Editorial: Newsom vetoes threaten LGBTQ health

While Governor Gavin Newsom recently signed numerous pro-LGBTQ bills, two vetoes stand out. One would have expanded PrEP access, while the other would have helped transgender people. We condemn both vetoes because the Golden State is trying to reduce HIV transmissions and trans people’s access to medication is under threat by the federal government, which has successfully blocked several medical centers from providing gender-affirming care.

PrEP bill
Assembly Bill 554 was known as the PrEPARE Act, short for Protecting Rights, Expanding Prevention, and Advancing Reimbursement for Equity. As we reported, gay Assemblymember Mark González (D-Los Angeles) had authored it to ensure patients can access HIV prevention medications as part of their pharmacy benefits offered to them under their health insurance plans.

It also aimed to see more pharmacists offer such drugs via having their costs for doing so recouped by health care service plans. Medi-Cal managed care plans would not have been impacted.

But Newsom vetoed the bill this month. In his veto message, the governor stated he had concerns about the law’s impacts on affordability should it become law due to provisions in the federal Affordable Care Act.

“By exceeding the cost-sharing provisions under the ACA, this bill would result in increased costs to health plans, which would then be passed on to consumers,” wrote Newsom. “At a time when individuals are facing double-digit rate increases in their health care premiums across the nation, the state must weigh the potential benefits of all new mandates against the comprehensive costs to the entire care delivery system.”

The veto is disappointing, especially since easing disparities around PrEP has consistently been discussed at numerous HIV/AIDS conferences and by HIV/AIDS advocates when noting the high cost of PrEP, particularly the newer injectable formulations. PrEP is an extremely effective HIV prevention medication, and AB 554 would have enabled more people to take it.

In light of the Trump administration’s efforts to dismantle public health, including cuts to the Centers for Disease Control and Prevention and other federal agencies, it’s crucial that California take up the slack. Yes, health care costs continue to increase, but people need affordability for drugs like PrEP to prevent HIV transmissions.

We hope that González brings back a similar version of his bill in the next legislative session.

Trans bill veto
Newsom has been criticized for backtracking on trans rights since he hosted the late right wing activist Charlie Kirk on his podcast earlier this year and agreed with him that trans women and girls playing on female sports teams was “deeply unfair.” One would think that Senate Bill 418 by lesbian state Senator Caroline Menjivar (D-San Fernando Valley) would have been an opportunity for Newsom to demonstrate that he understands what many trans people currently experience. Menjivar’s bill was incredibly important precisely because President Donald Trump has attacked the trans community since the first day of his second term in January. He has issued several executive orders that cover everything from sports to access to health care to defining the sexes.

Many trans people are extremely afraid of what the future holds, and SB 418 would have allowed some peace of mind. Under the bill, health insurance companies would have been barred from denying services based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded, nor would they be able to charge more for a person’s coverage for such reasons or refuse to provide coverage to them. It would have required a health care service plan to cover up to a 12-month supply of FDA-approved prescription hormone therapy and the supplies needed by an individual to self-administer this medication.

But in his veto message, as we reported, Newsom expressed concerns with how the bill would impact the dispensing of prescription hormone therapy at one time without utilization management (UM), a healthcare practice that aims to ensure that patients receive appropriate, efficient, and cost-effective medical services.

“I appreciate the author’s intent to ensure patient access to the comprehensive care they need. While there are provisions of this bill that are worthy of support, I am concerned about the limitation on the use of UM, which is an important tool to ensure enrollees receive the right care at the right time,” wrote Newsom. “Prohibiting this cost containment strategy is likely to result in an increase in enrollee premiums to offset costs incurred by health plans and insurers.”

Equality California, which had sponsored SB 418, was also disappointed in Newsom’s veto.

“California should be doing everything possible,” stated gay EQCA Executive Director Tony Hoang, to ensure “transgender people and their families could continue to access essential medications without disruption.”

Newsom signed other trans bills, including two important ones to ensure health care privacy and to make it easier to change one’s name to conform with their gender identity. The governor also signed a bill bolstering California’s status as a “trans refuge state.” All of these are vital in this age of Trump.

But access to health care, including medications, is such a key component of daily living that we are stunned the governor does not get that. The vetoes of the PrEP and trans bills will make it more difficult for those who are HIV-negative and those who are transgender to more easily access medication. Newsom should have signed both bills. The state is working to reduce HIV transmissions; and access to gender-affirming care for youth has already been halted or paused at several hospitals in the Golden State.

If similar bills arrive on Newsom’s desk next year, he needs to sign them.