Exemptions to birth-control coverage may be expanded

WASHINGTON — The Trump administration is expected to soon issue regulations that would expand religious and moral exemptions for covering birth control in employer healthinsurance plans, a move that critics say would limit women's access to contraception.

The rules likely would roll back a controversial Obama-era mandate in the Affordable Care Act that required employers to cover birth control. The regulations were filed last week for review with the Office of Management and Budget, indicating the administration is in the final stages of issuing the expanded exemptions.

The exact details of the exemptions, and when they would take effect, remain unclear. But women's health advocates are bracing for a legal fight. They expect the rules to mimic earlier regulations enacted by the Trump administration last year before being blocked by federal judges.

The rules allowed nearly any employer — nonprofit or for-profit — with a religious or moral objection to opt out of the Affordable Care Act provision requiring the coverage of contraception at no cost to the employee. The rules vastly expanded which companies could be exempt from the mandate and why, including a broad exemption for a “sincerely held moral conviction” not based in any particular religious belief.

Perhaps most significantly, it required employers to provide no other accommodations for employees seeking birth-control coverage.

The Trump administration rules were “nothing short of radical,” Louise Melling, deputy legal director of the American Civil Liberties Union, said Thursday. “There's no backstop to ensure coverage for employees.”

The number of companies that would actually opt for such exemptions is unclear. An employee's coverage would depend largely on the employer's insurance plan, as well as the state's laws. Currently, 30 states and the District of Columbia require insurance plans to cover contraceptives to some extent, with certain exemptions, according to the Kaiser Family Foundation. But state laws in those places do not have authority over all plans.

Meanwhile, 20 states have no contraception requirements for insurance plans.

The birth-control rules are part of a broader effort by conservatives inside and outside of the White House to prioritize religious liberty. It also comes in the midst of an ongoing court battle.

Before Trump took office, the Obama administration was facing scores of lawsuits from organizations, such as Hobby Lobby, arguing that the freecontraception mandate violated their religious beliefs. The mandate required employers to cover the full range of contraceptive services approved by the Food and Drug Administration, including emergency contraception and IUDs, without cost-sharing.

After a Supreme Court decision in the Hobby Lobby case, the Obama administration allowed religiously affiliated nonprofits and certain private, for-profit corporations to opt out of the coverage, as long as their employees were provided with an accommodation. The accommodations allowed for women to still get the coverage they needed for birth control, but the company's insurer would pay, not the company itself.

Then, in October 2017, the Trump administration issued its directive significantly expanding those exemptions.