Brief for HHS etÂ al. Thus, contrary to the dissentâs protestations, it was Congress, not the Departments, that declined to expressly require contraceptive coverage in the ACA itself. 82 Fed. See supra, at 8â9. It is not enough to ask whether noncompliance entails âsubstantial adverse practical consequences.â One must also ask whether compliance substantially burdens religious exercise. of Ind. Reg. See Tr. 39871 (2013). Among the first was the state of Pennsylvania and later joined by New Jersey, which challenged the Government in the United States District Court for the Eastern District of Pennsylvania, asserting that the process violated the Administrative Procedure Act (APA), Title VII of the Civil Rights Act of 1964, and the Equal Protection Clause of the Fourteenth Amendment and the Establishment Clause of the First Amendment of the Constitution. Thus, it is Congress, not the Departments, that has failed to provide the protection for contraceptive coverage that the dissent seeks.8, âNo party has pressed a constitutional challenge to the breadth of the delegation involved here. âThe position advocated by the Government and endorsed by the Court and the opinion concurring in the judgment encounters further obstacles. See 45 CFR Â§147.132. In fact, HHS has already devised and implemented a system that seeks to respect the religious liberty of religious nonprofit corporations while ensuring that the employees of these entities have precisely the same access to all FDA-approved contraceptives as employees of [other] companies.â). The request for comments in the 2017 IFRs readily satisfies these requirements. Additionally, this Court stated in Hobby Lobby that the mandate violated RFRA as applied to entities with complicity-based objections. See Gitlitz v. Commissioner, 531 U.Â S. 206, 220 (2001). The second created a similar âmoral exemptionâ for employers with sincerely held moral objections to providing some or all forms of contraceptive coverage. ), that extension, as just explained, cannot be extracted from the ACAâs text.16. Those Guidelines mandate that health plans provide coverage for all Food and Drug Administration approved contraceptive methods. 25 Â Religious organizations have observed that, under the self-certification accommodation, insurers need not, and do not, provide contraceptive coverage under a separate policy number. See supra, at 8â9. 7734 (2019). âIn these cases, the Court of Appeals held, among other things, (1) that the Little Sisters of the Poor lacked standing to appeal, (2) that the Affordable Care Act (ACA) does not permit any exemptions from the so-called contraceptive mandate, (3) that the Departments responsible for issuing the challenged rule1 violated the Administrative Procedure Â Act (APA) by failing to provide notice of proposed rulemaking, and (4) that the final rule creating the current exemptions is invalid because the Departments did not have an open mind when they considered comments to the rule. That reading of the ACA would create serious tension with Hobby Lobby, which pointed to the self-certification accommodation as an example of a less restrictive means available to the Government, 573 U.Â S., at 730â731, and Zubik, which expressly directed the Departments to âaccommodat[e]â petitionersâ religious exercise, 578 U.Â S., at ___ (slip op., at 4). 57592, codified at 45 CFR pt. See Chevron U.Â S.Â A. Inc. v. Natural Resources Defense Council, Inc., 467 U.Â S. 837, 842â843 (1984); see also Arlington v. FCC, 569 U.Â S. 290, 301 (2013) (holding that Chevron applies to questions about the scope of an agencyâs statutory authority). 57592; see also id., at 57537â57538. The dissent also does notâas it cannotâdispute our directive in Zubik. 77 Fed. Reg. Since the ACAâs passage, â[gainfully employed] [w]omen, particularly in lower-income groups, have reported greater affordability of coverage, access to health Â care, and receipt of preventive services.â Brief for 186 Members of Congress 21. âReligious employers, including petitioner Little Sisters of the Poor Saints Peter and Paul Home (Little Sisters), nonetheless urge that the self-certification accommodation renders them âcomplicit in providing [contraceptive] coverage to which they sincerely object.â Brief for Little Sisters 35. As relevant, the Statesârespondents hereâonce again challenged the rules as substantively and procedurally invalid under the APA. ââOur analysis begins and ends with the text.