Is RFK Jr. better on women’s health than Newsom? We’re about to find out

It’s a bad look when Robert F. Kennedy Jr. is ahead of you on scientifically sound health policy (women’s health, to make matters worse), but that’s exactly what happened to Gov. Gavin Newsom last week.

Ah.

At a Cabinet meeting, Kennedy deferred to Trump for more than six minutes. That’s pretty standard for these increasingly awkward meetings, but the Secretary of Health and Human Services specifically praised the president for ending “the 20-year war on women by removing black box warnings on hormone replacement therapy.”

As much as it shocks me to say this, RFK Jr. has a point.

A few days later, Oscar-winning actor Halle Berry, appearing on stage at the New York Times’ DealBook Summit, delivered an unexpected and harsh blow to Newsom for vetoing a menopause treatment bill.

“But that’s okay,” she said of Newsom killing the Menopause Care Equity Act (AB 432), which she lobbied to enact and which has strong bipartisan support in the Legislature.

“He probably shouldn’t be our next president either because he won’t be governor forever and because he ignores women, half the population, by devaluing us in middle age,” Berry said. “Just saying.”

These two events show how complex and controversial menopause care has become in the last few years; women are not only speaking out more openly about it, but they are also basically demanding care that is always denied or denigrated as unnecessary.

Looking a little deeper, this sudden moment of menopause gets to the heart of an insurance issue that most Americans, male or female, have an opinion on: How much power should insurance companies have to deny care that a doctor deems reasonable?

To put it simply, menopause is a period experienced by all women who cease to be fertile, meaning 50% of the population faces it. It has specific and life-changing symptoms; most of these can be treated, but often not because most doctors are not trained in menopause care (or perimenopause, which comes first) and the science is often overlooked or misunderstood.

As a result, many women stumble through menopause without realizing what is happening to them or realizing that there are excellent, scientifically backed treatments to help.

A prime example of this is the “black box” warning that has been on many hormone replacement drugs since the turn of the millennium; A large but flawed study found that such drugs may increase the risk of cancer or other diseases.

A black box warning is the most serious warning the Food and Drug Administration can give to a drug, and its inclusion in hormone replacement theory, or HRT, puts a serious chill on the drug’s use.

Subsequent research spanning two decades not only revealed flaws in the initial analysis but also demonstrated significant benefits of HRT. It may protect against cognitive decline, reduce heart disease, and relieve symptoms like hot flashes, among many other benefits.

In early November, the FDA removed these warnings from many HRT medications. The result will likely be greater access for more women, as doctors lose hesitancy to prescribe these drugs and women lose fear of using them.

“Misconceptions about risks have been exaggerated for decades, running counter to dogma on actual science and leading to missed population-level opportunities for life improvements for our aging women in the developed world,” Michael Rodgers, chairman of the Santa Clara County Health Advisory Commission, wrote in a public comment on the change.

While Rodgers is correct, insurance coverage and doctors’ know-how remain issues for women seeking care; Problems the Menopause Care Equity Act hopes to solve.

The bill would require private insurance companies to cover FDA-approved menopause treatments and reward doctors who voluntarily take continuing education classes on menopause issues. This latest version was already watered down from previous proposals that mandated coverage of more treatment options (such as non-FDA-approved compounded hormones) and required menopause education for doctors.

But Newsom appeared to oppose part of the bill that would ban insurers from applying “utilization management” to menopause treatments — and here’s RFK Jr. We return to the agreement with.

Utilization management, or UM, is basically how insurance companies decide what a patient needs and doesn’t need (pre-approvals, reviews, and denials); These are all often more about cost than maintenance.

Now AI is getting into the business of usage management, potentially meaning that not even a human can decide our treatments. UM is a multibillion-dollar industry under the premise of keeping healthcare affordable, often doing so by denying care.

That’s why Assemblywoman Rebecca Bauer-Kahan (D-Orinda), the author of the California bill, has introduced a ban against UM.

“The standard is ‘medically necessary’ when it comes to insurance coverage,” Bauer-Kahan notes.

“When we’re talking about menopause, it’s a really vague term, right? So in the short term I’ll survive without any treatment,” she said. “So what’s ‘medically necessary’ when it comes to menopause care is this very vague thing.”

His veto messageNewsom said the UM ban “will limit the ability of health plans to engage in practices that have been shown to provide appropriate care while limiting unnecessary costs.”

But the truth and the problem with menopause care is that it is specific to each woman. Like birth control pills, a treatment that works for one woman may cause side effects in another. There’s often a lot of trial and error to find the right path through menopause, and women need to be able to have the freedom and flexibility to work one-on-one with their doctors. Without interference.

Kennedy addressed in June prior permission and soon announced that it had received commitments from several major insurance companies to reform the process by 2026, eliminating the need for prior authorization for many treatments and procedures and streamlining the process overall.

If this reform happens it will be really great – I’m hopeful – but at the same time let’s wait and see. These changes are expected to begin in January.

In California, Newsom promised to do something about menopause coverage when he unveiled his budget proposal in January. In his veto message, Newsom said he would include that route in his budget package rather than work on a new bill during the regular legislative session. That remains the plan, although no details are available yet.

Apparently someone forgot to mention this to Berry.

The budget has become a piece of legislation that more and more governors want to get through with fewer problems because the budget and its trailer bills always pass at some point, and that might be an easier way for him to control it.

Newsom has made being a supporter of women’s rights, especially reproductive care, a core part of his policies and presidential campaign, and equality for women is a cause championed by his wife, First Partner Jennifer Siebel Newsom.

But the governor has also long hesitated to pass legislation that includes costs (the menopause bill would raise individual premiums by less than 50 cents a month for most private-pay consumers). His caution is not misplaced, given federal cutbacks, rising premiums, and general health care turmoil.

However, in this case, he may have been misguided. The only real opposition to the California bill came from insurance companies. Let’s see.

Bauer-Kahan said he has been in contact with the governor’s office but remains committed to following a law that limits usage management.

“I’m glad to hear that I hope we can achieve this, but it needs to be achieved in a way that really makes a meaningful difference in providing the menopause care that women need,” she said.

Newsom’s October veto didn’t make much of a ripple. Thanks to Berry’s punch, the January bid will not only be noticed, but scrutinized.

If it eliminates restrictions on UM, it will need to answer the broader question this action would raise: How much power should insurance companies have to override the decisions of doctors and patients?

It would be strange days if we saw in January that Kennedy and his chaotic and questionable Department of Health and Human Services were offering women better health care options than the state of California.

And it’s even weirder that Newsom is putting a price tag on women’s well-being.