Providence St. Joseph Hospital, in the small Northern California coastal city of Eureka, refused to provide the care she required because doctors could detect fetal “heart tones,” Nusslock said at a news conference Monday. California Attorney General Rob Bonta filed a lawsuit against the Catholic hospital detailing Nusslock’s dangerous experience and alleging the hospital violated multiple state laws when it discharged Nusslock — with an offer of a bucket and towels — to go elsewhere for what he described as standard medical care.

Bonta also filed a motion for a preliminary injunction in Humboldt County Superior Court, asking that it require Providence to treat anyone with an emergency medical condition. “The need for immediate relief is about to intensify,” the motion said. That’s because Mad River Community Hospital, where Nusslock ultimately got care 12 miles up the road, is slated to close its birth center this month.

Providence will be the only hospital within about 85 miles to offer labor and delivery, according to a KFF Health News analysis. When care is more than an hour away, academic researchers typically define the area as a hospital desert.

“It begs the question, what happens next time someone in Anna’s situation shows up at Providence? There will be no Mad River for them to go to,” Bonta said at a news conference. “With a dire lack of services, even here in California, and an influx of patients from states with abortion bans, we need hospitals to follow the law.”

The case illustrates how even in California, where the right to an abortion is enshrined in state law, there’s a glaring loophole. Catholic hospitals, which restrict reproductive health care because they follow the church’s “Ethical and Religious Directives,” are aggressively expanding nationally by acquiring secular hospitals. In swaths of the country, including parts of Northern California, they are the only choice. At the same time, maternity wards are closing rapidly, leaving more patients to contend with religious directives instead of accepted medical standards.

California’s lawsuit also comes amid uncertainty that emerged after the Supreme Court in 2022 overturned the constitutional right to an abortion: whether federal law requires hospitals to provide abortions as emergency medical care even in states that have banned the procedure. The high court punted on the question this summer. The Biden administration reaffirmed its policy that the Emergency Medical Treatment and Labor Act requires hospitals to stabilize or treat any patient who shows up at an emergency room. Texas is suing the administration over the policy.

The issue is also playing out in the presidential election. During the Oct. 1 vice presidential debate, Democratic Minnesota Gov. Tim Walz noted a Georgia woman who died because a hospital delayed care. Sen. JD Vance (R-Ohio) answered, in part, by asking Walz if he wanted to force Catholic hospitals to perform abortions against their religious beliefs, saying that “Kamala Harris has supported suing Catholic nuns.”

With federal protections in limbo, Bonta said California must rely on its state laws to protect patients. Specifically, Bonta, who is widely expected to run for governor, alleges that Providence violated a California law mandating that hospitals provide care “necessary to relieve or eliminate the emergency medical condition.”

Nusslock’s case isn’t an isolated incident, the lawsuit said. “One to two women per year receive abortion care at Mad River, after being refused care at Providence Hospital,” the lawsuit said. "These individuals, like Anna Nusslock, had all been discharged from Providence Hospital with instructions to go somewhere else." Bonta said his office is investigating how widespread cases are in California, where Catholic hospitals represent 15% of hospital beds.

In an Oct. 1 letter to employees that was obtained by KFF Health News, Providence Northern California Service Area Chief Executive Garry Olney said the hospital is “heartbroken” about Nusslock’s experience, which “did not meet our high standards for safe, quality, compassionate care.” He added the hospital is revisiting its training, education, and escalation processes to ensure it doesn’t happen again.

Providence spokesperson Bryan Kawasaki said its 51 hospitals abide by applicable federal and state laws, including EMTALA. Kawasaki declined to comment specifically on Nusslock’s case.

More women are running into barriers to obtaining care as Catholic health systems have gained market power, a KFF Health News investigation found. Four of the 10 largest hospital chains by number of beds are Catholic, according to federal data from the Agency for Healthcare Research and Quality.

Many Americans don’t have a choice — ambulances may take patients to a Catholic-run health system without giving them a say. Non-Catholic hospitals could be out of their insurance networks or too far to reach in an emergency. In the U.S, nearly 800,000 people have only Catholic or Catholic-affiliated birth hospitals within an hour’s drive, including pockets of Northern California.

Pregnant women who must drive farther to a delivery facility are at higher risk of harm to themselves or their fetus, research shows.

“It's really concerning, especially in a state like California, where people expect to have comprehensive access to care,” said Debra Stulberg, a family medicine physician at the University of Chicago. “The growth of Catholic hospitals, especially in this post-Dobbs era, continues to constrain the quality of care people get.”

The directives guiding care at Catholic-based health systems are issued by the U.S. Conference of Catholic Bishops. They state that abortions are “intrinsically evil” and “never permitted.”

The document does offer this guidance as an exception: Treatments that could cure “a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.”

“The church, I would say, helps Catholic hospitals to apply some of our deepest beliefs and moral principles to very, very complex situations,” said John Brehany, executive vice president of The National Catholic Bioethics Center, an ethics authority for Catholic health institutions. “And one of those beliefs is that you can never directly intend to end the life of a developing human being."

Brehany wouldn’t comment on Nusslock’s case but gave the example that if a woman needed cancer treatment, the church would allow her to proceed with the treatment even if it “results in the death of an unborn child.” He added that some situations are “more debatable” than others.

As Catholic-based systems have consolidated and acquired more medical facilities, their care denials have been compounded by other hospitals closing their labor and delivery wards at alarming rates across the country. In California, 56 hospitals have shuttered their maternity wards in the past 12 years, according to an investigation by CalMatters. Nationwide, at least 267 hospitals closed labor and delivery units between 2011 and 2021, representing about 5% of the country’s hospitals, according to Chartis, a health analytics and consulting firm.

