The Trump administration released two final rules earlier this month that broaden exemptions for birth control coverage in employer-sponsored insurance plans, allowing even more companies to decide not to cover medication on religious or moral grounds. Under the Affordable Care Act, all employers are required to cover at least one form of every FDA-approved birth control method in their insurance plans at no cost to the patient. That mandate was loosened a bit in when Hobby Lobby sued the U. The Supreme Court ruled in favor of Hobby Lobby in , arguing that requiring contraception to be included in the health insurance plans of religious-based corporations was a violation of religious liberty. Now, Trump's rules on the subject , which are essentially identical to those first introduced last year but are now final, broaden that exemption.
These lawsuits were not resolved at the time of the November presidential election. The Trump Administration has not continued to defend these lawsuits, and has settled with most of the litigants.
Contraceptive Coverage under the Affordable Care Act (ACA) has cost-sharing requirements, and exemptions among these mandates (Appendix A). to set preventive coverage requirements for health insurance across all. Plans in the Health Insurance Marketplace must cover contraceptive methods and counseling for all women, as prescribed by a health care provider. FDA-approved contraceptive methods prescribed by a woman’s doctor are covered, including: Hormonal methods, like birth control pills and. The Trump administration's two final rules on birth control, issued Wednesday, provide religious exemption from the contraceptive coverage mandate and Under the Affordable Care Act, employer-provided health insurance.
Under the October regulations, there would no longer be a guaranteed right of contraceptive coverage for female employees and dependents or students. These regulations greatly expand the number of employers that are eligible for an exemption to all nonprofit and closely held for-profit employers with objections to contraceptive coverage based on religious beliefs or moral convictionsincluding private institutions of higher education that issue student health plans.
In addition, publicly traded for-profit companies with objections based on religious beliefs would also qualify for an exemption.
Table 2 presents the changes to the contraceptive rule from the Obama Administration to those included in the new Interim Final regulations issued by the Trump Administration. Any employer eligible for an exemption could instead opt for an accommodation by notifying their insurer, third party administrator, or the government. If an employer opts for an accommodation, then their workers and dependents would still have contraceptive coverage without cost-sharing.
The mandate applies to all new health insurance plans effective August
It is not clear how many employers would choose an accommodation rather than an exemption. In the cases lead by California and Pennsylvania, the federal courts have issued preliminary injunctions blocking the enforcement of these regulations pending the outcome of the litigation.
As discussed earlier, federal law applies to all plans while state law applies to only individual plans and fully-insured group plans. Some of these states have gone beyond the ACA requirements mandating coverage of covering vasectomies or over-the-counter contraceptives. Most allow for fewer exemptions than currently permitted under federal law.
In these states, employers with fully-insured plans must comply with the higher state standard. While federal law is more expansive in benefit scope than most state laws, the Trump Administration regulations allow more types of employers to be exempt than is permitted by most state laws. Therefore, employers eligible for a federal exemption under the proposed regulations would still have to comply with their state law and provide the level of contraceptive coverage that is required in their state.
In some states, these benefit requirements are more limited than those required by the ACA. Nineteen states with contraceptive coverage laws allow cost-sharing and may not require coverage of all FDA approved methods. In these states, some employers with religious or moral objections who offer their workers a fully-insured plan would need to comply with this narrower state benefit requirement, even though the employer would be eligible for an exemption under federal law.
To illustrate the complicated intersection of state and federal law, it is helpful to compare how the contraceptive coverage exemption to the ACA requirement would play out for objecting employers with fully-insured plans in two states: California, a state with an expansive contraceptive coverage law, and Iowa, a state with a minimal contraceptive equity law and no exemption Table 3.
Only the exemptions offered by the state would be available to objecting employers with fully-insured plans. Because state law does not apply to self-insured plans, the federal rule would allow employers with those plans to qualify for the broader exemption.ACA birth control mandate put on hold
Unlike the federal and California requirements, plans in Iowa may charge cost-sharing for contraceptives. However, the state law has no religious or moral exemptions.
Currently, the federal government is blocked from enforcing the new regulations. The new regulations would substantially expand the exemption to nonprofit and for-profit employers, as well as to private colleges or universities with religious or moral objections to contraceptive coverage.
If the new regulations become effective, for women enrolled in fully-insured employer plans, the scope of their contraceptive benefits would depend on the coverage policies and exemptions established by state laws.
Employers who qualify for the exemption under federal law would still need to comply with the state contraceptive requirement. Depending on the state law, employers may still have to provide no-cost coverage for some or all methods of contraception or a narrower set of contraceptive benefits.
For women covered by fully-insured plans issued for employers with religious or moral exemptions, their choice of contraceptive methods would be determined by the scope of benefits and exemptions allowed by state law where they live. Secondly, our estimates for choice of contraceptive method were pulled from the NSFG, which does not have information on costs of contraceptive and non-contraceptive medical expenses by type of insurance coverage.
To assess contraception method mix, we analyzed data from the — NSFG. Future studies might consider using the more recently available — NSFG data, which may reflect more current contraception utilization patterns. However, we chose to use the earlier dataset to allow for corroboration of estimates and ensure the use of data analytic methodologies consistent with prior NSFG publications.
Additionally, the cross-sectional nature of the NSFG data source limits our ability to make assumptions about how women in the study might switch their birth control choices if they were to experience cost-sharing vs. For example, uninsured women in our model had higher use of long-acting contraceptives, which is in contrast to expectations based on the literature.
