Tag Archives: Hobby Lobby

The New HHS Regulations Can’t Win A Zero-Sum Game

Image credit:  American EHR Blog

Yesterday the Obama Administration released the long-awaited updates to the regulations that govern the availability of an accommodation for religious objectors to the Affordable Care Act’s contraceptive coverage requirement. They came in two parts:

1. A final interim regulation that allows objecting religiously-affiliated organizations who decline to fill out the original form required for an exemption to instead notify the government in writing that they object and to provide the government the contact information for their insurance company or third-party insurer.This, in effect, is the Wheaton College regulation. After such notification is received HHS will then take on the responsibility of contacting  that insurance company or third-party insurer to inform them that they must provide contraceptive coverage to the eligible employees at no cost to the employer in question. This regulation is effective immediately, but comments may be submitted for 60 days, after which a final regulation will be issued (which may or may not end up differing from the interim final regulation).

2. A proposed regulation to govern the process for closely-held corporations or non-corporate-form businesses to seek an accommodation from the contraceptive coverage requirement. This is the Hobby Lobby regulation. Under the regulation, closely-held for-profit businesses that object would have access to the same accommodation as non-profit organizations (i.e., the insurance company or third-party insurer must provide the coverage at no cost to the eligible employees or the company). The regulation is not in effect yet, and the government is actively seeking comments as to a number of elements, including how the regulations should define a closely-held corporation, and how the administering departments should evaluate the existence and scope of a religious objection (if at all). Comments may be submitted for 60 days, after which the government will issue a final regulation.

If you’re interested in the details of how this will all work, logistically, Marty Lederman has written up a nice concise explanation here; no reason to reinvent the wheel on that score. What I want to draw attention to in this post is the fact that none of these accommodations will satisfy the objectors who seem to believe that any type of notification to the government makes them impermissibly complicit in what they believe to be a sin. This may well turn out to be some of the for-profit businesses as well as some of the non-profit organizations. As I explained when the order was issued, this was always a problem with the logic of the Wheaton College order, and nothing in these accommodations will solve that problem. Instead, at least some of the plaintiffs will continue to maintain their suits on the grounds that nothing apart from a full exemption will satisfy their religious obligations, and the courts will likely end up drawing the line somewhere, which makes the entire Wheaton College order and all this rigamarole seem fairly silly. If courts are going to have to end up telling these plaintiffs that they have to notify the government in some way even if they believe that violates their religious beliefs, then it’s hard to understand why the Supreme Court shouldn’t have just required them to fill out the original form and be done with it. The alternative, that courts will eventually grant blanket exemptions to some of these plaintiffs, is an unacceptable outcome given the great harm that such an exemption would impose on the women covered by the insurance plans at issue.

Kara Loewentheil is the Director of the Public Rights / Private Conscience Project and a Research Fellow at Columbia Law School.

You Can Call It “Grave Moral Evil”, But It’s Still Critical Health Care

Originally posted on the Gender & Sexuality Law Blog on August 14th, 2014. 

Image Credit: Getty
Image Credit: Getty

The words “religious freedom” used to bring to my mind the image of Samah, a girl in Colorado who was denied the right to play soccer while wearing her hijab until her high school teammates all wore them in solidarity to the next game. I used to think of the Christians in Egypt who formed a circle around their praying Muslim neighbors to keep them safe from the surrounding protests in the streets. I thought of individuals asserting their right to religious exercise, of people coming together to advocate for the right to worship free from discrimination. Now, I think of a hypocritical discriminatory craft store and get a very different picture in my head. I imagine the Supreme Court in an episode of Oprah’s Favorite Things, Justice Alito on stage facing Hobby Lobby executives and Wheaton College administrators: “And you get an accommodation! And you get an accommodation!” Except in this episode the women are furious, some are facing unwanted pregnancies, and the only gift under their chairs is the Bible.

When promulgating new regulations implementing the Affordable Care Act, the Department of Health & Human Services (HHS) included an accommodation form for religiously affiliated institutions and non-profit organizations, to allow them to refrain from paying for coverage of contraceptives if they had a religious objection to doing so. The regulations required the objecting organization to send a designated form to HHS and a copy to their third-party insurer, which was designed to let the insurer know that it must supply contraceptive coverage separately to plan members at no cost to the organization or the insured individuals. In the Hobby Lobby Supreme Court case, Justice Alito, writing for the majority, held that the non-profit accommodation had to be extended to closely held for-profit corporations. The extension of an already broad religious exemption delivered hope to the plaintiffs of many similar cases suggesting that they too might receive special treatment for their beliefs.

