It looks bad when Robert F. Kennedy Jr. is ahead of you on scientifically sound health policy (women’s health, even worse), but that’s exactly what happened to Gov. Gavin Newsom last week.
Ouch.
During a Cabinet meeting, Kennedy kowtowed to Trump for more than six minutes. That’s pretty standard for these increasingly bizarre meetings, but the Secretary of Health and Human Services specifically praised the president for “ending the 20-year war on women by eliminating the black box warnings about hormone replacement therapy.”
Although this shocks me, RFK Jr. has a valid point.
Days later, Oscar-winning actor Halle Berry appeared on stage at The New York Times’ DealBook Summit to deliver an unexpectedly scathing criticism of Newsom’s veto of a menopause treatment bill.
“But that’s OK,” she said of Newsom’s repeal of the Menopause Care Equity Act (AB 432), which she lobbied for and received strong bipartisan support in the Legislature.
“Because he won’t be governor forever and he ignores women, who make up half the population, and devalues us middle-aged people, he probably shouldn’t be our next president either,” Berry said. “Just saying.”
These two incidents illustrate just how complex and controversial menopausal care has become over the past few years, as women are not only talking about it more openly, but asking for care is, well, essentially always being denied or denigrated as unnecessary.
Looking deeper, this seemingly unexpected menopausal moment goes to the heart of an insurance issue on which most Americans, men and women, have an opinion: How much power should insurance companies have to deny care that doctors deem reasonable?
Simply put, menopause is a stage that all women go through when their fertility ends, meaning 50% of the population goes through it. It has specific, life-changing symptoms—most of which are treatable, but often untreatable because many doctors aren’t trained in menopause care (or perimenopause, which comes first) and the science is often ignored or misunderstood.
The result is that too many women are stumbling through menopause, unaware of what is happening to them and unaware that excellent, science-based treatments are available to help.
A prime example is the “black box” warning that has appeared on many hormone replacement drugs since the turn of the century, when a large but flawed study found that such drugs may increase the risk of cancer or other diseases.
The Black Box Warning is the most serious warning issued by the U.S. Food and Drug Administration for a drug, putting it under Hormone Replacement Theory (HRT), severely discouraging its use.
The subsequent two decades of research not only revealed the flaws in the first analysis but also showed the significant benefits of HRT. It prevents cognitive decline, reduces heart disease, relieves symptoms like hot flashes, and has many other benefits.
In early November, the FDA removed these warnings from many HRT drugs. The result could be making these drugs more accessible to more women, as doctors no longer hesitate to prescribe them and women no longer fear using them.
“For decades, misconceptions surrounding these risks have been exaggerated and divorced from true scientific dogma, resulting in missed opportunities to improve their lives at a population level for older women in developed countries,” Michael Rodgers, chairman of the Santa Clara County Health Advisory Committee, wrote in public comments about the change.
While Rogers is right, insurance coverage and physician knowledge remain issues for women seeking care—problems that the Menopause Care Equity Act hopes to address.
The bill would require private insurance companies to cover FDA-approved menopause treatments and reward doctors who voluntarily take continuing education courses on menopause topics. The final version has watered down from earlier proposals that would have mandated coverage of more treatment options (such as compounded hormones that are not FDA-approved) and required menopause training for doctors.
But Newsom appears to be taking issue with a part of the bill that prohibits insurance companies from applying “utilization management” to menopause treatment—and that’s where we come back to agreeing with Robert F. Kennedy Jr.’s point.
Utilization management (UM) basically means insurance companies decide what patients do and don’t need—pre-approvals, reviews, and denials, which often seem to be more about cost than care.
Now artificial intelligence is getting into the utilization management business, which may mean it’s not even humans deciding our treatments. The University of Michigan is a multi-billion dollar industry that strives to keep health care affordable, often by denying care.
That’s why Rep. Rebecca Ball-Kahan (D-Orinda), the author of the California bill, banned the University of Michigan.
When it comes to coverage, “the standard is ‘medically necessary,'” Ball-Kahan noted.
“When you talk about menopause, it’s a very vague term, right? I mean, I’m going to survive it in the short term without any treatment,” she said. “So when it comes to menopause care, ‘medically necessary’ is a very vague thing.”
In his veto message, Newsom said the U-M ban “will limit the ability of health plans to adopt practices that have been proven to ensure appropriate care while limiting unnecessary costs.”
But the truth and the problem with menopause care is that it is specific to the individual woman. Just like birth control pills, a treatment that works for one woman may cause side effects for another. Finding the right path through menopause often requires a lot of trial and error, and women need the freedom and flexibility to have one-on-one treatment with their doctor. No distractions.
In June, Kennedy cited prior authorization as an issue across the health care industry and announced shortly after that he had received commitments from many large insurance companies to reform the process by 2026, eliminating the need for prior authorization for many treatments and procedures and streamlining the process overall.
It would be really great if this reform came to fruition – I’m hopeful – but in the meantime, we’ll see. The changes are expected to begin in January.
Back in California, Newsom also promised to do something about menopause coverage when he announced his budget proposal in January. Newsom said in his veto message that he would go that route — adding it to his budget proposal — rather than enact a new bill during the regular legislative session. This is still the plan, but there are no details yet.
Apparently, someone forgot to mention this to Berry.
The budget is increasingly becoming a catch-all for the governor who wants to get legislation done with less fuss, because the budget and its preview bill are always passed at some point, which may be an easier path for him to control.
Newsom has made supporting women’s rights, particularly in reproductive health care, a central part of his policies and presidential campaign, and women’s equality is a cause championed by his wife, first partner Jennifer Siebel Newsom.
But the governor has long been hesitant to pass legislation that would add costs (for most private pay consumers, the menopause bill would likely increase individual premiums by less than 50 cents a month). With federal cuts, premiums rising and health care generally in disarray, his caution is not unfounded.
But in this case, maybe it’s misguided. The only real opposition to the California bill comes from insurance companies. Go do the math.
Ball-Kahan said she has been in contact with the governor’s office but remains committed to pursuing laws that would limit use.
“I’m delighted to hear that we’re on track to achieve this, but it has to be done in a way that really makes a meaningful impact on women getting the menopausal care they need,” she said.
Newsom’s October veto caused few ripples. Thanks to Berry’s swipe, his January proposal will not only receive attention but scrutiny.
If he does lift restrictions on UM, he will need to answer the broader questions that action will raise — How much power should insurance companies have to overturn the decisions of doctors and patients?
It will be a strange day in January to see Kennedy and his chaotic and questionable Department of Health and Human Services provide women with better health care options than the state of California.
It would be even stranger if Newsom put a price tag on women’s well-being.
