Written by: Tina Batra Hershey, JD, MPH, Health Policy and Management
Copy editors: Linda S. Duchak, EdM, MCHES, Associate Director, and Kurt Holliday, Communications Specialist, Pennsylvania Public Health Training Center
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| US Supreme Court Building |
Once again, the
Affordable Care Act (ACA) came under fire before the Supreme Court on March 25,
2014. Nearly two years ago, the high
court heard extensive arguments regarding whether the landmark health reform
law’s individual mandate and expansion of Medicaid were constitutional. This time, the Supreme Court focused on the
ACA’s requirement that for-profit employers with 50 or more employees offer such
employees coverage for contraceptives.
Under the ACA, new
private plans must provide coverage for a broad range of preventive services,
including all methods of contraception approved by the Food and Drug
Administration. Houses of worship are
exempt from the requirement. The Obama
administration also offered an “accommodation” for religiously affiliated
nonprofits, such as church-run hospitals, parochial schools and charities.
Two for-profit secular companies
brought suit, claiming that the contraceptive coverage requirement violated the
tenets of their faiths. Hobby Lobby,
operated by the Green family who are Protestant, and Conestoga Wood
Specialties, owned by the Hahn family who are Mennonites, filed separate suits that
were then consolidated for review by the Supreme Court. Hobby Lobby objects to Plan B and Ella (emergency
contraceptives) as well as IUDs, claiming these types of contraception are
abortifacients. Conestoga Wood
Specialties objects to Plan B and Ella on the same grounds.
The case is considered
to be one of the most important decisions of this Supreme Court term. At issue is a question that has not been
answered by the Court in previous decisions: Can a corporation exercise
religion and thereby be entitled to protection under the Constitution and the Religious
Freedom Restoration Act of 1993 (RFRA)?
Under RFRA, the government is prohibited from imposing a substantial
burden on a person’s exercise of religion unless there is a compelling
government interest and the means to achieve the interest are the least restrictive
and most narrowly tailored.
The Court appeared
deeply divided along ideological lines at oral argument. As is frequently the case, Justice Kennedy seems
to hold the key vote in the decision; however, it is unclear from his questions
which way he will vote. Although he
expressed concern about the effect on employees when a religious employer
denies contraceptive coverage, he was also troubled that a for-profit
corporation could be forced in principle to pay for abortions if denied
protection under RFRA.
There is some speculation among legal scholars that Chief Justice Roberts may be looking for a narrow ruling in favor of Hobby Lobby and Conestoga Wood Specialties that would apply only to closely held corporations, and not publicly traded companies. Only time will tell, as the Court is expected to issue its ruling in June 2014.
