Sandra Van Scotter
August 16, 2026 · Newsletter
A Right You Cannot Reach
On March 8, 2024, France added one sentence to Article 34 of its Constitution. Translated, it reads: the law determines the conditions under which the guaranteed freedom of a woman to have recourse to a voluntary termination of pregnancy is exercised. [1]
Not right. Freedom.
I have been thinking about the specific word choice for weeks. When I first read it, I thought the French had gotten something right that we had gotten wrong. I have since learned that the story is more interesting than that, and I think it is worth telling.
Why they chose the smaller word
The French Senate is right-leaning, and it would not pass an amendment that said droit, right. It would pass one that said liberté, freedom. The Conseil d’État, which reviews bills before they go to Parliament, recommended the softer word, noting that “freedom” was the term France’s own constitutional court had already been using in its abortion decisions. The Senate’s summary of its own work says so plainly: a freedom is enshrined, and not a right. [2] [3]
So France picked the less powerful word on purpose. In legal language, a right is the stronger claim, because a right places a duty on somebody else. A freedom only means that no one may stand in your way.
And yet the amendment passed 780 to 72 in a joint session at Versailles [4], and it works, and it will protect French women in practice. Which raises the question I actually want to ask.
Why does the weaker word do more work in France than the stronger word does here?
Because in France, that freedom is standing on something.
Paragraph 11 of the Preamble to the French Constitution of 1946, which is still binding law today, says that the Nation guarantees to all, and notably to the child, the mother, and aged workers, the protection of health and material security. [5] In 1971 the Conseil constitutionnel ruled that the Preamble carries full constitutional weight. [6] France also has national health insurance that pays for the procedure.
So when France writes “guaranteed freedom” into its Constitution, that freedom lands on a floor. The floor was poured in 1946.
The United States never poured one.
What our Constitution actually promises
Our Constitution is, almost from beginning to end, a list of things the government may not do to you. It is a permission slip. It is very rarely a promise. A permission slip says nobody will stop you. A promise says somebody has to show up. The difference is not a matter of degree. It is a difference in who owes you anything.
The Supreme Court has said this out loud. In DeShaney v. Winnebago County in 1989, a four-year-old boy named Joshua DeShaney was beaten into permanent brain damage by his father after county caseworkers documented the abuse and then left him there. The Court ruled the county owed Joshua nothing under the Constitution. The Due Process Clause, the Court wrote, is phrased as a limitation on the State’s power to act, not as a guarantee of certain minimal levels of safety and security. [7]
Not a guarantee of certain minimal levels of safety. That is the sentence. That is our foundation, and it is not a floor.
And in Harris v. McRae in 1980, nine years before the DeShaney case, the Court upheld the Hyde Amendment while Roe v. Wade was still the law of the land. Women had the constitutional right to an abortion. Medicaid would not pay for it. The Court’s answer was that although government may not place obstacles in the path of a woman’s exercise of her freedom of choice, it need not remove those not of its own creation, and that poverty falls in the latter category. [8]
Let that sink in. In 1980 the Supreme Court told poor women that they held a constitutional right they could not afford to use, and that the Constitution had nothing further to say to them.
That is what I have been trying to name. We are a country with an enormous number of rights on paper and almost no floor underneath any of them.
What this looks like at a bedside
I spent 30 years in healthcare, 20 as a respiratory therapist (RT). I taught licensed RTs, nurses, physicians, paramedics, and families. I wrote policy and I enforced it. And I spent an enormous amount of time on the telephone with insurance companies, arguing about whether a patient could have whatever the physician had already ordered.
Nobody in those calls ever told me the patient had no right to what their doctor ordered. Nobody has to. The right was never in question. What was in question was whether anyone was obligated to meet the right, and the answer was usually no, and the patient went without.
A right that nobody is obligated to honor is a wish.
The reframe
I do not think Americans need to trade the word “right” for the word “freedom.” Both words are load-bearing and both are worth keeping. What I think we need is a third question that we have not asked because our political language does not have the vocabulary to ask it.
We ask: do I have the right to this?
We need to also be asking: and is there a floor under it, and who is obligated to fulfill that right?
A right with no floor is a permission slip. It tells you the government will not arrest you for trying. It does not tell you that you can get there, or afford it, or find a clinic within two hundred miles, or take the days off work, or that your insurance will cover it, or that a hospital in your county still delivers babies at all.
Where the promise runs out in this district
In the four counties I am running to represent, the promise runs out well before it reaches the person.
