Trump gropes repro rights: Closure of Sacramento women’s clinic foreshadows lost abortion access

Not a single picketer occupied the sidewalks outside Women’s Health Specialists on its final afternoon. Inside the North Sacramento building, two rows of empty chairs outnumbered a husband in the waiting room an hour before closing time. After 30 years of providing comprehensive medical care to women (and even some men), the nonprofit clinic shuttered its Ethan Way branch and two nearby satellites for good on April 28.

For those on either side of the abortion divide, the quiet wilting of a major reproductive health clinic in the heart of progressive California foreshadows how a constitutional right dies—with a whimper instead of a bang.

“It’s not a good day for women in this county,” reflected Shauna Heckert, executive director of Women’s Health Specialists of California.

In the past seven years, publicly funded women’s health clinics have been under an unrelenting siege, as an increasingly pro-life Congress re-litigates the national abortion debate. The conflict may reach its climax under the Trump administration through ongoing attempts to dismantle the Affordable Care Act and strip federal money from comprehensive women’s health centers that also conduct abortions.

The threats from D.C. still loom, but the Sacramento clinic closed for an unexpected reason: California politics.

Heckert said that the clinic closed due to low reimbursement rates under Medi-Cal managed care health plans, which bill private insurers instead of the government directly for services.

“Most of our clients are at or below the poverty level, so they rely on the Medi-Cal program or assisted programs, and the reimbursement is inadequate,” Heckert said. “[And] because it’s a privatized system—and we have health plans that we are billing instead of going directly to the state—our payments are getting lost in the system and we either don’t get paid at all, or we get paid too little and too late.”

Medical providers have complained in the past about low Medi-Cal reimbursements in general, and that revenue gap grew as the number of recipients soared under the Affordable Care Act. Today, Heckert said 80 percent of Women’s Health’s clients are covered by Medi-Cal.

In January, Gov. Jerry Brown outlined a state budget proposal that included drawing revenue from the Proposition 56 tobacco tax increase to grow Medi-Cal. Medical groups contend instead that the new money should be used to improve reimbursement rates, which Women’s Health supports. A final budget plan is due in June. The Sacramento locations couldn’t wait that long.

Last year, around 80 percent of Women’s Health’s revenue came from Medi-Cal and Family PACT, a 90:10 federal-state funding split for uninsured patients. None of this money pays for abortions, which represent a small percentage of the clinic’s services. But that hasn’t mattered to Republicans.

The latest GOP advance came in April, when the House of Representatives reversed an Obama-era rule that prevented states from cutting Title X federal family planning grants from clinics that perform abortions. If dismantling the ACA rolls back the number of Medi-Cal patients, or the federal government cuts off access to Medi-Cal reimbursements in particular, clinics could be starved of their resources.

“It’s only going to get worse,” Heckert predicted. “[We’re] hoping we’ll be able to survive. If Trump comes in and does what he would like to do, we are in grave danger.”

Heckert’s organization will continue to operate in Grass Valley, Redding and Chico, where its first location was founded in 1975. In the meantime, clients are being redirected to other clinics, including nearby Planned Parenthood locations. Approximately 10,000 annual patient visits were made to Women’s Health’s Sacramento locations, Heckert said. Seventeen employees were also laid off.

The Sacramento area’s system is already stretched to capacity, said Steve Heath, director of Capitol Health Network, which oversees the region’s federally qualified community health centers. The stress increased due to the Medi-Cal expansion, which bolstered the number of insured patients without creating a matching supply of doctors and providers.

Some are celebrating the loss of the Sacramento clinics. For six and a half years, Wynette Sills stood on the sidewalk weekly alongside other pro-life activists to picket and intercept women entering the Ethan Way clinic. The director of Californians for Life, Sills said her sidewalk ministry will now shift to other Sacramento abortion providers that are smaller and more vulnerable to government funding shifts.

“We’re grateful that it closed,” Sills said. “And we’re hoping other abortion businesses will follow.”

In the boardroom of Women’s Health, a large photo depicts a victory some 20 years past, when staff fended off protesters attempting to block the entrance of the original J Street location. To Heckert, last week’s closure is a loss of critical turf.

“Most of the work we do is political,” Heckert said. “We’ve been firebombed five times. … We have our leases getting canceled. … Doctors get death threats. We have protestors out in front that follow us home and monitor our every activity. There’s nothing normal about this work. And we started, one, so that women have this kind of health care, and two, we wanted women to control their health care. … Not their agenda. Her agenda.”