Federal judge rules for couple who opposes contraceptive coverage

July 22, 2016 — A federal judge on Thursday agreed with a Missouri lawmaker who argued his personal opposition to contraception should exempt him from having to purchase health insurance that complies with the Affordable Care Act (ACA) (PL 111-148), Modern Healthcare reports (Schencker, Modern Healthcare, 7/21).

The contraceptive coverage rules, which are implemented under the ACA, require most employers to offer such 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.

Legal background

In August 2013, Missouri Rep. Paul Wieland (R) asked a federal court to exempt his family from the contraceptive coverage provided through his state health insurance plan. The Thomas More Society filed the lawsuit on behalf of Weiland and his wife against HHS and two other federal agencies, contending that Weiland's religious, free-speech and parental rights had been violated.

In the lawsuit, Wieland said in previous years, he opted out of coverage for contraceptives, sterilization and abortifacients, but he can no longer do so because of the federal rules. Missouri stopped offering an opt-out for such coverage following a federal district court ruling -- Missouri Insurance Coalition v. Huff -- that the ACA pre-empted the state's opt-out provision.

Wieland said he is not seeking a blanket ruling against the federal policy, only an exemption in his individual case. However, he added that a legal victory in his case might give other like-minded people the same option.

In response to Wieland's lawsuit, the federal government argued that the couple did not have standing to challenge the rules because they do not apply directly to individuals, but rather to insurers and the state. A federal district court originally dismissed the suit for lack of standing, but the 8th Circuit Court of Appeals in July 2015 reversed that decision and remanded the case back to the lower court.

In a unanimous ruling, a three-judge panel on the 8th Circuit said the Weilands' complaints were "fairly traceable" to the contraceptive coverage rules and that the couple therefore had standing to challenge the rules. Further, the circuit court directed the lower court to reconsider the Huff ruling in light of the Supreme Court's decision in Hobby Lobby v. Burwell, which exempted closely held companies whose owners object to contraception on religious grounds from the rules (Women's Health Policy Report, 7/22/15).

HHS' argument

HHS refuted the plaintiffs' argument, saying that required enrollment in a health insurance plan covering a service the plaintiffs will not use does not constitute a substantial burden on their exercise of religion. Further, HHS said it would be impossible for insurance markets to operate if they were required to design individual health plans based on every enrollee's preferences.

Judge's ruling

In the decision Thursday, U.S. District Judge Jean Hamilton ruled in favor of the plaintiffs, finding that their exercise of religion is substantially burdened when they are required to enroll in a health plan that covers contraception or face fines for failing to enroll in a health plan.

Hamilton also disagreed with the federal government's argument that such accommodations would undermine the ability of insurance marketplaces to operate. She said the ACA differs from other government-operated programs, such as Medicare, because insurers -- not the federal government -- provide the health plans offered on the insurance marketplaces. She said insurers should be able to decide whether to provide a plan without contraceptive coverage, and she suggested that the government may adopt the plaintiffs' proposal to allow individuals to refuse contraceptive coverage by checking a box.

Hamilton underscored that the ruling applies only to the case in question and does not grant exemption from ACA coverage requirements to any other party (Modern Healthcare, 7/21).