How a Trump Win Would Threaten Access to Birth Control and Emergency Contraception

Donald Trump has long criticized the Affordable Care Act; he ran and won the presidency in 2016 on a promise to “terminate” Democrats’ signature health care law. But after he won, he and the GOP-controlled Congress repeatedly failed to repeal the legislation, as promised. More recently, Trump has declared on Truth Social he is still committed to ending the law, and “seriously looking at alternatives,” adding “we should never give up!”

Today, some 45 million Americans access coverage under the ACA. Even more women — 62.4 million, according to an estimate by the National Women’s Law Center — access birth control for free because of the law’s contraceptive mandate. Before the ACA, birth control made up between 30 and 44 percent of women’s out-of-pocket health care costs, according to a KFF analysis. After the legislation took effect, the cost of contraception of all kinds fell dramatically — including IUDs, the cost of which dropped 68 percent.

Project 2025 — the Heritage Foundation’s blueprint for Trump’s next term, compiled by the former president’s closest allies and advisors — envisions repealing ACA, ending the birth control benefits currently enjoyed by tens of millions of women. (Trump has repeatedly, and unconvincingly, claimed to “know nothing” about the project.)

The 887-page policy agenda also explicitly calls for ending no-cost emergency contraception, under the rationale that it is a “potential abortifacient.” (It is not: emergency contraception interrupts ovulation to proactively prevent a pregnancy; it can’t terminate a pregnancy already in progress.) An analysis by the Center for American Progress found that some 48 million women would lose access to emergency contraception under the conservative’ plan.

That prospect should be particularly chilling for the one in three women of reproductive age who live in states with an abortion ban, and for whom emergency contraception is one of the last options available to prevent an unintended pregnancy. 
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Elsewhere in the document, Project 2025 calls for restoring a Trump-era rule that allowed employers to opt-out of birth control coverage if they have “religious or moral” objections (p. 483). It calls for changing the name of the Department of Health and Human Services to the “Department of Life,” and “explicitly rejecting the notion that abortion is health care” (p. 489).  It also proposes prohibiting Medicaid funding from going to Planned Parenthood (p. 455).

Beyond ending birth control, Trump’s pick for vice president, Ohio Sen. J.D. Vance, has announced his and Trump’s intention to end coverage for pre-existing conditions if elected. 
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At a campaign event in North Carolina last week, Vance said, “We’re gonna actually implement some regulatory reform in the healthcare system that allows people to choose a health care plan that works for them,” adding that they envisioned a plan that would “allow people with similar health situations to be in the same risk pools” — which means sicker individuals and those with pre-existing conditions would be in different, more expensive, insurance pools. (I.e. defying the entire point of insurance.)

“That’s the biggest and most important thing that we have to change,” Vance told the crowd.