The University of Notre Dame was the first to take President Donald Trump up on his offer.
Since 2012, the Affordable Care Act (ACA) has included a requirement that all women with health insurance have coverage of all FDA-approved birth control methods and related care. When Hobby Lobby and another for-profit company sued for an exemption from the rule, the U.S. Supreme Court required that an accommodation be made for businesses that claim providing such coverage would offend their (meaning: the corporations’) religious views.
On Oct. 6, Trump undid even this compromise, leaving millions of women once again in the lurch for over a billion dollars in contraception-related medical care. And by late October, Notre Dame officials had embraced Trump’s new rules, announcing that employee and student insurance plans would no longer cover contraception.
The National Women’s Law Center (NWLC), alongside Americans United for Separation of Church and State, quickly sued the Trump administration on behalf of Notre Dame students. The suit followed similar legal challenges by the American Civil Liberties Union (ACLU) and a number of states, including California, Washington and Massachusetts, challenging rules that ACLU senior staff attorney Brigitte Amiri describes as “forcing women to pay for their boss’s [or school’s] religious beliefs.”
“We sue to protect decisions that only a woman, her doctor and her family should make,” Massachusetts Attorney General Maura Healey told Ms. “These rules are designed to hold women back, issued by a president who will break the law to hold women back.”
Trump’s rules are an outrage economically. The percentage of privately insured women who paid out of pocket for contraception before the ACA was 20.9 percent; after the ACA that figure dropped to 3.6 percent, according to the Kaiser Family Foundation.
Before the ACA inclusion, 30 to 44 percent of women’s out-of-pocket health care costs went to birth control. By one estimate, the ACA coverage saved U.S. women $1.4 billion in birth control costs.
The benefits to women from access to birth control cannot be overstated. It allows them to space their children, which lowers rates of infant and maternal mortality and morbidity; it enables them to pursue career and educational opportunities, increasing their lifetime earnings. In contrast, unintended pregnancy is linked to depression and puts women at increased risk for domestic violence.
Further, the ACA requirement allows women access to the medical care that should accompany contraception decisions, including related exams, screening and pregnancy care. And birth control has medical applications beyond contraception: 21 percent of women say they use contraceptives both to prevent pregnancy and to manage a medical condition, such as endometriosis or skin disorders. Finally, Trump’s rules throw women into a bureaucratic labyrinth of conflicting regulations and laws. The confusion collectively prevents women from receiving unified, coherent care.
In the face of well-publicized protests by its employees and students, Notre Dame reversed its decision in early November. Resistance in the Trump era requires grassroots effort. As Mara Gandal-Powers of the NWLC points out, “The key to keeping the protections in place, and extend[ing] them, is the same: Get informed, get active and show up.”
