Roughly half the population will go through menopause in their life.
Recently, lawmakers have been working to close the gaps in care that many women are facing. In California, two menopause care bills have received widespread support at the State Capitol.
But both bills were vetoed by Governor Gavin Newsom, who stated in a letter about one of the bills that it was “too far-reaching” because it would have required health insurance plans to cover expensive and non-FDA-approved treatments.
This issue entered the national spotlight during The New York Times DealBook Summit last week, when actress Halle Berry spoke about women’s health and called Newsom out for his opposition to the legislation.
“With the way he’s overlooked women — half the population — by devaluing us in midlife, he probably should not be our next president either,” Berry said. Newsom later told TMZ he had reconciled with the actress and that menopause funding will be added into next year’s state budget.
Democratic Assemblymember Rebecca Bauer-Kahan authored AB 432 and its predecessor, AB 2467. She spoke with Insight Host Vicki Gonzalez about her legislation, the roadblocks it encountered, and other policy challenges surrounding women’s health.
This interview has been edited for length and clarity.
Interview highlights
You were first elected in 2018. How did menopause care enter the conversation and become pieces of policy and legislation?
I'm now in my late 40s and I'm personally perimenopausal. So it really came to me through my own lived experience of not being able to find the right care, and my friends not being able to get the coverage they needed.
The experience of going through menopause can vary greatly from one person to another, and it could be common for some to not know much until they start experiencing it. When you were talking to stakeholders, what did you learn?
I've learned so much and honestly I'm now way more knowledgeable than I was when I was seeking care. But I've learned exactly what you said: it is different for every woman. Every person with ovaries will go through it if they live long enough, but it is something that requires individualized care. And then if we get the care we need we can live longer, healthier lives, and we can live the lives we deserve in our midlife. So we should have physicians and nurse practitioners and others trained to provide us that care, and it should be easy and accessible.
And that currently doesn't exist?
What we experienced and what we were able to confirm through our independent analysis, that's done in all healthcare bills in California, is that some care is covered. So if you have an estrogen patch – which is really frontline care — it is covered but there are many women, say you have a risk of breast cancer, who can't use those treatments and many of the alternative treatments are not covered by insurance.
And I will tell you that the training piece might be even more important because as a woman who went to three doctors, and it was only the third who could actually have the conversation with me, we need more physicians trained to help women get the care they need.
What kind of training and information do physicians receive about menopause?
From what we've gathered it can be an hour, one lesson in medical school. It is incredibly minimal what they are learning. The Menopause Society, it is a place to get good science-based resources for women looking for menopausal information, is taking steps to get Menopause Society-certified doctors who do have a better understanding and better training on these subjects. But doctors have to seek it out; it is not part of their medical training currently, although we're seeing a shift, the conversation that women like me are forcing is changing things like this every day.
You authored a pair of bills related to menopause care. What would they have done if they had been signed into law?
They were different pieces of legislation, but both fundamentally did two things. It ensured that when you walked into a doctor, they knew what the best way to treat you was if you were a menopausal woman. That's important not just for our frontline doctors… but for our cardiologists, for our neurologists, it affects your brain. When you have brain fog, you need the person you're talking to to be thinking about the way your body is changing in midlife.
In the second bill we actually went so far as to say that it needed to be part of their continuing education, which hit roadblocks. So then we shifted to incentivizing them getting that continuing education in California. And then it required that the insurance companies cover the care that was prescribed by these doctors that had the expertise to decide what our bodies need.
Why did you hit roadblocks?
This is not easy. We are just starting this conversation about menopause, and women are now almost half of the California State Legislature. That is a huge improvement in this conversation and the way it's being received, but it is a lack of understanding, honestly. There is very little research done on women in midlife on menopause.
Halle Berry has done huge work in Washington to get money [for] research on menopause and that's really important. But that lack of understanding has led to roadblocks of people not understanding. This is a context where insurance companies saying it's not medically necessary may be based on a lack of understanding of what our bodies need at this point.
Your bill overwhelmingly passed in the State Assembly and Senate, but Governor Newsom vetoed it saying, in part, it was too far reaching or had unintended consequences to healthcare costs. How do you respond to that?
Costs are really important. We are at a moment where as a result of what is happening in Washington healthcare costs are going to rise for everyday Americans and that includes Californians. So we do need to be vigilant about healthcare costs. We have the independent analysis that was done on the bill and it shows the costs would be minimal, so we really felt like we had managed the cost through the amendments we made in the bill, but [Newsom] didn't think I did enough.
So in the veto message it said he was going to work with us on it, and he was going to pass legislation in the budget which means it goes into effect immediately. Even in September we were excited that perhaps we could get menopausal related work done as early as January, and he's made that commitment… and I'm optimistic that will happen.
Since you had such overwhelming support, you could have overrode the governor's veto with another vote. Why not go that route?
I have never in my time in the Legislature seen a veto override, and there have been supermajorities in both houses my entire tenure. I think all government should be people working together to overcome differences. Policy is better when we find compromise and middle ground, and so I actually look forward to meaningful conversations that allow women to get the care that both Halle Berry and I think are necessary, but also the governor thinks it's feasible for Californians. I think the work is better done through the process that is currently underway rather than just brute force.
Have you corresponded or talked with Halle Berry? And what did you make of her statement at the DealBook Summit?
Halle Berry was the sponsor of my bill. She has been actively involved and provided testimony for hearings, wrote letters, and met with us and others to make sure that this moved forward. She has been a fierce leader in this, and I really want to express my gratitude not only as the author of this bill but as a perimenopausal woman.
I think it is important for women to be heard, and for women to have their policy front and center. We have never had a woman president, we've never had a woman governor in California. I think she wants to be heard, and she wants this policy to become law. I think we're going to get there.
How does California compare to other states when it comes to menopause-related legislation, especially as it touts itself as a sanctuary state for reproductive rights and women’s health?
We're falling behind, but this is an opportunity for us to surge ahead. I don't think it's surprising. As a woman who is experiencing this we have changed the conversation, our generation, and we are starting to demand good and accessible care, But it has not been going on for very long. We are a large state, and our healthcare system is incredibly complex, so it’s not surprising to me that it’s taking us a little longer. But I know that California does not want to be behind, and so I know we will step up.
What role do you think parity in the State Legislature has played?
It matters. Having women at the table and having us demanding things like perimenopause care is really important. When I entered the legislature just seven years ago, [women] were less than a quarter of the state legislature. I do not think when we were that small that we could have garnered this much support.
We've had three hearings on menopause to try to understand it and what the state can do. Those conversations have been well attended by my female colleagues and a few of our male allies. Those conversations happen, and policy moves, when women are at the table.
