Birth Control Benefit

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In this episode, Mara Gandal-Powers with the National Women’s Law Center talks to us about the Affordable Care Act’s momentous birth control benefit, which allows women to access contraception without a co-pay.

While the benefit has allowed 55 million women to receive birth control without extra out of pocket cots, it has been challenged along the way. When the benefit was first put into effect, a narrow exemption existed for churches and houses or worship, eventually evolving to include other religiously-affiliated non-profits or institutions that were headed by employers with a religious objection to birth control coverage. The Obama administration required that women seeking birth control and who were employed by an organization under religious accommodation would be able obtain birth control coverage directly from the insurance company. The podcast then discusses two of the major birth control benefit cases that went to the Supreme Court: Burwell v Hobby Lobby and Zubik v Burwell.

In October 2017, the administration rolled back the ACA birth control mandate by allowing any employer or insurer, who may have a “religious or moral objection” to birth control, to stop providing birth control coverage. California, Washington, Massachusetts and Pennsylvania have filed lawsuits with the administration and its decision to roll back the benefit. The American Civil Liberties Union, the National Women’s Law Center, and the Center for Reproductive Rights have also filed lawsuits.

Since recording this podcast episode:

Federal judges in both Pennsylvania and California have issued orders to temporarily block the Trump administration’s rollback of the ACA birth control benefit. The subject of basic healthcare for women is now facing intense legal battles.

Links from this episode

National Women’s Law Center Facebook
National Women’s Law Center Twitter
CoverHer

Photo by Simone van der Koelen on Unsplash

Transcript

Jennie: Welcome to rePROs Fight Back a podcast on all things repro. I'm your host Jenny Wetter. In each episode, I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode, I will be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for repros to fight back.

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Jennie: Okay. Welcome to rePROs Fight Back. Um, today we're going to you a bit of a deep dive into the Birth Control Benefit. And to help me do that, I'm really excited to have Mara Gandal-Powers the Senior Counsel for Reproductive Health and Rights at the National Women's Law Center. Thank you for joining me today, Mara. Mara: Thanks so much for having me. I'm very excited to be on my first podcast.

Jennie: Yay! So before we talk about what's currently going around around the Birth Control Benefit, which is a number of things. Yeah. Um, let's talk a little bit about how did we get here? So what is it?

Mara: Yeah. So the birth control benefit, maybe a lot of listeners have actually used it and might know about it, but some might not still. Um, it's part of the Affordable Care Act, Obamacare as it's also affectionately known, and it's the part of the law that requires your insurance company to cover your birth control without you having to pay out of pocket costs. So you've paid your premium, you get your health insurance, and then when you go to the pharmacy or the doctor's office, you don't have to open your wallet. And that's what the birth control benefit is. And you should be getting coverage of every different kind of birth control method, whether you want a pill, a patch, or ring an IUD, a diaphragm. Whatever you want, your insurance company should be covering it without out of pocket costs. And the whole point of it is that, um, it was part of the Affordable Care Act that requires coverage of preventative services. So it was switching, trying to be part of the system of switching our health insurance from a sick system to helping prevent things that are preventable. So, uh, there are immunizations in that part of the law. There's mammograms in that part of the law, there's well woman visits and birth control because birth control prevents unintended pregnancy.

Jennie: And that's been great for women. So what kind of results have you seen or what changes in behavior or benefits and we've seen from it?

Mara: Yeah. Yeah. So we've seen, there's a lot of things that we've seen happen. We know that there are over 62 million women who are currently eligible for coverage of their birth control without having to pay out of pocket costs. We don't know obviously that every one of those 62 million women are using it necessarily right now cause maybe they're pregnant, maybe they're trying to get pregnant, but 62 million women are eligible for that. We also, there've been studies showing how much money women have saved in out of pocket costs. In one year in 2013 alone, we know that women saved 1.4 billion, with a b, billion dollars just on birth control pills.

Jennie: That's crazy. Just on birth control pills?