With each closure, patients could lose options for abortion care, contraceptives, tubal ligations, and gender-affirming care, said Mona Shah, senior policy and strategy director with Community Catalyst, a national health equity organization.

Nusslock’s 12-mile trip for care at Mad River cost her, according to the lawsuit and her public statement. She had passed an “apple-sized blood clot” and was hemorrhaging in “blinding pain,” she said, by the time she reached the operating room. In the lawsuit, Nusslock said her doctor told her later that her test results showed she most likely had an infection.

It’s a trip Bonta described as “patient dumping” and one Nusslock should never have made.

Seven months later, Nusslock said, she has trouble sleeping, recalling how Providence sent her away.

“I’ll never forget looking at my doctor, tears streaming down my face, my heart shattered into a million pieces, and just pleading with her, ‘Don’t let me die,’” she said.

KFF Health News data editor Holly K. Hacker contributed to this article.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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“The politics of abortion and reproductive health can get voters to participate at higher rates,” said David McCuan, a political science professor at Sonoma State University. “Republicans have to moderate their stance if they’re going to be in the battle.”

After all, polls show most voters support restoring abortion rights overturned in 2022 by the Supreme Court. Aggressive ads are going up in competitive districts where Democrats see an opportunity to take control of the House by engaging voters who might not vote straight-ticket — or at all.

In New York, Democrat Josh Riley blasted Republican incumbent Marcus J. Molinaro in a 30-second ad for voting against abortion rights 13 times. Next door in New Jersey, Democratic hopeful Sue Altman called out Republican opponent Tom Kean Jr. for a “secret antiabortion agenda.” And in California, Democrat Will Rollins denounced Republican rival “Ken Calvert and MAGA extremists” for backing a national abortion ban.

Meanwhile, in March, shortly after her primary, Rep. Michelle Steel (R-Calif.) removed her support for a blanket abortion ban — the Life at Conception Act — saying it could create confusion because the bill could threaten in vitro fertilization. Following news reports about her reversal, the Orange County-area Republican released an ad in which she shared that she had used IVF and reiterated her support for the procedure.

On the campaign trail, Steel has said she supports exceptions to abortion bans in cases of rape, incest, and in which the mother’s health or life is at risk, a departure from bills she previously supported.

“What we all need to do is to make sure we look at her record, and that record is contrary to what she’s putting out there in her ads,” Steel’s Democratic challenger, Derek Tran, told me.

The Steel and Calvert campaigns told KFF Health News that their candidates oppose a national abortion ban. Calvert, who last backed a 20-week abortion ban in 2017, issued a statement saying the issue is best left to states.

Tim Rosales, a political strategist who has represented Republican candidates, said incumbents shouldn’t get heat for changing their minds over time.

Meanwhile, Rolling Stone reported in March that Rep. Don Bacon (R-Neb.) had deleted antiabortion endorsements from his website. Arizona Republican incumbent Rep. David Schweikert said he opposed a state abortion ban, even though he had co-sponsored a national ban six times.

And vice-presidential candidate JD Vance removed his antiabortion stance from his website the month former president Donald Trump selected him as his running mate.

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Democratic challenger Will Rollins also called out his rival, Rep. Ken Calvert, and “MAGA extremists” in an ad last week for their backing of a bill that could criminalize medical practitioners who provide abortions.

A few blocks from state Route 14 in Lancaster, about 70 miles north of downtown Los Angeles, Rep. Mike Garcia’s Democratic opponent, George Whitesides, planted two billboards promising to protect reproductive health care, a jab at the Republican congressman, who has voted to cut taxpayer funding of abortions for service members and other Americans.

As Election Day approaches, Democratic hopefuls are doing all they can to tie Republican opponents in contested congressional districts to their anti-abortion records. Aggressive ads are going up in California, Arizona, Nebraska, New Jersey, New York, and Oregon, as Democrats see an opportunity to take control of the House by engaging voters who might not vote straight-ticket — or at all. Republicans currently control the House by a slim margin.

“What we all need to do is to make sure we look at her record, and that record is contrary to what she’s putting out there in her ads,” Tran said in an interview about Steel. “We’re making sure that we educate and remind the voters of who she really is.”

Democrats are also linking Republican incumbents to former President Donald Trump, who has taken credit for the 2022 Supreme Court decision overturning Roe v. Wade. Democrats are warning voters that more restrictions could come. During the Sept. 10 presidential debate, Trump dodged a question about whether he would veto a national abortion ban if elected.

A majority of voters support restoring a federal right to abortion, according to a recent KFF poll. And 1 in 14 voters say abortion is the most important issue in determining their choice. Those voters have the potential to make a difference in the close races, said David McCuan, a political science professor at Sonoma State University.

“The politics of abortion and reproductive health can get voters to participate at higher rates,” McCuan said. “It’s going to be a defining issue.”

Democrats are hoping the issue plays to their favor in California. Voters two years ago codified abortion rights into state law. In May, Planned Parenthood Affiliates of California launched a seven-figure campaign targeting seven Republican seats and Democrat Katie Porter’s open seat.

As a result, political analysts say, Republicans have shied away from their votes on abortion and some incumbents — such as Steel, Garcia, and Central Valley U.S. Rep. David Valadao — have moderated their stances to appeal to voters.

Steel, like Garcia and Valadao, has said she supports exceptions to abortion bans in cases of rape, incest, or threats to the life of the mother. All three co-sponsored a bill amounting to a blanket abortion ban in the previous Congress. Garcia and Valadao left their names off the bill last year, but Steel signed on again as a co-sponsor — briefly.

She withdrew her support after she won her March primary, explaining that it could create confusion because the three-page bill could threaten in vitro fertilization. In a September campaign ad, Steel shared that she had used IVF to have children and reiterated her support for the procedure. Steel spokesperson Lance Trover said she opposes a national abortion ban.

