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"title": "Kaiser Eases Restrictions on Postpartum Depression Care After Investigations",
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"content": "\u003cp>A year after her son, Nico, was born and she still felt like an empty shell of herself despite multiple attempts to find treatment, Miriam McDonald “came out” as suffering from debilitating postpartum depression, a decision she now says was totally worth it.\u003c/p>\n\u003cp>For months, McDonald battled her health provider and insurer, Kaiser Permanente, which denied her the one and only FDA-approved medication for postpartum depression, brexanolone. [pullquote size=\"medium\" align=\"right\" citation=\"Miriam McDonald, mother\"]‘No woman should suffer like I did after having a child. The policy was completely unfair. I was in purgatory.’[/pullquote]But since she shared the details of her struggle in a\u003ca href=\"https://www.kqed.org/news/11879309/theres-only-1-drug-for-postpartum-depression-why-does-kaiser-permanente-make-it-so-hard-to-get\"> 2021 KQED investigation\u003c/a>, Kaiser has revamped its coverage guidelines twice, according to internal documents recently obtained by KQED, and federal regulators — citing KQED’s reporting — have launched an investigation into the insurer that is still ongoing.\u003c/p>\n\u003cp>“This will prevent other women from having to go through a year of depression to find something that works,” McDonald said after learning of Kaiser’s policy changes. “No woman should suffer like I did after having a child. The policy was completely unfair. I was in purgatory.”\u003c/p>\n\u003cp>When McDonald experienced her first symptoms of postpartum depression in 2019, including suicidal thoughts, Kaiser’s written guidelines required patients to try and fail four medications and electroconvulsive therapy before they would be eligible for brexanolone. But, because the drug was only approved for use up to six months postpartum, experts said this amounted to a blanket denial for all Kaiser patients, a potential violation of state and federal law.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One month after KQED published its investigation, Kaiser overhauled its guidelines, instead recommending women try just one medication before becoming eligible for brexanolone, and if that trial could not be completed before the six-month window expired, women could bypass it and go straight to brexanolone.\u003c/p>\n\u003cp>“Kaiser basically went from having the most restrictive policy to the most robust,” said Joy Burkhard, executive director of the nonprofit\u003ca href=\"https://www.2020mom.org/\"> Policy Center for Maternal Mental Health\u003c/a>. “It’s now a gold standard for the rest of the industry.”\u003c/p>\n\u003ch2>Next, a federal investigation\u003c/h2>\n\u003cp>But the scrutiny over Kaiser didn’t stop there. By late 2022, the federal Department of Labor had launched an investigation into the insurer, according to emails reviewed by KQED. Investigators called McDonald and contacted other patients to discuss the difficulty they had accessing postpartum mental health care, including brexanolone.\u003c/p>\n\u003cp>A few months later, in March 2023, Kaiser revised its brexanolone guidelines again, removing all fail-first recommendations. Patients need only decline a trial of another medication. [pullquote size=\"medium\" align=\"right\" citation=\"Kaiser Permanente statement\"]‘Kaiser Permanente is committed to ensuring brexanolone is available when physicians and patients determine it is an appropriate treatment.’[/pullquote]“Since brexanolone was first approved for use, more experience and research have added to information about its efficacy and safety,” Kaiser said in a statement. “Kaiser Permanente is committed to ensuring brexanolone is available when physicians and patients determine it is an appropriate treatment.”\u003c/p>\n\u003cp>The Department of Labor said in an email to KQED that it “will not confirm or deny the existence of an ongoing investigation” as a matter of policy but added the agency could sue a private insurer and force it to change its policies if they violate federal law. It can also force insurers to provide treatment or reimburse patients who paid out of pocket for treatments the department found improperly denied.\u003c/p>\n\u003ch2>A new era for postpartum therapies\u003c/h2>\n\u003cp>Brexanolone came on the market in 2019 with the hope of revolutionizing the treatment of postpartum depression by targeting hormone function instead of the brain’s serotonin system, as typical antidepressants do. \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression\">In early trials,\u003c/a> women with moderate to severe depression reported relief immediately after the three-day treatment. But brexanolone is expensive, $34,000 per treatment, and must be delivered intravenously during an inpatient hospital stay where patients can be closely monitored for side effects like fainting.\u003c/p>\n\u003cp>Both the price and finding a hospital certified to administer the drug proved to be prohibitive barriers for new mothers pursuing the treatment. Until recently, Kaiser did not have its own certification and had to refer women to one of only three other approved hospitals in California. [aside label='More Stories on health' tag='health']A new, more accessible pill form of the medication, zuranolone, taken once a day at home over 14 days, \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression\">was approved by the FDA in August\u003c/a>. In November, Sage Therapeutics, the company that makes both drugs, set the price for zuranolone at $15,900.