A federal judge in Pennsylvania on Monday issued a nationwide preliminary injunction that temporarily blocks a pair of federal rules that would allow more employers to seek exemptions from the Affordable Care Act's (ACA) contraceptive coverage rules based on moral or religious grounds.
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 were scheduled to take effect Monday, small businesses and individuals that morally object to offering contraception would be eligible for an exemption from the ACA's contraceptive coverage rules. However, the rules would 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 New Jersey and 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.
A federal judge in California on Sunday issued a preliminary injunction blocking the federal rules from taking effect in Washington D.C. and the 13 states involved in that suit. 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.
Pennsylvania judge blocks final rules across the US
Judge Wendy Beetlestone of the Federal District Court in Philadelphia on Monday issued a preliminary injunction that temporarily blocks the final rules from taking effect across the United States.
Beetlestone in a 65-page opinion wrote that a nationwide injunction is necessary because "[t]he negative effects of even a short period of decreased access to no-cost contraceptive services are irreversible." She wrote that more than 70,000 women would lose their access to contraceptive coverage if the rules took effect, putting those women at risk of unintended pregnancies. Further, Beetlestone wrote that, if the rules took effect, states would become responsible for covering the cost of contraceptive coverage for women.
Beetlestone in her ruling also wrote that the rules exceed the ACA's scope, claiming that the law prohibits HHS from offering the exemptions included in the final rules.
According to the Wall Street Journal, the injunctions blocking the final rules represent "early steps in what is likely to be a long court battle that could reach the … Supreme Court."
The Department of Justice (DOJ) is expected to appeal the rulings, the Journal reports.
Pennsylvania Attorney General Josh Shapiro (D), who led the lawsuit filed in Pennsylvania, applauded Beetlestone's decision. "Families rely on the [ACA's] guarantee to afford care … Congress hasn't changed that law, and the president can't simply ignore it with an illegal rule," he said.
However, Fatima Goss Graves, president of the National Women's Law Center, said, "Until these discriminatory rules are blocked for good, the health and livelihoods of millions across the country are still threatened."
Trump administration officials did not comment directly on the ruling, but reiterated the administration's position on moral and religious exemptions.
Kelly Laco, a DOJ spokesperson, said, "As we've said before, religious organizations should not be forced to violate their mission and deeply-held beliefs. In this case and others, the [DOJ] will continue to vigorously defend religious liberty."
HHS spokesperson Caitlin Oakley 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" (Pear, New York Times, 1/14; Raymond, Reuters, 1/14; Hackman, Wall Street Journal, 1/14; Goldstein, Washington Post, 1/14).
Cheat sheet: What you need to know about the ACA
The Patient Protection and Affordable Care Act, otherwise known as the ACA, is the comprehensive health care reform bill passed by Congress in March, 2010. The law reshapes the way health care is delivered and financed by transitioning providers from a volume-based fee-for-service system toward value-based care.
Download the ACA cheat sheet to get a quick overview of this significant U.S. health care legislation.