Healthcare Reform

Will Free Birth Control Disappear Under President Trump?

August 23, 2018

The Affordable Care Act and its subsequent regulations culminated in expanded access to contraceptive coverage. But girls are now wondering if insurance coverage for contraceptives will vanish, and whether they ought to find an IUD in the near future, in the event they revert into costing a few hundred dollars.

And based on ethical exemption and spiritual exemption rules published in the Federal Register on October 6, there is surely cause to be worried.

But the changes immediately faced legal challenges and the amount of companies expected to utilize the exemptions are fairly low.

Let’s take a look at the ACA’s contraceptive mandate, the effect it’s had, and that which we can reasonably anticipate going forward.

Contraceptives Under the ACA

Among the more controversial provisions of the Affordable Care Act (Obamacare) is contraceptive coverage. Under the ACA, most of non-grandfathered health plans need to cover–without a cost-sharing–at least one version of all the 18 different kinds of FDA-approved female contraceptives (it is notable that grandfathered plans still make up a substantial proportion of employer-sponsored programs; according to the leaked draft law, 36.5 million individuals with employer-sponsored coverage are on grandfathered plans, which aren’t required to provide contraception with no cost-sharing).

Although a number of these ACA’s provisions did not take effect until 2014, the demand that plans cover contraceptives has been set up since August 2012, for new and renewing plans.

For non-grandfathered programs that revived after there, contraceptive policy was added in the initial renewal. So by August 2013, all non-grandfathered plans included contraceptive coverage. An exception was granted for religious institutions, however, and enlarged in 2014 (as a consequence of this Supreme Court ruling in Burwell v. Hobby Lobby) to comprise”closely-held” associations whose owners have religious objections to the contraceptive mandate.

A 2015 Health Affairs study found that the ACA’s contraceptive mandate was rescuing the average oral contraceptive user $255 annually, and the average IUD consumer $248 per year (minus the ACA’s contraceptive coverage, IUDs generally cost $500 to $1,000. Pre-ACA, this had to be paid upfront, but the savings are calculated on an yearly basis, distribute over the years the girl has the device).

Underneath the ACA, guaranteed girls with non-grandfathered coverage do not have to pay anything at the time they get their birth control, presuming they opt to the contraceptives that their health insurance companies cover in total (the ACA requires health plans to cover a minumum of one of each type; it doesn’t require them to pay all versions of every type).

Although this is frequently known as”free” birth control, critics note that nothing is free. In reality, the cost of contraception is wrapped to the premiums that girls and their companies pay for coverage. Therefore for the sake of clarity, the conversation around free birth control in this guide is speaking about birth control that’s supplied without a cost-sharing at the time that it’s obtained.

Expanded Access to Contraception Reduce Abortions & Teen Birthrate

In November 2016, the CDC published data demonstrating that by 2013, abortion rates were in an all-time low from the U.S.

Abortion opponents note that this may also be a result of the plethora of legislation that have been passed in various states to limit access to abortions in the past couple of years. But evidence from Colorado–that isn’t one of the states that have passed laws restricting access to abortions–suggests that access to contraceptives is playing a important role: The Colorado Family Planning Initiative began providing long-acting reversible contraceptives (IUDs and implants) to teens and low-income women in 2009, before the ACA’s enactment. By 2014, the teen abortion and birth rates had dropped by 48 percent.

IUDs and Implants Gain Popularity Under ACA Rules

The CDC also reports that highly effective long-acting reversible contraceptive (LARC) usage is at an all-time high among American women.

This is probably due to a combination of greater education about LARC and the fact that the ACA took away the affordability barrier that occasionally prevented girls from getting LARC prior the implementation of the ACA’s requirements.

Legislative Efforts to Repeal the ACA Have Failed

The Trump Administration and the GOP-controlled Congress began 2017 with high hopes of repealing the ACA, but that did not come to pass in 2017. House Republicans passed the American Health Care Act (AHCA) in May 2017, but the Senate didn’t pass some of its own versions of the legislation, along with the September 30 end of this financial year was the deadline for utilizing reconciliation to have the ability to reform the ACA with just 50 votes (along with a tie-breaker vote from the vice president).

The House version of the AHCA and the several bills introduced in the Senate wouldn’t have eliminated the ACA’s preventative coverage mandate, but the majority of them would have allowed states to seek waivers so as to redefine crucial health benefits. Preventive maintenance, including contraception, is one of the ACA’s essential health advantages. If legislation have been enacted that allowed states to obtain waivers that redefine essential health advantages, contraceptive policy could theoretically no more be required. 

The various ACA repeal bills that were considered by Republican lawmakers in 2017 would likewise have ended federal funding for Planned Parenthood for a single year, reducing access to contraception among women who rely on Planned Parenthood for their care.

