Trump administration revisits moral and religious exemptions for birth control coverage

Packs of birth control pills
HHS is taking another stab at birth control coverage exemptions that were immediately challenged last year. (Getty/areeya_ann)

A contentious federal rule that would expand employer exemptions for contraceptive coverage based on “moral convictions” is back under review by the Office of Management and Budget (OMB).

Last year, the Department of Health and Human Services (HHS) released two proposed rules loosening contraceptive coverage exemptions under the Affordable Care Act (ACA). One interim final rule expanded exemptions for religious employers to opt out of the ACA's mandate. But the second—which generated immediate blowback from women’s rights organizations, the American Civil Liberties Union (ACLU) and state attorneys general—created an entirely new exemption for employers on the basis of “moral convictions.”

Following several legal challenges from the ACLU and a group of blue states, two judges blocked the administration’s rollback of the birth-control mandates. Several of those cases are on hold while the administration appeals a preliminary injunction requested by California.

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On Thursday, HHS sent new finalized versions of both rules to OMB, signaling another attempt by the administration to move forward with the religious and moral exemptions in some form.

The details of those rules are still uncertain. According to language in OMB’s spring unified agenda, the final rule “expands exemptions to protect moral convictions for certain entities and individuals whose health plans are subject to a mandate of contraceptive coverage” through the ACA. That mimics the language in last year's rule (PDF). 

But it's not clear how the new “moral exemption” rule will differ from last year’s interim rule that sparked so much pushback from consumer groups.

“If it mirrors the interim final regulation, hundreds of thousands of employees, if not more, could lose their birth control benefit simply because of their employer’s religious or moral beliefs, unless a court blocks the final regulation,” Brigitte Amiri, deputy director of the ACLU Reproductive Freedom Project said in an email to FierceHealthcare.

That’s likely to spark a new round of legal challenges from state attorneys general and the ACLU. Amiri said her organization would have to wait and see what the final rule says, but new legal challenges “could be folded into existing ones.”

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