Democrats Clear Reproductive Health Bill, Cutting Deal with Providence

The Catholic health insurer won an agreement that allows it to stand as the only participant in the insurance market that does not pay for abortions, as the state sets up a process to set up a work-around for these procedures.

The Committee on Ways & Means has cleared the women’s comprehensive health bill on a party-line vote, setting up an emotional floor debate at the end of the session.

House Bill 3391 will close contraception gaps for women, particularly unauthorized immigrants, by setting up a $6 million fund to pay for family planning services, and another $3 million for post-partum care. The bill also directs all remaining pre-ACA health plans to cover contraceptives without copayments and ensures that transgender individuals can receive routine screenings.

But the biggest hurdle for the bill is not over immigration status but that most divisive of issues, abortion, which this bill guarantees for women without cost-sharing, and allocates $500,000 for immigrant women who can’t get the Oregon Health Plan.

“Let’s put a lot of money into making sure these babies are healthy,” said Rep. Duane Stark, R-Central Point, a Christian minister and staunch opponent of abortion.

Sen. Elizabeth Steiner Hayward, D-Beaverton, spoke respectfully of her colleagues’ opposition to abortion, even as she held fast to her belief in a woman’s right to choose. "The woman's life always takes precedence," she said.

Passage had been cleared for HB 3391 after Oregon House Democratic negotiators struck a deal with Providence that allows the Catholic insurer to continue to deny abortion coverage to its members, but sets up a process for the Oregon Health Authority and the Department of Consumer & Business Services to develop a system whereby a third-party might contract the service.

Providence threatened to leave the Oregon insurance market in March if it were forced to provide abortion coverage for its members, even though Providence already pays for abortions for the Public Employee Benefit Board by contracting through a third-party, United Life.

“We are not permitted as an organization to provide or cooperate with the provision of abortion services … It is a red line we cannot cross,” said Providence CEO Mike Cotton. “The abortion mandate would not allow Providence to file forms or serve Oregon’s insurance market” -- effectively putting 260,000 people’s healthcare coverage at risk.

Other Oregon insurers are not required to cover abortion, but do so anyway. It’s a much lower cost procedure than covering an entire pregnancy, including delivery. But currently women with Providence health insurance are forced to pay for an abortion entirely out of pocket or go forward with an unwanted pregnancy.

Women’s health advocates, including Planned Parenthood, told The Lund Report that in response they would allow Providence to hire a third-party contractor for the Oregon private health insurance market, mirroring the agreement with PEBB and a deal New York state made with a different Catholic insurer.

HB 3391 would allow almost all women in the state to have access to the full spectrum of reproductive health services, but Providence’s members will have to wait a bit longer.

The final version of the bill was released on Wednesday morning as the Joint Human Services Subcommittee on Ways & Means approved a slate of healthcare policy bills, including House Bill 3391.

In her remarks to The Lund Report, Steiner Hayward emphasized that the bulk of the funding for the program will go for contraception, particularly for immigrant women: “It’s primarily to prevent unplanned pregnancies. Abortion is a small part of it,” she said. “The more access to contraception, the fewer abortions.”

Abortions peaked in Oregon at 15,700 in 1980, but despite significant population growth, the number of terminated pregnancies fell to 8,600 as of 2015. Meanwhile, 44 out of 1000 teenage girls got pregnant in 1980 compared to just 11 out of 1000 girls age 15 to 17 in 2015.

Steiner Hayward credited these public health improvements to gains in contraceptive access. She was also pleased the state could find a few million dollars to keep immigrant mothers covered for two months after giving birth, which will allow for the placement of long-acting reversible contraceptives. “People who come to this country want to have better lives for their family.”

Currently, immigrant women who will give birth to Oregon-born babies can receive federal assistance for prenatal care and delivery, but that care cuts off the day the child is born. Oregon will cover their postpartum care on its own with general fund dollars.

Rep. Knute Buehler, R-Bend, a self-described “rare pro-choice Republican,” also opposed the arrangement -- though on fiscal grounds, arguing that in a budget environment where schools and the foster care system are underfunded, the state should not be pumping money into new programs.

HB 3391 could increase the ire of the Oregon Family Council and anti-abortion activists, who have already been at work on a ballot measure to strip women on the Oregon Health Plan of abortion coverage. However, 63 percent of Oregonians support legal abortion in most circumstances, according to Pew Research.

Buehler also objected on fiscal grounds to $36 million that will extend the Oregon Health Plan to 14,000 immigrant children who are in  the United States without legal permission, arguing that they can already receive care in federally qualified health centers, which have been given a boost in state funding to provide primary care to immigrants.

But Steiner Hayward, who is a family physician while Buehler is an orthopedic surgeon, said that the $45 million for the two bills was a small price tag in a healthcare budget just shy of $20 billion, and that the current arrangement with safety-net health clinics leaves children cut off from expensive speciality care in case of a major illness.

Reach Chris Gray at [email protected].

Correction: An early version of this article incorrectly stated that public money would be used to cover Providence's costs of abortion.

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