Trump administration limits access to birth control under ACA

By Trévon Austin
7 October 2017

The Trump administration has announced plans to revoke the federal requirement for employers to include birth control coverage in health insurance plans. The new policy would expand exemptions under the Affordable Care Act (ACA) for employers who claim moral or religious objections to contraception.

Under the previous mandate, more than 55 million women employees had access to no-cost birth control. According to the Kaiser Family Foundation, the percentage of women employees that pay with their own money for birth control fell from 21 percent to 3 percent after contraception became a covered preventive benefit.

The new exemptions will be available to for-profit companies, nonprofit organizations and colleges and universities that provide health care to students and employees.

Hundreds of thousands of women could potentially lose access to benefits they receive at no cost. The Trump administration itself estimated that some 200 employers who have already voiced opposition to the Obama-era mandate would qualify for exemption, and that 120,000 women would be affected.

In expanding the exemption for employers, the Trump administration claims there are “dozens of programs that subsidize contraception for the low-income women” and various alternative sources for birth control exist.

The administration also cites health risks that it says are correlated with the use of certain types of contraceptives, and claims the previous mandate that required employers to cover birth control could promote “risky sexual behavior” among teenagers and young adults.

In contrast, many obstetricians and gynecologists say contraceptives have been and are generally beneficial for women’s health.

Dr. Haywood L. Brown, the president of the American College of Obstetricians and Gynecologists, expressed concern for consequences on women’s health. “Affordable contraception for women saves lives,” he said. “It prevents pregnancies. It improves maternal mortality. It prevents adolescent pregnancies.”

The Trump administration cites the Religious Freedom Restoration Act, a 1993 law protecting religious liberty, as legal reasoning for the new mandate. The administration admits that moral objections are not protected by the law, but states: “Congress has a consistent history of supporting conscience protections for moral convictions alongside protections for religious beliefs.”

Attorney General Jeff Sessions announced the Department of Justice would take steps to protect the new policy and stated, “President Trump promised that this administration would ‘lead by example on religious liberty,’ and he is delivering on that promise.”

The new policy is expected to face a large number of lawsuits. The National Women’s Law Center, a nonprofit advocacy group, has been preparing a lawsuit since last spring. Brigitte Amiri, a senior attorney for the ACLU, said, “We are preparing to see the government in court.”

In addition, Massachusetts Attorney General Maura Healey and California Attorney General Xavier Becerra announced plans to file a suit against the new mandate.

Trump’s new policy is an obvious attempt to win support from religious groups and conservatives, such as Speaker of the House Paul Ryan, who claimed today is “a landmark day for religious liberty.”

A group supportive of the administration’s action is the Little Sisters of the Poor, an order of Roman Catholic nuns who said that being required to cover contraception would make them “morally complicit in grave sin.” The organization sued the government, despite an already existing exemption for churches and other religious employers to opt out by notifying the government.

During his 2016 presidential bid, Trump promised that he would “make absolutely certain religious orders like the Little Sisters of the Poor are not bullied by the federal government because of their religious beliefs.” At a Rose Garden ceremony in May, he told the religious order, “Your long ordeal will soon be over.”

The Trump administration’s mandate sets a dangerous precedent for working women’s health. In 2014, in the case Burwell v. Hobby Lobby, the Supreme Court ruled that the ACA violated the religious liberty of Hobby Lobby, and stated that corporations could object to the birth control coverage mandate on religious grounds. Under Trump’s mandate, corporations could deny women employees access to no-cost birth control simply based on “moral objections.”

The new policy sets a precedent for corporations to deny other health coverage to employees under conditions in which the state of women’s health in the United States is already dire. The US holds the highest maternal mortality rate among industrialized nations, and a lack of access to birth control will potentially exacerbate the problem.

The new policy goes into effect immediately.

http://www.wsws.org/en/articles/2017/10/07/birt-o07.html

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Golden State sets the standard for resistance to Trump agenda

California’s big pushback:

Attorney General Xavier Becerra and progressive legislators are fighting back against the Trump agenda

California's big pushback: Golden State sets the standard for resistance to Trump agenda
Donald Trump; Xavier Becerra (Credit: AP/Alex Brandon/Marcio Jose Sanchez)

After Donald Trump’s shocking meltdown on Tuesday afternoon, it’s even clearer that progressives need effective strategies to blunt the effect of having a conspiracy-theory-driven, racist authoritarian in the Oval Office, backed by a congressional majority that is still too afraid to offer meaningful checks on his worst behavior. The good news is that some of the nation’s biggest cities and states remain controlled by Democrats. Activists and politicians in those states are looking for meaningful ways to throw wrenches in the Trump agenda.