None of the Republican incumbents who represent a California “toss-up” district, as determined by the nonpartisan Cook Political Report, granted KFF Health News an interview. Those who did respond said they do not support a national abortion ban.

Rep. John Duarte added that he opposes a ban because he’s “pro-choice,” and Calvert said “the issue is best decided with the states and their voters directly.” Both voted for a bill to limit medication abortion and supported a measure that would have authorized prison time for medical providers who don’t resuscitate babies born after an attempted abortion.

Tim Rosales, a political strategist who has represented Republican candidates, said these incumbents shouldn’t get heat for changing their minds over time, noting that Democratic former Presidents Bill Clinton and Barack Obama reversed their positions on same-sex marriage.

“There has to be some allowance for evolution on a variety of issues,” Rosales said.

Ben Petersen, a spokesperson for the National Republican Congressional Committee, said Democrats who have called out Republicans for inconsistencies want to move the conversation away from other topics, such as the “disastrous cost of living crisis hurting women and families caused by their one-party control of Sacramento.”

This political dance is playing out on the national stage, especially in battleground races where Republicans find themselves on defense in states where abortion is on the ballot. Roughly two dozen races are considered toss-ups.

In a March post on the social platform X, Republican Nebraska Rep. Don Bacon wrote, “I’ve always defended the life of the mother,” after his Democratic rival, Tony Vargas, called him out for supporting a national abortion ban, which makes no exceptions for cases in which the mother’s life is at risk. That same month, Rolling Stone reported that the Omaha-area congressman had deleted some anti-abortion endorsements from his website. Nebraskans will vote this November on competing abortion ballot measures.

In Arizona, where voters will also be asked whether to enshrine abortion rights into the state constitution, Republican incumbent David Schweikert this year did not support a national abortion ban, which he had co-sponsored at least six times from 2012 to 2021. In April, he wrote on X that he opposed an abortion ban in Arizona, calling on the state legislature to “address this issue immediately.”

On the airwaves, on their websites, and on the campaign trail, Republican candidates are pivoting to convince voters that they have voted to protect women. For example, Steel this month released an ad titled “Champion,” in which the Orange County sheriff says Steel has “worked tirelessly to protect victims of domestic violence and sexual abuse.”

Trover, the Steel spokesperson, said she voted two years ago to reauthorize the Violence Against Women Act. That vote was on a larger $1.5 trillion government spending bill, which included the measure.

The year before, Steel voted against reauthorizing the act.

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El retador demócrata Will Rollins también señaló a su rival, el representante Ken Calvert, y a los “extremistas de MAGA” en un anuncio reciente por respaldar un proyecto de ley que podría criminalizar a los profesionales médicos que brindan abortos.

A pocas cuadras de la ruta estatal 14 en Lancaster, a unas 70 millas al norte del centro de Los Ángeles, el oponente demócrata de Mike Garcia, George Whitesides, colocó dos carteles prometiendo proteger la atención médica reproductiva, una crítica al congresista republicano, quien ha votado para reducir los fondos públicos destinados a los abortos para los miembros del servicio militar y otros estadounidenses.

A medida que se acerca el día de las elecciones, los aspirantes demócratas están haciendo todo lo posible para vincular a sus oponentes republicanos en distritos congresionales disputados con sus antecedentes antiaborto.

Se están lanzando anuncios agresivos en California, Arizona, Nebraska, Nueva Jersey, Nueva York y Oregon, ya que los demócratas ven una oportunidad de tomar el control de la Cámara al involucrar a votantes que podrían no votar por un solo partido o incluso abstenerse de votar. Actualmente, los republicanos controlan la Cámara por un margen estrecho.

“Lo que todos debemos hacer es asegurarnos de revisar su historial, y ese historial es contrario a lo que ella está mostrando en sus anuncios”, dijo Tran en una entrevista sobre Steel. “Nos estamos asegurando de educar y recordar a los votantes quién es realmente”.

Los demócratas también están vinculando a los republicanos en ejercicio con el ex presidente Donald Trump, quien se ha atribuido el mérito de la decisión de la Corte Suprema de 2022 de anular Roe v. Wade.

Los demócratas advierten a los votantes que podrían venir más restricciones. Durante el debate presidencial del 10 de septiembre, Trump evitó una pregunta sobre si vetaría una prohibición nacional del aborto si fuera elegido.

La mayoría de los votantes apoyan la restauración del derecho federal al aborto, según una reciente encuesta de KFF: uno de cada 14 votantes dice que el aborto es el tema más importante a la hora de determinar su elección. Esos votantes tienen el potencial de marcar la diferencia en las contiendas reñidas, dijo David McCuan, profesor de ciencias políticas de la Universidad Estatal de Sonoma.

“La política del aborto y la salud reproductiva puede hacer que los votantes participen en tasas más altas”, dijo McCuan. “Va a ser un tema definitorio”.

Los demócratas esperan que el tema juegue a su favor en California. Hace dos años, los votantes codificaron los derechos al aborto en la ley estatal. En mayo, Planned Parenthood Affiliates of California lanzó una campaña de siete cifras dirigida a siete escaños republicanos y al asiento abierto de la demócrata Katie Porter.

Como resultado, los analistas políticos dicen que los republicanos han evitado hablar de sus votos sobre el aborto y algunos en ejercicio, como Steel, Garcia y el representante estadounidense del Valle Central, David Valadao, han moderado sus posturas para atraer a los votantes.

