SACRAMENTO – Assembly Speaker Anthony Rendon, D-Paramount, an avowed supporter of single-payer health care, nevertheless announced last week that he was pulling the plug on a Senate-passed measure that would create such a system in California.

Rendon, who is holding the bill in committee, was only the proximate cause of AB562’s death. Its fate was sealed after a Senate floor analysis last month pinned its likely cost at $400 billion – more than three times the state’s entire general-fund budget.

“It didn’t make any sense,” Rendon recently told the Sacramento Bee. “It just didn’t seem like public policy as much as it seemed a statement of principles. I hope the Senate takes this chance to take the bill more seriously than they did before.”

According to its bill language, the Healthy California Act would “provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state.” The measure would have tossed out California’s myriad systems of private, insurance-backed and government-funded health care and replaced it with a single, government-managed system run by a newly created state agency.

Such a massive change would demand volumes of detailed legislative language, yet the bill itself was remarkably brief and lacking in specifics. It even failed to include any explanation for how it would receive the necessary waivers from the federal government.

The Appropriations Committee analysis concluded the bill would lead to “increased utilization of health care services,” given that all residents would be free to “see any willing provider, to receive any service deemed medically appropriate by a licensed provider, and the lack of cost sharing, in combination, would make it difficult for the program to make use of utilization management tools such as drug formularies, prior authorization requirements, or other utilization management tools.” So all financial bets were off, given an expected – and probably massive – hike in demand.

To fund the $400 billion program, the Appropriations Committee concluded the state would have to raise about $200 billion in new tax revenues. That would mean a new 15 percent payroll tax, with no cap on the wages subject to the tax. Shifting any of those costs from taxpayers to enrollees would be impossible under provisions that prohibit “members from Healthy California from being required to pay any premium” or “from being required to pay any co-payment, co-insurance, deductible and any other form of cost-sharing for all covered benefits.” 

State officials often argue about programs that spend millions of dollars, but had a surprisingly short debate about one that would cost hundreds of billions of dollars. One reason that might be is that Gov. Jerry Brown already had expressed deep skepticism about the measure. “This is called ‘the unknown by means of the more unknown,’” he told reporters in March. It was unlikely he would have signed it, especially given his concern about creating new spending programs. Critics argue that the governor’s public views gave Democrats a free pass to vote for it and assuage their political base while knowing it was unlikely to become law. Rendon’s comments to the Bee certainly give ammunition to those who saw the bill as a half-baked “statement” bill.

Support and opposition fell along predictable and partisan lines. Liberal interest groups, unions and Democratic politicians typically supported the bill, while conservative groups, taxpayer organizations and Republicans opposed it. Some groups expressed views similar to Rendon’s – supporting the single-payer concept but expressing concern about specifics.

The latter, cautious point of view won the day. After all, the bill raised more questions than it answered. It’s unclear how the new system would work or how the new government agency would operate. There are questions about the effects a 15 percent payroll tax would on the economy and jobs creation and about the magnet effect if California created an unlimited, valuable new benefit available to anyone who simply lives in the state. There are questions about federal waivers and how the California system would intersect with federal programs. And that’s just for starters.

Instead of trying to answer those questions thoroughly, the bill’s backers did as Rendon suggested – introduced a measure that stated some principles and goals, but didn’t really explain how the state government might fund them. Given the debate the health care issue sparked at the latest state Democratic Party convention and on the floor of the Legislature, it’s clear that the single-payer issue will be around or a while, regardless of the fate of this particular bill.

Steven Greenhut is Western region director for the R Street Institute. Write to him at sgreenhut@rstreet.org.

State Sen. Ricardo Lara, D-Bell Gardens, has introduced a bill to overhaul California’s health care system to create a single-payer model, the latest example of the Golden State bucking the Trump agenda and taking a “go it alone” approach.

