President Donald Trump's administration issued a long-rumored rule today exempting a broad range of employers from covering birth control in employer-sponsored insurance plans for moral or religious reasons.
The new regulation, issued by the Health and Human Services Department, takes effect immediately, though it is likely to be challenged in court.
The measure is a rollback of one of the Affordable Care Act's most popular provisions, which stipulates that all insurance plans offered by employers and on the individual market must cover FDA-approved forms of birth control at no additional cost, including birth control pills, rings, intrauterine devices, and more.
Now, Trump's mandate revision could deny birth control to hundreds of thousands of women as it expands the exemption to all nonprofit and for-profit employers including publicly-traded companies, who can choose not to cover birth control based on religious belief. The plan also allows a similar exemption for "moral conviction," though publicly-traded companies are not included in this.
One of the Obama administration's goals when it passed the ACA was to expand birth control access to as many women as possible. And it was largely successful: More than 55 million women accessed birth control without co-payments because of the mandate, according to the New York Times.
The measure had a direct impact on women's wallets. For example, in the spring of 2014, 67% of women with private insurance paid nothing out-of-pocket for the birth control pill, up from just 15% in 2012, a report from the Guttmacher Institute found. A similar increase occurred among women using injectable contraception, vaginal rings, and IUDs, all of which added up to an estimated $1.4 billion in savings in 2013 alone, per the report. Average out-of-pocket spending on oral contraceptive pills has decreased by about $255 per year because of the ACA's birth control mandate, and by $248 for an IUD, a study published in Health Affairs found.
As MONEY has previously reported, the 2017 Willis Towers Watson Emerging Trends in Health Care survey found that 11% of employers would stop covering forms of birth control if it was no longer required (59% would definitely keep covering it). " Dozens of employers are already suing to get out of this benefit, so we know they will want to take advantage of this," says Mara Gandal Powers, senior counsel at the National Women's Law Center, which has vowed to fight the law.
Experts expect this to be challenged in court by women's advocacy groups. The Obama mandate was challenged often, too, by colleges and companies that objected to providing this service, with the most famous case being the Hobby Lobby case of 2014.
Currently, 28 states require health plans to cover all FDA-approved forms of birth control, according to the Kaiser Family Foundation.