In June 2022, the U.S. Supreme Court ruled in Jackson v. Dobbs that states have the power to restrict or ban abortion. Abortion remains legal and highly protected in Oregon, but 14 states now ban the practice with very limited exceptions.
Meanwhile, the number of abortions have increased in states like Oregon that have maintained access. In 2019, the last full year before the pandemic or legal abortion bans, 8,688 abortions were performed in Oregon. By 2023, that had increased to 8,937, according to preliminary state data. Many of those patients came from out of state, according to providers.
To understand what these changes have meant for providers who offer reproductive health care, including abortion, The Lund Report spoke with Dr. Alison Edelman at Oregon Health & Science University. Dr. Edelman grew up in Oregon and completed her medical training here. She’s now a professor of Obstetrics and Gynecology as well as the division director of Complex Family Planning at OHSU. The teaching hospital offers a range of services for people needing abortions, including virtual appointments for patients seeking medication abortions and overnight stays for people with complex or life-threatening medical situations.
The following interview has been edited for length and clarity.
The Lund Report: What has changed for you, as an Oregon-based provider, since the Dobbs decision?
Dr. Alison Edelman: Well, probably before Dobbs, you wouldn't be talking to me. We were incredibly careful about being vocal about what we do and how we do it. [When we realized Dobbs was coming] it was time to stand up and let people know who in their communities was providing this care and that we're here to provide this care in a non-judgmental manner and individualize it to the patient.
We understand the privilege of what our state allows and allowing travelers to come in to care for them too as well. We also have a tighter network of collaboration. We've always collaborated with our other sexual and reproductive health centers, but because they’re seeing increased volume, we then see increased referral volume.
And then we all increased capacity to see patients. So that’s something that we planned on and started a number of initiatives including the tele-health service at OHSU.
We also have special cash prices for people who can't use their insurance or don’t have insurance. That’s not usually somebody in Oregon because we have really amazing coverage for abortion care in Oregon, but travelers oftentimes have insurance that would cover their whole entire pregnancy, even if it was super complicated and they might die. But if they decide to do a treatment [abortion] that might prevent [death] it's not going to be covered. So that’s challenging for patients.
"As soon as Dobbs happened we started seeing people almost immediately from Texas, which was literally unheard of for us. We’ve seen people from Tennessee, Oklahoma, Colorado — even though Colorado is a permissive state — because we’ve set up a system here that allows people to not go into medical debt."
TLR: You said that before Dobbs, you wouldn’t have been talking to a reporter. Why are you talking to one now?
Edelman: We [at OHSU] had always just put our heads down and done our job just like everybody else. But with abortion care, it's incredibly important that your community know what you’re doing.
We're one of the top three abortion providers in the state, which people even at OHSU didn't know. We take the folks that are critically sick and also [we take] transfers for the rare complications that happen. We are the site that does that for the state and the region.
We’ve had a long time where we’ve normalized it but it still doesn’t feel normal for everybody. And unfortunately, abortion is one of those things in health care that people feel like it doesn’t need to be happening [and] that people will put a lot of effort into stopping, as we’ve seen.
TLR: Indeed. For people early in pregnancy who are seeking an abortion, there’s the option of being on a video call with a doctor and taking medication that will end a pregnancy. If somebody from out of state has a tele-health appointment, do they still have to be sitting somewhere in Oregon?
Edelman: Yeah. We don’t have the type of shield law that protects us from having the patients stay in their state. There are several states that now have that type of shield law. We do not.
But right now, what happens is if somebody wants to have a tele-abortion, let's say from Idaho, they have to step into Oregon or Washington where we’re licensed and have coverage. We mail them the medications and they’re supposed to do the entirety of their abortion while they’re in Oregon or Washington and then they can step back into their state.
So it is still cumbersome, but we’ve still had patients from Idaho that do that. We’ve had patients from other places too. I remember a patient from Texas came up because she had a friend in the area and it was just easy for her to arrive and do a tele-appointment with us.
We do FedEx the medications. But yeah, it's a little clunky for people outside our state.
TLR: You also work with people who have some pretty complicated medical situations. Have you had an uptick in those patients from out of state?
Edelman: Yeah, absolutely. We’ve seen people from states that we’ve never seen before. I’ve been here [at OHSU] as a medical student since 1993 so I have a good sense of what we were doing before and it’s pretty normal to see people from the Pacific Northwest.
As soon as Dobbs happened we started seeing people almost immediately from Texas, which was literally unheard of for us. We’ve seen people from Tennessee, Oklahoma, Colorado — even though Colorado is a permissive state — because we’ve set up a system here that allows people to not go into medical debt. We have specific cash prices for these patients [who have to pay out of pocket] and then they can get some justice funds.
