For those who've been living under a rock (or leaving all birth control concerns to their partners), one of the provisions of the Affordable Care Act was that all insurance plans must cover preventive health services without a copay or deductible, aka for free. The Obama administration defined preventive services for women to include annual well-woman exams, STD testing and treatment, breastfeeding supplies and counseling, and birth control—specifically, every method of contraception approved by the Food and Drug Administration.
Health secretary Tom Price, a former doctor who's an embarrassment to doctors, hates the fact that birth control is covered. In 2012, he famously said that "there's not one" woman in the United States who can't afford birth control and that the ACA's birth control mandate is a "trampling of religious freedom and religious liberty in this country." Fast forward to Trump winning the election, choosing Price for health secretary, and then signing an executive order on religious freedom. Trump directed the Treasury, Labor, and Health and Human Services departments to consider amending regulations to the preventive services mandate to address conscious-based objections, like religious employers balking at covering birth control.
The very same day Trump signed the order, Price released a statement titled "Secretary Price Welcomes Opportunity to Reexamine Contraception Mandate." It said:
"Religious liberty is our country's first freedom. Americans of faith play a vital role in caring for our most vulnerable citizens, including the elderly and the poor.
"We welcome today's executive order directing the Department of Health and Human Services to reexamine the previous administration's interpretation of the Affordable Care Act's preventive services mandate, and commend President Trump for taking a strong stand for religious liberty.
"We will be taking action in short order to follow the President's instruction to safeguard the deeply held religious beliefs of Americans who provide health insurance to their employees."
As Rewire reported on Friday, the Office of Budget and Management is currently reviewing an interim final rule from the HHS with the title "Coverage Of Certain Preventive Services Under The Affordable Care Act," which lawmakers suspect is about birth control, given Price's statement, but we don't know exactly what the rule says. The New York Times confirmed that the rule could be posted online any day now and would go into effect immediately.
The ACA only broadly requires insurers to cover preventive services; it's the HHS that determines what's considered a preventive service. It's possible that the rule would allow religious employers to opt out of covering birth control entirely, instead of having to fill out paperwork that they argue still makes them "complicit" in obtaining birth control. Or it could say they don't have to cover emergency contraception and IUDs, which anti-choice activists wrongly believe cause abortions, or it could leave the existing rules in place but let Catholic hospitals and universities opt out minus the sinful paperwork. The rule is still under wraps but advocacy groups including the National Women's Law Center and the Center for Reproductive Rights expect that some women would lose coverage and are already planning to file lawsuits.
But regardless, the bottom line is that there are American women who struggle to afford the most effective types of birth control, whether that's IUDs, which can cost up to $1,000 up front, or the pill, which can be $75 a month. The vulnerable, poor citizens that Price mentioned in his statement include these women, too. Removing cost barriers leads to women choosing more effective options which, in turn, reduces the number of unintended pregnancies. There's a federal family planning program called Title X that helps low-income women get the reproductive care they need at places like Planned Parenthood and other clinics, and Title X actually saves the government money: $7.09 for every dollar spent. But Trump, Pence, and Price want to limit women's access there, too, by letting states exclude Planned Parenthood from Title X funds simply because they provide abortions. The reviled American Health Care Act would block Planned Parenthood from Medicaid for one year for the same reason.
It's all horribly ironic because Obamacare's birth control mandate is the most likely reason the abortion rate is falling; as the number of unintended pregnancies falls, women are having fewer abortions. The Guttmacher Institute notes that "most of the decline in the number of abortions (62%) occurred in the 28 states (and DC) that did not have major new abortion restrictions in effect" between 2011 and 2014. If the Trump administration really wanted to reduce the number of abortions, it should stop targeting women's health providers like Planned Parenthood, which are experts in the 18 types of birth control approved by the FDA and cannot be replaced by federally qualified health centers.
Trump signed the religious freedom executive order days after he appointed two anti-choice activists to positions in the Department of Health and Human Services, one of whom doesn't believe that birth control even works. The birth control debate is just another example that even with an MD at the helm of the health department, science and evidence hold very little weight in a Trump administration.
Update 5/31/17: Vox obtained a leaked draft of the rule (dated May 23) and it would allow any employer or school to opt out of covering the cost of birth control for moral or religious reasons; not just religiously affiliated organizations and companies. Meaning even big, publicly traded companies could also seek an exemption, which is a huge change from current law. Insurers could also object to covering contraception for religious or moral reasons, though the draft notes that it's not aware of any insurers who have those objections. Employers would no longer be required to tell the government that they want to be exempted; currently they have to do that so the government can step in and make the insurer cover the cost of birth control for employees, but some employers said even that process violated their religious beliefs. Employers still have the option to ask the insurer to cover the cost, all of which means that women will be at the whim of their employers and may have to pay out of pocket.
Update 5/31/17: An original version of this story was titled "Tom Price Is Officially Going After Free Birth Control;" we changed after the draft was leaked.
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