Thursday was a bruising day for American health care.
In Congress, House Republicans rushed through an Obamacare replacement bill, without waiting for a CBO score, that is likely to cause tens of millions to lose health insurance. The bill would also allow states to roll back coverage for essential health benefits like hospitalizations, and to revoke protections for people with pre-existing conditions.
These policies will be particularly devastating for women and other people who can get pregnant. Before Obamacare required plans to cover essential health benefits, it was more common for insurance plans to opt not cover maternity and neonatal care than it was for them to cover it, and this care was often extremely expensive.
Plus, rape, domestic violence, sexual assault, Cesarean sections, and post-partum depression can all be classed as pre-existing conditions — meaning that Trumpcare opens the door for rape survivors, for example, to choose between reporting their rape and accessing affordable health insurance.
But that’s not all. President Trump and Health and Human Services Secretary Tom Price also indicated that, even aside from the sweeping changes to existing protections under Obamacare, the White House is ready to start rolling back birth control coverage.
On Thursday morning, President Trump signed an “executive order on religious freedom,” which would both make it easier for faith leaders to preach politics, and for employers to claim a religious exemption against providing contraceptive health care coverage to their employees.
“Your long ordeal will soon be over,” Trump told the Little Sisters of the Poor, an order of nuns that objected to Obamacare’s mandate that all health insurance plans cover birth control without additional co-pays.
Price immediately released a press release saying he was pleased to have the opportunity to rethink the mandate.
“We welcome today’s executive order directing the Department of Health and Human Services to reexamine the previous administration’s interpretation of the Affordable Care Act’s preventive services mandate, and commend President Trump for taking a strong stand for religious liberty,” his press release says. “We will be taking action in short order to follow the President’s instruction to safeguard the deeply held religious beliefs of Americans who provide health insurance to their employees.”
It’s a move that health care advocates have long expected from Price, who has previously objected to Obamacare’s birth control mandate. In his confirmation hearing, Price refused to commit to keeping this Obamacare provision intact. Years before that, Price dismissed the idea that women may struggle to access contraception.
“Bring me one woman who has been left behind. Bring me one. There’s not one,” Price said in an interview with ThinkProgress in 2012. “The fact of the matter is this is a trampling on religious freedom and religious liberty in this country.”
Now, as Secretary of the Department of Health and Human Services, Price has immense control over how to enforce the essential benefits provision, and will likely use Trump’s order to expand the exemptions for employers, allowing them to refuse to cover some or all birth control options.
It’s a move that could have real consequences for those relying on Obamacare’s no-copay provision.
In a March study, researchers at polling firm PerryUndem found that one in seven women said that if they had to pay any money for their birth control at all, they wouldn’t be able to afford it. One in three said that they could afford to pay only $10 or less.
Without coverage, that means they’d likely be going without birth control or have to choose options based on cost rather than which works best for them medically, either of which could have a huge impact over their short and long-term financial stability.
All of which means, even if the House version of Trumpcare does not become law — and it still has a long journey ahead of it — the Trump administration is set to actively roll back protections on women’s heath coverage.