The Obama administration cannot force a Missouri lawmaker and his family to carry health insurance that includes contraception coverage despite the Affordable Care Act's requirement that insurers cover birth control, a federal judge ruled Thursday.
U.S. District Judge Jean C. Hamilton said Thursday that HHS may not compel Republican state lawmaker Paul Joseph Wieland, his wife Teresa Jane Wieland or their insurer to include contraception coverage in their health plan. The ACA's contraception mandate otherwise requires group health plans and insurers to cover contraceptives and sterilization procedures.
The Wielands had argued that as Catholics they oppose the use of contraceptives, sterilization and abortifacients. They said paying for or participating in a health plan that includes such coverage violates their religious beliefs. The Weilands receive insurance though the state's Missouri Consolidated Health Care Plan as an employment benefit.
Attempts to reach Wieland and his attorneys for comment were not immediately successful Thursday afternoon. A Justice Department spokeswoman said the administration was reviewing the order and considering its options.
The decision represents yet another blow to the ACA's contraception mandate in court. In May, the U.S. Supreme Court punted cases (PDF) back to lower courts over how religious not-for-profits must respond to the mandate. The religious not-for-profits had argued that requiring them to formally notify the government or their insurers that they wanted to opt out of the mandate violated their religious beliefs because it made them complicit in helping the government arrange other coverage for their employees. The Supreme Court told lower courts to find compromises between the two sides.
Also, in 2014, the Supreme Court ruled in the Hobby Lobby case (PDF) that the government cannot force closely held companies to cover birth control for employees over their owners' religious objections.
In this latest case decided Thursday, the government had argued that requiring the Wielands to subscribe to a group health plan that covers services, such as contraception, that the family won't use because of religious reasons, isn't a substantial burden on the family.
The court, however, disagreed.
Hamilton wrote that the ACA's contraception mandate requires the Weilands to either violate their religious consciences or drop their health insurance, which would lead to fines and other consequences. She said the mandate imposes a substantial burden on the Wielands' religious beliefs in violation of federal law.
“The ultimate impact is that Plaintiffs must either maintain a health insurance plan that includes contraceptive coverage, in violation of their sincerely-held religious beliefs, or they can forgo healthcare altogether, which will result in the imposition of significant penalties (not to mention the potentially crippling costs of uninsured health care),” the judge wrote.
The government had also argued that the nation's insurance markets wouldn't be able to function if insurers had to tailor each health plan to each individual's needs and preferences.
But the judge said the ACA is fundamentally different from other government programs such as Medicare and Social Security, in that the government does not provide the insurance. It can be left up to insurers to decide whether or not to offer contraceptive-free plans, the judge wrote. The judge agreed with the Wielands' assertion that the government could allow individuals to check a box to opt out of contraceptive coverage.
Douglas Laycock, a law professor at the University of Virginia and expert on religious liberty law, said in an email that he believes the government will appeal the case.
He said he doesn't see how insurers could set up separate pools for beneficiaries who want contraception coverage and those who don't. Laycock also, however, said it makes sense, as the court suggested, to let insurance companies figure out what they can offer.
“If it's unworkable, as the government says and I suspect, the insurers won't do it, and the plaintiffs will have no remedy,” Laycock wrote. “If it is workable, or maybe only if it is essentially cost free or can be turned into a profit center, maybe the insurers will do it.”
The judge emphasized Thursday that her order does not prevent enforcement of any law or regulation against any insurer in the individual market when it comes to plans offered to anyone other than the Wielands.
The case has already taken a number of twists and turns. Last year, a three-judge panel of the 8th U.S. Circuit Court of Appeals ruled that the Wielands had standing to sue over the mandate, reversing a lower court's ruling on the standing issue. At that point, the case proceeded to the district court that made the decision Thursday.
