A U.S. district court decided on Wednesday to strike down a 2017 federal regulation that exempted religious employers from the Affordable Care Act’s mandate for employer-sponsored health insurance to cover the cost of contraception.
If the ruling holds, religious non-profit organizations such as the Little Sisters of the Poor, the defendants in the case, may now be required to file for an accommodation process with the government that still maintains employees’ access to contraception without the religious organization having to pay. For-profit employers would have access to no religious exemption from the mandate whatsoever.
Judge Wendy Beetlestone, chief judge for the Eastern District of Pennsylvania, found that the Trump administration’s 2017 rule expanding religious exemptions from the contraception mandate was “arbitrary and capricious,” thus violating statutory authority. Consequently, she declared the rule vacated.
“The Court sided with Pennsylvania and New Jersey in their years-long effort to force the Little Sisters of the Poor to provide contraceptive and abortion coverage in their healthcare plans,” it wrote. “Today’s ruling keeps that effort alive, and the Little Sisters have vowed to appeal the decision,” the Becket Fund, which represented the Little Sisters, said in a statement after the ruling.
“It is absurd to think the Little Sisters might need yet another trip to the Supreme Court to end what has now been more than a dozen years of litigation over the same issue. But we will fight as far as we need to fight to protect the Little Sisters’ right to care for the elderly in peace.”
If Judge Beetlestone’s ruling remains in place, the rules for religious exemptions from the federal contraception mandate will revert to the pre-2017 status quo. Religious non-profit and for-profit organizations would need to file accommodation requests with HHS to avoid paying for their staff’s contraception. Even if such a request is accepted, a religious organization’s employees would still be guaranteed access to contraception through their employer-sponsored health insurance.
The case, Commonwealth of Pennsylvania v. Trump et al., was brought by the state and alleged that the Trump administration’s 2017 expanded religious exemption violated the Administrative Procedure Act, the Affordable Care Act, the Due Process Clause of the Fifth Amendment, Title VII of the Civil Rights Act, the Pregnancy Discrimination Act, and the Establishment Clause of the First Amendment.
The Affordable Care Act, enacted in 2010, included a requirement that private employer health insurance plans cover “essential health benefits,” including “preventative and wellness services,” at no cost to patients. In the following years, the Obama administration used this authority to require employee health plans to cover female contraceptives as “preventative and wellness services.”
While houses of worship and their “integrated auxiliaries” were automatically exempted from the contraception mandate, other non-profit organizations, such as religiously affiliated hospitals, colleges, charities, and social service organizations were forced to apply for an “accommodation” process to avoid paying for employees’ contraception. Such organizations would have to file a form with HHS to qualify for a religious exemption. If approved, HHS was to come to an arrangement with the organization’s insurance carrier to cover the cost of its employees’ contraception without burdening the religious employer.
Religious for-profit employers were provided no access to either an automatic religious exemption or the accommodation process. They were required to pay for insurance covering contraception for their employees, regardless of their religious opposition to doing so.
The Little Sisters of the Poor, as a non-profit religious order of Catholic nuns engaged in social services, did not qualify for the automatic exemption that churches fell under. Instead, to avoid paying for their staff’s access to contraception, they needed to file a request for religious accommodation with the federal government. Even if they were granted such an accommodation, the Little Sisters’ health insurance carrier would still have been required to cover employees’ contraception, albeit at no cost to the Little Sisters.
In 2013, the Little Sisters of the Poor filed a lawsuit in federal court challenging the Obama administration’a contraception mandate. They argued that the mere act of submitting a request for a religious exemption from the mandate made them complicit in providing contraception, violating their rights under the Religious Freedom Restoration Act. That law, enacted in 1993, aimed to protect religious exercise by requiring the government to demonstrate a compelling interest and use the least restrictive means when substantially burdening religious practices.
The U.S. Supreme Court ruled in a 2014 case, Burwell v. Hobby Lobby Stores, Inc., that the Religious Freedom Restoration Act required that for-profit employers, such as Hobby Lobby, be given access to the same religious accommodation process available to non-profit organizations. It did not decide whether the accommodations process itself violated the law, as the Little Sisters alleged it did.
In response to further legal challenges to the contraception mandate, the Trump administration updated HHS rules in 2017 to create a full exemption for any employer, non-profit or for-profit, that held religious or moral objections to the mandate. This rule change effectively abolished the accommodation process established by the Obama administration. Religious employers such as the Little Sisters and Hobby Lobby would no longer have to file a request to avoid paying for employees’ contraception.
That broader religious exemption policy issued by the Trump administration was immediately challenged in court by multiple states, including Pennsylvania and New Jersey. Those challenges culminated in a 2020 Supreme Court case, Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, in which the Justices considered whether the 2017 expanded religious and moral exemption was lawful.
In a 7–2 decision, the court sided with the Little Sisters of the Poor and found the new exemption rule to be valid. Specifically, the court held that the Trump administration “had the authority under the ACA to promulgate the religious and moral exemptions,” and that the “rules promulgating the exemptions are free from procedural defects.”