At the top of that list is California, which not only has the largest population of any state but is controlled by progressive Democrats (relatively speaking) who seem ready and eager to fight Trump, especially on the issues of climate change and immigration. (New York is the next biggest state controlled by Democrats, but intra-party warfare has crippled the ability of progressives to get much done.)

California fired a significant shot across the bow at Trump on Monday, when state Attorney General Xavier Becerra declared that the state would sue the Trump administration over threats to withdraw law enforcement grants if the local and state police refuse to cooperate with federal efforts to deport immigrants. The lawsuit will be joined with an earlier one filed by the city of San Francisco.

“It’s a low blow to our men and women who wear the badge, for the federal government to threaten their crime-fighting resources in order to force them to do the work of the federal government when it comes to immigration enforcement,” Becerra said during a press conference announcing the suit. California received $28 million in law enforcement grants from the federal government this year, money it could lose if the police prioritize actual crime-fighting over federal demands that they focus their resources on deporting people.

“The government’s plan for deporting millions of people in this country is to coerce local law enforcement to be their force-multipliers,” explained Jennie Pasquarella, director of immigrants’ rights for the ACLU of California.

Pasquarella noted that most deportations currently occur because of an encounter with local law enforcement. By resisting pressure to step up efforts to persecute undocumented immigrants, she said, California can make it safe for people to “access basic services that are vital to our state and communities without fear of deportation, like schools and hospitals and libraries and health clinics.”

Some Democrats in the state are trying to take this idea even further, backing SB 54, titled the California Values Act. According to The Los Angeles Times, the bill would prohibit “state and local law enforcement agencies, including school police and security departments, from using resources to investigate, interrogate, detain, detect or arrest people for immigration enforcement purposes.”

While SB 54 is still being worked over in the legislature, California has already made progress in resisting the Trump administration’s efforts to repeal Obama-era actions to fight climate change. In July, Gov. Jerry Brown signed a bill extending a cap-and-trade program to reduce carbon emissions until 2030. The bill passed by a two-thirds majority in both the State Assembly and Senate.

Many environmentalist groups have come out against the bill, arguing that it doesn’t go far enough. Still, compared to the federal government’s evident retreat, it’s progress in the right direction. California has the largest state economy in the country, and demonstrating that climate action does not have to undermine economic growth could go a long way towards convincing other states to take similar action. This, in turn, could help the country meet the goals set by the Paris Accords, defying Trump’s efforts to pull the United States out of the historic climate change agreement.

This strategy to resist right-wing policies and protect California residents predates Trump, to be clear. While much of the country was experiencing an unprecedented rollback of reproductive rights — with numerous red states passing alarming new abortion restrictions while anti-choice activists fought insurance coverage of contraception in the courts — California moved to make birth control and abortion easier and safer to get.

In 2013, responding to research showing that abortions provided by nurse practitioners and midwives are safe, Brown signed a law giving those groups authority to offer abortion services. Brown has also signed off on three provisions to make it easier for women to get birth control: Letting pharmacists dispense it without a doctor’s prescription, requiring that health care plans cover contraception without a co-pay, and allowing women to get a full year’s worth of birth-control pills at a time.

These policies were already in place before Trump’s election, but they are all the more necessary now that the president is backing conservative efforts to make contraception more expensive and harder to get. It has also helped create a model for progressive cities and states to resist reactionary policies pushed by the federal government, which is already inspiring Democrats in other states. Chicago, for instance, is also suing the federal government over the threat to sanctuary cities.

There’s a deep philosophical irony here, because for decades now conservatives have claimed they wanted to reduce the power of the federal government and hand more decision-making authority to the states. That was always a disingenuous pose, of course. This conservative “principle” was largely invented to justify state resistance to Supreme Court decisions and federal legislation legalizing abortion, desegregating schools and protecting voting rights.

Still, it’s nice to see states like California calling the Republican bluff and showing that their supposed devotion to “small government” dries up the second states and cities move to protect human rights, instead of to attack them. Trump’s attorney general, Jeff Sessions, has always held himself out to be a small-government conservative, for instance. But his reaction to state and local officials who claim the power to set law enforcement priorities for themselves has been to accuse those officials of being law-breakers. This hypocrisy is already obvious, and it may soon be exposed in court.

Amanda Marcotte is a politics writer for Salon. She’s on Twitter @AmandaMarcotte

A new war on birth control

Trump hires an anti-birth control policy adviser — and Republicans in Congress prepare to escalate the attack

A new war on birth control: Trump's victory has empowered the sex scolds
(Credit: Getty/ Alex Wong/AP/Andrew Harnik/Getyy/hbak)

Bad news for anyone who hoped that Donald Trump’s history as an adultery-loving and fornication champion might put a chill on the Republican Party’s war on sex: It seems that his election is instead inspiring the party of scolds to double down on their quest to punish ordinary people for having sex because they like it.

