This week, Obamacare will have its second birthday, but there’s little reason to celebrate. Throughout the week, Obamacare advocates will be emphasizing the law’s supposed benefits on specific groups of Americans, but as Heritage’s research over the past two years has shown, Obamacare harms Americans—even the groups showcased by the left.

Today, the focus is on the law’s impact on American women. Advocates will be highlighting better benefits and free preventive care, but Heritage research shows that the health law’s new requirements will reduce patient choice, increase costs, and violate religious liberty—for women and everyone else, too.

Less Choice

Obamacare determines which preventive services must be covered by all insurers, with no cost-sharing, using the recommendations made by the United States Preventive Services Task Force (USPSTF). The USPSTF uses a rating system of A through D (or I for insufficient evidence) to recommend services. Under Obamacare, services that receive a rating of A or B will be required coverage and those with C, D, or I will not be. This turns otherwise harmless and good-intentioned recommendations into requirements, distorting the USPSTF’s original purpose.

Though these requirements are intended to create a “floor” for Americans’ covered benefits, they may have the opposite effect. The mandated benefits could instead create a “ceiling” because of their high cost, which will place pressure on insurers to cover only the preventive services required. This could lead to the exclusion of services that are “recommended” but are nevertheless crucial for specific patients.

For example, in 2009, the task force changed its recommendation for breast cancer screenings for women between the ages of 40 and 50 from B to C. Controversy ensued, which led Congress to overturn the recommendation in 2010. Prior to Obamacare, a change in recommendation ranking might have carried little weight; under the health care law, it may be the difference between coverage and no coverage.

In addition, the USPSTF is one of few government agencies legally allowed to take cost into consideration when deciding whether to recommend a medical service. As health care costs rise and the government’s role in health care grows, this may mean that cost will more strongly influence coverage.

Higher Costs

In addition, mandated coverage of preventive services with no cost-sharing will increase health care costs, since cost of services will simply be passed from the insurer to the patient through higher premiums. Moreover, as Heritage expert Ed Haislmaier explains, “Prohibiting enrollee cost-sharing for specific services will stimulate greater use of those services, further increasing premiums.” Even the Administration admits that these mandates will increase premiums on average by 1.5 percent.

A Violation of Religious Freedom

Among the women-specific preventive services required by Obamacare is a mandate that insurance cover, with no cost-sharing, abortion-related drugs, contraceptives, and sterilization. The mandate has a very narrow exemption for churches but does not exclude religious hospitals, schools, and charities that find such products morally objectionable on religious grounds. This violates the First Amendment right to freedom of religion for all Americans—regardless of gender or faith.

The best way to bring down costs and protect quality in the health care system is to give patients more choice, not to reduce it. Check out Heritage’s Saving the American Dream proposal to learn about some of the reforms needed to move in this direction.