According to a new report, more than two dozen for-profit or nonreligious US companies benefited from a provision in the Affordable Care Act that exempted religiously affiliated businesses from the requirement to cover birth control for employees. Obamacare gave 55 million women access to low-cost birth-control coverage, but as the new report suggests, many women likely lost out on coverage they were rightfully entitled to because of unfounded exemption requests.
The Center for American Progress, a liberal think tank, published a report on August 11 detailing the results of a Freedom of Information Act request to the US Department of Health and Human Services. The group asked for all records of requests for religious accommodation for contraceptive coverage under the Affordable Care Act. Those records revealed that of those 45 companies, 24 were for-profit corporations, while the rest were religiously affiliated nonprofits or education institutions.
Among the companies that submitted religious accommodation requests were those focused on human resources, agriculture and forestry, and garden supplies.
Half of the companies that requested religious accommodation asked for "a blanket exemption covering all forms of contraception," says CAP. Eleven companies specifically requested exemption from the most effective and expensive forms of birth control, including intrauterine devices (IUDs) and emergency contraception, or the morning after pill. Many companies incorrectly labeled such contraception "abortifacients," or methods that induce abortion, in their requests, says Jamila Taylor, senior fellow at CAP and an expert on domestic and international women's health and reproductive justice.
"For us, the most significant piece is the number of for-profit companies seeking the exemption relative to the other companies," Taylor tells POPSUGAR. "It's very chilling for us in terms of the cost for women."
The exemption requests, made between January 2014 and March 2016, followed the Burwell v. Hobby Lobby Supreme Court decision, which ruled that "closely held" for-profit corporations — generally a private company with a limited number of shareholders, and, according to the IRS, one where more than half the stock is owned by five or fewer people in the second half of the year — could deny healthcare services to their employees based on religious beliefs. Among the companies that submitted religious accommodation requests were those focused on human resources, agriculture and forestry, and garden supplies. The Center for American Progress did not supply POPSUGAR with the names of or any other details about the companies, citing the need to be mindful of information about small family businesses, and the women who work at them, becoming public.
According to the National Women's Law Center, in 2013 the contraceptive coverage mandate saved women $1.4 billion on birth-control pills. As Taylor says, "I was able to save hundreds of dollars per month now that my contraceptive is free." Unfortunately, the report suggests that potentially hundreds, if not thousands, of women may have been denied access to this benefit by companies that applied for an exemption they did not quality for.
The report is particularly important in light of the interim final rule on contraceptive coverage, which was leaked from the Trump White House in May. The IFR, as it is known, outlined new rules that would expand religious exemption and allow nearly any employer in the US to deny contraceptive coverage to their employees based on religious or moral objection. With no clear definition of what "moral" actually means in this case, "it's going to be a free-for-all," says Taylor.
Buried in the more than 30,000-word rule is the assertion that "these interim final rules will result in some enrollees in plans of exempt entities not receiving coverage or payments for contraceptive services."
Current healthcare policy requires most private health plans to cover contraception for employees. A religious exemption applies to houses of worship and other closely tied religious organizations; they do not have to cover anything. Other employers are eligible for a religious accommodation, meaning that employees can still get coverage from a company's insurance plan, even though the company doesn't have to cover it. Multiple lawsuits have challenged both of these waivers. Following Burwell v. Hobby Lobby, the Obama administration expanded the religious accommodation process and granted Hobby Lobby an accommodation. For-profit companies like Hobby Lobby can submit a form to the federal government outlining why their religious beliefs mean they want to deny their employees birth-control coverage.
"Employers should not be, in our words, discriminating against women. For the Trump administration to take things even further, really broadening what we saw under the Hobby Lobby decision" would be a disaster, says Taylor. "It would really give any individual or entity the option to refuse to cover contraception care for women, which is extremely dangerous."
The importance of access to contraception cannot be overstated, and it often gets lost in political fights like these. Birth control gives women and families social and economic freedom, lets women and girls stay in school, and helps to prevent unintended pregnancies. As is always the case when women's rights are under threat, there will be a disproportionate impact on the economic security and health of low-income women and women of color if the Trump administration's expanded rules come into force.
The CAP report is "more evidence to show that even the current policy can be harmful," says Adam Sonfield, senior policy manager at the Guttmacher Institute, a reproductive-rights think tank. But without seeing the details of the companies and their reasons for requesting an accommodation, it's difficult to determine whether or not they qualify, says Sonfield. In the case of the 45 companies, "they are making a statement about their beliefs about contraception, and that is what qualifies them." In any case, they were deemed qualified by the federal government, as all companies were granted accommodations, according to CAP.
"I don't think that the point of this report was to identify potential lawbreaking," says Sonfield. "I think the point of the report was to show that there are for-profit companies in this country that are claiming they have religious objections to contraception."
The 2017 legislative session has already seen a huge number of state-level rollbacks of women's reproductive rights. In addition to insane abortion laws — one of the strangest examples being a Kansas law that requires doctors to give their patients their résumés in a specific font — there are the fight to repeal and replace the Affordable Care Act, various attacks on maternity coverage, and the Global Gag Rule that Trump enacted earlier this year, which bars US federal dollars from going to international NGOs that provide, counsel on, or even discuss abortion. Trump's IFR would be yet another blow to women in the US and another victory for those staunchly against a woman's right to choose.
"Whether opponents of reproductive services and rights will be emboldened, I think they clearly already are by the actions of this administration and this congress," says Sonfield.