Oregon Decline Report 5.25.23: You Will Affirm Us

Republicans at the Bridge

Oregon state Republicans are boycotting the legislature to prevent a quorum and inevitable passage of an aggressive “reproductive healthcare” bill requiring insurers to fund all manner of transgender treatment, allowing minors over 15 full access to abortion and “gender affirming” surgery without parental consent and requiring all colleges and universities to maintain facilities providing all reproductive health care, in the Orwellian sense, short of surgical abortion. The bill would also allow providing “reproductive health care information and services to any person without regard to the age of the person”.

[sec. 8 1](b) A physician, physician assistant licensed under ORS 677.505 to 677.525, nurse practitioner licensed under ORS 678.375 to 678.390, pharmacist licensed under ORS chapter 689 or naturopathic physician licensed under ORS chapter 685 may provide [birth control] reproductive health care information and services to any person without regard to the age of the person.
(2) A minor 15 years of age or older may give consent, without the consent of a parent or guardian of the minor, to:
(a) Hospital care, medical or surgical diagnosis or treatment by a physician licensed by the Oregon Medical Board or a naturopathic physician licensed under ORS chapter 685, and dental or surgical diagnosis or treatment by a dentist licensed by the Oregon Board of Dentistry[, except as provided by ORS 109.660].
(b) Diagnosis or treatment by a physician assistant who is licensed under ORS 677.505 to 677.525 and who is acting pursuant to a collaboration agreement as defined in ORS 677.495.
(c) Diagnosis and treatment by a nurse practitioner who is licensed by the Oregon State Board of Nursing under ORS 678.375 and who is acting within the scope of practice for a nurse practitioner.

There are limits to minor consent, of course:

(d) Except when the minor is obtaining contact lenses for the first time, diagnosis and treatment by an optometrist who is licensed by the Oregon Board of Optometry under ORS 683.010 to 683.340 and who is acting within the scope of practice for an optometrist.

Much of the law is about enshrining abortion rights in state law in response to the overturning of Roe v Wade, greatly expanding access to contraception and abortion, shielding doctors in Oregon from lawsuits from other states and, in apparent anticipation, from charges of “assault and battery” for transgender surgery. It mandates colleges and universities maintain extensive contraceptive services and have readily available “morning after pills”, establishing an impressive oversight regime for implementation, mandating annual audits in perpetuity.

(2) No later than April 1 of each year, each public institution of higher education shall submit a plan to the authority. The plan must demonstrate how the institution will ensure its students have access to medication abortions, including having in place equipment, protocols, patient educational materials, informational websites and training for staff.

(3) No later than July 1 of each year, the authority shall determine whether each
institution’s plan submitted under subsection (2) of this section is adequate in proportion to the institution’s capacity to provide services and, if the authority determines that an institution’s plan is inadequate, shall provide further guidance to the institution with remedial measures for developing an adequate plan.

Parents are legally left out of the loop:

SECTION 9. ORS 109.650 is amended to read:
109.650. (1) Except as provided in ORS 192.567, a physician…may not disclose to the minor’s parent or legal guardian information regarding the information and services provided to the minor unless the minor has authorized the disclosure in writing.
(2) A hospital or a physician…may advise [a] the minor’s parent or legal guardian [of a minor] of the care, diagnosis or treatment [of] provided to the minor or the need for any treatment of the minor, without the consent of the minor.

As for runaways, juvenile delinquents and any ward of the state parental consent can be dismissed outright:

418.307. (1) A physician…is authorized to treat a child who is ward of the court or is a dependent or delinquent child in accord with the best medical judgment of the physician, naturopathic physician, dentist or responsible official of the hospital and without consent if:
(a) Because of the general state of the child’s health or any particular condition, the physician, naturopathic physician, dentist or responsible official of the hospital determines that in the medical judgment of the physician, naturopathic physician, dentist or responsible official prompt action is reasonably necessary to avoid unnecessary suffering or discomfort or to effect a more expedient or effective cure; and
(b) It is impossible or highly impractical to obtain consent for treating the child from the child-caring agency, the child’s parent or the child’s legal guardian.

An insurer will be required to accept “[a]ny combination of gender-affirming treatments”:

[sec. 20 (1)](b) “Gender-affirming treatment” means a procedure, service, drug, device or product that a physical or behavioral health care provider prescribes to treat an individual for incongruence between the individual’s gender identity and the individual’s sex assignment
at birth.
(c) “Health benefit plan” has the meaning given that term in ORS 743B.005.
(2) A carrier offering a health benefit plan in this state may not:
(a) Deny or limit coverage under the plan for gender-affirming treatment that is:
(A) Medically necessary as determined by the physical or behavioral health care provider
who prescribes the treatment; and
(B) Prescribed in accordance with accepted standards of care.
(b) Apply categorical cosmetic or blanket exclusions to medically necessary gender-affirming treatment.

(c) Exclude as a cosmetic service a medically necessary procedure prescribed by a physical or behavioral health care provider as gender-affirming treatment, including but not limited to:
(A) Tracheal shave;
(B) Hair electrolysis;
(C) Facial feminization surgery or other facial gender-affirming treatment;
(D) Revisions to prior forms of gender-affirming treatment; and
(E) Any combination of gender-affirming treatment procedures.

Cosmetic surgery is taken as gender affirming therefore “medically necessary”, but then all trans surgery is cosmetic surgery, so the logic of including such as “facial feminization” surgery is sound, albeit based on the pseudo science of gender affirmation. The “[r]evisions to prior forms of gender-affirming treatment” locks insurance companies into funding the many corrective surgeries often necessitated by “bottom surgery”, ensuring the continuing growth of the gender affirming surgery market. Who knows what it will cost the insurance industry or, rather, its customers.

The only doctors who can say no to gender treatment are those already working for the trans movement (and not necessarily doctors). Insurers may not:

(d) Issue an adverse benefit determination denying or limiting access to gender-affirming treatment unless a physical or behavioral health care provider with experience prescribing or delivering gender-affirming treatment.

The language appears to be lifted verbatim from similar legislation in Washington state, recently in the news for its new law allowing the concealment of minor runaways and their state-funded treatment from parents who oppose it.

The bill will fund “federally qualified health centers” in “underserved” (and more conservative) rural areas (those areas represented by the Republicans staging the boycott). The centers “may not be limited to reproductive health care”; they will also promote and enable gender transitioning.

SECTION 29. (1) The Office of Rural Health shall administer a program to provide grants to two federally qualified health centers located in rural and medically underserved areas of this state to each operate a pilot project providing expanded reproductive health services to individuals living in a geographical area of this state where there is limited access to reproductive health care.

(2) The grants must include funding for technical assistance in the design and administration of each pilot project and be flexible enough to permit the federally qualified health centers to use mobile health units or other temporary or transitional structures. Grantees must demonstrate that their governance bodies are committed to expanding access to reproductive health services, including abortion, but the services offered in the pilot projects may not be limited to reproductive health care.

(3) No later than September 15, 2025, the office shall report to the interim committees of the Legislative Assembly related to health, in the manner provided in ORS 192.245, on the results of the projects and recommendations for expanding the program to additional areas of this state.

The Republicans are also blocking with their action a gun control measure.