Mara: Yes. Pills. And for some women, those out-of-pocket costs may have been really low before the health care law. So you may have been paying, you know, five $10. And for some women, five or $10 actually isn't low when they look at their monthly budget. And I think that's what's really important to know about this part of the health care law is that all of these preventive services are being included because they are proven effective for women. And because we know that when women face out of pocket costs for preventive care, they don't get that care. If they have to spend five or $10, and they're deciding between preventive care for themselves or putting food on the table, or care for their child, they're picking the food or the and their kid, they're not picking the care for themselves. And so getting rid of these out of pocket costs is really important to ensure people can get the care that they know they need, that their health care providers recommend.

Jennie: And I know that's so important. The out of pocket costs could be a wide range. Like you said, you know, it could be five, $10, but I know when I was, um, taking the birth control pill, I had a generic that was five or 10, but I had side effects with it, so I had to switch to a name brand and that was $65 a month. And that was at a time where that was just something I couldn't afford. So it's really something that has been a great benefit to women.

Mara: Yeah. Yeah. So for something like a brand name pill, they could have high costs and even now there may be plans that someone might be listening and saying, wait, I'm still paying out of pocket for my brand name pill. What's going on? Under the health care law, part of the regulations and guidance that were put into place, uh, say that health insurance companies are supposed to cover whatever birth control method your health care provider recommends for you. So if your plans, uh, formulary only has the generic version of a pill and you know, that doesn't work for you, you've been on the brand name for however long and it works, uh, they're supposed to have a process so that you can get that brand name pill and those out of pocket costs don't keep you from, from using it. We know that those side effects can be enough to make people stop using their birth control. And the out of pocket costs, you know, for other methods can be really exorbitant, even though over time they work more effectively and are less expensive, right? So if we're thinking about an implant, so that's the implant that goes in your upper arm and can last for three years or an intrauterine device, an IUD, those last anywhere from five years to 10 years depending upon what kind you pick. And you know, if you don't have health insurance coverage, it's $1,000 up front. Most people don't have $1,000 sitting around to get an IUD. Um, even if that's what they want, um. And they know that it's going to cost less over time than buying, than paying for pills out of pocket. You just, you can't afford that. So it's really important that folks know that whatever method they want, they should be able to get under the the health care law.

Jennie: Yeah. And I think it's really been great to help establish some real reproductive freedom that women might have been really limited on before, saying maybe they wanted to use one of the more effective methods or something else that might've worked better for them, but their insurance was only going to really give good coverage for birth control or you know, any number of things. So you were limited on what kinds of method you would choose when you weren't choosing what works best for you. You were choosing what you could pay for.

Mara: Yeah, exactly. And we did see, you know, this has been in effect, it went into effect starting August 1st, 2011. it kicked in at different times for different health insurance plans. But the first couple of years we saw health insurance companies, not, I would say fully understanding what they were supposed to be doing under the health care law. So we saw insurance companies that were saying, oh, we cover hormonal methods. And they would put pills, patches, rings and IUDss in that category. And those all have very different ways that they are administered in your body. Different reasons that you might pick one over the other, they last for different periods of time. And that's a conversation that's supposed to happen between you and your health care provider, not your insurance company saying, Oh, here's our category, we cover one pill. And you have to either, you know, go through lots of hoops to get to the next level of, of what they determine is the next level of coverage or have failure on a method. Which failure for birth control is not just that it doesn't work, and like your acne doesn't go away or um, you know, it doesn't control whatever. It's like you get pregnant. That's what failure on birth control means. So that's not an okay alternative to have to go through to get to the method that works for you.

Jennie: So while we were all very excited by this new idea of birth control with no copay, not everybody was. And so the Obama administration faced a number of complaints when they started, first put this into effect around infringing on people's religious liberty. Um, so the Obama administration took action to try to accommodate them. Do we want to talk about the original accommodations that administration tried to work out?

