 Welcome you all to the 40th anniversary brunch for the Roe v. Wade decision, 40th anniversary of Roe v. Wade. There's an interesting article in January 14th Time Magazine and I made a few copies over there and you can don't take my copy of the magazine please. And there's a lot of stuff in there, you've seen the map so there are lots of states with one provider. He or she flies in, they don't have hospital privileges. The state's trying to shut down Planned Parenthood. So they have all these ways of just reducing the clinic's ability to function, making them have five foot wide doorways like they're a hospital facility. So in the time article it says that there were 600 and some bills, I think our speaker Philida Burlingame told us this from the ACLU, over 600 bills introduced across the United States to try and shut down and limit women's access and 92 of them passed in the states last year. So that's just more ratcheting down of access for women. There were in 1982, 2908 providers of abortion physicians. There are in 2008 there were 1793. Not one of our speakers later is training doctors over in San Jose to be providers. And the other just a little tidbit, you all remember during the election that Todd Aiken from Missouri made this unfortunate mistake from his standpoint of saying that legitimate rape the body could shut this down. So he was defeated by a Democrat but that Democrat is a pro-life Democrat who thinks abortion should only be legal in case of rape, incest or the life of the mother. So it's not over till it's over. So we're going to, the next thing we're going to do now is Congressman Farr couldn't be here but he has an aide Kristen Peterson from his office who has something that Sam read into the congressional record yesterday. So come on up Kristen. Good morning. It's my pleasure to be here today on behalf of Congressman Sam Farr who feels strongly about a woman's right to choose. He regrets that he cannot attend today as he is in Washington. However on Friday the 18th the congressman presented a congressional record on the floor of the House of Representatives and it reads in part. Those of us who believe that a woman can make their own choices about their bodies take heart in knowing that Roe v. Wade is still the law of the land 40 years after the Supreme Court's historical decision. On behalf of congressman Sam Farr and the United States Congress we thank all of you for all of the work that you do in continuing to ensure a woman's right to choose. Sam has been a really good friend to women and reproductive choice. I'm going to turn the program over to Cynthia Matthews, council member Cynthia Matthews, former public affairs director and founder, founding member, one of the original founders of Planned Parenthood here in Santa Cruz where she was only under 20 so those of you who are younger get moving. And I want to say to all the people standing across back I am looking at eight visible seats right up here so I'm not going to have any sympathy that there aren't any chairs back there for you so come and have a seat up front. This is I think with the 40th anniversary of Roe v. Wade it's one of those you know even zero-digit anniversaries that really makes you stand back and say let's take stock of what's happened. So there's certainly that and at a time like this we can see what that landmark decision meant in terms of really establishing a core principle but we also as we reflect back can see how much remains for that to be achieved. And also just coming out of the recent election so much was at stake Carol mentioned one candidate's unfortunate remarks but there was a clear division and now that the election is over we know the Affordable Care Act is moving forward. We know that a clearly pro-choice president will be in charge of judicial appointments and executive orders and setting direction for so much at the federal level. It gives us a lot of promise. We can see the opportunities that are ahead so we thought this program what we do is kind of go from macro to micro. So our first speaker is going to talk at the federal level and state level about taking stock and what we're looking at. Then we're going to hear from someone at the county level about what we're doing to expand access to care and how Santa Cruz County has a unique record and then we'll hear from a couple of our individual local safety net providers. So that's kind of the framework for this morning. It's a little bit different than some of our past programs. So our first speaker is Lupe Rodriguez. Lupe is the director of public affairs at Planned Parenthood Marmonte and she has an amazing record. I'm just going to take a minute to give you an idea of her career and her commitment to this issue. Prior to coming to Planned Parenthood she was program and policy director at Access Women's Health Justice and in this role she served as the Northern California coordinator for a national organization raising women's voices which is a collaborative for health care reform. She's an alumnus of the Women's Policy Institute, an advocacy training program sponsored by the Women's Foundation of California. She's also a member of the National Women's Health Leadership Network, a reproductive justice advisory group. She recently served on the board of directors of the California Family Health Council. This is a busy gal. She's a member of the Human Rights Commission in the city of San Jose and the Santa Clara County Commission on the Status of Women. She currently sits on the boards of California Latinas for reproductive justice and Access Women's Health Justice. In 2010 she was honored with the Generation Award for an emerging leader from the California Coalition for Reproductive Freedom. And I think you can see by this resume, and I'm sure there's a lot more, both her achievement in this field, her dedication and also the trend of looking at reproductive choice at reproductive justice in a bigger frame. We're focused on this day and this anniversary because of abortion rights but we see it in a much bigger frame these days. So, Lupi, where are you? Thank you. Thank you. I can hear myself echo. Thank you so much and good afternoon or good morning still. As was mentioned, I'm Lupe Rodríguez and I am the director of public affairs for Planned Parenthood, Marmonte. And in my role I work in several areas. I'm the representative from public affairs for our coast region, so here in Santa Cruz all the way down to Monterey County. But I also work in San Jose, in San Mateo County and Alameda County. So I have a kind of wide perspective of the work that we do. So I'll start today. As was mentioned, I'm here to talk about sort of the larger picture, the national picture. And I'll also actually talk a little bit about the state, our state and where we have challenges in this state as well in terms of access to reproductive health services. But I'll start off first by just talking a little bit about the organization that I work for, or I should say the organizations that I work for. So as many of you know, Planned Parenthood Marmonte is our service organization. It's the largest Planned Parenthood affiliate in the country. We have like 