As states across the nation restrict abortion access and launch legislative attacks on LGBTQ Americans, Oregon legislators are looking to protect people seeking reproductive and gender-affirming medical care, as well as doctors providing the services. House Bill 2002, sponsored by 34 Democratic lawmakers, would strengthen protections for medical providers who offer abortion services, close reproductive service gaps in rural areas of the state, and expand insurance coverage for medically necessary gender-affirming care.

“While there's a lot in the landscape that's changing when it comes to health and gender-affirming care in the rest of the country,” said Cassie Purdy, political director of Planned Parenthood Advocates of Oregon, “I really think that we can look at this bill as a continuation of what we know Oregon stands for.”

Oregon law protects the right to an abortion, but the shifting national landscape of abortion laws has still impacted the state. In the wake of the Supreme Court overturning Roe v. Wade in 2022, Speaker of the House Dan Rayfield convened a workgroup of healthcare professionals, legal experts, and impacted communities to evaluate gaps that exist in abortion access and protections for healthcare providers. The workgroup also tackled issues of access to gender-affirming care for transgender people—a population that’s also seen a rise in attacks on their rights and bodily autonomy in recent years. According to LGBTQ advocacy group Basic Rights Oregon, there are currently over 300 anti-LGBTQ bills in legislatures across the nation, like fining Texas businesses who allow children to watch a drag show or allowing officials in Tennessee to refuse to marry same-sex couples based on religious beliefs.

The result of the workgroup is a host of healthcare initiatives rolled into HB 2002 that aim to increase access to abortion and gender-affirming care services and protect providers who continue to provide that care under Oregon law.

“Folks may think of this as multiple bills, but it’s really one package bill because of the… connection to privacy, body autonomy, and protections for all of our communities,” Seth Johnstone, Transgender Justice Program Manager for Basic Rights Oregon, told the Mercury

If approved, HB 2002 would expand the definition of medically necessary gender-affirming care to include procedures that are currently deemed cosmetic, like facial affirmation surgery or some types of implants, so that they are covered by private insurance.

Carolyn Ward, a transgender woman who moved from Kentucky to Oregon a year ago in search of protection against hostile legislative attacks against trans people, said she’s been fortunate to have access to hormone replacement therapy through her health insurance. However, Ward hasn’t been able to receive facial electrolysis, or permanent facial hair removal, because the procedure is deemed cosmetic, not covered by health insurance, and too expensive to pay for out of pocket.

“I wake up nearly every day and see my facial hair in the mirror and it causes me an overwhelming wave of crushing dysphoria that’s only maintained throughout the day,” Ward said. “Because of my sensitive facial skin, I can only shave every 48 hours and, as a result, I only have a brief reprieve from this dysphoria.”

A 2021 research paper published in JAMA Dermatology found that gender-affirming hair removal for transgender and gender diverse people led to a 38 percent reduction in severe psychological distress for the previous month, 28 percent reduction in suicidal ideation compared to the previous year, and 24 percent reduction in tobacco use compared to the previous year. Because of the growing evidence that cosmetic procedures like facial hair removal have significant impacts on gender diverse peoples’ mental health and safety, the World Professional Association for Transgender Health and several American medical institutions now deem procedures like facial electrolysis and facial affirmation surgery medically necessary. 

Christina Milano, director of the Transgender Health Program at Oregon Health and Science University, also noted that ensuring transgender Oregonians are able to access healthcare in a safe environment can impact their overall health. If a transgender person feels unsafe or unsupported by their doctor, Milano said they are less likely to schedule yearly check-ups or seek help for other health concerns. However, if gender diverse people have access to health services that are critically important to them, they are more likely to see their doctor and be able to be treated holistically for their health concerns, which also improves overall health outcomes.

HB 2002 would also seek to strengthen protections for healthcare providers who offer abortion services. Nearly half of US states have banned or severely limited access to abortions in the wake of the Supreme Court overturning Roe v. Wade, many of which threaten criminal penalties for people who have or facilitate an abortion. According to Attorney General Ellen Rosenblum, while Oregon still protects the right to have and perform abortions, her office has seen confusion over what services are still allowed in the state and if medical providers are subject to criminal penalties if they provide abortion services to someone traveling from a state where abortion is illegal. To tackle that confusion, Rosenblum’s office launched a reproductive rights hotline in January which provides free legal advice and information on the status of reproductive health resources available in Oregon.

Rosenblum’s office also worked with the HB 2002 workgroup to create language that, if passed, would make certain Oregon providers who are following state law would be protected from criminal prosecution if they provide abortion services to people who had traveled from a place that criminalizes abortion. Healthcare providers would also be safeguarded against losing their medical license and medical practice insurance for providing reproductive health services that are allowed under Oregon law.

“We obviously can't control the laws of other states,” Purdy of Planned Parenthood Advocates of Oregon said. “We can do everything we can to make sure that folks who are licensed in Oregon are able to do their jobs.”

HB 2002 would also provide funding for mobile reproductive health clinics in rural areas of the state where services are more difficult to access, as well as direct public university health clinics to provide emergency contraceptives.

While the bill is strictly limited to expanding insurance coverage for gender-affirming care, adding infrastructure for reproductive healthcare, and protecting Oregon providers from persecution from other states, much of the opposition against the bill has centered on youth access to gender-affirming care and reproductive health services. During a five-hour public hearing on the bill Monday, several people—including lawmakers on the Behavioral Health and Health Care committee—took issue with the fact that minors can access reproductive health services without parental consent in Oregon. Under existing Oregon law, minors of any age can access reproductive healthcare services like STI tests and birth control without parental consent. HB 2002 also does not seek to change guidance on age-appropriate gender-affirming care, despite claims from opponents of the bill. 

Representative Ed Diehl, a Republican representing parts of Salem, raised concerns that Oregon is moving too quickly to increase access to healthcare services and should wait for more research to be conducted.

“We need to be careful—this is about our kids,” Diehl said during Monday’s hearing. “We’re going to look back 10 years from now and say ‘My god, what did we do?’”

Johnstone of Basic Rights Oregon told the Mercury that expanding insurance coverage for gender-affirming care has already been delayed in the past because there weren’t enough studies showing the impact gender-affirming care has on the livelihood and well being of transgender and gender diverse people. Now that those studies have been conducted, Johnstone says it's time to act.

"Because of all that evidence review and collection of data, we can finally demonstrate to our [lawmakers] that this always was necessary care,” Johnstone said. “We know that gender-affirming medical procedures that folks get to align their body with their identity give us long term mental health benefits, specifically for the population that faces extreme suicide ideation.”

As more states further restrict access to reproductive healthcare and threaten the safety of LGBTQ people, advocates and lawmakers anticipate that Oregon will see an increase in people coming here for services and protection, and the state needs to be ready to meet the moment. Between the rise in demand for abortion services in Eastern Oregon following Idaho’s abortion ban and people like Ward leaving Republican-controlled states for Oregon, that moment is likely already here.

“I am far from the only trans person who will migrate here from a state dead set on persecuting trans people,” Ward said. “It’s a strong belief of mine that every single transgender person who flees here looking for a safe home like I was will absolutely be able to find that here in Oregon.”

HB 2002 is scheduled for a work session on March 27 and is expected to be debated on the House floor in the coming weeks.