Mara: Yeah. So when this first went into effect, there was an exemption for churches and other kinds of houses of worship. So it's a very narrow exemption and it very literally is churches, right? So it's not, not sort of the entities that are associated with churches. And there was a really big uproar from folks particularly I would say the US Conference of Catholic Bishops were, were leading that. But it led to a lot of what basically I would say the last six years of, of litigation around birth control. And what the Obama Administration did was when they finalized the rules on birth control and said, yes, there is an exemption for churches and houses of worship. Um, we, they also said at the same time, we are going to create what they had called an accomodation for other nonprofits that had religious objections to birth control. And so I think what they were thinking of was religiously affiliated hospitals or religiously affiliated schools or universities or charities where the employer has a religious objection to covering birth control. And they were trying to make, you know, appease those entities and the people who run them. What they did through that accommodation over, over several years of rule making was ensure that the entities' health plan did not include birth control coverage. So that satisfied would satisfy the entity that objected. But women who were enrolled and people who are enrolled in that plan who needed birth control would get it through a third party that would step in and pay for the birth control. So usually that was the insurance company that they were already working with. They would step in and pay for it and it was separate from the coverage. Um, so for most folks who were in plans that used the accommodation, it probably looked and felt just like if they worked for any other employer, right. So you work at a Catholic hospital and you have the accommodation, it doesn't matter if you're working there or just uh, you know, your state hospital or a private hospital and you have birth control coverage. It should have looked and felt exactly the same.

Mara: After all that was put into place, there were for profit entities that objected to birth control coverage. And particularly hobby lobby, which folks may have heard of the case. Just maybe. And those entities, uh, sued saying we shouldn't have to cover birth control either. They sued under the Religious Freedom Restoration Act saying, we shouldn't have to cover birth control. We have objections just like these other entities. That case went all the way up to the Supreme Court, was decided in June of 2014. And what the court ultimately said was they sided with Hobby Lobby and they said there is a less restrictive way that the government could do this for entities like Hobby Lobby. They used the term closely held for profits, which was not defined, they didn't define it. But they said closely held for profits should also be able to make use of the accommodation that exists for nonprofits. So there was more rule making from the Obama administration. They defined what a closely held for profit meant and things were moving along. So if you worked at Hobby Lobby, you would now should now have been getting coverage through that third party that was stepping in to pay for birth control coverage. And then there was another line of lawsuits.

Jennie: I was going to say and so people were still not happy with what came from that. So there is a whole nother slew and I think the one most people might have heard of is the Little Sisters of the Poor. A very sympathetic sounding plaintiff.

Mara: Yes. Yes. So the Little. Sisters of the Poor was sort of the picture plaintiff of these cases. The cases were called Zubik versus Burwell. Zubik is the name of the bishop in Pittsburgh. And so it was his case that was the named case that went all the way up to the Supreme Court. But there were several cases where the nonprofits that had the accommodation, so they weren't covering birth control in their plan, a third party was stepping in. Those nonprofits said, even this accommodation violates our religious rights under RFRA. They didn't want to fill out a form that said, I object to birth control. I mean at the very base level of what they were arguing about. They didn't want to state their religious objection, um, because that would in their words, facilitate evil. And so those cases went all the way up to the Supreme Court again. We were just across the street from where we're recording this podcast. In March of 2016, they were argued.

Jennie: Wow has it only been a little over a year, not even.

Mara: It's been almost almost two years now. So it was March of 2016, they were argued. And then in May of 2016, the Supreme Court, um, did something unusual with Zubik. They didn't actually decide the case. They, um, sent all of the cases back down to the circuit courts and said, we really think that the the plaintiffs and the government can come to some sort of agreement here. You guys go negotiate this. Figure it out. But when you do that, you have to make sure that women have contraceptive coverage, birth control coverage. Right. That was one of the things that the court said when they sent those back down. And so between May of 2016 and you know, it was mid-May between until the summer, we were sort of waiting to see what the Obama administration was going to do. They were supposed to be negotiating all these cases. And they, the Obama administration released what was called a request for information. And I think rightly so, they said in that request for information, the Supreme Court told us to continue, um, negotiating with the plaintiffs, but we really think there aren't just plaintiffs who are impacted by this. Right? It's not just the employers who are impacted by the decision. In this case, it's people who work there, it's the insurance companies that have to facilitate the coverage. It's, you know, all of these folks are implicated. So they put forth in that request for information, several questions about what could be done, and groups like ours, the National Women's Law Center and others and you know, regular folks out in the world who would be impacted, commented. And ultimately in, I think it was, it was December or January, right? It was after the 2016 election, before the inauguration. In January of 2017, the Obama administration released, um, uh, a document, a set of frequently asked questions. Um, I think was the actual form of it saying, this, you know, we don't think that the accommodation violates RFRA. And you know, it ensures that women have, and that the objections are of these entities are, um, taken into consideration and there isn't a way to change it that would satisfy these plaintiffs. But then we got the new administration in January of 2017.