35 health centers throughout the state of California, Northern Nevada. And we serve over 250,000 patients a year. So we're a really large operation. And not only do we have services, but we also provide education work. So we have a very robust education system or program that provides services for pregnant and parenting teens. We have a really successful program called the Teen Success Program, which helps young women who are pregnant or parenting get through high school, maintain their family size and basically succeed in the future. And then we also have an advocacy program, which I work on. And through our advocacy program, we have a sister organization called Planned Parenthood Advocates Marmonte. And that organization helps with or through that organization, we're able to do political work. We're able to do candidate endorsements and independent expenditures for candidates. And we're able to do a lot more of the sort of vision of promoting elected officials and helping elected officials who support our work. And not only that, support reproductive justice generally, who support progressive issues and progressive movements for our communities. So that's a little bit of what I do. And that's from where I'll bring a lot of this information from the national perspective. Just for legal purposes, I'll be talking with my Planned Parenthood Advocates Marmonte had on, because I might be talking about specific candidates. So again, I want to start off with just giving an overview of abortion today. As we know with the Roe vs. Wade decision and 40 years ago, the country changed a lot. And it had a dramatic impact on the health and well-being of American women. And certainly abortion is now safer. We have access to health centers that are able to provide the care in the most, well, in many cases, in the best conditions. And they're able to provide care that's front-line medical care. And so the decision had a really great impact in making this important medical care accessible for women. However, as was mentioned, today in 2013, we have some of the worst access to care since that decision. We have some of the most barriers to care for women throughout the country than we've ever had before. And this, in part, is because of a number of state-level abortion restrictions that have been enacted in the past couple of years. It's actually been, in these past couple of years, as was mentioned, in 2011, there were over 900 provisions against reproductive health care that were put forth in various states throughout the country. And 92 of which were restrictions on abortion access specifically, which took effect. And in 2012, it was the second highest number of restrictions ever introduced with 43 restrictions that went into effect and are now the law of the land in a lot of states across the country. And one other stark note that we've seen is that more than half of all US women of reproductive age now live in a state that is hostile to abortion care, that is hostile to access to abortion. And whereas fewer than one third of those, a decade ago, less than a third of women lived in a state like that. So now more than half live in a state that's hostile to abortion care. I mean, that just shows that we've come a long way and a lot of different ways, but certainly not in access to abortion care and reproductive health care generally. But, you know, again, just to paint a picture of what's going on, and I think this is a statistic that's been heard a lot that about, you know, by age 45, about half of American women will have an unintended pregnancy. So that's, you know, something that's been known for a while, and it maintains at that level. So about half of women will have an unintended pregnancy. And nearly one in three of those who have an unintended pregnancy will have an abortion. So it's still, you know, a high percentage of folks who have an unintended pregnancy. And what we know about women who have abortions is, you know, that the sort of general stereotype that's presented is not true. One in six in 10 of these women who have abortions already have children. They have families. They, you know, they already have children. They're not the young women that are presented to us in the media. And 88% of them have their abortion the first 12 weeks of pregnancy. So I think in terms of some of the things that have sort of helped with access, it is important to note that women are having abortions earlier in their pregnancy when it's generally safer and when there's more access to it. So that's good to know, but still, you know, we face these barriers. I think something else that's important to note about the sort of trends in abortion now are that abortion in the US has really become concentrated among lower income women. For example, 42% of women having abortions are underneath the federal poverty line right now. So those are women who live, you know, unlike $20,000 a year for a family of four. And then, I mean, it's further show the reasons why some of this is happening is because unintended pregnancy rates amongst poor women have increased since the 1970s. And whereas the rates for higher income women have decreased since the 1970s. And compared to higher income women, lower income women have unintended pregnancies and abortions about five times more. So they're five times more likely to have an unintended pregnancy. And this is because there are huge inequities and disparities in our healthcare system that keep lower income women from having access to general health care. You know, lower income women are less likely to have health coverage, first of all. And then secondly, less likely to have somewhere to go. So even women who have coverage through some of the programs that we have, as was mentioned by Carol, you know, in California we have some great programs, some great public programs that help people get health care. But that doesn't mean that they can find a provider that will, you know, give them the care that they need. It's just, it's really hard, speaking from, you know, that perspective of a provider, it's really hard to provide services for lower income people when you don't get adequate reimbursement for services. And I'll talk a little bit more about how that's creating barriers in our own state, in the state that, you know, as we mentioned, has really great laws, really progressive laws on these issues. But we still see a lot of problems in this state. And then, well, and feeding into that, you know, one of the things that's been shown about lack of access is that, and one of the ways that a lot of the anti-choice movement has made it difficult for women to access care is in the way that it's paid for. As we know, right after we had the Roe vs. Wade decision in 1973, in 1976, there was this amendment to the Appropriations Bill that was called the Hyde Amendment that came into effect. And as many of you know, that makes it so that the federal government can't spend, or can't, you know, help pay for abortion in this country. And unless, you know, in the cases of rape incest, the health of the mother. And so what that means is that if a state doesn't choose to spend its own money on, you