Supreme Court Rules on ACA Contraceptive Coverage Requirement

On Wednesday, the U.S. Supreme Court announced its ruling in the case of Little Sisters of the Poor v. Pennsylvania, determining on a 7-2 vote that employers with a “religious or moral objection” to providing contraceptive coverage to their employees may indeed opt out of the requirement without penalty. Recall, under the Affordable Care Act (ACA), preventive health services for women were required to be included in most health insurance policies. The ACA itself did not explicitly determine the types of services to be provided, leaving it up to the discretion of the U.S. Department of Health and Human Services (DHHS). The Obama Administration DHHS directed the National Academy of Medicine to recommend to the department which women’s preventive health services had sufficient scientific backing to be included in the suite of services. The National Academy at that point recommended the coverage of FDA-approved methods of contraception.

Over several years, the requirement faced several legal challenges throughout the Obama Administration, particularly from churches, religious entities, and religious non-profit organizations. The Supreme Court in 2016 took up a consolidated set of cases on the matter, but the court ended up deadlocked on a 4-4 vote and instructed the parties involved to attempt to determine a compromise that would allow employees to receive contraception coverage without conceding the religious beliefs held by employers.

In 2018, the Trump Administration issued rules permitting organizations with religious and moral objections to the contraception coverage requirement to opt out. Following its move to expand the ability of employers to opt out of coverage, several entities and states sued the Trump Administration on the grounds that women should have access to contraceptive coverage at no cost and that states will likely end up paying for state-level contraception programs and costs associated with unintended pregnancies.

The ruling on Wednesday’s case is expected to have broader impacts beyond the loss of contraception coverage for hundreds of thousand U.S. women. Given that the Trump Administration’s 2018 rules additionally included objections based on “moral” grounds, the potential exists for many more employers to opt out of contraception coverage for women in the workplace. Wednesday’s ruling deals another blow to the broader ACA ahead of a pending Supreme Court case considering the act’s constitutionality that is expected to be taken up as early as October.