WASHINGTON -- Medical groups expressed disappointment in by the Trump administration that rollback contraceptive coverage requirements put in place by the Obama administration.
The new rules were issued as "interim final" regulations, meaning that they will be implemented immediately. The rules allow employers to refuse to cover contraceptives for any moral or religious reason. It also no longer requires employers to allow their insurers or third-party administrators to provide separate coverage, instead calling that arrangement an "optional" accommodation.
Under the Affordable Care Act, employers were required to cover all forms of contraception with no co-pay. Certain religiously affiliated employers, such as churches or religious affiliated hospitals or universities, were exempted from this rule; however, once they signed paperwork stating that they did not want to provide coverage, the employer's insurer or third-party administrator then had to provide that same coverage, with no co-pay, to employees who needed it.
"Reducing access to contraceptive coverage threatens to reverse the tremendous progress our nation has made in recent years in lowering the unintended pregnancy rate," Haywood Brown, MD, president of the American Congress of Obstetricians and Gynecologists, said in a statement. "Instead of fulfilling its mission 'to enhance and protect the health and well-being of all Americans,' HHS [Health and Human Services] leaders under the current administration are focused on turning back the clock on women's health."
"We are concerned that allowing employers to carve out exemptions to the ACA's requirements that health insurance plans cover evidence-based preventive services without cost-sharing, including but not necessarily limited to contraception, will create substantial barriers to patients receiving appropriate medical care as recommended by their physicians," said Jack Ende, MD, president of the American College of Physicians, in a statement.
The Trump administration is framing the decision as a religious freedom issue, and in fact most of the objections to the contraceptive coverage rule were based on religious grounds.
The new rules support religious freedom in the U.S. by allowing employers to follow their consciences, according to the Trump administration. "No American should be forced to violate his or her own conscience in order to abide by the laws and regulations governing our healthcare system," said HHS press secretary Caitlin Oakley, in a statement emailed to 51˶. "Today's actions affirm the Trump Administration's commitment to upholding the freedoms afforded all Americans under our Constitution."
But others disagreed. "In my mind, the freedom of religion argument is quite flawed," Katrina Mark, MD, assistant professor of obstetrics, gynecology, and reproductive services at the University of Maryland, in Baltimore, wrote in an email. "If a woman is denied access to needed and desired healthcare due to her employer's religious beliefs, how does that not qualify as suppressing her freedom of religion?"
"I have had patients who suffer from medical conditions that would make pregnancy life threatening for them, but their insurance has denied their coverage for contraception based on 'moral' grounds," she continued. "I cannot understand how anyone can argue that they have a moral objection to providing safe, effective contraception but no moral objection to forcing a woman to face the possibility of a life-threatening pregnancy."
Others in the ob/gyn community praised the new rules. "The American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG), representing nearly 4,800 members across the U.S., applauds the revision of the Affordable Care Act mandate, which will now allow relief for employers who do not want to participate in ending human lives," AAPLOG executive director Donna Harrison said in a statement. "It is exquisitely clear from science that a new human being begins at the moment of fertilization. So-called 'contraceptive' methods such as the IUD and Ella, which clearly kill embryos after fertilization, were included in the ACA mandate prior to these revisions. Now employers do not have to pay for drugs which kill human embryos."
"These revisions are a step forward toward recognition that some Americans do not want to pay for or participate in destroying other human beings," she continued. "These revisions are finally consistent with the deep history of conscientious objection to killing which has always previously been honored in the United States."
But others contend that bringing abortion into the discussion clouds the issue.
"None of the FDA-approved birth control methods induce abortion," said Jessica Atrio, MD, assistant professor of ob.gyn. and women's health at Montefiore Hospital and Albert Einstein College of Medicine in New York City, in an email. "All of our birth control methods prevent conception through thickening of cervical mucus, prevention of ovulation (as is the case in emergency contraception), or through spermicidal interactions (the copper IUD)."
And because no methods induce abortion, that argument "doesn't apply to any contraception that this mandate just reversed," said Tracey Wilkinson, MD, of Physicians for Reproductive Health, a pro-choice and pro-contraception organization, on a Friday conference call with reporters organized by the American Civil Liberties Union (ACLU).
Several organizations represented on the call said they are planning to sue over the rules. "We're prepared to take all action, including legal action, to defend women ... against these attacks," said Xavier Baccera, attorney general of California. "[With these rules], women's rights are fundamentally abridged. Everyone has a right to practice their religion, but they don't have the right to practice it on someone else."
"We are hoping to [file] as soon as possible; hopefully, that means today," said Brigitte Amiri, senior staff attorney for the ACLU.
Under the ACA provisions, women saved $1.4 billion on oral birth control medications alone, said Dana Singiser, spokesperson for the Planned Parenthood Federation of America, adding that unintended pregnancies are now at a 40-year low.
"With this rule, employers could make it more difficult if not impossible for women of all ages to access birth control," Wilkerson said. "Every day day I see how access to contraception improves patients' lives. I don't want to have to start treating my patients differently because their employer doesn't believe in contraception ... It's a dangerous intrusion in women's ability to get the care they need. We implore the administration to stop attacking women's healthcare and listen to the evidence."