know, including that in the package of services that a person can receive when they have a state healthcare program, then it's not covered at all. And people have to pay for it out of pocket. And one of the things to know is that the average cost of an abortion in 2008, it was estimated, is $580. I mean, for somebody who's making, you know, $20,000 a year with a family of four, $500 is an incredible amount of money. And so, you know, that has been a huge barrier for women throughout, you know, the last, what is it, 37 years that we've had the, you know, legal right to abortion in this country. So that's, I think, one of the important barriers to the note. And then, and this is where I'll sort of segue into talking about sort of all of the different restrictions that have come into effect, there are innumerable other barriers to abortion access that have come into effect. Things like, you know, biased counseling, which is when, you know, many states have these laws where their own doctor has to give women this incredibly faulty advice or not advice, but just information, quote, information that's like, you know, that abortion causes breast cancer or really egregiously, egregious misinformation about the procedure to, you know, counsel them out of, you know, the decision that they've made. There's also states that have insurance bans. So, you know, not only do we keep lower income women from accessing care by not, you know, by sort of pricing them out or not covering this care for them, but we all, we're also doing it in a lot of states to people who have private insurance, who have insurance through their employers by allowing employers to say, oh, we're not going to cover that because we don't want to. We don't believe in it or not even just don't believe in it, but simply that they don't want to. We also have things like waiting periods where women have to wait 24 to 72 hours to once they've decided, you know, that they want to move forward with having an abortion, they still have to wait 24 to 72 hours before they can get the procedure. And for many women who, you know, the other point is that many women have to travel really far to get the care that they need. I mean, for women who have to travel five hours to get to where they need to go to get this procedure, having to wait 72 hours before they're able to do it is incredible. I mean, it just creates so many barriers that are sometimes insurmountable for people and then there are the unnecessary ultrasounds in intimidation. It's making people listen to like a fake heartbeat that's in an ultrasound, making people look at an ultrasound and then the parental consent requirements. In many states, teens, young women have to either alert their parents that they're having an abortion or get their consent. And for many young women, many teens for whom, you know, who live in situations of violence or of other types of intimidation from their families. I mean, that that keeps them away from this care. And I can talk. I'll talk a little bit about how in California, some of these fights against that kind of proposal have really, you know, set us back. So as I mentioned, you know, in 2012, there were 40, so not as many as last year, not the 92 provisions that went into effect last year. But this year, or in 2012, there were 43 new provisions in 19 states. So, you know, still really high number of provisions going into effect to take away our rights. And most of the new restrictions enacted in 2012, concerned limits on later abortion, coverage in health insurance exchanges. So what I was mentioning about keeping more than just lower income women from getting this care and issues of, like as was mentioned by Carol, you know, taking away or making it more difficult for providers to be able to provide the care by putting these onerous requirements on them. So first of all, there's one provision called the targeted regulation of abortion providers called TRAP, which in 2012, Arizona, Michigan, and Virginia took steps to establish more stringent regulations. So basically making it so that health centers have to have, you know, hallways that are larger so that have to, you know, reconstruct their whole health center clinic to be able to be a surgical center to put that kind of thing into effect if they need, if they want to provide services, to requiring that providers have, like, easy hospital admittance to an emergency center, even if that emergency center is far away. And even if they don't provide the type of surgical procedure or surgical abortion procedure, that would require that in these states, they're putting that into effect. And then other things about, like, later abortion, they are in Arizona, Georgia, and Louisiana, they enacted measures to basically say that fetal viability starts at 19 weeks, and that procedures can only be done until then. I mean, in many of these states, there are only, like, two providers for the entire state. And when you reduce the time that those providers are able to provide this service, then, obviously, people are going to be left out. And one of the questions that always comes up about why that's so important, why that sort of limitation on the gestational age is so important, is because one of the things that we know from experience here in California is that women don't always know that they're pregnant. I mean, many do, but a lot of the reason why women have late-term abortions is because they're young women, we see that a lot, because they may not know that they're pregnant or they may not have made the decision. And then, furthermore, when I was talking about the money issue, if you have to pay $500 and you have maybe $10 a week that you can put away for this, you have to save up for weeks, for months even. And that delays your ability to get this procedure. That makes it so that you have to go into the 20-week range. And so this is really important. It might seem for a lot of people that, well, why are people having abortions at that late gestation? But I mean, that's part of the issue, the money issue. If they have to save up for this or they don't know they're pregnant or they have other conditions that keep them from being able to make this decision and getting the care they need, then they're left out. And then, furthermore, the fact that because of these new restrictions, there are less and less providers is really, really important to note. And then something else that has come into effect. So as I mentioned, a lot of the restrictions, the majority of the restrictions that came into effect in 2012 were around abortion care. But there are also these really, really awful restrictions on just funding in general for providers who provide abortion care. And these are providers like Planned Parenthood that, for the most part, provide preventative primary care, family planning services. And in fact, the majority of the care that we provide is that. And so there's these restrictions on, and frankly, discriminatory policies on who can receive state funding for the services they provide. So for example, as many of you know, in Texas this year. And so far, it's not looking so great because in Texas, the state decided