The Trump administration issued two final rules on Wednesday providing employers more flexibility with exemptions to deny women insurance coverage for birth control.
Under the Affordable Care Act, employer-provided health insurance plans are required to cover birth control as a preventive service.
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Now, the US Department of Health and Human Services has issued a final rule providing exemption from the contraceptive coverage mandate to entities that object to such coverage based on religious beliefs. The second final rule provides exemption to nonprofit organizations and small businesses that may have non-religious moral convictions to such coverage.
These rules finalize interim rules that were issued last year and take effect 60 days after their publication in the Federal Register, according to the agency.
"The religious and moral exemptions provided by these rules also apply to institutions of education, issuers, and individuals. The Departments are not extending the moral exemption to publicly traded businesses, or either exemption to government entities," the agency said in a news release Wednesday.
Fatima Goss Graves, president and CEO of the nonprofit National Women's Law Center, issued a statement Wednesday in response to the Trump administration finalizing the birth control rules.
"The Trump Administration decided to finalize these outrageous rules, despite several pending lawsuits and two federal courts blocking them," Graves said.
"It's clear that this Administration will stop at nothing to attack women's health care. By taking away access to no-cost birth control coverage, these rules try to give a license to virtually any employer, university, or health insurance provider to discriminate," she said. "But if the Administration thinks it can move these rules forward without a fight, they're wrong. Countless women depend on this critical birth control coverage for their health and economic stability -- and we will continue to fiercely defend them."
The conservative group Alliance Defending Freedom released a statement from Senior Counsel Gregory S. Baylor in response to the rules on Wednesday.
"The beliefs that inspire Christian colleges and universities, as well as groups like the Little Sisters of the Poor, to serve their communities should be protected," Baylor said. "Through these regulations, President Trump kept his promise that people of faith wouldn't be bullied on his watch. At the same time, contraceptives will remain readily available to those who wish to use them."
Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, a national organization representing publicly funded family planning providers and administrators, said in a statement Wednesday that the rules "could leave millions of women without access to birth control and reverse some of the important public health progress made under the Affordable Care Act in recent years," she said. "Family planning has been designated one of top ten public health achievements of the 21st century. It is baffling that the administration would support any policy that could diminish access to this essential preventive care."
In October 2017, the Trump administration issued two interim final rules providing an exemption for those who had religious or moral objections to such coverage, while seeking public comment on the rules.
In 2017, Health and Human Services officials said the rule would have no impact on "99.9% of women" in the United States. It based that percentage on the 165 million women in America, many of whom are not in their childbearing years.
The agency calculated that, at most, 120,000 women would be affected: mainly those who work at the roughly 200 entities that have been involved in 50 or so lawsuits over birth control coverage.
Policy experts, however, argued that this could open the door to hundreds of employers dropping coverage.
For instance, there are hundreds of Catholic hospitals, nursing homes and nonprofits that may want to stop providing contraceptives, said Tim Jost, emeritus professor at the Washington and Lee University School of Law.
Experts pointed out last year that many women use birth control for more than pregnancy prevention, including treatment of hormonal imbalances and endometriosis.
"There is no way to know how many women will be affected," said Alina Salganicoff, director of women's health policy at the Kaiser Family Foundation, a nonprofit that focuses on health policy research and communications.