California health care workers who commit to providing abortions could see their student loans repaid and prospective abortion industry workers could receive scholarships, if lawmakers retain a $20 million proposal in the state’s new draft budget.

The proposal drew criticism from pro-life advocates who worry it creates terrible incentives.

Kathleen Domingo, executive director of the California Catholic Conference, called the proposal “a gross overreach of what most Californians would want our tax dollars to go to.”

“There aren’t a lot of providers who like to do abortions. Abortion is not something that medical students are excited to be a part of. We’ve known that,” she told CNA Jan. 18. “The reason why abortion is not provided in certain areas has nothing to do with laws or regulations. There’s no doctor in the area who wants to perform abortions. They don’t want to do it.”

The California budget summary section for Health and Human Services is 32 pages, with a section dedicated to “reproductive health.” Pro-abortion rights advocates consider abortion to be reproductive health, and abortion is addressed in this section.

“To protect the right to safe and accessible reproductive health care services, the Administration will undertake a number of actions to maintain and improve availability of these essential services,” the summary says, adding, “The Administration will work with the Legislature to reduce barriers to accessing abortion and abortion related services through managed care plans.”

The summary says $20 million in grant funding would go to the general fund of the Department of Health Care Access and Information “to provide scholarships and loan repayments to a variety of health care provider types that commit to providing reproductive health care services.” The goal of this funding is “to support California’s clinical infrastructure of reproductive health care services.”

Domingo was very critical of this proposal.

“This is appalling,” she said. “It's a big deal to pay off medical student loans.”

Students graduate medical school with what seems to be “crippling debt.” For Domingo, incentivizing them to go into the abortion industry is “tantamount to coercion from the state.”

“It’s wonderful to be helping medical students and health care professionals as they go through schools. Let’s figure out a way to do that that’s not handicapping anyone who doesn’t want to do abortion,” she said.

According to Domingo, this section of the California budget is directly related to the recommendations of the California Future of Abortion Council. In December 2020, the council released a 14-page report on policy proposals to respond to possible changes if the U.S. Supreme Court revisits Roe v. Wade and other precedents that mandate permissive abortion laws nationwide.

The council is made up of some 40 California organizations. Its members include seven Planned Parenthood affiliates, three regional ACLU affiliates, and the Office of Gov. Gavin Newsom. Newsom has pledged to make California a “sanctuary” for abortion access, while State Sen. President Pro Tempore Toni Atkins, D-San Diego, wrote a letter introducing the council’s December report and voicing gratitude for a partnership with the council.

The council advocated that lawmakers should “improve the education pipeline by creating a California Reproductive Scholarship Corps” for those who train as physicians, nurse practitioners, certified nurse-midwives, physician assistants, and others, if they are “dedicated to providing abortion care in underserved areas in California.” These specified medical professionals, if properly licensed, may all perform abortions under state law.

According to the abortion council, lawmakers should also “optimize loan repayment to increase retention and recruitment of clinicians who provide abortion by allocating funds for health care workforce programs.”

Domingo said that these proposals are part of the initial budget, not necessarily the final budget scheduled for May.

“There’s still a lot of work to be done. It’s our job now to advocate that it not include those things, to raise awareness and say ‘This is not a good use of California tax dollars. This is not what Californians want to be paying for’,” she said. “I’m sure many adjustments will be done along the way.”

While the state legislature has a Democratic supermajority and Newsom has made strong commitments to expanded abortion access, Domingo said there are many moderates and others in the legislature “who might look at some of these things and say it is going way too far.”

“In terms of advocacy, it’s very important to make our voice heard,” she said, encouraging grassroots involvement to voice opposition to the proposal.

Californians also need to know about resources that are “life-affirming for women in need.”

“There are so many things that can be done to help people on the ground,” said Domingo. “We would really like to make California a place where women know that they are supported, that children and families are supported all the time.”

“We want to prove that we don’t need abortion expansion in California,” she said. In her view, California should aspire to be a place that “respects women, welcomes children, and protects families.”

The proposed budget would also remove requirements for follow-up visits and ultrasound for chemical abortions that currently apply under MediCal, the state’s Medicaid program for low-income individuals. Backers of abortion have stressed the importance of flexibility in medication abortion given the limits of the coronavirus pandemic.

Last week the California Catholic Conference criticized this aspect of the budget and other efforts to expand abortion access.

“The California Catholic Conference is disappointed and is actively advocating against the Governor’s planned $61 million in additional funding for abortion facilities based on the recommendations of the California Future of Abortion Council report,” the conference said Jan. 14.

Other budget proposals include $20 million in one-time funding for the state’s Department of Health Care Access and Information “to assist reproductive health care facilities in securing their physical and information technology infrastructure and to enhance facility security.” Still another $20 million would back the Covered California state health insurance marketplace’s one-dollar health care premium subsidy due to federal policy limiting abortion coverage.

While Domingo praised efforts to expand health care access, she said that MediCal gives full coverage of abortion and contraception, gender reassignment surgery, and assisted suicide.

“They’re funding all the really good stuff but also the really bad stuff,” she said.

Many in the immigrant community do not want this, according to Domingo.

“We’re in a situation where, particularly immigrant families, are appalled that their children, who now can qualify for MediCal, have access to all kinds of things they would never want their children to access.”

In California’s political context, the drive to expand health care access not only means expanding access to abortion, but also assisted suicide. California lawmakers last year passed a bill to reduce the waiting period for assisted suicide from 15 days to 48 hours and to eliminate a final attestation form, among other changes.

“They’re removing that mental health safeguard for the end-of-life,” Domingo said. She warned that this further reduces efforts to prevent coercion and to give time for additional intervention for those seeking assisted suicide.