The Healthy California Act would create a universal health care system – including covering residents who are in the country illegally. It’s a measure in response to the looming repeal of the Affordable Care Act in Congress. Since the ACAs passing, California has embraced Obamacare despite continued concerns over access to affordable care.

“We have reached a pivotal moment where there’s a threat to health care,” Lara said. “I felt it was important that we create a different narrative here in California.”

This isn’t the first time such legislation has come into focus, as then-Gov. Arnold Schwarzenegger vetoed a single-payer bill back in 2006.

Critics of a “Medicare for all” system cite heavy costs associated with an overhaul, as health care expenditures in California totaled $367.5 billion in 2016, making it the state’s largest industry. Furthermore, with undocumented immigrants being covered, those costs would substantially increase. As the Los Angeles Times explained, employees and their employers would face increased taxes and those revenues would be combined with the funds used for Medicare and Medicaid.

While at this point specifics appear light, it’s important to note that California currently relies on about $22 billion in federal funding every year to cover insurance subsidies.

More broadly, it’s the latest example of California waging a fight against the Trump administration. The state has already stoked high-profile battles to defend so-called “sanctuary city” policies, with major cities like Los Angeles and San Francisco vowing to continue to defy federal law by not cooperating with immigration authorities.

A recently published Rasmussen poll found that 41 percent of Republicans say America won’t be hurt if California became a separate country – and given its solo approach in the Trump era, it may already feel that way to those between the coasts.

Drew Gregory Lynch is a CalWatchdog contributor

@_drewgregory

Sacramento Democrats have centered attention around a shot at universal health care for all Golden State residents. 

“In a surprise move made in response to President Donald Trump’s push to repeal and replace the Affordable Care Act, two California lawmakers Friday introduced legislation to replace private medical insurance with a government health care system covering all 38 million Californians — including its undocumented residents,” the San Jose Mercury News reported. 

Joined by state Sen. Toni Atkins, D-San Diego, state Sen. Ricardo Lara, D-Long Beach, introduced the Californians for a Healthy California Act, offering “a comprehensive universal single-payer health care coverage program,” as KPCC confirmed. “Under this approach, private health insurance would be replaced with a single state-run program. Lara said his plan would guarantee coverage to all Californians and would bring down the cost of health care.” But advocates and critics hungry for specifics, the lawmaker conceded, will have to wait. “At the moment, Lara’s bill only says it is the ‘intent of the Legislature’ to establish a single-payer system. It does not say exactly how the program would work or how much it would cost.”

“It’s far from the first time this kind of system has been proposed in California. In 1994, voters rejected a ballot measure that would have established a single-payer system. The Legislature passed single-payer bills in 2006 and again in 2008, only to have Gov. Arnold Schwarzenegger veto the measures.” 

Past stumbles

Schwarzenegger’s veto was fueled by grim projections. “When the Legislature passed a single-payer bill in 2008 […] the legislative analysts found that those revenues would fall $40 billion short in the first year,” HotAir recalled. 

Although the bill has created a sensation among California Democrats looking to make a national point with a state-level effort, precedent for success is weak. “In 2011, Vermont became the first U.S. state to agree to establish a single-payer program, but the effort fizzled three years later over concerns about the cost,” KPCC noted. And in Colorado, “voters overwhelmingly rejected a similar proposal last fall amid widespread concerns about the cost,” according to the Mercury News. “Within the first decade, Colorado — a much smaller state than California — would have been $7 billion in the hole,” HotAir observed.

Cost and complexity

Any program along Lara and Atkins’ lines would need to be built from the ground up, according to rules no legislative body has had to contend with in doing so. “A single-payer system would have to overcome unique hurdles in a state where millions of dollars in federal funds are spent on health programs like Medicaid and treatment for veterans,” ABC News reported. “Other countries, like Canada, may have single-payer systems that differ slightly by state or province, he said, but the U.S. is more complicated. Nothing like this plan — a state-run single-payer system that must also comply with federal government rules — currently exists.” 

