Medical services for women and children face political challenges, particularly from President Donald Trump and Republicans who want to undo Barack Obama's signature health-care law.
But one participant at a symposium on women's health says the 2010 law, known as the Affordable Care Act, has helped make coverage possible for 95 percent of adults and 98 percent of children in Oregon.
"These are the basics we have accomplished," says Dr. Renee Edwards, a urogynecologist and co-executive director of the Center for Women's Health at Oregon Health & Science University. "But we want more."
She was one of several speakers at the ninth annual health care symposium sponsored by Virginia Garcia Memorial Health Center. The April 20 event was attended by hundreds at OHSU's Collaborative Life Sciences Building on Portland's South Waterfront and focused on "Women and Children First."
"The reason it is important to have a women's health center and be dedicated to women's health is because women are different," said Edwards, whose center logs 80,000 patient visits annually.
Edwards said aside from physical differences, women also react differently to medications and other treatments.
Virginia Garcia, the symposium sponsor, has a big presence in Washington County. It runs community clinics in Beaverton, Hillsboro and Cornelius, school-based clinics in Beaverton, Century, Forest Grove, Tigard and Tualatin high schools, and LifeWorks NW mental health and addiction services in Hillsboro.
Debate in D.C.
U.S. Rep. Suzanne Bonamici, the Oregon Democrat who opened the symposium, decried the legislation that House Speaker Paul Ryan proposed and Trump supported. It never reached a vote of the full House largely because of divisions among majority Republicans.
"A meaningful discussion about health care reform is in short supply in Washington right now," Bonamici said. "We know that recent proposals brought forward show a lack of caring for the well-being of people in Oregon and across the country."
Among other things, she said, the bill would have reduced or eliminated coverage of "essential benefits" such as maternity care, mental health and drug and alcohol treatment. It would have reduced insurance subsidies to older low-income people and ended service payments to Planned Parenthood.
"We would have gone back to the days when people bought insurance coverage and then discovered it did not cover what they really need when they really needed it," Bonamici said.
"People around this country spoke up and it really made a difference."
Republicans are working on a new version. Trump seeks political leverage from the insurance subsidies to get minority Democrats to support it, or to trade their continuation in exchange for federal money for his proposed border wall with Mexico.
Planned Parenthood remains a congressional target for defunding.
"We are at an all-time low for unplanned pregnancies right now," said Stacy Cross, chief executive of Planned Parenthood of the Columbia/Willamette. "There are simple reasons for that," namely broadened access to birth control with no copayments under the Affordable Care Act.
"We do not have to look far to see what could happen without it if Planned Parenthood gets defunded," Cross added.
She referred to studies in Texas and Wisconsin about increases in unplanned pregnancies and maternal deaths after the states chose to discontinue services.
"When we talk to people who believe this happens only in other countries, this is happening right now in America," Cross said.
Cristina Marquez, advocacy and civic engagement coordinator for Causa, said Trump's push for detentions and deportations by Immigration and Customs Enforcement has created turmoil among Oregon immigrants.
"Our stress levels are up," she said. "There is fear even of going to the doctor or taking kids to school because of the reality that ICE can come and deport mom or dad."
Current ICE policies bar such arrests at schools, hospitals and some types of clinics, but they are not written into law.
State budget woes
The challenges affect state government as well.
House Speaker Tina Kotek, D-Portland, says a rising state share of the Oregon Health Plan — the joint state-federal insurance program for low-income people — accounts for a chunk of the $1.6 billion gap between forecast income and projected spending in the two-year budget that starts July 1.
The expanded plan covers about 1 million people, one of every four Oregonians, and a third of those could lose out in the worst-case scenario.
"We have to be practical. Without new revenue, we will have to cut programs," Kotek said.
In the short term, the health-care portion could be covered by a new agreement with hospitals and health insurers to assess themselves to recoup more in federal dollars. But Kotek said such provider taxes, which date back to 2003, cannot be a permanent solution.
"The conversation about revenue has to happen," she said. "I do not know whether it will be successful, to be honest, but we are going to try really hard, because I think that is the state we want to have."
'Beacon of light'
Kotek and others said a couple of legislative proposals hold out hope.
One proposal introduced in both chambers (HB 2726 and SB 558) would set up a work group in the Oregon Health Authority to reach out to about 4 percent of children not covered by a 2009 expansion.
"We have been working to ensure that health care is a right for every Oregonian," said Linda Roman, director of health policy and government relations for the Oregon Latino Health Coalition. "One of our priorities is to cover all kids."
The other proposal (HB 3391) would require insurance coverage of some services for women's reproductive health. It's a backstop measure if Congress does away with them as "essential benefits" under federal law.
Monica Arce, lead clinician for the Virginia Garcia Women's Clinic, said unplanned pregnancies still account for half of the total.
"If we could cut that by even half, the effect would be huge," she said.
That goal is better accomplished, she said, if women have access to injectable contraceptives — known as long-acting reversible contraceptives — that are more effective than pills, which depend on an individual's ability to follow a regimen of taking them.
Both proposals are in the Legislature's joint budget committee.
Planned Parenthood's Cross says Oregon is the only state without any restrictions on family planning.
"In Oregon we do not have to be on defense, unlikely many of my peers," she said.
"It is being held as a beacon of light for the entire nation."