Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania

Background

Federal health rules required many employers to provide no-cost contraceptive coverage under guidelines tied to the Affordable Care Act. In 2017–2018, three federal agencies issued exemptions and accommodations for employers with religious or moral objections. The Commonwealth of Pennsylvania and the State of New Jersey sued, the District Court enjoined the rules, and the Third Circuit affirmed that injunction. A religious nonprofit, the Little Sisters of the Poor, intervened to defend the exemptions.

Reasoning

The central question was whether the agencies had legal authority and followed proper procedures when they created the exemptions. Writing for the majority, the Court read the ACA provision to give HRSA broad discretion to define preventive care "as provided for," which includes identifying or allowing exemptions. The Court also held that the agencies properly considered the Religious Freedom Restoration Act and that the rulemaking satisfied Administrative Procedure Act requirements. The Court reversed the Third Circuit and directed dissolution of the nationwide preliminary injunction.

Real world impact

Practically, the decision means employers with sincerely held religious or moral objections can claim exemptions instead of using the prior accommodation, which could eliminate plan-based, no-cost contraceptive coverage for affected employees. The Government estimated tens of thousands of women could lose seamless no-cost coverage (an estimate in the opinion ranged roughly from 70,500 to 126,400). The ruling resolves authority and procedural challenges but leaves open additional administrative-law review in lower courts.

Dissents or concurrances

Justice Kagan warned the exemptions may fail reasoned decisionmaking review and left that question to lower courts; Justice Ginsburg dissented, stressing harms to women's access; Justice Alito concurred, arguing RFRA requires the exemptions.