Update: On March 21, 2012, the Department of Health and Human Services released the final student health insurance regulation, which added a provision to the final rule that was not in the proposed version. As with employers, if religiously affiliated universities are not currently covering contraception in their student plans and object to contraception on religious grounds, they may self-certify that they qualify for a one-year waiver to delay contraceptive coverage until August 1, 2013 and then take advantage of an accommodation in which the insurer provides the contraceptive coverage to students directly. Students at such institutions have already begun pushing their universities to forgo the waiver and accommodation and to provide contraceptive coverage themselves this coming August.
This article contains a correction.
The Obama administration announced on Friday that, after reviewing countless public comments and enduring massive political pressure, the Health and Human Services Department will maintain a narrow exemption for religious employers in a regulation requiring coverage of contraception with no cost-sharing in most health plans. As reproductive health advocates cheer this decision, one often-overlooked population should be cheering especially loudly: students who obtain their health insurance through the universities they attend.
The realm of student health insurance is a legal abyss when it comes to regulation—that is, until the Affordable Care Act. Before 2011, virtually no law regulated the coverage, benefits, premiums, or cost-sharing in plans run by universities and offered to students. Yet most universities require that their students be covered by some form of insurance, and out of convenience, most students enroll in their own university’s plan while they’re in school. As a result, students are left at the mercy of their university administrators when it comes to deciding how much they will pay for their university-sponsored insurance and which benefits they will receive in return. Generally, none of the protections in the federal laws regulating employer-based insurance apply to universities with respect to their students.
One unfortunate result of this unregulated environment is that many religiously affiliated universities deny their students contraceptive coverage. Schools such as Georgetown* negotiate contracts with health insurers that purposely exclude coverage of benefits that they deem in conflict with the Vatican’s teachings—benefits including infertility treatments, abortion care, and contraception. These policies apply equally to undergraduate and graduate students alike—regardless of whether they are 18, 28, or 38 years old, married or single, childless or parenting. Ironically, these policies do nothing to reduce premarital sex, and instead increase the rates of unintended pregnancy and abortion.
In some cases, this coverage is provided to faculty and staff, either because some of these schools are located in states with contraceptive coverage mandates for employees or because they perceive their faculty to have more leverage and bargaining power.
Research by Georgetown Law Students for Reproductive Justice, Fordham Law Students for Reproductive Justice, Advocates for Youth, and others demonstrates that students need contraceptive coverage as a basic matter of preventive health, whether they attend a religiously affiliated university or not. Indeed, many advocates on and off campus argue that the actual religious freedom question is not whether a Catholic institution has conscience rights that trump student needs, but whether universities will be required to respect students’ conscience rights to control their fertility and plan their families. This tension will now be resolved in favor of students with the implementation of the Affordable Care Act.
Two regulations are at play here. First, the Affordable Care Act requires nongrandfathered health insurance plans to cover preventive services, including services for women, with no cost-sharing, such as deductibles or co-pays. Under the preventive care regulation, contraception is included in the list of health benefits that must be covered by most employers. Only employers whose purpose is to inculcate religious values and who primarily employ and serve persons of the same faith are exempted—mostly houses of worship. Religiously affiliated nonprofits, such as universities, hospitals, and charities, that engage in primarily secular activities and serve the general public may apply for a year of transitional relief in order to comply with the rule if they are not already covering contraception in their employee health plans.
The good news is that the preventive services regulation reaches students, but the religious exemption does not. The Department of Health and Human Services is currently finalizing a separate regulation that for the first time will regulate student health plans that are not self-insured by equating them with individual health plans. In other words, whatever benefits are afforded to consumers of health insurance under the Affordable Care Act will finally be enjoyed by students, too. And thanks to the recently announced preventive care regulation, one of those benefits will be contraceptive coverage. But because the religious exemption only applies to institutions in their role as employers, there is no grace period for student plans.
This is a major victory for the reproductive health of students enrolled at religiously affiliated universities that currently deny this coverage. Students often enroll at these universities without any knowledge of this gap in their health insurance, and they find themselves without the preventive care they need at a time when their income is low, their debt is growing, and their stress levels are high. While some students choose to have children while in school, most feel that it is not the optimal time to start or add to a family. Students need affordable contraception as much as other young adults do, and starting this August, they will have it with no cost-sharing, regardless of whether their university has a religious affiliation.
Of course, no hard-won fight for reproductive rights is ever fully resolved. The U.S. Conference of Catholic Bishops has promised to sue the Department of Health and Human Services to avoid complying with this regulation, despite the exemption that applies to houses of worship and certain nonprofit institutions. But this challenge will likely fail because the exemption is modeled after those in contraceptive equity statutes that survived high-level litigation from cases arising in New York and California.
That said, the political forecast for 2012 and beyond holds grim news for reproductive rights and health, should an antichoice majority overtake the executive and legislative branches. Students should therefore remain vigilant and monitor their universities to ensure they are receiving the health benefits they deserve.
But no matter what happens in the future, Friday’s announcement gave young people a reason to thank the Obama administration for protecting the consciences of people over institutions and for asserting that family planning is preventive care regardless of where you work or study.
Lucy Panza is a Policy Analyst with the Women’s Health and Rights Program at the Center for American Progress.
*This article originally stated that Fordham University does not cover birth control. It does, in fact, cover contraceptives due to a New York state mandate that requires it, but it does not write prescriptions for birth control, which increases the students’ costs.