Steel, al igual que Garcia y Valadao, ha dicho que apoya excepciones a las prohibiciones del aborto en casos de violación, incesto o amenazas a la vida de la madre. Los tres copatrocinaron un proyecto de ley que equivalía a una prohibición total del aborto en el Congreso anterior. Garcia y Valadao dejaron sus nombres fuera del proyecto de ley el año pasado, pero Steel volvió a firmarlo como copatrocinadora, aunque brevemente.

Luego retiró su apoyo después de ganar su primaria en marzo, explicando que podría crear confusión porque el proyecto de ley de tres páginas podría amenazar la fertilización in vitro. En un anuncio de campaña en septiembre, Steel compartió que había utilizado la fertilización in vitro para tener hijos y reiteró su apoyo al procedimiento. Lance Trover, vocero de Steel, dijo que ella se opone a una prohibición nacional del aborto.

Ninguno de los republicanos en ejercicio que representan un distrito “disputado” en California, según lo determinado por el Cook Political Report no partidista, concedió una entrevista a KFF Health News. Aquellos que sí respondieron dijeron que no apoyan una prohibición nacional del aborto.

El representante John Duarte agregó que se opone a una prohibición porque es “pro-elección”, y Calvert dijo que “el tema es mejor decidido por los estados y sus votantes directamente”. Ambos votaron a favor de un proyecto de ley para limitar el aborto con medicamentos y apoyaron una medida que habría autorizado penas de prisión para los proveedores médicos que no reanimen a los bebés nacidos después de un intento de aborto.

Tim Rosales, un estratega político que ha representado a candidatos republicanos, dijo que no debería criticarse a estos legisladores por cambiar de opinión con el tiempo, y señaló que los ex presidentes demócratas Bill Clinton y Barack Obama cambiaron sus posturas sobre el matrimonio entre personas del mismo sexo.

“Debe haber algún margen para la evolución en una variedad de temas”, dijo Rosales.

Ben Petersen, portavoz del Comité Nacional Republicano del Congreso, dijo que los demócratas que han criticado a los republicanos por sus inconsistencias quieren desviar la conversación de otros temas, como la “desastrosa crisis del costo de vida que afecta a las mujeres y las familias, causada por su control monopartidista de Sacramento”.

Este juego político se está desarrollando en el escenario nacional, especialmente en contiendas cruciales donde los republicanos se encuentran a la defensiva en estados donde el aborto está en la boleta electoral. Aproximadamente dos docenas de carreras se consideran disputadas.

En una publicación de marzo en la plataforma social X, el representante republicano de Nebraska, Don Bacon, escribió: “Siempre he defendido la vida de la madre”, después de que su rival demócrata, Tony Vargas, lo criticara por apoyar una prohibición nacional del aborto, que no hace excepciones para casos en los que está en riesgo la vida de la madre.

Ese mismo mes, Rolling Stone informó que el congresista de la zona de Omaha había eliminado algunos respaldos contra el aborto de su sitio web. Los habitantes de Nebraska votarán este noviembre sobre medidas de aborto en la boleta.

En Arizona, donde los votantes también decidirán si consagran los derechos al aborto en la constitución del estado, el representante republicano en ejercicio David Schweikert no apoyó este año una prohibición nacional, que había copatrocinado al menos seis veces desde 2012 hasta 2021. En abril, escribió en X que se oponía a una prohibición del aborto en Arizona, pidiendo a la Legislatura estatal que “abordara este tema de inmediato”.

En los medios, en sus sitios web y en la campaña electoral, los candidatos republicanos están girando para convencer a los votantes de que han votado para proteger a las mujeres. Por ejemplo, Steel lanzó en septiembre un anuncio titulado “Champion” (Campeona), en el que el sheriff del condado de Orange dice que Steel ha “trabajado incansablemente para proteger a las víctimas de violencia doméstica y abuso sexual”.

Trover, el portavoz de Steel, dijo que ella votó hace dos años para reautorizar la Ley de Violencia contra las Mujeres. Esa votación fue parte de un proyecto de ley de gastos gubernamentales más amplio de $1.5 trillones, que incluía la medida.

El año anterior, Steel votó en contra de reautorizar la ley.

Esta historia fue producida por Kaiser Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The bill, by Sen. Monique Limón (D-Santa Barbara) and backed by Democratic Attorney General Rob Bonta, will block health care providers, as well as any contracted collection agency, from sharing a patient’s medical debt with credit reporting agencies. At least eight states have banned medical bills from consumer credit reports in the past two years. In June, the Biden administration proposed similar federal protections, but it’s unclear when the rules will be enacted — or, if former President Donald Trump is elected again, if they will be at all.

“Nobody chooses to get sick, and then your credit gets ruined,” said Chi Chi Wu, a senior attorney with the National Consumer Law Center. “That’s why we encourage states to keep adopting laws. In case something goes wrong at the federal level, the states could protect their own consumers.”

When California’s new law goes into effect in January, it will extend these protections to credit reports used for employment and tenant screening, Wu said. This is in addition to the proposed federal ban on reporting to credit agencies that inform credit card companies and mortgage lenders.

California lawmakers noted that medical debt — unlike other kinds of debt — isn’t an accurate reflection of credit risk, and its inclusion can depress credit scores and make it hard for people to get a job, rent an apartment, or secure a car loan.

But California lawmakers have left a glaring loophole. Patients who pay hospital bills using medical credit cards or medical specialty loans — which can come with interest rates as high as 36% — won’t get that debt taken off their credit report, as residents of Colorado, Minnesota, and New York do. It’s a concession the financial industry won through late-in-the-game “hostile” amendments, which “influential entities opposed to the measure prevailed” in including, Limón said. In a 2022 KFF poll on medical debt, 15% of adults said they had used a medical credit card.

