Contraception coverage – and the new administration’s approach to it – is the perfect example of how President Trump doesn’t really share the sensibilities of conservatives, but is still allowing them to advance their goals.

Trump himself is a fan of contraception, no doubt about it. He’s praised Planned Parenthood for providing it to women. He once boasted to Howard Stern that he could trust his wife, Melania, to take her birth control every dayHe surprised many during his campaign last year by suggesting to Dr. Mehmet Oz that the pill should be made available over-the-counter.

You probably wouldn’t hear stances like that from Trump's conservative head honchos at the Department of Health and Human Services, who include former Rep. Tom Price (R-Ga.) and antiabortion leaders Charmaine Yoest and Teresa Manning. Price now serves as HHS secretary, while Yoest is assistant secretary of public affairs and Manning is deputy assistant secretary of population affairs. All three roundly criticized the Obama administration for its mandate on employers to cover contraception in company health plans, and backed scores of religious groups who challenged the rule in court.

To be fair, Trump also indicated he doesn’t feel employers should be required to provide birth control when pressed on the Dr. Oz show last year. And there’s certainly a distinction between opposing contraception itself and opposing a requirement for employers to pay for it.

But it’s likely these appointees – and not Trump himself – are the key drivers behind a HHS-proposed regulation currently under review at the White House Office of Management and Budget. The draft rule would open the door wide for employers to avoid the so-called “contraception mandate” by citing a religious or moral objection, according to a draft regulation leaked to Vox.

The regulation isn’t final – and HHS wouldn’t comment on it or confirm it to The Health 202 on Thursday. But the proposal ignited heated pushback yesterday from liberals and supporters of the Affordable Care Act while prompting praise from conservatives who have argued the mandate restricted employers’ religious freedom.

From the left:

And from the right:

The Huffington Post's politics reporter had fun with the news on Twitter:

Some observers noted the radio silence from Trump's daughter, Ivanka, who typically says nothing publicly about sticky reproductive-rights issues:

The contraception mandate came about in 2011, when the Obama administration released a rule that said all Food and Drug Administration-approved birth control is among the preventive services employers must provide free of copays under the ACA. (My colleague, Juliet Eilperin, wrote more about it.)

The rule meant that contraception became more affordable for many women after their plans started covering it for the first time -- or stopped charging a co-pay if it was already a covered benefit. Indeed, the share of women of reproductive age with employer-sponsored coverage with out-of-pocket costs for birth-control pills fell dramatically -- from 20.9 percent in 2012 to 3.6 percent in 2014, according to the Kaiser Family Foundation.

At the same time, many insurers were slow to fully comply with the requirement and there was lots of wiggle room for employer-sponsored plans to cover only certain kinds of contraception and not others (I reported on this back in 2013).

And the rule also sparked some strong pushback from Catholics and evangelicals who believe some types of birth control can cause abortions or who just oppose contraceptives overall. Under heavy pressure from these folks, the Obama administration added an exemption for churches, and then a workaround for certain nonprofits including schools, charities and hospitals where they could delegate the coverage responsibility to a third party.

But that didn’t appease dozens of employers, including owners of for-profit businesses, who subsequently filed lawsuits. The challenges eventually led to the Supreme Court’s 2014 Hobby Lobby ruling where the justices said certain for-profit corporations could be fully exempted from the mandate. Several lawsuits from religious groups also seeking a full exemption are ongoing.

If the administration goes ahead with a broad exemption to the mandate -- which could result in more women having to pay out-of-pocket for birth-control pills or other types of contraception -- it would likely prompt more lawsuits, but in the opposite direction. The National Women’s Law Center has already threatened legal action.

“The Trump administration should be ready for a fight if it takes away this essential coverage,” Gretchen Borchelt, vice president for reproductive rights and health, said in a statement. “If the rule is made final, we will file a lawsuit against it.”


AHH: "Oh absolutely, we’ll get it done by the end of July at the latest," the Senate's No. 2 Republican John Cornyn (R-Texas) told The Chad Hasty Show yesterday, when asked whether the Senate will pass a bill revamping the ACA. The Health 202 isn't marking our calendar quite yet.




OOF: Mick Mulvaney, director of the White House Office of Management, basically trashed the Congressional Budget Office to the Washington Examiner yesterday, calling its assumptions "absurd" and even suggesting that the head of its health-analysis division, Holly Harvey, can't be trusted because she worked for the Clinton administration. 

"At some point, you've got to ask yourself, has the day of the CBO come and gone?" Mulvaney told the Examiner. "How much power do we give to the CBO under the 1974 Budget Act? We're hearing now that the person in charge of the Affordable Health Care Act methodology is an alum of the Hillarycare program in the 1990s who was brought in by Democrats to score the ACA....We always talk about it as the nonpartisan Congressional Budget Office. Given the authority that that has, is it really feasible to think of that as a nonpartisan organization?"

The CBO is, actually, the nonpartisan scorekeeper for all federal legislation. Yet it's sparked lots of hatred lately from Republicans who don't like its estimate that their health-care bill would cause 23 million people to lose health coverage. Mulvaney argued that its score of the House's American Health Care Act was a perfect example of why Congress should stop being so deferential to the CBO.

