President Donald Trump has a longstanding pattern of throwing a temper tantrum when he doesn’t get what he wants. One of his latest fits, though, is more than a nuisance; it endangers women’s health care.
Faced with yet another failure by Senate Republicans to repeal the Affordable Care Act (ACA), Trump struck out by announcing he would roll back the ACA’s requirement that health insurers include birth control with no co-pay as part of their coverage. While select religious organizations and family-owned corporations are already exempt from the birth control mandate, under Trump’s policy, publicly traded companies and higher education institutions will be eligible to remove birth control from their insurance coverage on religious or vague “moral” grounds.
The ACA treats birth control like the medical necessity that it is by referring to it as a “preventive service,” which the ACA requires insurers to offer without a co-pay. By rightfully classifying birth control as a preventive service, the ACA ensures that patients have affordable access to at least one of eighteen forms of birth control through their health insurance plans.
Trump’s justification for reducing birth control coverage stems from a longstanding debate over whether the birth control mandate violates religious freedom. Since the ACA became law in 2010, a handful of corporations who offer health insurance to their employees have objected to the mandate on religious grounds, claiming that the First Amendment protects them from having to include birth control in their employees’ health insurance plans if the owners have a religious objection to some forms of contraception.
It should be noted that the Obama administration acknowledged religious organizations’ legitimate objections to the mandate and offered a creative solution to protect both their religious freedoms and women’s right to health care. Obama’s religious exemption policy exempted houses of worship (such as churches) from the mandate and created a mechanism for employees of non-exempt religious organizations to receive birth control directly through their insurers and not their employers. The compromise gave women birth control coverage without forcing religious organizations to endorse or subsidize their use of contraception.
Despite the Obama administration’s accommodations, corporate outcry surrounding the mandate continued. In 2014’s Burwell v. Hobby Lobby, the Supreme Court ruled 5-4 that family-run, for-profit corporations could be exempt from the birth control mandate for religious religions. The Court’s decision opened the door for Trump to allow further leeway for employers to excuse themselves from the birth control mandate on religious grounds, resulting in last week’s rollback.
Women across America will suffer if Trump’s birth control mandate takes effect. In 2012, the United Nations Population Fund declared birth control a “universal human right.” The American College of Obstetricians and Gynecologists has found that using birth control reduces a woman’s “risk of gynecologic disorders, including a decreased risk of endometrial and ovarian cancer.” Affordable birth control also reduces strain on the American healthcare infrastructure; a study from the Guttmacher Institute shows that for every dollar invested in publicly funded contraceptive options, our national healthcare system saves six dollars. Ironically, owners of companies like Hobby Lobby oppose the birth control mandate because they liken the effects of certain forms of birth control to abortion (which science has demonstrated is false), but birth control actually leads to fewer unintended pregnancies and thereby future abortions. A study at the Washington University School of Medicine found that free access to birth control reduces abortion rates by up to 78%. Trump’s decision to cut the birth control mandate could actually increase abortions.
Birth control is more than just contraception; doctors prescribe birth control (the pill in particular) to treat a wide variety of medical conditions, like polycystic ovary syndrome (PCOS), endometriosis, and primary ovarian insufficiency (POI). It is also commonly used to alleviate menstrual cramps and acne. Women should not have to justify their use of birth control to their employers, but it is important for employers to know that women sometimes need birth control for medical needs unrelated to contraception.
Thanks to the Maryland Contraceptive Equity Act enacted last year, Maryland health insurers are required to offer all forms of birth control sans co-pay in their coverage plans starting in January 2018. While Maryland has made birth control affordable and accessible, the rest of the nation is not so lucky. The right to birth control should not be contingent on your geographic location within the United States. Trump is abusing his executive power to strip women of their right to preventive health care simply for the sake of chipping away at Obama’s legacy.