One problem with this decision is that exempting Christian organizations doesn’t just affect Christian people. Unlike houses of worship, religiously affiliated non-profits often employ workers who do not share the religious beliefs of their employers. Some hospital systems are religiously affiliated non-profit organizations, for instance, and may employ thousands of people with diverse beliefs. Another problem is that even organizations allowed to use the exemption have sued, saying that even the exemption violates their rights. Shortly after the Hobby Lobby decision came down, the Supreme Court issued a temporary order in favor of Wheaton College, a Christian school whose administrators object to providing emergency contraceptive coverage to employees and students. Wheaton claimed that even the paperwork for the accommodation was a burden on its religious exercise because “authorizing its [third-party administrator] to provide these drugs in [its] place makes it complicit in grave moral evil.”[1] The Court’s injunction allows Wheaton College to refuse to file the form with HHS and its insurance company and allows it to simply inform HHS in some written form of its objection, without having any obligation to inform its insurance company. This decision requires HHS to restructure how they manage accommodations so that they can handle more incoming requests.

The danger that women will slip through the cracks when it comes to a college or university affects not only employees, but also students who may have fewer resources for protecting their reproductive health. If a student is looking to purchase emergency contraception, shouldn’t he or she be able to do so without having to go through confusing roundabout coverage? Studies have shown that even moderate copays for health services can result in an individual not obtaining the care they need.

Where will the accommodations end? Laws that allow the very thing they are prohibiting cannot be effective, and they encourage discrimination and endanger citizens. As for the Supreme Court, the majority of the men on the bench seem to hold the claims of religious employers in high esteem, addressing the needs of the Hobby Lobby employees in just a few sentences[2]. The decision to grant Wheaton’s injunction demonstrates that the Court is venturing further into the minefield Justice Ginsburg warned of in her dissent from the Hobby Lobby decision,[3] and further and further away from the ideals for which our courts and country should stand.

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[1] Burwell v. Wheaton College, page 10 http://www.supremecourt.gov/opinions/13pdf/13a1284_ap6c.pdf 

[2] Burwell v. Hobby Lobby, page 45 http://www.supremecourt.gov/opinions/13pdf/13-354_olp1.pdf 

[3] Burwell v. Hobby Lobby, page 94 http://www.supremecourt.gov/opinions/13pdf/13-354_olp1.pdf   

Sasha Conley is the Public Rights / Private Conscience Project Summer Junior Fellow and a rising junior at Hampshire College.

What a Difference Three Days Makes: The Hobby Lobby Fallout Arrives

Originally posted on the Gender & Sexuality Law Blog on July 3rd, 2014.

The Supreme Court is supposed to be the final word on our legal questions, but apparently it reserves the right to change its mind at a moment’s notice. When the Supreme Court issued its opinion in Burwell v. Hobby Lobby Stores on Monday June 30th, holding that the Religious Freedom Restoration Act required the government to allow for-profit businesses with religious objections to contraceptives to opt out of complying with the Affordable Care Act’s contraceptive coverage requirement, the majority opinion stressed at length the idea that the law was not narrowly tailored because the government could have offered for-profit businesses the same accommodation available to non-profit religiously-affiliated organizations. Under the regulations implementing the ACA, religiously-affiliated non-profit organizations are allowed to certify that they object to providing insurance coverage for contraception. They send that form to the government and to their insurance company, at which point their insurance company is required to pay for the coverage out of its own funds. The majority opinion relied on the existence of this program as proof that the government had a better option available to achieve its goal of universal contraceptive coverage. As Justice Alito wrote, that accommodation “does not impinge on the plaintiffs’ religious belief that providing insurance coverage for the contraceptives at issue here violates their religion, and it serves [the government’s] stated interests equally well.”[1]

One might have thought this meant that the accommodation was, in fact, a legally acceptable system that would withstand a challenge under RFRA (given the lack of enforcement or monitoring in the regulation, it’s far from a morally acceptable system anyway). But only three days later the Supreme Court has issued an order temporarily enjoining the government from enforcing the requirement that a non-profit religiously-affiliated organization certify that it objects to coverage. There are almost 80 cases pending in the lower federal courts brought by non-profit organizations that claim that even signing the certification form is a substantial burden on their free exercise, because they believe that signing the form “triggers” the insurance company to provide the contraceptives and thereby makes them – the nonprofit organization – complicit. And not just complicit, but so complicit it violates their religious freedomLet me just be clear again, we’re talking about signing a form, the entire purpose of which is to excuse the organization from being required to pay for contraceptive coverage. The majority held that these organizations need not sign the form nor send the required notifications. Instead the majority arbitrarily rewrote the applicable regulations, making it the government’s responsibility to make sure that women receive seamless contraceptive coverage once they have received some kind of undefined written notice that an organization objects. (One presumes that a scrawled note on a cocktail napkin will suffice).

