House Bill 3391 is about Church v State

Bill would expand reproductive care access -- with abortion becoming a sticking point amongst religious healthcare providers

Guest Opinion-  Life comes with many shades of gray. When people confront tragedies and circumstances beyond their control, they have to make difficult choices that may shake their moral compass.

Pollsters like to make believe that life is binary. When it comes to reproductive rights, either you are “pro choice” or “pro life.” Where that asserts itself, to the detriment of many women, is the Catholic hospital.

The House Health Care Committee held a hearing for House Bill 3391, a bill that “requires health benefit plan coverage of specified health care services, drugs, devices, products and procedures related to reproductive health.” The specific service that is controversial: abortion.

More than abortion is at stake. The American Health Care Act threatens to eliminate health insurance for Oregonians who have benefited from Medicaid expansion. 

The Hyde Amendment of 1977 marginalizes and stigmatizes abortion through banning states from using federal Medicaid dollars to pay for abortions except for rape, incest, or life endangerment. The Hyde Amendment is reauthorized each year under appropriations bills for the Department of Labor and the Department of Health and Human Services. However states are free to use their own funds to cover additional abortion services. 

Sadly, abortion rates are higher among women of color. The underlying reason for these disparities is financial access to health care. It’s why there’s a higher prevalence of sexually transmitted diseases, cervical cancer and diabetes among these women too. When free contraceptives are available, abortion rates plummet.

Oregon has progressive values when it comes to reproductive health. Oregon is one of 17 states, going beyond the Hyde Amendment, to cover all or most medically necessary abortions.Last year Oregon led the country to become the first state allowing women to obtain birth control without a prescription.

But Oregon is also among eight states in the U.S. where more than 30 percent of its total hospital admissions are to Catholic facilities. 16 acute care hospitals in Oregon are Catholic. In rural Oregon, a Catholic facility can serve as a regional monopoly for many small communities.

The Catholic Church explicitly forbids Catholic facilities from providing several reproductive health care procedures, regardless of the religious beliefs of the patient seeking services or that of the medical professional providing them. Under the 72 Ethical and Religious Directives, women who receive care at a Catholic hospital have no access to:  

  • Abortion—even in cases of rape or incest (Directive 45) 
  • Ectopic pregnancy (Directive 48)
  • Contraception (Directive 52) 
  • Sterilization (Directive 53)
  • Prenatal diagnosis which is used to abort a fetus with a serious defect (Directive 50)

Seven years ago, former Bishop Robert Vasa of the Diocese of Baker ended sponsorship of St. Charles of Bend after hospital administrators refused to stop offering and performing tubal ligations.  This just meant that Catholic Mass would no longer take place at the hospital. However, no funding was jeopardized.

A 2011 Catholics for Choice Memorandum notes: “As nonprofit institutions, Catholic hospitals benefit from significant amounts of public funding, including state and federal grants for Title X family planning programs, Medicare and Medicaid.  Despite relying heavily on taxpayers’ dollars, however, Catholic hospitals routinely deny basic reproductive health services.”

They also point out, “medical professionals employed by Catholic hospitals have reported that, out of fear of theo-political retribution or out of sincere adherence to the draconian measures imposed by Directives, their institutions have forced them to endanger women’s lives by denying timely and necessary reproductive healthcare”—which has lead to substandard care for miscarriages and ectopic pregnancies.

The other dominant player in Oregon is Providence Health Plans.  At the hearing, CEO Michael Cotton testified that Providence provides managed care services to more than one million individuals and serve almost 50% of Oregonians who purchase individual coverage through the federally subsidized exchange. All of Providence’s 16 plans sold on the exchange do not cover abortions, while the other 50 plans do so.

To put this into perspective (and in recognition that not all Catholics get their health insurance through Providence), less than 1/10 of Oregonians practice Catholicism. Indeed, Oregon has the highest percentage of religiously unaffiliated adults in the entire nation (37%). 

Providence also employs many Oregonians. The Hobby Lobby Supreme Court decision is a big deal because it allows employers to dictate their values about contraception. But the decision applies only to “closely held” corporations, those in which five or fewer people own 50 percent of the shares.

Non-profits mean non-ownershipProvidence is a nonprofit 501(c)3 whose mission is: “Healthcare with special concern for the poor and vulnerable in Oregon.” A non-profit belongs to the public at-large. So it's imperative that Providence insurance meets the health care needs of all their members. 

To bypass the Ethical and Religious Directives, nearby physician-owned ambulatory surgery centers perform necessary reproductive health services. But reimbursements through Providence health plans may be another problem.  Some employers use third parties to provide forbidden reproductive health coverage to their enrollees—although it’s not always clear on a company’s website. Indeed, some Providence Health Plans are supplemented with Unified Life plans to cover abortion.

There are only 11 facilities (8 of them Planned Parenthood) that provide abortion services in Oregon. Rural Oregon is grossly under-served.

House Bill 3391 pits Church v State. In the end, Oregon women will lose if this bill does not pass.

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