that they were not going to fund. They were going to exclusively leave out Planned Parenthood from state family planning funding. And because of the connection with providing abortions. And Planned Parenthood appealed, won an injunction on not receiving funding because they said that that was discriminatory. You can't single out a single provider for the care that they do if you're using that money for family planning. And but then another court, they sued again. And another court came back and said, you know what, they can exclude you. And that's where it is now that Planned Parenthood in Texas is essentially defunded. And they're still figuring it out. But I think that that's the kind of thing that we're moving towards. So this is not just, it's from every angle. It's not just, you know, straight restrictions on abortion. It's things like completely, you know, defunding all the providers that exist that are able to provide this care and making it so that there's nowhere to go. There's nowhere to go. So and then that goes to what was said earlier about the fact that we have, what is it, like one third of the providers we had a decade ago in everywhere in the country. And in fact, 87% of counties in the country don't have an abortion provider. And in California, it's a little bit better. But still, in California, about 47% of our counties don't have an abortion provider. And people have to travel to get care. So that sort of brings me to California. You know, as was mentioned, we have really great laws, really progressive movement for people. And we sort of sometimes feel like we live in a bubble. And in fact, actually, we are moving forward in the state of California this year with a bill that will hopefully increase access to abortion care. And I'll tell you a little bit more about that after I tell you about the problem. So the problem right now is that we don't have enough providers. And it's because of a number of factors. I mean, first of all, even before we had these awful budgets in the past couple of years in the state legislature, we were being reimbursed, and by we, I mean providers that provide health care services for medical beneficiaries, for low-income people, were being reimbursed at rates from the 1980s. So for an abortion, we would get $260. Regardless of what gestation, what kind of procedure was necessary, everybody gets reimbursed $260 for a procedure that costs over $500,000, whatever. So that's the first problem. I mean, it's difficult enough to be able to provide it, but if you're not, you know, you're not able to keep your doors open, that's important. But then additionally, just this December, a court agreed. So in when the budgets passed in past years, there was a provision that was put forth by the governor and was passed by the legislature to cut back reimbursement rates even further. So again, those rates from the 1980s are being cut 10% for most services. And, you know, several people went to court about it. And most recently in December, one of the courts upheld the right of the state to do that to providers. So again, you know, right now we're in this moment where, you know, 10% less of, for everything, not just abortion care, but for everything is going to be reimbursed 10% less. And I think that that's a really, I mean, that'll, if people think about, you know, again, we have a great state, but if there aren't any providers to provide this care, then nobody's going to get it. And I think that that's really important to think about in California. And in any kind of advocacy work that you do moving forward that this isn't like a really sexier or, you know, the thing that catches the news, but it's really important to know. And it's really, and it could be potentially really devastating to those of us who provide this care. And then, you know, and so one of the things that we're doing here in California, because we recognize, well, and even beyond that, you know, there, as I mentioned, in 47% of the counties in this state, we don't have abortion providers. And what we found is that a lot of women, particularly from areas like the Central Valley, have to travel to the coast to get the care that they need. And at the organization I worked for before, Access Women's Health Justice, we help with that. We basically gave people bus tickets and hotel rooms to stay overnight in San Francisco or in San Jose or wherever they had to travel to get the care that they needed. We gave them money for childcare. They have to leave their children for two days sometimes to get a procedure. We, you know, we gave them food money. So there are organizations like Access doing that work. And it's mind-boggling, you know, again, that people need the support to be able to get this care that they should be able to get in their own communities. And so that's what we're doing this year. We are sponsoring a bill that will increase access to early abortion care by expanding the statute and allowing advanced practice clinicians like nurse practitioners and physician's assistants and certified nurse midwives to provide abortion care early to aspiration abortion. And it's, you know, there's been a study by the University of California in San Francisco that just came out. It's a six-year long, seven-year long study that has shown that it is safe to do this. And so this year we're putting that legislation forward. It still doesn't have a number or name, so I can't tell you any of that. But we'll be sending out information about that. And I think, you know, we are hopeful that with the few providers that we have in these areas that if we're able to expand the workforce that is able to give this care, then people will be able to get the care in a more timely manner and won't have to go away, go, you know, 100 miles, 500 miles to get what they need. So that's what we're doing. And I guess one other thing I'll say, you know, that's a little bit of a silver lining here in California of sort of what we're doing proactively to increase this access to care. But I also want to talk a little bit about the fact that even though it seems like the country's going crazy and, you know, rights are eroding everywhere else, there's some really interesting research that Planned Parenthood and others have done around, you know, how most people feel about abortion. And I think one of the most sort of interesting things that was found in these studies is that, I mean, well, first of all, when you first poll people and ask them, like, do you identify as pro-choice or pro-life? Most people actually say they identify as pro-life. And these studies found that the reason is that people don't know what that means. They don't know what it means to be pro-life. They don't know what it means to be pro-choice. And frankly, they don't identify with any of those labels. And that's not a good way to talk about these issues. That's not a good way to, you know, to talk about the fact that abortion should be legal and is a, you know, medical choice that people should have. So, you know, when we delve further into this, we found that, as we thought, that nearly two-thirds of Americans believe that abortion should be legal. They, beyond