.

Right now, if someone wants to use an over-the-counter contraceptive method, such as spermicide or hormonal emergency contraception (sometimes called the morning after pill) — or, in the not-too-distant future, an over-the-counter regular birth control pill — the only way to get insurance to cover such contraception is to get a prescription for it first. That makes absolutely no sense.

The Food and Drug Administration has already determined that these methods are safe and effective enough to be sold without a prescription. Requiring someone to get a medically unnecessary prescription to get insurance coverage undermines the improvement in access that over-the-counter status confers. SB 523 would remedy this inconsistency.

The measure also seeks to expand contraceptive coverage benefits to millions of Californians, including those enrolled in health plans operated by institutions of higher education, and to prohibit employers from discriminating against their employees based on their contraceptive and reproductive health decisions. All Californians should have equal access to birth control regardless of where they work or go to school.

Another important bill, SB 245, was introduced by Sen. Lena Gonzalez (D-Long Beach) this year to expand access to abortion care. SB 245 prohibits California-licensed health plans and insurers from applying patient cost-sharing (including deductibles, copayments or coinsurance) to abortion and abortion-related services. By eliminating cost-sharing for abortion care, SB 245 would help remove the biggest barrier to abortion access — cost. While California requires health insurance plans to cover abortion, many patients are still forced to pay up to thousands of dollars in deductibles, pushing abortion access out of reach for families living on lower incomes. As my colleagues at UC San Francisco have found, significant harm results from the inability to obtain a wanted abortion.

Nationally, the right to legal abortion has faced the worst year on record and is in unprecedented jeopardy at the U.S. Supreme Court. Against this backdrop, the California Legislature — with a solid reproductive freedom majority and overwhelming support for reproductive freedom among California voters — has an opportunity and obligation to expand access to reproductive healthcare here at home.

That’s why it was so disappointing when both SB 245 and SB 523 were unexpectedly halted in the Assembly Appropriations Committee, which is chaired by Assemblywoman Lorena Gonzalez (D-San Diego).

With polls showing the outcome of the upcoming recall election extremely close, with the Texas abortion ban in effect, and with a Supreme Court case looming that could gut or overturn Roe vs. Wade next year, we can’t wait another year to safeguard reproductive freedom in California.

If Californians are forced to wait until next year for these bills to pass, there is no guarantee that we will have a governor who will sign these bills into law. In the face of political uncertainty and an ongoing pandemic, the time is now to advance health equity and continue California’s long history of protecting and expanding access to reproductive healthcare for all.

Daniel Grossman is a professor in the department of obstetrics, gynecology and reproductive sciences at UC San Francisco.