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- Written by: Lake County News Reports
Senate Bill 1237, sponsored by the California Nurse-Midwives Association and Black Women for Wellness, would address disparities in outcomes for Black women and infants and counter the obstetrician shortage – projected to be critical in some counties by 2025.
“I appreciate the support for this proposal, which will improve access to high-quality maternity care and help resolve inequities in treatment for women of color,” Sen. Dodd said. “The current gap is completely unacceptable. By increasing access to nurse-midwives, we can improve outcomes for mothers and babies, especially those in rural or inner-city settings.”
SB 1237 would expand access to care by authorizing nurse-midwives to conduct routine services without direct physician supervision, following the lead of 46 other states.
California’s current model has not been shown to increase the safety or quality of maternity care.
States that allow autonomous practice within a more integrated, collaborative model between physicians and midwives show significantly lower rates of cesarean, preterm birth, low birth-weight infants and neonatal death. Nurse-midwives perform 50,000 births a year in California.
Sen. Dodd’s bill comes as experts from the California Maternal Quality Care Collaborative report Black women in California still die at a rate that is 3-4 times higher than white women during pregnancy, childbirth and postpartum.
Furthermore, babies born to Black women were more than three times as likely to die of a preterm, birth-related issue as babies born to white women in 2017.
National and international organizations including the March of Dimes and the World Health Organization agree improved access to midwives is a necessary and innovative strategy to reduce and eventually eliminate racial disparities.
“We are in a moment that both our state and our nation are rethinking how we address racial inequities in our institutions that can better focus on centering people first,” said Nourbese Flint, executive director of Black Women for Wellness Action Project. “By expanding both maternal health and abortion access through the ability of highly trained nurse-midwives to practice independently, we are expanding our ability to tackle deep inequality for the women and birthing people who need quality healthcare the most. I am grateful that we are one step closer to seeing SB 1237 signed into law.”
“The burden of morbidity and mortality falls largely on Black and indigenous women and those from marginalized communities who cannot receive the care they need and desire,” said Kathleen Belzer, CNMA president. “This is unacceptable. SB 1237 will improve access to maternal health care by removing physician supervision which is extremely difficult to attain. This will be especially impactful in the community, out of hospital setting. This bill allows CNMs to work independently with low-risk women, and creates a collaborative framework for CNMs to work with physicians when necessary in a team-based model to ensure the safest and highest quality care available.”
The bill is also sponsored by the United Nurses Association of California/Union of Health Care Professionals and NARAL Pro-Choice California. It passed the Senate on a 35 to 1 vote and heads next to the Assembly.
Dodd represents the Third Senate District, which includes all or portions of Napa, Yolo, Sonoma, Solano, Sacramento and Contra Costa counties.
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Dr. Gary Pace said having the sustainable capacity to test at least 100 people per day is key to Lake County’s ability to continue reopening local business sectors and keep businesses open.
Local leaders, along with Sen. Mike McGuire, Assemblymember Cecilia Aguiar-Curry and the California COVID-19 Testing Task Force fought hard to make this valuable partnership happen, Pace said.
“Unfortunately, Verily has been testing at about one-third of their capacity,” or about 50 tests per day, said Pace.
Pace said the state’s goal is to test 80,000 per day, and each Verily and OptumServe site must perform near capacity to meet this statewide objective.
Volunteers are needed, particularly in the areas of clinical support – preferably nurses and similar medical personnel – and traffic control, Pace said.
To volunteer, please contact the Medical Health operational area coordinator at
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“Californians taking proactive steps to stay healthy and protect themselves from HIV should not face barriers to access and treatment,” said Insurance Commissioner Ricardo Lara. "Especially in this moment with the coronavirus pandemic exposing the inequality in our health system like the AIDS crisis did three decades ago for the LGBTQ community, we cannot allow for more HIV infections to occur when we can effectively prevent them. This new requirement for covering PrEP and the essential medical services needed to stay on PrEP without cost sharing will help reduce transmission of HIV and get us closer to our goal of ending the HIV epidemic, including in communities of color, among young adults, and in the transgender community.”
Commissioner Lara’s Notice describes the requirements for covering PrEP, following last year’s grade “A” recommendation from the U.S. Preventive Services Task Force (USPSTF) that individuals at high risk of contracting HIV must be offered PrEP medication, inclusive of lab and clinic visits, by their health care provider.
Provisions in the federal Affordable Care Act and the California Insurance Code require most private insurance plans and Medicaid expansion programs, which includes Medi-Cal, to cover all USPSTF grade “A” and “B” rated services and medications with no cost sharing for patients, including deductibles, copayments, and coinsurance.
