The President recently signed an illogical and unpopular executive order (EO) that would jeopardize access to affordable contraception for thousands of Minnesotans. Back in October President Trump rolled back the Affordable Care Act (ACA) mandate that required employers to offer insurance products with no-cost contraception included. This EO would allow employers or insurance companies with religious or moral qualms about offering no-cost contraception coverage to exclude those services from future benefits sets. The federal courts halted the implementation of the EO in December, but this rule could take effect if the courts overturn the injunction. Minnesota lawmakers on both sides of the aisle proposed bills that would protect Minnesotans from an EO like this one; future efforts would be prudent, because we risk losing affordable contraception.
The EO Is Hardly Limited to Religious Non-Profits
Though this executive order would seem to benefit religious organizations most, historically-religious organizations have been in the minority among organizations that applied for contraception coverage exemptions. After Burwell v. Hobby Lobby Stores, Inc., religious non-profits, religious institutions, and closely-held corporations with religious leadership were exempted from providing to their employees health insurance that include services antithetical to their beliefs—namely, contraception and abortion services.
On its face this rule would apply almost exclusively to religious organizations. However, a recent FOIA request found that secular for-profit companies claimed over half the total exemptions in non-religiously affiliated industries like agriculture, IT, manufacturing, and real estate. Because the religious views that would trigger an exemption are a literal matter of faith, they cannot be easily verified. This lack of transparency could lead to abuse of the exemption. Minnesotans shouldn’t have to consider the religious beliefs of the CEO.
Birth Control is Expensive
Birth control in Minnesota can be prohibitively expensive for thousands of women and families. Birth control pills can cost women without insurance up to $600 a year in Minnesota. The ACA requires that insurance companies classify birth control as a preventative service; qualified health plans must provide preventative care at no cost to the patient. Birth control is more affordable than it has ever been. According to Kaiser, the percentage of women that paid out of pocket for birth control pills dropped from 21% in 2012 to 4% in 2014.
Intrauterine devices (IUDs) also grew in popularity since the passage of the ACA. The FDA approved IUDs back in the 1960s, but today IUDs are among the fastest growing versions of contraception. Thousands across the country took advantage of the ACA mandate to receive one of the most effective methods of birth control on the market: IUDs fail between 0.2% and 0.8% of the time; hormone implants fail only 0.05% of the time; and, birth control pills fail 9% of the time, mostly due to inconsistent usage. IUDs cost more in Minnesota on average than almost any state in the country—up to $1,200 out of pocket—so Minnesotans jumped at the chance. If Minnesotans lose contraception coverage, then thousands could get priced out of one of the most effective contraception methods available to them.
Minnesotans Really Like Affordable Contraception
The American public broadly disapproves of the contraception executive order. A PerryUndem survey found 77% of respondents did not consider birth control a controversial issue. The survey also found that 71% of respondents supported the requirement for employers to provide cost-free birth control coverage in their health plans. Americans like their access to contraception, and do not want to lose it over the religious beliefs of their employers.
Immediately after the 2016 elections, Minnesotan women flooded health centers with requests for long-acting reversible contraception (LARC) methods. The Star Tribune reported last summer that IUD visits in Minnesota increased significantly from November of 2016 to January of 2017 compared to the same months in the year previous. These women feared that they could lose cost-free access to contraception indefinitely, so they opted for IUDs, which can protect them for several years—and perhaps even outlast the Trump presidency.
Minnesota high school students also prefer LARCs. According to the 2016 Minnesota Student Survey, 9th graders’ LARC usage increased 66% while 11th graders’ usage increased 50%. Birth control pills remained the most commonly preferred method of contraception among Minnesota high schoolers, behind condoms. The combination of birth control methods led to some record lows in unintended births.
Per the Guttmacher Institute, Minnesota already had among the lowest rates of unintended pregnancy in the US back in 2010. The ACA drove that figure down further, particularly among teens. In 2015 teen pregnancy in Minnesota fell to an all-time low, though unfortunately rates of sexually transmitted infections rose. A major public health problem hangs over young Minnesotans. The federal government shouldn’t take away access to the tools that protect them.
The EO Doesn’t Make Sense for the Needs of Minnesotans
This executive order makes no sense. The Trump administration defended it in December by conflating abortion with contraception and insinuating that contraception use increases the number of abortions, which it doesn’t. And while Trump has claimed that his EO is a victory for millions of religious Americans, the results that followed the Hobby Lobby case hardly support that assertion. Only nine Minnesota companies filed a lawsuit akin to the Hobby Lobby case. Though those companies did win their lawsuits, several struggled to afford the growth in premium costs and dropped insurance coverage altogether, which pushed those employees to plans on the individual marketplace. Because employees of companies that pulled a Hobby Lobby had to buy insurance on the individual market, they were eligible for tax credits through MNSure.
If the EO withstands judicial review, employers could eliminate contraception coverage from employer-sponsored health insurance with the flimsiest of rationale. If their employer offers insurance without contraception, then Minnesotans that want contraception coverage would not be able to buy from the MNSure exchange and still remain eligible for tax credits. Those employees would have to eat the cost of contraception. Our lawmakers should continue their efforts to ensure Minnesotans receive the contraception they choose at no out-of-pocket cost.