It’s a bad look when Robert F. Kennedy Jr. is ahead of you on scientifically sound health policy — women’s health, to make matters worse — but that’s exactly what happened to Gov. Gavin Newsom last week.

Ouch.

In a Cabinet meeting, Kennedy went on a six-minute-plus grovel to Trump. That’s pretty standard for these increasingly weird meetings, but the secretary of Health and Human Services specifically praised the president for ending a “20-year war on women by removing the black box warnings from hormone replacement therapy.”

As much as it shocks me to say it, RFK Jr. has a reasonable point.

A couple of days later, appearing onstage at the New York Times’ DealBook Summit, Oscar-winning actor Halle Berry took an unexpected and harsh shot at Newsom for vetoing a bill on menopause treatment.

“But that’s OK,” she said of Newsom killing the Menopause Care Equity Act (AB 432), which she had lobbied to pass and which had strong bipartisan support in the Legislature.

“Because he’s not going to be governor forever, and with the way he has overlooked women, half the population, by devaluing us in midlife, he probably should not be our next president either,” Berry said. “Just saying.”

The two events show just how complicated and controversial menopause care has become in the past few years, as women not only talk about it more openly, but demand care that for, well, basically always, has been denied or denigrated as unnecessary.

Looking a bit deeper, this seemingly out-of-the-blue menopause moment gets to the heart of an insurance problem that, male or female, most Americans have an opinion on: How much power should insurance companies have to deny care that a doctor deems reasonable?

To keep it simple, menopause is a phase that all women go through when their fertility ends, meaning 50% of the population deals with it. It has specific and life-altering symptoms — most of which can be treated, but often aren’t because many doctors aren’t trained in menopause care (or perimenopause, which comes first), and the science is too-often overlooked or misunderstood.

The result is that way too many women stumble through menopause not understanding what is happening to them, or that there are excellent, scientifically backed treatments to help.

A prime example of that is the “black box” warning that has been on many hormone replacement drugs since the turn of the millennium, when one large but flawed study found that such drugs might increase the risk of cancer or other diseases.

A black box warning is the most serious caution the Food and Drug Administration can put on a medication, and its inclusion on hormone replacement theory, or HRT, put a severe chill on its use.

Twenty years of subsequent research not only revealed the flaws in that first analysis, but also showed significant benefits from HRT. It can protect against cognitive decline, decrease heart disease and alleviate symptoms such as hot flashes, among many other benefits.

In early November, the FDA removed those warnings from many HRT drugs. The result will likely be greater access for more women as doctors lose a hesitancy to prescribe them, and women lose fear of using them.

“The misconceptions around the risks have been overblown for decades, fringing on dogma over real science and have led to population-level missed opportunities for life improvements for our aging women of the developed world,” wrote Michael Rodgers, chairman of the Santa Clara County Health Advisory Commission, on a public comment about the change.

While Rodgers is right, insurance coverage and doctor know-how remain problems for women seeking care — ones that the Menopause Care Equity Act hoped to address.

The bill would have required private insurance companies to cover FDA-approved menopause treatments and rewarded doctors who took voluntarily continuous education classes on menopause topics. That final version had already been watered down from earlier proposals that would have mandated coverage of even more treatment options (such as non-FDA approved compounded hormones) and made menopause training required for doctors.

But Newsom seemed to take issue with a part of the bill that banned insurance companies from applying “utilization management” to menopause treatments — and here’s where we get back to agreeing with RFK Jr.

Utilization management, or UM, is basically when insurance companies get to decide what a patient needs and what they don’t — the pre-approvals, the reviews and the denials, which all too often seem to be far more about cost than care.

Now artificial intelligence is getting in on the utilization management business, potentially meaning it’s not even a human deciding our treatments. UM is a multibillion-dollar industry that, under the premise of keeping healthcare affordable, too often does so by denying care.

Which is why Assemblymember Rebecca Bauer-Kahan (D-Orinda), the author of the California bill, put in a prohibition against UM.