Jennie: So things changed a little bit.

Mara: Things changed a lot. And I don't think I'm exaggerating when I say and, and not even don't think, I know, I'm not exaggerating when I say literally the attornies who were arguing on behalf of Little Sisters of the Poor and the other entities were, are now working for this administration. And they are the ones determining what happens to the Zubik cases and the birth control benefit. So you can imagine where things fell, where things would go. Yeah.

Jennie: So I think the first kind of major thing they took, a step they took addressing this set of cases is in the religious liberty executive order that was released I think in May. So we would talk a little bit about what that did?

Mara: Yeah. Yeah. So we had been hearing for a while, and you know, we at the Law Center were waiting.

Jennie: We were waiting, right?

Mara: We knew this was, had a giant target on it for this administration. Along with other, you know, rights, um, around health, but also just in general civil rights issues that this administration had a target on it and wanted to take on. And what we saw in early May was an executive order signed by the president with the Little Sisters of the Poor in the audience in the Rose Garden.

Jennie: I actually forgot that part.

Mara: Yes. It's sort of burned in my brain. Um, and it was an executive order, um, to, and it and it said that generally that the government should be, and specifically Attorney General Sessions should be looking at the laws of the US, the federal laws, and how, um, they interact specifically with RFRA, the Religious Freedom Restoration Act. And it specifically directed the, the departments that oversee the Affordable Care Act to consider the regulations on birth control and to make sure that, uh, folks, I'm putting air quotes at home, imagine me doing air quotes, that their religious freedom was not being infringed upon. And we knew that was coming. Right. So we, I was not surprised by it. Um, and I think I'm pretty typical President Trump fashion, he sort of went off script at the Rose Garden ceremony. He invited the Little Sisters of the Poor up on the stage with him and made a comment about how they had such great lawyers and. And so we knew that this wasn't just an EO about the birth control benefit, is that all of this was pointing towards a resolution of those Zubik cases, which still had not been resolved. Right. The government was still negotiating again, air quotes, negotiating with the plaintiffs because those negotiations were essentially with their former colleagues at, uh, several nonprofits that represent a lot of these plaintiffs. So we knew it was coming. And then at the end of May, we got a leaked draft of what was an interim final rule, um, on the birth control benefit. And it was everything I had feared. Like I had a checklist in my office of when it came out, what I wanted to look for, cause what I thought they were going to do. And it checked every box.

Jennie: I feel like that kind of goes to a lot of the repro stuff we had from this administration. I know in the next episode we're going to talk about the global gag rule, and that kind of did the same thing. Like it could've been back to normal of gag, but we kind of expected much worse. And that's kind of, that's what we got.

Mara: Yeah. I mean they are, they are being as sweeping as they can. So in the league draft we saw that it was going to be virtually any entity that had an objection to birth control. Um, and it was going to be and, and so not just churches and houses of worship that those, any entity could get an exemption. And we also saw that it wasn't just those that had religious objections to birth control, it was those that had moral objections to birth control as well.

Jennie: Sounds bad, but maybe kind of an inoculous in general, but like it's bad, right?

Mara: It's yes, its bad, because first of all, they don't define what moral means in the rule, but ultimately they are using moral as pretext for religion. Right? So if you can't pinpoint your specific religious belief, just claim that it's moral and you can get in that way too. Um, they are trying to create every open door that they can to not cover birth control entirely. So I think what, for folks who are trying to put this together and thinking about like, wait, there was an exemption in accommodation, now there's an exemption. What's going on? It means that what used to be a really narrow exemption is now extremely wide. Virtually any employer or university can get in that door. And while the accommodation still exists, it is optional. So we've seen a few entities that have said we're going to continue doing the accommodation or seem to still be doing it, which is really good for the women who and, folks who work there, who go to school there, who rely on the insurance coverage from there. But there's no guarantee that that accommodation is going to be what continues because it is optional. And so it's going to be very dependent on who is in charge at those places.

