People in Oregon are bracing themselves for changes to health care stemming from the election of Donald Trump, though the nature and extent of those changes is yet to be seen.
In Trump’s first term, the number of uninsured people increased and he tried to undermine the Affordable Care Act after Congress failed to repeal it.
During his latest campaign for the White House, Trump spoke infrequently on health care and offered few specifics, saying he had a “concept of a plan” for replacing the Affordable Care Act and waffling on what abortion restrictions he would support in the wake of the Supreme Court’s ruling making abortion access a state decision.
He has been more clear on proposed cuts to Medicaid and his opposition to funding for gender-affirming care, and his statements about “mass deportations” of United States residents who lack documentation have additional implications for health care.
“The fear” heard from patients came up yesterday in a staff meeting at OYEN Emotional Wellness Center, a behavioral health provider in Woodburn that serves the Latino community and others, said founder and CEO Melinda Avila.
“Kids are going to be worried about whether their parents will be deported. Our DACA recipients will be worried. There’s going to be a lot of depression and anxiety over this. It’s very scary,” Avila said, adding that she foresees “a lot of grief and loss, a lot of anxiety and a lot of depression.”
State Rep. Rob Nosse, a Portland Democrat who chairs the House Committee on Behavioral Health and Health Care, echoed other observers in saying health care policy appeared to be a second-tier issue for Trump, who did not campaign heavily on it. So Nosse is hopeful that changes affecting access to care would be limited in the short term.
“Any big swings that Trump and a completely Republican-controlled Congress would like to make would take time,” he said.
Nosse said he is concerned about possible cuts to Medicaid funding, which would affect the free care offered to low-income people in the Oregon Health Plan. But he said Trump also could make good on his promise to address drug prices.
“Who knows what he’ll do?” he said.
Oregon Health Authority Director Sejal Hathi told The Lund Report in a statement that “like other health agencies across the country, the Oregon Health Authority will continue to monitor, prepare for, and inform the public about potential federal changes that could impact the health of the people of Oregon.”
She added, “let us be clear: the Oregon Health Authority remains clear-eyed and committed to expanding opportunity, improving well-being, and eliminating health inequities for all Oregonians. Oregon’s health agency will continue to march at the vanguard of progressive policy, to champion affordable and quality care, and to safeguard essential health freedoms and benefits. There has been and will be no deviation from this mission.”
Fear grows over Latino health, access
“We’ve been here before, unfortunately,” said Olivia Quiroz, executive director of the Oregon Latino Health Coalition.
Her group will be focused on preserving the Oregon Health Plan, the state’s version of Medicaid, from possible reductions under the incoming Trump administration, she said, adding that during the last time he held office “we defended and protected our immigrant families, ensuring they still access (health) benefits.”
She said that the Oregon Health Plan serves a large portion of Latino working families. And Oregon, through the Healthier Oregon program, is one of six states that offers state health benefits to immigrants regardless of their legal status.
Already there are concerns that people have the coverage but are not using it. Quiroz said her organization is also concerned that families eligible for the plan will not enroll because they are concerned about being deported.
“We know that families isolate and retreat,” she said. “And it’s out of fear for their safety and their children.”
Avila, the founder of OYEN, added that providers and advocates are already discussing how to work together and protect people in the face of change. In another state, people would be even more fearful, she said.
“But we are in Oregon, and I’m hopeful that we are going to come together as a community with allies,” she added. “And we’re going to figure out how to support the most vulnerable people out there.”
Gender-affirming protections targeted by Trump
Trump has said he would sign an executive order directing federal agencies to cease all programs that support “gender transition at any age” and he would ask Congress to halt funding for these procedures.
Nosse said he is worried about the incoming Trump administration’s plans for transgender care. But he said any changes from the Trump administration would have a limited effect because health insurance is fragmented and different federal and state regulations mean there are effectively five health care systems in the U.S.
“They can try, but I just don’t think they would succeed,” he said.
Oregon lawmakers passed a bill in 2023 intended to protect access to gender-affirming care as well as reproductive health services in response to the U.S. Supreme Court’s Dobbs decision that ended the national right to an abortion.
The new law requires private insurers to cover more gender-affirming procedures such as hair removal or surgeries to make a patient’s face appear more masculine or feminine.