â Octane Fitness, LLC v. ICON Health & Fitness, Inc., 572 U.Â S. 545, 553 (2014). 83 Fed. Ibid. Ante, at 15. Co., 463 U.Â S. 29, 43 (1983) (internal quotation marks omitted). âUnder RFRA, the Federal Government may not âsubstantially burden a personâs exercise of religion even if the burden results from a rule of general applicability,â unless it Â âdemonstrates that application of the burden to the personâ(1) is in furtherance of a compelling governmental interest; and (2) is the least restrictive means of furthering that compelling governmental interest.â Â§Â§2000bbâ1(a)â(b). Reg. Â§553(b)(3)(B). Particularly in the context of these cases, it was appropriate for the Departments to consider RFRA. See Websterâs Third New International Dictionary 1827 (2002) (Websterâs Third); American Heritage Dictionary 1411 (4th ed. Moreover, the nationwide reach of the injunction âwas ânecessary to provide complete relief to the plaintiffs.âÂ â Trump v. Hawaii, 585 U.Â S. ___, ___, n.Â 15 (2018) (Sotomayor, J., dissenting) (slip op., at 25, n.Â 13) (quoting Madsen v. Women's Health Center, Inc., 512 U.Â S. 753, 765 (1994)). The District Court subsequently granted a temporary injunction on the new HHS rulings, which the Third Circuit upheld, stating that the new rules violated the APA and were unnecessary by both the ACA and the RFRA making them arbitrary and capricious, and ordering a nationwide injunction on their use. âThe same principle applies here. The District Court issued a preliminary nationwide injunction against the implementation of the final rules, and the Third Circuit affirmed. 930 F.Â 3d 543, 576 (CA3 2019). Finally, obtaining care from a government-Â funded program instead of oneâs regular care provider creates a continuity-of-care problem, âforc[ing those] who lose coverage away from trusted providers who know their medical histories.â NWLC Brief 18. âThe second option for women losing insurance coverage for contraceptives is to pay for contraceptive counseling and devices out of their own pockets. âEven assuming that the APA requires an agency to publish a document entitled ânotice of proposed rulemakingâ when the agency moves from an IFR to a final rule, there was no âprejudicial errorâ here. That issue is now ready for resolution, unaffected by todayâs decision. Reg. âJustice Thomas delivered the opinion of the Court. Respondents present two arguments on this score. See 83 Fed. â[O]ne personâs right to free exercise must be kept in harmony with the rights of her fellow citizens.â Hobby Lobby, 573 U.Â S., at 765, n.Â 25 (Ginsburg, J., dissenting). Â âUnder th[e] accommodation, [an employer] can self-certify that it opposes providing coverage for particular contraceptive services. The Departments requested post-promulgation comments on both IFRs. The first IFR significantly broadened the definition of an exempt religious employer to encompass an employer that âobjects .Â .Â . ââ1.Â The Departments had the authority under the ACA to promulgate the religious and moral exemptions. We now send these cases back to the lower courts, where the Commonwealth of Pennsylvania and the State of New Jersey are all but certain to pursue their argument that the current rule is flawed on yet another ground, namely, that it is arbitrary and capricious and thus violates the APA. I would bring the Little Sistersâ legal odyssey to an end. âFor years, religious organizations have challenged the self-certification accommodation as insufficiently protective of their religious rights. (emphasis added). Reg. âFourth, the Courtâs recognition in todayâs decision that the ACA authorizes the creation of exemptions that go beyond anything required by the Constitution provides further evidence that Congress did not regard the provisionÂ of cost-free contraceptives to all women as a compellingÂ interest. (I will call this the âchurch exemption.â) This narrow exemption was met with strong objections on the ground that it furnished insufficient protection for religious groups opposed to the use of some or all of the listed contraceptives. Reg. I would therefore affirm the judgment of the Court of Appeals.28. The Free Exercise Clause simply cannot be understood to require the Government to conduct its own internal affairs in ways that comport with the religious Â beliefs of particular citizens.