The White House has withdrawn a proposed rule that would have ensured private health insurance plans cover birth control when it is purchased over the counter. The withdrawal will be published in the Federal Register on Wednesday.

The proposed rule could have benefited 52 million women of reproductive age, government officials estimated when announcing the plan in October. At the time the plan was announced, White House officials said it would be the most significant expansion of contraception coverage under the Affordable Care Act in over a decade.

The rule would have leveraged the health law, which requires health insurance to cover at least one form of each method of contraception with no out-of-pocket costs — a benefit that has had sweeping impact since it took effect in 2012. Since then, women have become more likely to use birth control, including more expensive and effective methods such as intrauterine devices. Some research also associated the mandate with a decline in unintended pregnancies and suggested a heightened benefit for women with lower incomes.

Still, Democrats had long argued that the mandate required better enforcement, pointing to frequent reports of patients receiving surprise bills for their birth control when insurance should have covered the cost. A 2021 survey from KFF, a nonpartisan health policy, research and journalism organization, found that 1 in 5 women with private insurance said they had paid at least partially out of pocket for their birth control.

The contraceptive mandate does not cover condoms or emergency contraception — which are typically bought without a prescription — and it does not cover a new over-the-counter hormonal birth control pill known as Opill. The pill, which came to stores last year, costs $90 per six months.

The White House proposal aimed to address those concerns, strengthening the health law’s requirement that insurance cover contraception even without a prescription. Its October announcement came in the heat of a presidential campaign in which Democrats, including Vice President Kamala Harris, emphasized reproductive rights as an election issue. 

But the rulemaking process is time-consuming. After proposing the rule, President Joe Biden’s administration was legally required to seek public comment for several weeks — the comment period for this proposal ended December 27 — and then incorporate that feedback into its final regulation. The administration received more than 250 public comments, according to the proposed rule’s withdrawal notice, which was made available Monday. The notice suggests that the federal agencies involved — Health and Human Services, Labor and Treasure — ran out of time.

“The Departments have determined it is appropriate to withdraw the proposed rules at this time, focusing instead on other matters,” the notice read.

Representatives from the White House did not provide a comment.

Even last fall, White House officials said they anticipated the new birth control rule would take effect in 2025, leaving its status tenuous if Donald Trump returned to the White House. With Trump set to take office next week, expansion of the birth control mandate is unlikely. Trump has wavered on his approach to contraception policy, but his previous administration took steps to weaken the Affordable Care Act’s birth control mandate. Republicans, who now control Congress, have expressed interest in weakening provisions of the 2010 health law. 

Threats to contraceptive coverage could come from other government branches as well. The Supreme Court has agreed to hear a case challenging the health law’s entire preventive services mandate — the requirement that insurance cover birth control, but also vaccines, well-woman exams and mental health screenings. The court, which has 6-3 conservative majority, has in the past ruled to weaken the Affordable Care Act’s reach, including the law’s birth control coverage requirements.