A new Trump administration rule regarding employers providing no-cost birth control to women was set to take effect Monday. But at the last moment, two federal judges paused it.

The rule would have allowed some employers to opt out of the Affordable Care Act’s birth-control coverage mandate on religious or moral grounds.

But a Pennsylvania district court judge issued a nationwide injunction Monday afternoon. That ruling came less than 24 hours after a California district court judge issued a more limited stay in 13 Democratic states and the District of Columbia, while challenges are being argued.

The rulings in rapid succession, both by judges appointed by Barack Obama, are the latest legal twists in a dispute over an expansion of health benefits for women under the Affordable Care Act that has wound through the courts for years.

What does the ACA mandate do?

The ACA, the sprawling 2010 health-care law pushed through by a Democratic Congress, says that people should be insured for preventive services without paying any out-of-pocket fees — and that women’s health services must be included. Under the law, all forms of FDA-approved contraception have been covered since 2012.

Women’s health advocates and other supporters of no-fee birth control cite research showing that the Obama era policies have been beneficial to consumers.

Nearly 63 million U.S. women last year had insurance coverage for birth control without out-of-pocket fees — about seven million more than federal estimates from 2015, according to the National Women’s Law Center.

In a 2017 Health Affairs article, researchers at the University of Pennsylvania said hat women who either took birth control pills or used an IUD saved roughly $250 for the first year after the ACA coverage requirement began. Another study by Penn State researchers found an increase in the proportion of women using long-acting birth control such as IUDs or contraceptive implants, which tend to be most effective and preventing unwanted pregnancies.

How was the Trump administration proposing to change the mandate?

The dispute centers on the issue of “religious liberty” — specifically, the extent to which the government should carve out exceptions for churches, religious group and even non-religious employers that object to birth control coverage based on their beliefs. The Obama administration had narrow exceptions and a system of “accommodations” – a work-around to religious objections – in which a third-party insurer would cover birth control even if the employer did not.

But President Trump widened the circumstances under which employers could claim exemptions in an effort to accommodate social conservatives.

The Trump administration rules allow objections to covering birth control on moral grounds, as well as religious ones. They broaden the range of employers able to claim such objections to include essentially all non-governmental workplaces. And they give the employer the choice of whether to permit a workaround accommodation.

“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,” Caitlin Oakley, an HHS spokewoman, said in a statement. “The final rules affirm the Trump Administration’s commitment to upholding the freedoms afforded all Americans under our Constitution.”

Where does the law stand now?

The back-to-back court rulings represent the second time the same judges have issued preliminary injunctions, halting Trump administration rules while lawsuits against the revised policies play out.

Within a week or each other in December, 2017, U.S. District Judge Wendy Beetlestone for the Eastern District of Pennsyvlania and U.S. District Judge Haywood Gilliam for the Northern District of California ruled an interim revision to the contraceptive mandate should be blocked nationwide. Their ruling came in separate lawsuits from Democratic state attorneys general challenging the Department of Health and Human Services for issuing what are known as interim final rules. Those cases are now on appeal before circuit courts.

In the meantime, HHS in November issued a final rule, similar in most respects to the interim one, which was slated to take effect on Monday. These rules, too, were challenged in court, and they are the one the the judges are now blocking.

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