Trump, being wealthy and male, gets a pass for his lengthy history of sleeping with any woman who will have him — and bragging about grabbing the pussies of those who won’t. But for those of us who aren’t privileged enough to be wealthy men, Republicans are going to do everything in their power to inflict punishment in the form of sexually transmitted diseases and unwanted childbearing.

Trump’s willingness to fully embrace the Junior Anti-Sex League was demonstrated on Thursday, when his transition team announced the hire of Katy Talento as domestic policy counsel for the White House, focusing on health care. Not only is Talento against abortion — which is par for the course in Republican circles — she’s also an anti-birth control fanatic.

Like most anti-contraception militants, Talento has an elaborate set of pseudoscientific arguments against the use of hormonal birth control. In a 2015 piece she wrote for The Federalist titled “Miscarriage Of Justice: Is Big Pharma Breaking Your Uterus?” Talento tried to scare women away from using effective, female-controlled methods of birth control, like the pill or the implant, by claiming these methods cause miscarriage and infertility.

It’s all nonsense, of course. The pill doesn’t cause miscarriage and most research shows that it doesn’t affect fertility. It may, in fact, improve fertility when a woman goes off the pill and tries to become pregnant.

“Decades of established science clearly show contraception prevents pregnancy — it does not cause abortion or miscarriages,” Dr. Anne Davis, a consulting medical director for Physicians for Reproductive Health, said in a statement. “Women and doctors know from research, as well as our collective experiences, that birth control does not harm a woman’s fertility or health.”

Talento’s half-baked arguments are a classic example of a conclusion looking for an argument. The only reason to cherry-pick a couple of bad studies or arguments, while ignoring the scientific consensus that the pill is safe and effective, is because you don’t like women using it and you’re trying to come up with some nonsense to deter them. And the only reason not to have women take the pill is because you think it makes it too darn easy to have sex.

The Talento pick should put to rest any notion that Trump will stand in the way of the deep-seated Republican longing to deprive women, especially those with a low income, of access to contraception.

With drool practically dripping off his lips, House Speaker Paul Ryan announced on Thursday that Congress would try to defund Planned Parenthood and end Obamacare in a single bill, as soon as possible. While there are many horrific ramifications to such an act, one of the biggest would be stripping millions of women of their current methods of contraception.

About half of Planned Parenthood’s patientsmore than a million people — are on Medicaid. Ryan’s plan would immediately mean that this group of individuals would be prevented from relying on their current reproductive health center. That would leave hundreds of thousands of women abruptly cut off from contraception access, and many of them will not be able to find another provider, especially on short notice.

For many, there will be no way to restore that access, as half of Planned Parenthood clinics are in medically underserved communities, meaning that there are few, if any, alternatives for the women who visit them.

In some states, Republicans have tried to justify cuts to Planned Parenthood by presenting supposed lists of alternative providers for women on Medicaid. These lists were, to put it bluntly, constructed of lies. The majority of clinics on these lists do not have a gynecologist on staff. In Florida, the list of “alternatives” to Planned Parenthood included dentists, optometrists and school nurses.

Even if women can find community clinics that do offer gynecological care, it’s often not as good as what’s available from Planned Parenthood, which offers more flexible scheduling. Generally speaking, these clinics are less equipped to handle contraception needs. Planned Parenthood facilities often have a large stockpile of contraceptive medication, so women can fill their prescriptions on-site — a service more general health clinics typically can’t provide.

Repealing Obamacare, even if Republicans do bother to come up with some flimsy replacement, will be devastating for women’s reproductive health care. Right now, well-women visits and contraception services are covered by insurance plans, without a co-payment required. It’s unlikely these aspects of Obamacare will survive.

That’s a problem, because zero-co-payment contraception has been a wildly successful program. The percentage of women who had to pay nothing out of pocket for oral contraception rose from 15 percent to 67 percent from 2012 to 2014. Not only does that save money; it also improves the rate for contraception use. Research shows that women are more likely to use contraception consistently and effectively if there’s no cost. Other research has demonstrated that when women have to pay out of pocket for contraception, they are often tempted to skip their pills or otherwise skimp on birth control in order to save money — which frequently leads directly to unintended pregnancy.

Of course, a sudden drop in the number of women using contraception would be a feature, not a bug, of Republican attacks on Planned Parenthood and Obamacare. The nominal leader of their party may be a man who spent years going on Howard Stern’s show to brag about his sex life, but the GOP continues to begrudge ordinary women access to basic sexual health care.

Amanda Marcotte is a politics writer for Salon. She’s on Twitter @AmandaMarcotte