The Trump administration put in place a new rule Friday that allows employers to deny insurance coverage of birth control under the Affordable Care Act if that employer has a religious or moral objection to providing that coverage.

The new U.S. Department of Health and Human Services rule, which takes effect immediately, lifts a requirement under ACA that employers provide free birth control coverage, and pits employers' religious freedom and morality against women's reproductive rights for a second time in three years.

The change could affect as many as 1.9 million women in Michigan who now have access to birth control with no co-pay, and 55 million nationally, according to Planned Parenthood Advocates of Michigan.

"Religious liberty is not merely a right to personal religious beliefs or even to worship in a sacred place. It also encompasses religious observance and practice," U.S. Attorney General Jeff Sessions wrote in a memorandum to the executive branch offices offering guidance on the move. "Except in the narrowest of circumstances, no one should be forced to choose between living out his or her faith and complying with the law."

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Employers who choose to exercise the rule must notify workers of which types of birth control will no longer be covered using the religious or moral exemption.

The rule, which is to be published in the federal register Oct. 13, already faces legal challenges from the American Civil Liberties Union, the National Women's Law Center and the Planned Parenthood Federation of America.

“The Trump administration just took direct aim at birth control coverage for 62 million women," said Cecile Richards, president of Planned Parenthood. "This is an unacceptable attack on basic health care that the vast majority of women rely on. With this rule in place, any employer could decide that their employees no longer have health insurance coverage for birth control.

"We’re talking about a fundamental right — to be able to decide whether and when you want to have children."

But for Mary Jo Thayer, 57, of Grand Rapids, the new rule does not take away women's access to birth control. Rather, she said, it removed the government mandate to cover that birth control.

"What it didn't do was take away birth control for anyone," said Thayer, a retired schoolteacher. "Everybody can still get birth control. At any doctor's office, they can go in and get their birth control. I just don't think the government should pay for it or force people to cover something that maybe their organization doesn't believe in or doesn't need.

"That is strong-arming and forcing citizens to do something they don't need and they don't want and it's against their conscience. That's not the government's role. The government's role is to protect citizens."

Jen Anderson, a 33-year-old communications specialist from Holt, Mich., disagreed, saying that especially for low-income women, it absolutely is a barrier to access.

"I frankly kind of think it's terrifying," she said. "It is a way to control people who need reproductive care. There's no actual good reason to roll this back. And there's no good reason why your employer should even be able to control whether or not you have access to the care you need."

Anderson gets Depo-Provera injections, which she uses for birth control as well as to treat migraine headaches and to keep ovarian cysts in check. If she had to pay for that on her own, it would cost $560 a year.

"If I had to pay that out of pocket, it would be a significant hardship," she said. "I'm lucky because I work for an organization that values health care and values primary care. And it's not something that I have to worry about but there are plenty of other working women who need birth control who don't have the same luxury I do in making that kind of choice."

U.S. Rep. Brenda Lawrence, D-Southfield, also railed against the move Friday, saying in a statement: "The president's proposed rule allows virtually anyone, including bosses, health plans and schools to discriminate against women by refusing to cover birth control."

The move goes a step beyond the 2014 U.S. Supreme Court Hobby Lobby decision that found that privately owned, closely-held for-profit corporations do not have to provide insurance coverage under the Affordable Care Act for two specific kinds of contraception — the IUD and the morning after pill — for religious reasons.

Hobby Lobby and Conestoga Wood, a Pennsylvania cabinet-making company, sued the government and won, saying that forced coverage of emergency contraception like the morning-after pill and the IUD goes against their religious principles.

Mary Herbelet, 57, of Portland, Mich., commended the new birth control rule.

"You shouldn't impose on somebody's moral beliefs," she said. "I think it's the root of who we are. Our moral conscience and beliefs guide everything we do. We want to be open to everyone and be inclusive, but there's a line that we really shouldn't cross."

Women who want birth control that isn't covered by insurance, she said, "can go to Planned Parenthood and buy your own."

But for some women, even paying a $6 copay for birth control is more than they can afford, said Fatima Goss Graves, president and CEO of the National Women’s Law Center.

"The upfront cost of an IUD, one of the most effective forms of birth control, can be close to $1,000. ... It's not just the IUD costs. We know that prior to the ACA, copays as low as $6 kept women from getting the care they needed."

Concerns about President Donald Trump and Vice President Mike Pence, who enacted several reproductive rights rollbacks when he was governor of Indiana, led Barbara Twist, 27, to take proactive steps to take control of her fertility.

Before she moved from Ann Arbor to New York City earlier this year, and before changes to contraceptive coverage could take effect, she had a 10-year IUD implanted.

"I have been expecting this since Trump took office," she said. "I figured that would come to pass. ... Of course, it feels like this isn't about religious right or protection of religion. This isn't even about making America great again. This is about controlling women.

"If men got periods, this wouldn't be an issue. If men got pregnant, this wouldn't be an issue. ... We can cover your Viagra or we can cover your vasectomies but we can't cover your birth control or your abortions."

California Attorney General Xavier Becerra, who also plans to sue the government in federal court over this rule, said Friday: "It's pretty simple. Women's rights are being fundamentally abridged, everybody has their right to practice religion, but you don't have the right to practice it on somebody else.

"Fifty-five million women have saved something in the order of $1.4 billion. That's progress, and that's under attack by the Trump administration. They're moving us backward, not forward."

Genevieve Marnon, public affairs associate for Right to Life of Michigan, said the organization lauded the new birth control rule for including moral objections to providing birth control coverage.

"We're happy about it because we do have a moral framework that highlights what we do," she said. "We are always happy when we see religious liberties expanded. Even though we are not a religious organization, we have a moral base that enlightens our thinking ... This ... underscores that you can be moral without being religious per se."

Monica Migliorino Miller, director of Citizens for a Pro-life Society, based in South Lyon, said the Trump administration's birth control rule is a step in the right direction.

"I am in favor of what Trump did," she said.

"We believe that the issue is a religious liberty issue and that the Obama administration and the HHS overreached their authority in terms of forcing the coverage ... to mandate that they do something contrary to their conscious."

Contact Kristen Jordan Shamus: 313-222-5997 or kshamus@freepress.com. Follow her on Twitter @kristenshamus.

How to be heard

The public can express their views on the new birth control coverage rule until Dec. 5 by writing to: Centers for Medicare and Medicaid Services, Department of Health and Human Services, Attn: CMS-9925-IFC, P.O. Box 8016, Baltimore, MD 21244-8016.

Online comments can be made at: www.regulations.gov and following the "submit a comment" instructions.

To read the new rule in its entirity, go to: https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-21852.pdf