Jennie: So the rule went into effect little over a month...well I guess at this point it'll be like two or three months ago.

Mara: Yeah. So we saw the leaked draft in May. The rule officially came out at the beginning of October and I have to say I was shocked that it took that long.

Jennie: I mean, yeah, that's, I think everyone, there was always the like it's going to happen this Friday, it's going to happen this week. And we all were just like waiting, waiting for it.

Mara: Yeah. We had a few fire drills and you know, I think it ultimately came out first Friday in October. And I was shocked that it was not different. There was a little bit of a difference in that it was two different interim final rules, one about religious objections, one about moral objections. Ultimately I think that's, I'm not entirely sure why they did that. I don't think it gives them any extra protection in the litigation that is ongoing. But I think, you know, cause they all end up in the same place in the Federal Register with all the other regulations. So it, it seems a little bit ridiculous to me to have done that, but they did. So we, we at the Law Center and others and, and many, many folks across the country submitted comments at the beginning of December on these rules. Um, even though they were interim final rules, which meant they went into effect immediately, they still, you can still submit comments on those kinds of rules. Over half a million people did submit comments. So if you're listening and you're one of those people, thank you so much.

Jennie: Yeah, absolutely.

Mara: Um, I don't hold out hope that this administration is going to necessarily listen to what you and I and others have said, but it is really important to voice that, that resistance, that, um, to say that women's health matters. Um, these rules were really, I mean, they said birth control doesn't work. They said that birth control, you know, all these things that we know are false, right? Birth control doesn't work, but we should be worried about birth control because it can cause risky sexual behavior in young people, all these things that are not true, right? But that is where they're coming from. That is what they are basing policy on. And so it's important for us to push back and say, this is, this is wrong, you are wrong. You shouldn't be basing regulations on things that are wrong. Um, and it's kind of akin to calling your congress person. Which I think a lot of people are getting much more familiar, right? Submitting comments on regulations is just as important. Um, it sets a record for what's out there and what people think and what people want.

Jennie: And you know, that's not to say yes, the administration might not change what they're doing, but it may stop a company or a school from changing what they are doing. I think the biggest illustration of that I think was Notre Dame, right? They said that they were going to quit providing birth control and they got a lot of pushback and changed their mind.

Mara: Yeah. Yeah. And I, I want to tread lightly with Notre Dame because I am still unconvinced of what they're actually doing. Um, and, and we, you know, at the Law Center, um, I know we'll talk a little bit more about, about the litigation that's ongoing. We represent several students, uh, in law, in a lawsuit against the administration. Um, and we know that those students have not actually seen, uh, insurance documents yet saying that they have the coverage. So we want to make sure that they see those and, and um, that, that is clear and, and that it's happening, right? So it's one thing for Notre Dame to issue a press release and say we are not covering birth control. And then a week later to say, Oh, actually we were wrong. We're just gonna let this all continue the way it was happening before. I'm, I'm waiting to see a claim that is actually covered where someone doesn't have to pay out of pocket to really know that it's happening. But yeah, it's there, there are other entities, you know, we've seen Georgetown University is still doing the accommodation. There are others out there that are, but there are definitely others that are, we we know are going to start, uh, using the exemption instead of the accommodation. Right. Jennie: So there are ongoing lawsuits, um, you, do you want to talk a little bit about what's still percolating through the system or starting to percolate through the system?

Mara: Yeah, so we're, we're, I would say we're definitely at the very beginning of all of this with lot of states, right? We saw this when we went through this cycle when the folks who didn't like the birth control benefit challenged it. And I think we're sort of on the other side now. We're at the very beginning. So four states attorneies general filed lawsuits against the birth control benefit, California, Washington, Massachusetts and Pennsylvania. There are three lawsuits led by nonprofit organizations: the ACLU, the Center for Reproductive Rights, and then our lawsuit, National Women's Law Center, we filed along with Americans United for Separation of Church and State. And then there's also another lawsuit that was brought by a school teacher out in Colorado, just sort of out there and that's out there as well. So there are a lot of moving pieces. The California attorney general filed for a preliminary injunction, and the oral arguments for that were shortly before our taping. Um, and so potentially things could change between now and when this airs. Things are constantly changing right now and I think folks are familiar with that given all the lawsuits that have been brought against this administration.