According to the U.S. Centers for Disease Control and Prevention, more than 1 million Americans could benefit from PrEP, but less than 25 percent are actually using the medication. Increasing PrEP use is a key component of the federal government’s plan to reduce new HIV infections by 90 percent by 2030.
In 2018, there were 136,566 Californians living with diagnosed HIV infection and 4,747 Californians were newly diagnosed with HIV infection with the highest rate of new infections in the African American and Latinx communities.
Public and private insurance coverage for PrEP correlates with increased utilization and adherence among those who are prescribed PrEP.
Commissioner Lara’s Notice explains that, under California law, PrEP and the medical services necessary for prescribing and ongoing adherence to PrEP that are recommended by the U.S. Centers for Disease Control and Prevention, must be covered in-network without a deductible, copayment, or coinsurance. Insurance companies also cannot require prior authorization or step therapy for patients to access PrEP drugs.
Commissioner Lara further states in the Notice that disability insurance companies providing health insurance coverage in California can contribute to slowing the HIV epidemic by covering PrEP without cost sharing for all their policyholders beginning on the June 11th anniversary of the USPSTF recommendation, rather than waiting until policies renew.
In addition, the notice reminds insurance companies that they must not cover prescription drugs for treating HIV in a discriminatory manner by subjecting all or most drugs to high cost sharing or utilization management restrictions that are not grounded in evidence-based practices.
“No one should have to worry about whether they can afford their copays for HIV prevention medication, especially right now when many Californians are facing significant financial challenges due to COVID-19,” said Craig E. Thompson, CEO of APLA Health. “Today’s notice from the Department of Insurance is a critical step toward eliminating financial barriers and increasing PrEP uptake in California. APLA Health is grateful to Commissioner Lara for taking swift action to implement the USPSTF recommendation to make PrEP affordable for all Californians. We echo the Commissioner’s call on insurers to implement the notice for all policyholders this week and help further the state’s goal of ending the HIV epidemic.”
“San Francisco AIDS Foundation applauds Commissioner Lara’s quick work to implement the USPSTF’s recommendation that health insurance plans make PrEP affordable,” said Joe Hollendoner, CEO of San Francisco AIDS Foundation. “PrEP has been proven to be a highly effective intervention in preventing new cases of HIV, and this action is an important step towards increased access for all Californians. We urge the Department of Managed Health Care to follow suit. We know, however, that access does not automatically result in utilization so we also call on healthcare providers to do everything they can to build awareness and earn the trust of community members who are at-risk for HIV acquisition—especially those who are Black, Indigenous and other people of color—about PrEP and how it can protect their sexual health.”
"New HIV infections continue to disproportionately impact communities of color, making PrEP awareness, access, and affordability an urgent priority," said Dr. Ward Carpenter, Co-Director, Health Services of the Los Angeles LGBT Center. “We commend Commissioner Lara and the California Department of Insurance for taking these steps to increase the use of PrEP throughout California. Eliminating financial barriers and stigma while increasing accessibility will help people, including those most at-risk, stop the spread of HIV.”
"In light of the current health and economic crises, it's more important than ever that Californians have access to life-saving HIV prevention medication," said Equality California Executive Director Rick Chavez Zbur. "This action will help ensure no Californian is forced to choose between paying for PrEP and putting food on the table or paying their rent. We're grateful to Commissioner Lara for his leadership in the fight to end the HIV epidemic."
On June 20, 2019, Commissioner Lara issued a Notice advising all insurance companies and fraternal benefit societies licensed to sell life, disability income, or long-term care insurance in California that, under state law, a person’s history of PrEP use cannot be used as a justification to deny life, disability, or long-term care insurance coverage or charge higher premiums for that coverage.
This notice encouraged insurance companies to review their underwriting guidelines and practices to ensure they are not unlawfully discriminating against applicants seeking insurance coverage. A number of insurance companies have reported back to the Department of Insurance that they have since discontinued these discriminatory practices.
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Lake County Health Services offers free drive-thru testing at different locations around the county, open daily during the week.
Go to the Verily website and get screened and make an appointment.
Some have expressed frustrations surrounding the online registration process, and we really don’t want this to be a barrier for those who think they may have been exposed.
If you need assistance, please send an email request to
Frequently asked questions on drive-thru testing are available here.
For Lake County-specific Coronavirus information, visit the Lake County Health Services Department’s website.
The Lake County Coronavirus Response Hub also has additional information resources.