Becerril earns about $52,000 a year at a nonprofit in California’s Central Valley, putting her and her husband, Armando, at more than double the limit to qualify for Medi-Cal, the state’s Medicaid program for people with low incomes and disabilities. Private insurance would cost $1,230 a month in premiums, money needed for their mortgage.

“We’ve been resorting to home remedies to get through the pain,” Becerril said through a Spanish translator. Her husband has needed hernia surgery for 20 years. “It’s frustrating because we pay our taxes, but we can’t reap any of the benefits of where our taxes are going,” she added.

While many Californians who earn too much to be eligible for Medi-Cal can get subsidized coverage through Covered California, an estimated aren’t allowed to buy insurance through state-run insurance plans under the Affordable Care Act because they lack legal status. One Democratic lawmaker says it’s a small but glaring gap and is crafting a bill that could test Democratic Gov. Gavin Newsom’s commitment to reach universal health care.

“We’re going to need to figure out how to provide universal coverage for all who call this state home,” said the bill’s author, Assembly member Joaquin Arambula. “It’s an area our state has not leaned into enough, to provide coverage for those who are undocumented.”

Arambula’s bill would direct the state to ask the federal government to allow immigrants living in the state without authorization to get insurance through Covered California. Arambula sees the move as the critical first step to expand coverage. If approved, the Fresno lawmaker intends to push for state subsidies to help pay for insurance.

Both elements are essential for immigrants lacking legal status, said Jose Torres Casillas, a policy and legislative advocate with Health Access California, a consumer health group working with Arambula’s office on the measure.

“Access is one thing, but affordability is another,” Torres Casillas said.

Since taking office in 2019, Newsom has approved expanding Medi-Cal to regardless of immigration status. In doing so, the politician continuously rumored to be preparing for a presidential bid described the state as moving “one step closer” toward universal health care. But in January, Newsom announced a $22.5 billion state deficit and made no mention of new proposals for the state’s .

Newsom’s health secretary, Dr. Mark Ghaly, acknowledged the pressure to go further but he would not commit to a timeline.

“Up until now we’ve had so many other things to focus on,” Ghaly said. “This will become, frankly speaking, one of the most important next issues that we take on.”

California needs permission from the federal government to open Covered California to immigrants without legal residency because it is currently closed to them, and Arambula said he is in talks with Newsom administration officials about how to structure the bill.

Once the federal government opens Covered California up to all migrants, the state could set aside funding for subsidies. About 90% of enrollees in Covered California qualify for financial assistance, which is paid for with both state and federal funds. Since 2020, the state has spent $20 million a year on those subsidies, a fraction of the cost, because Congress has given states an infusion of money during the pandemic.

Previously, lawmakers had allocated roughly $300 million to lower insurance premiums for Covered California enrollees. Any financial assistance to people living in the state without authorization would likely have to come from state funds, and the costs could vary widely.

For instance, Colorado enrolled 10,000 such immigrants into a new insurance program designed solely for them at a cost of $57.8 million in state funds, said Adam Fox, deputy director of the Colorado Consumer Health Initiative. The program covered the full cost of insurance for enrollees.

In Washington state, immigrants who lack legal status can take advantage of a state fund next year to help all income-eligible state residents pay for insurance, said Michael Marchand, chief marketing officer for the Washington Health Benefit Exchange. State lawmakers have added $5 million to the fund for immigrants without legal authorization.

“It would serve as an incentive for additional undocumented immigration into our country,” said Sally Pipes, president and CEO of the Pacific Research Institute, a think tank that advocated against Medi-Cal expansion to immigrants without legal standing. “And put taxpayers on the hook for additional government health care costs and the inevitable higher tax bills to pay for them.”

California officials have previously considered allowing all immigrants to buy insurance from its state-run program before, submitting a request to the federal government in 2016. But the state rescinded its application after President Donald Trump took office, given his anti-immigration rhetoric and policies.

The Biden administration in December approved an exception to federal law for Washington state — a game changer in the eyes of immigration advocates, said Rachel Linn Gish, a spokesperson for Health Access.

“Seeing what other states have done and the waivers that are happening under Biden, it makes a huge difference in our approach,” she said.

But even if lawmakers pass a plan to open California’s insurance marketplace to all immigrants regardless of status, advocates said the state will have to wait until Jan. 1, 2024, to ask the federal government for permission, and it could take half a year or longer to get a response.

That means it could be years before Becerril can get coverage. Instead, she’s preparing for the worst.

“I’m paying for funeral coverage,” she said. “It’s more economical than paying the health coverage premium.”

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Eggman, a licensed social worker, co-authored the novel law that allows families, clinicians, first responders, and others to petition a judge to mandate government-funded treatment and services for people whose lives have been derailed by untreated psychotic disorders and substance use. It was a win for Newsom, who proposed the , or CARE Court, as a potent new tool to address the tens of thousands of people in California living homeless or at risk of incarceration because of untreated mental illness and addiction. The measure faced from disability and civil liberties groups worried about stripping people’s right to make decisions for themselves.

“We see real examples of people dying every single day, and they’re dying with their rights on,” Eggman said in an interview with KHN before the appointment. “I think we need to step back a little bit and look at the larger public health issue. It’s a danger for everybody to be living around needles or have people burrowing under freeways.”

Senate Pro Tem Toni Atkins announced Eggman’s appointment Thursday evening. Eggman replaces Dr. Richard Pan, who was termed out last year after serving five years as chair. Pan, a pediatrician, had prioritized the state’s response to the covid-19 pandemic and that tightened the state’s childhood vaccination laws. Those moves made him a , even as he faced taunts and physical threats from opponents.

The leadership change is expected to coincide with a Democratic health agenda focused on two of the state’s thorniest and most intractable issues: homelessness and mental illness. , California accounts for 30% of the nation’s homeless population, while making up 12% of the U.S. population. estimated that in 2020 about 25% of homeless adults in Los Angeles County had a severe mental illness such as schizophrenia and 27% had a long-term substance use disorder.

Eggman will work with Assembly member Jim Wood, a Santa Rosa Democrat who is returning as chair of the Assembly Health Committee. Though the chairs may set different priorities, they need to cooperate to get bills to the governor’s desk.

Eggman takes the helm as California grapples with a projected , which could force reductions in health care spending. The tighter financial outlook is causing politicians to shift from big “moonshot” ideas like universal health care coverage to showing voters progress on the state’s homelessness crisis, said David McCuan, chair of the political science department at Sonoma State University. Seven in 10 likely voters cite homelessness as a big problem, according to a recent by the Public Policy Institute of California.

Eggman, 61, served eight years in the state Assembly before her election to the Senate in 2020. In 2015, she authored California’s , which allowed terminally ill patients who meet specified conditions to get aid-in-dying drugs from their doctor. Her past work on mental health included changing eligibility rules for outpatient treatment or conservatorships, and trying to make it easier for community clinics to bill the government for mental health services.

She hasn’t announced her future plans, but she has around $70,000 in a for lieutenant governor, as well as $175,000 in a ballot measure committee to

Eggman said the CARE Court initiative seeks to strike a balance between civil rights and public health. She said she believes people should be in the least restrictive environment necessary for care, but that when someone is a danger to themselves or the community there needs to be an option to hold them against their will. A Berkeley Institute of Governmental Studies poll released in October found had a positive view of the law.

Sen. Thomas Umberg (D-Santa Ana), who co-authored the bill with Eggman, credited her expertise in behavioral health and dedication to explaining the mechanics of the plan to fellow lawmakers. “I think she really helped to put a face on it,” Umberg said.

But it will be hard to show quick results. The measure will unroll in phases, with the first seven counties — Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne — set to launch their efforts in October. The remaining 51 counties are set to launch in 2024.

County governments remain concerned about a steady and sufficient flow of funding to cover the costs of treatment and housing inherent in the plan.

California has allocated in seed money for counties to set up local CARE Courts, but the state hasn’t specified how much money will flow to counties to keep them running, said Jacqueline Wong-Hernandez, deputy executive director of legislative affairs at the California State Association of Counties.

Robin Kennedy is a professor emerita of social work at Sacramento State, where Eggman taught social work before being elected to the Assembly. Kennedy described Eggman as someone guided by data, a listener attuned to the needs of caregivers, and a leader willing to do difficult things. The two have known each other since Eggman began teaching in 2002.

“Most of us, when we become faculty members, we just want to do our research and teach,” Kennedy said. “Susan had only been there for two or three years, and she was taking on leadership roles.”

She said that Eggman’s vision of mental health as a community issue, rather than just an individual concern, is controversial, but that she is willing to take on hard conversations and listen to all sides. Plus, Kennedy added, “she’s not just going to do what Newsom tells her to do.”

Eggman and Wood are expected to provide oversight of , the Newsom administration’s sweeping overhaul of Medi-Cal, California’s Medicaid program for low-income residents. The effort is a multibillion-dollar experiment that aims to improve patient health by funneling money into social programs and keeping patients out of costly institutions such as emergency departments, jails, nursing homes, and mental health crisis centers. Wood said he believes there are opportunities to improve the CalAIM initiative and to monitor consolidation in the health care industry, which he believes drives up costs.

Eggman said she’s also concerned about workforce shortages in the health care industry, and would be willing to revisit a conversation about a for hospital workers after last year’s negotiations between the industry and labor failed.

But with only two years left before she is termed out, Eggman said, her lens will be tightly framed around her area of expertise: improving behavioral health care across California.

“In my last few years,” she said, “I want to focus on where my experience is.”

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SACRAMENTO — Mike Thomson’s friends refuse to stay over at his house anymore.

Thomson lives about 50 yards from a busy freeway that bisects California’s capital city, one that has been increasingly used as a speedway for high-speed races, diesel-spewing big rigs, revving motorcycles — and cars that have been illegally modified to make even more noise.

About the only time it quiets down is Saturday night between 3 and 4 a.m., Thomson said.

Otherwise, the din is nearly constant, and most nights, he’s jolted out of sleep five or six times.

“Cars come by and they don’t have mufflers,” said Thomson, 54, who remodels homes for a living. “It’s terrible. I don’t recommend it for anyone.”

Thomson is a victim of noise pollution, which health experts warn is a growing problem that is not confined to our ears, but causes stress-related conditions like anxiety, high blood pressure, and insomnia.

California legislators passed two laws in 2022 aimed at quieting the environment. One directs the California Highway Patrol to test noise-detecting cameras, which may eventually issue automatic tickets for cars that make noise above a certain level. The other forces drivers of illegally modified cars to fix them before they can be re-registered.

“There’s an aspect of our society that likes to be loud and proud,” said state Sen. Anthony Portantino (D-Glendale), author of the noise camera law. “But that shouldn’t infringe on someone else’s health in a public space.”

Most states haven’t addressed the assault on our eardrums. Traffic is a major driver of noise pollution — which disproportionately affects disadvantaged communities — and it’s getting harder to escape the sounds of leaf blowers, construction, and other irritants.

California’s laws will take time and have limited effect, but noise control experts called them a good start. Still, they do nothing to address overhead noise pollution from circling police helicopters, buzzing drones, and other sources, which is the purview of the federal government, said Les Blomberg, executive director of the .

In October 2021, the American Public Health Association declared noise a public health hazard. Decades of research links noise pollution with not only sleep disruption, but also a host of chronic conditions such as heart disease, cognitive impairment, depression, and anxiety.

“Despite the breadth and seriousness of its health impacts, noise has not been prioritized as a public health problem for decades,” . “The magnitude and seriousness of noise as a public health hazard warrant action.”

When there’s a loud noise, the auditory system signals that something is wrong, triggering a fight-or-flight response in the body and flooding it with stress hormones that cause inflammation and can ultimately lead to disease, said Peter James, an assistant professor of environmental health at Harvard University’s T.H. Chan School of Public Health.

Constant exposure to noise increases the risk of and , research shows. estimated in 2020 that noise exposure causes about 12,000 premature deaths and 48,000 cases of heart disease each year in Western Europe.

While California Highway Patrol officials will spend the next few years researching noise cameras, they acknowledge that noise from street racing and — where people block off intersections or parking lots to burn out tires or do “doughnuts” — has surged over the past several years and disturbs people right now.

Cars in California are supposed to operate at 95 decibels — a little louder than a — or less. But drivers often modify their cars and motorcycles to be louder, such as by installing “whistle tips” on the exhaust system to make noise or removing mufflers.

, the last full year for which data is available, the highway patrol issued 2,641 tickets to drivers for excessive vehicle noise, nearly double .

“There’s always been an issue with noise coming from exhausts, and it’s gained more attention lately,” said Andrew Poyner, a highway patrol captain. “It’s been steadily increasing over the past several years.”

The American Public Health Association says the federal government should regulate noise in the air, on roads, and in workplaces as an environmental hazard, but that task has mostly been abandoned since the federal Office of Noise Abatement and Control was defunded in 1981 under President Ronald Reagan.

Now the task of quieting communities is mostly up to states and cities. In California, reducing noise is often a byproduct of other environmental policy changes. For instance, the state will ban the sale of noisy gas-powered leaf blowers , a policy aimed primarily at reducing smog-causing emissions.

