The rulings in rapid succession, both by judges appointed by President Barack Obama, are the latest legal twists in a dispute over the expansion of health-care benefits for women under the Affordable Care Act that has wound through the courts for years. The rulings do not permanently block the Trump policy but stop it from going into effect while legal challenges are pursued.
The ACA, the sprawling 2010 health-care law pushed through by a Democratic Congress, says that people should be insured for preventive services without paying out-of-pocket fees — and that women’s health-care services must be included. Under the Obama administration’s interpretation of the law, all Food and Drug Administration-approved forms of contraception have been covered since 2012.
The dispute centers on the issue of “religious liberty” — an animating cause for social conservatives who are part of President Trump’s political base. The question is the extent to which the government should carve out exceptions for churches, religious groups and nonreligious employers that object to birth control coverage based on their beliefs.
The Obama administration had narrow exceptions for churches and religiously affiliated organizations and create
d a system of “accommodations,” or workarounds, in which a third-party insurer would cover birth control even if the employer did not. Trump health officials widened the circumstances under which employers could claim exemptions.
The new rules under Trump allow objections to covering birth control on moral, as well as religious grounds. They broaden the range of employers able to claim such objections to include essentially all nongovernmental workplaces, from small businesses to Fortune 500 companies. And they give the employer the choice of whether to permit a workaround accommodation.
In a 65-page opinion, Beetlestone concludes the Trump administration’s effort to carve out coverage of contraceptives for stricter limits than other types of preventive care “is inconsistent with the . . . text” of the ACA. And she rejects the contention that broader exemptions for birth control are required under a 1993 law called the Religious Freedom Restoration Act.
The judge said states would bear expenses from women seeking state-funded contraceptive services and from unintended pregnancies. Noting that federal health officials estimate 70,500 women would lose coverage under the policy, Beetlestone wrote: “The only serious disagreement is not whether the states will be harmed, but how much.”
Pennsylvania Attorney General Josh Shapiro (D), who initiated the lawsuit in the fall of 2017, praised Beetlestone’s decision to stay the policy.
“Families rely on the Affordable Care Act’s guarantee to afford care,” he said in a statement. “. . . Congress hasn’t changed that law, and the president can’t simply ignore it with an illegal rule.”
A Justice Department spokeswoman, Kelly Laco, said in a statement: “As we’ve said before, religious organizations should not be forced to violate their mission and deeply-held beliefs. In this case and others, the Department of Justice will continue to vigorously defend religious liberty.”
The back-to-back court rulings from Pennsylvania and California represent the second time the same judges have issued preliminary injunctions, halting Trump administration rules while lawsuits against the revised policies play out.
Within a week of each other in December 2017, Beetlestone for the Eastern District of Pennsylvania and U.S. District Judge Haywood Gilliam for the Northern District of California ruled an interim revision to the contraceptive mandate should be blocked nationwide. Their ruling came in separate lawsuits from Democratic state attorneys general challenging the Department of Health and Human Services for issuing what are known as interim final rules. Those cases are now on appeal before circuit courts.
In the meantime, HHS in November issued a final rule, similar in most respects to the interim one. These rules, too, were challenged in court, and they are the ones the judges are now blocking.
Women’s health advocates and other supporters of no-fee birth control cite research showing that the Obama-era policies have been beneficial to consumers.
Nearly 63 million U.S. women last year had insurance coverage for birth control without out-of-pocket fees — about 7 million more than federal estimates from 2015, according to the National Women’s Law Center.
In a 2017 Health Affairs article, researchers at the University of Pennsylvania said women who either took birth control pills or used an IUD saved roughly $250 for the first year after the ACA coverage requirement began.
Another study by Penn State researchers found an increase in the proportion of women using long-acting birth control such as IUDs or contraceptive implants, which tend to be most effective at preventing unwanted pregnancies.