The Thin Line between Religious & Moral Exemptions to Contraceptive Health Care

Both the cases of Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania and Trump v. Pennsylvania address the religious and moral exemptions that insurers can use to deny contraceptive health services to people.

Since 2010, the Affordable Care Act (ACA) has required covered employers to cover the costs of contraceptive care and screenings. The statute within the ACA does not define what falls under these types of care and screenings. It relies on the Preventive Care Guidelines by the Health Resources and Services Administration to determine what is considered under the contraceptive care umbrella. For years, religious objections questioned the burden this placed on religious organizations to freely exercise their beliefs. As a result, the HRSA eventually made clear that there are rules exempting certain employers with religious objections from this mandate. The state of Pennsylvania then challenged the IFRs (interim final rules) offering exemption on the basis of the Administrative Procedures Act, or APA, considering them to be both “procedurally and substantively” invalid. Soon, the state of New Jersey joined Pennsylvania’s suit and amended the complaint. They believed that the rules were unlawful as they stated the rules were not authorized by the ACA and that the rules failed to comply with the APA’s notice and comment procedures. The District Court soon issued a preliminary national injunction against the IFRs and the Third Circuit affirmed the decision. 

The main issue at hand is whether or not religious exemptions to the contraceptive requirement of the Affordable Care Act should be allowed under the Free Exercise Clause of the First Amendment. If so, the decisions of Pennsylvania, the District Court, and the Third Circuit would be deemed unconstitutional.

To determine the constitutionality of these cases, the Court combined both Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania and Trump v. Pennsylvania in their decision. In July, the Supreme Court reversed the Third Circuit’s decision on a 7-2 majority and decided that the Department of Health and Human Services rightfully created religious exemptions from the requirement of the Patient Protection and Affordable Care Act of 2010 to cover contraceptive care.

The Court overturned the Third Circuit’s decision for two main reasons. One, the Department of Health and Services had the authority under the Affordable Care Act to promote religious and moral exemptions. The Affordable Care Act has no wording within it that concerns what the guidelines should contain and gives the HRSA broad discretion in creating its definitions of “preventive care and screenings” as well as its ability to create religious and moral exemptions. It was also held in this definition that the government had the right to consider the protection for religious liberties regarding this mandate due to the Religious Freedom Restoration Act (RFRA). Two, the rules that the exemptions are based on are free from procedural defects.

I can agree somewhat with the idea of religious exemptions in some cases but it quickly becomes necessary for the Supreme Court to make sure that those exemptions don’t fall down a slippery slope for what can be exempted. The dangerous repercussions of a decision like this one can have startling impacts on the nation in the long run of what can or cannot be considered religious exemptions. It is the inclusion of both religious and moral exceptions that is so worrisome. The difference between religious and moral exemptions needs to be made early on so that the slippery slope does not become out of hand.

As Justice Ginsburg described in her dissenting opinion, there is supposed to be an important balance between the protection of religious liberties and the protection of the rights of those who do not share those views. In allowing moral exemptions to this mandate of the Affordable Care Act, the Court is heavily weighing that balance in favor of those with religious beliefs. Neither the First Amendment nor the Religious Freedom Restoration Act of 1993 (which was mentioned within the majority opinion of the case) condones harm to third parties as a result of their free exercise. If everyone with a moral argument against contraceptive care was to receive an exemption, at least 70,000 women across the United States would lose their access to no-cost contraceptive health services.

While banning religious exemptions can be a violation of the organizations’ rights to freely exercise, the idea of a moral exemption is not. Allowing for moral exemptions is problematic at best and only encourages individuals to force their personal beliefs upon others by claiming everything they do not agree with to have a “moral” exemption. The difference between religious beliefs and moral beliefs needs to have a clearer line so that this type of moral exemption does not become every insurer’s excuse. It becomes a clear question of what is more important to the courts: protecting the religious beliefs of some or protecting the rights of thousands of women’s access to no-cost contraceptive care. While some may disagree, I would argue that the latter is more critical to the overall well being of society and is enough of a compelling state interest to not allow moral exemptions to the requirement.