SACRAMENTO (CBS13) – It is now up to Governor Gavin Newsom to decide if all of the University of California and California State University campuses offer medication abortions to students looking to abort a fetus. His predecessor, Governor Jerry Brown, vetoed a similar bill last session.

Senate Bill 24 would require all university student health centers to offer medication abortions by January 1, 2023. An amendment made in the Assembly would allow the Student Health Centers to offer telehealth services.

The bill would only go into effect if the newly created fund raises nearly $10.3 million dollars from private donors by January 1, 2020. The total cost, according to the Bill Analysis, would be funded using grant money and private donations, not General Fund money or student fees; however, both systems previously expressed concerns about the costs and how the programs would be funded in the future. Some of that grant money, up to $200,000 to each Student Health Center, would allow staff to assess facility and training needs, buy equipment, make facility improvements, establish protocols, create educational materials for patients, and train staff. Each UC and CSU would also get a grant to cover various direct and indirect costs, including providing 24-hour backup medical support by telephone to patients.

The Assembly made several amendments to the bill before voting to approve it:

  • Delete the requirement that SHCs (Student Health Centers), as a condition of receiving a grant, participate in an evaluation of its medication abortion readiness and its provision of medication abortion.
  • Permit SHCs to provide medication abortion services through telehealth services.
  • Require CCSWG financial reports to include information from SHCs on their expenditures and activities associated with this bill. Require CCSWG to use
    Fund moneys to (a) maintain a system of financial reporting on all aspects of the Fund and specify what the reports must include; (b) support
    implementation of medication abortion readiness by SHCs by specified measures; and (c) pay direct and indirect costs to administer this bill, including
    costs of the hiring of staff.
  • Prohibit General Fund (GF) moneys from being appropriated, or otherwise provided, to support the Fund or the CCSWG costs to administer this bill.
  • Require CCSWG to assist SHCs in identifying other resources to pay for the costs of medication abortion readiness and for providing for medication
    abortion.
  • Prohibit this bill from being interpreted as requiring SHCs to bill public programs or health insurance providers to support the costs of providing
    medication abortion services onsite.

According to the bill,

“While all of the SHCs have the minimum requirements for medication abortion provision: a private exam room, ability to do pregnancy testing and counseling, and licensed clinicians, none of them are fully equipped to provide medication abortions. All SHCs would need training; even though a few sites have a clinician trained in abortion care, they are not currently providing care. Most CSU SHCs would also need an ultrasound machine and nurse hotline.”

However, both the UC and CSU system previously raised concerns about the cost.

The UC:

“estimates proposed grants would be insufficient to cover costs in the readiness phase (2019 – 2023). We estimate a funding shortfall of $4.6 to $7.8 million across the 11 UC student health centers. Beginning January 1, 2023, no source of funding is provided in SB 24. Without funding, the student health centers will incur ongoing costs in the range of $2.2 to $3.2 annually. Unless financing is made available post 2023, by the state or foundation, this cost will fall to students.”

CSU raised a number of concerns:

  • Equipment costs. Campuses will need to buy equipment to be in compliance. The CSU assumes a cost of $37,556 for ultrasound at each of our campuses (total of $863,788), and additional ongoing maintenance costs.
  • Training costs. $10,067 per campus to provide training (total of $231,541).
  • Establishing agreements with local hospitals. CSU doctors do not do inpatient care via the CSU, or have hospital admission privileges. Agreements are difficult to negotiate with local hospitals because CSU students are not required to have insurance, and it is unclear who would be responsible for paying the costs associated with the emergency room visit if the student did not have insurance.
  • Liability. The CSU’s existing health malpractice insurance would likely cover the costs (settlements, judgments, defense attorney fees and costs), assuming a possibility that underwriters may increase premiums based on the number of claims. For any incident related to SB 24, the CSU would be responsible for the first $5 million of costs. Campus deductibles would range from $35,000 to $900,000, depending on the campus. The remaining costs would be covered by the California State University Risk Management Authority (CSURMA) fund, which is a system-wide pool to support all CSU risk financing operations.
  • Billing. The CSU does not currently bill insurance, and it would be extremely costly to move to a billing system. While 12 CSU campuses utilize Family PACT, a publicly-funded, family planning clinical services program administered through the Department of Health Care Services, this is not the same as billing Medi-Cal or private insurers. Insurance-billing is not a viable option for CSU health centers.

A medication abortion is a two-step process that can happen up to ten weeks into a pregnancy. A woman does the first step in the clinic and is given a second drug to take at home.  The U.S. Food and Drug Administration approved the use in 2000. In 2014 medication abortions accounted for 31% of all non-hospital abortions and 45% of abortions within the first nine weeks of gestation.

None of the University of California or California State University campuses currently offer abortion services. Students are instead referred to outside providers.

The Guttmacher Institute says more than half of all U.S. abortions in 2014 were performed on women in their 20s (34% age 20-24, 27% age 25-29).

The bill’s sponsors estimated that 10 to 17 women would seek a medication abortion per month on each UC campus, and nine to 15 at each CSU school.

The legislature did approve a version of this bill last session, but Governor Jerry Brown vetoed it in October, writing;

“This bill requires every student health center at University of California and California State University campuses to offer medication abortions beginning January 1, 2022. Access to reproductive health services, including abortion, is a long-protected right in California. According to a study sponsored by supporters of this legislation, the average distance to abortion providers in campus communities varies from five to seven miles, not an unreasonable distance. Because the services required by this bill are widely available off-campus, this bill is not necessary.”

SB 24 is being supported by a number of groups, including ACLU California, California Academy of Family Physicians, and Planned Parenthood. It is opposed by several groups, including California Catholic Conference, Berkeley College Republicans, and Right to Life of Central California.

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