The Trump administration has drafted a sweeping revision of the government’s contraception coverage mandate that could deny birth control benefits to hundreds of thousands of women who now receive them at no cost under the health care law.
The new rule, which could go into effect as soon as it is published in the Federal Register, greatly expands the number of employers and insurers that could qualify for exemptions from the mandate by claiming a moral or religious objection, including for-profit, publicly traded corporations. A 34,000-word explanation of the intended policy change is blunt about its likely impact on women: “These interim final rules will result in some enrollees in plans of exempt entities not receiving coverage or payments for contraceptive services.”
More than 55 million women have birth control coverage without out-of-pocket costs, according to a study commissioned by the Obama administration and cited in the draft rule.
By spring 2014, two-thirds of women using birth control pills and nearly 75 percent of women using the contraceptive ring were no longer paying out-of-pocket costs. In 2013 alone, the mandate had saved women $1.4 billion on birth control pills, according to the National Women’s Law Center.
But a series of lawsuits filed over the last five years by priests, nuns, charitable organizations, hospitals, advocacy groups and colleges and universities convinced Trump administration officials that a change was needed.
The Obama administration and the National Academy of Sciences cited studies showing that as the use of contraceptives has gone up, the rate of unintended pregnancies has come down. But the Trump administration says “these studies are insufficient to demonstrate a causal link.”
Instead, the rule emphasized another issue: “as contraception became available and its use increased, teen sexual activity outside of marriage likewise increased.”
The draft rule would also create an exemption for health insurance companies that have religious or moral objections to covering birth control. It would change the current accommodation for certain religiously affiliated employers from mandatory to optional. And it would allow insurers and employers to provide a separate insurance policy excluding coverage of contraceptives to individuals who have religious or moral objections.
The Trump administration discounts the possibility of harm to women, saying they can obtain access to contraceptives through a family member’s health plan, a plan sold on a public insurance exchange or “multiple other federal programs that provide free or subsidized contraceptives.”