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The Trump administration will ask a federal appeals court today to reinstate rules that would allow virtually any employer and university to stop covering birth control in their insurance plans for employees or students—all they would have to do is claim a religious or moral objection to contraception.
This fight dates back to 2017, when the first Trump administration sought to gut the Affordable Care Act’s contraceptive coverage requirement. The landmark law required insurers to cover Food and Drug Administration-approved methods of birth control for women without cost-sharing, like copays. While the mandate always had exemptions for religious nonprofits like churches, the Trump administration issued a set of rules that dramatically expanded the carveouts by allowing businesses and universities to drop the coverage for ideological reasons as well. This meant employers could exclude birth control from insurance coverage entirely.
Cost can be a huge barrier to accessing birth control: The most effective methods, like intrauterine devices (IUDs), can cost well over $1,000. A recent Guttmacher Institute survey found that 31 percent of women who weren’t using contraception said they would if cost weren’t an issue, while 13 percent of contraceptive users said they would use a different method if cost wasn’t a barrier.
While the Biden administration started the process to roll back the rules in 2023, it ultimately abandoned the effort and the Trump rules remained on the books. A federal judge in Pennsylvania struck down the rules last summer, but the Justice Department is now asking the court to reinstate the sweeping insurance exceptions.
If the administration is successful, the changes would come at a time when it is attacking other birth control programs and spreading misinformation about contraception. Plus, new work requirements for Medicaid could leave millions more people without health insurance. Nearly two dozen states ban abortion early in pregnancy thanks to the votes of Trump’s Supreme Court appointees, and the administration may soon make it harder to access the abortion drug mifepristone. The White House is putting up barriers to prevent and end unwanted pregnancies.
The birth control litigation hasn’t gotten much attention amid the chaos of the second Trump administration, said Michelle Banker, senior director of litigation for reproductive rights and health at the National Women's Law Center. A decision in favor of the Trump administration “would allow virtually any employer or university to unilaterally, without notice, opt out of providing this essential benefit,” Banker told Autonomy News.
NWLC submitted an amicus brief in the case on behalf of more than 60 religious and civil rights organizations urging the Third Circuit Court of Appeals to keep the rules blocked.
“This is a really important case,” she said, “that has flown under the radar.”
How we got here
The first Trump administration moved to expand the birth control carveouts in October 2017, just months after Congressional Republicans failed to repeal the Affordable Care Act. The Departments of Health and Human Services, Labor, and the Treasury issued what are known as interim final rules: one to allow religious objections, and one for moral objections. Any employer could apply for an exemption, even publicly traded corporations.
Pennsylvania sued the Trump administration days later, arguing that the rules violated, among other laws, the Administrative Procedure Act (APA), which governs the federal rulemaking process. They also argued the broad exemptions would lead to increased state healthcare costs. New Jersey joined the case in 2018 after the administration issued final rules with minor revisions that didn’t change their substance. (A coalition of 13 states led by California also sued separately, and that case is ongoing in district court.)
The lawsuit has bounced around the courts for so long that it is now called Pennsylvania v. President of the United States, rather than naming the president in office at the moment. It even ended up at the Supreme Court in 2020, after an order of Catholic nuns that runs nursing homes intervened in the case to defend the religious exception. In Little Sisters of the Poor v. Pennsylvania, the high court said the Trump administration had the authority to make the rules, and sent the case back to the district court to dissolve a 2019 nationwide injunction blocking their enforcement, and continue litigation. The case was on hold for the duration of the Biden presidency, at its request.
“This is a really important case...that has flown under the radar.”
In early 2023, the Biden administration proposed new rules to eliminate the vague moral exemption and create a workaround policy for people whose employers had religious objections. But the administration withdrew its proposals at the end of 2024, weeks before Trump would return to office. Public health lawyer Matthew Cortland wrote on social media at the time that multi-agency rulemaking is “particularly complicated” and it was possible Biden administration lawyers were trying to prevent a scenario where right-wing plaintiffs challenged the rules and the Trump Justice Department refused to defend them, leading to a loss in federal court. That would make it harder for a future Democratic administration to repeal the rules.
No matter the reason, Trump was sworn in with the rules still on the books. Then in August 2025, Wendy Beetlestone, chief judge of the Eastern District of Pennsylvania, struck them down, writing in her opinion that the government didn’t follow the Administrative Procedure Act when it put the rules in place. The Trump administration appealed that ruling, which brings us to today’s hearing at the Third Circuit.
The three judges who will hear the case were nominated by Presidents Joe Biden, Barack Obama, and George H.W. Bush; they could rule at any time after the hearing. Should that panel side with Pennsylvania, the Trump administration could appeal for review before the full Third Circuit—which includes Trump’s former personal lawyer Emil Bove—or go directly to the Supreme Court. If the Third Circuit were to side with Trump, the rules would snap back into effect immediately, and Pennsylvania would likely appeal to the high court.
