The Trump administration has drafted a plan that would allow more employers to opt out of offering no-cost contraception coverage to women based on religious or moral grounds, according to a leaked copy of the interim rule.

The proposed rule, first obtained by the media outlet Vox, would greatly expand the religious exemption under the Affordable Care Act for employers otherwise subject to the ACA’s contraception mandate. If approved, the rule would allow additional entities and employers that object to the mandate for religious or moral reasons to be exempt from providing coverage. The exception would apply to plans sponsored by objecting employers, whether or not they operate as a nonprofit, according to the leaked rule .

The proposed rule is an attempt to better balance the interests of providing preventive health care coverage imposed by the ACA with the federal government’s duty to protect individuals and organizations with religious beliefs and moral convictions, HHS stated in the rule.

The American Congress of Obstetricians and Gynecologists denounced the rule, saying the proposal would wipe away women’s access to care and put women in all insurance plans at risk of losing coverage they have today.

“Contraception is an integral part of preventive care and a medical necessity for women during approximately 30 years of their lives. Access to contraception allows women to achieve, lead, and reach their full potentials, becoming key drivers of our Nation’s economic success,” Haywood L. Brown, MD, ACOG president, said in a statement . “Since the Affordable Care Act increased access to contraceptives, our nation has achieved a 30-year low in its unintended pregnancy rate, including among teens. Any move to decrease access to these vital services would have damaging effects on public health. Women, families, and our nation all benefit from seamless, affordable access to contraception.”

The White House has declined to comment about the leaked proposal. However, in early May, HHS Secretary Tom Price, MD, said he welcomed the chance to reexamine the ACA’s contraception mandate.

“Religious liberty is our country’s first freedom,” Dr. Price said in the statement . “Americans of faith play a vital role in caring for our most vulnerable citizens, including the elderly and the poor … We will be taking action in short order to follow the President’s instruction to safeguard the deeply held religious beliefs of Americans who provide health insurance to their employees.”

Since the ACA’s contraceptive mandate took effect, it has been the subject of multiple court challenges across the country. The mandate requires nearly all employers to provide coverage of birth control to employees, except for group health plans of “religious employers,” which are deemed exempt. Those religious employers are for the most part churches and other houses of worship.

The Obama administration later created a workaround for another group – nonprofit religious employers – to opt out of the mandate, but critics argued the process itself was a violation of their religious freedom. The issue led to the case of Zubik v. Burwell , a legal challenge over the mandate exemption that went before the U.S. Supreme Court in March 2016.

But the issue remained unresolved. In May 2016, the Supreme Court vacated the lower court rulings related to Zubik v. Burwell and remanded the case back to the four appeals courts that had originally ruled on the issue.

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