Just recently, Massachusetts Governor Charlie Baker (R) signed off on legislation safeguarding access to contraceptive care for Massachusetts residents. While most of the protections codified under this legislation are enshrined in the Affordable Care Act, recent executive actions by the Trump administration have significantly undermined these guarantees, placing the onus on states to protect their constituents’ rights to access contraceptive services.
In early October, the Trump administration released two new regulations that would undermine the Affordable Care Act’s contraceptive coverage mandate, which guarantees access to each distinct form of FDA-approved contraceptive services without cost-sharing for those who receive their insurance through their employer. These interim rules (see here and here) vastly expand the universe of employers who could potentially claim exemptions from covering these services, threatening the health and financial security of the women, transgender people and nonbinary individuals who need contraceptive services.
Prior to these new regulations, only a limited set of religious employers (primarily houses of worship) were exempt from guaranteeing coverage to their employees. The Obama administration also offered an accommodation to nonprofit employers and closely-held corporations with religious objections, allowing them to opt out of covering these services by notifying the Department of Health and Human Services, who would then arrange for a third-party insurer to pay for and administer contraceptive coverage. This accommodation protected both the employer’s religious beliefs and guaranteed contraceptive coverage for its employees.
But for the Trump administration, this compromise was not sufficient. Effective immediately, these new regulations widen the scope of employers which could qualify for an exemption by citing religious objections, while also creating a new category of exemptions based solely on moral objections. Collectively, these sweeping exemptions make the accommodation optional, allowing almost any employer to deny their employees coverage based on religious or moral objections.
In defending these new rules, the Trump administration has decided to ignore facts and cherry pick numbers to push an anti-choice agenda that is a direct threat to Americans’ economic security and well-being. Without the coverage mandate, low and middle-income people needing contraception could be left to pay for these services out of pocket, creating a financial strain on them. For example, the cost of an intrauterine device, which is one of the most effective forms of birth control, is “nearly equivalent to a month’s full-time pay for workers earning the minimum wage,” as noted by Supreme Court justice Ruth Bader Ginsburg. Contraceptive access for women of color, who experience both the gender wage gap and race wage gap, will be particularly threatened by this rollback in affordability.
Birth control methods like pills and implants also provide users with enhanced control over their lives by allowing them to plan their pregnancy on their own terms. According to a poll conducted by Small Business Majority, 79 percent of women-identifying business owners said access to birth control played a crucial role in their economic success. Women making incomes below the federal poverty line are two to three times more likely to have an unintended pregnancy. Denying patients access to birth control denies them an economic safety net that provides the agency to choose the path that makes the most sense for them personally and financially. All people should have affordable access to the contraception methods they feel are best for them as delay pregnancy to pursue their career, education or other goals.
But birth control’s role in economic security for its users does not stop at pregnancy. Contraception helps treat anemia in people with heavy menstrual cycles, pelvic pain and uterine fibroids. Common conditions like endometriosis and polycystic ovarian syndrome (PCOS) that could require expensive surgery can often be controlled with hormonal birth control methods. Birth control is believed to prevent ovarian cancer in patients who may be susceptible, and preventing such a serious condition is a worthwhile investment. It can also be a cost-effective way to control or prevent acne, bone thinning, cysts and infections. All of these conditions would be costly to treat but can be prevented at little to no cost under current ACA mandates.
The Trump administration justifies this rollback of the Affordable Care Act’s birth control benefit by citing principles of religious freedom for employers. But this is about a radical agenda that takes away the ability of people to determine their own futures and financial security by planning for or preventing pregnancy.
Given their history in regulating insurance markets, states have an important role to play in protecting consumers from this rollback. While states are unable to mandate a minimum set of benefits for self-funded plans, there are many opportunities for states to strengthen coverage requirements (through legislative or regulatory channels) for plans that are regulated by the state. Indeed, since the 2016 election, there has been a wave of state-level efforts to codify these consumer protections, with nine states now requiring coverage of contraceptive services without cost sharing. Advocates can also submit comments asking HHS to strike the new language (here for the religious accommodation and here for the moral accomodation) by Tuesday, December 5. It is clear that in the coming months, states will be an important battleground for protecting contraceptive access, and state consumer health advocates play an integral role in leading this fight.
Tori Bilcik hails from Connecticut and is a recent graduate of Emerson College. She is an intern with the Communications team at Community Catalyst and a freelance writer.