Recent events have highlighted a growing debate over menopause care and the role of insurance companies in determining access to treatment, placing California Governor Gavin Newsom in a politically uncomfortable position. The situation unfolded as Robert F. Kennedy Jr. received praise for advocating for changes to hormone replacement therapy, while Newsom faced criticism for vetoing a bill aimed at expanding menopause treatment coverage.
A Shifting Landscape in Menopause Care
The controversy began with a Cabinet meeting where Kennedy commended President Trump for removing “black box” warnings from hormone replacement therapy (HRT). These warnings, initially implemented around the turn of the millennium following a flawed study, had significantly curtailed the use of HRT despite subsequent research demonstrating its benefits, including protection against cognitive decline and heart disease. The FDA removed these warnings in early November.
Shortly after, Oscar-winning actor Halle Berry publicly criticized Newsom’s veto of the Menopause Care Equity Act (AB 432) at the New York Times’ DealBook Summit. Berry, who lobbied for the bill’s passage, stated that Newsom’s decision to overlook the needs of women “probably should not” qualify him for the presidency.
AB 432, which had bipartisan support in the California Legislature, would have required private insurance companies to cover FDA-approved menopause treatments and incentivize doctors to pursue continuing education on the topic. However, Newsom objected to a provision prohibiting “utilization management” (UM) – the practice of insurance companies pre-approving, reviewing, and potentially denying care based on cost considerations.
The Core of the Dispute: Insurance Oversight
The debate over UM underscores a broader question about the power insurance companies wield over medical decisions. Assemblymember Rebecca Bauer-Kahan, author of AB 432, pointed out the difficulty in defining “medically necessary” when it comes to menopause care, given its individualized nature. Newsom, in his veto message, argued that restricting UM would limit insurers’ ability to control costs.
Interestingly, Kennedy also spoke out against prior authorization requirements in June, securing pledges from insurance companies for potential reforms by 2026. This has led to the unusual situation where Kennedy’s position on healthcare access appears more progressive than Newsom’s, at least in this specific instance.
What’s Next?
Newsom has indicated he intends to address menopause coverage in his January budget proposal, potentially adding it as a “trailer bill” – a measure attached to the budget that is typically guaranteed passage. However, it remains unclear what specific provisions he will propose. It is possible he will attempt to address concerns about utilization management while still maintaining some level of cost control.
If Newsom’s budget proposal fails to satisfy advocates like Berry and Bauer-Kahan, further legislative efforts to limit insurance oversight of menopause care are likely. The outcome could also be influenced by the success of the insurance company reforms pledged by Kennedy, which are slated to begin in January.
Frequently Asked Questions
What is utilization management?
Utilization management, or UM, is when insurance companies decide what medical treatments a patient needs, often through pre-approvals, reviews, and denials, which can be driven by cost considerations.
What is the significance of the FDA removing the “black box” warning from HRT?
The removal of the warning could lead to greater access to HRT for women, as doctors may be more willing to prescribe it and patients may be less fearful of using it, based on more recent research showing its benefits.
What was the purpose of the Menopause Care Equity Act (AB 432)?
The bill would have required private insurance companies to cover FDA-approved menopause treatments and encouraged doctors to pursue additional training in menopause care.
How can we ensure equitable access to healthcare for all, particularly as it relates to conditions that disproportionately affect specific demographics?
Related reading