The Trump administration is fundamentally reshaping federal policy to be hostile to abortion and family planning, while the GOP-led Congress is writing anti-choice legislation and cutting health care funding as quickly as they can.

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Contraceptive coverage mandate

In October, 2017, Trump effectively ended the ACA’s contraceptive coverage mandate by issuing rules that allow any employer, public or private, to deny birth control coverage by claiming a "religious or moral" objection.  

Here's the background: The ACA's contraceptive coverage mandate requires marketplace insurance plans to provide coverage of all FDA-approved contraceptive methods without requiring co-pays, co-insurance, or deductibles. The ACA exempts religious employers (churches, mosques, temples, etc.) from this rule, and allows nonprofit religious hospitals and schools to have a third party arrange the coverage so they need not burden themselves with even thinking about contraception. The 2014 Supreme Court case Burwell v. Hobby Lobby extended that exemption to closely held for-profit corporations whose owners object on religious grounds to providing contraceptive coverage.

What Trump did by his executive action is essentially grant a gross expansion of Hobby Lobby to all employers. Not just religious employers, not just public employers, not just closely-held corporations. All employers. Under Trump's rules, the employer need not get permission from or even notify the federal government before ending insurance coverage for birth control. Simply put, unless state law or regulations dictate otherwise, women’s contraceptive coverage is now at the complete discretion of their employers.

UPDATE: On December 15, 2017, a federal court judge in Philadelphia issued a preliminary injunction to stop the new rules from going into effect. The judge ruled that federal officials likely violated the Administrative Procedure Act by adopting the regulations without first seeking public comment. 

Religious exemption laws

In October, 2017, the Department of Justice issued guidance on religious liberty protections that emphasizes the practice of religion as a fundamental right, warns against government interference with the autonomy of religious organizations, and prohibits the government from second-guessing the reasonableness of a religious belief.

In January, 2018, the Department of Health and Human Services announced a new Conscience and Religious Freedom division of the HHS Office for Civil Rights to make it easier for medical professionals to decline to provide services that violate their moral or religious beliefs. In addition to assisted suicide, the only other specific medical procedures mentioned are "abortion and sterilization." The division's mandate is so vague that it may be read to protect refusals to provide care to transgender patients or to gay patients. 

Combined with new rules on the contraceptive coverage mandate (explained above), the expansion of religious exemption laws will have devastating effects on women's health. It seems that an employer wanting to save some money on insurance costs can now say as little as, "I don't believe in birth control," and then rest assured that the decision will be safe from government scrutiny. Even more frightening, a doctor who doesn't like gay patients or has a personal objection to abortion can now say "In other words, these exemptions allow the stated religious beliefs of employers to determine whether women can get access to affordable contraception.

Anti-choice HHS strategic plan

In September 2017, the Department of Health and Human Services issued its draft strategic plan for the next four years. The plan states, more than once, that life begins at conception.  For example, here's a snippet from the "organizational structure" section: "HHS accomplishes its mission through programs and initiatives that cover a wide spectrum of activities, serving and protecting Americans at every stage of life, beginning at conception."  Here's one from Strategic Goal #3 (on strengthening "economic and social well-being"): "A core component of the HHS mission is our dedication to serve all Americans from conception to natural death."  Here's another from the introduction to Strategic Goal #1: "Our ultimate goal is to improve healthcare outcomes for all people, including the unborn."

This is a blatant politicization of health care that serves to legitimize and encourage the devaluing of women's lives. A policy that life begins at conception jeopardizes not only abortion care, but also contraceptive care and non-contraceptive related health care involving IUDs. Moreover, this plan conflicts with established constitutional law (Roe v. Wade; Whole Women's Health v. Hellerstedt) and with established principles of science and medicine. Since HHS is the federal department that oversees Medicaid, these anti-choice policies will disproportionately affect poor women and women of color.

The document is also riddled with language on "religious liberty” and plans to “reduce burdens on the exercise of religious and moral convictions.” Make no mistake about what that coded language means: decreased "burdens" on religious liberty inevitably mean increased burdens--financial and otherwise--on women.

Tax benefits for "unborn children"

The GOP tax bill originally proposed by the House included—for the first time in federal tax legislation—the term "unborn child." The bill proposed to expand tax-free college savings investment accounts known as 529 plans to an "unborn child" or "child in utero" which was defined as a "member of the species homo sapiens, at any stage of development, who is carried in the womb." Recognizing fertilized eggs, embyros and fetuses in the tax code would have been one more step toward diminished legal protection for women. Thankfully, this provision did not make it into the final bill.

Anti-choice conservatives were also pushing for language extending the child tax credit to "unborn children." This provision also did not make it into the final bill. But the attempt is especially offensive considering a provision aimed at immigrant parents that is included in the final bill: to get the child tax credit, parents will now need to provide a social security number (instead of a taxpayer ID number), something that is available only to US citizens and those with employment authorization. The GOP wants to deny the tax credit for living and breathing immigrant children, yet considered granting the credit for a fertilized egg.

In addition, the tax bill includes a repeal of the ACA's individual mandate, which requires people who choose to be uninsured to pay a penalty and then uses that revenue to keep insurance costs down for everybody else.

