The same week the House passed a new abortion ban, President Trump announced broad exemptions to the contraception mandate, a popular provision of the Affordable Care Act (ACA) that required insurers to provide free contraceptive options to women.
According to the Kaiser Foundation, savings on the birth control pill have accounted for nearly two-thirds of the total drop in out-of-pocket prescription drug spending since the mandate took effect in 2012. The percentage of women paying out-of-pocket for birth control declined from 21% in 2012, to just 3.6% in 2014.
Although the Obama administration offered exemptions to religious entities, the Trump administration claims the mandate conflicts with religious liberty, and expands the exemption to most employers and some insurers.
Despite being presented as a broad exemption, the Trump administration estimates only 120,000 women will be affected – based on recent lawsuits brought against the contraception mandate. The American Civil Liberties Union has filed a lawsuit against the expanded exemptions, stating “The Trump administration is forcing women to pay for their boss’s religious beliefs.”
True as that may be, the Supreme Court of the United States did not find it unconstitutional in 2014 when they ruled in favor of Hobby Lobby, a for-profit company, who cited religious beliefs as their reason for opposing contraception coverage. Furthermore, since Health and Human Services has broad oversight on how to enforce the mandate, I wouldn’t count on the courts to intervene.
Beyond the religious liberty justification, the Trump administration also claims the mandate encourages “risky sexual behavior” in young people. In fact, data collected by the national Youth Risk Behavior Surveillance Survey (YRBSS) found that risky teen sexual behavior has declined since the contraception mandate became effective in 2012.
In addition, according to the Guttmacher Institute, which has tracked abortion rates since 1975, the number of abortions dropped below one million for the first time in 2013 – a year after the contraception mandate took effect. They declined a total of 14% between 2011-2014. The authors believe increased access to contraception is largely driving the decline. If the goal is to reduce abortions, limiting access to contraception seems counterproductive.
While it’s possible that the expanded exemption may attract additional employers with religious objections to the mandate, the vast majority of women who obtained free birth control under the ACA are likely to continue receiving it. As long as maternity care is considered an essential health benefit, neither employers nor insurers have an incentive to deny contraception coverage for a fairly straightforward and obvious reason: pregnancies and babies cost a lot more. Prior to the implementation of the ACA, a 2010 Kaiser/HRET survey reported 85% of large employers covered contraceptives in their health plan, so they aren’t just doing it because the government is telling them to.
Nonetheless, millions of women continue to lack access to basic contraception. We should be working to expand coverage – not limiting it.
Follow Jenny Sue Kakasuleff on Twitter: @libgrrrl.