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Pa. Judge Rules Non-Religious Organization Not Exempt From Contraceptive Coverage Rules

A federal judge in Pennsylvania on Thursday ruled that an antiabortion-rights organization called Real Alternatives cannot claim an accommodation to federal contraceptive coverage rules because it does hold itself out as religious or have a religious affiliation, the Philadelphia Inquirer reports (Mondics, Philadelphia Inquirer, 12/12).

Background on Contraceptive Coverage Rules

The contraceptive coverage rules, which are being implemented under the Affordable Care Act (PL 111-148), require most employers to offer contraceptive coverage to their workers. Houses of worship are exempt from the requirement, and not-for-profits that hold themselves out as religious, as well as certain closely held corporations, are eligible for an accommodation that ensures they do not have to pay for or directly provide the coverage for their employees. Instead, employees will be able to receive coverage directly from their insurers.

To claim the accommodation, the not-for-profits may either complete a form to send to the insurers or third-party administrators or send a letter to HHS stating that they object to offering contraceptive coverage in their health plans (Women's Health Policy Report, 11/9).

Legal Background

Real Alternatives is a not-for-profit that operates in Indiana, Pennsylvania and Michigan. Service providers -- including 14 "pregnancy support centers" and one social service provider -- working with the organization are prohibited from affiliating with entities that offer abortion services or support abortion rights. Further, service providers are not allowed to use Real Alternatives' "abortion alternative" funding to endorse birth control (Women's Health Policy Report, 10/14).

Real Alternatives' three full-time employees all receive health coverage through the organization, which also covers their families. From 2008 to 2014, the organization was able to exclude contraceptive coverage from its health insurance plan because the plan was grandfathered for several years after the ACA took effect. However, the insurer discontinued the plan, and after 2014, Real Alternatives could not purchase a plan that did not cover contraception (Wenner, PennLive, 12/11).

In January, Real Alternatives filed a lawsuit against HHS, arguing that it should also be able to claim the accommodation offered to organizations that hold themselves out as religious and oppose contraception. The lawsuit said refusing Real Alternatives' request for the accommodation, while granting the accommodation to organizations that hold themselves out as religious and oppose contraception, violated the Fifth Amendment's due process clause.

Details of Ruling

U.S. District Court Judge John Jones III dismissed the suit brought by Real Alternatives, arguing that it cannot claim an accommodation to the contraceptive coverage rules because the organization's argument is based on moral, rather than religious, objections. "A vast history of legislative protections exists to safeguard religious freedom," Jones wrote in his decision, adding, "Moral philosophies, however, have been historically unable to enjoy the same privileged state. Real Alternatives does not hold itself out as a religious entity, is not incorporated as such, and has not adopted any religious views or positions."

Jones said HHS regulations that provide an accommodation for groups that hold themselves out as religious specifically point to their religious affiliation, meaning that Real Alternatives could not claim unfair treatment. For the same reason, Jones said Real Alternatives could not claim a violation of due process or the federal Administrative Procedure Act (Philadelphia Inquirer, 12/12).

Jones also dismissed an argument by Real Alternatives that the government has no need to require people to obtain benefits they do not want, writing, "Time and again, courts have found a government interest to be compelling even when it does not achieve a benefit for each and every member of the population. Not every person who pays into social security receives or desires its benefits. Not every person who pays taxes receives unemployment benefits, welfare, or a myriad of other services offered by the government through citizens' tax money."

In addition, Jones also touched on how members of a family might disagree about contraceptive coverage when the family is covered through a single employee health plan. He said if families were permitted to opt out of contraceptive coverage based on their religious beliefs, "the collective decision could create untold tension and family strife should disagreement over contraceptive coverage arise, which is more likely now that children up to the age of twenty-six may be covered by their parents' plans" (PennLive, 12/11).