Physicians Decry Trump's Rollback of Contraceptive Mandate

Alicia Ault

October 06, 2017

The Trump Administration has issued a set of rules that would allow a broad array of employers to decline to offer coverage of contraceptive pills or devices on the basis of religious or moral beliefs. A joint statement from six medical societies, representing more than 560,000 physicians and medical students, asked the administration to "immediately withdraw" the interim final rules.

 "No woman should lose the coverage she has today," declares the statement from the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, the American Osteopathic Association, and the American Psychiatric Association.

"Contraception is an integral part of preventive care and a medical necessity for women during approximately 30 years of their lives. Access to no-copay contraception leads to healthier women and families. Any move to decrease access to these vital services would have damaging effects on public health" the statement continues.

The rules — which went into effect immediately on October 6, but could still be changed, as they are not final — essentially shrink the Affordable Care Act (ACA) mandate that required employers to offer no-cost contraception to employees. The ACA offered narrow exemptions based on religious grounds, but many religious organizations and employers continued to challenge the mandate.

The new rules  one for religious objections and another for moral objections issued by the departments of Health and Human Services (HHS), Labor, and Treasury, offer many more opportunities for exemptions. Previously, "moral" objections were not considered.

The ACA's birth control mandate has long been targeted by congressional Republicans. House Speaker Paul Ryan (Wisconsin) applauded the new rules. "This is a landmark day for religious liberty," he said, in a statement. "The conscience protections installed will ensure that people and organizations can freely live out their religious convictions and moral beliefs." He added that he expects pending cases challenging the mandate would now be quickly resolved.

The issuance of the rules is a follow-up to President Donald J. Trump's May 4 Executive Order on religious liberty. Attorney General Jeff Sessions, charged with implementing the order at federal agencies, said in a statement today,  "The constitutional protection of religious beliefs and the right to exercise those beliefs have served this country well, have made us one of the most tolerant countries in the world, and have also helped make us the freest and most generous."

Sessions added, "President Trump promised that this administration would 'lead by example on religious liberty,' and he is delivering on that promise."

Rule Could Set Precedent

Physician organizations were quick to express concern.

"Reducing access to contraceptive coverage threatens to reverse the tremendous progress our nation has made in recent years in lowering the unintended pregnancy rate," said Haywood L. Brown, MD, president of The American College of Obstetricians and Gynecologists, in a statement.

"Instead of fulfilling its mission 'to enhance and protect the health and well-being of all Americans,' HHS leaders under the current administration are focused on turning back the clock on women's health," he said. He noted that contraception "improves the health of women, children and families as well as communities overall; reduces maternal mortality; and enhances economic stability for women and their families."

Pediatricians also objected. "For pediatricians, the science is clear: contraception is a safe, effective tool to prevent unintended pregnancy in women of any reproductive age, including adolescents, and to allow families to space out pregnancies, promoting healthy mothers and babies," said American Academy of Pediatrics President Fernando Stein, MD, FAAP, in a separate statement.

"We are concerned that today's actions not only limit access to a vital service unnecessarily, but also open the door for other businesses to decide not to offer certain kinds of physician-recommended health services due to moral objection, such as immunizations or other evidence-based preventive services," Dr Stein continued. "This rule sets a dangerous precedent and carries serious health consequences."

Similarly, the Society for Adolescent Health and Medicine's President, Tamera Coyne-Beasley, MD, said, "The Administration's action is not based on science, and instead, allows employers to overrule medical expertise…. "This rule is especially troubling for low-income adolescent women and families as it could put safe, appropriate contraceptives financially out of reach."

Jack Ende, MD, President of the American College of Physicians, also expressed concern about affordability. The new rule "could lead to many American women who currently receive no-cost contraception having to pay out of pocket for their medication," he said, in a statement.

The Endocrine Society pointed out in a statement that contraceptives allow pregnancy planning, which "has a positive impact on families' socioeconomic status and health," and that "the resulting reduction in unplanned pregnancies also has a positive impact on healthcare costs." Hormonal contraceptives are also used for medical conditions, such as polycystic ovary syndrome, excessive menstrual bleeding, menstrual pain and acne, noted the Society.

HHS: Most Women Not Affected

According to HHS, the rules do not overturn preventive services coverage guidelines where no religious or moral objection exists, which, it says, means "99.9% of the 165 million women in the United States" would not see a change in coverage. The agency estimates that the new rules might apply to 200 entities, which is how many have sued the federal government based on religious or moral objections.

Government programs that provide free or subsidized contraceptive coverage to low-income women will also stay in place, said HHS. "The mandate as defined by the previous administration suffered defeats in court after court, including the Supreme Court, which ruled that the government cannot punish business owners for their faith," the HHS statement said.

Comments on the rules are being accepted until December 5. Some tweaks might be made in light of comments, but the rules are unlikely to be overturned, as they are considered final.

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