President Obama's Affordable Care Act ensured that employer-provided health insurance plans covered birth control as a preventative service. But in an effort to "provide conscience protections for Americans who have a religious or moral objection" to health insurance that covers contraception methods, the Trump administration has released two new exemptions.
These exemptions, first issued as interim rules in October 2017, are for employers that object to birth control coverage based on religious beliefs, as well as nonprofit organizations and small businesses that "have non-religious moral convictions opposing services covered by the mandate." The rules are slated to take effect in January, although they will likely be challenged in court based on the fact that the attorneys general of California and Pennsylvania have already challenged the interim rules.
The Obama administration already allowed exemptions for churches, some for-profit organizations, and charities that could raise religious or moral objections to contraception coverage.
But these new rules lower the bar, letting any employer opt out. Employers also don't have to file paperwork with the government to be exempt; they just need to notify their insurance company. And there's no specific standard for claiming a religious or moral exemption, although, the HHS says, "The rules leave in place government programs that provide free or subsidized contraceptive coverage to low-income women, such as through community health centers." All of this could potentially put an untold number of women at risk of losing their birth control coverage, including those who use it to treat health conditions such as polycystic ovary syndrome (PCOS) and endometriosis.
While the HHS has argued that the rule would have no impact on "99.9% of women" in the U.S., it based that figure on the total number of U.S. women (around 165 million), rather than the number that matters: that of women of childbearing age who rely on birth control for pregnancy prevention or other health concerns.
The agency has also argued that a maximum of 120,000 women would be affected. But experts say that because the rule is so broad, there's really no way to predict how many women would lose coverage. Many Catholic nonprofits and hospitals, for example, could choose to stop providing contraceptives.
"It's impossible to know the full scope or impact of the Trump administration's actions," said Adam Sonfield, senior policy manager at the Guttmacher Institute. "But it’s highly likely that the impact will extend far beyond the administration’s estimate that only 200 employers (mostly those who have filed suit against the birth control benefit) will claim an exemption. This matters because having the full range of contraceptive options is critical for enabling people to use the birth control method that best fits their needs and circumstances, regardless of cost."
These final rules are just the latest in the Trump administration's efforts to restrict reproductive rights, from the 20-week abortion ban (which failed the Senate, but Trump has told an anti-choice crowd he wants to give it another try) to the confirmation of Justice Brett Kavanaugh to the Supreme Court.
"There is nothing in these newly posted rules that has substantially changed since the Trump administration first started chipping away at contraception coverage last year," Sonfield said.