Five years ago, Gov. Kate Brown signed groundbreaking legislation that expressly affirms individuals’ right to choose an abortion without interference from the government. The Reproductive Health Equity Act was designed to insulate Oregon from the turmoil unfolding across the country amid reports that the US Supreme Court may soon revoke the constitutional right to abortion established in Roe v. Wade.
Oregonians, who have consistently and emphatically shown their support for the ability of individuals to decide whether to have an abortion, rightly cheered the law’s passage. The act also expands access of low-income Oregonians to abortion and requires state-regulated health insurance plans to cover the procedure and other key reproductive health services with no out-of-pocket costs to patients.
But as with other innovative programs that Oregon leaders proudly champion, Oregon is falling short on implementation. Most concerning is insurer noncompliance – a problem the state has known about for more than two years. With a likely surge in non-Oregonians seeking abortions here if Roe is curtailed, state agencies, health care providers, advocates and others must bolster our current system both to provide Oregonians the benefits that are promised and to prepare the system for new stresses.
Start with insurer compliance. Or rather lack of compliance. In early 2020, the state agency that regulates insurers “found indications that insurance carriers may not have been providing full coverage” and charging out-of-pocket costs for abortion and other reproductive health services, a spokesman for the Oregon Department of Consumer and Business Services acknowledged in an email to The Oregonian/OregonLive Editorial Board. As a result, the agency opened an investigation focused on compliance.
Unfortunately, the agency declined a request by The Oregonian/OregonLive Editorial Board to share any findings until the investigation is finished, which will be sometime “in the next few months,” spokesman Mark Peterson said. Enforcement actions, such as restitution, also won’t come until the examination is complete. Peterson said late Friday afternoon that the pandemic, staffing issues and other logistics have helped prolong its examination, but stressed that the agency has been working with insurers in the meantime to improve compliance. Still considering the agency knew more than two years ago of problems, the delay in issuing a report and beginning any enforcement actions is inexcusable.
Such noncompliance is affecting real people. Portlander Kelly Stevens wrote recently about the billing confusion that followed her abortion, noting to The Oregonian/OregonLive Editorial Board, that she was the one informing the insurer or her provider’s office about the law. While Stevens was finally able to get the confusion sorted out, her experience raises the question of how many others either did not know or gave up trying.
Certainly, the law can be confusing. It does not cover all insurers in Oregon – religious employers are not required to offer contraception or abortion coverage and companies that are self-insured are among those not bound by the reproductive health act. But that’s why the state must do a better job in both education and enforcement. Without either, the law’s passage means nothing.
While the disappointing oversight by state government deserves the most attention, there are other hurdles. Oregonians in Portland and other urban areas can find multiple providers and clinics willing to perform abortions, but that’s not necessarily the case for those living in more rural areas, where health care as a whole is harder to access. Add in the challenges of offering abortions in a community that opposes them, and the difficulties of finding a willing provider get even more difficult, notes Christel Allen, executive director of Pro-Choice Oregon.
She said some providers are stepping into the breach, including Oregon Health and Sciences University, which has been offering training to nurse practitioners, physicians assistants and others in providing abortions and other reproductive health services. OHSU is exploring other ways to support rural colleagues as well, spokeswoman Sara Hottman said. Helping expand the number of professionals who can safely provide such services is critical for ensuring that the right to an abortion isn’t a theoretical one.
And finally, the state needs to develop a plan for how much it’s willing to spend to help non-Oregonians access abortion services in Oregon. Earlier this year, the state Legislature allocated $15 million to nonprofit Seeding Justice to assist patients and providers affected by Idaho’s newly passed law that bans abortions after six weeks. With Roe’s future in doubt, and Oregon as one of only five states with no restrictions on abortions, observers predict the number of pregnant women seeking abortions in Oregon will surge. While Oregonians should stand firm on their commitment to abortion rights for whoever needs access, they should also be pragmatic about how much public money is devoted to assistance.
It’s important to note that the state has taken numerous actions over the years to improve contraceptive access and education to prevent unwanted pregnancies, from making birth control pills available without a prescription to ensuring that Medicaid covers emergency contraception for no cost. And unsurprisingly, the number of abortions in Oregon has plummeted in the past decade from 10,000 in 2010 to about 6,600 for 2021, according to Oregon Health Authority’s Center for Vital Statistics. While the state should also ensure that those initiatives continue to help drive down the number of unwanted pregnancies even more, the ability to get an abortion must remain as a key part of our health care system.
Because of Oregon leaders’ actions, the state’s commitment to abortion rights persists regardless of the US Supreme Court’s ultimate decision. It must ensure that right is one Oregonians can exercise.
-The Oregonian/OregonLive Editorial Board
The Oregon Department of Consumer and Business Services urges that anyone with complaints about insurers contact them either by phone: 1-888-877-4894; by email at DFR.firstname.lastname@example.org; or by going to the website at https://dfr.oregon.gov.
Editorials reflect the collective opinion of The Oregonian/OregonLive editorial board, which operates independently of the newsroom. Members of the editorial board are Therese Bottomly, Laura Gunderson, Helen Jung and John Maher.
Members of the board meet regularly to determine our institutional stance on issues of the day. We publish editorials when we believe our unique perspective can lend clarity and influence an upcoming decision of great public interest. Editorials are opinion pieces and therefore different from news articles.