But public support among California progressives would likely remain high enough to encourage Sacramento Democrats to give a substantive bill a try. “The Legislative Analyst’s Office says the overall cost could be upwards of well over $100 billion,” Atkins recently admitted to KPBS. “But, here’s the difference, since we had those discussions a decade ago, we have implemented the Affordable Care Act in which we’ve looked at the cost and how to take advantage of the numbers. I mean California is the largest state in the country. We have large numbers to put into the risk pool. We put into place the individual mandate and we talked about businesses participating. So this is the next step to put together a financial package of how we can pay for it.”

The bad news: Providing certain health care services just became way more expensive for the counties. 

The Brown administration is ending a program that coordinated care for seniors and low-income families because it was no longer cost effective. As a result, the state will save $626 million this year, forcing counties to pick up the check. 

The Coordinated Care Initiative allows Californians who are eligible for both Medi-Cal and Medicare to “receive medical, behavioral health, long‑term services and supports, and home and community‑based services coordinated through a single health plan,” according to the budget document released Tuesday. 

But the law allows the Department of Finance to end CCI if it is deemed no longer cost effective. Federal regulations requiring in-home caregivers to receive overtime after 40 hours per week drove the cost of the program up with the minimum wage hike.

Last year, state analysts estimated the plan to gradually increase the minimum wage to $15 per hour would cost the state $4 billion by 2021. Cutting the CCI program will lower the state’s burden to $2.6 billion, according to a Department of Finance official. 

Cutting the program will shift the labor costs onto the counties, which is estimated to cost more than $4.4 billion over the next six years, according to the California State Association of Counties. 

 “This would be devastating to counties all over the state,” CSAC President and Alameda County Supervisor Keith Carson said in a statement. “We undoubtedly would have to make cuts in other vital social services to cover these costs.”

Republicans in Washington appear poised to repeal the ACA, better known as Obamacare, some time after Donald Trump is sworn in as president. With premiums on the rise and consistently poor polling, repeal is music to the ears of many, as evidenced by every federal election since the measure was passed in 2010.

However, a partial repeal would cause Californians to lose hundreds of thousands of jobs, billions of dollars in annual federal funding and kick millions of people out of coverage. Some of the losses would be offset by gains elsewhere, but it’s impossible to give a complete analysis of the offsetting effects without Republicans’ replacement plan.

What we know

Even with Republican majorities in Congress and a Republican president, a full repeal of the ACA is unlikely, due to a 60-vote threshold in the Senate that would require at least a handful of Democratic votes.

UC Berkeley Labor Center analysts used a 2015 partial-repeal bill that was ultimately vetoed by President Barack Obama to estimate the effects. Under that bill, California would lose $20.5 billion annually in federal funding for low-income subsidies and expanded Medi-Cal coverage.

As a result of that lost funding, 3.7 million Californians would lose Medi-Cal coverage, while another 1.2 million would lose subsidies, which may or may not make coverage unaffordable. 

Offsets

The billions in lost federal funds would be offset by smaller gains elsewhere, like $6.3 billion in tax cuts to California insurers and high-income earners. A repeal could also remove the requirement to have coverage, saving $1.3 billion in penalties for the uninsured. 

The study estimates approximately 250,000 jobs would be lost from repeal. However, approximately 41,000 jobs would be created through tax cuts, as well as through eliminating fees on insurers, penalties to companies for not providing coverage and penalties for the uninsured.

Popularity

Polling and electoral results have repeatedly shown the law to be unpopular with the public nationally, and Californians are facing an expected average increase in premiums by 13.2 percent next year. 

Nationally, the public is divided on the law. In November, 45 percent of adults had an unfavorable impression of the law, compared to the 43 percent who had a favorable impression, according to a Kaiser Family Foundation tracking poll.

Republicans have incrementally seized power in Washington on a repeal platform ever since Democrats passed the ACA in 2010 with their own congressional majorities and president, Barack Obama. In 2010, Democrats lost the House. In 2014, they lost the Senate. And in 2016, they failed to regain the Senate and lost the White House.

