Supreme Court narrows scope of ACA's contraception mandate

In 5-4 ruling, SCOTUS rules that closely held corporations cannot be required to provide contraceptive coverage

Editor's Note: We will be updating this article with more news and analysis, including this post on how many people will be affected by the ruling.

The Supreme Court in a 5-4 decision on Monday ruled that the government cannot require closely held corporations to provide contraception coverage to employees if doing so conflicts with the religious beliefs of the corporation's owners. The decision effectively narrows the scope of the Affordable Care Act's (ACA) contraception mandate.

The majority opinion, by Justice Samuel Alito, said that the Obama administration had failed to demonstrate that the federal contraceptive coverage rules are "the least restrictive means of advancing its interest" in offering women no-copay birth control coverage. The ruling could affect millions of Americans who work for closely held corporations.

Alito was joined in the majority opinion by Chief Justice John Roberts and Justices Antonin Scalia, Clarence Thomas, and Anthony Kennedy. Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor, and Elena Kagan dissented.

Hobby Lobby isn't the end: Four other anti-ACA lawsuits to watch

Background on the mandate—and the case against it

One of the most controversial provisions of the ACA, the contraceptive coverage rules require most businesses with 50 or more employees to offer FDA-approved methods of birth control in their employer-sponsored health plans.

However, not-for-profit employers do not have to offer the coverage if they are considered a "religious employer." In addition, the final rules provide accommodations for non-exempt, not-for-profit religious organizations, such as religiously affiliated hospitals, universities, and charities.

There were more than 100 lawsuits filed against the mandate. The Supreme Court agreed to consider two of those challenges: One filed by retail chain Hobby Lobby, and another from cabinet maker Conestoga Wood Specialties. Both companies are owned by Christian families.

In the cases, Burwell v. Hobby Lobby and Conestoga Wood Specialties v. Burwell, the companies argued that the policy goes against the personal religious beliefs of the for-profit company's owners and violates the 1993 Religious Freedom Restoration Act (RFRA), which "protects a person's exercise of religion."

How each side argued its case before the Justices in March

Meanwhile, the government argued that RFRA does not apply to corporations, and that the government's interest in providing no-cost contraception outweighs the corporations' potential religious rights.

Details of Alito's majority decision

In the majority opinion, Alito said that RFRA does not allow the federal government to require companies to provide coverage for contraceptives that company owners believe are tantamount to abortion.



Alito said that protecting the right of such organizations "protects the religious liberty of the humans who own and control those companies." He said that the government could ensure women had access to contraceptives either by paying for the coverage itself or by extending to eligible for-profit companies the accommodation that it offers religiously affiliated not-for-profits.

However, Alito also restricted the decision, ruling that the exemption applies only to "closely held organizations," which are defined by IRS as companies in which five or fewer individuals own a majority of the company's stock.

The ruling covers only contraception, according to Alito. It should not be interpreted as applying to other insurance mandates, such as those for blood transfusions or vaccinations, if they conflict with an employer's religious beliefs.

The decision does not apply to challenges filed by several not-for-profit organizations.

Analysis of Hobby Lobby ruling: How many people will be affected?

Details of Ginsburg's dissent

In her dissent, Ginsberg argued that the contraception coverage requirement is vital to women's health and reproductive freedom.

Ginsburg also argued that Congress never intended for for-profit corporations to receive religious-based exemptions. If it had, "a clarion statement to that effect likely would have been made in the legislation," she said.

She noted that the majority opinion could be "potentially sweeping" because it minimized the government's interest in mandating uniform compliance from employers to federal laws. She added, "And it discounts the disadvantages religion-based opt outs impose on others, in particular, employees who do not share their employer's religious beliefs" (SCOTUSBlog, 6/30; Liptak, New York Times, 6/30; Carlson, Modern Healthcare, 6/30 [subscription required]; AP/Washington Post, 6/30; Stohr, Bloomberg, 6/30). 

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