One of the most popular – and successful – aspects of the Affordable Care Act has been the access it has given women to no-cost birth control. Not only has it saved women millions of dollars, but also the increased use of birth control has corresponded to significant drops in the rates of unintended pregnancies and abortions.
It is troubling, then, that the Trump administration is either so shortsighted or so ideologically driven that it is reportedly considering a rule change that would cause hundreds of thousands of women to lose vital health-care coverage.
The draft of a proposed regulation, dated May 23 and obtained last week by Vox, would dramatically overhaul the government’s contraception coverage mandate. It would, if finalized, expand the exemption that currently applies to religious organizations and private employers with religious scruples to any employers or insurers expressing “religious beliefs and moral convictions” against birth control. No formal notification to the federal government would be required. “Moral” is not defined. And even for-profit, publicly traded companies would be able to lay claim to moral convictions.
“The rule essentially would allow any employer to drop birth control coverage in employee health plans virtually at whim,” wrote Michael Hiltzik of the Los Angeles Times.
Clearly, this is of little concern to the Trump administration. Health and Human Services Secretary Tom Price once famously said that “not one” woman has been unable to afford birth control, and he has staffed the department with appointees who are openly antagonistic to the efficacy of birth control. Never mind the scientific studies showing that as the use of contraceptives increases, the rate of unintended pregnancies decreases. Or that the decline in the rate of teen pregnancy in recent years is believed to be a result of the greater availability of free long-term reversible contraceptives.
Without insurance – which, it should be noted, women pay for – birth control can be out of reach. A recent survey from PerryUndem found that 33 percent of women could afford to pay only $10 or less out of pocket for oral contraceptives, and 14 percent said they couldn’t afford to pay anything. Before the mandate went into effect, co-pays ranged from $15 to $50 a month.
Again, this is of little concern to the Trump administration, which argues in the draft proposal that women can turn to federally subsidized family planning programs, a maddening if not insulting argument since the administration has also proposed cuts in Medicaid. Moreover, if Republicans had their druthers, Planned Parenthood, the main source of birth control for low-income women, would lose federal funding.
The repeal and replacement of Obamacare has stalled in Congress, but this proposed regulation, which could go into effect as soon as it is published in the Federal Register, sadly demonstrates the harm that can be done if the executive branch sets its mind – and authority – to dismantling key provisions.