The auditor found “that nearly 12 percent of California’s more than 79,000 foster children were prescribed psychotropic medications during the fiscal year 2014-15, whereas studies suggest that only about 4 to 10 percent of non-foster children are prescribed these medications.”

Even considering that “children in foster care … often have a greater need for mental health treatment,” the auditor points to serious concerns about possible over-medication, given these substances’ potential adverse side effects.

The key concern, raised by a five-part San Jose Mercury News investigative series beginning in 2014: “They are wrenched from abusive homes, uprooted again and again, often with their life’s belongings stuffed into a trash bag. … But instead of providing a stable home and caring family, the state’s foster care system gives them a pill. With alarming frequency, foster and health care providers are turning to a risky but convenient remedy to control the behavior of thousands of troubled kids: numbing them with psychiatric drugs that are untested on and often not approved for children.”

The auditor studied case files for 80 foster children in Los Angeles, Riverside, Madera and Sonoma counties and found that “many foster children had been authorized to receive psychotropic medications in amounts and dosages that exceeded the state’s recommended guidelines.”

Furthermore, the auditor found that “many of these children do not appear to have received follow-up visits or recommended psychosocial services in conjunction with their prescriptions.” And “counties did not always obtain required court or parental approval” before administering the drugs. The scathing report also pointed out that the current decentralized child-welfare system has reduced the state’s ability to oversee the process.

The most controversial legislation, which passed with a unanimous vote in the Assembly and which had only three “no” votes in the Senate, is Senate Bill 1174. The bill gives the Medical Board of California more power to investigate and prosecute “repeated acts of clearly excessive prescribing, furnishing or administering psychotropic medications to a minor without a good faith prior examination of the patient and medical reason.”

As the official Senate bill analysis points out, opponents believe “that initiating investigations as proposed will ultimately target prescribing physicians who specialize with patients with severe mental health difficulties” and would prefer a “review panel” by professionals who “could review outlying prescribing practices.” The California Medical Association, for instance, argues the bill will discourage physicians from working in these environments, according to a news report.

Senate Bill 1291 is mostly a record-keeping measure: “This bill would require annual mental health plan reviews to be conducted by an external quality review organization and, commencing July 1, 2018, would require those reviews to include specific data for Medi-Cal eligible minor and non-minor dependents in foster care, including the number of Medi-Cal eligible minor and non-minor dependents in foster care served each year.”

The final measure is Senate Bill 253, which also passed overwhelmingly. It requires that “an order authorizing the administration of psychotropic medications to a dependent child or a delinquent child in foster care be granted only upon the court’s determination that the administration of the medication is in the best interest of the child.” The main opposition to SB1291 and SB253 involved concerns over resource and budgetary matters.

These measures address, in part, the auditor’s call for a more “effective oversight structure” of drug prescriptions in the foster-care system. For instance, the auditor argues that counties should be better monitoring requests for such drugs; should “ensure court approval or parent consent prior” to their prescription; require that physicians follow up after such prescriptions; and “ensure proper mental health services are received along with psychotropic drugs.”

Three other related bills now are law. They require closer monitoring of psychotropic prescriptions at group homes and provide other expanded reporting and monitoring of such prescriptions. The main goal is to provide more oversight given the large percentage of foster-care children who are prescribed such drugs. As the Chronicle reported: “As many as 20 percent of foster children age 6 and older receive psychotropics, according to data compiled for senators.” And the state auditor found that more than a third of them had such drugs prescribed “without the required court approval.”

California’s reforms reportedly go further than those in other states. The governor’s decision on these three bills is well worth watching.

Steven Greenhut is the Western region director for the R Street Institute. He is based in Sacramento. Write to him at sgreenhut@rstreet.org.

On several fronts, California Democrats have used the tail end of this political season to push for advances on their health care agenda — with mixed results. 

