Vermont health care officials say it is not known how many people in the state may be impacted by a recent U.S. Supreme Court decision that allows employers to opt out of covering birth control.
In a 7-2 decision issued Wednesday, the court upheld a regulation from the Trump administration that allows employers with religious or moral objections to refuse to cover birth control and other contraceptive measures under their health insurance policies.Â
Almost half of insured Vermonters are not impacted by the ruling. That’s because a 2016 law requires health insurers to fully cover contraception costs.Â
The state statute, however, does not protect employees who work for Vermont companies that self-insure, providing in-house plans for workers’ health care rather than going through an insurer.Â
While some Vermonters who get insurance through employers that self-insure could potentially see contraceptive coverage change, state officials say the number of people who will be impacted depends on whether eligible companies and organizations choose to change their policies in light of the new federal rule.
The U.S. Department of Health and Human Services initially estimated in 2017, when Trump rolled out the rule, that a little more than 120,000 people nationwide will be impacted.
A spokesperson for the agency explained the metrics for that estimate.Â
“The exemptions only apply to certain entities that have religious or moral objections to the coverage, not to all plans or all self-funded plans, so the estimate was based on a number of considerations including (1) how many employers would take advantage of the exemptions, (2) how many women of childbearing age might be covered by such plans, and (3) how many of those plans were exempt or not covered by the previous regulations,” according to the HHS.
According to the Green Mountain Care Board’s 2018 annual report, which is the most recently available data, on the commercial insurance market, 259,934 people are “self-insured.” Meanwhile, 133,554 are insured through major medical insurance.
Commissioner of the Department of Financial Regulation Michael Pieciak said the scale of the impact of the decision on Vermont is unknown. Pieciak said just because the state has a self-insured population of more than 200,000 doesn’t mean all of those people will lose their contraceptive coverage.Â
“That’s who is on a self-funded plan,” he said. “But you know, who’s affirmatively going to make that change and say that they have a religious or moral obligation is obviously gonna be much smaller than that if any at all in Vermont.”
Pieciak emphasized that it is “unlikely” companies or religiously affiliated organizations in Vermont would pull back from covering birth control.Â
“By no means could we say it’s not going to impact anybody — I mean it certainly has the ability to impact women in Vermont,” Pieciak said. “We just don’t know. We just don’t have a good estimate of how significant [of an impact] that might be.”
Lucy Leriche, Planned Parenthood of Northern New England’s VP of Vermont Public Affairs said regardless of the impact, the ruling is “terrible.”
“I think it’s a huge step backward and it creates a kind of caste in our society,” she said. “It creates a whole other class of people: those who can get contraception, have access to it through their employer, and those who can’t.”
Birth control is an economic issue that impacts a woman’s right to choose the course of her life, Leriche said.Â
“If you can’t control your reproduction, you cannot control your life, you cannot control your life decisions,” Leriche said. “You cannot choose when to go to school, when to pursue a career or when to have a family. That all happens out of your control. And essentially that takes that control away from anyone who has a uterus.”
Mary Beerworth, the executive director of the Vermont Right to Life Committee said in a statement to VTDigger that the group doesn’t take a position on “true contraception,” but views the ruling as important.
“However, pro-lifers do support conscience protection in order to shield ourselves and our tax-payer dollars from any direct or indirect involvement in abortion — so for us, the ruling by the US Supreme Court is an important one,” Beerworth said. “Please note that the decision was 7-2 — with two liberal judges basically concurring with the majority in a separate opinion, while only two judges dissented.”Â
Beerworth said the state of Vermont gave $1.4 million in taxpayer money to family planning services this past year.Â
“Planned Parenthood’s objection to the court’s decision may have more to do with the fact that the organization promotes taxpayer funding of all abortions,” she said.Â
Leriche said Planned Parenthood will continue to support women who need access to contraception, regardless of the ability to pay.Â
Robin Lunge, a member of the Green Mountain Care Board, said the ruling is a setback for women’s access to contraception, especially as there has been a decline in the insured population in Vermont as more companies move to the self-insured model.
“That does mean that there could be a bigger impact on Vermont,” she said. “It’s hard to judge the true impact because it’s an employer by employer decision.”
Lunge said in a recent presentation to the board it appears the number of self-insured lives in Vermont recently dropped from 259,934 to 208,439 people.Â
Lunge said she’s hopeful the impact will be minimal.
“There was a study a couple of years ago that came out showing that Vermont was one of the states that tend to be more agnostic. I think you could look at that as one way to take that 250,000 potential impact number,” she said. “And think about realistically, how many employers would actually make that choice. I would hope that most employers would continue their coverage and provide women this access.”