One of the noise laws approved in California in 2022, AB 2496, will require owners of vehicles that have been ticketed for noise to fix the issue before they can re-register them through the Department of Motor Vehicles. Currently, drivers can pay a fine and keep their illegally modified cars as they are. The law takes effect in 2027.

The other law, SB 1097, directs the highway patrol to recommend a brand of noise-detecting cameras to the legislature by 2025. These cameras, already in use in Paris, New York City, and Knoxville, Tennessee, would issue automatic tickets if they detected a car rumbling down the street too loudly.

Originally, the law would have created pilot programs to start testing the cameras in six cities, but lawmakers said they wanted to go slower and approved only the study.

Portantino said he’s frustrated by the delay, especially because the streets of Los Angeles have become almost unbearably loud.

“It’s getting worse,” Portantino said. “People tinker with their cars, and street racing continues to be a problem.”

The state is smart to target the loudest noises initially, the cars and motorcycles that bother people the most, Blomberg said.

“You can make every car coming off the line half as loud as it is right now and it would have very little impact if you don’t deal with all the people taking their mufflers off,” he said. “That outweighs everything.”

Traffic noise doesn’t affect everyone equally. In , James and colleagues found that nighttime noise levels were higher in low-income communities and those with a large proportion of nonwhite residents.

“We’ve made these conscious or subconscious decisions as a society to put minority-race communities and lower-income communities who have the least amount of political power in areas near highways and airports,” James said.

Elaine Jackson, 62, feels that disparity acutely in her neighborhood, a low-income community in northern Sacramento sandwiched between freeways.

On weekends, sideshows and traffic noise keep her awake. Her nerves are jangled, she loses sleep, her dogs panic, and she generally feels unsafe and forgotten, worried that new development in her neighborhood would just bring more traffic, noise, and air pollution.

Police and lawmakers don’t seem to care, she said, even though she and her neighbors constantly raise their concerns with local officials.

“It’s hard for people to get to sleep at night,” Jackson said. “And that’s a quality-of-life issue.”

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Inglewood residents were poised to approve a ballot measure that would boost the minimum wage to $25 at private hospitals, psychiatric facilities, and dialysis clinics. The latest vote count showed Measure HC leading 54% to 46%, according to . In Duarte, roughly 35 miles away, voters were on track to decisively reject a similar proposal, Measure J, 63% to 37%.

Los Angeles County election officials plan to release final results Dec. 5.

The contests were the first ballot-box fight in what seems likely to be a multiyear battle between a powerful labor union and the influential hospital industry. Similar proposals are scheduled to go before voters in Los Angeles, Downey, Long Beach, and Monterey Park in 2024.

All were spearheaded by the Service Employees International Union-United Healthcare Workers West, which represents roughly , including medical assistants, food service workers, and custodial staff.

Suzanne Jimenez, the union’s political director, said the union still plans to pursue a $25 minimum wage in other cities and, eventually, statewide.

“We’re still moving forward on all fronts,” she said.

George Greene, president of the Hospital Association of Southern California, said in a statement that hospitals support “fair wages” for health workers but that their pay should be discussed at a “state or regional level.”

“Deeply flawed” local ordinances, he said, are “bad policy and the wrong approach.”

The union used Inglewood and Duarte, both in Los Angeles County, as test cases for raising wages, particularly for some of the lowest-paid health facility workers, such as nursing assistants, security guards, and janitors. Because the measures are city ordinances, they wouldn’t apply to state- and county-run medical facilities, just private hospitals and clinics.

Union officials argue that a $25 minimum wage is necessary to retain and attract workers in a sector that has been understaffed and overworked throughout the covid-19 pandemic.

The minimum wage in most of Los Angeles County is $16.04 per hour. But for a single adult with no children, the living wage — the amount that person would need to cover typical expenses such as food, housing, and transportation in the county — is $21.89 hourly, or about $45,500 a year, according . Occupations such as “healthcare support” generally pay around $33,000 annually in the county, according to the same tool.

Hospitals campaigned heavily against the union’s proposal and argued it would create “unequal pay” for staff at private and public facilities. An analysis commissioned by the California Hospital Association estimated that instituting a $25 minimum wage in the 10 cities originally targeted by the union would have raised costs for private facilities in those communities by , a 6.9% increase.

In Inglewood — a working-class city of about 107,000 people southwest of Los Angeles — Measure HC will apply to Centinela Hospital Medical Center and several for-profit dialysis clinics if it prevails. About 315 employees of the hospital would see their wages rise, according to Jimenez, who said she doesn’t know how many dialysis clinic employees would be affected.

In Duarte, a wealthier suburb of about 21,000 people east of Los Angeles, Measure J would have applied only to City of Hope, a cancer hospital.

Jimenez said the differences between those communities, and their residents’ experiences with the health care system, could account for how the measures fared. She said she noticed that Inglewood voters had more direct experience with Centinela — they may have visited the emergency room or had a baby — than Duarte voters had with City of Hope.

The union has taken two approaches to seeking a $25 minimum wage. It attempted to secure a statewide minimum wage during negotiations with hospitals this year in Sacramento. But the negotiations were complicated by competing hospital and union priorities, and the deal . The union has also pursued a city-by-city strategy, targeting 10 communities in Los Angeles and Orange counties, including Inglewood and Duarte, where internal polling showed minimum wage proposals could pass.

Earlier this year, city councils in Los Angeles, Downey, Monterey Park, and Long Beach adopted $25 minimum-wage ordinances for private facility health workers, but hospitals and health care facilities challenged them, pushing the issue to the 2024 ballot. Meanwhile, the union dropped its effort in Anaheim and failed to gather enough signatures in Culver City, Lynwood, and Baldwin Park to place measures before voters this year.

Both sides spent heavily. According to state campaign finance filings, spent about $11 million across all 10 cities from February through the week before the election. spent $12 million during the same time frame.

Many labor economists said that the health care workforce deserves higher wages and better working conditions but that increasing the minimum wage could cause ripple effects.

Neighboring towns or facilities that aren’t subject to the new minimum wage and other sectors of the local economy might have to compete for workers, said Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at the University of California-San Francisco. And facilities that increase pay may have to do more with fewer staffers, she said.

“To have a minimum wage that is specific to a limited category of workers, in a limited set of organizations, in a single city is really unusual,” Spetz said. “I cannot think of any other circumstances where this has happened.”

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Three times a week, Sherwin, 71, drives to a dialysis clinic in Elk Grove, California, the suburb south of Sacramento where she lives, and lies tethered to a machine for about four hours while it filters her blood. The treatment exhausts her, but she feels well cared for and knows the clinic workers will call the police if she doesn’t show up for an appointment and they can’t get in touch with her directly.

“They don’t play games,” said Sherwin.

Sherwin fears her access to the clinic is in jeopardy. A sign in the clinic’s window tells patients and visitors to vote “no” on Proposition 29, the third statewide dialysis initiative in five years. It would impose new requirements on dialysis clinics, such as requiring a doctor to be on hand during treatments.

She and other California voters have also been bombarded by , in which patients in wheelchairs and doctors in scrubs warn that “29 would shut down dialysis clinics throughout California.”

“We’re terrified,” said Sherwin. “If they stop it, where are we going to go? We just die.”

Sherwin is among roughly who rely on 650 dialysis clinics tucked into strip malls and medical centers around the state. Patients arrive in medical transport vans, minivans, and the occasional ride-hailing vehicle and are often too tired and hungry after treatment to drive themselves home. They drag duffel bags and pillows into clinics, prepared to sit for four or five hours at a time, typically three days a week, as their blood is cleaned and filtered through a machine because their kidneys can no longer perform those functions.

Proposition 29 would require clinics to report infections to the state and tell patients when doctors have a financial stake in a clinic, rules that are similar to existing federal regulations.

The biggest flashpoint is the requirement to have a doctor, nurse practitioner, or physician assistant present at every clinic while patients are being treated.

Requiring a clinician on-site would increase each facility’s costs by “several hundred thousand dollars annually on average,” according to by the nonpartisan state Legislative Analyst’s Office. To deal with the additional costs, the analysis concluded, clinics have three options: negotiate higher rates with insurers, lose profits, or close facilities.

The Service Employees International Union-United Healthcare Workers West, which is sponsoring Proposition 29, said reforms are necessary to keep patients safe during the physically arduous dialysis process. The union — which has tried but failed to organize dialysis workers — argues that the treatment is dangerous and that patients need access to highly trained medical professionals to deal with emergencies instead of relying on 911.

The union was also behind the two previous dialysis ballot initiatives, which failed by wide margins. Proposition 8 in 2018 would have capped industry profits, while Proposition 23 in 2020 was nearly identical to this year’s measure. Both for .

The Proposition 29 opposition campaign, funded mostly by the dialysis industry, says keeping a doctor or nurse practitioner around at all times is both costly and unnecessary. Clinics employ registered nurses who check on patients and medical directors — physicians who oversee facilities but are often on-site only part time. About three quarters of California’s dialysis clinics are owned or operated by two companies: DaVita and Fresenius Medical Care.

So far, both sides have raised at least , according to the Los Angeles Times, with roughly 85% coming from DaVita and Fresenius.

Joe Damian, 71, doesn’t buy the claim that clinics would close if Proposition 29 passed. Of course, he said, he’d feel more comfortable if a doctor were on-site when his wife, Yolanda, has her treatments. He also believes dialysis companies would continue to make money hand over fist.

“How could it not be better?” he asked. “They just don’t want to give up any of their profits.”

Damian drives his wife to her treatments in Elk Grove. He understands why other patients and their families are worried about clinics closing but thinks the industry is fearmongering.

“Closing facilities is a threat they’ll never do,” he said. “Why would they close a moneymaking business?”

Proposition 29 includes provisions intended to protect against clinic closures, such as requiring facilities to get approval from the state before they end or reduce services, but opponents argue the provisions won’t hold up in court.

Nearly all the patients interviewed going to or from dialysis appointments at five Sacramento-area clinics had witnessed workers call 911 for another patient. Most said the emergencies had been handled well by the workers and emergency personnel. Overall, they said, they felt the dialysis clinics took good care of them.

The majority of patients had internalized the language of the opposition ads that warned of clinic closures.

Norbie Kumagai, 65, spent last Thanksgiving at University of California-Davis Medical Center, and his family was told it was time to say goodbye. But Kumagai, who has stage 4 kidney disease and high blood pressure, pulled through and had to wait months for a dialysis chair to open up at a clinic in West Sacramento, about 13 miles from his home in Davis.

Kumagai generally agrees that the dialysis industry needs reforms. For instance, he said, he’d like the technicians who help him each week to get pay raises.

But he’s worried about what Proposition 29 might mean for the treatments that keep him alive.

“I’ve told my friends and neighbors I’m scared to death if it passes,” Kumagai said. “This facility will probably close.”

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Tony Ramirez, 39, a critical care technician at Garfield Medical Center in Monterey Park, California, finds more fulfillment in helping people in need than he once did editing technical documents for Disneyland. Before the pandemic, he would reposition and bathe patients and sometimes monitor their vital signs. After covid struck, he took on more duties, providing CPR or grabbing medications during an emergency, placing leads to monitor heart rhythms, and conducting post-mortem work. “We started doing that,” Ramirez said, “because of the influx of covid patients running very ill and in very intense situations.”

Through it all, his $19.40-an-hour pay hasn’t changed.

In Southern California, one labor union is trying to help by pushing for a at private hospitals, psychiatric facilities, and dialysis clinics. The Service Employees International Union-United Healthcare Workers West, which represents roughly in California, says a raise would help the providers retain workers who could land comparable positions at Amazon or fast-food restaurants amid labor shortages. It would also allow Ramirez to give up one of the three jobs he works just to make rent.

What began as a 10-city campaign by the union has been winnowed to November ballot measures in just two cities in Los Angeles County, reflecting expensive political jockeying between labor and industry. And the $25 minimum wage isn’t the only campaign being waged by SEIU-UHW this cycle — the union is also trying for the third time to get .

A the California Association of Hospitals and Health Systems — with funding from Kaiser Permanente of Northern California, Adventist Health, Cedars-Sinai, Dignity Health, and other hospitals and health systems — opposes a $25 minimum wage because it raises costs for private, but not public, hospitals and health care facilities. Opponents have latched on to this disparity by calling it the “.” An analysis commissioned by the California Hospital Association estimated that the change would raise costs for private facilities by , a 6.9% increase, across the 10 cities.

“No one in hospitals and no one in health care is opposed to a living wage,” said George Greene, president and CEO of the Hospital Association of Southern California. “But we believe that this should be a statewide conversation that is measured and thoughtful.”

Earlier this year, city councils in Los Angeles, Downey, Monterey Park, and Long Beach adopted similar $25 minimum wage ordinances for health workers, but they were challenged by hospitals and health facilities, which pushed the issue to the ballot in 2024. Meanwhile, the union dropped its effort in Anaheim and failed to gather enough signatures in Culver City, Lynwood, or Baldwin Park to get a minimum wage measure on the fall ballot. As a result, only voters in Inglewood and Duarte will cast their votes — on and , respectively — this November.

