The inclusion of those entities under the contraceptive mandate set off five years of Supreme Court cases and subsequent accommodations by the Obama White House. One major accommodation was that nonprofit religious entities that weren’t places of worship could refuse to cover contraceptive services through their own plans, but would still have to pay for the cost of that coverage through third-party or government insurers. Similar accommodations were granted for “closely-held for-profit entities” in the wake of the 2014 Burwell v. Hobby Lobby decision.
According to the Kaiser Family Foundation, about 10 percent of all eligible nonprofits have taken this accommodation, but several nonprofits, including those captured in the Zubik v. Burwell lawsuit that was remanded by the Supreme Court, wanted full exemptions, instead of accommodations.
The Trump administration’s new rule grants that wish and much more. According to a New York Times report Thursday, the White House has concluded that there is no way to accommodate every objector to the mandate, and that “application of the mandate to entities with sincerely held religious objections to it does not serve a compelling governmental interest.” But in creating such broad categories of employers that merely have religious or even moral convictions against providing contraceptive services, it opens the door for pretty much all employers to simply stop covering them and paying for them, with no alternatives. It leaves accommodations in place, but as optional measures to be taken by employers should they wish.
The new rules will probably result in a noticeable increase in the number of women who have to pay out of pocket again for contraceptive services. The regulation itself notes that “these final rules will result in some enrollees in plans of exempt entities not receiving coverage or payments for contraceptive services.” That might be an understatement. Half of all women receive their coverage through their employers, and the ACA’s mandate has reduced the percentage of women from ages 15 to 44 who have to pay for contraceptive coverage through their employer from 20 to 3.6 percent.
In addition to simply providing women with much more flexibility as to their birth-control options, the mandate also provides real health benefits. Early research indicated that lower costs mean that adherence to contraception is higher, and thus unwanted pregnancies might be avoided. Also, the law reduces total out-of-pocket spending by women and their families on health care and potential expenses for those pregnancies or for abortions.
While it’s unclear how many employers will cite religious or moral objections, exempting those already under accommodation and increasing that number when new objections are considered would mean at least thousands of women will have to pay for contraceptive services on their own—or forgo them.