\u003c/p>\n\u003cp>Since then, less than 1% of health plans have established criteria for when they will cover it, according to \u003ca href=\"https://www.2020mom.org/blog/2023/12/15/zurzuvae-the-new-postpartum-depression-drug-now-available-in-the-us-this-is-how-insurers-have-responded\">an analysis\u003c/a> using data from \u003ca href=\"https://www.policyreporter.com/\">Policy Reporter\u003c/a>, a website that tracks insurance policies. Regulators, lawyers, and advocates are watching closely to see how insurance companies will shape policies for the new drug.\u003c/p>\n\u003cp>“We’ll have to see if insurers cover this drug and what fail-first requirements they put in,” said \u003ca href=\"https://psych-appeal.com/meiram-bendat-attorney-founder/\">Meiram Bendat\u003c/a>, an attorney and licensed psychotherapist who represents patients.\u003c/p>\n\u003cp>These new policies will be written at a time when the regulatory environment around mental health treatment is shifting. The federal Department of Labor is now cracking down more on potential violations of the \u003ca href=\"https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity\">2008 Mental Health Parity and Addiction Equity Act\u003c/a>, which requires insurers to cover psychiatric treatments on par with physical treatments.\u003c/p>\n\u003cp>As of this summer, insurers must comply with new, stricter reporting and auditing requirements that are intended to increase patient access to mental health care and, advocates say, could compel them to be more careful about the policies they write in the first place. [pullquote size=\"medium\" align=\"right\" citation=\"Meiram Bendat, attorney and licensed psychotherapist, who represents patients\"]‘We’ll have to see if insurers cover this drug and what fail-first requirements they put in.’[/pullquote]In California, insurers must also comply with an even broader state mental health parity law from 2021, making sure their coverage policies are aligned with generally accepted standards of care. Highly awaited \u003ca href=\"https://www.kqed.org/science/1984855/is-californias-landmark-mental-health-law-working\">regulations for the law\u003c/a> are expected to be released this spring.\u003c/p>\n\u003cp>Many perinatal psychiatrists told KQED it is imperative to treat postpartum depression as quickly as possible to avoid negative impacts, including cognitive and social problems in the baby, anxiety or depression in the husband or partner, or the death of the mother to suicide, which accounts for \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/\">up to 20% of maternal deaths\u003c/a>.\u003c/p>\n\u003cp>It’s possible this reasoning is why Kaiser was quick to revise its guidelines for brexanolone for the first time in 2021, Burkhard said, who worked at an insurance company before becoming an advocate. But it is unclear what criteria Kaiser will set for the new pill zuranolone.\u003c/p>\n\u003cp>“We will apply the same evidence-based, expert review process to zuranolone as we do with all medications,” Kaiser said.\u003c/p>\n\u003cp>McDonald is hopeful that women will now have more choices for care in policy and practice, including treatments that work faster and they can access immediately. She doesn’t want them to be forced on a trial-and-error medication merry-go-round like she was and can choose the treatment that’s right for them.\u003c/p>\n\u003cp>“There has to be more options for women,” she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A year after her son, Nico, was born and she still felt like an empty shell of herself despite multiple attempts to find treatment, Miriam McDonald “came out” as suffering from debilitating postpartum depression, a decision she now says was totally worth it.\u003c/p>\n\u003cp>For months, McDonald battled her health provider and insurer, Kaiser Permanente, which denied her the one and only FDA-approved medication for postpartum depression, brexanolone. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>But since she shared the details of her struggle in a\u003ca href=\"https://www.kqed.org/news/11879309/theres-only-1-drug-for-postpartum-depression-why-does-kaiser-permanente-make-it-so-hard-to-get\"> 2021 KQED investigation\u003c/a>, Kaiser has revamped its coverage guidelines twice, according to internal documents recently obtained by KQED, and federal regulators — citing KQED’s reporting — have launched an investigation into the insurer that is still ongoing.\u003c/p>\n\u003cp>“This will prevent other women from having to go through a year of depression to find something that works,” McDonald said after learning of Kaiser’s policy changes. “No woman should suffer like I did after having a child. The policy was completely unfair. I was in purgatory.”\u003c/p>\n\u003cp>When McDonald experienced her first symptoms of postpartum depression in 2019, including suicidal thoughts, Kaiser’s written guidelines required patients to try and fail four medications and electroconvulsive therapy before they would be eligible for brexanolone. But, because the drug was only approved for use up to six months postpartum, experts said this amounted to a blanket denial for all Kaiser patients, a potential violation of state and federal law.