The NWLC appeals court brief argues that the federal agencies acted arbitrarily by not accounting for the harm the rules would cause to people who rely on their insurance to get birth control without cost-sharing. “The agency has to consider all of the relevant factors, including the costs of the risks and benefits and the potential harms,” Banker said. “They just completely fail to consider the impact on women and other people capable of pregnancy—particularly folks who may not be able to overcome financial barriers to contraception.”
Banker recalled paying $40 per month for birth control prior to the Affordable Care Act. “With inflation, the economy, costs are rising, and people are struggling to make ends meet,” she said. “This is often a cost that people cannot absorb.”
A coalition of 11 medical groups, including the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians, argued in another brief that the Trump administration’s solution for people who lose birth control coverage was merely “suggesting that they might avail themselves of other governmental programs or obtain contraceptive coverage elsewhere.”
But the White House is actively targeting the avenues that help people get low- or no-cost birth control, Banker said. It froze grants in the Title X family planning program, then announced that it would shift the focus from contraception to childbearing. It halted the majority of grants in the Teen Pregnancy Prevention Program, whose grantees provide information about contraception. Plus, the one-year “defunding” of large abortion providers led to the closure of nearly 30 Planned Parenthood clinics, and the end of a primary care practice in Maine.
And Trump could make it even harder to access birth control and abortion in the months ahead.
Conflating birth control and abortion
Project 2025 proposed even more changes to the ACA’s birth control benefit, like excluding from the coverage mandate one form of emergency contraception, ulipristal acetate, known under the brand name Ella. The FDA may also enact another Project 2025 priority by halting telemedicine prescriptions of the abortion medication mifepristone. The agency is under pressure from anti-abortion groups and GOP lawmakers to do this following its own politicized “review” of mifepristone’s safety, but it could also be ordered to do so by a federal judge in one of several ongoing lawsuits.
“There are many ways in which the administration continues to try to chip away at access to abortion, at access to birth control,” Banker said. “The fact that the administration continues to push forward these rules is just another sign of that.”
While Trump has attempted to recast himself as a moderate on abortion and other reproductive health policies in his second term, his administration’s actions say otherwise. In addition to the financial destruction of safety net programs like Title X and Medicaid, administration officials have repeatedly made dangerous comments to lawmakers, federal courts, and the press, sowing doubt about the safety of common birth control methods, conflating abortion and contraception, and questioning the actions of Biden’s FDA.
The Trump administration has been sowing doubt about the safety of birth control, conflating abortion and contraception, and questioning the actions of Biden’s FDA.
Conservatives have long claimed—falsely—that certain contraceptives, especially IUDs and other emergency contraceptives like Plan B and Ella, are “abortifacients.” In fact, this argument was a major feature of early opposition to the ACA’s contraceptive coverage mandate. The first Trump administration bolstered these claims in litigation over its contraceptive coverage rules: Trump’s DOJ refused to say that certain forms of birth control do not cause abortions, and said the federal agencies no longer “take a position” on the matter.
Beetlestone took the administration to task for this shift in her opinion, writing, “Although the Agencies purportedly did ‘not take a position on the scientific, religious, or moral debate on’ whether some kinds of contraception are abortifacients, the Agencies indeed had previously taken the opposite view.” In other words, federal agencies explicitly did not consider contraceptives abortifacients prior to Trump’s first term.
Alarmingly, to justify the administration’s attempt to destroy nearly $10 million in birth control that had been intended for U.S. aid programs in Africa, a spokesperson for the now-defunct United States Agency for International Development used the phrase “abortifacient birth control” to refer to a wide range of birth control methods—not just emergency contraception—in September.
These anti-science comments mirror actions by the current DOJ that undermine government science on mifepristone.
In September 2025, Health Secretary Robert F. Kennedy, Jr. and then-FDA Commissioner Marty Makary wrote a letter to Republican Attorneys General in which they said the FDA’s “review” of mifepristone’s safety is “informed by the lack of adequate consideration” underlying prior changes to restrictions on the drug. That includes the 2021 change, formalized in 2023, which allowed the medication to be prescribed via telehealth.
Louisiana cited that letter in its lawsuit against the FDA, filed late last year, which seeks to require in-person appointments for mifepristone. Justice Department lawyers repeated these statements earlier this year, and in May, the Fifth Circuit Court of Appeals cited the letter to justify its attempt to end telemedicine prescriptions of mifepristone. The Supreme Court paused the Fifth Circuit’s ruling until litigation concludes. The next hearing is in early September.
“They're not done with reproductive rights,” Banker said. “The idea that the administration is moderate or not pushing an extreme agenda on reproductive rights is absolutely wrong.”
This story was edited by Garnet Henderson and copy edited and fact checked by Hannah McAlilly.
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