Kelly Parsons-O’Brien, legislative chair of the California Association of Collectors, which represents collection agencies, said the exemptions were essential because medical credit card holders can buy nonmedical items and medical loans can be refinanced with nonmedical debt, making it “impossible” for creditors to know what’s actually a medical charge.

“More consumers will get into situations where they cannot afford to pay, and lenders will be operating in the dark,” Parsons-O’Brien said.

The three largest U.S. credit agencies — Equifax, Experian, and TransUnion — said they would stop listing some medical debt, including paid-off debts and those less than $500, but millions of patients were left with bigger medical bills on their credit reports. The Consumer Financial Protection Bureau reported in April that 15 million Americans still had medical bills on their credit reports.

About 4 in 10 Californians report carrying some type of medical debt, which disproportionately affects low-income, Black, and Latino patients, according to the California Health Care Foundation.

Dozens of states have enacted legislation to protect consumers from surprise billing and medical debt, according to the National Conference of State Legislatures. Newsom, a Democrat, also signed legislation on Tuesday banning hospitals from using liens on all real property owned by Californians who typically earn less than 400% of the federal poverty level. It expands current state law that protects a patient’s home from debt collectors.

A KFF Health News analysis found that credit reporting is the most common collection tactic used by hospitals to get patients to pay their bills. A credit score ban might make it more difficult for hospitals to collect.

When Sacramento resident Sonia Hayden and her boyfriend applied for a home loan last year, she discovered her credit score had dropped about a hundred points. It had been downgraded because of an approximately $200 emergency room charge after a car accident years ago.

The 44-year-old said her insurance covered tens of thousands of dollars in medical bills but that the hospital miscoded the $200 charge and she never received a bill for it. That, she said, should also have been charged to insurance.

Hayden tried unsuccessfully for over a year to resolve the issue with her health insurer. It’s still on her credit report. She was eventually able to get a home loan, but her interest rates were higher because of her credit score.

“Medical bills, they’re not on purpose, you know?” said Hayden, who testified in support of the legislation. “It was already a super traumatic accident. I almost died. And then to have this super stressful medical bill — nobody’s asking for that. It shouldn’t affect your credit.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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El proyecto de ley, presentado por la senadora Monique Limón (demócrata de Santa Bárbara) y respaldado por el fiscal general demócrata Rob Bonta, impedirá que los proveedores de atención médica, así como cualquier agencia de cobro contratada, compartan la deuda médica de un paciente con las agencias de informes de crédito.

Al menos ocho estados han prohibido que las facturas médicas aparezcan en los informes de crédito de los consumidores en los últimos dos años. En junio, la administración Biden propuso protecciones federales similares, pero no está claro cuándo se promulgarán estas reglas, o si lo harán en caso de que el ex presidente Donald Trump sea reelegido.

“Nadie elige enfermarse, y luego tu crédito se arruina”, dijo Chi Chi Wu, abogada principal del National Consumer Law Center. “Por eso alentamos a los estados a seguir adoptando estas leyes. En caso de que algo salga mal a nivel federal, los estados podrían proteger a sus propios consumidores”.

Cuando la nueva ley de California entre en vigencia en enero, extenderá estas protecciones a los informes de crédito utilizados para el empleo y la selección de inquilinos, dijo Wu. Esto además de la prohibición federal propuesta sobre la notificación a agencias de crédito que informan a las compañías de tarjetas de crédito y prestamistas hipotecarios.

Los legisladores de California señalaron que la deuda médica, a diferencia de otros tipos de deuda, no es un reflejo preciso del riesgo crediticio, y su inclusión puede afectar las puntuaciones de crédito y dificultar que las personas consigan empleo, alquilen un apartamento o consigan un préstamo para automóvil.

Sin embargo, los legisladores de California han dejado un vacío legal evidente. Los pacientes que pagan las facturas hospitalarias con tarjetas de crédito médicas o préstamos especializados para atención médica, que pueden tener tasas de interés de hasta el 36%, no verán esa deuda eliminada de su informe de crédito, como ocurre con los residentes de Colorado, Minnesota y Nueva York.

Es una concesión que sucumbió a la presión de la industria financiera a través de enmiendas “hostiles” de última hora, dijo Limón. En una encuesta de KFF de 2022 sobre deuda médica, el 15% de los adultos dijeron haber utilizado una tarjeta de crédito médica.

Kelly Parsons-O’Brien, presidenta legislativa de la California Association of Collectors, que representa a las agencias de cobro, dijo que las exenciones eran esenciales porque los titulares de tarjetas de crédito médicas pueden comprar artículos no médicos y los préstamos médicos pueden refinanciarse con deudas no médicas, lo que hace que sea “imposible” para los acreedores saber qué es realmente un cargo médico.

“Más consumidores se encontrarán en situaciones en las que no podrán pagar, y los prestamistas operarán a ciegas”, dijo Parsons-O’Brien.

Las tres agencias de crédito más grandes del país —Equifax, Experian y TransUnion— dijeron que dejarían de listar algunas deudas médicas, incluidas las pagadas y aquellas de menos de $500, pero millones de pacientes quedaron con facturas médicas mayores en sus informes de crédito.

La Oficina de Protección Financiera del Consumidor informó en abril que 15 millones de estadounidenses aún tenían facturas médicas en sus informes de crédito.

Aproximadamente 4 de cada 10 californianos reportan tener algún tipo de deuda médica, que afecta desproporcionadamente a los pacientes de bajos ingresos, negros y latinos (que pueden ser de cualquier raza), según la California Health Care Foundation.

Docenas de estados han promulgado leyes para proteger a los consumidores de facturas sorpresa y deudas médicas, según la Conferencia Nacional de Legislaturas Estatales. Newsom, demócrata, también firmó una legislación el martes 24 de septiembre que prohíbe a los hospitales usar gravámenes sobre todas las propiedades de los californianos que generalmente ganan menos del 400% del nivel federal de pobreza. La medida amplía la ley estatal actual que protege el hogar de un paciente de los cobradores de deudas.