So why should we care? After all, what does it matter whether the organizations have to sign a form or send some other kind of written notice? It matters for a few reasons. First, it matters for the actual women employed by these religiously-affiliated organizations, which includes Catholic hospitals, religiously-affiliated universities, and other large complicated institutions that employ thousands and thousands of women. The accommodation already suffered from a lack of monitoring and enforcement mechanism, and now objecting institutions need not even sign a standard form, and the government is supposed to somehow ensure that all these women don’t fall through the cracks, if it chooses to do so – the order doesn’t require it to do so, and neither do the current regulations. We can hope for the best, but should be prepared for the worst on that front.

The dangers of this order go far beyond those women though. Misguided as the opinion in Hobby Lobby was – inaccurate and poorly-reasoned though it might have been – at least the objectors were arguably requesting relief from an actual legal requirement.[2] The objectors in these non-profit cases are already being given an accommodation. The idea that signing a form that allows one to get an exemption can itself be a substantial burden on one’s free exercise boggles the mind. It makes a mockery of the substantial burden standard – forget the word “substantial,” even of the word “burden.” It effectively deprives the test under RFRA of any real meaning, and hollows out the court’s evaluative role in adjudicating these claims. If signing a form that gives you access to an exemption is a substantial burden, then anything is a substantial burden, and there’s absolutely no check on what religious objectors can refuse to do.

The only silver lining is that these cases – and this result – make clear what we have long suspected: religious objectors to the contraceptive coverage requirement (and other equality measures) aren’t looking for a reasonable compromise. They are looking to reject secular governmental authority altogether in favor of obedience to a religious law, regardless of the fact that the vast majority of the actual individuals affected do not share their religion or their beliefs. It’s the tyranny of the minority, and it looks like it may be here to stay.

[1] Burwell v. Hobby Lobby Stores, slip. op. at 34 (available at http://www.supremecourt.gov/opinions/13pdf/13-354_olp1.pdf)

[2] I say arguably because there was a strong argument in the case, first proposed by Marty Lederman but not accepted by the majority, that in fact there was no legal requirement to provide insurance coverage for contraception – rather there was a choice to provide comprehensive coverage or to provide no coverage and pay a tax to subsidize insurance on public exchanges instead. See e.g. Marty Lederman, http://balkin.blogspot.com/2013/12/hobby-lobby-part-iiitheres-no-employer.html.

Kara Loewentheil is a Research Fellow at Columbia Law School and the Director of the Public Rights / Private Conscience Project in the Columbia Center for Gender and Sexuality Law. 

In the Wake of the Hobby Lobby Ruling, What’s Next?

Originally published in Feministing on July 1st, 2014, cross-posted on the Gender & Sexuality Law Blog  on July 1st, 2014.

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Yesterday the Supreme Court ruled that some for-profit businesses do not have to comply with the Affordable Care Act’s requirement ensuring contraceptive coverage at no cost to the insured. The plaintiffs in these cases – and in almost 50 other cases filed making similar claims – claimed that providing coverage for various forms of birth control violates their rights under the Religious Freedom Restoration Act (“RFRA”), a federal statute that provides additional protections for religious believers beyond the minimum required by the First Amendment.

The Court’s decision held that (1) closely-held corporations (meaning that most of the shares are privately held by a small group of owners, and stock is not usually publicly traded) have religious free exercise rights under RFRA, (2) having to pay for contraceptive coverage would be a “substantial burden” on the plaintiffs (even though they could just choose to pay a tax to subsidize public insurance exchanges on which their employees could purchase comprehensive insurance instead), and (3) even if the government interest in providing comprehensive contraceptive coverage was “compelling,” the law was not “narrowly tailored” – meaning that the government could have achieved the goal in a different way that would not have violated the plaintiffs’ religious rights.

There’s plenty to argue with in that analysis – and Justice Ginsburg wrote a masterful dissentdoing just that – but what’s done is done. So what comes next? 

There are three big unknowns.