Spending on the fight over the minimum wage proposals in Southern California has reached nearly $22 million. According to state campaign finance filings, SEIU-UHW has spent nearly $11 million across all 10 cities. Hospitals and health facilities have also spent almost $11 million to defeat minimum wage proposals.

Unions have long agitated for across-the-board minimum wage increases. In 2016, labor played a key role in successfully lobbying then-Gov. Jerry Brown to make California the first state to set a $15 minimum wage, a graduated measure that as of this year applies to all employers with 26 or more workers. About set their own minimum wages above the state minimum. The federal minimum wage remains $7.25.

SEIU-UHW contemplated a statewide scope, as well as the current piecemeal strategy of targeting cities in and around Los Angeles. “At first we were looking at city by city,” said the union’s political director, Suzanne Jimenez. “And then a conversation around doing it statewide came up but ultimately didn’t move forward.”

That’s partly because a deal to set a statewide minimum wage at public and private hospitals , and wins like that are harder to pull off than they once were, said Bill Sokol, a labor lawyer who has worked with SEIU-UHW.

“It’s not about what we wish we could do, but about where can we win,” Sokol said. “The answer is in one city at a time.”

Union leaders said they targeted cities where internal polling showed support among residents. Jimenez said the proposal has majority support in Inglewood but Duarte is too small to sample. The measures need a majority vote in each city to pass, and if that happens, they will take effect 30 days after the results are certified.

Should the approach prove successful in Los Angeles County, the union will consider taking the proposal to other parts of the state, including the Inland Empire and Sacramento, Jimenez said. That could eventually build momentum for statewide change.

If voters in Inglewood and Duarte pass the $25 minimum wage, the effect would be limited. Workers at state- and county-run medical facilities aren’t covered by city ordinances, so the local measures wouldn’t apply. That means it excludes workers who do the same jobs at public hospitals, clinics, and health care facilities.

In Inglewood, the measure would apply only to Centinela Hospital Medical Center and several for-profit dialysis clinics. In Duarte, it would apply to City of Hope, a private cancer hospital.

Many labor economists agree that something must improve for this workforce: They need higher wages and better work conditions. But that comes at a cost to the health system, said Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at the University of California-San Francisco.

“In the end, who ends up paying for that? Consumers do,” Spetz said. “Maybe you’ll cut into the profit margins of a publicly traded company a little bit, but the reality is those companies have been pretty good at figuring out how to keep their revenues and profitability up.”

Still, the union says a $25 minimum wage would help members of the lowest-paid sector of the health care workforce, who are disproportionately women, immigrants, and people of color.

Andrew Kelly, assistant professor of public health at Cal State East Bay, said raising wages at one facility could have a cascade effect because surrounding facilities would then need to raise wages to compete.

Currently, a living wage in L.A. County for a single adult with no children is $21.89 hourly, or a little more than $45,500 a year, according . Occupations like “healthcare support” generally pay around $33,000 annually in the county, according to the same tool.

Come Election Day, most Southern California health workers will have to watch from the sideline.

In Monterey Park, where Ramirez works, the city council approved the $25 minimum wage, but opponents got the vote invalidated by arguing that the council lacked a quorum at the time. The council ended up placing the question on the ballot in 2024, two years from now. Ramirez said that new hires at his medical center start at $15.30 an hour doing the dirtiest jobs in the hospital and that five workers have left his department this year.

“It’s disheartening, I’m not going to lie,” Ramirez said. “These elected officials know what’s going on.”

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“With Proposition 1, the number of abortion seekers from other states will soar even higher, costing taxpayers millions more.”

California Together, No on Proposition 1, on its website, Aug. 16, 2022

, a campaign led by religious and anti-abortion groups, is hoping to persuade voters to reject a that would cement the right to abortion in the state’s constitution. The group is warning that taxpayers will be on the hook for an influx of abortion seekers from out of state.

Proposition 1 was placed on the ballot by the Democratic-controlled legislature in response to the U.S. Supreme Court’s to overturn Roe v. Wade. If passed, it would protect an individual’s “fundamental right to choose to have an abortion,” along with the .

California Together’s says: “With Proposition 1, the number of abortion seekers from other states will soar even higher, costing taxpayers millions more.”

The campaign raised similar cost concerns in a that will be mailed out to every registered voter ahead of the Nov. 8 election. One prominent argument is that Proposition 1 will turn California into a “sanctuary state” for abortion seekers, including those in late-term pregnancy — and that would be a drain on tax dollars.

We decided to take a closer look at those eye-catching statements to see how well they hold up when broken down.

We reached out to California Together to find out the basis for its arguments against the measure. The campaign cited an analysis from the pro-abortion rights Guttmacher Institute, which estimated before Roe was overturned that the number of women ages 15 to 49 whose nearest abortion provider would be in California in response to state abortion bans. The Guttmacher analysis said most of California’s out-of-state patients would likely come from Arizona because it’s within driving distance.

California Together does not cite a specific cost to taxpayers for the measure. Rather, it points to millions of dollars the state has already allocated to support abortion and reproductive health services as an indication of how much more the state could spend if the proposed amendment passes.

Sources indicate that people are already coming to the state for abortion services.

Jessica Pinckney, executive director of Oakland-based Access Reproductive Justice, which provides financial and emotional support for people who have abortions in California, said the organization had experienced an increase in out-of-state calls even before the high court ruled in June. Pinckney anticipates handling more cases as more states restrict abortion — regardless of Proposition 1’s outcome.

Will It Cost Taxpayers Millions?

In its fiscal year 2022-23 budget, California committed to expanding reproductive health care services, including for a fund to cover the travel expenses of abortion seekers, regardless of what state they live in. Once it’s up and running in 2023, the fund will provide grants to nonprofit organizations that help women with transportation and lodging.

However, none of that spending is connected to Proposition 1, said Carolyn Chu, chief deputy legislative analyst at the nonpartisan Legislative Analyst’s Office. It’s already allocated in the budget and will be doled out next year regardless of what happens with the ballot measure.

In the end, the Legislative Analyst’s Office found “” if Proposition 1 passes because Californians already have abortion protections. And people traveling from out of state don’t qualify for state-subsidized health programs, such as Medi-Cal, the state’s Medicaid program, Chu added in an interview. “If people were to travel to California for services, including abortion, that does not mean they’re eligible for Medi-Cal,” she said.

Still, Proposition 1 opponents see the cost argument playing out in a different way.

Richard Temple, a campaign strategist for California Together, said a “no” vote will send lawmakers a mandate to stop the support fund. “Defeat Prop. 1, and you send a loud signal to the legislature and to the governor that you don’t want to pay for those kinds of expenses for people coming in from out of state,” Temple said.

What About an Influx of Abortion Seekers?

A key element of California Together’s argument is pegged to the idea that California will become a sanctuary state for abortion seekers. Opponents assert that Proposition 1 opens the door to a new legal interpretation of the state’s . Currently, that law allows abortion up to the point of viability, usually around the 24th week of pregnancy, or later to protect the life or health of the patient.

An argument made in the voter guide against the constitutional amendment is that it would allow all late-term abortions “.”

Because the proposition says the state can’t interfere with the right to abortion, opponents argue that current law restricting most abortions after viability will become unconstitutional. They contend that without restrictions, California will draw thousands, possibly millions, of women in late-term pregnancy.

Statistically, that’s unlikely. The state doesn’t report abortion figures, but nationwide only , according to the Centers for Disease Control and Prevention.

Whether there will be a new interpretation if Proposition 1 passes is up for debate.

UCLA law professor Cary Franklin, who specializes in reproductive rights, said that just because Proposition 1 establishes a general right to abortion doesn’t mean all abortion would become legal. Constitutional language is always broad, and laws and regulations can add restrictions to those rights. For example, she said, the Second Amendment to the U.S. Constitution grants the right to bear arms, but laws and regulations restrict children from purchasing guns.

“The amendment doesn’t displace any of that law,” Franklin said.

But current law was written and interpreted under California’s current constitution, which doesn’t have an explicit right to abortion, said Tom Campbell, a former legislator who teaches law at Chapman University. If Proposition 1 passes, courts might interpret things differently. “Any restriction imposed by the state on abortion would have to be reconsidered,” Campbell said.

The Legislative Analyst’s Office concluded that “whether a court might interpret the proposition to expand reproductive rights beyond existing law is unclear.”

California voters will soon have their say.

Polling has found widespread support for the constitutional amendment. An August survey by the Berkeley IGS Poll found of voters would vote “yes” on Proposition 1. A September survey by the Public Policy Institute of California pegged support at

Our Ruling

California Together warns voters: “With Proposition 1, the number of abortion seekers from other states will soar even higher, costing taxpayers millions more.”

Proposition 1 would protect an individual’s “fundamental right to choose to have an abortion.”

While it could lead to more people coming to California for abortion services, that’s already happening, even before voters decide on the measure.

In addition, Proposition 1 doesn’t allocate any new spending. So the $20 million state fund to cover travel expenses for abortion seekers would exist regardless of whether the constitutional amendment is adopted. Bottom line: A nonpartisan analyst found there will be no direct fiscal impact to the state, and out-of-state residents don’t qualify for state-subsidized health programs.

It’s speculative that Proposition 1 would expand abortion rights beyond what’s currently allowed or that the state would allocate more money for out-of-state residents.

Because the statement contains some truth but ignores critical facts to give a different impression, we rate the statement Mostly False.

Sources

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SACRAMENTO, Calif. — California is trying to ease the pain of vasectomies by making them free for millions of residents.

Federal law and state law require most health insurers to cover prescription contraceptives at no cost to the patient. But those provisions apply to only 18 FDA-approved birth control options for women, so anyone with testicles is out of luck.

California lawmakers are now considering a bill that would expand that requirement to male sterilization. If the passes, commercial insurance plans regulated by the state won’t be allowed to impose out-of-pocket costs, like copays, coinsurance, and deductibles, for vasectomies.

“It’s pretty groundbreaking in that way — it’s a whole new framework to think about contraception as something that is relevant for people of all genders,” said Liz McCaman Taylor, a senior attorney with the National Health Law Program, a group that advocates for the health rights of low-income people.

is an outpatient surgical procedure in which the patient’s supply of sperm is cut off from his semen by sealing or snipping the tubes that transport sperm from the testes to the penis. Most men need to recover on the couch with an ice pack for a day or two, and a test a few months later determines whether the procedure worked.

Because vasectomies are elective procedures and usually not urgent, price can be a deciding factor.

For Nathan Songne, cost was the most stressful part of the procedure. For several years, the 31-year-old had known he didn’t want to have kids biologically. Better to adopt a 4-year-old and skip the diaper stage, he thought. He was adopted by his stepfather as a child and knew he didn’t need to be genetically related to his children to love them.

“My only concern was that I had no idea how much it was going to cost me because nobody told me,” said Songne, who lives in Mission Viejo, in Orange County. If the procedure cost $1,000, as he expected, he wouldn’t be able to afford it, he said.

Songne’s insurance, which he gets through his work assembling guitars, covered 70% of the Aug. 8 procedure, leaving him with a bill of just under $200. “Cost did affect my decision, but because it was only $200, it made me feel a lot more relieved about continuing on with the vasectomy,” he said.

There are two hot times of year in the vasectomy business, according to Dr. Mary Samplaski, an associate professor of urology at the USC Keck School of Medicine. First, she sees an uptick during the March Madness college basketball tournament, when men choose to recover on the couch watching hoops.

The end of the year is also busy, she said, because many patients have finally met their annual insurance deductible and can afford the procedure.

Patients discuss out-of-pocket costs in about 20% of her vasectomy consultations. “It’s obviously a nerve-wracking procedure,” Samplaski said. “And on top of that, if your copay is high, there’s even less reason to want to do it.”

In April, Jacob Elert comparison-shopped for a vasectomy near his home in Sacramento because his health plan doesn’t cover the procedure. He had hoped to schedule one with his regular urologist, he said, but that would have come with a $1,500 price tag.

Instead, he found a chain of vasectomy clinics where he could get the procedure for $850. Three months later, a test confirmed the vasectomy was a success.

Elert has no regrets, but had price not been a factor, he would have preferred to go to his regular urologist. “That’s the doctor I trust,” Elert said. “But it was just way too expensive.”

In November, California whether to lock rights to abortion and contraception into the state constitution. But doesn’t address issues such as cost and coverage, said Amy Moy, a spokesperson for Essential Access Health, a group that runs California’s .

“The constitutional amendment is kind of the long-term protection, and we are still working to reduce barriers for Californians on the short-term and day-to-day level regardless of their gender,” she said.

SB 523 has sailed through preliminary votes in the state legislature, which faces an end-of-August deadline to act on bills. If the measure passes, it would take effect in 2024, and California would join that require plans they regulate to completely cover vasectomies.

The California Association of Health Plans is still evaluating the measure, which may be amended in the final days of the legislative session. But the association generally opposes bills that require additional insurance benefits because they could lead to higher premiums, spokesperson Mary Ellen Grant said.

