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Margot Riphagen

Lawsuits pile up against the Trump administration as women risk losing preventative care

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The American Civil Liberties Union (ACLU) and others are suing the Trump administration over the rollback on an Affordable Care Act (ACA) mandate that required employers and insurers to provide contraception coverage.

The announcement by the Department of Health and Human Services (HHS), effective last Friday, means an employer can deny women the preventative care they need for family planning or severe medical conditions that require the use of hormonal birth control pills. It also means companies can opt-out of providing contraceptive coverage without notifying the federal government.

Birth Control Pills
In this August 1974 file photo, a woman holds a birth control pill dispenser in New York. (AP Photo/Jerry Mosey, File)

Preventative services are considered minimum essential benefits under the ACA for employer-sponsored health insurance plans, with contraceptive use listed among other basic medical necessities like vaccinations and screenings.

The fact that companies can now slash coverage for a basic preventative service which affects only women has many decrying the administration's actions for being rife with gender discrimination.

The ACLU filed a lawsuit within hours of the HHS announcement, arguing that the rule violated the separation of church and state, and defied the 14th Amendment's Equal Protection Clause, which guards the rights of all people to receive equal protection under the law.

"The Trump administration is forcing women to pay for their boss's religious beliefs."
Brigitte Amiri, ACLU Senior Staff Attorney

In addition to the ACLU, other groups and individuals are now suing over the rollback, including the Center for Reproductive Rights, National Women's Law Center, Americans United for Separation of Church and State, California Attorney General Xavier Becerra (D) and Massachusetts Attorney General Maura Healey (D).

In her complaint filed in the US District Court of Massachusetts, AG Healey pointed to protections in Title VII of the Civil Rights Act of 1964, which "prohibits discrimination in the provision of employer-sponsored health care plans."

Many conservative Christian activists and congressional Republicans lauded the broadening of exemptions, having fought for years against the ACA's contraceptive mandate.

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This despite the fact that the Obama administration had already accounted for religious freedoms pertaining to contraceptives in the Affordable Care Act. Any organization that didn't want to provide birth control coverage could file Form 700 to request an exemption, and the insurance company would provide the contraceptive coverage directly to employees without the objecting company's involvement.

But for some, like the Little Sisters of the Poor, this compromise wasn't enough, and many religious entities argued signing the form was the equivalent of sanctioning the use of birth control.

Trump gave a resounding victory to the Little Sisters of the Poor and other religious organizations who have long sought to give businesses the same religious freedoms under the First Amendment as people.

But many pointed out that being both anti-birth control and anti-abortion was self-sabotaging.

Birth control pills have a demonstrable link to a lower rate of women who seek abortions. A 2012 study from Washington University School of Medicine found that providing no-cost birth control to women decreased the instances of unplanned pregnancies and reduced abortion rates by 62 to 78 percent. In another instance, when Colorado began providing cost-free intrauterine devices (IUDs) to teenagers and low-income women, the abortion rate in that state fell by 40 percent between 2009 and 2013.

But aside from the preventative aspects of birth control, the pill is often prescribed to alleviate symptoms of endometriosis, a painful and often debilitating disease in which tissue lining the uterus, which normally sheds each month, instead grows on the outside, and has no way to exit the body during each menstruation cycle.

For patients with endometriosis and other diseases that require birth control for non-family planning purposes, the new measure could mean a terrifying blow to health benefits.

The ACLU warns the HHS announcement could also mean a slippery slope for discriminatory exemptions in other contexts.

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The new guidance could lead to a range of interpretations of the Religious Freedom Restoration Act (RFRA), and broadens the range of contexts in which an employer can discriminate against employees or customers by claiming a religious exemption. The ACLU warns that the Justice Department could theoretically use the lax threshold for religious exemption to deny services to minorities and minority religious groups, simply by alleging a conflict with prejudices dictated by one's own religion.

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