Ridgecrest Regional Hospital shut down its labor and delivery unit on March 1, 2024. Four beds out of service. Thirty-one people out of work. And a notice filed with the state listing where women should go instead: Antelope Valley Hospital in Lancaster, Memorial in Bakersfield, Barstow Community Hospital. [9] The closest of the three is Barstow, at an eighty-three-minute drive. The others are farther. The hospital told the state its patients were nearly a hundred miles from the nearest maternity care. [10] The Navy, in its own paperwork, put it more plainly still: Ridgecrest Regional Hospital is the only full-service health care facility within ninety miles’ driving distance of Naval Air Weapons Station China Lake. [11] Ridgecrest is also a town with no commercial air service. [12]
Nobody in Ridgecrest lost a right that day. They lost the access to fulfill that right.
The labor and delivery unit reopened nine months later. It did not reopen because a court ordered it. It did not come back because an insurer raised a rate or a right got enforced. It reopened because the Navy wrote a check. A standby medical services contract, awarded in September 2024 under the Navy’s emergency and extraordinary expense authority, because the base needed people willing to live in Ridgecrest. [11] The hospital’s chief executive officer, writing in the Daily Independent last December, called it seven million dollars in one-time money. [12]
The Navy did not build a floor in Ridgecrest. It put up scaffolding. Scaffolding is temporary by design. It goes up because there is work to do, and it comes down when the money runs out.
The CEO also wrote something else in that column. He listed what has kept the hospital solvent and what is pulling it under, and if you set the two lists beside each other, the pattern is unmistakable. Nearly everything holding Ridgecrest Regional Hospital up is temporary: a loan that has to be repaid, a defense appropriation that was one-time by its own description, a contract renegotiated with commercial insurers. Nearly everything pulling it down is permanent, starting with reimbursement rates that have not been adjusted since 2012. The one durable thing on the good side of that ledger is the hospital’s Critical Access designation, worth about six million dollars a year, and that is a federal decision. Which is the whole point. The only permanent thing holding this hospital up is a decision made in Washington, and decisions made in Washington can be unmade. [12]
In the town of Tulare, the maternity ward closed on June 6, 2024, and it has not reopened. That hospital building belongs to a health care district, which is a local public agency with an elected board and about eighty-eight thousand residents in its service area. The board wanted a maternity ward. It pushed the company that runs the hospital to open one. The obstetricians did not come back and neither did the patients, and the losses were not sustainable. Kaweah Health in Visalia now handles more than half the deliveries in Tulare County. [13] [14]
People in Tulare elected a board that wanted a labor and delivery unit, and they still do not have it. Wanting does not create access either.
In Kings County the labor and delivery unit stayed open, and something quieter happened. In September 2024, the medical group that had been supplying obstetric call coverage at the Hanford birth center stopped supplying it. [15] The beds are still there. The doctors accepting obstetrics patients are fewer. That kind of loss does not show up on a closure list anywhere, and the loss is real to the women seeking care.
And in three communities that serve people in this district, Tehachapi, Lake Isabella, and part of Bakersfield, there are hospitals with emergency departments and no obstetric service at all. [16]
Federal law still applies to these hospitals. In 1986 Congress passed the Emergency Medical Treatment and Labor Act, otherwise known as EMTALA. Under it, a hospital that takes Medicare has to screen you, has to stabilize you within the capability of the hospital, and if it cannot, has to arrange an appropriate transfer. [17] [18] I want to be fair to that law. Before 1986, hospitals could and did turn poor women away at the door, and EMTALA is the reason they cannot.
This is worth noting, because EMTALA is proof that we can legislate fulfilling a right. Congress took a situation where nobody was obligated to anyone and wrote an obligation into law. Not a constitutional amendment. A bill.
But look at what that floor actually is. Within the capability of the hospital. A hospital with no obstetric unit has no obstetric capability. So, the federal guarantee, honored perfectly, in full compliance, with no violation of any kind, is a screening and a ride. It is a promise that you will not be turned away from a building that cannot help you.
Let’s look at some numbers, and note these are county numbers, not congressional district numbers: In Kern County, 52 percent of residents receive Medi-Cal. In Fresno County, just under 50 percent. In Kings County, 43 percent. In Tulare County it is 59 percent of the total population and 74 percent of children under nineteen, which is the highest rate of any county in California. The statewide average is 35 percent of all residents and 51 percent of children under nineteen. [19]
These numbers are not a coincidence sitting next to the closure list. They are the cause of the closure list. A labor and delivery unit has to be staffed around the clock whether or not anyone is in labor, and hospitals close them where the insurance payer mix (ratio of commercial insurance to Medicare/Medi-Cal) cannot carry that baseline cost. Ridgecrest Regional Hospital was subsidizing its labor and delivery unit by about four million dollars a year before it closed. [20]
So, when someone asks me whether women in this district have the right to reproductive health care, I have to say yes, because they do. And then I am going to ask the second question. Is there a floor under it? Who is obligated to fulfill that right? And how far do they have to travel to fulfill it?