SB 523 applies to more than 14 million Californians who work for the state, have a student health plan through a university, or have state-regulated commercial health plans. The bill would not apply to the millions of Californians whose health insurance plans are regulated by the federal government.

Women aren’t completely left out by the bill. They would become eligible to receive free over-the-counter birth control — such as emergency contraception, condoms, spermicide, and contraceptive sponges.

The specifics of how the benefit would work, including the frequency and amount of birth control that insurers must cover and whether patients would have to pay upfront and be reimbursed later, would be hammered out after the measure is adopted. McCaman Taylor said allowing people to simply present their insurance card at a pharmacy counter and walk away with the birth control they need would be preferable.

“We kind of learned from the national experiment with covid over-the-counter tests that reimbursement wasn’t the best model,” she said. “If people can’t afford to pay out-of-pocket for it, they’re just not going to get it.”

The , which analyzes legislation, projected that roughly 14,200 people with state-regulated commercial insurance would get vasectomies in California this year. Eliminating cost sharing would increase the number of vasectomies by 252 in the law’s first year, the program estimated.

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If they vote “yes” on , they will also lock in a right that has gotten less attention: the right to birth control.

Should the measure succeed, California would become one of the first states — if not the first — to create explicit constitutional rights to both abortion and contraception.

The lawmakers and activists behind the constitutional amendment said they hope to score a one-two punch: protect abortion in California after the U.S. Supreme Court ended the federal constitutional right to abortion under Roe v. Wade, and get ahead of what they see as the next front in the reproductive rights fight: birth control.

“The United States Supreme Court said that the privacy and liberty protections in the United States Constitution did not extend to abortion,” said UCLA law professor Cary Franklin, an expert in constitutional law and reproductive rights who has testified before the California legislature in support of the amendment. “If they said ‘no’ on abortion, they’re probably going to say ‘no’ on birth control because that has a similar history.”

In June, the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization ended the federal right to abortion and left states to regulate the service. , Justice Clarence Thomas said the court should revisit other cases that have created protections for Americans based on an implicit right to privacy in the U.S. Constitution, such as Griswold v. Connecticut, which established a federal right to contraception for married people — which was later extended to unmarried people.

Some congressional Democrats are now trying to codify the right to contraception in federal law. In July, the U.S. House of Representatives passed the , which would give patients the right to access and use contraception and providers the right to furnish it. But the bill has little chance of success in the U.S. Senate, where Republicans have already blocked it once.

Protecting access to contraception is popular with voters. conducted in late July found that 75% of registered voters support a federal law that protects a right to birth control access.

California isn’t the only state where voters are considering reproductive rights in their constitutions.

On Tuesday, Kansas voters that would have allowed state lawmakers to ban or dramatically restrict abortion. It failed by nearly 18 percentage points.

voters will face a similar decision in November with a proposed constitutional amendment that would declare that the state’s constitutional right to privacy does not cover abortion.

Vermont is going in the opposite direction. Voters there will weigh a ballot measure in November that would add a right to “personal reproductive autonomy” to the state constitution, though it does not explicitly mention abortion or contraception. In Michigan, a that would guarantee a right to both abortion and contraception is expected to qualify for the November ballot.

In California, Proposition 1 would prevent the state from denying or interfering with “an individual’s reproductive freedom in their most intimate decisions, which includes their fundamental right to choose to have an abortion and their fundamental right to choose or refuse contraceptives.”

The proposed constitutional amendment doesn’t go into detail about what enshrining the right to contraception in the state constitution would mean.

California already has some of the strongest contraceptive-access laws in the country — and lawmakers are considering more proposals this year. For instance, state-regulated health plans must cover all FDA-approved contraception; pharmacists to anyone with a prescription, regardless of age; and pharmacists can pills on the spot. State courts have also interpreted California’s constitution to include a right to privacy that covers reproductive health decisions.

The amendment, if adopted, could provide a new legal pathway for people to sue when they’re denied contraceptives, said Michele Goodwin, chancellor’s professor of law at the University of California-Irvine.

If a pharmacist refused to fill a birth control prescription or a cashier declined to ring up condoms, she said, customers could make a case that their rights had been violated.

Making the rights to abortion and contraception explicit in the state constitution — instead of relying on a right to privacy — would also protect against shifting political winds, said state Senate leader Toni Atkins (D-San Diego), who was the director of a women’s health clinic in the 1980s. Although California’s lawmakers and executive officers are solid supporters of abortion rights, she said, the composition of the legislature and courts’ interpretation of laws could change.

“I want to know for sure that that right is protected,” Atkins said at a legislative hearing in June. “We are protecting ourselves from future courts and future politicians.”

The amendment as a as much of the country chips away at birth control availability, Goodwin added.

Experts said two forms of birth control that are vulnerable to restrictions in other states are intrauterine devices, or IUDs, and emergency contraception like Plan B. These methods are often incorrectly conflated with abortion pills, which end a pregnancy instead of preventing it.

have laws that restrict emergency contraception — for example, by allowing pharmacies to refuse to dispense it or excluding it from state family planning programs — according to the Guttmacher Institute, a research organization that supports abortion rights. In and this year, abortion opponents introduced legislation that would restrict or ban abortion, and would also apply to emergency contraception.

“We’re seeing an erosion of abortion access that is playing out in statehouses across the country that have and will continue to target contraceptive care as well,” said Audrey Sandusky, senior director of policy and communications for the .

Susan Arnall, vice president of California’s Right to Life League, said the proposed amendment is symbolic and merely echoes current laws. Arnall thinks the campaign is mostly about Democratic politicians trying to score political points.

“It just allows the pro-abort legislators to trumpet and give them talking points about how they’re doing something about the overturn of Roe v. Wade,” she said. “It is political virtue signaling. I don’t think it does much of anything else.”

Goodwin argues that the measure’s symbolism is significant and overdue. She pointed to the Civil War era, when enslaved people in Southern states could look to free states for spiritual hope and material help. “Symbolically, what that meant is a kind of beacon of hope, that those places did exist, where one’s humanity could be regarded,” Goodwin said.

But California’s reputation as a haven for contraceptive availability may not be fully warranted, said Dima Qato, an associate professor at the University of Southern California School of Pharmacy. In her of contraceptive access in Los Angeles County, which has some of the highest rates of teen and unintended pregnancy in the country, Qato found that only 10% of pharmacies surveyed offered pharmacist-prescribed birth control. Pharmacies in low-income and minority communities were the least likely to offer the service, Qato said, worsening disparities instead of solving them.

Qato supports the constitutional amendment but said California should focus on improving and enforcing the laws it already has.

“We don’t need more laws when we don’t address the root cause of a lack of effectiveness of these laws in these communities,” Qato said. “Lack of enforcement and accountability disproportionately impacts communities of color.”

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This wasn’t an abortion rights rally. It wasn’t a protest against the recent that gutted Roe v. Wade. It was the “Defeat the Mandates Rally,” a jubilant gathering of anti-vaccine activists in April to protest the few remaining covid-19 guidelines, such as mask mandates on mass transit and vaccination requirements for health care workers.

Similar scenes have played out across the country during the pandemic. Armed with the language of the abortion rights movement, anti-vaccine forces have converged with right-leaning causes to protest covid precautions.

And they’re succeeding. Vaccine opponents have appropriated “My Body, My Choice,” a slogan that has been inextricably linked to reproductive rights for nearly half a century, to fight mask and vaccine mandates across the country — including in California, where lawmakers had vowed to adopt the toughest vaccine requirements in the U.S.

As the anti-vaccine contingent has notched successes, the abortion rights movement has taken hit after hit, culminating in the June 24 Supreme Court decision that ended the federal constitutional right to abortion. The ruling leaves it up to states to decide, and are expected to ban or severely limit abortion in the coming months.

Now that anti-vaccination groups have laid claim to “My Body, My Choice,” abortion rights groups are distancing themselves from it — marking a stunning annexation of political messaging.

“It’s a really savvy co-option of reproductive rights and the movement’s framing of the issue,” said Lisa Ikemoto, a law professor at the University of California-Davis Feminist Research Institute. “It strengthens the meaning of choice in the anti-vaccine space and detracts from the meaning of that word in the reproductive rights space.”

Framing the decision to vaccinate as a singularly personal one also obscures its public health consequences, Ikemoto said, because vaccines are used to protect not just one person but a community of people by stopping the spread of a disease to those who can’t protect themselves.

Celinda Lake, a Democratic strategist and pollster based in Washington, D.C., said “My Body, My Choice” is no longer polling well with Democrats because they associate it with anti-vaccination sentiment.

“What’s really unique about this is that you don’t usually see one side’s base adopting the message of the other side’s base — and succeeding,” she said. “That’s what makes this so fascinating.”

Jodi Hicks, president of Planned Parenthood Affiliates of California, acknowledged that the appropriation of abortion rights terminology has worked against the reproductive rights movement. “In this moment, to co-opt that messaging and distract from the work that we’re doing, and using it to spread misinformation, is frustrating and it’s disappointing,” Hicks said.

She said the movement was already gravitating away from the phrase. Even where abortion is legal, she said, some women can’t “choose” to get one because of financial or other barriers. The movement is now focusing more heavily on access to health care, using catchphrases such as “Bans Off Our Bodies” and “Say Abortion,” Hicks said.

Vaccination hasn’t always been this political, said Jennifer Reich, a sociology professor at the University of Colorado-Denver, who has about why parents refuse vaccines for their kids. Opposition to vaccines grew in the 1980s among parents concerned about school vaccine requirements. Those parents said they didn’t have enough information about vaccines’ potential harmful effects, but it wasn’t partisan at the time, Reich said.

The issue exploded onto the political scene after a measles outbreak tied to Disneyland in 2014 and 2015. When California lawmakers moved to prohibit parents from claiming for required childhood vaccines, opponents organized around the idea of “medical choice” and “medical freedom.” Those opponents spanned the political spectrum, Reich said.

Then came covid. The Trump administration politicized the pandemic from the outset, starting with masks and stay-at-home orders. Republican leaders and white evangelicals implemented that strategy on the ground, Reich said, arguing against vaccine mandates when covid vaccines were still only theoretical — scaring people with rhetoric about the loss of personal choice and images of vaccine passports.

They gained traction despite an obvious inconsistency, she said: Often, the same people who oppose vaccine requirements — arguing that it’s a matter of choice — are against abortion rights.

“What’s really changed is that in the last two or so years, it’s become highly partisan,” Reich said.

Joshua Coleman leads V is for Vaccine, a group that opposes vaccine mandates. He said he deploys the phrase strategically depending on what state he’s working in.

“In a state or a city that is more pro-life, they’re not going to connect with that messaging, they don’t believe in full bodily autonomy,” Coleman said.

But in places like California, he takes his “My Body, My Choice” rhetoric where he thinks it will be effective, like the annual Women’s March, where he says he can sometimes get feminists to consider his perspective.

Perception of the word “choice” has changed over time, said Alyssa Wulf, a cognitive linguist based in Oakland, California. The word now evokes an image of an isolated decision that doesn’t affect the broader community, she said. It can frame an abortion seeker as self-centered, and a vaccine rejector as an individual making a personal health choice, Wulf said.

Beyond linguistics, anti-vaccination activists are playing politics, intentionally trolling the abortion rights groups by using their words against them, Wulf said. “I really believe there’s a little bit of an ‘eff you’ in that,” Wulf said. “We’re going to take your phrase.”

Tom Blodget, a retired Spanish-language instructor from Chico, California, sported a “My Body, My Choice” shirt — complete with an image of a cartoon syringe — at the Defeat the Mandates Rally in Los Angeles. It was “an ironic thing,” he said, meant to expose what he sees as the hypocrisy of Democrats who support both abortion and vaccine mandates. Blodget said he is “pro-life” and believes that covid vaccines are not immunizations but a form of gene therapy, which is not true.

For Blodget, and many other anti-vaccination activists, there is no inconsistency in this position. Abortion is not a personal health decision akin to getting a shot, they say: It is simply murder.

“Women say they can have an abortion because it’s their body,” Blodget said. “If that’s a valid thing for a lot of people, why should I have to take an injection of some concoction?”

About a week later and nearly 400 miles to the north in Sacramento, state lawmakers heard testimony on bills about abortion and covid vaccines. Two protests, one against abortion and one against vaccine mandates, converged. Truckers from the “People’s Convoy,” a group that opposes covid mandates that had been touring the country with its message of “medical freedom,” testified against a bill that would stop police from investigating miscarriages as murders. Anti-abortion activists lined up to oppose a bill that would update reporting requirements to the state’s vaccine registry.

“My Body, My Choice” was ubiquitous: Kids petting police horses in front of the Capitol wore T-shirts with the slogan, and truckers watching a sword dance toted signs above their heads.

At the time, two tough legislative proposals to mandate covid vaccines for schoolchildren and most workers had already been shelved without a vote. One controversial vaccination proposal remained: a bill to allow children 12 and older to get covid vaccines .

Lawmakers have since watered down the measure, raising the minimum age to 15, and it awaits crucial votes. They have shifted their attention to the latest political earthquake: abortion.

