The U.S. Supreme Court this summer upheld a policy change by the Trump administration that permits employers to deny birth control coverage through their health insurance plans if they object on religious or moral grounds.

The Court voted 7 to 2, with liberal justices Elena Kagan and Stephen Breyer siding with the court's conservative majority. The case, which overturned a federal appeals court injunction preventing implementation of the Trump administration rules, has now been sent back to the lower court, where additional challenges could be considered.

The mandate for employers to provide cost-free contraceptive coverage in employee insurance plans was made part of the Affordable Care Act by the Obama administration. Houses of worship were exempt from the mandate but institutions, such as religiously affiliated universities, schools, hospitals, and other nonprofits, were not. Pending the lower court's action, these employers may soon be able to claim exemptions.

It is unclear how many companies would do so. But because so many women receive health coverage through their employers, the Trump administration rules could potentially affect thousands of people. About 3% of religiously affiliated nonprofits already use a compromise workaround in which employees receive contraceptive coverage directly from the health insurer, without financial or administrative arrangements by the employer.

According to the Guttmacher Institute, nearly all U.S. women use birth control during their lifetime, and 86% have used at least three different methods by their early 40s. No-cost contraceptive coverage through employment, moreover, enables women to use the birth control of their choice, receive consistent reproductive health care, and manage both childbearing and their economic futures. A Commonwealth Fund report similarly found that access to birth control can "lift women out of poverty."

Cost is the biggest barrier to contraceptive use, and many of the more effective methods have significant up-front costs, according to the Guttmacher Institute. The new policy would reduce contraceptive choices for many women. Low-income women, in particular, might have to fall back on less effective, lower-cost methods or possibly forgo contraception.-Joan Zolot, PA