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The Trump administration’s argument for letting lots of employers opt out of covering birth control is…not exactly bulletproof.
Yesterday, Vox reported that the Trump administration is considering a broad exemption to Obamacare’s mandate on contraceptive coverage, according to a leaked draft of the proposed rule. If passed, the rule would allow virtually any employer, not just a religious one, to remove birth control coverage from its insurance plan if contraception violates the organization’s religious beliefs or “moral convictions”—a broad and murky standard.
But, in a curious twist, part of the Trump administration’s justification for the move hinges on the existence of hundreds of Planned Parenthood clinics, many of which the White House is actively trying to close by “defunding” Planned Parenthood.
As the draft text explains, the administration believes the past rationale for Obamacare’s contraception mandate is insufficient. The document lists several reasons why this is the case. Here’s one of them:
“There are multiple Federal, state, and local programs that provide free or subsidized contraceptives for low-income women, including Medicaid (with a 90% Federal match for family planning services), Title X, health center grants, and Temporary Assistance for Needy Families. According to the Guttmacher Institute, government-subsidized family planning services are provided at 8,409 health centers overall. Various state programs supplement Federal programs, and 28 states have their own mandates of contraceptive coverage as a matter of state law. For example, the Title X program, administered by the HHS Office of Population Affairs (OPA), provides voluntary family planning information and services for clients based on their ability to pay.
“The availability of such programs to serve the most at-risk women identified by IOM [Institute of Medicine, now known as the National Academy of Medicine] diminishes the Government’s interest in applying the Mandate to objecting employers.”
The implication here is that since there are already programs like Medicaid and Title X to help low-income women afford contraception, the requirement that most employers provide no-cost birth control is less pressing.
But there are a couple of glaring contradictions here: First of all, of the 8,409 health centers that provide Medicaid and Title X family planning services, as cited in the rule, 817 of them are run by Planned Parenthood—the very group that Congress and the administration are trying to exclude from using Title X and Medicaid funds to provide health care.
Trump has already signed a bill into law allowing states to exclude Planned Parenthood and other providers who offer abortions from receiving Title X family planning funding—never mind that Title X funding is used exclusively for nonabortion services. Beyond that, there are several more proposals moving through government—including in the House’s American Health Care Act and in the Trump budget proposal—to withhold Medicaid and other federal dollars, including Title X, specifically from Planned Parenthood.
The problem with the White House’s logic boils down to this: As the nation’s largest provider of federal Title X-funded care, in 2015 Planned Parenthood centers served more than 40 percent of women nationwide using Title X-funded family planning care—a whopping 1.58 million patients. But if Planned Parenthood can no longer receive a single federal dollar to provide contraception and other family planning care—an oft-repeated goal of the Trump administration—then these nearly 1.6 million low-income patients will suddenly lose their family planning care. And now their employers may not cover that care either.