Equity in Health Care

Before being elected to the United States Congress by the citizens of our Central Coast, I had served for many years as a school nurse for the Santa Barbara School District. It was a distinct honor and a privilege to live among and work with the families of our community in supporting the health and welfare of our children.

However, during these years, I also became keenly aware of disparities in access to affordable health care by so many of these hard-working families. And this despite the availability of Medi-Cal and our Neighborhood Clinics. Fortunately, the state and federally funded Child Health and Disability Prevention Program is available in California for periodic childhood screening. But there were — for a variety of reasons — many gaps in health-care coverage and service.

Of special importance to me during my years as a school nurse were the teenagers who became pregnant and parents at a young age. Their experiences and many challenges underscored the value of the appropriate inclusion of comprehensive sex education as a part of the school curriculum beginning at a young age.

While working with these teenagers I became aware of many of the resources available in our community, especially our Central Coast Planned Parenthood affiliate. They underscore a value I share: Knowledge is Power! And this in addition to and along with the exemplary services they provide. The physicians and staff who serve at Planned Parenthood have been real heroes in our midst.

When my husband, Walter, and I moved to the area many years ago, I soon learned of the illustrious history of our local Planned Parenthood. It was and is definitely nonpartisan. In fact, the story is that years ago it happened to be a group of Republican women who banded together to support the start of a local branch. I’ve come to associate their efforts with those of the suffragettes. This issue was never meant to be a partisan one, and it pains me to see that it has become that.

With this background and through a variety of unusual circumstances, I found myself a candidate for the United States House of Representatives in a special election in 1998. It was not a landslide victory! In fact, one local newspaper had editorialized in words to the effect — “Who does she think she is, running for Congress; she’s just a school nurse!” When I was elected, I discovered that there were three of us nurses in the House.

Fortunately, the Ranking Member (chair of the minority side) of the Energy and Commerce Committee (with its prize Health Subcommittee) was the venerable and “old-school” John Dingell of Detroit. He had an opening on his committee, and he had, as he said, always put nurses on a pedestal. (I had pointed out to him that he had no nurses on his committee). I was invited to join. Then when Barack Obama was elected U.S. president in 2009, he found that he had, as he said, “the wind at his back,” meaning he had a Congress he could work with! He told us he had two goals, to reform health care and to create a renewable energy policy.

Our Health Subcommittee was one of three committees to tackle health-care reform, and it took us a full year to draft a bill. Despite the partisan final vote in the House, the discussion and debate were very bipartisan and thorough with input from every corner. I argued successfully for the inclusion of school-based health clinics. And reproductive health, including access to abortion services, became an essential part of the Affordable Care Act (ACA). This experience of being a part of hammering out and then voting for this legislation was one of the most rewarding of my time in Congress.

Fundamental to the ACA is its implementation by each state. We know it here as Covered California. Certain provisions such as the extension of some Medicare benefits have been provided through federal legislation, but the ACA itself has not been fully adopted by all states nor fully funded by many. We are fortunate here in our state! But it has remained a Standard of Care. Not a gold standard by any means, but a ground floor. And unfortunately, a whipping post for anti-choice advocates.

The Affordable Care Act has survived at least one challenge by the Supreme Court. Now it is being challenged again — however it is a different court. How it survives remains to be seen. But I believe there is perhaps an even bigger question. President Clinton once stated that he wanted abortion to be safe, legal, and rare. Most Americans, in fact, agree. But perhaps the significance of this Supreme Court decision will be less about a specific medical procedure than the larger question — whether to affirm or deny the opportunity for equal rights for all. It will signal for our time how far it is that we have come toward a just society.

Lois Capps was the U.S. Representative for Santa Barbara’s 24th Congressional District from 1998 to 2017.