the labels, like, they might call themselves pro-choice, but they still think abortion should be legal. So they don't, again, those labels don't mean anything to people. And furthermore, and about 40% of those people say that it's a personal decision and they don't want to have anything to do with it. They think it should be legal and people should make their own choices. And well, and then the other thing is that about overall, about 76% of people of color in this country, people who sometimes we've thought, you know, are more conservative for religious reasons, and I'm talking particularly about Latinos, 76% of Latinos believe that abortion should be legal in most of all cases. So that's another thing that I think is important to know because it shows that a large part of our population believes this should happen and is with us on these issues. So that's a little bit of the silver lining of all of this craziness, that, you know, this is actually going against most of what people feel and believe and that gives us the hope that, you know, if we're able to move this constituency, then we're going to be able to change what's going on. And so one of the things about us, about Planned Parenthood, is that we found that we're able to help people win elections with, you know, by using some of this messaging, by helping them, you know, oftentimes like, you know, the money that we're able to give them isn't that great, but to candidates that is. But just having our support and having our name and having the messaging is helpful. And we know that because we actually did some really good studies in 2010 in the gubernatorial election and the Senate race with Senator Boxer and found that more than a third of voters in the state of California who heard about the issue of abortion in the 2010 race said that they were less likely to vote for Carly Fiorina because they knew that she was anti-choice or that she was against abortion. So so I think, you know, that kind of thing. And similarly with with with Governor Brown, when people heard that Governor Brown was pro-choice against Meg Whitman, who's who wasn't, you know, pro-choice, they were more likely to to vote for to say that they were not going to vote for for Meg Whitman. So so the messaging works again, people are pro-choice or let's not use that word anymore. People believe that abortion should be legal and believe that people should have the right to make these choices for themselves. And so I think this is what we're we're taking and moving forward, that we are, you know, we have everybody behind us and in these beliefs. And and so I think we'll be able to do great things moving forward. Thanks so much. Thank you. Thank you, Lupe. And doesn't that give you confidence about our future? Great. Thank you. Mike is not on. Speak louder, lean forward. I'm a little taller. Our next and now we're going to bring our focus on reproductive choice and access to services down a little bit closer to the local level. Louder still. That better. OK. I can. No, it's taped on. I can't do that. They won't let me. I'm going to make a couple of comments before I introduce our next speaker. First of all, I can't say enough about the value of Planned Parenthood's involvement electorally through its advocates. And I will tell you as a candidate that Planned Parenthood is a five star golden name to have as an endorsement. It's a very trusted name. And when you know all the women and by extension, their partners and their families who have turned to Planned Parenthood and received quality care, sensitive care, it's a very trusted name. And that's the importance of what when they weigh in on a on a political issue, it it really counts for a lot. And so I urge you in the next election cycle to support the advocates. There you go, a plug. Bringing it back down locally, Lupe mentioned a little bit about some of the better range of policies that we have at the state level. And what we're going to look at now is how Santa Cruz has taken those policies and really run with them to make it to offer the best possible care. And I will mention just a couple that aren't related to abortion services, but in the area of emergency contraception and sexually accurate or medically accurate sex education. Those are two areas where in in past years, the state of California has really been in the forefront of ensuring good progressive policies. Those policies have come come at the local level. Santa Cruz has been often the county that did the pilot study that led to those laws being adopted and that proved that those were sound public policy. So that's what we're going to do now is move to the county level. Our next speaker is Ellie Litman. Ellie is the director of the Health Improvement Partnership, which is an amazing, unique collaborative. You may not have heard of it, but it's done terrific things here in Santa Cruz County and she'll explain it more. She's had a lifetime in progressive public policy and work. She mentioned to me that she was named after Eleanor Roosevelt, so that shows you the family values transmitting here. She served in the Peace Corps. Her first professional degree was in planning. She worked in the Seattle area. She got then very interested in some of what was being done in Santa Cruz in the area of childbirth, moved to Santa Cruz, did a career switch, went to Cabrillo and got her nursing degree, has worked in the fields of childbirth and hospice, both. And more recently, now with her work of the Health Improvement Partnership, she said she wanted to bring a clinical voice to health policy. So that's what she's doing now brilliantly, helping pull together providers so that we can offer the best possible care here in Santa Cruz County with the tools at our disposal and invent some new ones. So, Ellie, it's yours. Well, I'm so local. I have the community cold, so I'm at the end of it. But let me know if my voice trails off and you can't hear. And I have my stuff here, just in case. So I really want to thank both Carol and Cynthia for this invitation to join you today and to really follow what Lupe so well laid out for us in terms of the national and the state landscape and challenges. Of course, my first reaction is thank goodness I work at the local level and not at the state or national level. And obviously our work at the local level has to always be within the context of what's happening at the state level and the national level. So really applaud them and, you know, important to know about. And also important to know about kind of how do we take the opportunities here in Santa Cruz County and maximize the opportunity, particularly of the Affordable Care Act, to really increase access to health care in our community and to move forward, particularly in the area of reproductive services. I thought that comment about the low income women is five times as likely to have untended pregnancies as well and therefore as abortions is really important to remember at the local level because that's where we can do something in terms of making sure that there's access to reproductive services and as well as access to abortions. So the Health Improvement Partnership of Santa