Women's Health Clinics in California Struggle in a Shifting Health Care Landscape

Closures and consolidations have been increasing among community clinics that provide reproductive health services.

Two beloved women’s clinics in San Francisco are consolidating with outside partners in order to keep operating. Another two, in Santa Rosa and Sacramento, have shut their doors.  All four were unintended casualties  of the Affordable Care Act, which shifted payments and changed incentives throughout California's health industry.

Because of the health law, more women in California have coverage for a full range of health services through Medi-Cal. As a result, many of those women are now going to a regular doctor or primary care center for their family planning needs, instead of a dedicated women’s clinic. In addition, the state is paying these clinics less money under Obamacare.

“Of course, I love the Affordable Care Act, but it was very harmful to reproductive health clinics,” said Dr. Rebecca Jackson, director of New Generation, a teen clinic in San Francisco's Mission neighborhood. New Generation  announced last spring it would have to close, but then UCSF agreed to fund it one more year.

This week, managers announced the next steps to ensure the clinic's ongoing survival.  New Generation will move into a smaller, shared office; partner with the city’s Department of Public Health to cover administrative costs such as billing and medical records; and continue intensive and urgent fund-raising efforts in the private sector.

“That allows us to get long-term sustainability that we didn't have as a free-standing clinic,” Jackson said.

In Sacramento, Women’s Health Specialists couldn’t get the numbers to work and shut down last month. Their Santa Rosa location closed two years ago. Outgoing director Shauna Heckert warned the same could happen to the three remaining clinics in Grass Valley, Chico, and Redding if the state doesn’t increase Medi-Cal reimbursements. That's something Governor Jerry Brown has refused to do for years.

“Number one, raising rates for poor people's health care is not popular,” Heckert explained. “Number two, raising rates for reproductive health  — that includes abortion and chlamydia [and] gonorrhea — is certainly not something people even feel comfortable talking about.”

Women’s clinics are now lobbying state lawmakers, asking them to direct some of the revenues from the newly-passed tobacco tax specifically to them. The Legislature must pass the state budget by June 15th.

But the Women’s Community Clinic in San Francisco couldn’t wait to see what might happen with the state budget.  The clinic, which had previously suffered a temporary closure and re-organization in 1999, announced a merger this week with HealthRight360, a statewide nonprofit health system.

Carlina Hansen, the clinic's executive director, explained that the Women’s Community Clinic had lost some federal grants. But she noted that the merger with HealthRight360 will also benefit her patients: in addition to family planning, they'll be able to access primary care, mental health services and addiction treatment.

“It was not all about money,” said Hansen, who will step down from running the clinic after 17 years. “It was really also about adapting, to do better for our clients in the future.”