In the Crosshairs

Trump Is One Step Away From Dumping Obamacare’s Copay-Free Birth Control

Senate Obamacare proponents are urging Mick Mulvaney to stop chipping away at birth-control access after the OMB posted a new rule governing ‘certain preventive services.’

Photo Illustration by Elizabeth Brockway/The Daily Beast

Trumpland is a single step away from enacting a rule that could affect millions of women’s access to health care, in one fell swoop changing the Obamacare mandate that required insurance give women access to copay-free birth control.

We don’t know exactly how this rule will affect women, how many it will affect, because, though it’s just one set of approvals away from being officially on the books, it’s been kept under wraps from the public. But given the Trump administration’s track record of hostility toward government-sanctioned contraception, women’s health advocates are bracing for the worst.

On Wednesday, the Office of Management and Budget quietly posted this seemingly innocuous item to its website. It’s a notice that a new rule governing “certain preventive services under the Affordable Care Act” is one layer of approval away from being enacted. Some say the contraceptive mandate is likely in its crosshairs.

The Affordable Care Act categorizes contraception as “preventive services” that insurance companies must provide to patients at no cost, and the Trump administration has made no secret that this provision has had a target on it from Day 1. Wednesday’s notice indicates that the rule (again, not being shared with the public) is an “interim final rule,” which in layman’s terms means the rule has passed through every step of the approval process and only needs to be rubber-stamped by the OMB. Once that happens, it will be posted to the Federal Register and become effective immediately.

Nobody except its framers know what the new rule will mandate. But it’s fair to infer from previous policies from Trumpland that women (and everybody who benefits from the availability of contraception) should find this all pretty alarming.

Tom Price has vocally opposed Obamacare’s so-called contraception mandate since it was enacted, first as a congressman and now as secretary of health and human services. This month, when President Trump signed an executive order promoting “religious liberty,” Price said he’d “welcome” the chance to “protect religious liberty” in the context of health care.

That’s led some ACA proponents in the Senate to write a letter to OMB Director Mick Mulvaney. On Friday, they sent the message urging him to stop chipping away at birth-control access, or at least to stop doing what they’re pretty sure he’s about to do. They’re not sure exactly how this rule would affect the 55 million women who now use birth control for which they did not pay out of pocket.

“We write to urge you to cease any efforts related to President Trump’s May 4th Executive Order that would undermine access to affordable preventive services including contraception for women,” the letter reads.

“Access to affordable preventive services including contraception is a critical part of women’s health care, as well as an economic priority for many women. It should be treated as such,” it adds.

Other women’s health advocates feel frustrated but unsurprised by the Trump administration’s latest maneuver. Because the rule hasn’t been released to the public, it’s impossible to drum up outrage on its specifics.

It’s unclear, for example, if the new rule will allow certain employers who hold religious beliefs to omit birth-control coverage from their employees’ health plans, or if it will simply change contraceptive coverage back to the way things were pre-ACA. It’s not clear if the new rule would go into effect like a ton of bricks, suddenly causing birth control that was free last week to cost its users money, or if it would be up to insurance companies to jack up contraceptive prices.

“Republicans want to take us back to 1950,” says Alex De Luca of EMILY’s List. “And they’re being sneaky about it.”