Little Sisters of the Poor Home for the Aged v. Sebelius

6 F. Supp. 3d 1225, 2013 WL 6839900, 2013 U.S. Dist. LEXIS 180867
CourtDistrict Court, D. Colorado
DecidedDecember 27, 2013
DocketCivil Action No. 13-cv-2611-WJM-BNB
StatusPublished
Cited by15 cases

This text of 6 F. Supp. 3d 1225 (Little Sisters of the Poor Home for the Aged v. Sebelius) is published on Counsel Stack Legal Research, covering District Court, D. Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Little Sisters of the Poor Home for the Aged v. Sebelius, 6 F. Supp. 3d 1225, 2013 WL 6839900, 2013 U.S. Dist. LEXIS 180867 (D. Colo. 2013).

Opinion

ORDER DENYING IN PART DEFENDANTS’ MOTION TO DISMISS AND DENYING PLAINTIFFS’ MOTION FOR PRELIMINARY INJUNCTION

William J. Martinez, United States District Judge

In this case, Catholic religious organizations challenge the regulations implementing the Patient Protection and Affordable Care Act, Pub.L. 111-148, specifically the requirement that group health care plans provide all women coverage for certain preventative contraception services without a co-payment or deductible.

Before the Court are the following: (1) Plaintiffs’ Motion for Preliminary Injunction (ECF No. 15); and (2) Defendants’ Motion to Dismiss or, in the alternative, for Summary Judgment (ECF No. 30). For the reasons set forth below, the Court finds that Plaintiffs have standing to bring this action and, therefore, the standing portion of the Motion to Dismiss is denied. The remainder of the issues raised in the Motion to Dismiss remain pending and will be ruled on by way of subsequent order. The Court also denies Plaintiffs’ Motion for Preliminary Injunction.

I. BACKGROUND

A. History of the Challenged Regulations

The Patient Protection and Affordable Care Act (the “ACA”) requires that group health insurance plans cover certain preventative medical services without cost-sharing, ie., a co-payment or a deductible. Among the preventative services that must be covered are contraception, sterilization, and related counseling (the “Mandate”). As set forth in more detail below, the Mandate results from extensive and complex Congressional legislation and agency rulemaking by the Department of Labor [1230]*1230(“DOL”), the Department of the Treasury (“DOT”), and the Department of Health and Human Services (“HHS”) (collectively, the “Departments”).

In March 2010, Congress enacted the ACA along with the Health Care and Education Reconciliation Act. These acts placed a variety of new requirements on “group health plans,” a term which encompasses both insured and self-insured employer plans that provide health care coverage to employees. See 42 U.S.C. § 300gg-91(a)(1) (defining “group health plan”); Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventative Services Under the Patient Protection and Affordable Care Act, 75 Fed.Reg. 41,726, 41,727 (July 19, 2010) (“Interim Final Rules”) (“The term ‘group health plan’ includes both insured and self-insured group health plans.”). The portion of these acts that is relevant to this action is the requirement that group health plans provide coverage — at no charge to the patient — for women’s “preventative care and screenings ... as provided for in comprehensive guidelines supported by the Health Resources and Services Administration!)]” See 42 U.S.C. § 300gg-13(a)(4).

Because there were no existing guidelines concerning preventative care and screenings for women at the time of the Interim Final Rules, the Health Resources and Services Administration (“HRSA”) commissioned- the Institute of Medicine (“IOM”), a Congressionally-funded body, to conduct a study on preventive services necessary to women’s health. The IOM, in a report entitled “Clinical Preventive Services for Women: Closing the Gaps,” recommended that “preventative care and screenings” include “[a]ll Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.” Women’s Preventive Services: Required Health Plan Coverage Guidelines, health .resources and services administration, http:// www.hrsa.gov/womensguidelines/ (last visited December 19, 2013). Among the FDA-approved contraceptive methods are diaphragms, oral contraceptive pills, emergency contraceptives, and intrauterine devices.

HRSA adopted the IOM’s recommendations on August 1, 2011. Two days later, the Interim Final Rules were amended to “provide HRSA additional discretion to exempt certain religious employers from the [HRSA] Guidelines where contraceptive services are concerned.” Group Health Plan and Health Insurance Issuers Relating to Coverage of Preventative Services under the Patient Protection and Affordable Care Act, 76 Fed. Reg. 46,623 (Aug. 3, 2011); see also 45 C.F.R. § 147.130(a)(l)(iv)(A). The amended Interim Final Rules permitted HRSA to exempt a religious organization that: “(1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization under section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii) of the [Internal Revenue] Code.” Id.

The Departments received over 200,000 comments on the amended Interim Final Rules, including many submitted by religiously-affiliated institutions asserting that the religious employer exemption was too narrow, and that the limited scope of the exemption raised religious liberty concerns. Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventative Services Under the Patient Protection and Affordable Care Act, 77 Fed.Reg. 8,725, 8,726-27 (Feb. 15, 2012). Despite these comments, the Departments adopted the definition of religious employ[1231]*1231er set forth in the Interim Final Rules. Id. at 8,727. However, the Departments created a “temporary enforcement safe harbor” of one year during which they intended to “develop and propose changes to these final regulations that would meet two goals — providing contraceptive coverage without cost-sharing to individuals who want it and accommodating non-exempt, non-profit organizations’ religious objections to covering contraceptive services[.]” Id.

On March 21, 2012, the Departments published an advance notice of proposed rule-making (“Advance Notice”) outlining alternative plans to accommodate religious organizations’ objections to the Mandate. See Certain Preventative Services under the Affordable Care Act, 77 Fed.Reg. 16,-501 (Mar. 21, 2012). The Departments received over 400,000 comments in response to the proposals set forth in the Advance Notice and, in July 2013, issued rules finalizing the Mandate. See Coverage of Certain Services under the Affordable Care Act, 78 Fed. Reg. 39,870, 39,871 (July 2, 2013) (the “Final Rules”).

The Final Rules provide that they accommodate for employers with religious objections to the Mandate in two ways. First, the Final Rules revise the definition of “religious employer” by eliminating the first three requirements contained in the Interim Final Rules. The Final Rules define “religious employer” as simply any non-profit referred to in 26 U.S.C. § 6033(a)(3)(A)(i) or (in), which includes churches, their integrated auxiliaries, associations of churches, and the exclusively religious activities of religious orders. See 78 Fed. Reg. at 39,874.

Second, the Final Rules provide for an accommodation for “eligible organizations” that do not meet the definition of “religious employer”. An “eligible organization” is one that meets the following criteria:

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Leal v. Azar
N.D. Texas, 2020
Preterm-Cleveland, Inc. v. Kasich (Slip Opinion)
2018 Ohio 441 (Ohio Supreme Court, 2018)
Flynn v. Ascension Health Long Term Disability Plan
73 F. Supp. 3d 1080 (E.D. Missouri, 2014)
Wheaton College v. Sylvia Burwell
134 S. Ct. 2806 (Supreme Court, 2014)
Burwell v. Hobby Lobby Stores, Inc.
134 S. Ct. 2751 (Supreme Court, 2014)
University of Notre Dame v. Kathleen Sebelius
743 F.3d 547 (Seventh Circuit, 2014)

Cite This Page — Counsel Stack

Bluebook (online)
6 F. Supp. 3d 1225, 2013 WL 6839900, 2013 U.S. Dist. LEXIS 180867, Counsel Stack Legal Research, https://law.counselstack.com/opinion/little-sisters-of-the-poor-home-for-the-aged-v-sebelius-cod-2013.