Supreme Court upholds exemptions to the Affordable Care Act’s birth control mandate, a victory for religious objectors
The Trump administration’s efforts to protect moral and religious objectors to birth control had been challenged by state leaders.
SALT LAKE CITY — The Supreme Court on Wednesday upheld the Trump administration’s broad exemptions to the Affordable Care Act’s contraceptive mandate, ensuring that most moral and religious objectors to birth control will not be required to cover it in employee health plans.
“We hold today that (the government) had the statutory authority to craft” these exemptions, wrote Justice Clarence Thomas in the majority opinion. “We further hold that the rules promulgating these exemptions are free from procedural defects.”
The court’s four other more conservative justices joined Thomas’ opinion. Justice Elena Kagan wrote an opinion concurring in the judgement, which was joined by Justice Stephen Breyer.
The Supreme Court’s decision closes the latest chapter in a years-long clash over the Affordable Care Act’s contraceptive mandate. Health officials, lawmakers and business owners have never agreed on who should be exempted from the rule requiring employers to cover birth control in employee health plans.
At first, the Obama administration exempted only churches and closely related auxiliary organizations from the coverage mandate. But, after listening to the concerns of religiously affiliated colleges and other faith-based organizations, officials created an accommodation process that allowed other employers with religious objections to birth control to avoid paying for it. It empowered these companies’ insurers to contact employees directly about contraceptive coverage.
Some people of faith were unhappy with this solution, and some brought their concerns all the way to the Supreme Court. The justices have previously ruled that closely held, for-profit companies with objections to birth control should be eligible for an accommodation and that the government should work with religious nonprofits to come up with a birth control compromise that was more satisfactory to everyone involved.
These two Supreme Court decisions did little to resolve broader controversy related to the birth control mandate. When President Donald Trump took office in January 2017, legal scholars, faith leaders and policymakers still didn’t agree on how best to expand access to birth control and protect religious objectors to contraception at the same time.
In the face of seemingly unending conflict, the Trump administration decided to focus on protecting people of faith. Officials announced new religious and moral exemptions to the Affordable Care Act’s contraceptive mandate in the fall of 2017 that enabled almost any company with religious or philosophical objections to birth control to stop covering it in employee health plans.
“Even if (federal religious freedom law) does not compel the religious exemptions, ... the departments believe they are the most appropriate administrative response to the religious objections that have been raised,” Trump administration officials said at the time.
Leaders from Pennsylvania and New Jersey challenged the policy changes in court, claiming that federal officials failed to follow administrative procedure and lacked the authority to make such major adjustments to the Affordable Care Act. The Little Sisters of the Poor, a religiously affiliated nonprofit, joined with the Trump administration to defend the exemptions, but the state leaders won at both the district and circuit court levels.
Now, the Supreme Court has overturned those lower court decisions, ruling that concerns about procedure and authority were unfounded. The Trump administration acted within its power when it broadened existing exemptions to the Affordable Care Act’s contraceptive mandate, Thomas wrote.
Although the majority opinion mostly focuses on how to apply complicated administrative law, it includes praise for the work of the Little Sisters and other religious organizations. The federal government should not be condemned for hearing and then addressing the concerns of religious objectors to birth control, Thomas said.
The Little Sisters — “like many other religious objectors who have participated in the litigation and rulemakings leading up to today’s decision — have had to fight for their ability to continue in their noble work without violating their sincerely held religious beliefs,” he wrote. “The federal government has arrived at a solution that exempts the Little Sisters from the source of their complicity-based concerns.”
Several religious leaders and policymakers released statements Wednesday applauding the court’s decision, describing it as a meaningful victory for religious freedom.
“The Little Sisters case was about a lot more than contraceptives and a group of Catholic nuns. It was about the right of religious persons everywhere to practice their beliefs freely without interference from the federal government,” said Orrin Hatch, who represented Utah in the Senate for more than 40 years.
Leaders from the U.S. Conference of Catholic Bishops expressed their hope that protracted battles over birth control will soon come to an end.
“We welcome the Supreme Court’s decision. We hope it brings a close to this episode of government discrimination against people of faith,” they said in a statement.
However, other advocacy groups characterized the ruling as an attack on women’s health. The Supreme Court should not allow such a broad and harmful interpretation of religious freedom to be the law of the land, argued Rachel Laser, the president and CEO of Americans United for Separation of Church and State, in a statement.
“Our government should be protecting the health of America’s workers and students, not putting them at risk and calling it religious freedom,” she said.
Justice Ruth Bader Ginsburg made a similar point in her dissent, which was joined by Justice Sonia Sotomayor.
“This court leaves women workers to fend for themselves, to seek contraceptive coverage from sources other than their employer’s insurer and, absent another available source of funding, to pay for contraceptive services out of their own pockets. The Constitution’s free exercise clause ... does not call for that imbalanced result,” she wrote.
These concerns could fuel future challenges to the Trump administration’s religious and moral exemptions to the contraceptive mandate, which remain vulnerable despite the Supreme Court’s ruling.
In her concurring opinion, Kagan noted that the policies may be deemed “arbitrary and capricious” and, therefore, unlawful upon further review.
Officials “allow even publicly traded corporations to claim a religious exemption. That option is unusual enough to raise a serious question” about whether the Trump administration adequately justified the policy moves, she wrote.
Even if the exemptions survive additional legal review, a future administration could issue new regulatory guidelines revoking them, as Frederick Gedicks, a law professor at Brigham Young University, told the Deseret News in May.
“Every change in administration brings the possibility of repeal or amendment,” he said.