The Contraceptive Coverage Requirement and Legal Challenges Five Years After Hobby Lobby

Summary

When Congress enacted the Patient Protection and Affordable Care Act (ACA) in 2010, it required employment-based health plans and health insurance issuers to cover certain preventive health services without cost sharing. Those services, because of agency guidelines and rules, would soon include contraception for women. The “contraceptive coverage requirement,” or “contraceptive mandate” as it came to be known, was heavily litigated in the years to follow. These challenges primarily concerned (1) what types of employers and institutions should be exempt from the requirement based on their religious or moral objections to contraception; (2) what procedures the government can require for an entity to invoke a religious-based accommodation; and (3) how much authority federal agencies have to create exceptions to the coverage requirement. As originally formulated, only houses of worship and similar entities were exempt from the requirement, but the government later added an accommodation process for certain religious nonprofit organizations.

On June 30, 2014, the Supreme Court held in Burwell v. Hobby Lobby Stores, Inc. that the contraceptive coverage requirement violated federal law insofar as it did not also accommodate the religious objections of closely held, for-profit corporations. The law at issue in that case—the Religious Freedom Restoration Act of 1993 (RFRA)—prohibits the federal government from “substantially burden[ing] a person’s exercise of religion” except under narrow circumstances. Since Hobby Lobby, the agencies tasked with implementing the ACA have faced numerous hurdles in their attempts to accommodate the interests of sincere objectors while minimizing disruptions to the provision of cost-free contraceptive coverage to women. The lower courts split on whether the accommodation process—which required eligible objecting entities to notify their insurers or the government that they qualified for an exemption—substantially burdened the objectors’ exercise of religion. Initially, most circuit courts rejected the view that such an accommodation triggered, facilitated, or otherwise made objectors complicit in the provision of coverage, denying their RFRA claims. After consolidating some of these cases for review, the Supreme Court ultimately vacated and remanded the decisions when the government and the objecting parties suggested that a solution might be reached so that the objectors’ insurers could provide the required coverage without notice from the objecting parties.

However, following a change in presidential administration, the implementing agencies reevaluated and reversed their position on the legality of the then-existing accommodation process, concluding that it violated RFRA when applied to certain entities. The agencies opted to automatically exempt most nongovernmental entities that objected to providing coverage for some or all forms of contraception on religious or moral grounds. These expanded exemptions sparked a new round of litigation based on claims that the agencies exceeded their authority under the ACA or violated federal requirements for promulgating new rules. Federal courts have preliminarily enjoined the government from implementing the expanded exemptions. At the same time, the government is largely precluded from relying on the prior accommodation process as a result of a nationwide injunction issued by a federal district court.

From a legal perspective, Congress has several options for clarifying the scope of the contraceptive coverage requirement, including through amendments to the ACA and RFRA. For now, the implementing agencies and the courts will likely continue to grapple with the extent of the mandate and its compliance with RFRA and other legal protections.