Blocking abortion access for unaccompanied immigrant minors

The Office of Refugee Resettlement (ORR) within the Dept. of Health and Human Services (HHS) is responsible for the care and custody of young immigrants who enter the country without adult guardians. The Trump administration has a new policy of blocking abortion access for unaccompanied minors in their case. Read about the ACLU's successful suit to let a 17-year old immigrant get the abortion she wanted and the shameful tactics ORR's staff used to try to deny her rights. While that young woman finally did get her abortion, there are other young women in similar circumstances who are at risk of being denied their constitutional rights by this rabidly anti-choice administration.

Title X grant restrictions

Title X is the federal grant program providing low-income families with family planning and related preventive health services. It's called Title X because it was created in 1970 by Title X of the Public Health Service Act. It's run by the Office of Population Affairs of the Department of Health and Human Services. As the federal HHS website explains, Title X is “the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services. The Title X program is designed to provide access to contraceptive services, supplies and information to all who want and need them. By law, priority is given to persons from low- income families.”

The law provides grants to nonprofit organizations to provide family planning services, including contraception, breast and cervical cancer screening, STD and HIV prevention, adolescent abstinence counseling, infertility services and more. Title X also funds training and research initiatives.

The grant recipients are often state health departments, who then disperse the money to "subrecipients" like Planned Parenthood and other clinics. This structure gives states the power to direct the federal money, and Republican-led states used that power to withhold Title X funds from Planned Parenthood.

President Obama was able to stop this politicization of women's health care with a regulation stating that states could withhold Title X funds from certain organizations only for one reason: if the organizations did not have "the ability to deliver services in an effective manner."  Since Planned Parenthood is as effective as it gets at delivering health care services, their Title X funds were secure from these kinds of GOP sneak attacks. 

Then came the 2016 election, and on March 30, 2017, Congress passed a joint resolution rescinding Obama’s rule, with Mike Pence casting the tie-breaking vote. Trump signed the resolution into law on April 13, 2017, meaning states are now allowed to restrict Title X funds to Planned Parenthood for no legitimate reason, preventing Planned Parenthood patients from obtaining the services they need from the provider they choose.

As another indication of how Title X will fare in a Trump administration, consider who Trump initially appointed to lead the program: anti-contraception activist Teresa Manning, a former Family Research Council staffer, former lobbyist for the National Right to Life committee, and longtime opponent of contraception. In January 2018, Manning resigned for unknown reasons. That would be good news, except that her replacement is Valerie Huber, champion of abstinence-only sex ed. 

In March, 2018, the Trump administration announced its funding priorities for Title X grants. The grant announcement makes no reference to contraception, instead focusing on "fertility awareness" and "family participation" in reproductive decisions. 

Abstinence-only education

Trump and Congress have taken steps to revive abstinence-only education (now re-branded as "sexual risk avoidance for teens")––rather than comprehensive sexuality education––as a key component of our education and population policy. This is harmful to women's health, as abstinence-only education has been shown to lead to increases in teen pregnancy, unwanted pregnancy, and sexually transmitted infections.

The Trump Administration abruptly ended funding for all 81 grants awarded in 2015 by President Obama's Teen Pregnancy Prevention Program. The grants, which were awarded as five-year grants but will now end after three years, funded programs that had been proven effective in reducing teen pregnancy. For more reading on this topic, see this New York Times article about the program, this good analysis from the Washington Post of just how short-sighted these partisan cuts are, and read the letter that 37 Democratic Senators sent to HHS objecting to the administration's disregard for women's health programs that actually work to improve women's lives.

In another sign of a retreat from comprehensive sex ed, Trump named Valerie Huber, a leader of an abstinence education advocacy organization, to be chief of staff to the HHS Assistant Secretary who oversees adolescent health. Here's some great reporting by Teen Vogue unearthing five things you should know about Huber and what those thing tell us about the future of sex ed in America.

Global Gag Rule

During his first week in office, Trump signed an executive order reinstating and expanding the Mexico City Policy, better known as the “Global Gag Rule” (GGR).

In the past—under President Reagan and both Presidents Bush—this policy prohibited foreign NGOs (non-governmental organizations) that receive US family planning funding from providing abortions or “actively promoting abortion as a method of family planning.” The rule does not just prohibit US money from funding the abortion-related services of a given NGO. Instead, it completely withholds all US family planning funding from an NGO if it provides abortions or abortion counseling, even if it does so using non-US money.

As if that wasn’t restrictive enough, Trump’s rule actually expands previous GGRs by extending the limits from international family planning funds to all global health assistance funds. For more information, read this GGR Fact Sheet from the Center for Health and Gender Equity.

Combined with funding cuts to the United Nations Population Fund (also called UNFPA), the global gag rule expansion will lead to serious reductions in the availability of contraception for women around the world.

In March, 2018, the State Department ordered that its annual human rights report eliminate discussions of lack of contraception and abortion access in various countries and focus instead on forced sterilization and forced abortion. As Huffington Post reports, "the 'Reproductive Rights' subsection in the report will be renamed 'Coercion in Population Control.'" The State Department will also reduce the section focusing on racial and sexual discrimination.