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Religious Employers Granted Permanent Injunction Against Enforcement of Contraceptive Coverage Mandate as HHS Concedes Violation of RFRA




Christian Employers Alliance v. Azar, 2019 WL 2130142 (D. N.D. 2019)

In a long-running challenge to the Affordable Care Act mandate that health plans cover all FDA-approved contraceptive methods, including abortifacients (contraceptives that prevent a fertilized egg from implanting in the uterus rather than preventing conception), a federal trial court has ruled that the mandate violates the Religious Freedom Restoration Act (RFRA) and issued a permanent injunction to an alliance of religious employers. As background, qualifying religious employers are exempt from the mandate, and certain other employers with religious objections to contraceptives may engage in an accommodation process relieving them of their coverage obligation (see our Checkpoint article). Final regulations expanded the exemption to include additional individuals and entities based on sincerely held religious beliefs, as well as others objecting to coverage based on sincerely held moral convictions (see our Checkpoint article). However, those regulations were blocked from enforcement by a nationwide preliminary injunction (see our Checkpoint article).

In 2016, the court granted a temporary restraining order to this group of employers. However, further action in the case was stayed, pending either the outcome of a similar case in the controlling federal appellate court or resolution of the issue by legislative, regulatory, or executive action. After the final regulations were issued and the appellate court case had been dismissed, the court considered the employers’ request for a permanent injunction, and HHS acknowledged that requiring employers with sincerely held religious objections to comply with the mandate would violate the RFRA. Based on this concession, the court ruled that a permanent injunction is warranted.

EBIA Comment: Although injunctions currently block enforcement of the expanded exemption, challenges to the contraceptive coverage mandate persist in the courts. It will be interesting to see if HHS continues to concede on the RFRA issue while the cases blocking the final regulations proceed through the courts. For more information, see EBIA’s Health Care Reform manual at Section XII.C (“Coverage of Preventive Health Services”) and EBIA’s Group Health Plan Mandates manual at Section XIV.E (“Contraceptive Coverage: Exemptions and Accommodations Based on Religious Beliefs and Moral Convictions”). See also EBIA’s Self-Insured Health Plans manual at Section XIII.C.1 (“Preventive Health Services”).

Contributing Editors: EBIA Staff.

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