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Appeals Court Affirms Federal Contraceptive Coverage Rules' Accommodation

Appeals Court Affirms Federal Contraceptive Coverage Rules' Accommodation

July 15, 2015 — The 10th U.S. Circuit Court of Appeals on Tuesday ruled that the federal government's contraceptive coverage accommodation for not-for-profits that hold themselves out as religious does not infringe on the organizations' religious rights, AP/Modern Healthcare reports.

The plaintiffs in the case included a Colorado-based order of nuns and four Christian colleges in Oklahoma, as well as an evangelist organization called Reaching Souls International. The Becket Fund for Religious Liberty, which is representing the plaintiffs in the case, said it will appeal the decision to the Supreme Court (AP/Modern Healthcare, 7/14).


The contraceptive coverage rules, which are being implemented under the Affordable Care Act (PL 111-148), require most employers to offer coverage to their workers. Houses of worship are exempt from the requirement, and not-for-profits that hold themselves out as religious are eligible for an accommodation that ensures they do not have to pay for or directly provide the coverage for their employees.

In September 2013, the Becket Fund for Religious Liberty filed a class-action suit against the rules on behalf of several organizations. The suit argued that under the accommodation for religiously affiliated employers, the not-for-profits "would be required to actively facilitate and promote the distribution of these [contraception] services in ways that are forbidden by their religion."

In December 2013, Supreme Court Justice Sonia Sotomayor granted a temporary injunction against the rules to the Little Sisters of the Poor Home for the Aged in Colorado and more than 200 other Catholic not-for-profits that use the same health insurance provider. The Supreme Court extended the injunction in January. Separately, U.S. District Judge Stephen Friot granted a preliminary injunction against the rules in December 2013 to four Oklahoma universities while their suit against the mandate is pending. The universities include Southern Nazarene University, Oklahoma Baptist University, Mid-America University and Oklahoma Wesleyan University (Women's Health Policy, 12/9/14).

Ruling Details

The 10th Circuit Court affirmed the federal contraceptive coverage rules' accommodation and rejected the plaintiffs' claim that the arrangement violated their rights under the Religious Freedom Restoration Act (PL 103-141) (Pear, New York Times, 7/14). The court wrote, "Although we recognize and respect the sincerity of plaintiffs' beliefs and arguments, we conclude the accommodation ... does not substantially burden their religious exercise."

The judges added, "The accommodation relieves plaintiffs from complying with the mandate and guarantees they will not have to provide, pay for, or facilitate contraceptive coverage" (AP/Modern Healthcare, 7/14).

Further, Circuit Judge Scott Matheson Jr. in the opinion wrote that using the accommodation is "as easy as obtaining a parade permit, filing a simple tax form or registering to vote." The court also noted, "Plaintiffs do not 'trigger' or otherwise cause contraceptive coverage because federal law, not the act of opting out, entitles plan participants and beneficiaries to coverage," adding, "Although plaintiffs allege the administrative tasks required to opt out of the mandate make them complicit in the overall delivery scheme, opting out instead relieves them from complicity."

Matheson wrote, "Congress has created a federal entitlement to contraceptive coverage and formulated a framework to guarantee that coverage will be provided even if plaintiffs decline to provide it" (New York Times, 7/14).

The judges also distinguished between the current case and the Supreme Court case that ruled the for-profit business Hobby Lobby did not have to comply with the contraceptive coverage rules. They explained that the not-for-profit organizations that hold themselves out as religious have an exemption option that was not available to Hobby Lobby at the time (AP/Modern Healthcare, 7/14).