Sometimes we’ll see people bumped over from a permissive state just because we know that people would need abortion care in the hospital because of their severity of disease. And that gets really expensive. With the No Surprises Act [that requires people to be told what they will be charged for medical care], people [with complex medical situations] are getting quoted anywhere from $40,000 to $100,000 that they're going to have to pay out of pocket. We can tell them, ‘Hey, you're gonna come in, we have two days [in the hospital] covered for you. That’s less than $15,000 for those two days and then we have a price if people need to see additional days.’
This week — I mean, it is, again, unheard of that we would see people from Florida, we’re just so far away — but the Florida ban went in place May 1 and we are starting to get patients in from Florida.
TLR: We’re a really long way from Florida.
Edelman: We’re a really long way from Florida but also we have the capacity.
What happens is many of these people start on their abortion journey six, eight weeks before. They’ve been trying to get into care and they end up coming up against [time] limits or they have to come in and out of a state three different times because of the laws there. They might be able to get an abortion there, but they have to go in and state that they want it, they have to go back and make sure that they see the same provider within a certain amount of waiting time and then they have to come back for the abortion. So they're needing three visits for something that would take one.
Instead, they might choose to come to a state that they don’t need to do all that and they can just come here, do it, have coverage for their work and their family and then go home.
Imagine if for a pap smear you needed to say, ‘Hi, I really would like a pap smear.’
And then they said ‘Come back in 72 hours, but you have to see me again, and I'm gone on vacation for a week. So now you'll have to come back next week.’
And then I have to come back to that provider again and say ‘Yeah, I still want it.’
"There are several states that now have that type of shield law. We do not. But right now, what happens is if somebody wants to have a tele-abortion, let's say from Idaho, they have to step into Oregon or Washington where we’re licensed and have coverage."
TLR: Nobody wants a pap smear that much.
Edelman: Yeah, nobody would want a pap smear that much. But for abortion care, people will do it because if people need an abortion then they need an abortion.
I don’t want to minimize it – [to say] that an abortion is the same as a pap smear. What I’m trying to show is: It’s routine care. To have routine care have so many barriers – it just makes it really challenging.
TLR: What does it feel like to be caring for people from all over the state and country with all of these additional needs?
Edelman: It’s challenging. It’s traumatizing to both the patient and the care team. They're coming in with a lot of extra needs and the stories that people have… Their pathway to get to us has been really terrible.
We have a great team. We have nursing staff on labor and delivery who have specifically come to work for us to support these patients. It’s been a challenge. The folks that need to travel in, even from our rural areas, it’s really challenging for them just having to leave their family. They’re coming to a state that they’ve never been to before.
We had a patient recently who’d never been on a plane before. She came by herself and had to leave her family and was having to pay out of pocket, and all of that is really awful. But on the other hand, we feel really privileged and honored to be able to take care of these folks in a way that hopefully they feel like they have amazing care. And oftentimes we get that from patients: [they] are like, ‘This is the most amazing care I've ever gotten in my life for health care.’ That makes us really proud.
"What happens is many of these people start on their abortion journey six, eight weeks before. They’ve been trying to get into care and they end up coming up against [time] limits or they have to come in and out of a state three different times because of the laws there."
TLR: What do you think people need to understand about abortion as health care?
Edelman: We need [to do] everything that we can do to allow people to access [abortion]. I mean, this is routine care. I don't want to diminish what people feel about it, but it’s as common as needing to go get your hair cut. But it’s not dealt with that way. And so, so many people have to leave their community to get this routine care because it’s not seen as routine care.
Everybody thinks that they have a say in the care that the patient is getting when it's abortion care. They could have nothing to do with our service and nothing to do with the patient. But then I get a phone call or an email saying, ‘Hey, I heard you did an abortion on that patient.’
I'm like, ‘First of all, you should not know about that. You're not involved in the care. Second of all, it doesn't matter because you’re not involved in the care.’
And they're like, ‘Well, it’s bothersome to me.’
There are a lot of things in healthcare that you may feel uncomfortable with. I'm not really sure why, for abortion care, you feel the need to reach out.
TLR: Before you go, can you just say a little about why you got into obstetrics and gynecology in the first place?
Edelman: Well, I'm an OBGYN but also I’m trained in complex family planning, which is basically abortion and contraception.
I think many of us have a drive for the mission. The mission is that women, girls and individuals with pregnancy capacity, have very specialized needs for care and that can be some of the most important care that we provide individuals in their lifetime. Abortion is that type of care, just as much as delivering somebody’s baby is that type of care.
