In October 2017, the Trump administration announced additional exemptions to protect those with religious objections to the distribution of contraception. These have been the subject of ongoing legal challenges.
Judge Wendy Beetlestone of the Federal District Court in Philadelphia issued a preliminary injunction against the Trump administration's initial rules Dec. 15, 2017, saying Pennsylvania could suffer "serious and irreparable harm" from the rules because a lack of cost-effective contraception would mean "individual choices which will result in an increase in unintended pregnancies" burdening the state.
Shortly after Beetlestone's ruling, Judge Haywood Gilliam Jr. of the Federal District Court in Oakland also blocked the Trump administration's rules, saying they would "transform contraceptive coverage from a legal entitlement to an essentially gratuitous benefit wholly subject to their employer's discretion."
Both of these cases were appealed by the administration and remain pending.
In April, 2018, District Court Judge David Russell issued a permanent injunction and declaratory relief against the mandate for members of the Catholic Benefits Association.
Russell also ruled that the mandate violates the Religious Freedom Restoration Act by attempting to force employers to provide contraception and sterilization in violation of their sincerely held religious beliefs.
The updated exemptions, released Wednesday, will not include publicly-traded businesses. Employers that still wish to cover contraceptives as part of their insurance plan remain free to do so.
In addition to the exemption, employers and other affected bodies can still choose to arrange for a third-party accommodation, which would provide contraceptive coverage to its employees and their dependents either through independent action by their insurer or insurance administrator.
A press release for HHS also confirmed that government programs providing contraception either for free or at a lower cost to low-income women will not be impacted by these new rules.
In addition to these two rules, the Centers for Medicare and Medicaid Services issued a proposed rule concerning eligibility for premium subsidies through the Affordable Care Act Exchange.
This rule, titled "Patient Protection and Affordable Care Act (PPACA): Exchange Program Integrity," looks to ensure that patients are eligible for these subsidies. It also proposes that issuers bill patients abortion services separately from other medical services.