by Nina Liss-Schultz, Reporting Fellow, RH Reality Check
February 26, 2015 – 1:04 pm
Four Oregon lawmakers Thursday introduced the Comprehensive Women’s Health Bill, intended to ensure access to affordable, full-spectrum reproductive health care for every woman and transgender man in the state. The bill, if passed, would make Oregon the first state in the nation to ensure every state resident is covered for every type of reproductive health care, including abortion, under all forms of insurance.
Backed by a handful of local groups, the bill is part of a larger progressive legislative effort announced Thursday that will also tackle sexual assault and domestic violence issues.
“I’m proud to be working with such a wide range of legislators and advocates on this issue,” state Sen. Elizabeth Steiner Hayward,RH Reality Check. “We’ve got Republicans and Democrats, men and women, and advocates from across the spectrum who care deeply about this bill.”
Oregon is often considered a bastion of progressivism in a country battling over abortion and reproductive rights on both the federal and state level.
The Oregon Health Plan (OHP) provides extensive Medicaid coverage of health care for low-income residents, including abortion, though that coverage is currently added as a line item in the governor’s budget each year. And there is only one anti-choice law on the books to date. Both of the Oregon’s legislative chambers are controlled by Democrats, and the state’s new Democratic Gov. Kate Brown, who was sworn in last week following the resignation of John Kitzhaber, is widely seen as more progressive than her predecessor.
Still, even under a progressive government, efforts are needed to ensure that the funding and systems are in place for everyone to get the care they need. Even in Oregon, the high cost of family planning, abortion, prenatal, and childbirth care, among other reproductive-related services, can force people, particularly those with low incomes, to carry unwanted pregnancies to term or forgo important services during and after pregnancy.
“Currently, because of gaps in coverage, our clients have issues regarding lack of access to prenatal care and high teen pregnancy rates,” said Levi Herrera, executive director of the Mano a Mano Family Center in Salem, Oregon, which annually serves 2,000 families, most of whom identify as Latino immigrants. “Two-thirds of our clients are female. These women are part of the community, and having access to the full spectrum of health care will improve quality of life for everybody.”
Safety net health centers in 2012 alone provided contraceptive care to more than 123,300 women. In 2010, 46 percent of pregnancies in Oregon were unintended, and 32 percent of those pregnancies resulted in abortion, according to the Guttmacher Institute.
That same year, publicly funded family planning services helped women avoid 30,200 unintended pregnancies.
The Comprehensive Women’s Health Bill seeks to close those gaps in access. The bill would require that all health insurance—whether private, employer sponsored, or public plans—cover contraception, abortion, prenatal care, childbirth, and postpartum care, including breast-feeding support and folic acid without prescription. Insurers would be barred from imposing cost-sharing for abortions at more than 10 percent of the cost of the procedure, and deductibles for abortions would be barred altogether. And, critically, the bill strengthens and protects existing abortion coverage under OHP by removing it from the annual budget and codifying such coverage.
The bill also ensures coverage for a 12-month supply of birth control, without cost, to be dispensed at one time, removing time and cost constraints faced by those who seek to prevent an unwanted pregnancy.
Insurance plans would also be required to cover the cost of out-of-network provider care for these services under certain circumstances.
Access to preventive reproductive health services has increased significantly under the Affordable Care Act. As part of the law, insurers are required to cover a range of reproductive health services, including sexually transmitted infection counseling, contraceptive methods and counseling, and breastfeeding support, without cost-sharing.
But advocates in Oregon say the bill introduced today is significant, as both a proactive measure and a solution to holes in coverage.
“There are parts of the state statute that don’t align with the ACA, so it’s important to make sure state law aligns with federal,” Hayward said. “This bill standardizes across the board what we mean by access to full-spectrum reproductive health from pre-conception to postpartum.”
Reproductive rights advocates said the Oregon bill could prove critical, as the U.S. Supreme Court could soon gut the ACA’s federal exchanges and many Republican governors and GOP-dominated state legislatures refuse to expand health-care coverage.
“As the ACA is being eroded in states across the country, we’re trying to make sure that in this state there’s an assurance of care across all populations and for all Oregonians,” Aimee Santos-Lyons, director of programs for Western States Center, told RH Reality Check. “Plus, there are still communities of women that don’t have access to coverage right now, so we want to start that process. And as we’ve recently seen, governors can change on a dime, so we want to make sure this kind of health care is is codified law in our state.”