Fifty-five million women nationwide could lose access to free contraceptives through employer health coverage if a Trump administration plan to alter an Affordable Care Act mandate is finalized.
The Wall Street Journal reported this month that federal health officials are close to finalizing changes to the Obama-era mandate, which required most employers to make at least one of 18 FDA-approved contraceptives available at no cost through their health plans, with the exception of some religious groups.
The changes proposed by the Trump administration would allow any employer to apply for an exemption to covering contraceptive care based on religious beliefs or “moral convictions.”
The draft revision, leaked in May, has been praised by religious freedom advocates, who have been engaged in years of legal battles with the federal government over the mandate.
Tami Fitzgerald, executive director of N.C. Values Coalition, said opposition to the mandate is about more than religious or moral objections.
“It’s no business of the government to mandate that anyone has to cover contraceptives in their health care plan,” she said. “These are private businesses we’re talking about. They should have the freedom to run their business the way they see fit.”
The overhaul of the policy follows President Donald Trump's May executive order, directing cabinet officials to address “conscience-based” objections to the preventative care mandate.
The mandate required private health insurance plans to fully cover the costs of a range of preventative services in addition to birth control, including screenings and immunizations.
In North Carolina, 1.6 million women have preventative services with zero-cost sharing, according to the U.S. Department of Health and Human Services.
Alison Kiser, senior director of external affairs at Planned Parenthood South Atlantic, said the ACA mandate’s ban on co-pays, deductibles and other expenses allowed some of Planned Parenthood’s patients to access affordable birth control for the first time.
“Prior to this requirement, women might have to pay up to $60 per month just to get their monthly birth control, which, for women on a tight budget, low income women, students, really put this basic health care service out of reach,” she said.
Before the ACA, even those with insurance policies that did cover contraceptives typically had some out-of-pocket costs. Tara Romano, executive director of NARAL Pro-Choice NC, said while some women only pay $5 to $15 per month for birth control pills, the cost can add up.
“It’s a long term, as opposed to other prescriptions that you might get once — like antibiotics — for some illness you’re dealing with,” she said.
Since the contraceptive coverage mandate was enacted, the number of privately insured women who paid nothing out-of-pocket for birth control has skyrocketed. According to data from reproductive rights research group the Guttmacher Institute, before the guarantee, just 15 percent of women had no out-of-pocket fees for the birth control pill — after the guarantee, over two-thirds of women paid nothing out of pocket.
Kiser said the mandate eliminated the cost barrier for long-acting contraceptives such as the IUD and the implant, which can cost hundreds of dollars up front without insurance.
“Birth control is not one-size fits all," she said. "And it’s really unfortunate that a woman might not be able to choose the best method for her due to financial constraints."
Legal battles in the years since the mandate was passed have broadened the scope of companies that can receive exemptions. In Burwell v. Hobby Lobby Stores, Inc., the U.S. Supreme Court ruled that requiring closely held corporations to provide female employees with free birth control violates religious freedom.
In response, the Obama administration created a rule that would allow the employee of a company that requested an exemption to go directly through the insurance company to obtain coverage. Religious groups again took objection, arguing they were complicit in providing birth control.
Now as religious freedom advocates praise the government’s proposed changes, reproductive rights organizations are threatening their own litigation. The National Women’s Law Center has argued that by addressing just birth control, the revision to the mandate is gender discrimination and that it violates the separation of church and state.
Fitzgerald dismissed the argument.
“It’s an outlandish claim to say that it’s discrimination against women for the government to give business owners the freedom to cover what they feel necessary to cover in their own health plans,” she said.
Fitzgerald said women can already access birth control at county health departments, hospitals and clinics like Planned Parenthood.
“What we’re talking about here is who pays for it,” she said.
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