“The standard is ‘medically necessary‘” when it comes to insurance coverage, Bauer-Kahan points out.

“When you talk about menopause, that’s a really fuzzy term, right? I mean, I will survive in the short term without any treatment,” she said. “So what is ‘medically necessary’ is this very vague thing when it comes to menopausal care.”

In his veto message, Newsom said the UM prohibition “would limit the ability of health plans to engage in practices that have been shown to ensure appropriate care while limiting unnecessary costs.”

But the truth, and problem, with menopause care is that it is specific to the individual woman. Like birth control pills, a treatment that works for one woman might cause side effects for another. There is often a lot of trial and error to find the right path through menopause, and women need to be able to have the freedom and flexibility to work one-on-one with their doctor. Without interference.

In June, Kennedy called out prior authorization across the healthcare industry as a problem, and announced shortly after that he had received a pledge from many large insurance companies to reform that process by 2026, removing the need for prior authorization from many treatments and procedures and streamlining the process overall.

If that reform comes to pass, it will indeed be terrific — I am hopeful — but also, let’s wait and see. Those changes are supposed to begin in January.

Back in California, Newsom has also pledged to do something about menopause coverage in January, when he announces his budget proposal. In his veto message, Newsom said he would go this route — adding it into his budget package — rather than work on a new bill in the regular legislative session. This remains the plan, though no details are yet available.

Apparently, someone forget to mention it to Berry.

The budget has increasingly become a catch-all for legislation the governor wants to get done with less fuss because the budget and its trailer bills always pass at some point, and it can be an easier route for him to control.

Newsom has made it a core part of his policies, and his presidential campaign, to be a backer of women’s rights, especially around reproductive care — and equity for women is a cause championed by his wife, First Partner Jennifer Siebel Newsom.

But the governor also has long been hesitant to pass legislation that has costs attached (the menopause bill could raise individual premiums by less than 50 cents a month for most private-pay consumers). With federal cuts, increasing premiums and the generalized hot mess of healthcare, his caution is not unwarranted.

But also, in this case, maybe it is misguided. The only real opposition to the California bill came from insurance companies. Go figure.

Bauer-Kahan said she has been in touch with the governor’s office, but remains committed to pursuing a law that limits utilization management.

“I am happy to hear that we are going to hopefully achieve this, but it needs to be achieved in a way that actually meaningfully makes a difference for getting the menopausal care women need,” she said.

Newsom’s October veto made barely a ripple. Thanks to Berry’s punch, his January proposal will be not just noticed, but scrutinized.

If he does eliminate the restrictions on UM, he’ll need to answer the broader question that action would raise — how much power should insurance companies have to override the decisions of doctors and patients?

It would be strange days if January saw Kennedy and his chaotic and questionable Department of Health and Human Services offering better healthcare options for women than the state of California.

And stranger still if Newsom puts a price tag on the well-being of women.

A key committee of the U.S. Centers for Disease Control and Prevention voted Thursday to alter its recommendation on an early childhood vaccine, after a discussion that at times pitted vaccine skeptics against the CDC’s own data.

After an 8-3 vote with one abstention, the CDC’s Advisory Committee on Immunization Practices will no longer recommend that children under the age of 4 receive a single-shot vaccine for mumps, measles, rubella and varicella (better known as chicken pox).

Instead, the CDC will recommend that children ages 12 to 15 months receive two separate shots at the same time: one for mumps, measles and rubella, or MMR, and one for varicella.

On Friday morning, the group decided unanimously to table an anticipated vote on changes to the hepatitis B vaccination schedule, after vaccine skeptics installed on the committee raised concerns that a proposal to delay the first dose by a month didn’t go far enough.

ACIP member Vicky Pebsworth, a nurse who serves as research director for the National Vaccine Information Center, an organization long criticized for promoting inaccurate vaccine information, challenged the previous day’s presentation by CDC staff on the vaccine’s safety.

She criticized the CDC for glossing over side effects such as fever, sleepiness and fussiness.