In Sacramento, they succeeded in passing legislation targeting health care cost sticker-shock after several recent misfires. “The unexpected charges come when patients are treated by an out-of-network provider at an in-network facility,” NPR explained. “After several failed attempts in recent years, the California legislature last week passed Assembly Bill 72, which aims to protect patients’ pocketbooks when they’re hit by these surprise bills. Gov. Jerry Brown has until the end of September to sign or veto the legislation. He is expected to sign it into law.”

“A 2015 Consumers Union survey suggests the surprise bill phenomenon is fairly common,” the station added. “It found nearly 1 in 4 Californians who’d had hospital visits or surgery in the prior two years reported receiving an unexpected bill from an out-of-network provider.”

Waiver wanted

In Washington, D.C., meanwhile, a who’s who of members of Congress hailing from California tried to flex their muscle around California’s unlikely request that the federal government allow unlawful and undocumented immigrants in state to access health benefits under Obamacare. “In a letter announced Wednesday, 37 members of California’s congressional delegation asked Treasury Secretary Jack Lew and Health and Human Services Secretary Sylvia Burwell to accept California’s request for a waiver that would allow the state to offer health care to an estimated 50,000 undocumented immigrants,” TPM reported. 

“The letter is just the latest in the fight to expand health care coverage to California’s undocumented population. In June, California Gov. Jerry Brown signed a bill passed by the state’s Legislature that allowed California’s undocumented population to buy their own health insurance on the state’s exchange, Covered California. However, a special federal waiver — a 1332 waiver — is needed before the state is allowed to enact its law.”

It hasn’t been clear whether President Obama could be moved to take action before the end of his term in office. He has already wound up under immense personal pressure to convince insurers to remain committed to the Affordable Care Act’s health care exchanges, despite a growing sense in industry that doing so will be harmful.

Unaffordable care

“With no lifeline coming from the divided Congress, Obama and his administration are redoubling their pleas for insurers to shore up the federal health care law and pushing uninsured Americans — especially younger ones — to sign up for coverage,” Politico observed. “The administration is nervously preparing for its final Obamacare open-enrollment season just a week before Election Day, amid a cascade of headlines about rising premiums, fleeing insurers and narrowing insurance options.”

“But six years after passage of Obama’s signature domestic achievement, the litany of woes afflicting the Obamacare marketplaces is formidable. Enrollment has plateaued at half of what was projected. Three major insurers have largely quit, citing big losses. Double-digit rate hikes are the norm for plans across the country. And roughly one in five Americans may find just one insurer selling plans in their area when they shop for 2017 coverage.”

At the same time, although California’s exchange program has been one of the biggest relative success stories for the ACA, the state’s health cost burden has continued to rise over time. A new study released by the University of California Los Angeles Center for Health Policy Research revealed that “spending is projected to total more than $367.5 billion in 2016, with about 71 percent covered by public funds when additional resources such as the Affordable Care Act subsidies and county spending are included,” according to U-T San Diego.

Indeed, California Democrats pushing the White House used the problem as ammunition for their own waiver goal, arguing before the press “that denying undocumented immigrants health care was only driving up the long-term costs of health care,” as TPM recalled. “Without insurance coverage, many immigrants have been forced to depend on emergency services to be treated.”

The measure is unusual in that it assigns cleanup costs to the producer of a product instead of to its users. But many officials throughout Los Angeles County depict themselves as overwhelmed by the problem posed by proper disposal of the medical waste, especially items that pose health risks to trash handlers.

Burbank recycling coordinator Kreigh Hampel told KPCC that this waste is “one of the things we’re completely ill-equipped to take. … We just had one of our biggest days ever just a few months ago where we had almost 27 1/2 pounds of needles come through the line. The workers up there have leather gloves, but there are no gloves made that can stop a fine, little puncture from a needle.”

