If you currently receive birth control as part of your workplace health plan, you might want to check on the religious beliefs of your company’s owner.
As of this week, employers and insurers that claim religious or moral objections will no longer have to cover birth control in their insurance plans.
That’s because of changes announced last Friday by the Trump administration.
Since August 2011, health plans across the country have been subjected to a contraceptive coverage mandate implemented under the Affordable Care Act (ACA).
That mandate required most private health plans to include coverage for female contraceptives at no cost to patients.
Some religious employers were exempted from this requirement, including churches and houses of worship.
However, many other enterprises controlled or owned by religious organizations that oppose contraception were required to follow the mandate.
That changed last week, when the White House issued two new interim final rules that make it easier for employers and insurers to opt out of providing contraceptive coverage.
While the rules came into effect immediately, the administration is accepting comments on them until Dec. 5.
Reactions have been mixed
Many opponents of the contraceptive coverage mandate welcomed the change in policy.
“Employers with religious objections to providing contraception and potentially abortion-inducing drugs will now be protected,” Eric Scheidler, executive director of the Pro-Life Action League, told Healthline.
“That said, we’d have preferred a total rollback in the policy, which was instituted under the ACA’s preventive care provision. Fertility is not a syndrome that needs to be prevented, but rather a marker of health. Our first objection to the HHS mandate was that it treats pregnancy as a kind of disease,” he added.
Similarly, Scott Phelps from the Abstinence and Marriage Education Partnership thinks the entire policy of promoting contraceptive coverage “is backward.”
“We don’t see pregnancy as a health problem. We see it as a necessity for a growing, thriving society and economy,” Phelps told Healthline.
“We’re concerned about the declining fertility rate, which in America is now at an all-time recorded low,” he added.
On the other hand, many members of the medical community and women’s rights advocates oppose the change in rules.
“Unplanned pregnancies have a serious, negative impact on both women and babies,” Dr. Michael Munger, president of the American Academy of Family Physicians (AAFP), told Healthline.
“These rules would create a new standard that would allow employers to deny [contraceptive] coverage to their employees, based on their own moral objections,” he added. “That inappropriately inserts the employer into the patient-physician relationship, interferes with patients’ personal health care decisions, and opens the door to exceptions for other essential, physician-recommended preventive services, such as immunizations.”
Along with five other medical organizations representing more than 560,000 frontline physicians, the AAFP is calling on the White House to withdraw these interim final rules.
Increasing financial costs
According to an Obama administration report, more than 55 million women were guaranteed access to no-cost birth control under the contraceptive coverage mandate.
Now, an unknown number of women will lose that access.
“I don’t expect to see any negative health impact at all on women as a consequence of this change,” Scheidler told Healthline.
“As we’ve argued all along, birth control was already widely available and inexpensive before the HHS mandate was implemented,” he continued.
But Munger disagrees.
He expects the change to “have a financial impact that could deny access to contraception to many of the 55 million women” who currently are guaranteed access to no-cost birth control.
Along with other contraceptive methods, more employers and insurers can now opt out of providing no-cost IUDs and birth control implants.
These long-acting reversible contraceptive (LARC) methods are highly effective.
But they’re also costly to purchase without health insurance coverage.
Without coverage, birth control pills cost up to $50 per month. With typical use, they are about 91 percent effective at preventing pregnancy.
Access improves health outcomes
According to the Centers for Disease Control and Prevention (CDC), the proportion of women who use an IUD or implant has increased from almost 4 percent in 2006–2010 to slightly more than 7 percent in 2011–2013.
Some researchers have suggested that increased usage of IUDs and implants helps account for declining rates of unintentional pregnancy and abortion.
Studies have also linked these LARC methods to more optimal “birth spacing,” or intervals between births.
Longer intervals between births are associated with better health outcomes for mothers and infants, including lower risk of premature birth, low birth weight, and infant death.
The ability to plan and space births also tends to improve women’s education and employment prospects, reduce conflicts in their relationships, and lower their risk of depression and anxiety, reports the Guttmacher Institute.
For affected women, the new interim rules may negatively affect their ability to prevent, delay, and plan pregnancies.
It may also affect the ability of some women to prevent other medical conditions.
“Contraception medications are necessary for multiple medical reasons,” Munger said. “For example, contraceptive pills are necessary to prevent osteoporosis in young women with ovarian failure due to chemotherapy or radiation treatment for cancer.”
“Whether the 2018 budget preserves adequate funding for Medicaid coverage of contraception, and whether that coverage would be at no cost to women, is yet to be seen,” he added.