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Eighth Circuit Holds State Government Employee Has Standing to Challenge ACA’s Contraceptives Coverage Mandate

A member of the Missouri House of Representatives had standing to challenge the Affordable Care Act’s (ACA’s) contraceptive coverage mandate, the Eighth Circuit held. (Wieland v. U.S. Department of Health and Human Services (2015, CA8) 2015 WL 43935722015)


ACA requires providers of health insurance, including companies that administer self-insured employer health plans, to cover certain preventive services without cost to the insured. With respect to women, such coverage includes all Food and Drug Administration approved contraceptive methods.

As a member of the Missouri House of Representatives, Paul Wieland, a Roman Catholic, obtained healthcare coverage for himself and his family through the Missouri Consolidated Health Care Plan (MCHCP), a group healthcare plan made available to him by his employer, the State of Missouri. Whereas before August 1, 2013, MCHCP offered Wieland an opportunity to opt out of coverage for contraceptives under state law, Missouri and MCHCP discontinued offering the opportunity to opt out of such coverage following the decision in Missouri Insurance Coalition v. Huff.

In Huff, health insurers and insurance-industry groups sought a declaratory judgment that certain provisions of Missouri statutes, which required health insurers offering plans in Missouri to offer employers plans that excluded coverage for contraceptives if such coverage was contrary to the employer’s and/or an employee’s religious beliefs, were preempted by ACA. The district court in Huff held that these provisions were preempted by ACA under the Supremacy Clause of the U.S. Constitution.Missouri did not appeal the Huff decision, and on August 1, 2013, MCHCP placed the Wielands in a healthcare plan that included coverage for contraceptives.

Then, in July 2014, the U.S. Supreme Court held inBurwell v. Hobby Lobby Stores, Inc. (see Pension and Benefits Week ¶  6  07/07/2014) that the Religious Freedom Restoration Act of 1993 (RFRA) prohibited the government from enforcing ACA and its implementing regulations that required closely held corporations to provide health-insurance coverage for methods of contraception that violate the sincerely held religious beliefs of the companies’ owners.

Although certain religious nonprofit organizations may qualify for an accommodation from the contraceptives mandate, as may closely held corporations whose owners have religious objections to the mandate, MCHCP did not qualify for these, or any other, exemptions or accommodations, and was thus subject to the mandate.

District court proceedings.

The Wielands filed a complaint against the U.S. Department of Health and Human Services (HHS), generally contending that HHS’s enforcement or threatened enforcement of certain provisions of ACA that did not apply to individuals, but were instead applicable to group health plans, caused MCHCP to place the Wielands in a healthcare plan that included coverage for contraceptives, thereby forcing them to provide that coverage to their dependent daughters in violation of their religious beliefs. The Wielands also challenged an interim final rule (mandate) that required all group health plans offering group or individual health insurance coverage to provide coverage for contraceptives on the grounds that the mandate violated their rights under the RFRA, the Free Exercise, Free Speech, and Due Process Clauses of the U.S. Constitution, together with the Administrative Procedure Act, by forcing them to provide their daughters with contraceptives coverage.

Specifically, the Wielands sought a declaration that the mandate and HHS’s enforcement of the mandate against them violated their rights, and an order prohibiting HHS from enforcing the mandate against them. Claiming that if the requested relief were granted, Missouri and MCHCP would offer them a healthcare plan without coverage for contraceptives or an opportunity to opt out of such coverage, the Wielands also sought a temporary restraining order (TRO) and a preliminary injunction prohibiting HHS from requiring that the Wielands’ health plan contain coverage for contraceptives.

HHS moved to dismiss the complaint for lack of standing on the grounds that the Wielands were challenging provisions of ACA that did not apply to them, and were seeking an injunction prohibiting HHS from enforcing the mandate against MCHCP and, ultimately, the State of Missouri, neither of which was a party to the case.

The district court agreed with HHS, and concluded that even if the court granted the Wielands the relief they had sought, whether the Wielands would ultimately be offered a contraceptive-free healthcare plan was linked with the independent discretionary actions of the state and MCHCP, neither of which was a party to the action before the court.Concluding that the Wielands had not met their burden to establish standing, the district court dismissed the Wielands’ complaint with prejudice, and without reaching the merits of the case. The district court also ruled that the Wielands’ failure to establish standing was fatal to their motion for declaratory and injunctive relief, and denied their motion for relief as well.

The Wielands filed a notice of appeal from the district court’s order, and also moved for a preliminary injunction pending appeal. HHS opposed the motion for a preliminary injunction, and an administrative panel of the Eighth Circuit denied the Wielands’ motion.

Eighth Circuit analysis and holding.

Reviewingde novothe district court’s grant of HHS’s motion to dismiss for lack of standing, the court noted that federal court jurisdiction is restricted to “cases and controversies,” which exist only if a plaintiff has personally suffered some actual or threatened injury as a result of the putatively illegal conduct of a defendant. To satisfy its burden of proof, a plaintiff must show: (1) that he has suffered an injury in fact that is actual or imminent, not conjectural or hypothetical; (2) that the injury is causally connected to the defendant’s allegedly illegal conduct and not to the independent action of some third party not before the court; and (3) that it is likely, as opposed to merely speculative, that the injury would be redressed by a favorable decision. A plaintiff’s burden to establish standing depends on the stage of litigation, and whereas at the pleading stage, general factual allegations may suffice, on a motion to dismiss, it is presumed that general allegations embrace those specific facts that are necessary to support the claim.

Here, the Wielands’ injury was fairly traceable from HHS’s enforcement or threatened enforcement of the mandate, to MCHCP, and to the Wielands, according to the court.In the court’s view, the Huff decision merely put Missouri and MCHCP on notice that HHS’s enforcement of the mandate would result in significant penalties in the event that MCHCP continued offering contraceptive-free healthcare plans under relevant Missouri law. The Huff decision simply clarified that the Missouri law’s opt-out provisions were preempted by federal law. Thus, it was the federal law itself—the mandate—that was the but-for cause of the change in the Wielands’ healthcare plan, the court said.

There was no discretion involved in MCHCP’s decision to include coverage for contraceptives, according to the court. Missouri and MCHCP were required by federal law, by the mandate, to include such coverage in all healthcare plans they offered, including the Wielands’ healthcare plan. The court therefore concluded that the Wielands had established a sufficient causal connection between their injury and HHS’s enforcement of the mandate to satisfy the causation element of standing.

Since an injunction would have prohibited HHS from enforcing the mandate against MCHCP, and would have resulted in MCHCP offering the Wielands a contraceptive-free health care plan under Missouri law, the court also concluded that the Wielands had sufficiently alleged that it was more than merely speculative that their injury would have been redressed if they had been granted the remedy they sought.

As the continued validity of the Huff decision was a matter that had to be addressed in light of the U.S. Supreme Court’s decision in Hobby Lobby, the court reversed and remanded to the district court for further proceedings to determine whether Huff remains good law after Hobby Lobby. If Hobby Lobby overruled Huff, the Missouri law’s opt-out provision would again be available, and MCHCP would be required to comply with the statutory provision, the court posited.