First, we don’t know how broadly this opinion reaches, or how slippery the slope downhill could be. The Court repeated several times in the opinion that it was only deciding the particular question here (contraceptive coverage, closely-held corporations, etc.) but there aren’t any principled reasons in the opinion to cabin it to that question. Why wouldn’t the same principles apply to a company that didn’t want to cover, say, blood transfusions (to which Jehovah’s Witnesses object) or psychiatric medication (to which Scientologists object) or even vaccines? And it’s not just insurance coverage at issue – it’s sex discrimination, race discrimination, sexual orientation, and gender identity discrimination, among other issues. What about a company whose owners believe men should be paid more than women because the bible teaches that men are the heads of the household? (True story, those cases have been brought before). Or a company whose owners believe that LGBT individuals shouldn’t marry or reproduce? (We’re all too familiar with that refrain). Or even a company who believes that African-Americans and Jews should not work with Caucasian Christians? (As many companies did in the Jim Crow era). Some of these scenarios may seem far-fetched, but there are no safeguards in the court’s opinion to prevent this expansive reading of RFRA from being used as a backdoor wedge to start undermining a lot of the civil rights protections we now take for granted.

Second, we can only guess how this ruling will affect the legal and social status of contraception – and the guessing doesn’t look good. We’re all too familiar with “abortion exceptionalism” – the way that abortion is considered “different” from other forms of health care, from other categories of rights, and from other indicators of equality. These cases are part of a concerted legal and social effort by anti-choice advocates to blur the boundaries between contraception and abortion and to taint contraception with the social controversy and stigma of abortion. In these opinions, contraception is isolated. It’s singled out from all other forms of medical care, and it’s singled out from other equality rights – and that makes it vulnerable to legal and social attacks on access from all sides. And that’s nothing to look forward to.

And finally, we don’t know what will happen next in the courts – or what the government will do in response to the decision. There are almost 50 cases in the lower federal courts filed by similar corporations that, after this decision, are probably now all going to be decided in favor of the religious objectors. Then there are over 80 cases filed by religiously-affiliated nonprofits that don’t even want to certify that they object because they say just signing the form violates their free exercise rights. And outside the courts, the Administration and/or Congress will have to decide whether and how to respond. The Court’s opinion was very clear that the accommodation that the Administration has offered to non-profit religiously-affiliated organizations (which allows them to certify that they object to providing coverage for birth control and then requires their insurance company to pay for it instead) would have been a “better” alternative because it would have maintained free access to contraceptives while not burdening the religious exercise of the business owners who sued. So the Department of Health and Human Services might be able to issue regulations making that change, or the Administration might be able to come up with some other way of ensuring coverage through executive action, or Congress might be able to amend the Affordable Care Act or pass stand-alone legislation providing national contraceptive coverage. There are a lot of options, but we don’t know yet which ones will transpire.

And if there’s no fix, then all those female employees of the objecting businesses will have to pay for their own birth control or will have to purchase private insurance on an insurance exchange that actually provides comprehensive coverage. As far as the majority opinion of the Supreme Court is concerned, that’s just the price of doing business.

Kara Loewentheil is a Research Fellow at Columbia Law School and the Director of the Public Rights / Private Conscience Project in the Columbia Center for Gender and Sexuality Law. 

Religious Accommodations Cost More Than Money

Originally published in Balkinization on March 26th, 2014.  Cross-posted on the Gender & Sexuality Law Blog on March 26th, 2014.

Yesterday the Supreme Court heard arguments in the consolidated cases of Hobby Lobby and Conestoga Wood. With the publication of the full argument transcript online, it became clear that even the experienced lawyers arguing these cases – along with the Supreme Court Justices themselves – were struggling to understand how to think about the relationship between religious accommodations and third party rights. In this context, that means the impacts that accommodations granted to religious employers would have on their female employees who would otherwise have access to contraception without cost-sharing under the Affordable Care Act’s contraceptive coverage requirement (and indirectly on their partners and children).

This came as no surprise to me. In When Free Exercise Is A Burden: Protecting “Third Parties” In Religious Accommodation Law, a paper I authored that is shortly forthcoming in the Drake Law Review, I argue that neither scholars nor courts have thus far provided a satisfying account of how to balance free exercise rights against the impact of those rights on “third parties.” In the paper I provide a thorough analysis of the existing case law on this issue and propose both a novel framework for balancing such rights as well as insight into how to better utilize the existing constitutional and statutory doctrine toward this end.