Cruz County, it's an eight-year-old coalition of public and private health care leaders that includes the hospitals, that includes physician groups, it includes safety net clinics, including the groups that are on either side of me here, Planned Parenthood, Mar Monte, and Santa Cruz Women's Health Center. And there are brochures on the table under the ACLU sign about our organization, our members, and what we do. But there are also many hipsters in the audience here today who, of course, are going to be the best way to learn more about the Health Improvement Partnership. So how many hipsters do I have? Hipsters, raise your hand. Hi. We define a hipster as anyone who's been to more than two meetings, anyone who came the first time and came back as it joins the hipster group. So at the core of what hip believes is the old adage that politics as well as health care are local and that really at the local level, we can really do a lot of things if we work together to do those. For the last two years, in anticipation of federal health care reform and specifically coverage expansion, we have focused on strategies to maximize the local benefit of federal reform. That is to ensure that coverage expansion, more people, and particularly low income people getting health care coverage, translates for them into health care and into the kind of health care that we think people have the right to have. Hip's collaborative vision is that all residents of our county will have access to a patient-centered medical home that provides comprehensive primary care services, including reproductive services. So what is a patient-centered medical home? Do we have to, health care professionals do tend to make up, need a term and a jargon for things? It actually is no one thing. It looks really different. It's different models, different framework. But the essence of it and what is the common element and I think really important to the discussion today is that a patient-centered medical home is a primary care medical setting that supports developing a relationship between the patient and their health care providers. And that's the common thread and that's kind of the overall purpose of all the various things that go into having a patient-centered medical home. Ideally, a medical home includes non-medical services such as behavioral health and I think you'll hear a little bit from Jen Hastings about that this morning. And particularly for safety net clinics serving primarily a low-income population, health care centers are also, health care centers to be medical homes also need to be engaged with other community organizations to really work collaboratively with the community on the things that really determine 80% of the community's health status. Which are the safe streets and good nutrition and when someone is seriously ill also helping to build communities of support for that individual. And essentially, we're talking about health homes in health neighborhoods. I know Leslie and Jen will be talking about some of the things they specifically have done over the last three years, both independently and under the Umbrella Health Improvement Partnership to advance patient-centered medical homes in their clinics. But I wanted to tell you about what the Health and Brewer Partnership is doing with all our members in 2013. Because I think it's something that will have a really impact on the patient experience that we have in this county if we can move in this direction. And of course, we want to hear whether that's indeed the case. We're really going to focus this year on something called team-based care. And we want to move, we want to start transforming our primary care system so that it's not so much centered anymore on that PCP, that primary care provider. And it is really more centered on a primary care team. This is not new. We've been doing, you know, this has happened. This exists in a lot of, there are lots of teams out there that have been working in this way. But really to make that part of the standard of practice in Santa Cruz County, particularly starting the safety nets, we like to start innovations in the safety nets and move them up or down to the non-safety net providers in our community. And so specifically what we're doing is we're partnering with UCSF and their Center for Primary Care Excellence and Cabrillo College to develop a local program, a local curriculum and training program for medical assistants to teach them the skills to be health coaches and to really be an important member of that health care team. And we're also going to have community-wide medical education programs that, you know, the team needs not just well-trained members, but it also needs kind of, needs to know how to, people need to work, know how to work as a team. So we're also going to do community-wide training for physicians and nurse practitioners, physicians, assistants, other members of the team about how to work as a team and about the concepts of sharing care among a team. Now, why are we doing this this year? Well, we know that with coverage expansion, the ongoing problem we've had, the chronic problem we've had in terms of shortage of primary care physicians is just going to get worse. And so team-based care is a way of helping to spread primary care physicians and onto a team and, quite honestly, to help mitigate that shortage. And, you know, that's the motivation. That's what primarily brings health care providers to the table. That's what brings the foundations to us and the Central California Alliance for Health to us to help support this work. But at the same time, the proponents of team-based care really believe that it also improves the experience of care for patients. Because, one, it gives you more access if you're not just talking about one person you need to get in to see, but you're talking about a team that may be a team of physician and a nurse practitioner, for example, or a physician's assistant. But the other side of it is that, particularly around asking questions, sounding board to make decisions, to have a team of people at where you get primary care who know who you are gives you more choice in terms of getting consultation on both the smallest of questions that you may have about a medication or what you should do, as well as those important questions like reproductive services. So, we, you know, I say I'm paid to be optimistic, but that's, we really hope that this is not only a thing, not only an intervention that will make a difference in terms of cost of care, access to care, but also will also improve my, your experience of care in primary care in this county. And, you know, those are local things we can do. Those are things we can do within the existing structure. And so, that's what we're up to this year. I also wanted to just comment that the, on an article you may have seen in the paper about the fact that Medicare came to Santa Cruz County to find out why we are, why our healthcare locally is really different than it is in the, in the rest of the state and the rest of the country. Specifically, they came because the data shows that they spend less money in Santa Cruz County on institutional