White House moves to exempt religious employers from birth control coverage

The White House Office of Management and Budget is currently considering a rule that would allow religious employers to decline coverage of birth control in their health insurance plans, according to the New York Times. While the precise contents of the proposed rule, which is one step from finalized, aren't clear, the administration does look poised to roll back women's access to free contraception.

The Affordable Care Act obligates insurers to cover the cost of FDA-approved contraception, categorizing birth control as a preventive service. Although the Supreme Court ruled in its 2014 Hobby Lobby decision that employers with strong religious beliefs did not have to pay for employees' contraception, former President Barack Obama subsequently allowed accommodations for those employers. Companies wouldn't have to pick up the birth control tab themselves, but insurers would have to offer employees a plan that would. 

While running for office, President Donald Trump promised Roman Catholic order the Little Sisters of the Poor that he would reverse that mandate. In October, he reiterated in a letter to leaders of Roman Catholic organizations that they would not be "bullied by the federal government because of their religious beliefs" in his administration, the Times reported, making good on that pledge with his recent executive order on religious liberty. 

In signing the order May 4, Trump directed his administration to revisit mandatory coverage of contraceptives, a move that pleased Secretary of Health and Human Services Tom Price, a longtime opponent of the Obama-era mandate.

"We welcome today's executive order directing the Department of Health and Human Services to re-examine 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," Price said in a press release, promising imminent action "to safeguard the deeply held religious beliefs of Americans who provide health insurance to their employees."

The administration would not comment on the specifics of the rule, but Senate Democrats are taking action. In a letter dated May 25, a group of 14 senators asked White House Budget Director Mick Mulvaney to "cease any efforts ... that would undermine access to affordable preventive services, including contraception, for women."

"Women saved more than $1.4 billion in out-of-pocket costs for birth control in 2013 alone," the senators wrote. "Access to affordable preventive services, including contraception, is a critical part of women's health care as well as an economic priority for many women." 

In addition to cutting back out-of-pocket expenses, access to free contraception seems to have contributed to a decline in abortion rates. According to a Guttmacher Institute policy review, a 13% drop in the national incidence of abortion between 2008 and 2011 is attributable to the ACA's expansion of contraceptive access and insurance coverage. It stands to reason that, if coverage and access are constricted once again, we can expect that trend to reverse itself.