â Id., at 699.22, âRoy signals a critical distinction in the Courtâs religious exercise jurisprudence: A religious adherent may be entitled to religious accommodation with regard to her own conduct, but she is not entitled to âinsist that .Â .Â . âIn these consolidated cases, we decide whether the Government created lawful exemptions from a regulatory requirement implementing the Patient Protection and Affordable Care Act of 2010 (ACA), 124 Stat. Likewise, though we did not decide whether the self-certification accommodation ran afoul of RFRA in Zubik, we directed the parties on remand to âaccommodat[e]â the free exercise rights of those with complicity-based objections to the self-certification accommodation. âNone of this is to say that the Departments could not issue a valid rule expanding exemptions from the contraceptive mandate. 932, 957 (1919))). Reg. Some of these women may have a greater need for free contraceptives than do women in the work force. We have had a history of accommodation, of tolerance. See Ali v. Federal Bureau of Prisons, 552 U.Â S. 214, 227 (2008); see also Rotkiske v. Klemm, 589 U.Â S. ___, ___ (2019) (slip op., at 6); Husted v. A. Philip Randolph Institute, 584 U.Â S. ___, ___ (2018) (slip op., at 16). Accordingly, respondentsâ second procedural challenge also fails.14. Once it is recognized that the prior accommodation violated RFRA in some of its applications, it was incumbent on the Departments to eliminate those violations, and they had discretion in crafting what they regarded as the best solution. Pp. The ACA does not explicitly exempt RFRA, and the regulations implementing the contraceptive mandate qualify as âFederal lawâ or âthe implementation of [Federal] lawâ under RFRA. This means that HRSA has virtually unbridled discretion to decide what counts as preventive care and screenings. See 78 Fed. 13 Â We note as well that the Departments promulgated many other IFRs in addition to the three related to the contraceptive mandate. This provision was designed âto promote equality in womenâs access to health care,â countering gender-based discrimination and disparities in such access. Nothing in RFRA requires thatÂ a violation be remedied by the narrowest permissibleÂ corrective. âJustice Alito, with whom Justice Gorsuch joins,Â concurring. CBO, Federal Subsidies for Health Insurance for People Under Age 65: 2019 to 2029, pp.Â 15â16 (2019). 22â24. 28844 (statement of Sen. Hagan) (âWhen .Â .Â . See supra, at 13. âTo correct this oversight, Senator Barbara Mikulski introduced the Womenâs Health Amendment,â now codified at Â§300ggâ13(a)(4). For other nonprofit and closely held for-profit organizations opposed to contraception on religious grounds, the agencies made available an accommodation rather than an exemption. The Supreme Court issued a ruling today upholding a pro-life order from President Donald Trump that protected the Little Sisters of the Poor from being force to pay for abortion-causing drugs under their health insurance plan. Moreover, that same rule forced 1,041 health providers, serving more than 41% of Title X patients, out of the Title X provider network due to their affiliation with abortion providers. Reg. Litigation surrounding that requirement has lasted nearly as long. âOur remand in Zubik put these two conflicting interpretations to the test. âThus, as the Departments began the task of reformulating rules related to the contraceptive mandate, they did so not only under Zubikâs direction to accommodate religious exercise, but also against the backdrop of Hobby Lobbyâs pronouncement that the mandate, standing alone, violated RFRA as applied to religious entities with complicity-based objections. It is hard to see how the Departments could promulgate rules consistent with these decisions if they did not overtly consider these entitiesâ rights under RFRA. 16â17. 57536 (2018); id., at 57592. I therefore dissent from the Courtâs judgment, under which, as the Government estimates, between 70,500 and 126,400 women would immediately lose access to no-cost contraceptive services. As Justice Alito acknowledges, however, the critical inquiry has two parts. Brief for Petitioners in No. âThe first optionâthe one suggested by the Government in its most recent rulemaking, 82 Fed. In the Departmentsâ view, the exemption was ânecessary to expand the protectionsâ for âcertain entities and individualsâ with âreligious objectionsâ to contraception. Until that rulemaking occurred, the 2012 rule also provided a temporary safe harbor to protect such employers. 