Despite failures to repeal and replace Obamacare, Trump isn't done chipping away at it just yet. On Friday, Trump overhauled the Obamacare birth control mandate. The Affordable Care Act policy required employers to include birth control coverage in their health insurance plans, giving more than 55 million women access to various forms of contraception — including the pill, IUD, ring, and the patch — without co-payments. The new regulations, which will take effect immediately, now allows any employer to deny contraception coverage for moral or religious reasons, which means hundreds of thousands of women could lose their benefits and pay out of pocket for birth control.
Under the Affordable Care Act, only nonprofit religious organizations, including hospitals and institutions of higher education, could seek exemption from covering birth control based on religious objection. The Trump administration's new rules have expanded that exemption to any employer or insurer that objects to covering contraceptives "based on religious or moral convictions." In other words, if you don't want to provide birth control coverage, you don't have to provide it, said health law professor Tim Jost to Vox. "It’s just a very, very, very broad exception for everybody," he said.
Under Trump, both nonreligious and for-profit companies will now be open to exemption, regardless if it's a small, family-run business or a company owned by thousands of shareholders. The Obama administration had previously barred publicly traded companies from seeking an exemption from the birth control requirement on religious or moral grounds.
The Obamacare birth control mandate sparked dozens of employers to sue, and the mandate's overhaul will most likely generate lawsuits, too. Most lawsuits attacking the Obama-era mandate claimed the policy violated the Religious Freedom Restoration Act of 1993. New lawsuits, however, could claim the Trump-era mandate violates that same law, which “does not provide protection for nonreligious, moral conscientious objections.”
The Guttmacher Institute found that under the Affordable Care Act, the percentage of insured women on the pill who were projected to pay $0 for it jumped from 15 percent in 2012 to at least 67 percent in 2014. The Obamacare contraception mandate saves women as a whole an estimated $1.4 billion dollars a year in expenses for birth control pills, according to researchers from the University of Pennsylvania.
“In the long term, if we do in fact see an increase in the use of contraceptives, that could potentially lead to a lower overall fertility rate, and potentially increased economic opportunities for women and their families," said Daniel Polsky, a professor of health care management and economics at the University of Pennsylvania's Perelman School of Medicine.
Dr. Haywood L. Brown, president of the American College of Obstetricians and Gynecologists, told The New York Times these rules would reverse the progress made in women's reproductive health:
Affordable contraception for women saves lives. It prevents pregnancies. It improves maternal mortality. It prevents adolescent pregnancies.
The Trump administration reasoned that certain health risks come with using contraceptives, and states that the mandate could promote "risky sexual behavior" among young people, the Times reported. It also states the government already engages in programs that subsidize contraception for low-income women who are most at risk for unintended pregnancy. Examples of federal health care and family planning programs targeted at lower-income Americans include Medicaid and Title X. But had the GOP been successful this past summer in its attempt to repeal and replace Obamacare, the government would have slashed hundreds of billions of dollars from Medicaid.
Medicaid also makes up the bulk of Planned Parenthood's funding and this past April, Trump signed legislation allowing states to withhold funding to reproductive health service providers (like Planned Parenthood) that perform abortions. The majority of Planned Parenthood's services consists of birth control and STD/STI screening and treatment.
According to the Trump administration, the latest overhaul to Obamacare will "better balance the interests” of women with those of employers and insurers who object contraceptive coverage.
"No American should be forced to violate his or her own conscience in order to abide by the laws and regulations governing our healthcare system," Health and Human Services press secretary Caitlin Oakley said in a statement on Friday. "Today's actions affirm the Trump Administration's commitment to upholding the freedoms afforded all Americans under our Constitution."