The Trump administration issued a rule Friday that sharply limits the Affordable Care Act’s contraception coverage mandate, a move that could mean many American women would no longer have access to birth control free of charge.

The new regulation

Issued by the Health and Human Services Department, the new rule allows a much broader group of employers and insurers to exempt themselves from covering contraceptives such as birth control pills on religious or moral grounds.

The decision, anticipated from the Trump administration for months, is the latest twist in a seesawing legal and ideological fight that has surrounded this aspect of the 2010 health-care law nearly from the start.

The controversy

The controversy first arose as part of the Obama administration’s initial definition of preventive care that insurers must cover under the ACA — which encompassed birth control, officials decided.

When the contraception mandate was first implemented in August 2012, it required all health insurance offered by employers to cover at least one of the 18 forms of birth control approved by the Food and Drug Administration. Since then, savings on the birth control pill have accounted for more than half of the drop in all out-of-pocket prescription drug spending, according to the Kaiser Family Foundation.

Subsequent accommodations gave exemptions of sorts to houses of worship, nonprofits with religious affiliations and closely held for-profit companies. Such employers have been able to opt out of providing the coverage and instead have their insurance company pay for it by notifying the insurer, a third-party administrator or the federal government. That situation will continue.

Organizations affiliated with the Catholic Church, which teaches against birth control other than by natural means, have been among the most vocal opponents.

They’ve argued that having to cover the cost of contraception through health insurance plans is tantamount to being forced by the government to be complicit in a sin.

In the past several years, lawsuits have been filed by nuns, Catholic charities, hospitals and universities. Even now, litigation remains in several federal appeals courts.

One challenge was heard by the Supreme Court, and the justices ruled in 2014 that it was illegal to impose the mandate on “closely held corporations” such as Hobby Lobby, the craft store chain. Its Christian owners had objected to the idea of paying for several kinds of the birth control that must be covered.

Number of women to lose access to free birth control

Senior Health and Human Services officials, briefing reporters early on condition of anonymity, contended the change will still leave “99.9 percent of women” with access to free birth control through their insurance. They said the estimate was based on the finite number of groups that have filed about 50 lawsuits over the provision.

Despite HHS’s officials 99.9 percent prediction, no one knows how many companies and institutions will now claim an exemption and, in turn, how many women will lose access to no-cost birth control.

However, administration officials estimate that 120,000 women at most will lose access to free contraceptives — many fewer than critics predict.

Reactions from religious groups

Several religious groups, which battled the Obama administration for years over the controversial requirement, welcomed the action.

Reactions from women’s rights organizations

Women’s rights organizations and some medical professionals portrayed it as a blow to women’s health, warning that it could lead to a higher number of unintended pregnancies.

The National Women’s Law Center — which estimates that in 2013 alone, the contraception requirement saved women $1.4 billion in oral contraceptive costs — has vowed to challenge the Trump administration in court.

  • It plans to argue that the new policy amounts to sex discrimination, since it will disproportionately affect women.
  • It also plans to allege religious discrimination, arguing that it will allow employers to impose their religious beliefs on employees.

Over the summer, a leaked early draft of the regulation began circulating in Washington, priming both sides for a renewed fight. That draft immediately drew praise from one side and condemnation from the other. The reactions have been similarly divided ever since.

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