47813, 47854. serve[d] people of different religious faiths.â 78 Fed. as Amici Curiae 22. Section 300ggâ13(a)(4) includes no such exemption. 2 Â The ACA exempts âgrandfatheredâ plans from 42 U.Â S.Â C. The safe harbor covered nonprofits âwhose plans have consistently not covered all or the same subset of contraceptive services for religious reasons.â3 Thus, the nonprofits who availed themselves of this safe harbor were not subject to the contraceptive mandate when it first became effective. See supra, at 18â19.26 Â But that use originated from the ACA and its once-implementing regulation, not from religious employersâ self-Â certification or alternative notice. Chrysler Corp. v. Brown, 441 U.Â S. 281, 297â298 (1979). âThe States also object to the new rule because it makes exemptions available to publicly traded corporations, but the Government is ânot awareâ of any publicly traded corporations that object to compliance with the mandate. The Government next points to the modifier âevidence-informedâ placed in (a)(3), but absent in (a)(4). Brief for HHS etÂ al. Even if the mandate served a compelling interest, the accommodation still would not satisfy the âexceptionally demandingâ least-restrictive-means standard. The statute does not, as Congress has done in other statutes, provide an exhaustive or illustrative list of the preventive care and screenings that must be included. 41324 (final rule explaining that â[t]he Departments believe that the definition adopted in these regulations complies with and goes beyond what is required by RFRA and Hobby Lobbyâ). 578 U.Â S., at ___ (slip op., at 4). Based on this analysis, the Court of Appeals affirmed the nationwide injunction issued by the District Court. contraceptives .Â .Â . 41325 (2015) (the exemption ârecogni[zes] [the] particular sphere of autonomy [afforded to] houses of worship .Â .Â . âUnder the ACA, an employer-sponsored âgroup health planâ must cover specified âpreventive health servicesâ without âcost sharing,â 42 U.Â S.Â C. Â§300ggâ13, i.e., without Â such out-of-pocket costs as copays or deductibles.2 Those enumerated services did not, in the original draft bill, include preventive care specific to women. Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, 591 U.S. ___ (2020), was a United States Supreme Court case involving ongoing conflicts between the Patient Protection and Affordable Care Act (ACA) and the Religious Freedom Restoration Act (RFRA) over the ACA's contraceptive mandate. Cf. Â§2000bbâ3(b). But the dissent points to no case, brief, or rule in the nine years since the church exemptionâs implementation in which the Departments defended its validity on that ground. âSecond, if Congress thought that there was a compelling need to provide cost-free contraceptives for all working Â women, why didnât Congress mandate that coverage in the ACA itself? It strikes a balance between womenâs health and religious opposition to contraception, preserving womenâs access to seamless, no-cost contraceptive coverage, but imposing the obligation to provide such coverage directly on insurers, rather than on the objecting employer. Then, in Wheaton College v. âMost saliently, the language in Â§300ggâ13(a)(4) mirrors Â that in Â§300ggâ13(a)(3), the provision addressing childrenâs preventive health services. Automobile Ins. Together with a diverse network of collaborators, we serve the elderly poor in … 10 Â This opinion uses âBrief for HHS etÂ al.â to refer to the Brief for Petitioners in No. That statute instructs that the âGovernment shall not substantially burden a personâs exercise of religion even if the burden results from a Â rule of general applicability,â unless doing so âis the least restrictive means of furthering [a] compelling governmental interest.â 42 U.Â S.Â C. Â§2000bbâ1(a), (b). Burwell v. Hobby Lobby Stores, Inc., 573 U.