What I will do
I don’t think we need a constitutional amendment. France added one to protect a floor it already had, poured in 1946. [21] The United States is missing the floor, not the language. And floors do not get poured by amendment. They get poured by statute and appropriation.
The law that stops hospitals from turning women away at the door began as an ordinary bill, and whether Medicaid pays for a delivery in any hospital in our congressional district gets decided every year by ordinary appropriation. Those instruments are already in Congress’s hands. Using them is the work, and it is the work I am asking you to send me to do.
What I will do is stop treating access as a footnote to the right. Every time this district’s healthcare comes up, I intend to ask the second question out loud: what supports meeting the right, who pays for it, and how far do my neighbors have to drive to reach it? That is a question a district office can answer, case by case, constituent by constituent, from day one.
France gave its women a freedom that stands on a floor they built in 1946. The United States gave its women a right and told them to figure out the rest.
I am not willing to leave you at “figure out the rest.” The distance between a right and a promise is not a mystery. It is a gap somebody left open, and gaps that were left open by decisions can be closed by decisions. I intend to spend my time closing this gap.
We will not finish this work in one term. But I know what the work is and who it is for, and I am prepared to do it in front of you, with your participation and involvement.
Thank you for following along in this discussion. Now ask the second question: Where is the floor the right is built on? Ask it of everyone who wants to serve in this office, and ask it of me.
Notes and sources
Numbers correspond to the markers in the text. Facts, figures, and links in this piece were verified as of August 16, 2026. Several of the underlying documents carry their own reporting periods, which are given below. Hospital service lines, funding arrangements, and enrollment figures change, and the situations described here are still moving.
Loi constitutionnelle n° 2024-200 du 8 mars 2024, Légifrance
Congress vote record, Versailles, March 4, 2024, Assemblée nationale
Décision n° 71-44 DC du 16 juillet 1971, Légifrance. See also the Sénat archives account of the decision.
DeShaney v. Winnebago County Department of Social Services, 489 U.S. 189 (1989)
Ridgecrest Regional Hospital, notice of labor and delivery suspension, November 30, 2023. The notice lists the three alternative facilities. Drive times are not from the notice and are independently checkable.
Naval Air Warfare Center Weapons Division, contract award for standby medical services, September 28, 2024. See also Ridgecrest Regional Hospital’s reopening announcement, September 2024.
James A. Suver, year-end update, Ridgecrest Daily Independent, December 8, 2025; reposted by the hospital, January 8, 2026
ABC30, on the Adventist Health Tulare labor and delivery closure
Valley Voice, on the Adventist Health Tulare closure and the health care district
The Business Journal, on obstetric call coverage at Adventist Health Hanford
Centers for Medicare and Medicaid Services, Emergency Medical Treatment and Labor Act. See also HHS Office of Inspector General on EMTALA.
Department of Health Care Services, County Penetration Rates for Medi-Cal Certified Eligibles by Age Group, January 2026 (PDF). Report date January 29, 2026. Figures are certified eligibles as a share of projected county population. DHCS notes these counts are preliminary and that a month’s counts are considered complete for statistical reporting twelve months after the month ends. Population denominators are California Department of Finance projections for 2025.
Two separate points, each sourced above. On why France amended when it did, see note 3: the Sénat’s own summary identifies the June 2022 United States Supreme Court decision, and moves to restrict access in other countries, as the context in which the President proposed the change. On the constitutional health guarantee that was already in place, see notes 5 and 6.
Consulted but not cited in the text: HCAI Hospital Profile, Ridgecrest Regional Hospital, for licensed beds, emergency room service level, and payer mix. CSIS, on U.S. signature and non-ratification of the International Covenant on Economic, Social and Cultural Rights.
Notes 7 and 8 link to Justia and FindLaw rather than to a .gov site because the Supreme Court posts full opinion text on its own website only back to the mid-1990s. The official citations are 489 U.S. 189 and 448 U.S. 297, and bound-volume PDFs of both are available through the Library of Congress.
Paid for by Sandra Van Scotter for Congress