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Federal Appeals Court Upholds Contraceptive Coverage Accommodation

Federal Appeals Court Upholds Contraceptive Coverage Accommodation

August 10, 2015 — A federal appeals court panel on Friday ruled that four not-for-profits that hold themselves out as religious are not substantially burdened by an accommodation in the contraceptive coverage rules that ensures they do not have to pay for or directly administer such coverage, the New York Times reports (Clifford, New York Times, 8/7).

According to AP/Modern Healthcare, the ruling affects more than 25,000 employees at six hospitals, three nursing homes, two high schools and several not-for-profits (AP/Modern Healthcare, 8/7).


The rules, which are being implemented under the Affordable Care Act (PL 111-148), require most employers to offer contraceptive coverage to their workers, although houses of worship are exempt from the mandate (Women's Health Policy Report, 12/17/13). Not-for-profits that hold themselves out as religious are eligible for an accommodation that enables them to notify their insurer or third-party administrator of their objection so the insurer or third-party administrator can facilitate contraceptive coverage for members of their health plans (Women's Health Policy Report, 7/10).

The Roman Catholic Archdiocese of New York and four affiliated not-for-profits in the state -- Catholic Health Care System, Catholic Health Services of Long Island, Cardinal Spellman High School and Monsignor Farrell High School -- challenged the rules on the grounds that the accommodation violated their religious freedom. The government later clarified that the archdiocese itself is exempt from the mandate but that the affiliated organizations must comply with the accommodation.

In December 2013, a federal judge granted the not-for-profits a permanent injunction against the contraceptive coverage rules. U.S. District Court Judge Brian Cogan ruled that requiring the not-for-profits to authorize a third party to provide contraceptive coverage violated the religious beliefs of the organizations, even if the organizations are not required to financially support the coverage (Women's Health Policy Report, 12/17/13).

Panel Overturns Lower Court's Ruling

On Friday, a three-judge panel of the appeals court unanimously ruled to overturn the lower court's permanent injunction. The panel in its ruling noted that six other circuit courts throughout the U.S. had made similar rulings.

In the ruling, 2nd U.S. Circuit Court of Appeals Judge Rosemary Pooler also noted the "modicum" of paperwork required for the accommodation "relieves, rather than imposes, any substantial burden" on the plaintiffs' religious rights. Pooler wrote, "Eligible organizations are provided the opportunity to freely express their religious objection to such coverage as well as to extricate themselves from its provision. At the same time, insured individuals are not deprived of the benefits of contraceptive coverage."

In addition, Pooler noted that when "[v]iewed objectively, completing a form stating that one has a religious objection is not a substantial burden." She wrote, "There must be some method by which the government can be notified of the objection. Otherwise there is no way that the government can know which organizations it needs to accommodate. Here, the government has provided flexible, largely effortless and essentially cost-free options for notification" (New York Times, 8/7).

The judges added that the burden was not substantial "even if the religious objector sincerely finds the ultimate actions taken by the government and third parties offensive." The ruling stated, "To the contrary, the accommodation relieves them of providing contraceptive coverage, and instead enlists third-party administrators to provide such coverage" (AP/Modern Healthcare, 8/7).


Brigitte Amiri -- an attorney at the American Civil Liberties Union, which filed an amicus brief in the lawsuit -- called the ruling "a huge victory for all the female employees who work at the organizations." She added, "The scorecard is really 7-0 in the Courts of Appeals on this issue" (New York Times, 8/7). According to AP/Modern Healthcare, four of the cases have been appealed to the Supreme Court (AP/Modern Healthcare, 8/7).

Meanwhile, Joseph Zwilling, a spokesperson for the archdiocese, said the group's attorneys are reviewing the ruling (New York Times, 8/7).