The Affordable Care Act's approach to birth control is straightforward, and at least at first blush, noncontroversial. As regular readers know, under "Obamacare," contraception is covered as standard preventive care that insurers are required to provide. Houses of worship are exempt, and thanks to the Supreme Court's 5-4 Hobby Lobby ruling, that exemption is quite broad.
Donald Trump -- or more accurately, the people responsible for making policy decisions in his administration -- are of the opinion that the exemption isn't nearly broad enough. Today, the president's team dramatically altered the ACA's policy, opening a dangerous door in the process.
The Trump administration loosened Obama-era birth control requirements Friday, saying just about any provider of health insurance could refuse to pay for an employee's birth control if they show "sincerely held" religious or moral objections.The new regulations protect groups such as the Little Sisters of the Poor from litigation if they refuse to provide contraceptive coverage, but widen the pool of those shielded to include non-profits, for-profit companies, other non-governmental employers, and schools and universities.
The practical effects of the change are obvious: some American women who receive contraception at no cost will, as a result of the Trump administration's new policy, have to pay higher out-of-pocket costs for birth control -- because their employer says so.
How many employers? No one really knows for sure. HHS says only about 200 entities are likely to scrap their workers' birth-control coverage, but that's based on the number of employers that filed lawsuits against the Obama administration's policy. The trouble is, now that Team Trump has opened the door to every employer, it's hard to predict just how many will take advantage.
This doesn't come as too big of a surprise. A leaked draft of the policy came to public light in June, a month after the president signed an executive order he said was intended to "restore" religious liberty.
Fatima Goss Graves, president of the National Women's Law Center, told NBC News, "By taking away women's access to no-cost birth control coverage, the rules give employers a license to discriminate against women."
By all appearances, Trump administration officials know this, but there's no reason to believe they care.
All of this policymaking is regulatory, not legislative, so there's no meaningful role for Congress to play. As we discussed in June, when drafting the Affordable Care Act, lawmakers did not specify what would constitute women's preventive care benefits; it was up to Obama administration officials to come up with the list, which ended up including things like contraception, domestic-abuse screenings, breastfeeding equipment, etc.
After the election, the power shifted to the Trump administration's hands -- with no new legislation necessary.
Of course, the irony of the circumstances is apparently lost on the White House. The thrice-married, serial-adulterer president, who was recorded bragging about sexually assaulting women, and who was accused by several women of doing exactly what he boasted about doing, is now the same president who's rolling back the clock on women's access to contraception.