The Oregon Legislature has passed the Reproductive Health Equity Act, which will ensure that Oregonians, regardless of income, citizenship status, gender identity, or (with a few exceptions) type of insurance, will have access to the full range of preventive reproductive health services, including contraception, abortion, and postpartum care. This victory offers important lessons about how to continue making gains for equity and empowerment in the face of the national government's push to the right, and the law offers important ground for building toward further health equity, including single-payer.
Although the Reproductive Health Equity Act, like the Affordable Care Act, includes an exemption for "religious employers," it largely moves counter to the trend in many other states and at the federal level to restrict access to reproductive health care.
With this bill, Oregon will become only the second US state, after California, to require private insurers to cover all abortions. In contrast, 25 states restrict abortion coverage allowed in plans offered through their state insurance exchanges.
And funding is only one method of restriction. Just this year (according to the Guttmacher institute), legislators in 28 states have introduced 88 measures that would ban abortions completely or under certain circumstances, while another five states have already adopted 10 major new abortion restrictions.
The federal government, since the 1976 Hyde Amendment, has prohibited using federal funds to cover termination of pregnancy, except in cases of rape, incest, or endangerment to the life of the mother. The common exception for rape, of course, helps reveal that a driving concern in controlling access to abortion is less the purported life of the fetus, than the right of women to choose to be sexually active.
Anyway, federal funds have been supporting other forms of reproductive health care. Medicaid is indispensable for ensuring that low-income people have coverage for family planning, pregnancy-related care, STI testing and treatment, and other reproductive health services. But right-wing policymakers are seeking to undermine or even dismantle Medicaid, the source of health coverage for 74 million U.S. residents, including 13 million U.S. women of reproductive age.
A contributor to Forbes calculated that the republican health bill will provide about 3 million dollars in tax cuts to the wealthy for each person who dies because of loss of access to health care.
Even if the Republican bill passes, the Reproductive Health Equity Act will make safe, legal abortion more affordable and more accessible for about 43,000 Oregonians whose insurance plans have prohibitively high deductibles.
But the Reproductive Health Equity Act concerns more than just abortion; and it includes access provisions for non-documented women and anti-discrimination protections for transgender Oregonians.
It will remove barriers that hinder access to essential reproductive health care services, including prenatal care and lifesaving cancer screenings, for transgender and gender-nonconforming Oregonians.
It will expand postpartum care to about 48,000 Oregonians who have coverage for labor and delivery that drops immediately after birth.
It will help almost 19 thousand Oregon residents who are forced to pay out-of-pocket costs for preventive health services, including contraception, and it will continue to ensure that all Oregonians receive the full range of preventive reproductive health services at zero out-of- pocket cost, even if the Affordable Care Act is overturned.
And it will safeguard the right to abortion even if Roe v. Wade is overturned.
This legislation is not just a response to the Trump administration. The bill was developed, written, and supported, over the last three years, through the work of people directly affected by these obstacles to health care, and through the work of organizations that have been building the knowledge, capacity, and community to develop legislation, educate voters, petition the state, lobby legislators, and get out the vote.
Like the Cover All Kids bill--which also passed the Oregon House this past week, making Oregon the seventh state in the nation to provide healthcare for all children, regardless of residency status, and up to 300 percent of the federal poverty level—the Reproductive Health Equity Act is the product of long years of work on the part of many, many groups and individuals.
The success and value of such legislation requires the thoughtful and long-term work of a wide and diverse coalition of activists. The steering committee of the Pro-Choice Coalition included not just reproductive healthcare organizations – the state groups for NARAL and Planned Parenthood—but also legal and community organizations, and racial and gender justice groups, including the Oregon Latino Health Coalition; the Asian Pacific American Network of Oregon (APANO); the ACLU of Oregon, Family Forward Oregon, which works at the intersection of family and labor issues for family friendly workplace policy; and the Western States Center, which works to connect and build the power of community organizations . . . to achieve racial, gender and economic justice.
The list of supporting groups is even longer and more diverse, but special mention should go to We Are BRAVE, a project of the Western States Center led by women on color and focusing, as the acronym indicates, on Building Reproductive Autonomy and Voices for Equity.
The Director of Programs and Strategies at APANO, Kara Carmosino, describes the work that began three years ago to make the bill a success. In those three years,
APANO members and staff have supported a truly coalitional effort that collected nearly 10,000 petition signatures, gave dozens of workshops on strong families and reproductive justice, created art and collected stories to include transgender and gender-nonconforming people, as well as immigrants and refugees, in the narratives around who needs reproductive health care.
[They] launched a Mend the Gap report that directly challenged the myth that everyone in Oregon already has access to the reproductive health care they need. And [they] built a policy and a campaign that centered the stories of those who need this win the most.APANO also has a handy link for thanking the legislators who passed the bill. But, as Carmosino notes, the "victory belongs to ... many people, from those who canvassed events two summers ago, to those who bravely shared their stories, to those who signed petitions and lobbied in the capitol."
The importance of that wide and diverse coalition goes back to the origins of the bill and its design. Collaboratively developed to address the needs of marginalized communities, it was written by and for those who have been most impacted by the gaps existing in reproductive healthcare, to address the things that those communities themselves said they needed.
Although some of the arguments brought to bear in support of the bill pointed to economic questions—highlighting the fact that birth control is cheaper than maternity care, for instance. But saving money is just part of a strategy, never the goal; the goal is better healthcare—and thus better health and lives.
By lifting up the voices and supporting the advocacy of the least advantaged, these organizers have helped improve the lives of tens of thousands of Oregonians, and have demonstrated that the intersectional approach is not just ethical but effective. Their work has provided examples of how to expand access to healthcare, and have taken further steps toward getting health care for all.
If you're interested in working for a state single payer system in Oregon, you might want to check out the work of Health Care for All Oregon. They're offering a free screening Wednesday at noon at the Multnomah County Health Department 426 SW Stark, in the tenth floor conference room, of the video "Sick Around the World: Other Rich Countries Have Universal Health Care. Why Don't We?" HCAO's calendar on their website, lists other events and meetings around the state.