care, less money on hospital care, and a lot less money on long-term care. They spend more money on hospice, and, and overall, they spend less and get more in Santa Cruz County. And the data didn't tell them that, so they had to come to find out what, what it, to hear the stories and begin to understand what it was that made, that makes the data look that way and, and therefore, you know, and obviously they're trying to figure out how can they, how can they export what we do to other places. One of the things that, that came out of a really interesting afternoon of telling stories to them is that they're, you know, yes, we are a collaborative community. We have lots of collaboratives. This is one of them, and, and those are all really important. But, but the thing that stood out from the stories and, and what people, what people remarked on was that we're a community that, that, an activist community. And, but we also like to work at this, at the seams. We like to, not, not over the, you know, we don't go over the limits. We were careful with Medicare in the room, not to say that we don't follow their rules, but we'd like to, we would like to work to the limits of their rules to make healthcare work for us as a community and to make healthcare work for us as individuals. So, you know, I think that's really in the spirit of what we're talking about today. It's important to know what's happening, to know what the issues are in California, to support legislation, such as expanding abortion providers to do that, and then figure out ways to make the reimbursement work and to make our healthcare system work. Because I think that's, there, there's something there. We're just starting to think about it. There's something there that's the essence of what makes this community and, you know, this room full of people is really an example of, of that is we need to know the issues, we need to be involved, and then on the individual level, we need to really make it work for, for patients and figure out how we can do that within our framework. So, I thank you, and I thank you for the work that you do and for being here today. Thank you, Ellie, and I hope you've all learned something about the Health Improvement Partnership. It's just a great success story here in Santa Cruz. So, again, bringing it down even closer to a couple of our key healthcare providers, safety net providers, we're next going to hear from Leslie Conner. Leslie has a career in, as I know her, in safety net services. I first met her when she was the Development Director for Dantes, the local dental clinic. Locally, she then went to HIP, Health Improvement Partnership, where she was the Program and Policy Director for several years, and for the last 14 months, she's been the Executive Director of the Santa Cruz Women's Health Center, while at the same time getting a Master's in Public Health at Columbia, a busy girl, yeah. But before Leslie comes up, I also want to acknowledge, in the audience today, Ciel Benedetto, I saw you. A long time, long time, early and visionary and effective Executive Director of the Women's Health Center. So what we're hearing today is a continuation of a great tradition. So Leslie, tell us what's in your future. Thank you very much. I'm glad that you noted Ciel is here because I've had a chance to talk with her and learn more about the history. So for a 40-year-old organization at 14 months, I'm sort of an infant in the history of the clinic. I just want to give a shout out to also to the Women's Health Center staff that are here, a fabulous staff. Yeah. So 40 years ago, there was a lot happening, as we know, with Roe v. Wade's anniversary. Last year was the 40th anniversary of our women, our bodies ourselves, which is that revelatory book that so many of us were inspired by and motivated by. And in 1974, 40 years ago, next year, the Women's Health Center was born and it was essentially born by a group of women from UCSC, primarily, who converged to help drive women over to the Bay Area, to San Francisco for abortions that weren't available locally. And then they evolved and became a reproductive health and education organization designed to empower women to take care of their own bodies and make decisions about their own health. And 40 years later, the healthcare system and healthcare needs have grown so dramatically and changed so much that the Women's Health Center has likewise evolved. And so today, because of skyrocketing costs, because of a system that creates rationing of care based on your income or your health condition, the epidemic of chronic conditions and diabetes and then pediatric obesity to name two that are really impacting the health of our community, the Santa Cruz Women's Health Center is now a full service family practice health center that provides prevention, chronic disease management, family planning, acute care, mental health services. We serve homeless patients. We serve women who are single moms, who are trying to get out of an unsafe relationship. We have every day, we receive thanks from our patients and it's not uncommon for us to say, this clinic saved my life for us to hear that. So today, we are poised to change even more because the Affordable Care Act has granted us with new funds to expand. And so in 2014, when we turned 40, we were also going to be opening up a second clinic in the live vote community. And so that's an underserved area. As we all know, there's a pockets of need in our community, Live Oak is one of them. There are no health clinics serving low income patients and in a full service way, the Rota Care is there, which is a great resource, but we wanna open a full service clinic that serves patients of all genders, that has a wellness and prevention focus, that serves, provides pediatric care and that really helps to create more access across the community so that when more people are eligible because of the Affordable Care Act, there will be an additional high quality healthcare center for them to go to. Our mission is to provide high quality healthcare services and advocate the feminist goals of political, social and economic justice. So again, the spirit in which we were born lives on today despite all those changes. Our downtown clinic when we expand will remain a thriving women's healthcare center and we will never leave those roots behind as advocates so whether we're providing healthcare to women or whether we're registering our patients to vote or whether we're out there in the community screening and identifying people that need access to care so we bring them back to the clinic to be assigned to a primary care provider. We're gonna still hold true to those original values. We believe that healthcare is a fundamental human right, not a privilege, that all healthcare decisions need to be driven by the best of what science tells us. In concert with what a woman or a patient's values and needs are delivered by a provider with respect and dignity who understands what her patient needs and works with her to make the decisions that are right for her or him. The last thing I just wanted to note is that as Ellie sort of referred to we have to remember that true