Governor Gavin Newsom's vetoes over the weekend of two health-related bills send the wrong message to LGBTQs and straights alike. One would have required public schools to provide free condoms to students while the other would have closed loopholes and strengthened protections for insurers to provide coverage for preventive services like PrEP, one of the most effective HIV prevention tools available. At a time when red states are taking action to restrict reproductive rights and conservative business leaders want to be able to refuse PrEP coverage because it goes against their religious beliefs, Newsom's actions are head-scratching.
Condoms in high schools
Lesbian state Senator Caroline Menjivar (D-San Fernando Valley) authored Senate Bill 541. In addition to requiring public high schools to offer free condoms to students, the bill would have also prohibited retailers from refusing to sell condoms to youth. Condoms, as we well know, are not only effective at preventing unwanted pregnancies, they're also effective at preventing sexually transmitted infections like HIV. The LGBTQ community, in particular, was regularly bombarded with safer sex messages regarding the usage of condoms.
Menjivar was frustrated by Newsom's action.
"Governor Newsom set us back in the fight for sexual health equity with the veto of SB 541- Youth Health Equity and Safety," she stated. "This is a youth-led bill, and we need to meet high school students where they are to properly address the STI crisis in California. Statewide data indicates over half of all STIs are experienced among youth ages 15-24 years old. That age group is in school, which means we need to provide resources for them while in school."
In his veto message, Newsom blamed the bill for being an "unfunded mandate" as for why he couldn't sign it given the state's $30 billion deficit. That means that public school districts, many of which are cash-strapped, would have had to pay for the condoms. But for large orders, condoms are cheap, a fact pointed out by the Los Angeles-based AIDS Healthcare Foundation, which criticized the governor's veto.
"When purchased in bulk, as a state the size of California certainly would do, condoms cost just pennies apiece," stated Whitney Engeran-Cordova, vice president of AHF's public health division. "Unplanned teen pregnancies and sexually transmitted infections, on the other hand, disrupt lives and can cost teens, their families, and the state of California countless millions in health care, housing, and other services.
"Governor Newsom is being short-sighted with his ill-conceived veto," Engeran-Cordova added.
He's right. While HIV is no longer the death sentence it once was, getting infected can lead to major changes in a person's life, including the need for stable housing and specialized health care. HIV medications aren't cheap either.
Menjivar dismissed money as a legitimate reason for the veto.
"Governor Newsom stated this veto is based on funding, but California has extensive funding for STI prevention, community partners are ready and able to provide condoms to these programs in their service areas, and we spend millions of dollars on STI health care annually when prevention costs far less than treatment," she stated. "I am committed to continuing the fight for sexual health equity for all Californians."
AHF pointed to research that found young people, such as those in Generation Z (born between 1997-2012), have the least knowledge about HIV compared to previous generations. HIV/AIDS has been with us for more than 40 years, and today many young people do not know what the dark days of the epidemic were like, or about effective prevention such as condoms.
The veto also doesn't make sense given that Newsom has promoted himself as a champion of reproductive rights — and he's signed numerous bills to strengthen those in recent years even as many parts of the country are restricting access to abortion and other services. The cost for condoms would be a rounding error in California's $310.8 billion budget.
PrEP
Making legislative changes in support of PrEP access was not a winner this year in Sacramento. Gay state Senator Scott Wiener (D-San Francisco) had to pull his SB 339 in September after the Assembly Appropriations Committee inserted language into it that he considered to be a "poison pill" amendment that ran counter to his aim of expanding access to PrEP. His bill sought to increase the amount of PrEP that pharmacists are authorized to provide without a doctor's prescription. It also would have required health plans to reimburse pharmacists for PrEP services. It built on Wiener's first-in-the-nation legislation passed in 2019 that authorized people to acquire PrEP from a pharmacist without a doctor's prescription.
Newsom vetoed the other piece of PrEP legislation, Assembly Bill 1645 by gay freshman Assemblymember Rick Chavez Zbur (D-Santa Monica/West Hollywood). It would have closed loopholes and strengthened protections in existing law to ensure that California health insurers continue to provide free and complete coverage for preventive services like PrEP, an effective medicine for ensuring people remain HIV-negative, and testing for STIs.
As we reported this week, HIV advocates have raised concerns about access to such preventative health services because of a federal lawsuit conservative business owners have filed seeking to cite their religious beliefs as a reason for not covering PrEP and other sexual health services in the health insurance policies they offer to employees.
Newsom, however, cited other reasons, including the bill's impact on costs. "However, components of this proposal depart from structures in federal and state law, such as the existing policies for reimbursement to non-contracted providers," his veto message stated. "Further, because this bill exceeds the cost-sharing provisions under the Affordable Care Act, it would result in increased costs to health plans passed on to consumers through premiums."
We've reported for years that the number of people eligible to be on PrEP is vastly lower than it should be, especially among people of color. This legislation was an effort to ease those disparities by making sure that PrEP remains free and covered on insurance plans in California.
Prevention is cheaper than providing care. We all know this. Yet the governor has demonstrated with these two vetoes that even prevention is too expensive. We urge Menjivar, Wiener, and Zbur to reintroduce their respective pieces of legislation next year with changes if needed.
Newsom should have signed the bills by Menjivar and Zbur so that California could be on the forefront of HIV prevention and so that young people could be in more control of their lives. Instead, we got excuses of dollars over common sense and good public health.
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