Jennie: Yeah, if something changes, we'll make sure to put an addendum in the show notes. So go to the website reprosfightback.com. Um, and check the show notes and we'll make sure to have any updates listed there.

Mara: We and others are very, you know, we're optimistic about our cases. We wouldn't have brought a lawsuit if he didn't think we had a good chance. And also, you know, the position that the government is taking, and we saw that pretty clearly in the arguments in the California case, is that, you know, the government's attorney was arguing that the state has not shown that there will be women who are impacted. And that's just flat. That's just false. I mean we know that there are women who are going to be impacted because we know there are women who were getting coverage through the accommodation, and many of those entities had sued so that they could get exactly what they got from this administration.

Jennie: It seems kind of like the bottom line, like why all this fight if people aren't going to be impacted?

Mara: Exactly. Exactly. I mean they're, you know, they're really arguing out of two sides of their mouth. Right. And I think similarly, one of their justifications for the rule was that, oh, you know, people who need birth control can just get it through Medicaid or Title X family planning clinics that'll meet their need.

Jennie: But let's talk about that. We're trying to cut them, stop those programs.

Mara: Ignore the fact, ignore the man behind the curtain who is trying to gut Title X and radically change Medicaid for the future. Aside from the fact that you know, some folks who get employer coverage are not going to be eligible for Medicaid or Title X because of their income level. And those programs are not designed to absorb many, many people coming from employer sponsored insurance without using that insurance. Right. If you go to a Title X clinic, a family planning clinic, and you have employer sponsored insurance, they bill your insurance because they are just like any other doctor's office or health care provider. If you have insurance, they will make use of it. And it's, it ultimately highlights how little the folks who wrote these rules, actually know, one, about women's health, but also about how the public health safety networks in general. Um, they either don't know or they willfully ignored how it all works. Um, which is, neither is a good option for the folks who are in charge to have that.

Jennie: Yeah. And I think again, it just goes to show, you know, several years ago you would again hear people talking about, I mean, they're attacking abortion, but like birth control is fine. You guys are just overreacting. Like no one's going after birth control. And I think we've slowly started to really make that clear. That it's not just about abortion, it's attacking birth control and women's access to reproductive health care.

Mara: Yeah. I mean, neither is neither is okay. And they're coming for it all right. Like they are coming for it all. That is their goal and there is zero acknowledgement, not just about what birth control does for women's health and helping them prevent unintended, unintended pregnancy, but what being able to control your own fertility. And if you had children when you have those children, what that means for your life in general. Right? So finishing school, going for a promotion, deciding to go to graduate school, those kinds of things are all really intrinsically linked to women's ability to control their fertility. Right? It's, and it's just a totally different viewpoint when you think that women should just be having babies. I mean that ultimately that's, that's where we're at. Right? And I think most women will, no matter where they are on the political spectrum, understand that the ability to say, you know, even just to say our family is finished. We have the kids that we, we want, we have the kids we can afford. This is what we want our life to look like. That is really intrinsic to being able to say, you know, and this is where I'm going with everything in my life, right? My job, my, you know, how I, how I parent. All of these things are really deeply linked to birth control, and that's what's under attack. Not just our health, our economic lives, our participation in society. That's, that's what they're going for.

Jennie: So I know it's still early days since the new accommodation went into effect or accommodation exemption. So it's still early to see what kind of effect we're going to see. But what are we starting to see?