Â S. 682, 717 (2014) (noting the oddity of âa publicly traded corporation asserting RFRA rightsâ). First, they took strong exception to the requirement that they maintain and pay for a plan under which coverage for contraceptives would be provided. The Little Sisters, among others, maintained that the accommodation itself made them complicit in providing contraception. But Â RFRA cast a long shadow over the Departmentsâ rulemaking, see ante, at 19â22, and that statute does not apply to those with only moral scruples. Unlike the earlier church exemption, the accommodation did not exempt these religious employers from the contraceptive mandate, but the Departments construed invocation of the accommodation as compliance with the mandate. Foundation, 454 U.Â S. 151, 168 (1981). Here, the pivotal phrase is âas provided for.â To âprovideâ means to supply, furnish, or make available. is simply too attenuated.â Hobby Lobby, 573 U.Â S., at 723â724. When the 2010 IFR was originally published, the Departments began receiving comments from numerous religious employers expressing concern that the Guidelines would âimpinge upon their religious freedomâ if they included contraception. 75 Â Fed. 83 Fed. 57576â57577 (âOf course, some of the[Â ] religiousâ institutions that âdo not conscientiously oppose participatingâ in the accommodation âmay opt for the expanded exemption[,] but others might notâ); id., at 57561 (â[I]t is not clear to the Departmentsâ how many of the religious employers who had used the accommodation without objection âwill choose to use the expanded exemption insteadâ). After seven years of unending legal conflict to save their ministry, the Supreme Court has ruled in favor of the Little Sisters of the Poor 7-2, allowing them to continue serving the elderly poor and dying without threat of millions of dollars in fines. The District Court answered âno,â and preliminarily enjoined the blanket exemption nationwide. Unless otherwise noted, this opinion refers to the religious and moral exemptions together as âthe exemptionâ or âthe blanket exemption.â. The Departments stated that the accommodation aimed to âprotec[t]â religious organizations âfrom having to contract, arrange, pay, or refer for [contraceptive] coverageâ in a way that was consistent with and did not violate the Religious Freedom Restoration Act of 1993 (RFRA), 107 Stat. Reg. But Â the same capacious grant of authority that empowers HRSA to make these determinations leaves its discretion equally unchecked in other areas, including the ability to identify and create exemptions from its own Guidelines. The Little Sisters of the Poor are headed back to the Supreme Court to protect themselves from being force to fund abortions under Obamacare. Automobile Ins. Â§300ggâ13(a)(4)âi.e., âthose [plans] that existed prior to March 23, 2010, and that have not made specified changes after that date.â Burwell v. Hobby Lobby Stores, Inc., 573 U.Â S. 682, 699 (2014). 19 Â Title X âis the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services.â HHS, About Title X Grants, www.hhs.gov/opa/Â title-x-family-planning/about-title-x-grants/index.html. See Zubik v. Burwell, 578 U.Â S. ___, ___ (2016) (perÂ curiam) (slip op., at 4) Â (â[T]he parties on remand should be afforded an opportunity to arrive at an approach .Â .Â . On that question, all the two opinions have in common is equal certainty they are right. Zubik v. Burwell, 578 U.Â S. ___, ___ (2016) (per curiam). of Oral Arg. âCompelling interest. Id., at 47850, 47861â47862. One hundred nine of those plans covering 727,000 people, the Government estimates, will use the religious exemption, while 100 plans covering more than 2.1 million people will continue to use the self-certification accommodation. That âÂ âabsent provision[s] cannot be supplied by the courts,âÂ â ante, at 16 (quoting Rotkiske v. Klemm, 589 U.Â S. ___, ___ (2019) (slip op., at 5), militates against the Courtâs conclusion, not in favor of it. Reg. See Dept. Ultimately, however, we opted to remand the cases without deciding that question. 10 Â The dissent claims that âall agreeâ that the exemption is not supported by the Free Exercise Clause. We have repeatedly stated that the text of the APA provides the âÂ âmaximum procedural requirementsâÂ â that an agency must follow in order to promulgate a rule. In Hobby Lobby, the Government asserted and we assumed for the sake of argument that the Government had a compelling interest in âensuring that all women have access to all FDA-approved contraceptives without cost sharing.â 573 U.Â S., at 727. And Affordable care Act Implementation part 36, p.Â 4 ( 2017 ) providing contraceptives! 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