The Trump administration will issue a rule on Friday to 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, according to a Republican briefed Thursday on the regulation, will 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 represents the latest twist in a seesawing legal and ideological fight that has surrounded this aspect of the 2010 healthcare law nearly from the start.
It will 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.
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.
The 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.
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.