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One month after KQED published its investigation, Kaiser overhauled its guidelines, instead recommending women try just one medication before becoming eligible for brexanolone, and if that trial could not be completed before the six-month window expired, women could bypass it and go straight to brexanolone.\u003c/p>\n\u003cp>“Kaiser basically went from having the most restrictive policy to the most robust,” said Joy Burkhard, executive director of the nonprofit\u003ca href=\"https://www.2020mom.org/\"> Policy Center for Maternal Mental Health\u003c/a>. “It’s now a gold standard for the rest of the industry.”\u003c/p>\n\u003ch2>Next, a federal investigation\u003c/h2>\n\u003cp>But the scrutiny over Kaiser didn’t stop there. By late 2022, the federal Department of Labor had launched an investigation into the insurer, according to emails reviewed by KQED. Investigators called McDonald and contacted other patients to discuss the difficulty they had accessing postpartum mental health care, including brexanolone.\u003c/p>\n\u003cp>A few months later, in March 2023, Kaiser revised its brexanolone guidelines again, removing all fail-first recommendations. Patients need only decline a trial of another medication. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Since brexanolone was first approved for use, more experience and research have added to information about its efficacy and safety,” Kaiser said in a statement. “Kaiser Permanente is committed to ensuring brexanolone is available when physicians and patients determine it is an appropriate treatment.”\u003c/p>\n\u003cp>The Department of Labor said in an email to KQED that it “will not confirm or deny the existence of an ongoing investigation” as a matter of policy but added the agency could sue a private insurer and force it to change its policies if they violate federal law. It can also force insurers to provide treatment or reimburse patients who paid out of pocket for treatments the department found improperly denied.\u003c/p>\n\u003ch2>A new era for postpartum therapies\u003c/h2>\n\u003cp>Brexanolone came on the market in 2019 with the hope of revolutionizing the treatment of postpartum depression by targeting hormone function instead of the brain’s serotonin system, as typical antidepressants do. \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression\">In early trials,\u003c/a> women with moderate to severe depression reported relief immediately after the three-day treatment. But brexanolone is expensive, $34,000 per treatment, and must be delivered intravenously during an inpatient hospital stay where patients can be closely monitored for side effects like fainting.\u003c/p>\n\u003cp>Both the price and finding a hospital certified to administer the drug proved to be prohibitive barriers for new mothers pursuing the treatment. Until recently, Kaiser did not have its own certification and had to refer women to one of only three other approved hospitals in California. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>A new, more accessible pill form of the medication, zuranolone, taken once a day at home over 14 days, \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression\">was approved by the FDA in August\u003c/a>. In November, Sage Therapeutics, the company that makes both drugs, set the price for zuranolone at $15,900.\u003c/p>\n\u003cp>Since then, less than 1% of health plans have established criteria for when they will cover it, according to \u003ca href=\"https://www.2020mom.org/blog/2023/12/15/zurzuvae-the-new-postpartum-depression-drug-now-available-in-the-us-this-is-how-insurers-have-responded\">an analysis\u003c/a> using data from \u003ca href=\"https://www.policyreporter.com/\">Policy Reporter\u003c/a>, a website that tracks insurance policies. Regulators, lawyers, and advocates are watching closely to see how insurance companies will shape policies for the new drug.\u003c/p>\n\u003cp>“We’ll have to see if insurers cover this drug and what fail-first requirements they put in,” said \u003ca href=\"https://psych-appeal.com/meiram-bendat-attorney-founder/\">Meiram Bendat\u003c/a>, an attorney and licensed psychotherapist who represents patients.\u003c/p>\n\u003cp>These new policies will be written at a time when the regulatory environment around mental health treatment is shifting. The federal Department of Labor is now cracking down more on potential violations of the \u003ca href=\"https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity\">2008 Mental Health Parity and Addiction Equity Act\u003c/a>, which requires insurers to cover psychiatric treatments on par with physical treatments.\u003c/p>\n\u003cp>As of this summer, insurers must comply with new, stricter reporting and auditing requirements that are intended to increase patient access to mental health care and, advocates say, could compel them to be more careful about the policies they write in the first place. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>In California, insurers must also comply with an even broader state mental health parity law from 2021, making sure their coverage policies are aligned with generally accepted standards of care. Highly awaited \u003ca href=\"https://www.kqed.org/science/1984855/is-californias-landmark-mental-health-law-working\">regulations for the law\u003c/a> are expected to be released this spring.