OUCH: The Wall Street Journal takes a deep dive into the inner drama of Molina Healthcare, a prominent Obamacare insurer that fired its CEO a few weeks ago. "On May 2, J. Mario Molina walked into the boardroom of Molina Healthcare Inc., the company founded by his father, which he had run for more than two decades, ready for a routine meeting. The first shock came quickly. A board member made a motion to remove Dr. Molina as chairman. The rest of the board, except Dr. Molina and his brother, John Molina, agreed, and the vote passed. They weren’t finished. Next came a motion to fire Dr. Molina as CEO of the health insurer, one of the country’s biggest players on the ACA marketplaces. And then, to dump John Molina as CFO. Both motions carried, with only the Molinas opposed."


--Members of Congress are back in their districts this week (or traveling somewhere else outside of Washington). In Glendale, Ariz., GOP Sen. Jeff Flake told a local Chamber of Commerce he doubts the Senate will manage to vote on a health-care bill this summer and that his colleagues aren't close agreeing on some of the stickiest policy questions, like how to handle Medicaid. Flake is one of just two Republican senators facing a serious reelection battle next year, so how he's talking about the unpopular GOP health-care bill -- and President Trump -- is especially interesting.

"There are some still saying that we’ll vote before the August break. I have a hard time believing that,” Flake told business leaders, according to my colleague Ed O'Keefe, who was on the ground in Arizona.

"Flake isn’t afraid to buck President Trump — or to defy the Republican orthodoxy in Washington that the agenda is proceeding apace," Ed writes. "He did it last year, refusing to support Trump for president, and he’s doing it again now by publicly doubting that the GOP can revamp the nation’s health-care system....Few congressional Republicans go as far as Flake, fearful that pro-Trump forces could derail their reelection campaigns next year. And Flake is already paying his own price, drawing a conservative primary opponent and probably earning him the distinction as the GOP incumbent most vulnerable to an intraparty challenge."

--Freedom Caucus Chairman Mark Meadows (R-N.C.), whose group pushed the House health-care bill further to the right, lives in a pretty conservative district -- yet even he lured some liberal constituents staging protests, Axios's Caitlin Owens reports from Hendersonville, N.C. Still, Meadows won the district comfortably in 2016 and many of his supporters say they still love him.

"They often told me one of two things," Caitlin writes. "They don't believe the Congressional Budget Office or media reports warning about millions of people losing health coverage, and they're not yet paying attention because the Senate is going to change the bill anyways....Meadows' district is a classic example of people choosing their news: They either don't believe the worst things they've heard about the bill — and they might think anything is better than the Affordable Care Act anyway — or they believe all of the bad things and are up in arms about it."


--Skeptics of Republican Sen. Bill Cassidy’s alternative to the ACA moaned and jeered at him during a town hall in Louisiana Wednesday, the AP reports. Cassidy teamed up with moderate Sen. Susan Collins (R-Maine) on the plan, which conservatives have termed "Obamacare forever" because it would allow states to decide whether to keep or reject the ACA's main elements.

"The Republican senator had his supporters among the more than 200 people who jammed a meeting hall in Covington, north of New Orleans. They applauded loudly when he said insurance premiums and deductibles for health insurance have skyrocketed for some under President Barack Obama’s health care law...But many of his constituents were doubtful that the replacement bill he is pushing will sufficiently protect Louisiana residents...Outside, meanwhile, a few dozen people who couldn’t get into the packed room chanted 'Health care, not wealth care,'" the AP writes.

--At least one Republican in Congress can make light of his party's ongoing struggle with passing a health-care bill. Sen. John McCain, who is incidentally one of The Health 202's favorite politicians to stalk in the Senate, poked fun in a speech he gave Tuesday in Sydney, Australia.

"Let me thank you all for being here this evening," the Arizona Republican said at the University of Sydney's U.S. Studies Center. "I know there are many better things you could be doing. And you will wish you had after the two hour address I have planned on the latest Republican plan to reform healthcare in America."

--You'd think health insurers would want permission to charge higher premiums to the sicker, more expensive patients. But not the CEO of Blue Cross Blue Shield of Massachusetts. Andrew Dreyfus writes in The Hill that opening the door to higher costs for people with preexisting conditions, as the House health-care bill would do, is just plain a bad idea because it would create even more divisions in the United States.

"Our nation is already struggling with enough division — economic, racial, geographic, and political," Dreyfus writes. "It would be both tragic and unnecessary to create a new divide between those who are seriously ill and those who are healthy. Rather than trying to fix the pre-existing condition provisions in the House bill, the Senate should take them off the table, permanently."

  • Lawmakers will continue to hold town halls tonight, and will likely face questions about the Republican health-care effort. House Freedom Caucus member Rep. Justin Amash (R-Mich.), who voted for the GOP bill but later said it was “not the bill we promised the American people,” is scheduled to have a town hall on Thursday afternoon in Battle Creek, Mich.
Coming up

Secretary of Veterans Affairs David Shulkin said yesterday that federal law prohibits his agency from prescribing medical cannabis, but it may be helpful to some veterans:

Secretary of Veterans Affairs David Shulkin said May 31 that federal law prohibits his agency from prescribing medical cannabis. (Reuters)

The world searches for the meaning of "covfefe:"

President Trump tweeted a garbled late-night message that baffled everyone on Twitter. (Monica Akhtar/The Washington Post)

Watch Stephen Colbert put the CBO's 23 million number into perspective: