The Trump administration had legal authority to allow private employers with moral or religious objections to opt out of providing birth control health insurance required under Affordable Care Act (ACA) implementation regulations, the U.S. Supreme Court ruled today.
“We hold today that the departments had the statutory authority to craft that [religious] exemption, as well as the contemporaneously issued moral exemption,” Justice Clarence Thomas wrote for a 7-2 majority. “We further hold that the rules promulgating these exemptions are free from procedural defects.”
Justice Ruth Bader Ginsburg, joined by Justice Sonia Sotomayor, dissented.
“In accommodating claims of religious freedom, this court has taken a balanced approach, one that does not allow the religious beliefs of some to overwhelm the rights and interests of others who do not share those beliefs,” Ginsburg wrote. “Today, for the first time, the court casts totally aside countervailing rights and interests in its zeal to secure religious rights to the nth degree.”
Justice Elena Kagan, joined by Justice Stephen Breyer, concurred in the majority’s result but not its reasoning.
- A copy of the Little Sisters opinion is available here.
- An article about oral arguments in the Little Sisters case is available here.
The court’s decision marked the third time the justices have considered the contraceptive insurance requirement since the federal law was enacted in 2010. The government estimates that, under the Trump administration’s expanded exemptions, between 70,500 and 126,400 of the 59 million women covered by employer-sponsored health plans, or up to 0.2% of the women in those plans, would lose access to cost-free birth control in one year.
This latest dispute centered on the administration’s 2017 effort to grant categorical exemptions, sometimes called the “conscience exemptions,” to for-profit and nonprofit employers. The Obama administration had created narrower exemptions for churches and other houses of worship, and offered “accommodations,” for religiously affiliated organizations, such as hospitals and universities, through which they would not directly contribute to the cost of the insurance but would let plans or the government know that women had no contraceptive coverage.
In the combined cases Little Sisters of the Poor v. Pennsylvania and Trump v. Pennsylvania, the states of Pennsylvania and New Jersey challenged the Trump exemptions, arguing that the exemptions were not authorized — as claimed by the administration — by the Affordable Care Act and the Religious Freedom Restoration Act.
The states also argued that the Trump administration had violated the federal Administrative Procedure Act when it issued the first interim rules in 2017, expanding the exemptions without first providing notice and an opportunity for public comment. That violation, they argued, made the final rules in 2018 invalid. The 3rd U.S. Circuit Court of Appeals ruled in favor of the states and upheld a nationwide injunction against enforcement of the new exemption regulations.
During telephonic arguments in May, U.S. Solicitor General Noel Francisco, defending the Trump administration, countered, “There is nothing in the ACA” that requires contraceptive coverage. The ACA delegates to the enforcing agencies the decision whether to provide it, he said.