The Merger of Two Health Giants Raises Questions About Access to Reproductive Health Services

When Providence Plan Partners takes over CareOregon, tens of thousands of Medicaid patients could lose access to services as basic as Pap smears.

(Wesley Lapointe)

Critics fear the recently announced merger of two large local health insurers—Providence Plan Partners and CareOregon—could leave patients worse off.

Providence, which is affiliated with the Catholic Church, does not cover the cost of abortions and a host of other reproductive health services for private clients.

Now Providence, the state's largest health care system, wants to take over CareOregon, one of the state's biggest Medicaid providers, serving one quarter of those on the Oregon Health Plan. That raises concerns that tens of thousands of Medicaid patients could lose access to services as basic as Pap smears.

The pending merger has created confusion and concern among patient advocates. Patients won't lose coverage for abortions, but there are many unanswered questions about other reproductive health services.

"Providence is a large and growing health care system that already denies people crucial services," says Felisa Hagins, a lobbyist for Service Employees International Union Local 49, many of whose custodian and hospital-worker members receive Medicaid services through the Oregon Health Plan. "Now they want to get a lot bigger."

Providence Portland hospital campus. (Wesley Lapointe)

The deal, announced by both companies Aug. 20, would place CareOregon, a Portland-based nonprofit that has incurred losses in recent years, under the corporate umbrella of Providence St. Joseph Health, which is headquartered in Renton, Wash.; operates 50 hospitals, 829 clinics and a major insurance company across five Western states; and has annual revenues of about $25 billion.

Providence and other large health systems are jockeying for position as the state tweaks the Oregon Health Plan in what policymakers have dubbed Coordinated Care Organizations 2.0.

The merger of Providence and CareOregon comes amid dramatic changes in the political climate nationally. For advocates of abortion access and reproductive health care in general, the past two years have been discouraging. President Donald Trump succeeded in flipping the U.S. Supreme Court against abortion with the nomination of Justice Brett Kavanaugh; states such as Alabama and Ohio have banned abortions; and Trump's administration cut $60 million in federal funds to Planned Parenthood.

Aside from its Medicaid business, Providence has long occupied an unusual position in Oregon, which is one of the most pro-choice states in the U.S. (Last year, voters walloped an initiative that would have banned state-funded abortions by a margin of 64 to 36 percent.)

State Rep. Andrea Salinas (D-Lake Oswego), chairwoman of the House Health Care Committee, says all Oregonians are guaranteed abortions because of the 2017 Reproductive Health Equity Act. The law also prohibits private insurers from discriminating based on gender.

All insurers except one. At the time, Providence lobbied for—and received—an exemption. It's the only private insurer in the state not required to cover abortions and other reproductive health services, such as birth control and treatment for various sexual dysfunctions.

That exception in its private coverage may provide a clue about its intentions.

That's why advocates are worried about Providence's further expansion into Medicaid via CareOregon.

(Wesley Lapointe)

Currently, Providence's Medicaid members—those with publicly funded health care—can still get abortions. That's because the state pays for them directly. What could be in jeopardy for Medicaid patients are a variety of other reproductive health services. They range from routine items such as over-the-counter birth control to fertility treatment to sexual disorders and dysfunctions and sex-change operations.

One of the leading providers of such services is Planned Parenthood. Providence does not contract with Planned Parenthood, however. That's a problem because, while Providence may refer patients to others for services its hospitals and clinics don't provide, it doesn't contract with the one organization—Planned Parenthood—that specializes in treating Medicaid patients, who pay a lower level of reimbursement than private clinics desire.

When CareOregon, which serves more than 300,000 patients, announced the Providence deal, the insurer said it intended to remain "secular" and preserve an independent board of directors.

But some worry the company could be absorbed into the Providence system.

"CareOregon said they plan to remain secular and maintain an independent board," says Kimberly Koops-Wrabek, policy director for NARAL Pro-Choice Oregon. "But it's not clear if that makes sense from Providence's point of view. Our concern is what happens down the road."

Koops-Wrabek questions how long Providence will overlook its religious affiliation as it operates CareOregon.

"Catholic hospital mergers and acquisitions are a huge threat to reproductive health here and across the country," she says. "We just don't know what Providence's long-term plan for CareOregon is, and we're very concerned."

Planned Parenthood is similarly alarmed.

"Providence has declined to work with us in the past, although we continue to welcome the opportunity for collaboration moving forward," says Anne Udall, president and CEO of Planned Parenthood Columbia Willamette.
CareOregon did not respond to a request for comment. Gary Walker, a Providence spokesman, says CareOregon patients and advocates need not worry. He says the deal is still in preliminary stages and nobody will be denied coverage they currently have.

"Here's the simple answer," Walker says. "We will continue to fulfill the terms of our existing contracts with the state. CareOregon will continue to fulfill theirs. If it's a service we perform today, our intent is to continue performing it tomorrow."

The combination of Providence and CareOregon requires approval from two state agencies: the Oregon Health Authority, which oversees the Oregon Health Plan, the state's Medicaid program; and the Department of Consumer and Business Services, which regulates insurance companies. A DCBS spokesman says that process should take six months from when the companies file paperwork with the state. Both agencies report to Gov. Kate Brown.

"Gov. Brown expects the full complement of reproductive health services to be available to all Oregon Health Plan patients in accordance with the law, including all Medicaid clients receiving services through Providence," Kondayen says.

"We are incredibly concerned," SEIU's Hagins says. "The state should be concerned and CareOregon patients should be concerned."

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