\u003c/p>\n\u003cp>Many perinatal psychiatrists told KQED it is imperative to treat postpartum depression as quickly as possible to avoid negative impacts, including cognitive and social problems in the baby, anxiety or depression in the husband or partner, or the death of the mother to suicide, which accounts for \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/\">up to 20% of maternal deaths\u003c/a>.\u003c/p>\n\u003cp>It’s possible this reasoning is why Kaiser was quick to revise its guidelines for brexanolone for the first time in 2021, Burkhard said, who worked at an insurance company before becoming an advocate. But it is unclear what criteria Kaiser will set for the new pill zuranolone.\u003c/p>\n\u003cp>“We will apply the same evidence-based, expert review process to zuranolone as we do with all medications,” Kaiser said.\u003c/p>\n\u003cp>McDonald is hopeful that women will now have more choices for care in policy and practice, including treatments that work faster and they can access immediately. She doesn’t want them to be forced on a trial-and-error medication merry-go-round like she was and can choose the treatment that’s right for them.\u003c/p>\n\u003cp>“There has to be more options for women,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Sen. Laphonza Butler Is an Expert in Labor Issues. But What About Climate?",
"headTitle": "Sen. Laphonza Butler Is an Expert in Labor Issues. But What About Climate? | KQED",
"content": "\u003cp>Organizations across California came out of the woodwork to praise Laphonza Butler as she ascended to the U.S. Senate this week, touting her long record on progressive issues and fighting for working class people.\u003c/p>\n\u003cp>But as the newly sworn-in senator begins her tenure, environmentalists in California are wondering what her appointment means for climate action in this state.\u003c/p>\n\u003cp>Butler’s background is cemented in labor issues, having served as president of California’s SEIU for more than a decade. She’s also a well-known political strategist and a champion of abortion rights, most recently serving as president of EMILY’s List.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Steve Maviglio, democratic strategist\"]‘She’s fought all her life for poor people and people living in urban areas, and I think more and more we see how climate is affecting those very same constituencies.’[/pullquote]But Butler has never held elected office and has virtually no experience with climate policy.\u003c/p>\n\u003cp>“The governor did not appoint somebody who has a long track record on these issues, and I think that raises some questions in the community,” said democratic strategist Steve Maviglio.\u003c/p>\n\u003cp>Gov. Gavin Newsom has made the issue fundamental to his time in office. Most recently, California filed a lawsuit against major oil companies claiming they deceived the public for decades on climate. And he \u003ca href=\"https://www.kqed.org/news/11961602/gov-gavin-newsom-says-he-will-sign-climate-focused-transparency-laws-for-big-business\">committed\u003c/a> to sign landmark legislation that would require billion-dollar corporations working in California to disclose their greenhouse gas emissions.\u003c/p>\n\u003cp>At the helm of a state that has become the poster child of climate change disasters, Newsom’s choice to appoint Butler surprised environmental activists.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It was totally out of the box,” Maviglio said. “She was not on anybody’s short list.”\u003c/p>\n\u003cp>Butler now represents about 40 million Californians in one of the most powerful lawmaking positions in the country. She will be tasked with promoting climate change mitigation on the national stage, as well as voting on water policy, wildfire mitigation strategies and plans for handling drought, among other issues.\u003c/p>\n\u003cp>She’s also stepping in on the heels of the late Sen. Dianne Feinstein who, over her many decades in office, played a significant role in shaping environmental legislation, including protecting millions of acres of California deserts and regulating oil drilling off the state’s Pacific coast and pollution from cars.\u003c/p>\n\u003cp>Meanwhile, Butler’s political career has so far been rooted primarily in labor issues. During her tenure at SEIU 2015, the labor union was peripherally involved in clean energy bills, including \u003ca href=\"https://legiscan.com/CA/text/SB100/id/1819458\">SB 100\u003c/a>, which set a target of 100% carbon-free electricity by 2045. Unlike other private sector unions at the time, SEIU also showed support for fossil fuel divestment legislation, like \u003ca href=\"http://www.leginfo.ca.gov/pub/15-16/bill/sen/sb_0151-0200/sb_185_cfa_20150528_124751_sen_comm.html\">SB 185\u003c/a>. However, SEIU declined to say whether Butler was involved directly in those efforts.\u003c/p>\n\u003cp>[aside postID=\"news_11963215,news_11963066\" label=\"Related Stories\"]“[Environmental justice] was important to Laphonza because we represented women of color and low-wage workers living in areas where the air isn’t the best, the water isn’t the best,” said current SEIU 2015 executive vice president Carmen Roberts. “So that was certainly one of our justice agenda items.”