The Republican proposal to repeal and replace Obamacare would cut funding to Planned Parenthood and ban the use of federal tax credits to help buy health insurance plans that cover abortion.
The proposals are stirring controversy nationwide and in the Rogue Valley, where reproductive rights proponents are joining in protests and donning bright pink shirts proclaiming their support for Planned Parenthood.
Meanwhile, anti-abortion groups say the proposals will reduce federal spending and the number of abortions.
Federal law already prohibits spending federal money on abortion except to save the life of the woman or in cases of rape or incest.
Planned Parenthood says abortion makes up 3 percent of its services, and the Republican plan would block low-income Americans on Medicaid from getting contraceptives, cancer screenings, sexually transmitted disease testing and other care.
The American Health Care Act proposed by House Republicans would reduce federal funding of Planned Parenthood by $178 million in the first year, according to the nonpartisan Congressional Budget Office, which released financial estimates about the plan this week.
Republicans say Planned Parenthood could receive funding after the one-year freeze if it stops providing abortions — a demand the organization's leaders have refused.
About 15 percent of people visiting Planned Parenthood health care clinics would be unable to access replacement care, the CBO estimates.
During the one-year funding freeze, less access to services that avert pregnancies would lead to several thousand more births that would be covered by Medicaid, causing a $21 million increase in spending for childbirth care, the CBO estimates.
The Medicaid program already covers the costs of about 45 percent of births in the nation. Many of the additional children born to low-income parents would qualify for Medicaid and other federal programs, further increasing spending, the CBO says.
The Centers for Disease Control and Prevention estimated that teen pregnancy and childbirth cost American taxpayers $9.4 billion in 2010 for increased health care, foster care, parent incarceration and tax revenue losses from lower educational attainment and earnings by teen moms.
That figure dates from before the Affordable Care Act significantly expanded coverage and federal spending on health care. Conversely, the teen pregnancy rate was slightly higher in 2010 than in recent years.
Nationwide, 86 percent of women and girls having abortions are unmarried, and 75 percent are economically disadvantaged. Fifty-nine percent already have one or more children, according to the Guttmacher Institute.
Cuts would be felt locally
Local resident Susan Haines, who attended a Medford rally this week in support of Planned Parenthood, says the Republican plan would negatively impact health care.
"My concerns are primarily with eliminating accessible preventative care for millions of young women," she says.
Haines says she used to counsel pregnant high school girls. She says Planned Parenthood provided those girls with information about abortion, adoption and parenting.
"They would outline all the options to deal with unplanned pregnancies," Haines says. "Planned Parenthood never promoted any one choice. They were never forcing a particular decision."
Haines says Planned Parenthood is one of the key places for people, especially young women, to get birth control, sexually transmitted disease testing and other services.
"For many young women, Planned Parenthood is the only place they know for birth control," she says. "Teenagers are not going to go to their parents' doctors."
Haines is also a volunteer Court Appointed Special Advocate, advocating for the interests of abused and neglected children and helping them navigate the Jackson County court system.
"Many of their parents were ill-prepared to have them," she said. "That puts a tremendous burden on social services agencies."
Advocates helped 628 children in the county in 2016, according to CASA of Jackson County, Inc.
Sky Loos, director of external affairs for Planned Parenthood of Southwestern Oregon, says the six Planned Parenthood clinics in Ashland, Medford, Grants Pass and the Eugene area serve 30,000 people per year. The vast majority received care at little or no cost, thanks to federal funding.
"Republicans say they can go to other health centers," Loos says. "But they do not have the capacity to take on 30,000 patients."
Loos said medication-induced abortion is available at the Ashland clinic. Surgical abortion is available at the Eugene headquarters of Planned Parenthood of Southwestern Oregon.
Medication-induced abortion triggers cramping and heavy bleeding similar to an early miscarriage. It can be used at up to 10 weeks of pregnancy. Surgical abortions are typically used in later weeks of a pregnancy, according to Planned Parenthood.
Clinics also offer emergency contraception, often called the morning-after pill, for use up to five days after unprotected sex or a birth control method failure.
Local clinics also provide birth control, annual wellness exams for women, breast and cervical cancer screenings, sexually transmitted disease testing and treatment, HIV testing, urinary tract and yeast infection treatment and vasectomy counseling.
Nationwide, 2.5 million people use Planned Parenthood health centers.
The American Medical Association issued a statement opposing the Republican plan to pull funding from Planned Parenthood, saying Americans should not be blocked from choosing to receive care from the organization. The American Public Health Association, the American Congress of Obstetricians and Gynecologists and other medical groups also oppose the plan.
March for Life praises Republican plan
Anti-abortion groups support the proposal.
"House leadership and those who drafted the American Health Care Act deserve high accolades for their efforts to make certain that any changes to the health care system do not encourage, subsidize or directly pay for abortions," March for Life said in a statement. "They also deserve praise for sticking to their commitment to eliminate Planned Parenthood, America's largest abortion provider, from Medicaid reimbursements for one year."
March for Life says the proposal will redirect women to other health centers, which outnumber Planned Parenthood clinics. The group says the entire Republican bill needs to be pro-life, with no tax credit or health savings account money going toward abortions.
Under the ACA, health plans on insurance exchanges can cover abortions if they collected a separate premium so it's clear no federal funds are used. The Republican legislation goes farther, prohibiting the use of new federal tax credits to buy any plan that covers abortion.
U.S. Rep. Greg Walden, R-Hood River, has taken the most heat from residents opposed to the Republican plan. He is chairman of the House Energy and Commerce Committee that oversees health care and released the proposal. His district includes Jackson County.
Oregon Sens. Ron Wyden and Jeff Merkley, both Democrats, are fighting the legislation.
Abortion rates have dropped
The emotional and contentious debate over abortion comes at a time when abortion rates have fallen to their lowest recorded level since the Supreme Court legalized abortion in its 1973 Roe v. Wade decision.
In 1973, 16.3 abortions were recorded per 1,000 women of childbearing age. Numbers peaked at 29.3 in 1980 and 1981, then began a gradual, prolonged slide to 14.6 abortions per 1,000 in 2014, according to the Guttmacher Institute.
Some believe new restrictions in many states played a role.
Texas adopted a range of restrictions, including 24-hour wait periods, mandatory counseling to dissuade people from having abortions, parental notification and consent requirements for minors and a requirement that an ultrasound be taken of the fetus, with the health care provider showing and describing the image to the girl or woman.
Texas saw a 28 percent drop in abortions from 2011 to 2014, the Guttmacher Institute reported.
Oregon, which has not adopted such restrictions, saw a 15 percent decline during those years, the institute says.
Others say the drop in abortion rates reflects better access to contraception — including long-lasting methods like the intrauterine device — and a historically low teen pregnancy rate.
Births by teenagers age 15 to 19 fell from more than 60 per 1,000 females in 1991 to 24 per 1,000 females in 2014. Still, a quarter-million babies were born to American teens in 2014. The U.S. teen pregnancy rate is substantially higher than in other western industrialized nations, according to the Centers for Disease Control and Prevention.
Americans remain divided on the abortion issue, with 29 percent saying abortion should be legal under any circumstances, 50 percent saying it should be legal under certain circumstances and 19 percent saying it should be illegal in all circumstances, according to a 2016 Gallup poll.
According to Planned Parenthood, three out of 10 women in America have an abortion by the time they are 45 years old.