WASHINGTON – The Trump administration could issue a rule as early as Friday that would sharply limit the Affordable Care Act’s contraception coverage mandate, a move that could mean hundreds of thousands of American women would no longer have access to birth control free of charge.
The action, first reported Thursday evening by the New York Times, would allow a much broader group of employers and insurers to exempt themselves from covering contraceptives such as birth control pills on religious or moral grounds. It would be the latest twist in a seesawing legal and ideological fight that has surrounded this aspect of the 2010 health care law nearly from the start.
The expected rule change would be among the latest moves by President Donald Trump to dismantle initiatives enacted under the Obama administration. It would fulfill a crucial promise Trump made as a candidate to appeal to social conservatives and in May when he signed an executive order in the Rose Garden to expand religious liberty.
The controversy first arose as part of the Obama administration’s initial definition of preventive care that insurers must cover under the ACA – which encompassed birth control, officials decided.
A subsequent accommodation gave exemptions of sorts to houses of worship, nonprofits with religious affiliations and closely held for-profit companies. Such employers have been able to opt out of providing the coverage and instead have their insurance company pay for it by notifying the insurer, a third-party administrator or the federal government. That situation will continue.
Organizations affiliated with the Catholic church, which teaches against birth control other than by natural means, have been among the most vocal opponents. They’ve argued that having to cover the cost of contraception through health insurance plans is tantamount to being forced by the government to be complicit in a sin.
In the past several years, lawsuits have been filed by nuns, Catholic charities, hospitals and universities.
Even now, litigation continues in several federal appeals courts. In 2014, the Supreme Court ruled that it was illegal to impose the mandate on “closely held corporations” such as Hobby Lobby, a crafts store chain with Christian owners who objected to the idea of paying for several kinds of the birth control that must be covered.
Action by the Trump administration is almost certain to spark fresh litigation. The National Women’s Law Center – which estimates that in 2013 alone, the contraception requirement saved women $1.4 billion in oral contraceptive costs – has vowed to challenge the administration in court.
With some women who lose the ACA’s contraceptive coverage, “it means choosing between preventive care like contraceptives and paying their rent, their mortgage, electric bill,” said Mara Gandal-Powers, senior counsel at the National Women’s Law Center.
In his sweeping May 4 executive order on free speech and religious liberty, Trump ordered his Cabinet to address the concerns of those who had “conscience-based objections” to contraceptive coverage.
Over the summer, a leaked early draft of the rule began circulating in Washington, priming both sides for a renewed fight unfolding. The draft immediately drew praise and condemnation from the respective sides.
When the contraception mandate was first implemented, it required all health insurance offered by employers to cover at least one of the 18 forms of birth control approved by the Food and Drug Administration.
Since it took effect in August 2012, savings on the birth control pill have accounted for more than half of the drop in all out-of-pocket prescription drug spending, according to the Kaiser Family Foundation. Researchers at the foundation say contraceptives account for between 30 percent and 44 percent of women’s out-of-pocket health care spending.
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