WASHINGTON -- The administration of President Donald Trump on Friday moved to roll back the federal requirement for employers to include birth-control coverage in their health insurance plans, vastly expanding exemptions for those that cite moral or religious objections.
"President Trump promised that this administration would 'lead by example on religious liberty,' and he is delivering on that promise," Attorney General Jeff Sessions said in a statement announcing the change.
More than 55 million women have access to birth control without co-payments because of the contraceptive coverage mandate, according to a study commissioned by President Barack Obama's administration. Under the new regulations, hundreds of thousands of women could lose birth-control benefits they now receive at no cost under the Patient Protection and Affordable Care Act.
Democrats assailed the new regulations.
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"The administration is now stooping to a new low by attempting to deny women the preventive health care coverage they need," said Sen. Ron Wyden of Oregon, the senior Democrat on the Finance Committee.
Dr. Haywood Brown, president of the American College of Obstetricians and Gynecologists, said the rules would turn back the clock on women's health.
"Affordable contraception for women saves lives," he said. "It prevents pregnancies. It improves maternal mortality. It prevents adolescent pregnancies."
But House Speaker Paul Ryan, R-Wis., said, "This is a landmark day for religious liberty." The new rules, he added, ensure that people "can freely live out their religious convictions and moral beliefs."
One new rule offers an exemption to any employer or insurer that objects to covering contraceptive services "based on its sincerely held religious beliefs." The other new rule offers a new exemption to employers that have "moral convictions" against covering contraceptives.
There is no way to satisfy all of the religious objections to the contraceptive coverage mandate, so "it is necessary and appropriate to provide the expanded exemptions," the Trump administration says in the new rules.
The Trump administration acknowledged that the new rules, drafted mainly by political appointees at the White House and the Department of Health and Human Services, constitute a reversal of Obama's conclusion that the mandate was needed because the government had a compelling interest in protecting women's health.
"Application of the [contraceptive coverage] mandate to entities with sincerely held religious objections to it does not serve a compelling governmental interest," the Trump administration says in the new rules.
The administration also notes that the Affordable Care Act does not explicitly require coverage of contraceptives.
"The Trump administration is treating birth control as if it's not even health care. We see this as part of the larger war they are waging on women's health," said Mara Gandal-Powers, senior counsel at the National Women's Law Center. "For some [women], it means choosing between preventive care like contraceptives and paying their rent, their mortgage, electric bill."
In expanding the exemptions for employers, the Trump administration says there are many other sources of birth control. "The government already engages in dozens of programs that subsidize contraception for the low-income women" who are most at risk for unintended pregnancy, it says.
Health and Human Services spokesman Caitlin Oakley said in a statement, "No American should be forced to violate his or her own conscience in order to abide by the laws and regulations governing our health care system."
The administration in the new rules also lists health risks that it says may be associated with the use of certain contraceptives and says the mandate could promote "risky sexual behavior" among some teenagers and young adults.
But many doctors, including obstetricians and gynecologists, said contraceptives have generally been a boon to women's health.
Since contraception became a covered preventive benefit, the share of women employees paying with their own money for birth-control pills has plunged to 3 percent, from 21 percent, according to the latest Kaiser Family Foundation figures.
"It was really important for women to have a choice of the full range of contraceptive methods that were FDA-approved," said Alina Salganicoff, director of women's health policy for the Kaiser foundation. "This will now make it up to the employer whether or not to cover contraception, and whether to cover all methods."
Salganicoff said she's concerned about coverage for implantable devices that are more expensive but also much more effective. "It opens up a lot of opportunities for employers to make choices about the coverage that women have right now," she said.
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The contraceptive coverage mandate, the administration argues, imposes a "substantial burden" on the free exercise of religion by certain employers who object to it. The new rules are motivated by "our desire to bring to a close the more than five years of litigation" over the contraceptive coverage mandate, it says.
The mandate generated dozens of lawsuits by employers, including religious schools, colleges, hospitals and charitable organizations, priests and nuns, and even some owners of private for-profit companies who objected to some forms of birth control.
However, the rules are likely to generate more litigation, this time by advocates for women and public health groups.
The National Women's Law Center, a nonprofit advocacy group, has been preparing a lawsuit since spring, when it learned that the Trump administration intended to rewrite the contraception coverage mandate.
The Trump administration cited legal reasons for issuing two rules, one for religious objections and one for moral objections. Most lawsuits attacking the mandate assert that it violates a 1993 law protecting religious liberty. The administration acknowledges that the law, the Religious Freedom Restoration Act, "does not provide protection for nonreligious, moral conscientious objections."
But, the administration says, "Congress has a consistent history of supporting conscience protections for moral convictions alongside protections for religious beliefs."
Employers claiming an exemption from the contraceptive coverage mandate "do not need to file notices or certifications" with the government, although they would need to inform employees of changes in coverage.
The exemption will be available to for-profit companies, whether they are owned by one family or thousands of shareholders.
The Trump administration said the new rules would take effect immediately, because "it would be impracticable and contrary to the public interest to engage in full notice and comment rule-making." Still, it said, it will accept comments from the public.
The United States Conference of Catholic Bishops welcomed the administration's decision.
"Such an exemption is no innovation, but instead a return to common sense, long-standing federal practice, and peaceful coexistence between church and state," Cardinal Daniel DiNardo, the group's president, said in a joint statement with Archbishop William Lori of Baltimore, head of its religious liberty committee.
Among those who have resisted the mandate are the Little Sisters of the Poor, an order of Roman Catholic nuns who said compliance with the mandate would make them "morally complicit in grave sin."
As a candidate, Trump promised that he would "make absolutely certain religious orders like the Little Sisters of the Poor are not bullied by the federal government because of their religious beliefs."
Information for this article was contributed by Robert Pear of The New York Times; by Ricardo Alonso-Zaldivar, David Crary and Rachel Zoll of The Associated Press; and by Juliet Eilperin, Amy Goldstein, William Wan and Matt Zapotosky of The Washington Post.
A Section on 10/07/2017