The Affordable Care Act required all new private health insurance plans to provide contraception with no out-of-pocket cost to consumers. When the rules were drawn up, I was among the Obama administration officials who worked to strike a balance between guaranteeing women's access to these and other important preventive services while respecting religious organizations that didn't want to pay for their employees' birth control.
These new rules upset that balance and cause harm in several ways.
First, the rules end the broad guarantee of contraceptive coverage for women whose employers have religious objections to it. Under Obamacare, certain religious employers could opt out of paying for that coverage, but women still received the birth-control benefit provided by insurance companies separately.
Now, this separate coverage is not required, leaving many women vulnerable
to a large increase in their health care costs. Students employed at large Catholic universities, nurses at religious hospitals or nursing homes, and even employees of bookstores whose owners object to contraceptive coverage may no longer get it.
The Obamacare rules limited the birth control exemptions to religious organizations or those that were family-owned and could demonstrate their sincere religious beliefs. But the new rules allow even large, publicly traded companies to drop contraceptive coverage if they object to it. This means many more women could lose coverage.
The Trump administration also puts "moral" objections on the same level as religious ones. There is no clear legal authority doing so.
The Religious Freedom Restoration Act provides the authority to make, within bounds, religious exemptions, but neither it nor any other law expressly gives the administration the authority to make conscience exemptions to the health coverage rules. Beyond this overreach, the rule lets a conscience objection be in the eye of the beholder. This could open the floodgates to abuse by employers at the expense of women and families.
New policies in these rules undermine the insurance system. Thanks to the Trump administration, insurance companies now have the right to object to providing contraception on religious and moral grounds. Should they claim such an objection (with no documentation required), they would not have to sell health plans with such services -- potentially creating access gaps in some parts of the country.
Complicating the insurance system further, Trump's new rules create an "individual exemption," meaning that willing employers and insurers can let employees who object to contraception have an individualized plan without it. This would not only create "Swiss-cheese" health plans that are challenging to run, but it could raise premiums as the insurance pool gets frayed.
Last but not least, the Trump administration prioritizes a boss's beliefs over a woman's health. The rules spend page after page describing the burden placed on employers by the contraception "mandate." They spend more time trying to discredit research on how contraception reduces unintended pregnancies. Their alternative to the previous rules seems to be to send women to other federal and state programs like family planning clinics -- not acknowledging that they propose to cut funding for those very programs.
The negative implications of this rule for women's health cannot be ignored, but lurking in the background of these two rules is the nagging question: What next?
Childhood immunizations along with contraceptive services are guaranteed benefits under the ACA. Will the administration let "anti-vax" employers claim moral objections, leading to measles or other disease outbreak? Will employers assert religious and moral objections to other core health benefits: prenatal care for unmarried women, treatment for drug addiction or HIV/AIDS, or equal services for transgender people, for example?
The laws that protect the public's health and important consumer protections in the insurance system could be undermined by such an allowance for corporate and individual objections.
Already, four groups
have launched lawsuits to stop these rules in their tracks. Congress could stop the rules as well. As Americans, we are left with more evidence that President Trump's health policy agenda is less about improving health and more about repealing anything that President Obama put in place.