The Trump administration issued new rules Friday to make it easier for employers to refuse to provide insurance coverage for certain birth control methods if they claim to have moral objections to contraception.
The Affordable Care Act required all employers to cover birth control for their workers without any co-payment, but the provision has been embroiled in lawsuits ever since.
The new rules allow any employer or insurer to stop covering contraceptive services if they have religious beliefs or moral convictions against covering birth control. It would be up to states to determine how companies should make these decisions.
In a statement, the agency said "these rules will not affect over 99.9% of the 165 million women in the United States." Senior Health and Human Services (HHS) officials said some large companies, including Pepsi and Exxon, had pre-ACA plans that will continue and not have to cover contraception. Some church groups were already exempt from the law and not providing this coverage. The officials requested anonymity during a Friday call with reporters.
HHS referred to the rules as "protecting the conscience rights of all Americans."
The National Women's Law Center immediately vowed to sue the administration to block the rules, which CEO Fatima Goss Graves said showed "callous disregard for women's rights, health and autonomy."
But abortion opponents hailed the new rules. Marjorie Dannenfelser, president of the Susan B. Anthony List said "moral objectors" like her group will "no longer have to pay for life-ending drugs that are antithetical to their mission and for which we have argued there is certainly no ‘compelling state interest.’”
The Supreme Court decided in 2014 that the Affordable Care Act couldn't require employers to offer insurance coverage for certain birth control methods they equate with abortion. The decision applied only to private corporations such as the family-owned companies — including retailer Hobby Lobby — that challenged the law. Women working for those companies would be able to get morning-after pills and IUDs from other sources, such as the government or private insurers.
Critics of the rule, including American Public Health Association executive director and physician Georges Benjamin, said it is a way for the Department of Health and Human Services to achieve what it hadn't been able to do in Congress despite repeated attempts to replace and replace the ACA.
It's a "roundabout" way for the Trump administration to eliminate the ACA's birth control coverage mandate, said American College of Obstetrics and Gynecology President Haywood Brown, an OB/GYN.
The group also said contraception reduces maternal mortality and improves the health and economic stability of families and communities.
ACA opponents sought to get rid of the so-called "essential health benefits" that the law requires all insurance plans to cover, which includes birth control.
Brown joined opponents of the Trump administration in a call about the expected rule that was set up by Planned Parenthood late Thursday.
"Any move to decrease access (to contraception) will have damaging effects on public health," says ACOG CEO and OB/GYN Hal Lawrence, citing premature births which are more common when babies aren't planned.
The agency is showing a "deep disregard for women’s health," he said.
It may be a costly change too. For every public dollar spent on birth control, ACOG notes $7 is saved on other Medicaid costs associated with unintended pregnancies.
While contraception prices may not rival some of the sky-high prescription drug prices that have dominated the news, a 2010 Hart Research poll found one in three women voters struggled to afford prescription birth control and 57% of women aged 18 to 34 had trouble paying.
The percent of people who had to cover some of their birth control costs dropped from more than 20% before the ACA to 4% after it went into effect, according the Kaiser Family Foundation.
More than 25 million people are already exempted from the preventive-care mandate because they are insured through an employer that has a health insurance plan that existed before the ACA took effect. These people are unaffected by Friday's rules. Neither are those low income women who get free or subsidized contraceptive coverage, including through community health centers.
Conservative groups that fought the Obama administration in court over the birth control mandate applauded the expected rule when a draft began circulating this spring. These supporters said women seeking birth control from employers could still buy separate policies directly from insurance companies. They estimated fewer than 200,000 women would be affected.
Friday, the conservative Faith and Family Foundation heralded the rules as a welcome departure from eight years under the Obama administration, which it said "trampled on the First Amendment rights of people of faith (and) persecuted Christians who objected to taking innocent human life," along with taking the Little Sisters of the Poor to court.
Now, however, the Center for American Progress warned "the flood gates" could open to "nearly any private employer refusing to cover birth control."
Of the companies that filed requests for exemptions from offering birth control without a co-payment, 53% were for-profit companies, the group said in August. The group obtained the information through a Freedom of Information Act request.
"The data are only a small slice of those seeking the right to deny coverage, but they demonstrate that this debate isn’t about houses of worship or faith-based organizations wanting accommodations," said CAP's Devon Kearns. "A change in the rule would enable even more for-profit corporations the ability to make getting birth control more difficult."