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ASHINGTON — For the last six years, nearly all employers have had no choice but to include birth control coverage in the health insurance plans they offer their employees.

On Friday, however, the Trump administration rescinded that regulation, allowing employers to exclude contraceptive care from insurance benefits for religious or moral reasons.

The announcement from the Department of Health and Human Services strikes a substantial but narrow blow to the Affordable Care Act, rolling back the so-called contraception mandate in a move it cast as “providing relief to those who have been under the thumb of the federal government and had their religious expression and religious conscience violated.”

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Women’s health advocates said millions of women who had gained access to birth control at no cost would be at risk of losing that coverage. They also said some employers not associated with religious movements will use the move to justify declining to cover birth control because of unspecified moral objections.

Former president Barack Obama’s administration had previously established a workaround for religious organizations with moral objections to providing birth control, allowing women whose employers opted out to obtain birth control directly from their insurer at no cost.

The new move is expected to go further, making that workaround optional for employers and potentially leaving millions of women responsible for the out-of-pocket costs of their birth control, according to Planned Parenthood. HHS, however, estimated the number of impacted women at roughly 120,000.

“With this rule, the Trump administration is taking direct aim at birth control coverage for more than 62 million women,” Dawn Laguens, the executive vice president for Planned Parenthood, said in a statement. “Under this rule, any employer could decide that their employees no longer have health insurance coverage for birth control.”

The Trump administration issued the directive as an interim final rule, meaning it will become law immediately but is subject to a public comment process.

By and large, employers do not save money by deciding not to cover contraceptive care, as the savings from not providing birth control are typically mitigated by an uptick in pregnancies, births, and associated costs.

Conservative groups, many of which have been outspoken in their opposition to the contraception mandate and supported lawsuits to derail it, lauded the decision.

“Americans will remain free to make their own decisions about, and purchase or find coverage for, the drugs and devices at issue in the mandate,” Melanie Israel, a research associate at the Heritage Foundation who focuses on religious liberty and pro-life issues, said in a statement. “And, entities with objections will not be forced to be complicit in choices that would violate their religious or moral convictions.”

The move comes after months of speculation, and at a time when HHS is without a long-term chief executive following former HHS secretary Tom Price’s resignation amid scandal last week.

Don J. Wright, the acting secretary, is a physician whose chief of staff in his prior role has advocated for abstinence-based sex education, and who women’s groups have assailed for overseeing cuts to programs that fund contraceptive care.

It also comes after months of Congressional attempts to legislate some of those changes, including cuts to the Title X family planning grant program, restricting foreign aid funding from organizations that provide or promote abortions, a ban on fetal tissue research, and a ban on abortions after 20 weeks of pregnancy.

Groups including the National Women’s Law Center and the American Civil Liberties Union are expected to sue the Trump administration for eliminating the policy, they say, in part because its impact on women specifically could make the ruling unconstitutional.

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  • I am the CEO of a company with 500 employees. I have a sincerely held religious/moral belief that prostate cancer is God’s punishment for sinful behavior. I do not wish to be complicit in the prevention, diagnosis, or treatment of prostate cancer, since I believe this to be contrary to God’s will. The health insurance which is part of the benefit package I provide to my employees will no longer cover prostate cancer. If they acquire this condition, they are free to pay for it themselves. If they can’t pay, not my problem.

    • This is a good “slippery slope” analogy.

      What recognized religion do you belong to? Some “religions” claim human sacrifice is necessary, but they’re not tax-exempt, to my knowledge.

      Prostate cancer is an illness, a disorder. Pregnancy is not. In fact, if we eliminated pregnancy, our species would cease to exist. Birth control is a lifestyle choice. Prostate cancer is not a choice of any sort.

      But, disregarding all of that, let’s assume your analogy is legitimate. It represents a step down the slippery slope of moral objections to medical “treatments” (birth control is not typically a medical treatment, and in cases where it is, I believe the Catholic Church allows it if no other treatment exists). If we can contemplate a slippery slope in this direction, we should honestly contemplate the slippery slope of government mandates. If the government can mandate that you provide a service such as birth control, and justify it by saying most people agree that it’s a good thing to make available, then they can mandate that you provide other services that people think is good. They may then say all single women must take birth control measures, in the interest of eliminating the ills of single motherhood, for the common good, and the cost will be borne by all taxpayers, because it benefits all taxpayers. Where does it stop? Perhaps the government will state that anyone over the age of 85 that contracts cancer cannot be treated for the illness. Why not?

      Once you allow the government to force someone to pay for something they would otherwise chose to not pay for, regardless of the reason, you have imbued the government with a power that they should not have, and, if you really follow the logic of the Constitution, they cannot legally exercise. You may like the idea that you are obligated to pay for birth control or abortions for others. But eventually the government will pass a law forcing you to pay for something you really do not want to pay for. Too late, you have already set the precedent of allowing the government to do so. Your Constitutional rights are already eroded.

      If you want to offer insurance that denies coverage for prostate cancer, you should be able to do so, as ridiculous as it may be. In fact, you can simply not offer medical insurance at all. But you will have a much tougher time attracting employees.

      I have never believed the ACA actually addressed the real problem; lack of transparency. It’s off topic, but the current system truly is opaque, in that, when you buy medical services, you really don’t know what you are buying, and you have no clue what you are paying for it. The pricing signals are completely stripped away, and therefore costs have skyrocketed. But, that’s another issue.

  • Gkb, you are implying that only those with a uterus are capable of empathy and critical thinking. This is sexist.

    Regardless of your gender, I would hope you are capable of understanding that there are, indeed, legitimate objections on religious grounds to a law that forces someone to provide birth control pills to someone else. The “workaround” does not resolve the conflict because the moral objection to the law has nothing to do with the cost incurred. This is, in fact, a legitimate First Amendment issue. It matters not a whit how anyone feels about it, what matters is that it does indeed force employers to make available a service they find deeply immoral and contrary to their religion.

    Consider if the majority were to decide euthanasia is a great thing and all insurance must cover it. The vast majority of mainstream religions consider euthanasia to be immoral, for several understandable reasons. These people can be forced to provide euthanasia? That would not violate their Constitutional rights? Of course it would.

    This is not about denying anyone access to anything. This is about forcing people to do something against their will. If you want to provide contraception to someone for free, go right ahead. Just don’t use the force of law, of government, to coerce others to do so against their will. You should not have that authority.

  • Not a big deal. If people want birth control, they can surely afford the $20 to $50 a month it costs to purchase without insurance. Even folks on welfare can afford this if they cut down on their purchase of cigarettes.

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