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The Trump administration says it will let employers opt out of providing health plans that cover birth control, weakening a requirement put in place by Obama administration officials, as part of a wider push to expand religious freedom.

The shift would broaden an Obama-era religious exemption from providing contraception coverage to more for-profit corporations and others not included in an earlier workaround. It would also permit employers to decide against offering contraception coverage for “moral,” rather than religious, reasons.

(Related: Obama Administration Turns Contraceptive Fight Over to Trump)

The move was one of a series of steps taken by the Trump administration Friday to provide what it says will be greater protections of religious freedom. Attorney General Jeff Sessions issued guidance to federal agencies telling them to give broad deference to religious beliefs in their actions and enforcement.

Advocates for women’s health and civil rights expressed opposition to the change in the contraception-coverage rules. The American Civil Liberties Union filed a suit on Friday in San Francisco federal court to oppose the rule. Attorneys general in California and Massachusetts said they would take legal action to block the rules, as did the National Women’s Law Center, which called them “outrageous.”

‘Medical Necessity’

The Affordable Care Act required employers to cover preventive health services with no out-of-pocket costs for the enrollees. Officials in Obama’s U.S. Department of Health and Human Services concluded that the preventive services benefits package should include coverage for birth control services, prescription drugs and devices.

The Obama administration had allowed some religious organizations to opt out of the contraceptive requirement, but the religious groups said that the exemption process didn’t go far enough.

The new rules would let employers avoid a workaround that was created by the Obama administration to let women gain access to contraceptives even if their employers object.

Both rules allow companies to choose which contraceptive methods they don’t want to cover. Some religious institutions object to forms of contraception that they view as causing an abortion.

The American College of Physicians said the rule change will “create substantial barriers to patients receiving appropriate medical care as recommended by their physicians.” The American Congress of Obstetricians and Gynecologists said the rules would hurt patients.

“Contraception is a medical necessity for women during approximately 30 years of their lives,” the group said. “It improves the health of women, children and families as well as communities overall; reduces maternal mortality; and enhances economic stability for women and their families.”

The pro-life group Susan B. Anthony List called the rules a victory for religious people.

“We thank President Trump for fulfilling a core promise to voters of faith and conscience who elected him,” President Marjorie Dannenfelser said in a statement.

Uncertain Effects

About 200 employers that are involved in suing the government over the requirement to provide contraception coverage would likely take advantage of the rule change, the Trump administration estimated. That could affect about 120,000 women, costing them a total of $70.1 million, the administration said.

The government said that the ultimate effects of the new rules are uncertain. Among the “multiple levels of uncertainty,” one of the rules lists: how many entities will use their new exempt status; how many women will be covered by plans of entities using the exemption; and how many women in newly exempt plans want contraception.

The rules were proposed in “interim final” form, meaning they go into effect immediately.

The Obama administration Affordable Care Act preventive services package regulations required coverage for a broad range of contraceptive options, according to the Kaiser Family Foundation, including surgical sterilization, pills, and intrauterine devices. Before it went into effect, about 21% of women ages 15 to 44 with employer-provided health coverage reported spending their own money on birth-control pills, according to Kaiser. That fell to 3.6% in 2014.

The Planned Parenthood Federation of America said most women use birth control and coverage shouldn’t be controversial.

“It’s basic health care that the vast majority of women will use in their lifetime,” said Dana Singiser, vice president for government relations and public policy. “We are talking about a fundamental right.”

Unintended Pregnancies

The rule on the religious exemption comes to the conclusion that the government doesn’t need to calculate the number of unintended pregnancies that may result from women losing access to contraception coverage. It claims the data linking contraception to a decrease in unintended pregnancy is uncertain.

It refers to a 2011 recommendation from the National Academies of Sciences, Engineering, and Medicine, then called the Institute of Medicine, on preventive services that recommends requiring contraception coverage to help women avoid unintended pregnancies.

“The assertions rely on association rather than causation, and they associate reduction in unintended pregnancy with increased use of contraception, not merely with increased access to such contraceptives,” according to the rule.

The government also said imposing a coverage mandate could “affect risky sexual behavior in a negative way.”

— Read View: Obama Didn’t Need To Wage War Over Contraception on ThinkAdvisor.


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