ceptive coverage requirement group health plans of a “religious employer,”
which are generally churches and the exclusively religious activities of any
46 The regulations also provide an accommodation for group
health plans of other non-profit organizations that hold themselves out as
religious and have religious objections to covering contraception, including
religiously affiliated colleges and universities.
47 After an organization self-certifies that it meets the eligibility criteria for the accommodation, women
who participate in the organization’s health plan will have access to contraceptive coverage directly through a third party insurer and the organization
will not have to contract, arrange, pay, or refer a patient for contraception.
Not satisfied with the exemption and accommodation, plaintiffs have
filed dozens of lawsuits across the country challenging the contraceptive
49 The plaintiffs in these cases are generally nonprofit
religious entities that do not want to complete the self-certification form and
for-profit secular corporations and their owners asserting religious objections to providing their employees with health insurance that covers some
or all methods of contraception. The Supreme Court has ruled in favor of
three closely held for-profit corporations in two consolidated cases,
has issued injunctions pending appeals in two cases involving nonprofit entities.
(excluding Pub. L. No. 113-79) approved Apr. 1, 2014); Coverage of Preventive Health Services, 45 C.F.R. § 147.130 (West, WestlawNext through May 22, 2014; 79 Fed. Reg.
29,379). Because HRSA did not have existing coverage guidelines, it asked the Institute of
Medicine (IOM) to develop recommendations. See generally Coverage of Certain Preventive
Services Under the Affordable Care Act, 78 Fed. Reg. 39,870, 39,871-73 (July 2, 2013)
(codified in various parts of the C.F.R.). Among other things, the IOM recommended that
women have access to the full range of Food and Drug Administration approved contraceptive methods—a recommendation HRSA accepted. See U.S. Dep’t of Health & Human
Servs., Health Res. & Servs. Admin., Women’s Preventive Services: Required Health Plan
Coverage Guidelines, http://www.hrsa.gov/womensguidelines (last visited June 2, 2014).
46. 45 C.F.R. § 147.131(a). A “religious employer” is a non-profit organization described in a tax code provision that refers to “churches, their integrated auxiliaries, and conventions or associations of churches” and “the exclusively religious activities of any religious order.” Id. (referring to 26 U.S. C. §§ 6033(a)( 3)( A)( i), (iii)).
45 C.F.R. § 147.131(a)-(b) (defining “eligible organization”).
48. See § 147.131(c) (stating an eligible organization may provide “benefits through
one or more group health insurance issuers” and an “issuer may not impose any cost-sharing
requirements (such as a copayment, coinsurance, or a deductible), or impose any premium,
fee, or other charge, or any portion thereof, directly or indirectly” to an eligible organization).
49. See Nat’l Health Law Program, Health Reform Litigation Docket (Updated May
50. See Burwell v. Hobby Lobby Stores, Inc., Nos. 13-354 & 13-356, 2014 WL
2921709 (U.S. June 30, 2014).
51. See Little Sisters of the Poor Home for the Aged v. Sebelius, 134 S. Ct. 1022 (2014)
(stating the “respondents are enjoined from enforcing against the applicants the challenged
provisions of the Patient protection and Affordable Care Act and related regulations” pend-