Trump Administration Thwarted In Attempts To Remake Policy On Reproductive Health

By | May 15, 2019

In this May 22, 2018 file photo, President Donald Trump speaks at the Susan B. Anthony List 11th Annual Campaign for Life Gala at the National Building Museum in Washington. The Trump administration is methodically remaking government policy on reproductive health – potentially limiting access to birth control and abortion while advocating abstinence-only sex education. (AP Photo/Andrew Harnik)

Associated Press

Twice this year the Trump administration has been thwarted in its efforts to remake federal policy on reproductive health.

Two weeks ago, a federal judge in Washington state blocked a Trump administration rule that would prohibit taxpayer-funded family planning clinics from referring women to abortion providers. The rule would have gone into effect on May 3rd.

The state of Washington is a plaintiff in litigation challenging restrictions proposed by the Department of Health and Human Services (HHS) to the Title X program. This program subsidizes reproductive healthcare and family planning costs for women with low incomes. One of President Trump’s campaign pledges was to end federal support for Planned Parenthood, an organization that provides a large number of health services, including abortion, to women under the Title X program.

And, in January of this year, a federal court issued a preliminary nationwide injunction that prevents “interfering with women’s access to covered birth control guaranteed under the Affordable Care Act.” Under the Affordable Care Act (ACA), employers and health insurers must fully reimburse preventive health services, including most methods of contraception approved for women by the Food and Drug Administration.

For nearly two years the Department of HHS has been crafting ways to circumvent the ACA mandate. Initially, under rules issued in October 2017, HHS expanded exemptions from the contraceptive coverage mandate, allowing employers to opt out if they had “religious or moral objections.” In a follow-up, HHS released a set of revised rules in November 2018, which stated that employers could obtain an exemption if they objected to some or all forms of contraception based on their “sincerely held religious beliefs.”These rules allowing exemptions from the contraceptive coverage mandate appear to have more symbolic meaning than significant policy impact. Before the ACA was passed, close to 90% of insurers and 85% of large employers covered contraceptives. Contraception was deemed by the vast majority of large employers and insurers then, as it is considered now, a low cost preventive measure. Furthermore, for several decades, predating ACA, birth control pills have been largely available as relatively inexpensive generic products with low or no co-payments.

It is unknown why prior to enactment of the ACA 10% of insurers and 15% of large employers didn’t reimburse contraceptives. Under current law, they must. Should the injunction be overturned at the end of a lengthy court battle that could be decided by the Supreme Court, employers and insurers who wish to deny coverage could then cite the “religious or moral objection” clause.

While domestically, in the face of judicial restraint on executive powers, the Trump administration has thus far not been able to achieve its goal of reshaping reproductive rights policy, internationally it has been imposing its will with no court judge standing in the way. For the second year in a row, the U.S. State Department published its annual Country Reports on Human Rights Practices without a subsection on reproductive rights.

The 2017 and 2018 reports were prepared with explicit instructions to excise the portion of the report on reproductive rights. This includes information on rates of unsafe abortions, accounts of denial of family planning information, statistics on maternal mortality and its causes, and research on discrimination and violence against women in healthcare settings.

Forbes – Healthcare