But not one of those bills passed, and October represented the conclusion of the instant opportunity to enact legislation to repeal the ACA. Republican lawmakers pledged to continue the fight to repeal the law, but the Trump Administration has also been employed to create modifications through executive orders and regulations.

What is from the New Regulations?

On May 4, 2017–the exact same afternoon House Republicans passed the AHCA–President Trump Issued an executive order that directs the Secretaries of the Treasury, Labor, and HHS, to”contemplate issuing amended regulations, consistent with law, to address conscience-based objections to the preventive-care mandate” This set the stage for new regulations, which, according to the New York Times, the Trump Administration was thinking about in late May.

On May 31, Vox got a leaked draft of a new HHS and IRS regulation, which would substantially undermine the present contraceptive mandate. Nothing happened for the upcoming few months, and the focus during the summer was generally about the legislative attempts to redesign the ACA.

But on October 6, two regulations were published in the Federal Register that allow employers broad access to exemptions from the contraceptive mandate: a moral exemption and spiritual exemption.

The regulations take effect immediately, without the usual notice and comment period. Comments are being accepted for 60 days (through December 5), however, the regulations took effect October 6. HHS normally accepts public comments on proposed regulations, considers them, and clarifies how the public comments shaped the last regulation.

But in this scenario, they’re saying they have”great cause” to execute regulations immediately and it would be”impracticable and contrary to the public interest to postpone putting those provisions in place until a full public notice-and-comment procedure is completed. ” In defense of bypassing the notice and comment period, HHS also promised they do not need to go through the comment procedure again, since they obtained opinions on the contraceptive mandate difficulty when regulations were published in previous decades. It’s worth noting, but that these new regulations are more far-reaching compared to contraceptive mandate exemptions which HHS previously promulgated, which comments would probably be quite different as well. 

Under the new regulations, any employer, college, or medical insurer can invoke an exemption in the marital mandate, together with any religious or moral grounds as the justification for the exemption. The exemption does not need to be accepted by the government–companies which don’t want to cover contraception within their group health plans only have to notify their employees of the change in benefits.

The rules explain that”Increasing the exemption removes religious/moral hurdles that entities and certain people may confront who otherwise want to participate in the healthcare marketplace. ” But advocates for available contraception notice that the effects of the regulation will be that fewer girls have realistic access to contraceptives, particularly long-acting reversible contraceptives (IUDs and implants) that tend to have high up-front costs if they’re not covered by medical insurance.

After the draft of these regulations was leaked in May, the ACLU promised to”see the Trump government in court if they try to follow through on those programs. ” And really, the ACLU filed suit promptly on October 6, as did Massachusetts Attorney General Maura Healey.

To be clear, the Obama Administration already took measures to make sure that religious employers didn’t have to directly pay for contraceptive advantages, but the workaround still ensures that girls covered by those companies’ health programs continue to have access to no-cost contraceptive coverage (that is not always uniformly enforced, however, and some girls with spiritual employers don’t have access to no-cost contraceptives by using their employer-sponsored health plan). But this is a solution that many spiritual employers believe is still infringing on their religious liberties.  

What Happens Next?

The new regulations confronted rapid legal struggles, and it is too soon to tell if they will hold up in court. In a statement regarding the principles, HHS claimed that the new rules”won’t affect over 99.9% of the 165 million girls in the United States” since they expect only about 200 entities–those who already filed suits over the contraceptive mandate based on moral or religious objections–will invoke exemptions under the rules. 

But consumer advocates worry that the rules might wind up being much more far-reaching, which the rules pose a significant loophole in the contraceptive mandate. 

Several states have employed their particular contraceptive reputations, but those just apply to state-regulated plans. Self-insured programs (which is what most very large companies use) are controlled under federal, rather than statelaw. The ACA’s contraceptive mandates apply across the board, but state-based regulations do not apply to self-insured plans.

Former Rep. Tom Price (then a Republican Representative from Georgia, who later became Secretary of HHS for a short time under the Trump Administration before resigning in September 2017) claimed in 2012 that”none” girl was unable to afford contraceptives prior to the ACA’s mandate. But a ​2010 survey conducted by Planned Parenthood discovered that 34 percent of women had”struggled with the cost of prescription birth control at a certain point in their lives”

In 2012, Georgetown University law student, Sandra Fluke, testified before a congressional panel concerning contraceptive coverage under the ACA. She declared that 40 percent of feminine Georgetown University law students reported the college health plan’s lack of coverage for contraceptives had induced them to struggle financially.

A return to cost sharing or lack of health insurance coverage for contraceptives might not pose a lot of problem for women with incomes that place them in at least the middle course. But it could pose a significant issue for lower-income ladies. And access to highly effective IUDs and implants might be radically impacted if their significant up-front prices cease to be completely covered by medical insurance.