Mara: Yeah, I mean we, so at the law center, we for a long time have had a hotline called "cover her". It's, there's a website coverher.org and we have a lot of information about the birth control benefit there. And we have started to hear from people who are worried about what's going to happen to their birth control, because they know based on who their employer is, that it could go away, that their employer might take up the exemption. So that's what we're starting to hear. People who are concerned. I do think after January 1st, which is when a lot of people's health plan year start, right. I think we'll start hearing more and I think people will start seeing more. We typically, you know, on our hotline in the past have seen an uptick in, in people contacting us after January 1st because they have a new health plan year and the holidays are over and they can actually focus on things like their health insurance and, and I think we will start hearing from more, and we want to hear from people like we want to know what's actually happening on the ground. We have filed a lawsuit. You know, as I said, we filed a lawsuit in the Northern District of Indiana representing five women. Three of them are Notre Dame students. Um, one is someone who works at a university in Illinois and another is a woman who works at a church in Indiana. And um, you know, we are thinking about other strategies, ways to push back. But if, if you or someone you know is impacted by, by these rules, we want to hear, um. In part because the government doesn't actually, and this was true under the Obama administration as well, they don't actually know who the, all of the employers are that are using the exemption, right, accommodation. They don't have to tell the government, they don't have to fill out a form. There's no master list that you like when you're job searching can look at and say, oh, would this new employer not cover my birth control? There's no, no check on that. And so we want to know where it's happening. We want to know what's going on and help women fight back.

Jennie: So now that everybody is so educated on everything that's going on around the birth control benefit.

Mara: And depressed.

Jennie: Yeah. Sorry. I feel like that's going to be the story of this show, in general is not a lot of happy topics. Yeah. But that's, it's important topics. So what can people do, what can people do to get involved on these issues?

Mara: Yeah. So I would say, you know, figuring out what's going on with your own health insurance. If you have problems and definitely get in touch with us, you know, coverher.org as the best way to do that. One. Two, let your member of Congress know that this is not okay. They have, you know, conversations with the departments and they, it's important even if you think your member of Congress completely disagrees with you on this, it's important for them to hear where you stand so that when when stuff is coming through their office and they're hearing from other organizations, they know that it's not just the people who think entities should be able to get out of this. That there are women who are their constituents who are concerned about their coverage. I think we are going to see over the next couple of months a number of states taking actions protect birth control coverage, um, through state law. And it's incredibly exciting to see that. Um, there hasn't been a ton, I would say until the last year or two around birth control laws in the state. Um, because there just hadn't been. It's great to see these states doing things like codifying the ACA benefit and saying, you know, insurance that's regulated by the state has to cover birth control without out-of-pocket costs. They have to cover all the methods, you know, doing a lot of what the ACA did. The only drawback there is that a lot of people in employer sponsored insurance coverage, their insurance is not necessarily regulated by the state. It's around 60% of people in employer sponsored coverage. So the state laws aren't going to reach everyone.

Mara: But it's important to, to, to stand up, to fight back, to show up when there are, um, conversations about birth control and to, to push back against this idea that we're seeing here. This is in the realm of women's health and, and it's another attack on women's health, but it is the same thing as where we see religion being used to discriminate in other areas. Right? So it is not that far a field from saying you don't have to bake a cake for a gay couple because it's against your religion, right. It violates your religion, it's not that far a field from saying you are a clerk and you don't have to issue marriage licenses. You are a counselor, and you don't have to counsel LGBTQ Youth. You know, birth control. This, this is sort of, if there was a ven diagram, it's like the overlap of women, the attack on women's health and religion being used to discriminate like this is right in the middle there. Um, so we know what happens in these cases, um, that we are bringing and the result of the Zubik cases, it's not isolated just to birth control and women's health. This is, these are the themes of this, of this administration. Some of the themes, right? Attacking Women's health, attacking women's rights, elevating quote unquote religious freedom above everything else. And using religion to discriminate. And this is not new, right? We've, we in the birth control and reproductive rights world have been seeing this for years, but the same religious arguments were used back in the 60s and the 50s to say it's okay to discriminate against people of color. I mean, this is not new. They're recycling old ideas, but they are in charge and so we need to push back as much as we can.

Jennie: Well, thank you, Mara. Thank you for being here. Um, for more information, you can definitely check out our show notes, which will have links to all of the things you need. Um, and thanks for stopping by.

Mara: Thanks so much. This was really fun.

Jennie: For more information, including show notes from this episode and previous episodes, please visit our website reprosfightback.com. You can also find us on Facebook and Twitter at rePROs Fight Back. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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