Donald Trump's updated contraceptive rule was recently leaked, raising concerns about women's ability to access affordable family planning. It's hard to keep track of what we need to be keeping track of these days, especially when it comes to women's health. So let's review.
What is the contraceptive mandate?
The contraceptive mandate, aka the "birth control benefit," was a part of the Affordable Care Act's (ACA) Essential Health Benefits, which included the list of ten services that the non-partisan Institute of Medicine determined all insurance providers must cover because, well, they are essential. The rule's preventive care guidelines meant that women could access the form of contraception they need at no cost.
It's been great for women's health, and their wallets.
Thanks to the contraceptive mandate, more than 48 million women no longer face cost barriers to accessing birth control. The National Women's Law Center reported that in 2013, women saved more than $483 million in out-of-pocket birth control costs, for an average of $270 per woman. The number of women who filled their birth control prescriptions without copays grew from 1.3 million to 5.1 million, and in one year the share of women who had access to birth control with no out-of-pocket costs grew from 14 percent to 56 percent.
As described in a recent report released by the Roosevelt Institute and the Ms. Foundation for Women, these benefits have an outsized impact on women with low incomes and women of color, whose ability to access health care, including contraception, is compromised by stark disparities in wages, employment benefits, and proximity to providers, among many other factors. Historic racial and gendered inequities continue to shape economic opportunities and outcomes for those women and their families.
The benefit sparked outcry from day one.
The birth control benefit has been marked with a bullseye since the moment it became part of the health law. Despite the fact that President Obama included an exemption for churches and other places of worship, there have been more than 100 lawsuits challenging the provision, two of which have made it to the United States Supreme Court. In the first such case, Hobby Lobby Stores Inc. v. Burwell, the Court expanded the definition of what can be considered a "religious" organization and allowed for those non-religious entities to deny contraceptive coverage. To ensure that employees of those organizations could still access birth control, the Obama administration created an "accommodation," which requires employers to simply sign a form stating their religious objection to providing the coverage, thereby triggering a process by which a woman can get coverage directly through her insurance provider.
Everyone moved on, right? Wrong. A number of organizations protested, saying that even signing the form was a violation of their religious liberty because it enabled women to access a service they find at odds with their beliefs. So the Supreme Court heard a second series of cases, including Little Sisters of the Poor v. Burwell, punting a decision to a later date. Given how loudly the new administration has lobbied for so-called "religious freedom" at the expense of women's health, the future of the birth control benefit in the courts is murky, at best. In a recent ceremony at the White House, President Trump told nuns from the Little Sisters of the Poor, "Your long ordeal will soon be over, okay?"
What would this leaked rule do?
The rule would vastly expand an employer's ability to deny birth control coverage. It would allow any employer—not just faith-based organizations—to deny coverage based on moral objections and exempt those workplaces from the accommodation. Because the leaked rule modifies existing regulations and not law, it can go into effect as soon as it is published in the Federal Register. This is just one way the administration can undermine women's health without having to actually repeal the ACA.
What would this mean for women?
Tens of thousands of cisgender women, transgender individuals, and people who are gender non-binary are at risk of losing access to affordable family planning of their choice.
But can't women just go elsewhere for their contraception?
The current head of the US Department of Health and Human Services has said there isn't one woman who can't afford contraception.
Not so fast, Secretary Price. First and foremost, family planning is a central part of women's preventive care, and we should be able to access it alongside a host of other health services, not have to jump through hoops to get it. For women with low incomes, and young women in particular, birth control costs are prohibitive, with serious implications for their health. Before the birth control benefit, women had to shoulder the costs of their chosen contraception method, which can exceed $1,000 annually. Nearly one in four women with incomes under $75,000 put off seeing a doctor for a birth control prescription to save money.
Current versions of the new health care bill also defund Planned Parenthood, which would decimate communities' access to responsive and stigma-free care. The administration has also moved to weaken Title X, the nation's only federal family planning program. This has put the sustainability of local family planning providers in jeopardy even as the administration's larger policy agenda of austerity is likely to drive up demand for their services.
There will be significant health and economic consequences.
Without access to affordable contraception (and to be clear, access to unaffordable contraception is not really access at all), women's economic security and safety is compromised. In addition to the financial toll, the rule takes decision-making power away from women, which impacts how power plays out in interpersonal relationships and with sexual partners. The consequences will be most acutely felt and borne by women with no alternatives for getting contraception -- namely, women with low incomes and women of color.
We don't need to guess what will happen if the administration succeeds at rolling back access to reproductive health care. Over the past five years, Texas has passed several similar bills. As a result, claims for long acting reversible methods of contraception (like the IUD) dropped by one-third, thousands of women have attempted self-induced abortion, the maternal mortality rate doubled, and the percentage of births covered by Medicaid has increased. Given that the costs to the government -- yes, *you* the taxpayer -- rise, the economic consequences of denying birth control extend far beyond individual circumstance.
Want to do something about it?
Find out if your state guarantees contraceptive coverage with no copay and contact your representatives at the state level. Earlier this month Nevada became the fifth state to codify the ACA's birth control benefit into state law. At least 15 states have similar legislation pending.
Support organizations on the ground. The Ms. Foundation for Women funds women-led grassroots organizations fighting for women's health across the country. Check out grantee partner Raising Women's Voices for resources on how the ACA has benefitted women and why it is so critical that we expand access to the full range of reproductive health services.