Drug companies question wisdom of approach

Santa Clara County reportedly has a similar law. But pharmaceutical companies appear ready to step up efforts to assign them a costly new task when the party involved is the most populated county in the United States:

“We agree that it’s really vital that consumers dispose of their medicines properly,” says Priscilla VanderVeer, spokeswoman for the Pharmaceutical Research and Manufacturers of America, a national trade association.

But “a mandated costly and frankly inefficient take-back program is not the way to do that,” she says. “There are cheaper, less burdensome ways to dispose of medicines.”

VanderVeer says a mandatory program would force a liability risk onto pharmacies that handle controlled substances. A better option, she says, would be to educate residents about proper disposal and to promote voluntary drug drop-off sites, such as those offered by the Los Angeles County Sheriff’s Department and some pharmacies.

That’s from KPCC’s reporting.

Mattress law set precedent for requiring help in cleanup

Forcing producers to help oversee the cleanup of the goods they make has a precedent in California. In September 2013, Gov. Jerry Brown signed Senate Bill 254. The Waste360 website reported that “the law requires mattress manufacturers to create and manage a mattress recycling organization that will provide recycling services to municipalities for free. The program will be financed by a visible mattress recycling charge, or ‘eco-fee,’ which will be collected from consumers at the point of sale.”

The mattress program, which began gearing up this January, draws criticism from mattress makers.

Ryan Trainer, president of the Mattress Recycling Council, told Capitol Public Radio earlier this year that “at the end of its useful life, a used mattress has relatively low value. It’s a very bulky product and so we don’t want to handle it multiple times before it gets to the recycler and in turn to the scrap markets where the foam and steel can be reused in making new products.”

But so far mattress companies haven’t sued over the law, as some expected when it was first discussed several years ago.

“California lawmakers approved a health plan tax package Monday designed to continue pulling in more than a billion dollars in matching federal money, while committing several hundred million dollars to services for the developmentally disabled, debt relief and other programs,” the Sacramento Bee reported. “The final deal includes tax offsets designed to minimize any hit to health plans that could be passed on to consumers. In addition, to achieve enough Republican support, the package includes several components Republican lawmakers wanted, such as providing more money to help people with autism and other developmental disabilities and forgiving a budget debt owed by skilled-nursing facilities.”

By shifting the balance of taxes, lawmakers ensured that California’s own budget was not hit with a billion-dollar deficit. No money was allocated to make up that difference if a deal was not reached and federal funds dried up. For that reason, Gov. Jerry Brown all but hounded elected officials to hammer out a bargain. Brown “called a special session on health care last year, tasking lawmakers with finding a long-term solution for funding Medi-Cal so the program doesn’t rely so heavily on the general fund, which pays for most state services,” recalled the San Francisco Chronicle. “One of the key priorities was to expand the state’s tax on managed-care organizations — a tax that the Obama administration said did not comply with federal law.”

Winning support

The political brambles could not be cleared until Republicans felt a deal was appropriately structured given the state’s current budget surplus. Assembly Minority Leader Chad Mayes, R-Yucca Valley, who worked with Brown to negotiate the package, said that “as a whole [it] would be a tax cut – and it also includes several GOP priorities, like paying down debt,” as Capital Public Radio paraphrased his position. “Republicans who support the bill will have some political cover,” the station added, noting the Howard Jarvis Taxpayers Association and the state Chamber of Commerce “both say the governor’s proposal would not result in a net tax increase.”

Providers of private health insurance plans, which initially balked as well, acquiesced to the deal because lawmakers pared back their tax burdens elsewhere in order to make up for what they will now have to pay. As the Chronicle noted, “plans that don’t accept Medi-Cal patients would pay the additional tax, but the state would reduce their corporation and insurance tax liability by $371 million so that the plans will not raise patient premiums. The overall effect is a net increase to the plans, state Senate senior policy staff said. With the change, health plans now support the proposal.”