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Becerril earns about $52,000 a year at a nonprofit in California’s Central Valley, putting her and her husband, Armando, at more than double the limit to qualify for Medi-Cal, the state’s Medicaid program for people with low incomes and disabilities. Private insurance would cost $1,230 a month in premiums, money needed for their mortgage.

“We’ve been resorting to home remedies to get through the pain,” Becerril said through a Spanish translator. Her husband has needed hernia surgery for 20 years. “It’s frustrating because we pay our taxes, but we can’t reap any of the benefits of where our taxes are going,” she added.

While many Californians who earn too much to be eligible for Medi-Cal can get subsidized coverage through Covered California, an estimated aren’t allowed to buy insurance through state-run insurance plans under the Affordable Care Act because they lack legal status. One Democratic lawmaker says it’s a small but glaring gap and is crafting a bill that could test Democratic Gov. Gavin Newsom’s commitment to reach universal health care.

“We’re going to need to figure out how to provide universal coverage for all who call this state home,” said the bill’s author, Assembly member Joaquin Arambula. “It’s an area our state has not leaned into enough, to provide coverage for those who are undocumented.”

Arambula’s bill would direct the state to ask the federal government to allow immigrants living in the state without authorization to get insurance through Covered California. Arambula sees the move as the critical first step to expand coverage. If approved, the Fresno lawmaker intends to push for state subsidies to help pay for insurance.

Both elements are essential for immigrants lacking legal status, said Jose Torres Casillas, a policy and legislative advocate with Health Access California, a consumer health group working with Arambula’s office on the measure.

“Access is one thing, but affordability is another,” Torres Casillas said.

Since taking office in 2019, Newsom has approved expanding Medi-Cal to regardless of immigration status. In doing so, the politician continuously rumored to be preparing for a presidential bid described the state as moving “one step closer” toward universal health care. But in January, Newsom announced a $22.5 billion state deficit and made no mention of new proposals for the state’s .

Newsom’s health secretary, Dr. Mark Ghaly, acknowledged the pressure to go further but he would not commit to a timeline.

“Up until now we’ve had so many other things to focus on,” Ghaly said. “This will become, frankly speaking, one of the most important next issues that we take on.”

California needs permission from the federal government to open Covered California to immigrants without legal residency because it is currently closed to them, and Arambula said he is in talks with Newsom administration officials about how to structure the bill.

Once the federal government opens Covered California up to all migrants, the state could set aside funding for subsidies. About 90% of enrollees in Covered California qualify for financial assistance, which is paid for with both state and federal funds. Since 2020, the state has spent $20 million a year on those subsidies, a fraction of the cost, because Congress has given states an infusion of money during the pandemic.

Previously, lawmakers had allocated roughly $300 million to lower insurance premiums for Covered California enrollees. Any financial assistance to people living in the state without authorization would likely have to come from state funds, and the costs could vary widely.

For instance, Colorado enrolled 10,000 such immigrants into a new insurance program designed solely for them at a cost of $57.8 million in state funds, said Adam Fox, deputy director of the Colorado Consumer Health Initiative. The program covered the full cost of insurance for enrollees.

In Washington state, immigrants who lack legal status can take advantage of a state fund next year to help all income-eligible state residents pay for insurance, said Michael Marchand, chief marketing officer for the Washington Health Benefit Exchange. State lawmakers have added $5 million to the fund for immigrants without legal authorization.

“It would serve as an incentive for additional undocumented immigration into our country,” said Sally Pipes, president and CEO of the Pacific Research Institute, a think tank that advocated against Medi-Cal expansion to immigrants without legal standing. “And put taxpayers on the hook for additional government health care costs and the inevitable higher tax bills to pay for them.”

California officials have previously considered allowing all immigrants to buy insurance from its state-run program before, submitting a request to the federal government in 2016. But the state rescinded its application after President Donald Trump took office, given his anti-immigration rhetoric and policies.

The Biden administration in December approved an exception to federal law for Washington state — a game changer in the eyes of immigration advocates, said Rachel Linn Gish, a spokesperson for Health Access.

“Seeing what other states have done and the waivers that are happening under Biden, it makes a huge difference in our approach,” she said.

But even if lawmakers pass a plan to open California’s insurance marketplace to all immigrants regardless of status, advocates said the state will have to wait until Jan. 1, 2024, to ask the federal government for permission, and it could take half a year or longer to get a response.

That means it could be years before Becerril can get coverage. Instead, she’s preparing for the worst.

“I’m paying for funeral coverage,” she said. “It’s more economical than paying the health coverage premium.”

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Eggman, a licensed social worker, co-authored the novel law that allows families, clinicians, first responders, and others to petition a judge to mandate government-funded treatment and services for people whose lives have been derailed by untreated psychotic disorders and substance use. It was a win for Newsom, who proposed the , or CARE Court, as a potent new tool to address the tens of thousands of people in California living homeless or at risk of incarceration because of untreated mental illness and addiction. The measure faced from disability and civil liberties groups worried about stripping people’s right to make decisions for themselves.

“We see real examples of people dying every single day, and they’re dying with their rights on,” Eggman said in an interview with KHN before the appointment. “I think we need to step back a little bit and look at the larger public health issue. It’s a danger for everybody to be living around needles or have people burrowing under freeways.”

Senate Pro Tem Toni Atkins announced Eggman’s appointment Thursday evening. Eggman replaces Dr. Richard Pan, who was termed out last year after serving five years as chair. Pan, a pediatrician, had prioritized the state’s response to the covid-19 pandemic and that tightened the state’s childhood vaccination laws. Those moves made him a , even as he faced taunts and physical threats from opponents.

The leadership change is expected to coincide with a Democratic health agenda focused on two of the state’s thorniest and most intractable issues: homelessness and mental illness. , California accounts for 30% of the nation’s homeless population, while making up 12% of the U.S. population. estimated that in 2020 about 25% of homeless adults in Los Angeles County had a severe mental illness such as schizophrenia and 27% had a long-term substance use disorder.

Eggman will work with Assembly member Jim Wood, a Santa Rosa Democrat who is returning as chair of the Assembly Health Committee. Though the chairs may set different priorities, they need to cooperate to get bills to the governor’s desk.

Eggman takes the helm as California grapples with a projected , which could force reductions in health care spending. The tighter financial outlook is causing politicians to shift from big “moonshot” ideas like universal health care coverage to showing voters progress on the state’s homelessness crisis, said David McCuan, chair of the political science department at Sonoma State University. Seven in 10 likely voters cite homelessness as a big problem, according to a recent by the Public Policy Institute of California.

Eggman, 61, served eight years in the state Assembly before her election to the Senate in 2020. In 2015, she authored California’s , which allowed terminally ill patients who meet specified conditions to get aid-in-dying drugs from their doctor. Her past work on mental health included changing eligibility rules for outpatient treatment or conservatorships, and trying to make it easier for community clinics to bill the government for mental health services.

She hasn’t announced her future plans, but she has around $70,000 in a for lieutenant governor, as well as $175,000 in a ballot measure committee to

Eggman said the CARE Court initiative seeks to strike a balance between civil rights and public health. She said she believes people should be in the least restrictive environment necessary for care, but that when someone is a danger to themselves or the community there needs to be an option to hold them against their will. A Berkeley Institute of Governmental Studies poll released in October found had a positive view of the law.

Sen. Thomas Umberg (D-Santa Ana), who co-authored the bill with Eggman, credited her expertise in behavioral health and dedication to explaining the mechanics of the plan to fellow lawmakers. “I think she really helped to put a face on it,” Umberg said.

But it will be hard to show quick results. The measure will unroll in phases, with the first seven counties — Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne — set to launch their efforts in October. The remaining 51 counties are set to launch in 2024.

County governments remain concerned about a steady and sufficient flow of funding to cover the costs of treatment and housing inherent in the plan.

California has allocated in seed money for counties to set up local CARE Courts, but the state hasn’t specified how much money will flow to counties to keep them running, said Jacqueline Wong-Hernandez, deputy executive director of legislative affairs at the California State Association of Counties.

Robin Kennedy is a professor emerita of social work at Sacramento State, where Eggman taught social work before being elected to the Assembly. Kennedy described Eggman as someone guided by data, a listener attuned to the needs of caregivers, and a leader willing to do difficult things. The two have known each other since Eggman began teaching in 2002.

“Most of us, when we become faculty members, we just want to do our research and teach,” Kennedy said. “Susan had only been there for two or three years, and she was taking on leadership roles.”

She said that Eggman’s vision of mental health as a community issue, rather than just an individual concern, is controversial, but that she is willing to take on hard conversations and listen to all sides. Plus, Kennedy added, “she’s not just going to do what Newsom tells her to do.”

Eggman and Wood are expected to provide oversight of , the Newsom administration’s sweeping overhaul of Medi-Cal, California’s Medicaid program for low-income residents. The effort is a multibillion-dollar experiment that aims to improve patient health by funneling money into social programs and keeping patients out of costly institutions such as emergency departments, jails, nursing homes, and mental health crisis centers. Wood said he believes there are opportunities to improve the CalAIM initiative and to monitor consolidation in the health care industry, which he believes drives up costs.

Eggman said she’s also concerned about workforce shortages in the health care industry, and would be willing to revisit a conversation about a for hospital workers after last year’s negotiations between the industry and labor failed.

But with only two years left before she is termed out, Eggman said, her lens will be tightly framed around her area of expertise: improving behavioral health care across California.

“In my last few years,” she said, “I want to focus on where my experience is.”

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SACRAMENTO — Mike Thomson’s friends refuse to stay over at his house anymore.

Thomson lives about 50 yards from a busy freeway that bisects California’s capital city, one that has been increasingly used as a speedway for high-speed races, diesel-spewing big rigs, revving motorcycles — and cars that have been illegally modified to make even more noise.

About the only time it quiets down is Saturday night between 3 and 4 a.m., Thomson said.

Otherwise, the din is nearly constant, and most nights, he’s jolted out of sleep five or six times.

“Cars come by and they don’t have mufflers,” said Thomson, 54, who remodels homes for a living. “It’s terrible. I don’t recommend it for anyone.”

Thomson is a victim of noise pollution, which health experts warn is a growing problem that is not confined to our ears, but causes stress-related conditions like anxiety, high blood pressure, and insomnia.

California legislators passed two laws in 2022 aimed at quieting the environment. One directs the California Highway Patrol to test noise-detecting cameras, which may eventually issue automatic tickets for cars that make noise above a certain level. The other forces drivers of illegally modified cars to fix them before they can be re-registered.

“There’s an aspect of our society that likes to be loud and proud,” said state Sen. Anthony Portantino (D-Glendale), author of the noise camera law. “But that shouldn’t infringe on someone else’s health in a public space.”

Most states haven’t addressed the assault on our eardrums. Traffic is a major driver of noise pollution — which disproportionately affects disadvantaged communities — and it’s getting harder to escape the sounds of leaf blowers, construction, and other irritants.

California’s laws will take time and have limited effect, but noise control experts called them a good start. Still, they do nothing to address overhead noise pollution from circling police helicopters, buzzing drones, and other sources, which is the purview of the federal government, said Les Blomberg, executive director of the .

In October 2021, the American Public Health Association declared noise a public health hazard. Decades of research links noise pollution with not only sleep disruption, but also a host of chronic conditions such as heart disease, cognitive impairment, depression, and anxiety.

“Despite the breadth and seriousness of its health impacts, noise has not been prioritized as a public health problem for decades,” . “The magnitude and seriousness of noise as a public health hazard warrant action.”

When there’s a loud noise, the auditory system signals that something is wrong, triggering a fight-or-flight response in the body and flooding it with stress hormones that cause inflammation and can ultimately lead to disease, said Peter James, an assistant professor of environmental health at Harvard University’s T.H. Chan School of Public Health.

Constant exposure to noise increases the risk of and , research shows. estimated in 2020 that noise exposure causes about 12,000 premature deaths and 48,000 cases of heart disease each year in Western Europe.

While California Highway Patrol officials will spend the next few years researching noise cameras, they acknowledge that noise from street racing and — where people block off intersections or parking lots to burn out tires or do “doughnuts” — has surged over the past several years and disturbs people right now.

Cars in California are supposed to operate at 95 decibels — a little louder than a — or less. But drivers often modify their cars and motorcycles to be louder, such as by installing “whistle tips” on the exhaust system to make noise or removing mufflers.

, the last full year for which data is available, the highway patrol issued 2,641 tickets to drivers for excessive vehicle noise, nearly double .

“There’s always been an issue with noise coming from exhausts, and it’s gained more attention lately,” said Andrew Poyner, a highway patrol captain. “It’s been steadily increasing over the past several years.”

The American Public Health Association says the federal government should regulate noise in the air, on roads, and in workplaces as an environmental hazard, but that task has mostly been abandoned since the federal Office of Noise Abatement and Control was defunded in 1981 under President Ronald Reagan.

Now the task of quieting communities is mostly up to states and cities. In California, reducing noise is often a byproduct of other environmental policy changes. For instance, the state will ban the sale of noisy gas-powered leaf blowers , a policy aimed primarily at reducing smog-causing emissions.