Un análisis de KFF Health News encontró que los informes de crédito son la táctica de cobro más común utilizada por los hospitales para que los pacientes paguen sus facturas. Una prohibición de puntuación crediticia podría dificultar más que los hospitales cobren.

Cuando Sonia Hayden, residente de Sacramento, y su novio solicitaron un préstamo para una casa el año pasado, descubrió que su puntaje de crédito había bajado unos cien puntos. Fue degradado debido a un cargo de aproximadamente $200 por una visita a una sala de emergencias después de un accidente automovilístico hace años.

La mujer de 44 años dijo que su seguro cubrió decenas de miles de dólares en facturas médicas, pero que el hospital codificó mal el cargo de $200 y nunca recibió una factura por ese gasto, que también debería haber sido cargado al seguro.

Hayden intentó sin éxito durante más de un año resolver el problema con su aseguradora de salud. Todavía está en su informe de crédito. Finalmente pudo obtener un préstamo para una casa, pero sus tasas de interés fueron más altas debido a su puntaj de crédito.

“Las facturas médicas no son intencionadas, ¿sabes?”, dijo Hayden, quien testificó en apoyo de la legislación. “Ya fue un accidente súper traumático. Casi muero. Y luego tener esta factura médica súper estresante… nadie está pidiendo eso. No debería afectar tu crédito”.

Esta historia fue producida por Kaiser Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Nine counties have begun rolling out the Community Assistance, Recovery, and Empowerment Act, which Gov. Gavin Newsom (D) signed into law in 2022 to get people with untreated schizophrenia or other psychotic disorders, many of them incarcerated or homeless, into treatment. But often those skilled clinicians have been pulled by counties from other understaffed behavioral health programs.

“There’s just so much change coming with a limited workforce, limited treatment resources, and high expectations for counties to solve things like homelessness,” said Scott Kennelly, director of the Butte County Behavioral Health Department. “It’s like I’m turning on a fire hose and saying, ‘Start drinking.’”

The bill by state Sen. Tom Umberg would create an annual scholarship fund for students who pursue a mental health profession provided they work for three years with CARE Court. Umberg had requested $10 million for the program, but it’s unclear how many students would receive the scholarship, said Jackie Koenig, a spokesperson for the senator. The bill sailed through the legislature without a single lawmaker voting against it.

Umberg, a Democrat from Orange County, said CARE Court deserves targeted funding because it’s a new program, and he noted other state scholarships are available for students pursuing a behavioral health degree. For instance, the state announced in March 2023 that it would issue $118 million in grants to support behavioral health providers at 134 nonprofit community-based organizations.

“CARE Court is new, and it is in a unique space that requires unique behavioral health skills, dealing with schizophrenics,” Umberg said. “So, we want to encourage folks to go into that space, because it is a challenge.”

But local behavioral health administrators say shifting experts into CARE Court may create shortages in other programs or thrust mental health specialists into multiple demanding programs.

The CARE Act allows patients or others, such as their relatives, behavioral health care providers, or roommates, to petition their county court for help. Individuals who agree to participate can receive up to 24 months of treatment, which can include outpatient substance use disorder treatment, stabilization medication, connection to social services, and housing. It is one of Newsom’s experimental initiatives intended to get some of the state’s 181,000 homeless people off the streets and into housing without resorting to mandatory conservatorships.

Only 7,000 to 12,000 Californians are estimated to be eligible for treatment, according to the Judicial Council, which helps oversee the program.

The state has allocated $251 million to staff and launch the CARE program through the current budget year, including $122 million in grants to counties, according to the state Legislative Analyst’s Office. At the same time, counties have been directed to implement a host of other behavioral health programs, such as mobile crisis teams, and boost mental health services for Medi-Cal patients. Last year, Newsom also signed legislation that broadened the number of Californians who could be involuntarily committed.

“As a high-profile mandate, counties are largely moving existing, skilled, experienced staff over to launch and staff the CARE Court teams,” said Michelle Cabrera, executive director of the County Behavioral Health Directors Association of California, which supports the bill.

It’s why critics, including ACLU California Action, Mental Health America of California, and some counties, say a CARE Court scholarship should also support other county programs that treat individuals with serious mental illness and housing instability.

“Restricting workforce development initiatives solely to one of the many new behavioral health initiatives will not solve the issues of staffing across the continuum of behavioral health services,” said Alexandra Pierce, an assistant director at the Merced County Behavioral Health and Recovery Services Department.

County behavioral health departments are in the midst of a massive behavioral health workforce shortage — running 25% to 30% below full staff capacity, on average, according to an internal 2023 survey conducted by the county behavioral health director association and the University of California-San Francisco’s Healthforce Center, Cabrera said.

More than a dozen rural and urban county behavioral health directors told KFF Health News that hiring challenges are widespread and not unique to CARE Court, pointing to burnout since the start of the covid-19 pandemic and steep competition from schools, correctional facilities, and the private sector, which can offer skilled clinicians higher pay, work-from-home telehealth jobs, and generous vacation.

Michelle Funez, division director of Marin County Behavioral Health and Recovery Services, said a CARE Court scholarship could incentivize students to pursue county jobs that support vulnerable individuals in the community.

Finding the right clinician for CARE Court can be tricky because the job requires skilled individuals to work in homeless encampments and other nontraditional environments, Funez said.

“It can feel like we’re looking for the needle in the haystack,” Funez said, drawing from “an already smaller body of staff who have the requisite skills for this type of work, who are also up for the challenge.”

