A federal judge in California on Sunday issued a preliminary injunction blocking a pair of federal rules that allow more employers to seek exemptions from the Affordable Care Act's (ACA) contraceptive coverage rules based on moral or religious grounds.
Background
The ACA's contraceptive coverage rules require most employers to offer contraceptive coverage to their workers. Houses of worship are exempt from the requirement, and nonprofits 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.
But some nonprofits that hold themselves out as religious and oppose contraception have challenged the accommodation in federal courts throughout the United States. Most appeals courts dismissed the challenges, and some of those cases were appealed to the Supreme Court, which in May 2016 sent the cases back to lower courts to reconsider the issue.
The Trump administration in October 2017 issued interim final rules that significantly expanded exemptions available to employers that oppose the ACA's contraceptive coverage rules on religious or moral grounds, but those rules ultimately were blocked in court.
In November 2018, the administration released two new final rules to address the challenges raised in court. Under the final rules, which are scheduled to take effect Monday, small businesses and individuals that morally object to offering contraception are eligible for an exemption from the ACA's contraceptive coverage rules. However, the rules do not extend such exemptions to publicly traded businesses or government agencies, as the interim final rules did.
The latest rules also faced legal challenges, including one filed by Pennsylvania state officials and another filed by a group of states led by California. Both lawsuits requested a nationwide injunction to block the rules from taking effect.
Judge blocks final rules in 13 states and Washington, DC
Judge Haywood Gilliam of the U.S. District Court for the Northern District of California on Sunday issued a preliminary injunction that prevents the rules from going into effect, but he limited the injunction's scope to Washington, D.C., and the 13 states that requested the injunction. The ruling blocks the final rules from taking effect in:
- California;
- Connecticut;
- Delaware;
- Hawaii;
- Illinois;
- Maryland;
- Minnesota;
- New York;
- North Carolina;
- Rhode Island;
- Vermont;
- Virginia;
- Washington; and
- Washington, D.C.
Gillam in his ruling wrote that tens of thousands of women would lose their access to low- or no-cost contraception if he did not block the final rules from taking effect. He said the administration's "moral convictions" exemption did not implicate the U.S. Constitution's religious liberty protections and was "inconsistent with the language and purpose of" the ACA. Gillam has not made a final decision in the case, but he wrote that the final rules likely violated federal law, Reuters reports.
According to Politico's "Pulse," the judge overseeing the Pennsylvania case could rule as soon as Monday on whether to grant a nationwide injunction.
Reaction
Many observers applauded the ruling.
California Attorney General Xavier Becerra (D) in a statement said, "The law couldn't be clearer—employers have no business interfering in women's health care decisions." He added that the "ruling stops another attempt by the Trump administration to trample on women's access to basic reproductive care."
Planned Parenthood President Leana Wen, said, "It's time that politicians recognize birth control as health care and that women, in consultation with doctors, decide what contraception we receive — not our employers."
However, others voiced concerns about the ruling and defended the final rules.
Mark Rienzi—president of Becket, a legal group representing Little Sisters of the Poor, which is a Catholic order of nuns intervening in the case—said, "Now the Little Sisters have no choice but to keep fighting this unnecessary fight so they can protect their right to focus on caring for the poor. We are confident this decision will be overturned."
Caitlin Oakley, an HHS spokesperson said, "No American should be forced to violate his or her own conscience in order to abide by the laws and regulations governing our health care system. The final rules affirm the Trump Administration's commitment to upholding the freedoms afforded all Americans under our Constitution" (Schwartz, NPR, 1/14; Wolfe, Reuters, 1/13; Miranda Ollstein/Colliver, Politico, 1/13; Thanawala, Associated Press, 1/14; Diamond, "Pulse," Politico, 1/14).
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