One of the noise laws approved in California in 2022, AB 2496, will require owners of vehicles that have been ticketed for noise to fix the issue before they can re-register them through the Department of Motor Vehicles. Currently, drivers can pay a fine and keep their illegally modified cars as they are. The law takes effect in 2027.

The other law, SB 1097, directs the highway patrol to recommend a brand of noise-detecting cameras to the legislature by 2025. These cameras, already in use in Paris, New York City, and Knoxville, Tennessee, would issue automatic tickets if they detected a car rumbling down the street too loudly.

Originally, the law would have created pilot programs to start testing the cameras in six cities, but lawmakers said they wanted to go slower and approved only the study.

Portantino said he’s frustrated by the delay, especially because the streets of Los Angeles have become almost unbearably loud.

“It’s getting worse,” Portantino said. “People tinker with their cars, and street racing continues to be a problem.”

The state is smart to target the loudest noises initially, the cars and motorcycles that bother people the most, Blomberg said.

“You can make every car coming off the line half as loud as it is right now and it would have very little impact if you don’t deal with all the people taking their mufflers off,” he said. “That outweighs everything.”

Traffic noise doesn’t affect everyone equally. In , James and colleagues found that nighttime noise levels were higher in low-income communities and those with a large proportion of nonwhite residents.

“We’ve made these conscious or subconscious decisions as a society to put minority-race communities and lower-income communities who have the least amount of political power in areas near highways and airports,” James said.

Elaine Jackson, 62, feels that disparity acutely in her neighborhood, a low-income community in northern Sacramento sandwiched between freeways.

On weekends, sideshows and traffic noise keep her awake. Her nerves are jangled, she loses sleep, her dogs panic, and she generally feels unsafe and forgotten, worried that new development in her neighborhood would just bring more traffic, noise, and air pollution.

Police and lawmakers don’t seem to care, she said, even though she and her neighbors constantly raise their concerns with local officials.

“It’s hard for people to get to sleep at night,” Jackson said. “And that’s a quality-of-life issue.”

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Inglewood residents were poised to approve a ballot measure that would boost the minimum wage to $25 at private hospitals, psychiatric facilities, and dialysis clinics. The latest vote count showed Measure HC leading 54% to 46%, according to . In Duarte, roughly 35 miles away, voters were on track to decisively reject a similar proposal, Measure J, 63% to 37%.

Los Angeles County election officials plan to release final results Dec. 5.

The contests were the first ballot-box fight in what seems likely to be a multiyear battle between a powerful labor union and the influential hospital industry. Similar proposals are scheduled to go before voters in Los Angeles, Downey, Long Beach, and Monterey Park in 2024.

All were spearheaded by the Service Employees International Union-United Healthcare Workers West, which represents roughly , including medical assistants, food service workers, and custodial staff.

Suzanne Jimenez, the union’s political director, said the union still plans to pursue a $25 minimum wage in other cities and, eventually, statewide.

“We’re still moving forward on all fronts,” she said.

George Greene, president of the Hospital Association of Southern California, said in a statement that hospitals support “fair wages” for health workers but that their pay should be discussed at a “state or regional level.”

“Deeply flawed” local ordinances, he said, are “bad policy and the wrong approach.”

The union used Inglewood and Duarte, both in Los Angeles County, as test cases for raising wages, particularly for some of the lowest-paid health facility workers, such as nursing assistants, security guards, and janitors. Because the measures are city ordinances, they wouldn’t apply to state- and county-run medical facilities, just private hospitals and clinics.

Union officials argue that a $25 minimum wage is necessary to retain and attract workers in a sector that has been understaffed and overworked throughout the covid-19 pandemic.

The minimum wage in most of Los Angeles County is $16.04 per hour. But for a single adult with no children, the living wage — the amount that person would need to cover typical expenses such as food, housing, and transportation in the county — is $21.89 hourly, or about $45,500 a year, according . Occupations such as “healthcare support” generally pay around $33,000 annually in the county, according to the same tool.

Hospitals campaigned heavily against the union’s proposal and argued it would create “unequal pay” for staff at private and public facilities. An analysis commissioned by the California Hospital Association estimated that instituting a $25 minimum wage in the 10 cities originally targeted by the union would have raised costs for private facilities in those communities by , a 6.9% increase.

In Inglewood — a working-class city of about 107,000 people southwest of Los Angeles — Measure HC will apply to Centinela Hospital Medical Center and several for-profit dialysis clinics if it prevails. About 315 employees of the hospital would see their wages rise, according to Jimenez, who said she doesn’t know how many dialysis clinic employees would be affected.

In Duarte, a wealthier suburb of about 21,000 people east of Los Angeles, Measure J would have applied only to City of Hope, a cancer hospital.

Jimenez said the differences between those communities, and their residents’ experiences with the health care system, could account for how the measures fared. She said she noticed that Inglewood voters had more direct experience with Centinela — they may have visited the emergency room or had a baby — than Duarte voters had with City of Hope.

The union has taken two approaches to seeking a $25 minimum wage. It attempted to secure a statewide minimum wage during negotiations with hospitals this year in Sacramento. But the negotiations were complicated by competing hospital and union priorities, and the deal . The union has also pursued a city-by-city strategy, targeting 10 communities in Los Angeles and Orange counties, including Inglewood and Duarte, where internal polling showed minimum wage proposals could pass.

Earlier this year, city councils in Los Angeles, Downey, Monterey Park, and Long Beach adopted $25 minimum-wage ordinances for private facility health workers, but hospitals and health care facilities challenged them, pushing the issue to the 2024 ballot. Meanwhile, the union dropped its effort in Anaheim and failed to gather enough signatures in Culver City, Lynwood, and Baldwin Park to place measures before voters this year.

Both sides spent heavily. According to state campaign finance filings, spent about $11 million across all 10 cities from February through the week before the election. spent $12 million during the same time frame.

Many labor economists said that the health care workforce deserves higher wages and better working conditions but that increasing the minimum wage could cause ripple effects.

Neighboring towns or facilities that aren’t subject to the new minimum wage and other sectors of the local economy might have to compete for workers, said Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at the University of California-San Francisco. And facilities that increase pay may have to do more with fewer staffers, she said.

“To have a minimum wage that is specific to a limited category of workers, in a limited set of organizations, in a single city is really unusual,” Spetz said. “I cannot think of any other circumstances where this has happened.”

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Three times a week, Sherwin, 71, drives to a dialysis clinic in Elk Grove, California, the suburb south of Sacramento where she lives, and lies tethered to a machine for about four hours while it filters her blood. The treatment exhausts her, but she feels well cared for and knows the clinic workers will call the police if she doesn’t show up for an appointment and they can’t get in touch with her directly.

“They don’t play games,” said Sherwin.

Sherwin fears her access to the clinic is in jeopardy. A sign in the clinic’s window tells patients and visitors to vote “no” on Proposition 29, the third statewide dialysis initiative in five years. It would impose new requirements on dialysis clinics, such as requiring a doctor to be on hand during treatments.

She and other California voters have also been bombarded by , in which patients in wheelchairs and doctors in scrubs warn that “29 would shut down dialysis clinics throughout California.”

“We’re terrified,” said Sherwin. “If they stop it, where are we going to go? We just die.”

Sherwin is among roughly who rely on 650 dialysis clinics tucked into strip malls and medical centers around the state. Patients arrive in medical transport vans, minivans, and the occasional ride-hailing vehicle and are often too tired and hungry after treatment to drive themselves home. They drag duffel bags and pillows into clinics, prepared to sit for four or five hours at a time, typically three days a week, as their blood is cleaned and filtered through a machine because their kidneys can no longer perform those functions.

Proposition 29 would require clinics to report infections to the state and tell patients when doctors have a financial stake in a clinic, rules that are similar to existing federal regulations.

The biggest flashpoint is the requirement to have a doctor, nurse practitioner, or physician assistant present at every clinic while patients are being treated.

Requiring a clinician on-site would increase each facility’s costs by “several hundred thousand dollars annually on average,” according to by the nonpartisan state Legislative Analyst’s Office. To deal with the additional costs, the analysis concluded, clinics have three options: negotiate higher rates with insurers, lose profits, or close facilities.

The Service Employees International Union-United Healthcare Workers West, which is sponsoring Proposition 29, said reforms are necessary to keep patients safe during the physically arduous dialysis process. The union — which has tried but failed to organize dialysis workers — argues that the treatment is dangerous and that patients need access to highly trained medical professionals to deal with emergencies instead of relying on 911.

The union was also behind the two previous dialysis ballot initiatives, which failed by wide margins. Proposition 8 in 2018 would have capped industry profits, while Proposition 23 in 2020 was nearly identical to this year’s measure. Both for .

The Proposition 29 opposition campaign, funded mostly by the dialysis industry, says keeping a doctor or nurse practitioner around at all times is both costly and unnecessary. Clinics employ registered nurses who check on patients and medical directors — physicians who oversee facilities but are often on-site only part time. About three quarters of California’s dialysis clinics are owned or operated by two companies: DaVita and Fresenius Medical Care.

So far, both sides have raised at least , according to the Los Angeles Times, with roughly 85% coming from DaVita and Fresenius.

Joe Damian, 71, doesn’t buy the claim that clinics would close if Proposition 29 passed. Of course, he said, he’d feel more comfortable if a doctor were on-site when his wife, Yolanda, has her treatments. He also believes dialysis companies would continue to make money hand over fist.

“How could it not be better?” he asked. “They just don’t want to give up any of their profits.”

Damian drives his wife to her treatments in Elk Grove. He understands why other patients and their families are worried about clinics closing but thinks the industry is fearmongering.

“Closing facilities is a threat they’ll never do,” he said. “Why would they close a moneymaking business?”

Proposition 29 includes provisions intended to protect against clinic closures, such as requiring facilities to get approval from the state before they end or reduce services, but opponents argue the provisions won’t hold up in court.

Nearly all the patients interviewed going to or from dialysis appointments at five Sacramento-area clinics had witnessed workers call 911 for another patient. Most said the emergencies had been handled well by the workers and emergency personnel. Overall, they said, they felt the dialysis clinics took good care of them.

The majority of patients had internalized the language of the opposition ads that warned of clinic closures.

Norbie Kumagai, 65, spent last Thanksgiving at University of California-Davis Medical Center, and his family was told it was time to say goodbye. But Kumagai, who has stage 4 kidney disease and high blood pressure, pulled through and had to wait months for a dialysis chair to open up at a clinic in West Sacramento, about 13 miles from his home in Davis.

Kumagai generally agrees that the dialysis industry needs reforms. For instance, he said, he’d like the technicians who help him each week to get pay raises.

But he’s worried about what Proposition 29 might mean for the treatments that keep him alive.

“I’ve told my friends and neighbors I’m scared to death if it passes,” Kumagai said. “This facility will probably close.”

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Tony Ramirez, 39, a critical care technician at Garfield Medical Center in Monterey Park, California, finds more fulfillment in helping people in need than he once did editing technical documents for Disneyland. Before the pandemic, he would reposition and bathe patients and sometimes monitor their vital signs. After covid struck, he took on more duties, providing CPR or grabbing medications during an emergency, placing leads to monitor heart rhythms, and conducting post-mortem work. “We started doing that,” Ramirez said, “because of the influx of covid patients running very ill and in very intense situations.”

Through it all, his $19.40-an-hour pay hasn’t changed.

In Southern California, one labor union is trying to help by pushing for a at private hospitals, psychiatric facilities, and dialysis clinics. The Service Employees International Union-United Healthcare Workers West, which represents roughly in California, says a raise would help the providers retain workers who could land comparable positions at Amazon or fast-food restaurants amid labor shortages. It would also allow Ramirez to give up one of the three jobs he works just to make rent.

What began as a 10-city campaign by the union has been winnowed to November ballot measures in just two cities in Los Angeles County, reflecting expensive political jockeying between labor and industry. And the $25 minimum wage isn’t the only campaign being waged by SEIU-UHW this cycle — the union is also trying for the third time to get .

A the California Association of Hospitals and Health Systems — with funding from Kaiser Permanente of Northern California, Adventist Health, Cedars-Sinai, Dignity Health, and other hospitals and health systems — opposes a $25 minimum wage because it raises costs for private, but not public, hospitals and health care facilities. Opponents have latched on to this disparity by calling it the “.” An analysis commissioned by the California Hospital Association estimated that the change would raise costs for private facilities by , a 6.9% increase, across the 10 cities.

“No one in hospitals and no one in health care is opposed to a living wage,” said George Greene, president and CEO of the Hospital Association of Southern California. “But we believe that this should be a statewide conversation that is measured and thoughtful.”

Earlier this year, city councils in Los Angeles, Downey, Monterey Park, and Long Beach adopted similar $25 minimum wage ordinances for health workers, but they were challenged by hospitals and health facilities, which pushed the issue to the ballot in 2024. Meanwhile, the union dropped its effort in Anaheim and failed to gather enough signatures in Culver City, Lynwood, or Baldwin Park to get a minimum wage measure on the fall ballot. As a result, only voters in Inglewood and Duarte will cast their votes — on and , respectively — this November.

