New Contraceptive Rules Have Troubling Implications for Public Health, Commentary Says

WASHINGTON, DC (Jan. 8, 2019) — New final rules from the Trump administration that take effect later this month permit employers to halt or limit coverage of contraceptives without cost-sharing in employee health plans. A new commentary published today in Women’s Health Issues says the rules should raise a red flag for clinicians and policymakers as they will reduce women’s access to effective contraception, which could lead to unintended pregnancies.

Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health and is based in the Department of Health Policy and Management at the George Washington University Milken Institute School of Public Health (Milken Institute SPH).

Under the Affordable Care Act (ACA), employer-sponsored insurance plans must cover the full range of FDA-approved forms of contraception without requiring cost-sharing from the employee. The Obama administration permitted houses of worship to exempt themselves from the mandate. It also allowed some religious nonprofit and for-profit organizations to request accommodations in which insurance companies paid for no-cost contraceptive coverage for the organizations’ employees and their dependents, rather than the organizations themselves. With its new rules, the Trump administration allows far more employers to exempt themselves from the mandate based on religious or moral objections and does not require that employees and their dependents be provided contraceptive coverage through another avenue. The commentary’s authors note that these policies have been and will continue to be challenged in court.

Previous research has found that the removal of cost barriers to contraception increase women’s use of the most effective methods and that prevention of unintended pregnancies provides many public health benefits. “The new final regulations that permit corporate objections to preempt the rights of individual women in such personal and private health matters are deeply problematic,” the authors of the new commentary write.

“Prior to the ACA, many privately insured women struggled to afford effective contraception,” said Leighton Ku, PhD, MPH, professor of health policy and management at Milken Institute SPH and senior author of the commentary. “These rules roll back progress made under the ACA and will have a disproportionate impact on women with low incomes.”  

The authors call on clinicians and researchers to speak out, concluding, “It is critical to continue making the case for affordable access to safe and effective contraception and to explain why these choices are best made by individuals in consultation with their health care providers.”  

“These rules may particularly reduce access to long acting reversible contraceptives, such as IUDs or implants, which are the most effective forms of contraception but have high initial costs,” said co-author Lydia Pace, MD, MPH, director of women’s health policy and advocacy at the Mary Horrigan Connors Center for Women's Health & Gender Biology at Brigham and Women’s Hospital, and an assistant professor of medicine at Harvard Medical School.

Ku, Pace, and Maya Behn, a research assistant at Brigham and Women’s Hospital, authored the commentary. "The Trump Administration’s Final Regulations Limit Insurance Coverage of Contraception" was published online Jan. 8 and will appear in the March/April issue of Women's Health Issues.