As the choice for use of oral contraception was more proximal to the NSFG survey, the level of usage was predictably lower.
The Trump administration's final rules could make birth control inaccessible to some. That mandate was loosened a bit in when Hobby Lobby sued requiring contraception to be included in the health insurance plans. The federal contraceptive coverage guarantee applies to most private health plans nationwide; . State Actions to Reinforce the Coverage Mandate. Mandatory employer-based insurance coverage of contraception in the U.S. has .. The ACA's Contraceptive Mandate: Religious Freedom, Women's Health.
Finally, there may potentially be a difference between the choice of contraceptive methods among women who have no insurance at all and women that use coverage only for non-contraceptive medical expenses. However, the use of the NSFG provides a nationally representative analysis of contraception use by insurance status, allowing for greater insight into demographic differences than has previously been possible.
Effects of individual-level characteristics, such as sexual activity and marital status, were influential on the model outcomes, suggesting that employee demographics and population-level characteristics may influence the costs and consequences of contraception coverage or lack of coverage. These characteristics should be taken into consideration when developing policies related to contraception coverage in the future.
Additionally, we found that private insurance coverage of contraception is cost-effective from the employer and private health plan perspectives. Employers and health plans that are deciding whether or not to offer coverage at no cost-sharing to their employees should consider the full impact that this decision could have on their bottom line, on the physical and economic health of their employees, and on public health outcomes.
Using a decision model to extrapolate to pregnancy outcomes, we found a large and statistically significant difference in unintended pregnancy and terminations.
Denying women contraception coverage may have significant consequences for pregnancy outcomes. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
National Center for Biotechnology InformationU. Author manuscript; available in PMC Jan 1. Author information Copyright and License information Disclaimer.
Here's What Trump's Final Rules on Birth Control Coverage Mean for You
Corresponding Author: Elisabeth Vodicka ude. Copyright notice. The publisher's final edited version of this article is available at Contraception. See other articles in PMC that cite the published article. Abstract Objectives Mandatory employer-based insurance coverage of contraception in the U.
Study Design A decision-tree was developed from the employer perspective to simulate pregnancy costs and outcomes associated with insurance coverage. Conclusions Denying female employees full coverage of contraceptives increases total costs from the employer perspective, as well as the total number of terminations.
Introduction Current contraceptive methods are efficacious,[ 1 ] safe,[ 2 ] and cost effective. Material and Methods A decision model was developed from the employer perspective to simulate costs and outcomes associated with employer-sponsored coverage of contraception methods as mandated by the ACA. Open in a separate window. Probability of Events and Health Outcomes Joint probabilities for key patient characteristics described in our model - sexual activity by marital status and choice of contraceptive method by insurance status, sexual activity and marital status-were derived through descriptive analysis of National Survey of Family Growth NSFG survey data.
Variable Value Range Distribution Ref. Costs Inputs Annual costs of contraception were drawn from publicly available pricing tools, as well as a previously conducted cost-effectiveness study, and inflated to dollars. Total Costs Total costs were calculated for three separate scenarios to account for the different ways that employers may cover contraception and pregnancy.
Sensitivity Analysis To assess the robustness of our results under differing assumptions, we varied all cost and event parameters across a plausible range of values. Conclusions Our model shows that removing private health insurance coverage for contraceptive methods results in more unintended pregnancies, more medically induced abortions, and greater total costs from the societal and employer perspectives, regardless of whether medically-induced abortion was modeled as a covered insurance benefit.
Figure 2. Figure 3. Appendix Figure 1A. Appendix Figure 1B. Unwanted 14 38 12 0. E Vodicka: none.
D Downing: none. J Trussell serves on advisory boards for Merck and Teva. References 1. Trussell J. Contraceptive failure in the United States. Grimes DA. The safety of oral contraceptives: epidemiologic insights from the first 30 years. American journal of obstetrics and gynecology. Cost effectiveness of contraceptives in the United States.
Robertson R, Collins SR. Women at risk: why increasing numbers of women are failing to get the health care they need and how the Affordable Care Act will help. Issue brief Commonwealth Fund ; 3 :1— Mulligan K.
Shifts in intended and unintended pregnancies in the United States, — American journal of public health. Unintended pregnancy in the United States: incidence and disparities, The public costs of births resulting from unintended pregnancies: national and state-level estimates.
Perspectives on Sexual and Reproductive Health. Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception.
Trump administration weakens Obamacare birth control coverage mandate
Milbank Quarterly. Current contraceptive use in the United States, —, and changes in patterns of use since National health statistics reports. Experts told SELF they expect another lawsuit to be filed now that the rule is finalized.
Those clinics, referred to as Title X clinics, are funded through a federal grant that exclusively provides money for family planning services—there are 4, Title X clinics across the country. But the Trump administration has been threatening to revamp that program as well, releasing a rule that prohibits Title X clinics from giving or referring for abortion care.
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The federal contraceptive coverage guarantee applies to most private health plans . Changes in State Prescription Contraceptive Mandates For Insurers: The. New Trump Health Care Attack Targets Obamacare Birth Control Mandate. Religious groups, nonprofits and small businesses will soon be. You might have heard that birth control may be free as part of health care reform. Is your type covered? What about condoms? Are there any.