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Two court decisions have halted new Trump administration regulations that would allow for expanded religious or moral exemptions to the Affordable Care Act mandate requiring employers to cover contraceptive products.
On Monday, a federal judge in Pennsylvania issued a nationwide preliminary injunction on the regulations, which came less than a day after a California judge blocked the regulations in 13 states and the District of Columbia.
The regulations focused on the component of the ACA that requires employers to provide no-cost birth control to employees under their insurance plans. While the ACA allows for religious exemptions for a narrow group of churches and religious organizations, the Trump administration regulations would expand exemptions to more employers with “sincerely held” religious or moral objections to contraception. Federal health officials estimated that tens of thousands of women could potentially lose their coverage if the injunction was not granted.
And while the Obama administration included a “workaround” to the religious exemption that would have third-party insurers—not employers themselves—to cover the costs, the Trump administration’s regulations would give employers the choice of whether to permit such a maneuver.
For one religious organization that was counting on the regulations to take effect Monday, the rulings are another obstacle in a long court battle. The Little Sisters of the Poor, a national order of nuns who care for the elderly in a home in D.C., has been engaged in court cases and sought an exemption to the mandate since 2013. It is an intervenor defendant in the lawsuits the California and Pennsylvania judges heard.
Mark Rienzi, the president of the Becket Fund for Religious Liberty, represents the Little Sisters. He argues that the federal government must find less invasive ways of achieving their goal of accessible contraception.
He says concerns about the federal exemption regulations being too broad are unfounded because so few employers are trying to take on the regulations and obtain an exemption. According to Rienzi, states were unable to locate an example of an additional employer, other than ones that have already received protection through their own lawsuits, that might remove contraceptive coverage from employees’ insurance plans.
The Pennsylvania judge who blocked the regulations nationwide held that states did not need to identify specific affected employers or women, stating “There is no need to wait for the ax to fall before an injunction is appropriate.”
“The court’s ruling is incorrect,” Rienzi says. “Obviously the federal government has a lot of ways to give out these products without involving nuns. … [The Little Sisters are] not saying other people can’t have them. They’re not trying to stop people from getting them elsewhere, they’re just saying, ‘Hey, not me. I can’t be the one to provide it to you.’”
Rienzi says the federal government “has an obligation to respect people’s religious liberty.”
States argued in their lawsuits that the regulations would cause financial harm to local jurisdictions, because without employer coverage of contraceptives, states might have to provide contraceptives and potentially pay for social services as the result of an increase in unintended pregnancies.
“We joined this lawsuit to protect access to essential health care for women who live and work in the District. We welcome the decision and will continue to fight the Trump Administration’s attempts to roll back or limit our residents’ access to birth control even if they don’t work for a religious employer,” D.C. Attorney General Karl A. Racine said in a statement to Washington City Paper.
Women’s reproductive health care advocates in the District and around the nation argue that the increased regulations were an attempt to restrict women’s birth control access.
“When you think of all the things in this country that are controversial, birth control is not one of those things,” Dr. Laura Meyers, president and CEO of Planned Parenthood of Metropolitan Washington, says.
“Birth control is so basic—it is a basic health care right,” Meyers adds. “Women should never have to choose between making decisions like, ‘Can I put food on the table, can I buy my medication, or can I pay for my birth control?’”
The District has previously taken steps to make contraceptives more accessible to residents. Last year, Mayor Muriel Bowser signed the Defending Access to Women’s Healthcare Services Act into law, which gave pharmacists the ability to prescribe and distribute birth control to patients who would have needed a doctor’s prescription before. The law also requires insurers to cover copay-free contraceptives, and includes a provision for religious exemptions.
Meyers says women in D.C. are fortunate to have councilmembers and a mayor who have “championed women’s access to birth control” in the face of the Trump administration, and adds that last year’s law was passed in anticipation of threats to birth control access.
If they were to be implemented, the proposed federal regulations would not necessarily override the District law, which has narrower criteria for a religious exemption. In other words, a D.C. organization that might receive exemption status through the federal regulations would not necessarily be exempt from D.C. requirements.
These most recent rulings have not dissuaded Rienzi and the Little Sisters of the Poor. He says his organization has appealed both decisions. “Either we’ll win there or we’ll go to the Supreme Court,” he says.