“These are not trivial reactions,” Pebsworth said. “I personally think we should be erring on the side of caution and adopt a more prudent vaccination policy.”

The group is slated to vote later Friday on changes to the COVID-19 vaccine.

The MMRV vote represents a relatively small change to current immunization practices. But doctors said the lack of expertise and vaccine skepticism on display during much of the discussion would only further dilute public trust in science and public health guidance.

“I think the primary goal of this meeting has already happened, and that was to sow distrust and instill fear among parents and families,” Dr. Sean O’Leary, chair of American Academy of Pediatrics’ Committee on Infectious Diseases, said Thursday during a news conference over Zoom.

“What we saw today at the meeting was really not a good-faith effort to craft immunization policy in the best interest of Americans. It was, frankly, an alarming attempt to undermine one of the most successful public health systems in the world,” O’Leary said. “This idea that our current vaccine policies are broken or need a radical overhaul is simply false.”

Giving the MMR and chickenpox vaccines in the same shot has been associated with a higher relative risk of brief seizures from high fevers in the days after vaccination for children under 4 — 8 in 10,000 children typically have febrile seizures after receiving the combination shot, compared with 4 in 10,000 who receive separate MMR and chickenpox shots at the same time.

Distressing as they are for family members to witness, seizures are a relatively common side effect for high fevers in young children and have not been associated with any long-term consequences, said Dr. Cody Meissner, a former pediatric infectious diseases chief at Tufts-New England Medical Center who is serving on ACIP for the second time (he previously served under Presidents George W. Bush and Obama).

The problem with splitting vaccines into multiple shots is that it typically leads to lower vaccine compliance, Meissner said. And the risks of not vaccinating are real.

“We are looking at a risk-benefit of febrile seizures … as compared to falling below a 95% coverage rate for herd immunity, and the consequences of that are devastating, with pregnant women losing their babies, newborns dying and having congenital rubella syndromes,” said Dr. Joseph Hibbeln, a psychiatrist and neuroscientist and another current ACIP member.

Meissner, Hibbeln and Hilary Blackburn were the only three members to vote against the change.

The first day of the meeting ended with a vote regarding continued coverage of the MMRV shot under the CDC’s Vaccines for Children Program, a publicly funded service that provides immunizations to nearly half of the nation’s children. The program currently only covers shots that ACIP recommends.

As chair Martin Kulldorff called the vote, several committee members complained that they did not understand the proposal as it was written. Three abstained from the vote.

As the meeting broke up, members could be heard trying to clarify with one another what they had just voted for. The group recast the vote Friday, and elected to align VFC coverage with their recommendation. The combined shot will no longer be covered by the public program.

The committee spent much of its first day debating whether to delay the first dose of the hepatitis B vaccine, a shot typically given at birth, until the child is 1 month old. They will vote on the proposal Friday.

The medical reason for altering the hepatitis B schedule was less clear.

“What is the problem we’re addressing with the hepatitis B discussion? As far as I know, there hasn’t been a spate of adverse outcomes,” said pediatrician Dr. Amy Middleman, one of several people to raise the point during the discussion and public comment period.

Committee member Dr. Robert Malone replied that changing the recommendation for when children should get vaccinated for hepatitis B would improve Americans’ trust in public health messaging.

“A significant population of the United States has significant concerns about vaccine policy and about vaccine mandates, [particularly] the immediate provision of this vaccine at the time of birth,” Malone said. The issue, he said, “is not one of safety, but one of trust.”

Hepatitis B is often asymptomatic, and half of infected people don’t know they have it, according to the CDC. Up to 85% of babies born to infected mothers become infected themselves, and the risk of long-term hazards from the disease is higher the earlier the infection is acquired.

Infants infected with the hepatitis B virus in the first year of life have a 90% chance of developing chronic disease, and 25% of those who do will die from it, according to the the American Academy of Pediatrics.

Since the vaccine was introduced in 1991, infant hepatitis B infections have dropped by 95% in the U.S. Nearly 14,000 children acquired hepatitis B infections from 1990 to 2002, according to the CDC; today, new annual infections in children are close to zero.

This week’s two-day meeting is the second time the committee has met since Kennedy fired all 17 previous ACIP members in June, in what he described as a “clean sweep [that] is necessary to reestablish public confidence in vaccine science.”

The next day, he named seven new members to the committee, and added the last five earlier this week. The new members include doctors with relevant experience in pediatrics, immunology and public health, as well as several people who have been outspoken vaccine skeptics or been criticized for spreading medical misinformation.

They include Pebsworth, whose organization has a long history of sharing inaccurate and misleading information about vaccines, and Malone, a vaccinologist who contributed to early mRNA research but has since made a number of false and discredited assertions about flu and COVID-19 shots.

In some cases, the new ACIP members also lack medical or public health experience of any kind. Retsef Levi, for example, is a professor of operations management at MIT with no biomedical or clinical degree who has nonetheless been an outspoken critic of vaccines.

“Appointing members of anti-vaccine groups to policy-setting committees at the CDC and FDA elevates them from the fringe to the mainstream. They are not just at the table, which would be bad enough; they are in charge,” said Seth Kalichman, a University of Connecticut psychologist who has studied the vaccine information center’s role in spreading vaccine misinformation. “It’s a worst-case scenario.”

Though ACIP holds three public meetings per year, it typically works year-round, said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and a former ACIP member in the early 2000s.

New recommendations to the vaccine schedule are typically written before ACIP meetings in consultation with expert working groups that advise committee members year-round, Offit said. But in August, medical groups including the American Medical Assn., the American Academy of Pediatrics and the Infectious Diseases Society of America were told they were no longer invited to review scientific evidence and advise the committee in advance of the meeting.

That same month, Kennedy fired CDC Director Susan Monarez — who had been appointed to the position by President Trump and confirmed by the Senate. On Wednesday, Monarez told a Senate committee that Kennedy fired her in part because she refused to sign off on changes he planned to make to the vaccine schedule this month without seeing scientific evidence for them.

She did not specify during the hearing what those changes would be.

The ACIP’s recommendations become official only after the CDC director approves them. With Monarez out, that responsibility now goes to Health and Human Services Deputy Secretary Jim O’Neill, who is serving as the CDC’s acting director.

Asked by reporters Wednesday whether the U.S. public should trust any changes the ACIP recommends to the childhood immunization schedule, Sen. Bill Cassidy (R–La.) was blunt: “No.”

Cassidy chairs the Senate committee that oversees the Department of Health and Human Services, and cast the deciding vote for Kennedy’s nomination. Before running for office, Cassidy, a doctor and liver specialist, created a public-private partnership providing no-cost hepatitis B vaccinations for 36,000 Louisiana children.

He cast his vote after Kennedy privately pledged to Cassidy that he would maintain the CDC immunization schedule.

As public trust in the integrity of CDC guidelines wobbles, alternative sources for information have stepped up. Earlier this year, the American Academy of Pediatrics announced that it would publish its own evidence-based vaccination schedule that differs from the CDC’s on flu and COVID shots. And on Wednesday, Gov. Gavin Newsom signed a law giving California the power to establish its own immunization schedule, the same day the state partnered with Oregon and Washington to issue joint recommendations for COVID-19, flu and RSV vaccines.

On Tuesday, an association representing many U.S. health insurers announced that its members would continue to cover all vaccines recommended by the previous ACIP — regardless of what happened at Thursday’s meeting — through the end of 2026.

“While health plans continue to operate in an environment shaped by federal and state laws, as well as program and customer requirements, the evidence-based approach to coverage of immunizations will remain consistent,” America’s Health Insurance Plans said in a statement. The group includes major insurers Aetna, Humana, Kaiser Permanente, Cigna and several Blue Cross and Blue Shield groups. UnitedHealthcare, the nation’s largest insurer, is not a member.

It’s unclear what will be covered after 2026.

After the Eaton and Palisades fires ripped through Los Angeles County, the vast majority of residents in and around the burn scars were concerned about the hazardous compounds from the smoke and ash lingering in their homes, water and soil, according to a new survey published Tuesday. Yet many felt they lacked the support to move back safely.

While more than 8 in 10 residents hoped to test their properties for contamination, only half of them could. And as fire survivors searched for information to protect their health, many distrusted the often conflicting messages from media, public health officials, academics and politicians.

Researchers studying post-fire environmental health as part of the university consortium Community Action Project LA surveyed over 1,200 residents around the Eaton and Palisades burn scars from April through June, including those with destroyed homes, standing homes in the burn area and homes downwind of the fires.

Eaton and Palisades fire survivors said the lasting damage to their soil, air and water caused anxiety, stress, or depression. On average, survivors in the Eaton burn area — which has more significant environmental contamination — worried more than those in the Palisades.

An independent survey conducted for the L.A. fire recovery nonprofit Department of Angels in June found that the environment — including debris removal and contamination — was the most pressing issue for people who moved back home and those still displaced, more than construction costs, insurance reimbursements or a lack of strong government leadership.

Soil was the biggest worry for Eaton-area respondents in the Community Action Project survey. The team had just started collecting responses in April when the Los Angeles County Department of Public Health announced the first comprehensive soil testing results for the burn scars.

About a third of samples taken within the fire perimeter and nearly half downwind had lead levels above the state’s stringent health standards, designed to protect the most vulnerable kids playing in the dirt. Scientists attribute this lead to the Eaton fire, and not other urban contamination because samples taken in a nearby area unaffected by the fire had far lower lead levels.

The county sampling came after The Times reported in February that the U.S. Army Corps of Engineers would break precedent and forgo soil testing and remediation in its cleanup efforts.

Three quarters of Eaton fire survivors and over two thirds of Palisades fire survivors expressed worry over the air in their homes. Through private testing, many in both burn areas have found contaminants on surfaces in their home, including lead — which can cause brain damage and lead to developmental and behavioral issues in kids — as well as arsenic and asbestos, known carcinogens.

Around the start of the survey period, two groups independently found widespread lead contamination on surfaces inside homes that were left standing — some exceeding 100 times the level the Environmental Protection Agency considers hazardous.

The majority of survivors also felt distress over the safety of their drinking water, although to a lesser extent. Water utilities in both burn areas found small amounts of benzene — which can be a product of the incomplete combustion of vegetation and wood, and a carcinogen — in their drinking water systems.

But, thanks to a fire-tested playbook created by researchers like Whelton and adopted by the California State Water Resources Control Board, utilities were quick to begin the formidable undertaking of repressurizing their damaged systems, testing for contamination and flushing them out.

All of the affected utilities had quickly implemented “do not drink” and “do not boil” water orders following the fires. The benzene levels they ultimately found paled in comparison to blazes like the Tubbs fire in Santa Rose and the Camp fire in Paradise.

The last utility to restore safe drinking water did so in May. Around the same time, independent scientists verified the utilities’ conclusion that the drinking water was safe.

As researchers neared the end of collecting survey responses, L.A. County Department of Public Health launched a free soil testing program for residents in and downwind of the Eaton burn area. By the start of September, the County had shared results from over 1,500 properties.

Yet, residents in the Palisades hoping to test their soil, and residents in both burn scars looking for reassurance the insides of their homes are safe, have generally had to find qualified testing services on their own and either pay for it themselves or battle with their insurance companies.

The survey also found that, amid conflicting recommendations and levels of alarm coming from the government, media and researchers, Palisades fire survivors trusted their local elected officials most. For many living in the foothills of the Santa Monica Mountains, L.A. City Councilmember Traci Park has become the face of recovery.

Survivors in the Altadena area — which has no city government because it is an unincorporated area — turned to academics and universities for guidance. They’ve had a lot of contact with researchers because the Community Action Project LA, which conducted the survey, routinely meets with residents in both fire areas to understand and address the health risks homeowners face. Other post-fire research efforts, including from USC and Harvard University, have done the same.

Social media and the national news media ranked lowest in trust.