Spending on the fight over the minimum wage proposals in Southern California has reached nearly $22 million. According to state campaign finance filings, SEIU-UHW has spent nearly $11 million across all 10 cities. Hospitals and health facilities have also spent almost $11 million to defeat minimum wage proposals.

Unions have long agitated for across-the-board minimum wage increases. In 2016, labor played a key role in successfully lobbying then-Gov. Jerry Brown to make California the first state to set a $15 minimum wage, a graduated measure that as of this year applies to all employers with 26 or more workers. About set their own minimum wages above the state minimum. The federal minimum wage remains $7.25.

SEIU-UHW contemplated a statewide scope, as well as the current piecemeal strategy of targeting cities in and around Los Angeles. “At first we were looking at city by city,” said the union’s political director, Suzanne Jimenez. “And then a conversation around doing it statewide came up but ultimately didn’t move forward.”

That’s partly because a deal to set a statewide minimum wage at public and private hospitals , and wins like that are harder to pull off than they once were, said Bill Sokol, a labor lawyer who has worked with SEIU-UHW.

“It’s not about what we wish we could do, but about where can we win,” Sokol said. “The answer is in one city at a time.”

Union leaders said they targeted cities where internal polling showed support among residents. Jimenez said the proposal has majority support in Inglewood but Duarte is too small to sample. The measures need a majority vote in each city to pass, and if that happens, they will take effect 30 days after the results are certified.

Should the approach prove successful in Los Angeles County, the union will consider taking the proposal to other parts of the state, including the Inland Empire and Sacramento, Jimenez said. That could eventually build momentum for statewide change.

If voters in Inglewood and Duarte pass the $25 minimum wage, the effect would be limited. Workers at state- and county-run medical facilities aren’t covered by city ordinances, so the local measures wouldn’t apply. That means it excludes workers who do the same jobs at public hospitals, clinics, and health care facilities.

In Inglewood, the measure would apply only to Centinela Hospital Medical Center and several for-profit dialysis clinics. In Duarte, it would apply to City of Hope, a private cancer hospital.

Many labor economists agree that something must improve for this workforce: They need higher wages and better work conditions. But that comes at a cost to the health system, said Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at the University of California-San Francisco.

“In the end, who ends up paying for that? Consumers do,” Spetz said. “Maybe you’ll cut into the profit margins of a publicly traded company a little bit, but the reality is those companies have been pretty good at figuring out how to keep their revenues and profitability up.”

Still, the union says a $25 minimum wage would help members of the lowest-paid sector of the health care workforce, who are disproportionately women, immigrants, and people of color.

Andrew Kelly, assistant professor of public health at Cal State East Bay, said raising wages at one facility could have a cascade effect because surrounding facilities would then need to raise wages to compete.

Currently, a living wage in L.A. County for a single adult with no children is $21.89 hourly, or a little more than $45,500 a year, according . Occupations like “healthcare support” generally pay around $33,000 annually in the county, according to the same tool.

Come Election Day, most Southern California health workers will have to watch from the sideline.

In Monterey Park, where Ramirez works, the city council approved the $25 minimum wage, but opponents got the vote invalidated by arguing that the council lacked a quorum at the time. The council ended up placing the question on the ballot in 2024, two years from now. Ramirez said that new hires at his medical center start at $15.30 an hour doing the dirtiest jobs in the hospital and that five workers have left his department this year.

“It’s disheartening, I’m not going to lie,” Ramirez said. “These elected officials know what’s going on.”

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“With Proposition 1, the number of abortion seekers from other states will soar even higher, costing taxpayers millions more.”

California Together, No on Proposition 1, on its website, Aug. 16, 2022

, a campaign led by religious and anti-abortion groups, is hoping to persuade voters to reject a that would cement the right to abortion in the state’s constitution. The group is warning that taxpayers will be on the hook for an influx of abortion seekers from out of state.

Proposition 1 was placed on the ballot by the Democratic-controlled legislature in response to the U.S. Supreme Court’s to overturn Roe v. Wade. If passed, it would protect an individual’s “fundamental right to choose to have an abortion,” along with the .

California Together’s says: “With Proposition 1, the number of abortion seekers from other states will soar even higher, costing taxpayers millions more.”

The campaign raised similar cost concerns in a that will be mailed out to every registered voter ahead of the Nov. 8 election. One prominent argument is that Proposition 1 will turn California into a “sanctuary state” for abortion seekers, including those in late-term pregnancy — and that would be a drain on tax dollars.

We decided to take a closer look at those eye-catching statements to see how well they hold up when broken down.

We reached out to California Together to find out the basis for its arguments against the measure. The campaign cited an analysis from the pro-abortion rights Guttmacher Institute, which estimated before Roe was overturned that the number of women ages 15 to 49 whose nearest abortion provider would be in California in response to state abortion bans. The Guttmacher analysis said most of California’s out-of-state patients would likely come from Arizona because it’s within driving distance.

California Together does not cite a specific cost to taxpayers for the measure. Rather, it points to millions of dollars the state has already allocated to support abortion and reproductive health services as an indication of how much more the state could spend if the proposed amendment passes.

Sources indicate that people are already coming to the state for abortion services.

Jessica Pinckney, executive director of Oakland-based Access Reproductive Justice, which provides financial and emotional support for people who have abortions in California, said the organization had experienced an increase in out-of-state calls even before the high court ruled in June. Pinckney anticipates handling more cases as more states restrict abortion — regardless of Proposition 1’s outcome.

Will It Cost Taxpayers Millions?

In its fiscal year 2022-23 budget, California committed to expanding reproductive health care services, including for a fund to cover the travel expenses of abortion seekers, regardless of what state they live in. Once it’s up and running in 2023, the fund will provide grants to nonprofit organizations that help women with transportation and lodging.

However, none of that spending is connected to Proposition 1, said Carolyn Chu, chief deputy legislative analyst at the nonpartisan Legislative Analyst’s Office. It’s already allocated in the budget and will be doled out next year regardless of what happens with the ballot measure.

In the end, the Legislative Analyst’s Office found “” if Proposition 1 passes because Californians already have abortion protections. And people traveling from out of state don’t qualify for state-subsidized health programs, such as Medi-Cal, the state’s Medicaid program, Chu added in an interview. “If people were to travel to California for services, including abortion, that does not mean they’re eligible for Medi-Cal,” she said.

Still, Proposition 1 opponents see the cost argument playing out in a different way.

Richard Temple, a campaign strategist for California Together, said a “no” vote will send lawmakers a mandate to stop the support fund. “Defeat Prop. 1, and you send a loud signal to the legislature and to the governor that you don’t want to pay for those kinds of expenses for people coming in from out of state,” Temple said.

What About an Influx of Abortion Seekers?

A key element of California Together’s argument is pegged to the idea that California will become a sanctuary state for abortion seekers. Opponents assert that Proposition 1 opens the door to a new legal interpretation of the state’s . Currently, that law allows abortion up to the point of viability, usually around the 24th week of pregnancy, or later to protect the life or health of the patient.

An argument made in the voter guide against the constitutional amendment is that it would allow all late-term abortions “.”

Because the proposition says the state can’t interfere with the right to abortion, opponents argue that current law restricting most abortions after viability will become unconstitutional. They contend that without restrictions, California will draw thousands, possibly millions, of women in late-term pregnancy.

Statistically, that’s unlikely. The state doesn’t report abortion figures, but nationwide only , according to the Centers for Disease Control and Prevention.

Whether there will be a new interpretation if Proposition 1 passes is up for debate.

UCLA law professor Cary Franklin, who specializes in reproductive rights, said that just because Proposition 1 establishes a general right to abortion doesn’t mean all abortion would become legal. Constitutional language is always broad, and laws and regulations can add restrictions to those rights. For example, she said, the Second Amendment to the U.S. Constitution grants the right to bear arms, but laws and regulations restrict children from purchasing guns.

“The amendment doesn’t displace any of that law,” Franklin said.

But current law was written and interpreted under California’s current constitution, which doesn’t have an explicit right to abortion, said Tom Campbell, a former legislator who teaches law at Chapman University. If Proposition 1 passes, courts might interpret things differently. “Any restriction imposed by the state on abortion would have to be reconsidered,” Campbell said.

The Legislative Analyst’s Office concluded that “whether a court might interpret the proposition to expand reproductive rights beyond existing law is unclear.”

California voters will soon have their say.

Polling has found widespread support for the constitutional amendment. An August survey by the Berkeley IGS Poll found of voters would vote “yes” on Proposition 1. A September survey by the Public Policy Institute of California pegged support at

Our Ruling

California Together warns voters: “With Proposition 1, the number of abortion seekers from other states will soar even higher, costing taxpayers millions more.”

Proposition 1 would protect an individual’s “fundamental right to choose to have an abortion.”

While it could lead to more people coming to California for abortion services, that’s already happening, even before voters decide on the measure.

In addition, Proposition 1 doesn’t allocate any new spending. So the $20 million state fund to cover travel expenses for abortion seekers would exist regardless of whether the constitutional amendment is adopted. Bottom line: A nonpartisan analyst found there will be no direct fiscal impact to the state, and out-of-state residents don’t qualify for state-subsidized health programs.

It’s speculative that Proposition 1 would expand abortion rights beyond what’s currently allowed or that the state would allocate more money for out-of-state residents.

Because the statement contains some truth but ignores critical facts to give a different impression, we rate the statement Mostly False.

Sources

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SACRAMENTO, Calif. — California is trying to ease the pain of vasectomies by making them free for millions of residents.

Federal law and state law require most health insurers to cover prescription contraceptives at no cost to the patient. But those provisions apply to only 18 FDA-approved birth control options for women, so anyone with testicles is out of luck.

California lawmakers are now considering a bill that would expand that requirement to male sterilization. If the passes, commercial insurance plans regulated by the state won’t be allowed to impose out-of-pocket costs, like copays, coinsurance, and deductibles, for vasectomies.

“It’s pretty groundbreaking in that way — it’s a whole new framework to think about contraception as something that is relevant for people of all genders,” said Liz McCaman Taylor, a senior attorney with the National Health Law Program, a group that advocates for the health rights of low-income people.

is an outpatient surgical procedure in which the patient’s supply of sperm is cut off from his semen by sealing or snipping the tubes that transport sperm from the testes to the penis. Most men need to recover on the couch with an ice pack for a day or two, and a test a few months later determines whether the procedure worked.

Because vasectomies are elective procedures and usually not urgent, price can be a deciding factor.

For Nathan Songne, cost was the most stressful part of the procedure. For several years, the 31-year-old had known he didn’t want to have kids biologically. Better to adopt a 4-year-old and skip the diaper stage, he thought. He was adopted by his stepfather as a child and knew he didn’t need to be genetically related to his children to love them.

“My only concern was that I had no idea how much it was going to cost me because nobody told me,” said Songne, who lives in Mission Viejo, in Orange County. If the procedure cost $1,000, as he expected, he wouldn’t be able to afford it, he said.

Songne’s insurance, which he gets through his work assembling guitars, covered 70% of the Aug. 8 procedure, leaving him with a bill of just under $200. “Cost did affect my decision, but because it was only $200, it made me feel a lot more relieved about continuing on with the vasectomy,” he said.

There are two hot times of year in the vasectomy business, according to Dr. Mary Samplaski, an associate professor of urology at the USC Keck School of Medicine. First, she sees an uptick during the March Madness college basketball tournament, when men choose to recover on the couch watching hoops.

The end of the year is also busy, she said, because many patients have finally met their annual insurance deductible and can afford the procedure.

Patients discuss out-of-pocket costs in about 20% of her vasectomy consultations. “It’s obviously a nerve-wracking procedure,” Samplaski said. “And on top of that, if your copay is high, there’s even less reason to want to do it.”

In April, Jacob Elert comparison-shopped for a vasectomy near his home in Sacramento because his health plan doesn’t cover the procedure. He had hoped to schedule one with his regular urologist, he said, but that would have come with a $1,500 price tag.

Instead, he found a chain of vasectomy clinics where he could get the procedure for $850. Three months later, a test confirmed the vasectomy was a success.

Elert has no regrets, but had price not been a factor, he would have preferred to go to his regular urologist. “That’s the doctor I trust,” Elert said. “But it was just way too expensive.”

In November, California whether to lock rights to abortion and contraception into the state constitution. But doesn’t address issues such as cost and coverage, said Amy Moy, a spokesperson for Essential Access Health, a group that runs California’s .

“The constitutional amendment is kind of the long-term protection, and we are still working to reduce barriers for Californians on the short-term and day-to-day level regardless of their gender,” she said.

SB 523 has sailed through preliminary votes in the state legislature, which faces an end-of-August deadline to act on bills. If the measure passes, it would take effect in 2024, and California would join that require plans they regulate to completely cover vasectomies.

The California Association of Health Plans is still evaluating the measure, which may be amended in the final days of the legislative session. But the association generally opposes bills that require additional insurance benefits because they could lead to higher premiums, spokesperson Mary Ellen Grant said.

