By Tara Bannow
A pair of Oregon lawmakers have launched a pre-emptive effort to preserve the requirement that health insurance policies provide free birth control and other services to women in case the Affordable Care Act is repealed.
House Bill 2232, which supporters have dubbed the Reproductive Health Equity Act, would also require health insurers in Oregon to provide annual well-woman visits, pregnancy testing and prenatal services with no out-of-pocket costs to patients. It also would require such coverage for abortions, which would be rare and is not currently part of federal or state law.
Sen. Laurie Monnes Anderson, a Democrat from Gresham, said she pre-filed the measure ahead of the legislative session, which begins Feb. 1, to protect services currently required under the Affordable Care Act, the federal health care reform law that Republicans in Congress are working to dismantle.
“This is just another way to be proactive because we do not know the landscape at the federal level,” she said.
Oregon joins a number of other states in which lawmakers have recently launched efforts to preserve free birth control if the ACA is repealed. Currently, only California, Illinois and Vermont require insurers to cover birth control without making patients pick up a portion of the cost, according to the Guttmacher Institute, a research and advocacy organization focused on sexual and reproductive health.
Twenty-eight states, including Oregon, have laws that mandate contraceptive coverage, although most allow cost-sharing. If the ACA is repealed, policies sold in Oregon will still need to cover contraceptives, but insurers could impose copayments or other out-of-pocket costs.
HB 2232 directs the Oregon Health Authority to reimburse the cost of providing the services outlined in the bill. It directs the agency, in collaboration with insurance regulators, to seek federal funding, such as through waivers or demonstration projects, that could help fund the services, but says the measure isn’t contingent on federal support.
Seven advocacy groups helped craft the bill, including Planned Parenthood Advocates of Oregon, NARAL Pro Choice Oregon, Family Forward Oregon, Asian Pacific American Network of Oregon, ACLU of Oregon, Western States Center and the Oregon Latino Health Coalition, said Jimmy Radosta, a spokesman for Planned Parenthood Advocates of Oregon.
The coalition plans to publicly announce the measure late Wednesday morning, Radosta said. He declined to comment before then.
The measure would also require coverage for a number of screenings, including cervical cancer, urinary tract infections, osteoporosis, anemia, gestational diabetes, sexually transmitted infections and genetic breast cancer risk. Insurers would also need to cover breastfeeding support and supplies and interventions for tobacco use interventions and domestic violence.
It also says insurers can’t limit enrollees’ ability to choose which contraceptive method they prefer.
The bill also requires coverage for abortions, an item that’s likely to be controversial among lawmakers. It would allow employers to claim religious exemptions.
“Termination of pregnancies is always an issue that’s very volatile in this body,” Monnes Anderson said.
State mandates on abortion coverage, especially with no out-of-pocket costs, are rare, said Elizabeth Nash, senior state issues manager in the Guttmacher Institute’s Washington, D.C., office.
“In a sense, this is refreshing that this bill really covers the gamut of reproductive health care,” she said.
The Affordable Care Act does not include abortions in its list of required health care services, so this measure would go beyond the federal law.
The U.S. abortion rate reached a historic low in 2014. The estimated 926,200 abortions performed that year represented a 12 percent decline from 2011, according to a report released Tuesday by the Guttmacher Institute. The study didn’t answer why, but Nash said she believes the Affordable Care Act’s contraceptive coverage mandate played a big role.
“More women are able to access contraceptives and they’re able to access the methods that are best for them,” Nash said. “So we are expecting to see that unintended pregnancies will continue to decline, which is one reason why we’re seeing fewer abortions.”
Monnes Anderson said she grew up before Roe v. Wade, the 1973 Supreme Court decision that cleared the way for women to obtain abortions.
“We do not want to go back to the dark ages,” she said. “This just codifies what we have right now and will want to keep, no matter what federal law says.”
A typical abortion that’s performed within the first trimester of pregnancy costs about $500, which is a lot for many women to pay out-of-pocket, Nash said.
It’s unclear how health insurance carriers will react to the measure, which would take effect Jan. 1, 2018. A number of carriers declined to comment for this article. Lobbyists with Providence Health Plans and Health Net supported the Oregon law that allows pharmacists to prescribe birth control, which makes Monnes Anderson hopeful they’ll support this one as well.
“We know they are going to be a big player at the table,” she said. “We’re very open to what they have to say.”
Rep. Jeff Barker, a Democrat from Aloha, introduced the bill in the House.
Nash, of the Guttmacher Institute, said she’s glad to see legislation like this.
“At the very least, it shows Washington that state legislatures are interested in protecting this coverage,” she said. “Perhaps they could change their minds.”
— Reporter: 541-383-0304,