The nine counties that have launched the specialized courts have received more than 600 petitions in the first 10 months of the program, said Leah Myers, a spokesperson for the state Department of Health Care Services, which helps oversee the program. The remaining 49 counties are slated to launch their programs by Dec. 1.

There have been early successes with the program. A year in, San Diego County is already beginning to “graduate” patients, meaning they have received treatment and have made enough progress to transition out of the court system.

As more counties roll out CARE Courts, they will need more clinicians. A scholarship program, some counties said, could help. But the bill’s price tag could be its downfall. In June, Newsom signed a state budget closing an estimated $46.8 billion deficit, and last year he vetoed hundreds of bills, many of them over cost. Newsom spokesperson Elana Ross declined to comment on the measure.

Newsom has until the end of the month to sign or veto the bill.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Marin Community Clinics referred the 75-year-old to a dentist about 20 miles away in San Francisco, but his tooth decayed while he waited months for authorization to cover the procedure. In the end, his tooth was pulled.

It was the sixth time in a decade Moske had lost a tooth for lack of dental care, he said. The behavioral health peer specialist wears a denture that must be removed at mealtime, making eating a chore. He often struggles to mash food between his gums, and he limits his diet to things he can easily chew. Nuts and steak, for instance, are off the table. It can be embarrassing to sit down for a meal with clients or colleagues.

“I feel like I give off the impression of somebody who doesn’t take care of himself, and I do take care of myself,” Moske said. “I try very hard. So, when I go out, I try not to smile.”

California is among a growing number of states that provide comprehensive dental benefits to adults enrolled in Medicaid, and some lawmakers want to add more dental cleanings, examinations, and implants to the safety-net program. Yet many dentists don’t accept Medi-Cal, the state’s Medicaid program, so new benefits would offer no guarantee that patients could get care.

The UCLA Center for Health Policy Research found that 21% of California dentists saw Medi-Cal patients of all ages, according to data from 2019 to 2021. Often those dentists limit the number of Medi-Cal patients they will see, meaning only 15% of adults might get dental care in any given year, said Elizabeth Mertz, a dentistry professor and medical sociologist at the University of California-San Francisco.

“The issue is you have coverage that is useless,” Mertz said. “The state does provide coverage, but almost no dentist will accept it.”

One of the bills moving through the California Legislature would expand Medi-Cal coverage of dental implants — artificial tooth roots implanted into the jawbone that support artificial teeth — and crowns, giving patients with broken or missing teeth more options.

Currently, Medi-Cal covers implants only when “exceptional medical conditions are documented,” according to the state’s 2024 benefits guide. It’s unclear how many private dental plans cover implants, but preliminary research has shown about half of individuals enrolled in a PPO plan nationwide have some type of coverage, said Mike Adelberg, executive director at the National Association of Dental Plans.

Under the bill, introduced by Democratic Sen. Aisha Wahab, Medi-Cal patients could qualify for an implant if their dentist determines it is the best option to replace a missing tooth.

“If you need an implant, you should be able to get it, especially our most vulnerable,” Wahab said. “The poorest of the poor in California deserve this.”

The Senate passed the bill unanimously in May, and a vote is pending in the Assembly Appropriations Committee. Elana Ross, a spokesperson for Democratic Gov. Gavin Newsom, declined to comment on the bill.

Four in 10 U.S. adults have had permanent teeth pulled, according to an analysis by the Centers for Disease Control and Prevention. The CDC also reports that low-income older adults are at higher risk for tooth loss, which can cause discomfort and affect eating and speaking. The fix can be prosthetic devices, such as bridges and dentures, or replacement teeth, but they can be costly, especially for those without insurance or on government programs with limited benefits.

While the alternatives might be a better fit for some patients, implants are “the standard of care,” said Sohail Saghezchi, director of UCSF’s oral surgery residency program.

“They’re not able to eat everything that they want, and, a lot of times, foods like vegetables and fruits are harder to eat,” he said.

The Department of Health Care Services, which oversees Medi-Cal, estimates it would cost between $4 billion and $7 billion a year for about 1.5 million implants — a price tag Wahab fears could be problematic since Newsom in June signed a state budget closing an estimated $46.8 billion deficit.

The cost of an implant varies widely. DHCS estimates it would reimburse dentists between $3,000 and $4,500 for each implant surgery. FAIR Health, a national nonprofit that estimates health costs, reported a median charge for a typical implant in California between October 2022 and September 2023 ranged from about $4,000 to $4,800. Location matters, too. In San Franciso, for example, an implant is closer to $8,000, Saghezchi said.

“Reimbursement rates need to cover the costs of providing the service,” said Alicia Malaby, a spokesperson at the California Dental Association. “As with any Medi-Cal benefit, coverage is not meaningful unless the state is willing to fully invest in it to ensure people can actually access the care they need.”

The California Dental Association, which does not support the current bill, has raised concerns about the invasiveness of implant surgery, which requires regular follow-up appointments. It’s sponsoring legislation to require Medi-Cal to cover a standard two teeth cleanings and examinations a year for people 21 and older, as opposed to one.

DHCS spokesperson Leah Myers said the state has increased Medi-Cal reimbursements to dentists since the passage of Proposition 56 in 2016 and created a web-based app to enlist more dentists. More than 14,000 dentists — about 40% — were enrolled in the Medi-Cal program, as of July, according to the latest numbers published by the Dental Board.

But for people such as Moske, finding a dentist and getting needed care feels impossible. In most of California, 3 in 4 Medi-Cal patients 21 and up didn’t have a dental appointment in 2023, according to DHCS.

When Moske testified in support of the implant bill in June, he took out his denture, held it up to show lawmakers, and opened his mouth.