Blair Stenvick, spokesperson for Basic Rights Oregon, said the new law will help ensure patients can access gender-affirming care in Oregon.
But Stenvick said a GOP-led Congress or the U.S. Supreme Court could still hand down more restrictions on gender-affirming care or reproductive rights. So Basic Rights Oregon, the ACLU of Oregon and other like-minded groups are preparing for a 2026 ballot initiative that will enshrine protection for gender-affirming care, abortions and IVF procedures in the state constitution, similar to a measure recently passed by voters in New York state.
“We have a strong defense in Oregon,” Stenvick said. “And we are building a stronger defense.”
Other states have placed restrictions on gender-affirming care particularly for minors.
Last year, the health authority’s advisory committee on health equity raised concerns about the effects of these bans and Oregon’s need to respond. According to a letter from the committee to health authority leaders, over 160,000 trans individuals and families have migrated to Oregon seeking care.
Abortion access faces test
Since the U.S. Supreme Court’s Dobbs decision, Oregon has strengthened its already strong protections for abortion access.
But the state’s reproductive health advocates remain worried that a Trump administration could limit access to mifepristone, a drug commonly used for medication-induced abortions.
Following the Dobbs decision, access to mifepristone became a new front in legal fights over abortion access. The Biden administration sought to expand access to mifepristone, and the U.S. Supreme Court dismissed an attempt earlier this year to halt the drug from being distributed through the mail.
Medications are used for 70% of abortions in Oregon. Planned Parenthood Columbia Willamette & Southwestern Oregon is making preparations to allow the use of other medications or surgical procedures to conduct abortions.
The organization reiterated its commitment to providing abortions in a sharply worded statement on Thursday.
“When we say ‘care, no matter what,’ we mean it,” the group said in the statement. “Here in Oregon and Washington, the right to sexual and reproductive health care is protected by law, and we are committed to upholding that right.”
Oregon lawmakers also set up a merger review program that could limit major transactions involving health systems or other providers who do not provide access to abortion, gender-affirming care or other types of treatment.
Universal health care and Trump
Dr. Sam Metz, a single-payer advocate affiliated with Physicians for a National Health Plan, told The Lund Report that Trump’s election amounts to “really bitter medicine that will make single payer-advocates better, if we can swallow it.”
For a single-payer health care system, similar to what’s in place in Canada or the United Kingdom, to get traction in the U.S. it needs to be viewed as a nonpartisan issue that is not part of a politically progressive agenda, he said.
Metz said he has met with Congressional aides to discuss single-payer and has found surprising interest among Republicans.
Currently, Oregon is devising a plan for a state-based universal health plan and there is a Democratic-backed bill in Congress that would help other efforts. Metz pointed out that Trump has previously made positive remarks about single-payer systems in places like Scotland. He said it’s possible that the president is mercurial enough to support single-payer.
“But it is not clear that he has any understanding of what that means, and if health care even registers on his agenda,” Metz said.
Additional uncertainties
Several other health care—related programs and issues are in play on the national and Oregon scenes:
Medicare: Republicans have been more supportive of the privatized version of Medicare, called Medicare Advantage, even as criticism among Democrats based on excessive costs, fraudulent billing and deceptive marketing has grown.
Health care mergers: The rapid pace of mergers and consolidation and their potential for harmful effects is a hot topic in Oregon. In the second half of Trump’s first term the Federal Trade Commission took an aggressive stance on health care mergers, a position that has broad bipartisan support. But his more recent campaign trail statements blasting the FTC when it comes to mergers in big tech have some observers fearing the worst.
Public health: Trump has said he’ll give a prominent role to Robert F. Kennedy Jr., a conspiracy theorist and vaccine skeptic.
Medicaid changes: While Republicans have pressed for cuts and changes to Medicaid, it’s unclear how much of an impact those efforts would have in Oregon, which secured a five-year renewal of its program in 2022, or whether those changes would face opposition among Republican governors.
Drug costs: Trump and his allies have talked about combatting drug costs but also have criticized Medicare’s ability to negotiate lower drug prices. Trump’s first administration approved a request by Florida to import low-cost drugs from Canada.
