How a Republican trifecta could reshape abortion access in a deep blue state like Oregon

On the issue of abortion, Oregon is — quite literally — as liberal as a state can get. The state has among the strongest protections for abortion rights and the fewest limits on the procedure of any in the nation.

Current state law guarantees the right to abortion, without a waiting period or gestational limit, for anyone who’s pregnant and 15 years or older.

For most Oregonians, including those on Medicaid — the public program that provides health care to low-income individuals and families — the cost of abortion is covered by health insurance.

The state remains controlled by Democrats, but at the federal level, Republicans have won a trifecta, giving them control of the presidency and both chambers of the U.S. Congress.

That has abortion providers in Oregon planning for changes they say could make it harder for them to operate, regardless of protective state laws.

Gov. Tina Kotek is also preparing. Earlier this month, OHSU secured a new supply of mifepristone, a drug that’s often used in first-trimester abortions and has been a particular target of conservative legal challenges. Last year, Kotek’s administration purchased 22,500 doses of the drug, but they expire next year. The new supply won’t expire until Sept. 2028, according to the governor’s office.

“While I will seek to work with the incoming administration, I will not stand idly by as abortion access, environmental standards, civil liberties, or other priorities come under attack,” Kotek said in a written statement.

The most straightforward potential new challenge to the right to abortion in Oregon is a federal ban on the procedure. Congress has the power to pass a national ban, and the idea of a 15-week ban has some traction among Republican lawmakers.

“A federal abortion ban is very real,” said Amy Handler, president and CEO of Planned Parenthood of Southwestern Oregon. “We’re not naive to that possibility.”

In most situations, federal law takes precedence over state law. If Congress passed a federal abortion ban, it would almost certainly apply in Oregon, though its effect would depend on the exact language of a ban and if attorneys general in blue states like Oregon file legal challenges.

While possible in theory, a national abortion ban is politically unlikely, according to Stephanie Kennan, a federal lobbyist with McGuireWoods Consulting and former senior health policy advisor to U.S. Sen. Ron Wyden.

The rules in the U.S. Senate give the minority party considerable power to derail legislation, and Senate Democrats would filibuster to try to block a federal abortion ban, Kennan said.

President-elect Donald Trump, too, could veto a ban, something he tweeted he would do during the vice-presidential debate. However, at other times, he has appeared to indicate support for a 15-week ban.

Discerning Trump’s real position on the issue is “somewhat confusing,” Kennan said, but “Trump has said that it belongs in the states and that’s what he did.”

Lois Anderson, the executive director of Oregon Right to Life, a lobbying and advocacy group that opposes abortion and medical aid in dying, agrees that a nationwide abortion ban is unlikely to pass during Trump’s second term.

“It wouldn’t be shocking if maybe a pro-life member of Congress introduced it,” she said, “but it would be shocking to me if leadership took it up.”

Anderson is skeptical that any further restrictions on abortion will be a priority issue for the Trump administration. Still, she considers it a significant victory that Democrats, including Vice President Harris, campaigned hard on abortion and lost the presidential race and their majority in the Senate.

A second avenue opponents of abortion could use to reach into states where it remains legal rests on a 151-year-old law. The 1873 Comstock Act is an anti‐obscenity law that made it illegal to mail material relating to contraception or performing an abortion. Over the decades, the courts narrowed the scope of the Act, but it was never repealed.

After the U.S. Supreme Court overturned Roe v. Wade and ended federal abortion protections, the Biden Administration held that because abortion remains legal in many circumstances, the Comstock Act shouldn’t be interpreted literally and didn’t enforce it.

But a new administration could use it to limit the distribution of the two pills, mifepristone and misoprostol, used to induce abortion and to manage miscarriages. Kennan said conservative groups have been in congressional offices discussing that prospect.

Medication abortion accounted for about 60% of abortions nationwide last year, according to the Guttmacher Institute.

Dr. Sara Kennedy, President and CEO of Planned Parenthood Columbia Willamette, says the Comstock Act is among her top concerns because it wouldn’t require any new legislative action.