Cautious optimism

Amid an acrimonious presidential campaign season defined by sharp accusations of political breakdown in Washington, both state parties in California have used the tax deal to claim a measure of political victory. While Mayes cast Republicans as strong negotiators who kept taxes in check, state Senate President Pro Tem Kevin de León, D-Los Angeles, contrasted Sacramento’s performance with the “severe dysfunction in Washington,” according to the San Jose Mercury News. “Here in California, we’re proving that Republicans and Democrats — no matter how difficult the issue may be — can work together and get things done.”

Still, even with Gov. Brown’s signature, one more hurdle remains before legislators can pop the champagne. “Once the governor signs the package,” the Bee cautioned, “state officials must sell the health plan tax to the Obama administration, which will have the final say on whether the state’s approach is eligible for federal matching money.”

“Under a law expected to go into effect by April, women in California will be able to stop by their neighborhood pharmacy and buy birth control pills without a prescription,” the Los Angeles Times reported. “Proponents argue that easing women’s access to birth control will reduce unintended pregnancies, which make up as many as half of all pregnancies nationwide.”

Not everyone cheered the result. “Critics have argued that not requiring a doctors visit to get birth control could reduce the number of women who get tested for STDs and breast cancer,” CBS San Francisco noted. Pro-life advocates have also been uneasy, concerned that allies of abortion providers would use readier birth control access to strengthen their legal and political position.

California’s proximity to Latin American areas affected by the Zika virus, however, spurred Pope Francis to put pro-lifers a bit more at ease. In recent remarks, he “suggested women threatened with the Zika virus could use artificial contraception, saying ‘avoiding pregnancy is not an absolute evil’ in light of the global epidemic,” the Associated Press reported. “The pope unequivocally rejected abortion as a response to the crisis in remarks Wednesday as he flew home after a five-day trip to Mexico.”

An accelerating trend

With the regulatory changes, the Golden State has positioned itself close to the forefront of a relatively new approach to clearing the use of birth control. “California will become the third state to permit pharmacist-issued birth control once the law, passed in 2013, gains regulatory approval,” the Times observed. “Similar legislation in Oregon was approved last year and enacted in January. Hawaii lawmakers introduced a similar measure last month, and advocates in New Mexico and Alaska say they want to follow suit.” Washington has permitted pharmacist-dispensed birth control for several decades.

The bill behind the law, SB493, was introduced last year by state Sen. Ed Hernandez, D-West Covina. The state pharmacy board had anticipated the law working its way through the Sacramento bureaucracy in time to take effect “as early as Oct. 1,” the Orange County Register reported last June. “The board recently finalized the protocols but they still have to be reviewed by multiple state agencies for legal and budgetary approval.”

Clearing SB493 was not as simple as waving along birth control. The law “also allows pharmacists to prescribe prescription-strength inhalers, gums and lozenges for nicotine addiction, as well as medication for travel abroad, including vaccinations and antibiotics. Along with hormonal contraceptives, these three categories of drugs are considered preventive services for major public health issues,” the Register noted.

Red tape and startups

But a technicality specific to pharmacists’ requirements took an additional toll on getting birth control onto shelves. The approval process “ground to a halt when several doctors and the American Congress of Obstetricians and Gynecologists questioned whether pharmacists should have to check a woman’s blood pressure, saying the test would be an unnecessary barrier for women,” the Register reported separately last month. “The Obstetricians and Gynecologists group argued that blood pressure can be adequately obtained through self-reporting and that self-reporting would increase access to contraception.”

Meanwhile, Silicon Valley has moved on birth control at a characteristically speedy pace. “At a time when users can summon a meal, a massage or marijuana through a smartphone app, Nurx and fellow San Francisco startup Lemonaid Health, as well as a few other companies, are working to make getting hormonal birth control as easy as requesting an Uber ride,” the San Francisco Chronicle noted. “It’s an evolution of telemedicine to simplify access to some standard prescription drugs, a system designed to appeal to younger people already accustomed to on-demand gratification.”