\u003c/p>\n\u003cp>Numerous environmental groups released statements in the aftermath of Butler’s appointment, including California Environmental Voters, whose political and organizing director Mike Young called her a “known advocate” and said the group looked “forward to working with her on the progressive values she’s represented throughout her career.”\u003c/p>\n\u003cp>But none of the statements from California-based environmental groups, including EnviroVoters, said anything about Butler’s environmental achievements. None agreed to an interview with KQED, either, saying they couldn’t speak to her climate record.\u003c/p>\n\u003cp>Her appointment could set up her now-counterpart, Sen. Alex Padilla, to be the more active member of the California delegation in the Senate on climate change. Prior to his time in office, Padilla served for six years as chair of California’s Committee on Energy, Utilities, and Communications, where he led efforts on renewable energy and climate policies. As a senator, he co-sponsored the Green New Deal and now serves on the Environment and Public Works Committee.\u003c/p>\n\u003cp>But Democratic strategist Maviglio — who worked with Butler during her time at SEIU — isn’t counting her out.\u003c/p>\n\u003cp>“She may emerge as a[n environmental] leader because she knows how important it is to California and to the governor,” he said.\u003c/p>\n\u003cp>And in fact, he said, she could bring a fresh perspective to the issue.\u003c/p>\n\u003cp>“She’s fought all her life for poor people and people living in urban areas, and I think more and more we see how climate is affecting those very same constituencies,” he said. “So I think you’ll see her rise up, particularly on environmental justice issues, and be an outspoken force for those in the Senate.”\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It was totally out of the box,” Maviglio said. “She was not on anybody’s short list.”\u003c/p>\n\u003cp>Butler now represents about 40 million Californians in one of the most powerful lawmaking positions in the country. She will be tasked with promoting climate change mitigation on the national stage, as well as voting on water policy, wildfire mitigation strategies and plans for handling drought, among other issues.\u003c/p>\n\u003cp>She’s also stepping in on the heels of the late Sen. Dianne Feinstein who, over her many decades in office, played a significant role in shaping environmental legislation, including protecting millions of acres of California deserts and regulating oil drilling off the state’s Pacific coast and pollution from cars.\u003c/p>\n\u003cp>Meanwhile, Butler’s political career has so far been rooted primarily in labor issues. During her tenure at SEIU 2015, the labor union was peripherally involved in clean energy bills, including \u003ca href=\"https://legiscan.com/CA/text/SB100/id/1819458\">SB 100\u003c/a>, which set a target of 100% carbon-free electricity by 2045. Unlike other private sector unions at the time, SEIU also showed support for fossil fuel divestment legislation, like \u003ca href=\"http://www.leginfo.ca.gov/pub/15-16/bill/sen/sb_0151-0200/sb_185_cfa_20150528_124751_sen_comm.html\">SB 185\u003c/a>. However, SEIU declined to say whether Butler was involved directly in those efforts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“[Environmental justice] was important to Laphonza because we represented women of color and low-wage workers living in areas where the air isn’t the best, the water isn’t the best,” said current SEIU 2015 executive vice president Carmen Roberts. “So that was certainly one of our justice agenda items.”\u003c/p>\n\u003cp>Numerous environmental groups released statements in the aftermath of Butler’s appointment, including California Environmental Voters, whose political and organizing director Mike Young called her a “known advocate” and said the group looked “forward to working with her on the progressive values she’s represented throughout her career.”\u003c/p>\n\u003cp>But none of the statements from California-based environmental groups, including EnviroVoters, said anything about Butler’s environmental achievements. None agreed to an interview with KQED, either, saying they couldn’t speak to her climate record.\u003c/p>\n\u003cp>Her appointment could set up her now-counterpart, Sen. Alex Padilla, to be the more active member of the California delegation in the Senate on climate change. Prior to his time in office, Padilla served for six years as chair of California’s Committee on Energy, Utilities, and Communications, where he led efforts on renewable energy and climate policies. As a senator, he co-sponsored the Green New Deal and now serves on the Environment and Public Works Committee.\u003c/p>\n\u003cp>But Democratic strategist Maviglio — who worked with Butler during her time at SEIU — isn’t counting her out.\u003c/p>\n\u003cp>“She may emerge as a[n environmental] leader because she knows how important it is to California and to the governor,” he said.\u003c/p>\n\u003cp>And in fact, he said, she could bring a fresh perspective to the issue.\u003c/p>\n\u003cp>“She’s fought all her life for poor people and people living in urban areas, and I think more and more we see how climate is affecting those very same constituencies,” he said. “So I think you’ll see her rise up, particularly on environmental justice issues, and be an outspoken force for those in the Senate.”\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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