WASHINGTON — For the last six years, nearly all employers have had no choice but to include birth control coverage in the health insurance plans they offer their employees.

On Friday, however, the Trump administration rescinded that regulation, allowing employers to exclude contraceptive care from insurance benefits for religious or moral reasons.

The announcement from the Department of Health and Human Services strikes a substantial but narrow blow to the Affordable Care Act, rolling back the so-called contraception mandate in a move it cast as “providing relief to those who have been under the thumb of the federal government and had their religious expression and religious conscience violated.”

Women’s health advocates said millions of women who had gained access to birth control at no cost would be at risk of losing that coverage. They also said some employers not associated with religious movements will use the move to justify declining to cover birth control because of unspecified moral objections.

Former president Barack Obama’s administration had previously established a workaround for religious organizations with moral objections to providing birth control, allowing women whose employers opted out to obtain birth control directly from their insurer at no cost.

The new move is expected to go further, making that workaround optional for employers and potentially leaving millions of women responsible for the out-of-pocket costs of their birth control, according to Planned Parenthood. HHS, however, estimated the number of impacted women at roughly 120,000.

“With this rule, the Trump administration is taking direct aim at birth control coverage for more than 62 million women,” Dawn Laguens, the executive vice president for Planned Parenthood, said in a statement. “Under this rule, any employer could decide that their employees no longer have health insurance coverage for birth control.”

The Trump administration issued the directive as an interim final rule, meaning it will become law immediately but is subject to a public comment process.

By and large, employers do not save money by deciding not to cover contraceptive care, as the savings from not providing birth control are typically mitigated by an uptick in pregnancies, births, and associated costs.

The move comes after months of speculation, and at a time when HHS is without a long-term chief executive following former HHS secretary Tom Price’s resignation amid scandal last week.

Don J. Wright, the acting secretary, is a physician whose chief of staff in his prior role has advocated for abstinence-based sex education, and who women’s groups have assailed for overseeing cuts to programs that fund contraceptive care.

It also comes after months of Congressional attempts to legislate some of those changes, including cuts to the Title X family planning grant program, restricting foreign aid funding from organizations that provide or promote abortions, a ban on fetal tissue research, and a ban on abortions after 20 weeks of pregnancy.    

Groups including the National Women’s Law Center and the American Civil Liberties Union are expected to sue the Trump administration for eliminating the policy, they say, in part because its impact on women specifically could make the ruling unconstitutional.

Republished with permission from STAT. This article originally appeared on October 6, 2016