health, lasting health really is created in the community, not in the exam room and that is really up to all of us to ensure that healthy choices in our community are the easy choices that no one is isolated and left behind or left to fend for themselves in a healthcare crisis or other kind of crisis that our community is equitable, that our community members are empowered, particularly young women are empowered to take advantage of all the opportunities that we can help make available to them and that's really how we get to a healthy community. So as the Women's Health Center we're dedicated to making sure that there's access and respect and choice for all our patients and we look forward to working with you on the outside of our walls to really help make a healthy community. So it starts here today for me going forward and I look forward to working with you all, thank you. It does make you proud of our community, doesn't it? It's great. So our final speaker is someone known to many of us, Dr. Jennifer Hastings from the Westside Planned Parenthood Clinic where she's been for 15 years now. She's the resident physician there at Westside but has a reach that far extends that one health center. She currently is teaching abortion to residents from UCSF and the Tivodod in the San Jose Clinic, Planned Parenthood Clinic. She's been mentoring, who mentioned the state legislation for mid-level practitioners, to expand the pool of providers. Well, Jen is mentoring some of those advanced mid-level clinicians, nurse practitioners and physician assistants to become abortion providers in anticipation. This is a pilot project in anticipation that the research will again confirm that this is a both cost effective and quality way of providing that service. She also was a leader in offering, developing and offering transgender medical care at Planned Parenthood Westside which has now become a national protocol for Planned Parenthood. So Jennifer is not only a wonderful physician for an individual client with whom she's working but she's been visionary in bringing forth new programs and is a great leader. And she's gonna tell us what's in store for Planned Parenthood. So I'm short, so hopefully I can be heard. Sound good? Thank you so much. This is a great honor to speak at this event. Leslie, you gave me goosebumps. I think you really articulated so beautifully what we hope for our community. And we love that we get to collaborate with other safety net clinics and the health improvement partnership and the safety net clinic collaborative have been just a wonderful forum for us to really truly support each other. And Rama, thank you so much. Rama Khalsa is here who really started and had the vision for this collaborative. And it's so important and we truly are a model for the rest of the country. It's and that the, you know, the federal folks from Medicare came to look. I think the health improvement partnership is one reason that we do stand out in providing for our community quality care that is also cost effective. And I think that's where there's something called the triple aim that is a national effort and we're at the leading edge. And Ellie, it's a lot thanks to you that that's happening. So I have just a few minutes and what I wanted to talk about were two things in particular. They're these very colorful flyers at the table because in fact what Lubey was talking about in terms of access, challenges have come to Santa Cruz and that is that every Saturday there are protesters at our clinic and we do want and need escorts to make sure that a woman and her partner or a woman and her family feel emotionally safe coming into the clinic. And so you have an opportunity to support women and support our community and create the vision that Leslie was talking about where we all feel safe to get the care that we need. And so I'm gonna have Ellie stand up. She is based in San Jose but has her email which either is sanacruzvol at planparenthoodmarmonti.org or San Jose. It goes to the same spot. And you can email her if you're interested in being coming and escorted. There is a training. You need to spend some time to learn how to be an effective and helpful escort but we'd love to have you join us on Saturday mornings. In addition, in our clinic we welcome volunteers as well. We do need at least a six month commitment but we'd love to have you join us in various ways. So if that interests you, you can also contact Ally and we're interested in young and if you're retired and have some time on your hands we'd love to have you join us. Then I also wanna talk about something that I think was on your seat. Join us for an event. And this is an event that is highlighting a pilot program for planparenthood which and it is happening this concept of integrating behavior health, mental health and primary care is happening around the country and already in the safety net clinics in Santa Cruz if you're part of the Metacruz Advantage program. But essentially we wrote a grant to the community foundation and they gave us some funds to start a pilot program and we wanna tell you about it. And this is in kind of an alignment with the Affordable Care Act and we have an incredible speaker, February 7th. We'd love for you to join us. Michael Pawlikar who is, if you've never heard him before, he is stunning and he's gonna talk about the Affordable Care Act and what that might look like for planparenthood and women's health but then I'll be talking about the behavioral health aspect. Please join us. So in order to find out where it is you need to go to the link that is on this piece of paper that's on your chair. If you are not comfortable with email and webs and all that, John Waller is behind there and would love to talk with you if you'd like more information. His phone number, I'll give it to you if you're not a web user, 460-310-460-3110 and we'd love for you to join us February 7th and thank you so much for coming today. It's so important that we acknowledge this day and this time and some of us feel like Roe v. Wade will never go away but as we heard today even if it's legal there are ways in which women cannot access safe care so thank you so much for honoring this day and spending it with us and now I think it's Cynthia again, so thank you. Stay here. And I would like, I would like to ask Leslie where are you to come up and Ellie? You know you all made a contribution when you came in and that contribution helps support the work of the Reproductive Rights Network which includes advocacy and some support for basic patient services but we also are gonna give a contribution to support the work of these organizations so, Health Improvement Partnership. Here's your check. And Santa Cruz Women's Health Center and Planned Parenthood, so I wanna thank you and for us this money will go to the other important activity we do which is try to cover all kids in our county and so it will go for healthy kids and if you would like to contribute to healthy kids there are brochures by side the hip brochures back there for this other important program. Take a look at the literature, do what you can to help and never say die here. Thanks for coming.