The era of free birth control for women could be coming to an end.
The requirement that insurance companies cover contraception at no cost is believed to be on the chopping block now that Tom Price has taken over the Department of Health and Human Services (HHS).
Price opposed the mandate as a member of Congress and could take aim at the regulation — and other rules related to ObamaCare — as Republicans in Congress move to repeal and replace the Affordable Care Act.
“There’s a lot of pressure on this administration and a lot of people within the administration who clearly have an agenda that runs contrary to this provision,” said Adam Sonfield, a senior policy manager at the Guttmacher Institute, a liberal think tank.
“It certainly looks like a strong possibility that they’re going to try to do something.”
Religious advocates fought the mandate all the way to the Supreme Court, resulting in the landmark Burwell v. Hobby Lobby Stores, Inc. decision that found closely held for-profit corporations cannot required to pay for some forms of contraceptives if the owner objects.
Now that Republicans hold Congress and the White House, they have the chance to do away with the mandate entirely.
Reversing the birth-control mandate would not necessarily require an act of Congress. HHS could issue a regulation excluding birth control from the list of women’s preventive health services that insurers must cover with no cost sharing.
Asked to comment for this story, HHS responded: "We aren't going to speculate on future policy."
Price could further be emboldened by an executive order Trump issued just days into his presidency that instructs agencies to loosen ObamaCare’s regulations.
“They could issue new guidance that says plans have more leeway to cover what they need to cover,” said Laurie Sobel, associate director for women’s health policy at the Kaiser Family Foundation.
The Republican Congress could also abolish the mandate by including a provision in ObamaCare repeal that does away with the requirement that insurers cover preventive care for free.
It isn’t yet clear which portions of the healthcare law Republicans will keep and which ones they will replace.
“I think the contraception requirement is at risk,” Sobel said, though she stressed that she did not know which route Republicans would take.
As a lawmaker, Price criticized the mandate, saying he didn’t believe any woman could struggle to afford birth control.
“Bring me one woman who has been left behind. Bring me one. There’s not one,” he said in 2012.
“The fact of the matter is, this is a trampling of religious freedom and religious liberty in this country.”
At his confirmation hearing last month, Price indicated that women with insurance would have to pay for birth control again.
Asked about ensuring access to free contraception, he said: “I think contraception is absolutely imperative for many, many women and the system that we ought to have in place is one that allows women to be able to purchase the kind of contraception they desire.”
Other Republicans, too, have indicated that women will likely have to pay for contraception out of pocket again.
Rep. David Brat (R-Va.), when asked what would happen to the mandate, said women could use health savings accounts to pay for birth control and other medical expenses.
Health savings accounts are central to the Republican push to repeal and replace ObamaCare. The accounts, which people can put money in tax-free, are intended to make consumers more responsible for their healthcare costs.
“The HSAs are your personal money — then those are individual decisions that a patient can make with them,” Brat said.
Asked whether Republicans would keep the birth-control mandate, Rep. Phil Roe (R-Tenn.), co-chair of the GOP Doctors Caucus, said: “We probably wouldn’t require that, but in doing that, we need to make them behind or across the counter.”
Roe, a former OB-GYN, said the caucus is discussing whether allowing the sale of birth control over the counter would be worthwhile.
“In other words, you come in [to a pharmacy], you want birth control, you get it, you go.”
But over-the-counter sales wouldn’t help women who want other contraceptives currently covered at no cost by insurers that aren’t available at pharmacies, including intrauterine devices (IUDs).
A reversal of the birth control mandate won’t happen immediately. New regulations must go through a formal notice and comment period before finalized, and the change would not affect current health plans.
Regardless, a move to reverse the mandate could stir a backlash.
According to the National Women’s Law Center, 55 million women receive contraceptives through their insurers with no out-of-pocket costs.
And a 2015 poll by The Washington Post and Kaiser Family Foundation found the vast majority of Americans supports the requirement, 71 percent to 25 percent.
A Vox analysis found that IUD insertions spiked after Trump won the presidential election in November.
“We have seen a lot of articles over the last several months after the election of women who have been rushing to get the long-term contraceptive methods in place because they’re anticipating a rollback of coverage and are worried they’ll lose those benefits that matter a lot to them,” Sonfield said.