OPINION: Make America sick again? In California, GOP could pay a price

Jan. 21--The Planned Parenthood clinic in Bakersfield was busier than you might think, given that it was Martin Luther King Day. Veronica Sanchez, a 28-year-old stay-at-home mom, needed a shot of Depo-Provera. Angel Ford, a 26-year-old perfume saleswoman, needed a checkup and her regular doctor's office was closed.

Vanessa Rivera, 26, a nurse, needed a definitive pregnancy test and her only window was her lunch hour. Toeum Yun, a 39-year-old mother of four, and Alexis Harris, a 25-year-old grad student baby-sitting her toddler nephew, needed PAP tests and a doctor who took Medi-Cal.

"I started coming here because you can get free screenings," said 18-year-old Ashley Martin, a rail-thin bleached blond rummaging for a pack of Newports in her purse outside the big brown stucco medical building. "I was treated for gonorrhea here once. Careless partying. Wild nights."

Now she was back for a pregnancy test.

"He's an older guy. Better I guess than a younger guy. He'll be in the kid's life." She lit a cigarette and took a long drag, fingernails glinting with dark blue sparkly polish. "I'm not ready for it, though."

So it went Monday outside the most endangered health center in the congressional district of Republican House Majority Leader Kevin McCarthy, whose party's crusades against Planned Parenthood and Obamacare are on a collision course with millions of Californians just trying to manage their lives.

As if it isn't enough that the GOP Congress and the Trump administration have vowed to repeal the Affordable Care Act -- a plan that would disrupt or end health insurance for about 5 million people in this state, including hundreds of thousands in Republican districts -- they also have greased the skids for defunding the state's best known provider of women's reproductive health care. At some point, you have to wonder what kind of politician hassles this many people at their doctors' offices.

In red states, politicians might benefit from bashing Planned Parenthood's federal funding. But California isn't a red state. People like Planned Parenthood here.

Here, it's less anti-abortion rally backdrop than fallback gynecological clinic. About 850,000 Californians visited Planned Parenthood last year, including about 123,000 in Republican congressional districts. Mississippi has one Planned Parenthood center. Here, there are 115 locations. It's as ubiquitous as Costco.

More than nine in 10 patients come for something other than abortion: STD screenings, discounted contraception, ob-gyn checkups when nearby physicians won't take Medi-Cal patients.

Those services are what the federal funds pay for. Except in cases of rape, incest and life endangerment, federal taxpayer money by law can't be used for abortions -- though that procedure is actually rarer now than at any time in the 44 years since Roe v. Wade made it legal. Fewer than a million are performed each year nationally.

Even so, polls show Californians overwhelmingly support a woman's right to choose when and whether to have children. A 2015 Public Policy Institute of California survey showed 69 percent here say the government shouldn't interfere with a woman's access to abortion, including 62 percent of Republicans and 60 percent of Catholics.

Gov. Ronald Reagan signed the law legalizing abortion in California in 1967. Californians approved a state constitutional right to privacy in 1972. And Pete Wilson and Arnold Schwarzeneggger, the last two Republican governors, supported abortion rights.

So far, talk has been cheap for politicians who are social conservatives, or pay lip service in conservative districts. So much congressional grandstanding on abortion has gone on for so long with so little relevance to California that voters here don't tend to take right-wing talking points too literally.

And the young and poor women who make up the bulk of Planned Parenthood's caseload aren't the sort to keep an eagle eye on congressional voting records. Of more than a dozen women I spoke to outside the Bakersfield clinic, only one knew that McCarthy represented her in Congress, and she had no idea where he stood on the Medi-Cal she'd qualified for under the Affordable Care Act, or on Planned Parenthood.

But I can't help but wonder how long that will last if Obamacare is repealed and replaced with the snake oil that is widely anticipated, and a Planned Parenthood-sized hole is then blown into California's health care network. In a Bee op-ed, McCarthy said Republicans "plan to rescue people from Obamacare's imminent crash," and accused skeptics of "blaming a guy for removing a flat tire from his car when he's just about to put on a better one."

In other words, trust him, Speaker Paul Ryan, Senate Majority Leader Mitch McConnell, President Donald Trump, Tom Price and the other guys controlling health care policy in Washington.

But the Republicans' tax-credit-based plan, such as it is, sounds more like replacing that fixable car with half of a bus ticket. It's one thing to never have had insurance, or primary care, or a trustworthy place to go if you find a lump in your breast, or fear your teenager could get -- or might already be -- pregnant. It's something else again to have had both, and then have them gutted or taken away.

Will that matter politically? Maybe not in red states. But who'll get the blame in Republican-represented parts of California when all those constituents have to scramble for health care?

Imagine the community clinic, for example, that could suddenly accommodate even a fraction of the 12,044 patients who relied last year on the Redding and Chico Planned Parenthoods in Rep. Doug LaMalfa's district.

Or the 16,832 Planned Parenthood patients who were treated last year at the Fresno clinic and Visalia satellite in Rep. Devin Nunes' district.

Or the 10,206 who turned to the Roseville Planned Parenthood in Rep. Tom McClintock's district, in large measure because so few Placer County doctors accept Medi-Cal.

"Taxpayers who are morally opposed to abortion shouldn't be forced to fund organizations that perform them," Nunes said in a statement, expressing sentiments echoed by spokesmen for LaMalfa and McClintock. "Planned Parenthood's federal funds should be redirected to the many women's health services and organizations that don't perform abortions."

But a state association for community clinics has told Congress the existing network lacks the resources and staff to handle the overflow if Planned Parenthood significantly curtails operations. And that's not counting the chaos that will ensue with the repeal and ostensible replacement of Obamacare.

Outside the Bakersfield clinic -- which, for the record, doesn't offer abortions -- I ran some numbers. Kern and Tulare counties rank first and third in births to teenagers. Roughly half of the surrounding congressional district is on Medi-Cal and unemployment is about double the state average.

Kern County is second in the state in congenital syphilis and Chlamydia infections. Congenital. Think about that. Mothers pass it to their babies. Pollsters haven't yet figured out how to elicit infants' opinions about women's health issues. But if they could talk, I suspect they would support treatment for themselves and their mommies.

Just shy of 10,000 patients used the Bakersfield Planned Parenthood last year, not enough to much trouble McCarthy, whose spokesman didn't respond to a request for comment on defunding. But Republicans in other districts aren't so lucky.

Rep. Darrell Issa only held his Southern California seat by 1,621 votes in November; more than 9,600 patients would be ousted if Planned Parenthood closed in his district.

Rep. Jeff Denham hung on to his Modesto-area berth by 8,201 votes; more than 14,600 patients rely on his district's clinics.

Luckily for the GOP, many of these patients didn't bother to vote, if interviews in Bakersfield, Roseville, San Diego and elsewhere last weekend are any indication. But take away their insurance and backup health care, and there's no telling how many will discover civics.

Californians aren't known for getting political at the doctor's office. But come 2018, the 14 Republicans representing California in Congress might be busier defending themselves than they might think.

Shawn Hubler: 916-321-1646, @ShawnHubler

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