WASHINGTON — Two Trump administration rules intended to allow employers and universities to stop providing insurance coverage for birth control were blocked nationwide by a federal court in Pennsylvania on Monday, the same day they were supposed to take effect. This is the second time this has happened.
The ruling came less than a day after a California judge blocked the rules from taking effect in 13 states and the District of Columbia, which had sued, Sunday night. The Pennsylvania ruling now means that the rules will not go into effect anywhere.
The Affordable Care Act requires the majority of employers and universities to provide insurance coverage for contraception as a preventative health service. The Trump administration rules — which were supposed to take effect Monday — would have enabled entities that provide insurance coverage to stop providing contraception coverage for “religious” or “moral” reasons. The policy would likely have impacted many women seeking free or low-cost birth control.
These new rules, which the Department of Health and Human Services announced the day after the 2018 midterm elections, are revamped versions of two other rules that the administration first released in October 2017. The October rules were quickly taken to court by several states and blocked, and the second version was an endeavor to make changes that would be accepted by the courts.
The US District Court for the Eastern District of Pennsylvania previously issued a temporary nationwide injunction on the 2017 rules, which was then appealed by the Trump administration. This appeal was still pending when the administration issued the new rules. The plaintiffs in that case, the attorneys general of Pennsylvania and New Jersey, asked that the new rules be included in the injunction that blocked the old rules in 2017. The Monday ruling granted this request.
“The only serious disagreement is not whether the States will be harmed, but how much,” US District Court Judge Wendy Beetlestone wrote in Monday’s order. She went on to say that, had she granted the injunction to just the two states involved in the lawsuit, the injunction would only apply to a limited number of women, noting that women attending college in Pennsylvania and New Jersey from out of state, but who are still official residents of their home state, for example, could still be subject to the new rules. Another example is women who live in New Jersey or Pennsylvania but work for a company based in another state where the Trump administration rules still apply. Those women would lose their contraception coverage from their employer and supplement it with state resources, Beetlestone argued, costing the states more money.
“Fundamentally, given the harm to the States should the Final Rules be enforced — 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 — a nation-wide injunction is required to ensure complete relief to the States,” the order states.
This ruling comes on the heels of that of Judge Haywood S. Gilliam Jr. of the United States District Court in Oakland, California, who had issued an order temporarily blocking the new rules in just 13 states and the District of Columbia. Gilliam wrote Sunday night that the new rules “are nearly identical to” the administration’s previous version, and therefore still in violation of the Affordable Care Act. Gilliam was one of the judges to block the last set of rules.
The more than a dozen states that sued the administration over the rule in California argued that the changes to the rules were not significant enough to bypass the injunctions the courts had put on the prior rules. They also resurrected their previous arguments, saying the rules were in violation of the Affordable Care Act, that it would cost women in their states significant amounts of money, and that it would significantly impact their access to birth control.
The Trump administration appealed Gilliam’s previous ruling, and in December, the US Court of Appeals for the 9th Circuit upheld Gilliam’s injunction but limited its scope. Because of this, Gilliam chose to only apply Sunday’s injunction to the states that sued rather than the whole country.
Gilliam wrote Sunday that he “fully recognizes that limiting the scope of this injunction to the plaintiff states means that women in other states are at risk of losing access to cost-free contraceptives when the final rules take effect.”
Beetlestone, on the other hand, argued that the only way to provide “complete relief” to the states suing was to block the rules nationwide.
Just before the new year, the five states that opposed the 2017 rules — New York, California, Maryland, Virginia, and Delaware — filed a second complaint over the new version. This new complaint was joined by Connecticut, Hawaii, Illinois, Minnesota, North Carolina, Vermont, Washington state, Rhode Island, and Washington, DC.
Despite most of the new rules remaining the same as the 2017 version, there were “at least three changes [that] bear mentioning,” Gilliam wrote in his order. Two of the changes show a greater impact on women seeking contraception coverage than the prior rules. The first is that the new rules estimate that “no more than 126,400 women of childbearing age will be affected,” an increase from the estimated 120,000 of the 2017 rules. The new rules also increased the estimation of how much the exemptions will cost women seeking contraception nationally to $67.3 million annually (in the previous rules, the estimate was $18.5 million for the religious exemption alone).
The third change is that the new rules emphasized that those affected by the change could seek cheap or free birth control from clinics that receive Title X family planning government funding. This would increase the financial burden on the states, both the federal judges argued, by causing more women to rely on grant money designated for a smaller patient pool. Another Trump administration rule that would limit that funding to organizations that don’t provide or refer for abortions is expected to take effect soon.
Mere hours after Sunday night’s injunction in California, Mark Rienzi, a lawyer representing Little Sisters of the Poor, a Catholic religious institute and charity for nuns, appealed Gilliam’s decision, arguing that the injunction gave Democrats the green light to “threaten the rights of religious women.”
“Yesterday’s decision will allow politicians to threaten the rights of religious women like the Little Sisters of the Poor,” Rienzi told BuzzFeed News in an email. “Now the Little Sisters have no choice but to keep fighting this unnecessary fight so they can protect their right to focus on caring for the poor. We are confident this decision will be overturned.”
Louise Melling, deputy legal director for the American Civil Liberties Union, which has been involved in the cases surrounding these rules since 2017, celebrated the ruling in the group’s official statement, despite the fact that the rule will still take effect in the majority of states.
“It is a good day when a court stops this administration from sanctioning discrimination under the guise of religion or morality,” the statement read. “We applaud the order to enjoin the enforcement of these discriminatory rules.”
UPDATE
This post was updated after a federal judge in Pennsylvania ordered a nationwide injunction blocking both of the Trump administration’s new birth control rules.