A coalition of seven state attorneys general has joined with a nun, a Catholic missionary and three Roman Catholic organizations to file a federal lawsuit in Lincoln, Neb., asking a judge to strike down HHS' final rule that requires insurance plans to cover government-approved contraceptives.

The lawsuit (PDF) alleges that the contraception rule violates three clauses in the First Amendment as well as the federal Religious Freedom Restoration Act by forcing Catholic employers to either subsidize services and drugs they find morally objectionable or essentially withdraw from the insurance market.

For example, Catholic missionary and Omaha resident Stacy Molai said she would rather drop her current Cigna health plan, which does not have contraceptive coverage, than be forced to pay for a plan that allows services for others, which she finds objectionable—even though she has an incurable chronic disease. 

“Health insurance coverage is critical to Molai in order to avoid financial ruin and possibly life-threatening consequences,” the lawsuit says. “However, she would drop such coverage if it would result in her subsidization of contraception, abortifacients, sterilization and related services.”

The employers argue that they would have to screen their employees' religious beliefs if the rule is upheld, or decide to drop coverage, which the lawsuit says would result in more beneficiaries going onto Medicaid.

The state attorneys general that filed the lawsuit are Nebraska's Jon Bruning, South Carolina's Alan Wilson, Michigan's Bill Schuette, Texas' Greg Abbott, Florida's Pam Bondi, Ohio's Michael DeWine, and Oklahoma's Scott Pruitt. The other plaintiffs are Molai, Sister Mary Catherine of Lincoln, Catholic Social Services in Lincoln, Pius X Catholic High School in Lincoln, and the Catholic Mutual Relief Society of America in Omaha.

Federal officials were not immediately available to comment on the litigation. 

HHS announced in January that many Catholic organizations would have to start offering contraception coverage through their insurance plans as part of a requirement in the Patient Protection and Affordable Care Act that non-grandfathered group insurance plans offer preventive health services without cost sharing.

But earlier this month, the Obama Administration announced changes in the rule that said insurers, not employers, would have to offer those services. The changes failed to mollify many critics of the rule, including the U.S. Conference of Catholic Bishops.

Officials with the Catholic Hospital Association, who supported the reform law despite opposition from the bishops, initially said they were “disappointed” with the rule. After the revisions were announced, the association said it would begin a careful review of notifications that “our organizations would not have to buy or refer employees for contraception and other services.”

Several other Catholic organizations have already filed lawsuits to strike down the requirement in other jurisdictions, all of which are backed by the Becket Fund for Religious Liberty in Washington. Those include a lawsuit filed this week by Ave Maria University in Naples, Fla.