“I’m here to show you something,” Moske said. “Please don’t be offended. These are the teeth I lost.”

After Moske had finished speaking, Assembly member Reggie Jones-Sawyer (D-Los Angeles) turned to his fellow members and removed his own denture.

“I know exactly what you went through,” he said. “I have dental insurance from the city of Los Angeles and the state of California and still had problems getting things covered. I thank you for being brave enough to let people know.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Planned Parenthood’s political and advocacy organizations will use a more than $40 million war chest to blitz GOP officeholders and candidates in an effort to flip the House and maintain Democratic control of the Senate and presidency.

The plan is to focus on the records of Republicans who have repeatedly voted against access to abortion, contraceptives, in vitro fertilization or gender-affirming care for trans people.

On Tuesday, the organization’s lobbying arm, Planned Parenthood Action Fund, announced its endorsement of Kamala Harris for president.

Since Roe v. Wade was overturned in 2022, the right to abortion has proved to be an issue that motivates voters, and Planned Parenthood is betting that will again be true at the ballot box this fall. News that Harris is now the leading Democratic presidential candidate, with President Biden stepping back, is also energizing advocates.

Alexis McGill Johnson, Planned Parenthood Action Fund president and CEO, called Harris “one of the fiercest voices we have on sexual and reproductive rights.”

“Having spent meaningful time and energy with abortion providers, patients, organizers and advocates, the Vice President’s presence takes the conversation around abortion rights to heights we’ve never seen before in a presidential campaign,” she said. “There’s no doubt that she will generate new energy for the future of the fight ahead.”

Twenty-five states ban abortion in almost all circumstances or limit access to it beginning early in pregnancy. Other states are considering similar restrictions. And support for a national abortion ban may pick up currency if Republicans gain control of Congress and the White House.

Shwetika Baijal, who runs political initiatives for Planned Parenthood, said recent elections have shown that abortion drives voter turnout, especially among young people and people of color. An example of this is the 2022 Kansas primary election, in which voters from a red state turned out in record numbers shortly after the Dobbs decision to resoundingly protect abortion rights.

“I think you find that when you take someone’s rights away, it makes them really angry,” Baijal said.

The national Planned Parenthood campaign is hoping to leverage this anger starting with races in several battleground states, including Arizona, Michigan and Nevada. The aggressive ad campaign has already hit multiple platforms, including podcasts like Call Her Daddy, a sex and relationship show, which has received an average of 5 million listeners a week.

On top of that, Planned Parenthood’s California affiliates will spend a seven-figure amount to target eight congressional districts, most of which typically vote Republican but in which voters supported a 2022 ballot measure to enshrine abortion rights in the state constitution.

Republicans dismiss the Planned Parenthood efforts, noting that even districts that backed the 2022 measure also voted to keep their Republican leaders in charge. California Assembly Republican leader James Gallagher, who is on the state Republican Party board, said he doesn’t see a reason the 2024 elections will play out differently.

“People can be supportive of abortion rights and still vote for the Republicans because they feel the Republican is better at addressing the everyday issues,” Gallagher said.

Baijal said calling attention to Republicans’ voting records is crucial now that many are backing away from long-held, hard-line antiabortion positions that are proving unpopular. Some candidates, like Republican Senate nominee Sam Brown of Nevada, have pledged to protect abortion rights, even if their past statements suggest otherwise.

“We have to talk about what these people are trying to do, not what they’re saying,” Baijal says.

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This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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The Biden administration proposed barring medical debt from credit reports. This morning, Senate Health Committee Chair Bernie Sanders (I-Vt.) will convene a hearing in D.C. on medical debt.

Now local governments are looking at how they can assist residents by buying up medical debt on the cheap and retiring it.

Under a measure the Los Angeles County Board of Supervisors approved unanimously last month, the county will enter into a pilot program with Undue Medical Debt (previously known as RIP Medical Debt), a national organization that turns the debt collection process on its head. Instead of buying outstanding debt from hospitals and pursuing patients for payment, as commercial debt collectors do, Undue Medical Debt looks to buy debt, usually for pennies on the dollar, then retire it.

Los Angeles County’s $5 million investment is expected to allow Undue Medical Debt to help 150,000 low-income residents and eliminate $500 million in debt. It’s one component of the county’s larger medical debt plan, which includes tracking hospitals’ role in feeding the $2.9 billion problem, boosting bill retirement for low-income patients and monitoring debt collection practices.

Four in 10 adults in the United States struggle with health-care debt, and Los Angeles County has labeled it a public health issue on par with diabetes and asthma.

The logic behind the effort is simple. “Getting health care should never make anyone sicker,” said Naman Shah, medical and dental affairs director at the county public health department.

Undue Medical Debt has contracted with more than a dozen city, county and state governments across the country to provide local debt relief, including Cook County, Ill. (home to Chicago); Toledo; Arizona and New Jersey.

Since its inception, Undue Medical Debt has relieved almost $12 billion in medical debt across the country.

Beginning in 2022, Cook County has leveraged American Rescue Plan dollars — federal emergency funds made available during the coronavirus pandemic — to wipe out over $382 million in medical debt for more than 213,000 residents. About 15 other state or local governments have also used American Rescue Plan funds to retire medical debt, according to Undue Medical Debt, and other jurisdictions are developing similar plans.

Mona Shah of Community Catalyst, a national health equity and policy organization, applauds the local government moves but cautions that one-time debt relief goes only so far. She endorsed Los Angeles County’s approach: pairing debt relief with a longer-term effort to understand and address the root causes of medical debt, in part by getting a better handle on debt collection practices and helping hospitals improve their financial assistance programs.

“We don’t want to ever deny that relief, but we really need to focus on preventing medical debt from happening in the first place,” Shah said.

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