A federal judge on Monday issued an injunction against the Trump administration’s efforts to allow employers to deny women health insurance coverage for birth control, as mandated under the Affordable Care Act. Judge Wendy Beetlestone, of the Federal District Court of Philadelphia, said that the threat of the new rule to U.S. states was “actual and imminent,” and that more than 70,000 women would be immediately subject to its effects.
Judge Beetlestone’s injunction comes on the heels of a more limited block issued one day earlier by Judge Haywood Gilliam of California. Judge Gilliam’s block extended to just 13 states and the District of Columbia, whereas Beetlestone’s took immediate effect nationwide.
“Donald Trump broke the law to undermine women’s health, and women here in Pennsylvania stood up and proved that in court,” said Pennsylvania Attorney General Josh Shapiro in a statement following the court’s decision. “Together we’ve won a nationwide halt to their rules, protecting women across the country. This is just the first step, but today is a critical victory for millions of women and families and for the rule of law.”
The Trump administration rules subject to the injunction sought to allow businesses and nonprofits to file for exemptions from the ACA mandate requiring employers to provide contraceptive coverage without copayments to their employees, citing religious or moral reasons for what would ultimately provide for a money-saving scheme used by employers. According to Beetlestone, the ACA is clear in its prohibition of such exemptions.
What’s more, she said, the rules would result in “numerous citizens losing contraceptive coverage, resulting in significant, direct and proprietary harm to the states in the form of increased use of state-funded contraceptive services, as well as increased costs associated with unintended pregnancies.”
In his ruling just the day before, which came just in time to prevent the new “Final Rules” drafted by the Health Resource and Services Administration (HRSA) from taking effect, Judge Gilliam granted the injunction to 13 states on grounds that the language of the law was clear. “Without dispute, the guidelines continue to identify contraceptive services as among those for which health plans and insurers shall, at a minimum provide coverage…and shall not impose any cost sharing requirements,” he wrote. Like Judge Beetlestone, Judge Gilliam went on to note the result of “potentially dire public health and fiscal consequences from the implementation of the Final Rules.”
The administration’s implementation of the new Final Rules was an effort to replace interim rules, drafted in 2017, that were the original subject of the lawsuit. In December of 2017, Beetlestone issued a similar injunction against those earlier rules, an injunction that led to their being updated last year.
The administration struck back against the ruling, taking up the usual conservative stance on such issues. “No American should be forced to violate his or her own conscience in order to abide by the laws and regulations governing our healthcare system,” said Caitlin Oakley, a spokeswoman for Secretary of Health and Human Services Alex M. Azar II. Secretary Azar, who was deputy secretary of the department towards the end of President George W. Bush’s term in office, is a former industry lobbyist who incorrectly forecasted Republican success in ending Obamacare in 2017 during his period of confirmation to the secretary position.
“There will be a piece of legislation passes this year that is called ‘the repeal of Obamacare,’” he said at the time. “I don’t know what’s going to be in the substance of it, but there will be a piece of legislation that says that.”
The real challenge to the program, however, has come not through Congress but through the courts
The back-to-back rulings were handed down at a fraught moment for the ACA, which was challenged by a federal judge in Texas in early December. In that decision, Federal District Judge Reed O’Connor argued that, because the tax penalty for failure to sign up for health insurance under the law’s Individual Mandate had been reduced to zero by the 2017 Republican tax bill, the Individual Mandate itself had been rendered unconstitutional. No longer a function of Congress’s tax power, the mandate had, he argued, become a violation of the Interstate Commerce Clause, an interpretation that seems no doubt to have been informing Congressional Republicans in their original decision to remove the penalty.
O’Connor went on to argue that the Individual Mandate was so fundamental to the legislation that it undermined the constitutionality of the entire Obamacare system. That ruling, which pending appeal has yet to take effect, drew surprisingly measured support among Congressional Republicans, who despite their vocal disdain for Obamacare and control of both the House and Senate for the past two years were unable to consolidate behind legislation to bring an abrupt end to a program that currently enrolls some 9 million people.
President Trump, a frequent critique of his predecessors landmark piece of legislation, refrained from immediately speaking out on the two rulings.
In defending the new rules as a replacement to those introduced in 2017, the Justice Department argued in court documents that they protected “a narrow class of sincere religious and moral objectors” from being forced by the federal government to violate strongly held beliefs. What they do not acknowledge, however, is the profit motive playing a role in an employers determination to cheapen the cost of the healthcare they provide to employees. What’s more, the original Obama-era legislation already exempts religious institutions themselves from the mandate; the Trump rules would widen that margin to include any private employer claiming religious or “moral convictions.”
Opponents of the administration argue that such exemptions are not only an excuse for employers and insurers to transfer the cost of birth control to workers, but that the original law is designed to prevent employers from exerting undue influence over the lives of their employees. “The law couldn’t be clearer: employers have no business interfering in women’s healthcare decisions,” said California Attorney General Xavier Becerra in response to Gilliam’s limited injunction on Sunday. “Today’s court ruling stops another attempt by the Trump administration to trample on women’s access to basic reproductive care.”
One of the more farcical aspects of the new rules, should they take ever take effect, was pointed out by the Associated Press in its coverage of the case as it played out before Judge Gilliam. The changes would allow large, publicly traded companies to plead exemptions on religious grounds. Letting that play out in one’s head for a moment conjures up images of Jeff Bezos and the investors on the Board of Directors at Amazon making a case to the federal government that they, too, would like to be exempt from providing birth control to tens of thousands of women working for minimum wage in the United States because of their shared and deeply held beliefs. Or picture McDonalds, or Walmart, or Apple arguing that the executives and investors at the top of these bloated industry titans must be allowed to save millions on the cost of employee healthcare because to do otherwise would be nothing short of ungodly.