A contraceptive mandate is a government regulation or law that requires health insurers, or employers that provide their employees with health insurance, to cover some contraceptive costs in their health insurance plans. In 1978, the United States Congress ruled that discrimination on the basis of pregnancy was discrimination on the basis of sex. In 2000, the Equal Employment Opportunity Commission ruled that companies that provided insurance for prescription drugs to their employees but excluded birth control were violating the Civil Rights Act of 1964. President Obama signed the Patient Protection and Affordable Care Act (ACA) on 23 March 2010. As of 1 August 2011, female contraception was added to a list of preventive services covered by the ACA that would be provided without patient co-payment. The federal mandate applied to all new health insurance plans in all states from 1 August 2012. Grandfathered plans did not have to comply unless they changed substantially. To be grandfathered, a group plan must have existed or an individual plan must have been sold before President Obama signed the law; otherwise they were required to comply with the new law. The Guttmacher Institute said that even before the federal mandate was implemented, twenty-eight states had their own mandates that required health insurance to cover prescription contraceptives, but the federal mandate innovated by forbidding insurance companies from charging part of the cost to the patient. In 2017, the Trump administration issued a ruling letting insurers and employers refuse to provide birth control if doing so would violate their religious beliefs or moral convictions. (en)