In this short post, however, I simply want to draw attention to one particularly overlooked element of the contraceptive coverage requirement that can only be understood in relation to the “third parties” (female employees) in this case. The arguments yesterday focused entirely on the practical benefit of the contraceptive coverage requirement, and analyzed everything – from the compelling interest the government advanced to the effect of already-existing exemptions – in terms of the tangible access or lack of access to contraception for the women affected. But law has more than practical impacts – it has important expressive impacts that are explicitly meant to, and do, shape social norms and priorities. In my paper I argue that the contraceptive coverage requirement has an enormously important expressive element – it signifies a social and political commitment to women’s social and economic equality, and symbolizes an acceptance of social and shared responsibility for gender equality. The importance of contraception to women’s equality has been recognized by the Supreme Court, and is featured prominently in the Government’s briefing on its compelling interest in the law. That equality is impossible to achieve without access to contraception. In that light, allowing religious accommodations without ensuring seamless and no-cost contraceptive access for the employees of objectors would be inflicting a serious expressive and dignitary harm.

Now compare that understanding to this exchange on pages 37-38 of the transcript. It comes in the midst of a dialogue between Clement, arguing for the objecting plaintiffs, and Justice Kagan during yesterday’s argument, in which Clement distinguishes between the effect of race discrimination on a prospective employee and the effect of religious exemptions on women seeking contraception:

Now, each of those has a burden on third parties, but I would respectfully suggest they’re different.  In the case of the employee who’s been subject to racial discrimination, even if they can get another job, that racial discrimination is a unique injury to them that you can’t remedy unless you tell the employer, don’t discriminate on the basis of race. . . . Here . . . all we’re really talking about is who’s going to pay for a subsidy that the government prefers. This is not about access to the contraception.  It’s about who’s going to pay for the government’s preferred subsidy.

Clement’s description of what’s at stake is as minimal as can be: it’s just who is going to pay for contraception. It’s just a matter of money, with no expressive or dignitary implications. What is fascinating about this set-up is that Clement specifically contrasts this case to a race discrimination case, in which he happily admits that an employee discriminated against on the basis of race would have a recognizable harm apart from not getting the job. What kind of harm could that be? Obviously it’s a dignitary harm, a “unique injury” that exists “even if they can get another job.” Contraception, on the other hand, is positioned as simply a consumer good in the market, with absolutely no greater purpose or significance. (Which is ironic, of course, since part of his argument is that his clients view it as a sin.)

This focus on expressive norms and purposes is not just theory-talk. It has direct implications for the way we understand the details of the doctrinal standards as well. In the second half of the argument the conservative justices hammered General Verrilli, arguing for the Government, on how the Government’s interest in the contraception coverage requirement could be compelling when there were allegedly various other exemptions in the law, including for companies with fewer than 50 employees, religious organizations, and grandfathered plans. Verrilli did his best to defend the exemptions, noting that (1) companies with fewer than 50 employees are exempted from providing all health insurance but must cover contraception if they choose to offer health insurance, (2) religious organizations are exempted if they are houses of worship but are only offered an accommodation that ensures access if they are religiously-affiliated nonprofits, and (3) that the grandfathered plans will decrease over the next several years until very few, if any, remain.

The conservative justices were particularly obsessed with the grandfathered plans, and Verrilli had a bit of a difficult time explaining why the practical impact of leaving millions of women without contraceptive access during the intervening years did not undermine the Government’s compelling interest. Embracing the expressive import of the contraception coverage requirement, however, would have cast the exemptions in an entirely different light. The expressive message of exempting small businesses from health care coverage requirements generally is far different than if contraceptive coverage was singled out from those policies. Similarly, the exception for grandfathered plans reads, expressively-speaking, as an administrative transition matter affecting all preventative health care coverage, along with other of the law’s requirements, not as a judgment about the importance of contraception. The religiously-affiliated organizations, meanwhile, are subject to an accommodation that ensures seamless coverage for women in their employ; it is true that the lack of an adequate enforcement mechanism sends a troubling expressive message about the importance of this right, but the core signal of the accommodation is to affirm the Government’s commitment to contraceptive access, not to undermine it.

In other words, understanding the expressive impact of the law reframes the question of the baseline, helping us understand the compelling interest and narrow tailoring tests in a deeper, more coherent way. Such a perspective also has implications for the First Amendment analysis when it comes to whether a law is neutral or generally applicable, but like the Court I leave those questions for another day.

Kara Loewentheil is a Research Fellow at Columbia Law School and the Director of the Public Rights / Private Conscience Project in the Center for Gender and Sexuality Law.