This post was updated since its original publication in January 2019.
Earlier this week, the Trump administration filed a petition asking the Supreme Court of the United States (SCOTUS) to review an ongoing legal tussle over the Affordable Care Act’s (ACA) contraception coverage requirement.
This petition effectively asks SCOTUS to overturn the decision of a federal appeals court, which in July unanimously blocked the administration’s attempt to roll back the contraception coverage requirement. In its decision, the Third Circuit Court of Appeals prevented the administration from limiting an ACA requirement that protects U.S. women’s right to access contraception.
Under this provision, the ACA requires employers to provide contraception as a free preventive service. The Obama administration allowed religious exemptions but provided women whose employer exercised the exemption with a work-around so they could access contraception directly through an insurance company. The Trump administration announced a final rule last November — even after the interim rule faced legal challenges — making it possible for virtually any nongovernmental employer to request an exemption from providing contraception based on moral or religious objections. While the ACA ensured that women who work for employers that object to contraceptive coverage receive it through other means, the new rule does not include this requirement.
The circuit court decided in its July ruling that the Trump administration’s new rules would “impose an undue burden” on “female employees who will lose coverage for contraceptive care.” The administration, in its petition to SCOTUS, makes the case that the court of appeals should not have granted a preliminary injunction before the final rule was implemented.
Since the majority of women in the U.S. receive health coverage through their employer, these rules, if implemented, could have huge consequences for millions of women and their families.
In addition to preventing unwanted pregnancies, the ability to make choices about reproductive health allows women to exert control over their economic future. Indeed, having access to birth control has been shown to lift women out of poverty. The administration’s rule would undermine women’s capacity to make decisions about whether and when to have children. If employers opt not to cover contraception, women may have a harder time finding or affording it.
For low-income women who struggle to pay for their birth control, the alternative is usually family planning clinics, including those that receive federal Title X funding. However, in August 2018 the administration announced shortened funding periods for Title X grants, from three years to just seven months.
Moreover, earlier this year the administration stopped Title X funding for clinics that refer women to abortion services, making it difficult for clinics to stay open and further threatening access to both birth control and reproductive health services, particularly for low-income and minority women. Planned Parenthood, which serves more than 40 percent of Title X patients in its clinics, withdrew from the Title X program as a result of this so-called gag rule, relying instead on its emergency funds to provide services in the near term.
The administration’s attempt to make it harder for women to access birth control is especially worrisome in light of a recent Commonwealth Fund study on women’s health and health care. Among 11 high-income countries, women in the U.S. had the highest rate of maternal mortality because of complications from pregnancy or childbirth. The recently passed Preventing Maternal Deaths Act, which channels federal funding to states to study ways of preventing pregnancy-related deaths, is a much-needed step toward improving maternal care.
Our study showed that women in the U.S. have a harder time getting needed care than women in other high-income countries do. They also have worse health outcomes. Notably, U.S. women have the highest incidence of chronic illness, emotional distress, and dissatisfaction with care compared with their peers in other countries. Unlike in the U.S., women in the 10 other countries we studied enjoy access to health care that isn’t tied to their employment status, and all have access to free or affordable contraceptives.
If SCOTUS rules in favor of the administration and the rule goes into effect, it will worsen access to care and health outcomes for U.S. women. Women in the U.S. already pay among the highest out-of-pocket health care costs, and one of three skip needed care because it is unaffordable. The ACA reduced women’s contraceptive out-of-pocket expenses by 20 percent. If the Trump administration ultimately succeeds and employers can deny contraceptive coverage for any reason, it will hinder women’s ability to afford birth control.