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President-elect Joe Biden is poised to roll back several of the Trump administration's most restrictive sexual and reproductive health policies, including limits on abortion.
Reproductive rights advocates expect Biden to quickly overturn Trump-era rules, like banning federal funds for foreign and national health organizations that promote and provide abortion and giving employers more freedom to deny free contraceptive coverage for their workers.
"We have a ton of work to do to undo the harm over the last four years, but knowing we have champions there who understand what needs to happen in the first 100 days is tremendously exciting," said Alexis McGill Johnson, president and CEO of Planned Parenthood.
Abortion rights opponents are concerned about the new administration and warn that they will continue to push back.
"It's certainly disheartening, but we aren't going to give up, and we will do whatever we can to stop abortion from being promoted," said Carol Tobias, president of the National Right to Life Committee, who said she expects a wave of abortion restrictions at the state level this year.
Biden is a devout Roman Catholic, and his position on abortion has evolved throughout his career. Most recently, in 2019, he dropped his long-standing support of the Hyde Amendment, a decades-old policy restricting federal funding for abortions, after having faced mounting criticism. He has also vowed to codify Roe v. Wade and to fight state-level policies limiting access to abortion.
Here are some of the ways Biden has indicated he will restore and improve access to reproductive care:
The Mexico City Policy
The Reagan administration implemented the Mexico City Policy, which barred foreign organizations that receive U.S. family planning assistance from providing information, referrals or services for abortions. Since then, it has been rescinded by Democratic presidents and then restored by Republicans.
When President Donald Trump reinstated the policy, he also expanded it by applying the restrictions to nearly all federal global health assistance. Trump's hard-line stance on abortion forced organizations that treat HIV, malaria, tuberculosis and other infectious diseases to comply or lose funding.
"The Trump administration launched a wholesale assault on sexual and reproductive health across the world by buying up providers and limiting the services that they can offer to women," said Jonathan Rucks, senior director of policy and advocacy at PAI, an international reproductive health and rights organization.
Trump's move led to reduced access to abortion care, along with contraception, HIV testing and treatment and cancer screening in Kenya, Nepal, Nigeria and South Africa, according to a 2019 study.
While Biden pledged to quash the Mexico City Policy, abortion rights advocates are calling on Congress to pass the Global HER Act, which would permanently prohibit the rule.
The Title X program
The Title X program, which was established 50 years ago, helps fill in gaps in health care access and affordability by providing family planning assistance to clinics serving low-income and uninsured people in the U.S. Specifically, it offers grants to providers that fund services like contraception, pregnancy tests and STD screenings. However, it has never funded abortion care.
In 2019, the Trump administration blocked clinics in the program from referring people to abortion providers or performing abortion procedures with other funds. Consequently, the number of clinics and patients served by the program dropped dramatically. A quarter of Title X sub-recipients and sites left the network, including independent clinics and Planned Parenthood. Planned Parenthood health centers served 40 percent of all Title X patients before it withdrew from the program, according to the organization.
"It's not like there is a lot of money out there for providing services for family planning, and anything that restricts funding and support has the impact of reducing access," said Alina Salganicoff, senior vice president and director of women's health policy at the Kaiser Family Foundation.
As a result of the mass exodus of providers from the program, the Office of Population Affairs, the federal agency that operates the program, reported that the number of people served by the Title X program in 2019 was 21 percent lower than in 2018.
Biden is expected to dial back the Trump administration rule and "restore federal funding for Planned Parenthood."
The contraceptive coverage mandate
The contraceptive coverage mandate of the Affordable Care Act required most private insurance plans to cover birth control without copayments; the requirement increased access to contraception and made it affordable for millions.
Most women will use birth control at some point, and 86 percent have used three or more methods by their early 40s, according to the Guttmacher Institute, a pro-abortion rights research institute.
However, Trump rolled back the reach of the contraception mandate, allowing any employer with a religious or moral objection to birth control to be exempt from the requirement. Last summer, the Supreme Court upheld the exemptions in the case Little Sisters of the Poor v. Pennsylvania.
"Although everyone has a right to their religious beliefs, those beliefs should never be used to discriminate against others, including by taking away their health insurance coverage. No one should be denied birth control coverage because of where they work or where they go to school," said Georgeanne Usova, senior legislative counsel at the American Civil Liberties Union.
Biden said he would restore the Obama-era policy, which exempts only houses of worship but provides an accommodation for other objecting employers, which allows their employees and dependents access to contraceptive coverage through their insurance companies or third-party administrators.
The Hyde Amendment
For decades, the Hyde Amendment has prohibited federal programs from paying for abortions, except in the case of rape or incest or to save the life of the woman. While the amendment originally applied only to Medicaid recipients, most of whom are part of communities of color or are categorized as low-income, Congress extended it to apply to federal employees and their dependents, military personnel, the Indian Health Service, Peace Corps volunteers and residents of Washington, D.C.
"The Hyde Amendment is an attack on low-income families and an attempt to take away the promise of Roe v. Wade. For many, abortion care has been a right only in name and not in practice, because if you can't actually afford it, the legal right is moot," said Kelsey Ryland, co-director of the All* Above All abortion coverage campaign.
Those covered by Medicaid in 34 states and D.C. have minimal abortion coverage because of the Hyde Amendment, according to the Kaiser Family Foundation. In that case, the cost of an abortion is often a significant financial barrier. On average, the cost of an abortion procedure is about $500; nearly 40 percent of Americans can't cover an unexpected $400 expense. Meanwhile, 16 states use their own funds to pay for abortions for those insured by Medicaid, including California, Illinois and New Mexico.
Since 1976, the amendment, which isn't a permanent statute and doesn't require a repeal, has been added every year to legislation passed by Congress to fund the federal government. Biden has vowed to end the policy, which he once supported, but it would require congressional action to eliminate it.
"The work that we all need to be doing right now is making sure that we are expanding access to health care, not finding ways to limit it," said McGill Johnson of Planned Parenthood.