Health insurers not following Oregon law requiring free reproductive health care, state audit says

Oregon’s governor, lawmakers and state agency officials have often touted the state’s reproductive rights law as one of the most comprehensive and equitable in the country.

But there’s a problem: Many insurers providing coverage to more than 1 million Oregonians are not following the regulations.

That is one of the findings of an audit ordered by the state Department of Consumer and Business Services, which regulates the insurance industry. Released Tuesday, the report said investigators found widespread evidence of violations of the Reproductive Health Equity Act, passed by the Legislature in 2017 and effective in 2019. The law requires insurers to provide free coverage for reproductive health care, including screenings, abortions and contraceptives – even to undocumented immigrants.

The violations mean that Oregonians have been paying, at least in part, for reproductive services that are supposed to be free. The report did not say how many Oregonians were affected.

The act applies to commercial insurers, including individual and large and small group plans. The only exceptions to the law are religious-based insurers, such as Providence Health Plan, which are exempted from the law.

The audit examined claims from Jan. 1, 2019, through Dec. 31, 2020. The department initiated the audit when its work on a legislative report in June 2020 found that the requirements were not being fully followed.

The agency found “variations in coverage and indications of potential widespread noncompliance with the law,” specifically the failure to fully pay for certain services, the report said.

Reproductive rights supporters were angered but not shocked by the report.

“It’s incredibly disappointing and incredibly unsurprising,” state Sen. Elizabeth Steiner Hayward, D-Portland and a physician at Oregon Health & Science University, told the Capital Chronicle. While acknowledging that “it is tough to revamp when new requirements go into place,” she said insurers have had almost three years to adapt to the law. 

“What baffles me is this: All those things are things that ultimately save insurance companies money,” Steiner Hayward said. “It is cheaper to provide contraception than to care for someone when she’s pregnant. It’s also smarter because people who get pregnant when they’re planning to are more likely to have healthy babies.”

Under the law, insurers must cover abortions, anemia screenings, contraception, pregnancy screening, sterilization and screening for sexually transmitted diseases for free. The law also requires coverage for undocumented immigrants. 

Abortion bans could be coming

The report comes as reproductive rights activists and anti-abortion groups – along with the public – await a decision by the U.S. Supreme Court that could overturn Roe v. Wade, which was decided in 1973, and a subsequent decision – Planned Parenthood v. Casey – which upheld Roe in 1992.

The department is preparing reports on each company’s violations. Mark Peterson, acting communications director for the Consumer and Business Services Department, said it has received few complaints about coverage from consumers. 

The report did not name the insurance companies, but Peterson told the Capital Chronicle they are: Aetna, Inc., Cigna, Health Net Health Plan of Oregon, Kaiser Foundation Health Plan of the Northwest, Moda Health Plan, Inc., PacificSource Health Plans, Providence Health Plan, Regence BlueCross BlueShield of Oregon, Samaritan Health Plans, Inc., UnitedHealthcare Insurance Co., UnitedHealthcare of Oregon, Inc., and BridgeSpan Health Co. Their commercial health plans cover 1,042,661 Oregonians – one-fourth of the population.

“Not every violation was found at every insurer,” the department said.

Details about each insurer’s violations will be released after the companies have had the opportunity to review them, the agency said.

Range of violations

The audit found insurers didn’t pay for services they were required to cover for free, mishandled claims and applied inaccurate cost-sharing allocations between patients and insurers.

“Some insurers failed to provide coverage of certain benefits until 2020 or later, including preventive services covered by the Affordable Care Act,” the report said. ACA covers annual wellness checks and other preventive services, including mammograms, screenings for cervical cancer and prenatal care.

The report said that insurers in some instances required at least partial payment for abortions, anemia screening, contraception, pregnancy screening, sterilization and screening for sexucally transmitted diseases.

An Do, executive director of the Planned Parenthood Advocates of Oregon, said the report was an important first step.

“It’s important now, more than ever, that we have elected officials and agencies who stand up to insurers and hold corporations accountable for wrongdoing,” Do said in a statement to the Capital Chronicle. “Every Oregonian who was forced to pay out-of-pocket for sexual and reproductive health services — in violation of state law — deserves to be reimbursed, and insurers should be held accountable.

State lawmakers also welcomed the report. 

State Rep. Dan Rayfield, D-Corvallis and speaker of the House, told the Capital Chronicle that insurance companies must comply with the law.

“It is unacceptable that any Oregonian may have paid out of pocket for these critical health care services or was negatively impacted in any other way for accessing health care. I appreciate the work DCBS is doing on enforcement and hope they will continue to use their full authority to protect reproductive health services for all Oregonians,” he said.

State Rep. Rob Nosse, the newly appointed chair of the House Health Care Committee, said that “this examination is vital in light of what we know is coming with regard to reproductive health and abortion services in the United States to protect Oregonians.” 

Lawmakers and advocates said they eagerly await the company reports, which the department is finalizing.