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Providence Threatens to Leave Oregon Insurance Market Over Bill that Would Ensure Abortion Access

House Bill 3391, the comprehensive reproductive health bill, requires abortion, vasectomies and contraceptive care be covered at no additional out-of-pocket costs to consumers, gives postpartum care to low-income unauthorized immigrants, and adds further clarity to stop insurers from discriminating against transgender individuals.
March 17, 2017

Providence Health Plan has threatened to pull out of the state health insurance market if they are forced to cover abortion services, citing First Amendment rights in an effort to block a bill that requires coverage of abortion and other reproductive health services with no additional cost-sharing.

“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.

House Bill 3391 works to fill gaps other than abortion -- it would extend pregnancy care to include post-partum care for immigrant women that receive Medicaid for Oregon-born babies, it requires insurers to cover pap smears and other cancer screenings for transgender men who still have a uterus, and it requires legacy, pre-Obamacare health plans to include contraception.

Cotton’s testimony is in direct conflict with what his company is already doing for the Public Employees Benefit Board. Providence offers abortion and contraceptive services through a third-party, Unified Life Insurance, a conditional requirement that Providence agreed to in order to receive the lucrative PEBB contract, which pulled in $31 million for the insurer in 2013.

“Abortion services are covered in all PEBB plans,” said Courtney Warner Crowell, a spokeswoman for the Oregon Health Authority. “They have a contract with a third-party, and that third-party does that service.”

HB 3391 would ensure coverage for all consumers insured with plans regulated by the Oregon Department of Consumer & Business Services. Providence could appeal under a federal statute if it felt its religious values were being violated, or it could simply use the same process as done with PEBB.

“There’s nothing that would stop them from doing that,” said Kimberly McCullough, an attorney with the American Civil Liberties Union.

Laurel Swerdlow, advocacy director for Planned Parenthood Advocates of Oregon, said that New York state has mandated abortion coverage for all its insurers, and Fidelis Care, another Catholic insurer, complies through the same third-party arrangement as Providence uses for PEBB.

And although Providence representatives at Wednesday’s hearing did not raise objections to providing contraceptive care, the Catholic Church is also opposed to contraception, even as Oregon state law clearly requires them to cover contraception and as women with Providence plans are receiving this coverage.

1st Amendment Protects Freedom Of and From Religion

Opening the door to religious control of medical coverage decisions could, hypothetically, lead to a Scientologist-run health plan that denies psychiatric care or a Christian Scientist health plan that doesn’t cover chemotherapy or a Jehovah’s Witnesses health plan that blocks coverage for blood transfusions. However, within the U.S., the Catholic Church is the most influential large-scale provider of religious-affiliated healthcare.

Providence argues that the Constitution prohibits the state from requiring it to provide services it objects to on religious grounds, but its threat to leave Oregon’s insurance market also brings up First Amendment issues for a different reason. Congress, and by extension the Legislature, shall make no laws respecting the establishment of religion. By allowing a Catholic health provider to impose its religious beliefs on millions of non-Catholic Oregonians, it could end up violating their rights.

“There might be a Constitutional argument there,” said McCullough, although she said that the argument had never been litigated.

Providence is now one of only two health insurers selling plans statewide on the online marketplace. Providence’s sole competitor is Bridgespan, a subsidiary of Regence BlueCross BlueShield, which for 2017 has sold just 10,000 health plans on the exchange, compared to 81,000 for Providence. Though other insurers offer coverage in limited geographic portions of the state, if Bridgespan pulls out, many Oregon residents would be forced to accept restrictions imposed by the Roman Catholic Church if they wanted to receive healthcare coverage.

Other Protections in Bill

Beyond abortion, advocates of House Bill 3391 are pushing to close several coverage gaps for reproductive healthcare that exist in the current system.

Kaden Merrill, a transgender man, testified that he was denied coverage for a hysterectomy after a pap smear revealed precancerous cells, which have spread in the past two years as he has fought two different insurers for coverage.

“The [first] insurance company did not have a code for a transgender man to receive a hysterectomy. … Transgender men like me face this discrimination all the time,” Merrill said. The bill would codify rules that health insurers cannot discriminate on the basis of gender identity.

Swerdlow told The Lund Report that about 18,600 women of reproductive age do not have health plans that include contraceptive care at no additional cost, despite a mandate in the Affordable Care Act.

This is because Oregon has allowed the continuation of so-called grandfathered plans -- substandard health plans that existed before the ACA placed new requirements on health plans.

HB 3391 adds no-cost contraceptive care to these plans.

The bill will also extend care coordination for immigrant women receiving pregnancy care by allowing them to receive post-partum care for two months as they recover from childbirth. Oregon has been able to provide Medicaid coverage, with federal support, to about 2800 women each year who do not have legal permission to live in the United States, but whose babies will be American citizens.

This section of the bill might have a considerable fiscal impact to the state budget, since the federal government may not provide support for the mothers once the child is born.

In addition to requiring coverage for abortion, the bill also requires health insurers to include the cost of this care in premiums, and stop charging large out-of-pocket costs to women faced with the difficult decision of terminating a pregnancy, which is typically an unplanned and unbudgeted expense.

Reach Chris Gray at [email protected].