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WASHINGTON – The Trump administration is making it easier for employers to exclude birth control from health insurance benefits provided under the Affordable Care Act. A new rationale has been put forward: Employees can get contraceptives at family planning clinics at great prices. people with income.
This, in turn, could increase the demand for clinical services, which are already limited. This plan is one of many recent proposals that may affect access to birth control, such as the physical separation of services in clinics and the adoption of strict new rules on insurance payments.
The Health Act generally requires employers to cover preventive health services and the Government indicates that these include contraceptives for women. According to the final rules published last week, employers can obtain a waiver if they oppose all or part of contraceptive methods based on their "sincere religious beliefs" or their moral beliefs.
In a separate rule proposal, the Trump administration stated that women who were denied contraceptive coverage by their employer would be eligible for the family planning program created by Congress in 1970 under Title X of the Services Act. public health.
The clinics in this program serve four million people a year, mostly low-income women and adolescents. Clinics must give priority to low-income families, defined as those with annual incomes less than or equal to the poverty line ($ 20,780 for a family of three).
The demand for clinical services already exceeds what can be provided with the available funds, or $ 286.5 million a year.
According to the Trump administration's proposal, some women would be entitled to free contraceptives regardless of their income.
The proposed rule states that "a woman may be considered as belonging to a" low-income family "if she enjoys health insurance through an employer" who, for religious or moral reasons, refuses to cover contraceptives that she is looking for.
Administration officials said the proposed regulation, issued by Alex M. Azar II, secretary of health and social services, would meet the needs of women while diverting legal barriers to births of the president.
The proposed rule will "preserve the conscience protection" of employers and provide free or low-cost family planning services to women who need it, said the administration.
But Clare Coleman, President and CEO of the National Association for Family Planning and Reproductive Health, which represents many clinics, said the proposal would "divert the Title X programs and use their federal funds limited to subsidize employers' refusal to comply with contraceptive coverage. requirement."
Groups that fought the contraceptive coverage mandate, such as the Little Sisters of the Poor, Order of Roman Catholic Sisters, praised this policy.
"This shows that the government has the means to provide contraceptive services without calling on the Little Sisters of the Poor," said Mark L. Rienzi, president of the Becket Fund for Religious Freedom, who represents nuns in several trials.
Gregory S. Baylor, a lawyer with the conservative Christian Alliance Defending Freedom, said: "Thanks to these regulations, President Trump has kept his promise that people of faith would not be intimidated under his watch. . At the same time, contraceptives will remain easily accessible to those who wish to use them. "
The latest measures taken by the administration will be the subject of close scrutiny after Democrats take control of the House in January.
Representative Nita M. Lowey of New York, a senior Democrat on the House Credit Committee, tried to block the new family planning rule. The Republicans have thwarted her efforts this year, but Lowey is expected to become chair of the committee next year, which would give her more weight for the administration.
The federal law, unchanged since 1970, stipulates that Title X funds can not be used in "programs in which abortion is a method of family planning." The current rules, adopted by the Clinton administration in 2000, stipulate that clinics should give pregnant women the opportunity to receive information and advice about prenatal care, infant care, adoption and "l & rsquo; Abortion ".
The Trump administration has proposed radical changes to these rules to "ensure that federal funds are not used to fund the abortion sector in violation of the law."
Representative Diana DeGette, Colorado Democrat, criticized the initiative by saying that "the Trump administration is working hard to roll back women's rights."
President Trump also proposed removing the requirement for clinics to provide information, advice and referrals related to abortion upon request. As a result, said the administration, Title X funds would be available to "healthcare providers who refuse to participate in abortion-related activities such as counseling and guidance . "
Under the current rules, clinics receiving Title X funding must provide a wide range of "medically approved family planning methods". The proposal of the Trump administration would delete the words "medically approved". The proposal also states that clinics will not have to provide each effective method of contraception.
In contrast, health insurance plans and health insurance plans offered by employers are generally required to cover all forms of contraception approved for women by the Food and Drug Administration.
The Trump administration also has strict rules requiring the physical separation of family planning and abortion services from clinics offering both services. Federal health officials estimate that 10% to 20% of Title X sites are non-compliant and should spend an average of $ 20,000 each to meet the proposed requirements.
Mr. Trump would like to go even further. His goal, he told an anti-abortion group in May, was "to prevent funding of Title X from visiting an abortion clinic."
Under the Affordable Care Act, insurers are allowed to cover abortions, but they can not use federal funds to pay for the costs. Insurers are allowed to send consumers a single monthly bill detailing the amount of the abortion premium and other types of coverage, and consumers can pay the full premium with a single check. .
The Trump administration has proposed this month to tighten up separate billing and payment requirements. Insurers should send invoices in separate envelopes with separate postage, or in separate e-mails, and consumers would be asked to make separate payments by check or electronic funds transfer.
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