According to Kennedy, broad enforcement of the Act could limit the availability of abortion medication even in states like Oregon, where the procedure remains fully legal.

And, she said, the U.S. Department of Justice’s enforcement of the Comstock Act could apply not only to abortion pills but other medical supplies used in abortion and pregnancy care.

“If a company is afraid of getting sued by a hostile DOJ because they’re violating a federal law, the supply chain of those medications, that equipment, the IV fluids, could dry up,” Kennedy said. “It would be, probably, more effective than an abortion ban.”

Kennedy and Handler are also concerned about their safety and how the incoming administration will respond to threats to doctors and clinics.

“We had a brick thrown through a window in our Grants Pass health center a couple of years ago,” Handler said. The federal DOJ prosecuted that person. “I don’t imagine that happening in this administration.”

Grayson Dempsey, director of public affairs for Portland’s Lilith Clinic, which provides abortions through 28 weeks, is concerned there could be an increase in efforts to stop patients from crossing state lines for abortions or to prosecute people who help them.

“It’s real today that a patient can be seeing a doctor throughout their pregnancy, find out they have a fetal anomaly, and the doctor will say, ‘I can’t talk to you. This conversation is over,’” Dempsey said. “And then they return to that doctor, and not be pregnant anymore, and they can’t talk about it.”

Finally, Democrats in Oregon could find it harder and more expensive to keep their promises to provide access to abortion and contraception to all residents, regardless of their ability to pay.

The state’s Medicaid reimbursement rates haven’t budged in years, Kennedy said, and they don’t cover the full cost of providing reproductive care. For example, Planned Parenthood loses between $200 and $300 each time it screens a Medicaid patient for cervical cancer.

Unless reimbursement rates for primary and reproductive care rise, Kennedy said, the state’s two Planned Parenthood affiliates will struggle to keep open the clinics they operate across the state, in Beaverton, Portland, Milwaukie, Salem, Eugene, Bend, Medford, Grants Pass and Ontario.

Finding money to increase provider payments won’t be easy and could get harder under the new administration. Medicaid is jointly funded by the state and federal government, and the larger share of funding, about 70%, is federal.

Cutting federal spending on Medicaid is an option for Republicans seeking to find a way to pay for tax cuts. Trump has promised not to touch Medicare — the health care entitlement program for seniors — and Republicans have proposed cuts to Medicaid in the past.

Planned Parenthood, too, could see a more targeted effort to cut its Medicaid funding.

Already, federal dollars don’t pay for abortions through a policy known as the Hyde Amendment. In Oregon, Democratic lawmakers have circumvented that regulation by allocating state general fund dollars to cover abortions for people insured through Medicaid.

But abortions make up only 14% of visits to Planned Parenthood’s clinics in Oregon, according to Kennedy. The majority of services that Planned Parenthood’s affiliates provide, like primary care and contraception, do qualify for Medicaid reimbursement.

Kennedy believes the Trump administration and congressional opponents of abortion may try to disqualify Planned Parenthood from receiving any federal funding at all.

It’s a strategy abortion opponents have used, with success, in Texas, though some argue it runs afoul of a provision in the Social Security Act that gives Medicaid patients the right to see any qualified provider.

“In that scenario, we would have to flip to be a cash-only organization,” Kennedy said. “So only people who present with $1,500 to get an IUD could get an IUD. We have never done it that way.”

At the same time, Oregon Right to Life is also anticipating a difficult four years in the state. For now, whether or not abortion remains legal is determined at the state level, Anderson said.

She doesn’t expect to see any meaningful new limits in Oregon, given Gov. Kotek’s position and Democratic control of the state Legislature.

“I just don’t think that’s politically realistic, because of how committed they’ve shown themselves to legal abortion for any reason,” Anderson said.

She is hoping, though, for more opportunities for her organization, church groups and other anti-abortion allies to work directly with pregnant people and promote alternatives to abortion.

“Oregon has, honestly, a pretty robust social support network,” she said. “We think that’s great, and we want more pregnant women to know about it.”