SB 523 applies to more than 14 million Californians who work for the state, have a student health plan through a university, or have state-regulated commercial health plans. The bill would not apply to the millions of Californians whose health insurance plans are regulated by the federal government.

Women aren’t completely left out by the bill. They would become eligible to receive free over-the-counter birth control — such as emergency contraception, condoms, spermicide, and contraceptive sponges.

The specifics of how the benefit would work, including the frequency and amount of birth control that insurers must cover and whether patients would have to pay upfront and be reimbursed later, would be hammered out after the measure is adopted. McCaman Taylor said allowing people to simply present their insurance card at a pharmacy counter and walk away with the birth control they need would be preferable.

“We kind of learned from the national experiment with covid over-the-counter tests that reimbursement wasn’t the best model,” she said. “If people can’t afford to pay out-of-pocket for it, they’re just not going to get it.”

The , which analyzes legislation, projected that roughly 14,200 people with state-regulated commercial insurance would get vasectomies in California this year. Eliminating cost sharing would increase the number of vasectomies by 252 in the law’s first year, the program estimated.

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If they vote “yes” on , they will also lock in a right that has gotten less attention: the right to birth control.

Should the measure succeed, California would become one of the first states — if not the first — to create explicit constitutional rights to both abortion and contraception.

The lawmakers and activists behind the constitutional amendment said they hope to score a one-two punch: protect abortion in California after the U.S. Supreme Court ended the federal constitutional right to abortion under Roe v. Wade, and get ahead of what they see as the next front in the reproductive rights fight: birth control.

“The United States Supreme Court said that the privacy and liberty protections in the United States Constitution did not extend to abortion,” said UCLA law professor Cary Franklin, an expert in constitutional law and reproductive rights who has testified before the California legislature in support of the amendment. “If they said ‘no’ on abortion, they’re probably going to say ‘no’ on birth control because that has a similar history.”

In June, the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization ended the federal right to abortion and left states to regulate the service. , Justice Clarence Thomas said the court should revisit other cases that have created protections for Americans based on an implicit right to privacy in the U.S. Constitution, such as Griswold v. Connecticut, which established a federal right to contraception for married people — which was later extended to unmarried people.

Some congressional Democrats are now trying to codify the right to contraception in federal law. In July, the U.S. House of Representatives passed the , which would give patients the right to access and use contraception and providers the right to furnish it. But the bill has little chance of success in the U.S. Senate, where Republicans have already blocked it once.

Protecting access to contraception is popular with voters. conducted in late July found that 75% of registered voters support a federal law that protects a right to birth control access.

California isn’t the only state where voters are considering reproductive rights in their constitutions.

On Tuesday, Kansas voters that would have allowed state lawmakers to ban or dramatically restrict abortion. It failed by nearly 18 percentage points.

voters will face a similar decision in November with a proposed constitutional amendment that would declare that the state’s constitutional right to privacy does not cover abortion.

Vermont is going in the opposite direction. Voters there will weigh a ballot measure in November that would add a right to “personal reproductive autonomy” to the state constitution, though it does not explicitly mention abortion or contraception. In Michigan, a that would guarantee a right to both abortion and contraception is expected to qualify for the November ballot.

In California, Proposition 1 would prevent the state from denying or interfering with “an individual’s reproductive freedom in their most intimate decisions, which includes their fundamental right to choose to have an abortion and their fundamental right to choose or refuse contraceptives.”

The proposed constitutional amendment doesn’t go into detail about what enshrining the right to contraception in the state constitution would mean.

California already has some of the strongest contraceptive-access laws in the country — and lawmakers are considering more proposals this year. For instance, state-regulated health plans must cover all FDA-approved contraception; pharmacists to anyone with a prescription, regardless of age; and pharmacists can pills on the spot. State courts have also interpreted California’s constitution to include a right to privacy that covers reproductive health decisions.

The amendment, if adopted, could provide a new legal pathway for people to sue when they’re denied contraceptives, said Michele Goodwin, chancellor’s professor of law at the University of California-Irvine.

If a pharmacist refused to fill a birth control prescription or a cashier declined to ring up condoms, she said, customers could make a case that their rights had been violated.

Making the rights to abortion and contraception explicit in the state constitution — instead of relying on a right to privacy — would also protect against shifting political winds, said state Senate leader Toni Atkins (D-San Diego), who was the director of a women’s health clinic in the 1980s. Although California’s lawmakers and executive officers are solid supporters of abortion rights, she said, the composition of the legislature and courts’ interpretation of laws could change.

“I want to know for sure that that right is protected,” Atkins said at a legislative hearing in June. “We are protecting ourselves from future courts and future politicians.”

The amendment as a as much of the country chips away at birth control availability, Goodwin added.

Experts said two forms of birth control that are vulnerable to restrictions in other states are intrauterine devices, or IUDs, and emergency contraception like Plan B. These methods are often incorrectly conflated with abortion pills, which end a pregnancy instead of preventing it.

have laws that restrict emergency contraception — for example, by allowing pharmacies to refuse to dispense it or excluding it from state family planning programs — according to the Guttmacher Institute, a research organization that supports abortion rights. In and this year, abortion opponents introduced legislation that would restrict or ban abortion, and would also apply to emergency contraception.

“We’re seeing an erosion of abortion access that is playing out in statehouses across the country that have and will continue to target contraceptive care as well,” said Audrey Sandusky, senior director of policy and communications for the .

Susan Arnall, vice president of California’s Right to Life League, said the proposed amendment is symbolic and merely echoes current laws. Arnall thinks the campaign is mostly about Democratic politicians trying to score political points.

“It just allows the pro-abort legislators to trumpet and give them talking points about how they’re doing something about the overturn of Roe v. Wade,” she said. “It is political virtue signaling. I don’t think it does much of anything else.”

Goodwin argues that the measure’s symbolism is significant and overdue. She pointed to the Civil War era, when enslaved people in Southern states could look to free states for spiritual hope and material help. “Symbolically, what that meant is a kind of beacon of hope, that those places did exist, where one’s humanity could be regarded,” Goodwin said.

But California’s reputation as a haven for contraceptive availability may not be fully warranted, said Dima Qato, an associate professor at the University of Southern California School of Pharmacy. In her of contraceptive access in Los Angeles County, which has some of the highest rates of teen and unintended pregnancy in the country, Qato found that only 10% of pharmacies surveyed offered pharmacist-prescribed birth control. Pharmacies in low-income and minority communities were the least likely to offer the service, Qato said, worsening disparities instead of solving them.

Qato supports the constitutional amendment but said California should focus on improving and enforcing the laws it already has.

“We don’t need more laws when we don’t address the root cause of a lack of effectiveness of these laws in these communities,” Qato said. “Lack of enforcement and accountability disproportionately impacts communities of color.”

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This wasn’t an abortion rights rally. It wasn’t a protest against the recent that gutted Roe v. Wade. It was the “Defeat the Mandates Rally,” a jubilant gathering of anti-vaccine activists in April to protest the few remaining covid-19 guidelines, such as mask mandates on mass transit and vaccination requirements for health care workers.

Similar scenes have played out across the country during the pandemic. Armed with the language of the abortion rights movement, anti-vaccine forces have converged with right-leaning causes to protest covid precautions.

And they’re succeeding. Vaccine opponents have appropriated “My Body, My Choice,” a slogan that has been inextricably linked to reproductive rights for nearly half a century, to fight mask and vaccine mandates across the country — including in California, where lawmakers had vowed to adopt the toughest vaccine requirements in the U.S.

As the anti-vaccine contingent has notched successes, the abortion rights movement has taken hit after hit, culminating in the June 24 Supreme Court decision that ended the federal constitutional right to abortion. The ruling leaves it up to states to decide, and are expected to ban or severely limit abortion in the coming months.

Now that anti-vaccination groups have laid claim to “My Body, My Choice,” abortion rights groups are distancing themselves from it — marking a stunning annexation of political messaging.

“It’s a really savvy co-option of reproductive rights and the movement’s framing of the issue,” said Lisa Ikemoto, a law professor at the University of California-Davis Feminist Research Institute. “It strengthens the meaning of choice in the anti-vaccine space and detracts from the meaning of that word in the reproductive rights space.”

Framing the decision to vaccinate as a singularly personal one also obscures its public health consequences, Ikemoto said, because vaccines are used to protect not just one person but a community of people by stopping the spread of a disease to those who can’t protect themselves.

Celinda Lake, a Democratic strategist and pollster based in Washington, D.C., said “My Body, My Choice” is no longer polling well with Democrats because they associate it with anti-vaccination sentiment.

“What’s really unique about this is that you don’t usually see one side’s base adopting the message of the other side’s base — and succeeding,” she said. “That’s what makes this so fascinating.”

Jodi Hicks, president of Planned Parenthood Affiliates of California, acknowledged that the appropriation of abortion rights terminology has worked against the reproductive rights movement. “In this moment, to co-opt that messaging and distract from the work that we’re doing, and using it to spread misinformation, is frustrating and it’s disappointing,” Hicks said.

She said the movement was already gravitating away from the phrase. Even where abortion is legal, she said, some women can’t “choose” to get one because of financial or other barriers. The movement is now focusing more heavily on access to health care, using catchphrases such as “Bans Off Our Bodies” and “Say Abortion,” Hicks said.

Vaccination hasn’t always been this political, said Jennifer Reich, a sociology professor at the University of Colorado-Denver, who has about why parents refuse vaccines for their kids. Opposition to vaccines grew in the 1980s among parents concerned about school vaccine requirements. Those parents said they didn’t have enough information about vaccines’ potential harmful effects, but it wasn’t partisan at the time, Reich said.

The issue exploded onto the political scene after a measles outbreak tied to Disneyland in 2014 and 2015. When California lawmakers moved to prohibit parents from claiming for required childhood vaccines, opponents organized around the idea of “medical choice” and “medical freedom.” Those opponents spanned the political spectrum, Reich said.

Then came covid. The Trump administration politicized the pandemic from the outset, starting with masks and stay-at-home orders. Republican leaders and white evangelicals implemented that strategy on the ground, Reich said, arguing against vaccine mandates when covid vaccines were still only theoretical — scaring people with rhetoric about the loss of personal choice and images of vaccine passports.

They gained traction despite an obvious inconsistency, she said: Often, the same people who oppose vaccine requirements — arguing that it’s a matter of choice — are against abortion rights.

“What’s really changed is that in the last two or so years, it’s become highly partisan,” Reich said.

Joshua Coleman leads V is for Vaccine, a group that opposes vaccine mandates. He said he deploys the phrase strategically depending on what state he’s working in.

“In a state or a city that is more pro-life, they’re not going to connect with that messaging, they don’t believe in full bodily autonomy,” Coleman said.

But in places like California, he takes his “My Body, My Choice” rhetoric where he thinks it will be effective, like the annual Women’s March, where he says he can sometimes get feminists to consider his perspective.

Perception of the word “choice” has changed over time, said Alyssa Wulf, a cognitive linguist based in Oakland, California. The word now evokes an image of an isolated decision that doesn’t affect the broader community, she said. It can frame an abortion seeker as self-centered, and a vaccine rejector as an individual making a personal health choice, Wulf said.

Beyond linguistics, anti-vaccination activists are playing politics, intentionally trolling the abortion rights groups by using their words against them, Wulf said. “I really believe there’s a little bit of an ‘eff you’ in that,” Wulf said. “We’re going to take your phrase.”

Tom Blodget, a retired Spanish-language instructor from Chico, California, sported a “My Body, My Choice” shirt — complete with an image of a cartoon syringe — at the Defeat the Mandates Rally in Los Angeles. It was “an ironic thing,” he said, meant to expose what he sees as the hypocrisy of Democrats who support both abortion and vaccine mandates. Blodget said he is “pro-life” and believes that covid vaccines are not immunizations but a form of gene therapy, which is not true.

For Blodget, and many other anti-vaccination activists, there is no inconsistency in this position. Abortion is not a personal health decision akin to getting a shot, they say: It is simply murder.

“Women say they can have an abortion because it’s their body,” Blodget said. “If that’s a valid thing for a lot of people, why should I have to take an injection of some concoction?”

About a week later and nearly 400 miles to the north in Sacramento, state lawmakers heard testimony on bills about abortion and covid vaccines. Two protests, one against abortion and one against vaccine mandates, converged. Truckers from the “People’s Convoy,” a group that opposes covid mandates that had been touring the country with its message of “medical freedom,” testified against a bill that would stop police from investigating miscarriages as murders. Anti-abortion activists lined up to oppose a bill that would update reporting requirements to the state’s vaccine registry.

“My Body, My Choice” was ubiquitous: Kids petting police horses in front of the Capitol wore T-shirts with the slogan, and truckers watching a sword dance toted signs above their heads.

At the time, two tough legislative proposals to mandate covid vaccines for schoolchildren and most workers had already been shelved without a vote. One controversial vaccination proposal remained: a bill to allow children 12 and older to get covid vaccines .

Lawmakers have since watered down the measure, raising the minimum age to 15, and it awaits crucial votes. They have shifted their attention to the latest political earthquake: abortion.

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