Real Alternatives, Inc. v. Burwell

150 F. Supp. 3d 419, 2015 WL 8481987, 2015 U.S. Dist. LEXIS 165495
District Court, M.D. Pennsylvania·Decided December 10, 2015·No. 1:15-cv-0105·Published·Cited by 2 cases

Opinion

MEMORANDUM

Hon. John E. Jones, III, District Judge

Presently before the Court are the Defendants’ Motion to Dismiss or, in the alternative, for Summary Judgment, and the Plaintiffs’ Motion for Summary Judgment. Docs. 27, 29. For the reasons that follow, the Court will deny the Plaintiffs’ motion in its entirety and grant Defendants’ motion for Summary Judgment.

1. FACTUAL BACKGROUND

A. The Affordable Care Act

In March 2010, the Patient Protection and Affordable Care Act, Pub. L. No. Ill— 148, 124 Stat. 119 (2010) and the Health Care and Education Reconciliation Act, Pub. Li No. 111-152, 124 Stat. 1029 (2010) (collectively, the “ACA”) passed into law. The ACA requires non-grandfathered group health, care plans1 and insurance providers offering non-grandfathered coverage to supply four categories of recommended preventive health services, without requiring copayments or deductibles from plan participants and beneficiaries. Doc. 1, ¶¶ 49-53; see Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under .the Patient Protection and Affordable Care Act, 76 Fed. Reg. 46,621, 46,622-23 (Aug. 3, 2011). The four categories of preventive health services include: (1) items or services that have an “A” or “B” rating from the United States Preventive Services Task Force; (2) immunizations as recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention; (3) preventive care and screenings for, infants, children and adolescents as provided for by the guidelines supported by the Health Resources and Services Administration (“HRSA”);2 and (4) preventive care and [426] screenings for women, also as provided by guidelines supported-by the HRSA. 76 Fed. Reg. 46,622-28 (Aug. 3,2011). -

At the time that the ACA passed into law, no guidelines regarding preventive care and screenings for women existed. Doc. 27, p. 4. Thus, the HHS requested recommended guidelines from the Institute of Medicine (“IOM”), a nonprofit organization established by the National Academy of Sciences and funded by Congress.3 Doc. 1, ¶ 56; Doc. 27, p. 4. In response to this request, the IOM recommended that the HRSA adopt guidelines endorsing, among other measures, 'breastfeeding support, domestic violence screening, and also “the full range of [FDA]approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity.” Doc. 27, p. 5. FDA-approved contraceptive methods include diaphragms, oral contraceptives, intrauterine devices, and emergency contraceptives (such as “Plan B,” also known as the “morning-after pill,” and ulipristal, also known as “Ella” or the “week-after pill”). Id.4 The IOM asserts that the services recommended by its proposed guidelines are “shown to improve well-being, and/or decrease the likelihood or delay the onset of a targeted disease or condition.” Id. at 4-5.

On August 1, 2011, the HRSA adopted the IOM’s recommended guidelines regarding preventive care and screenings for women in full. Doc. 1, ¶ 66. In doing so, the HRSA required every non-exempt employer to provide these services for their employees in their health insurance coverage plans (the “Contraceptive Mandate”). Id. On the same day, an exemption from the Contraceptive Mandate for certain- religious employers was proposed as an interim final regulation. Doc. 1, ¶¶ 71-72. The Departments of Treasury, Labor, and the HHS (collectively, the “Departments”) explained that certain commenters to the proposed guidelines had suggested that requiring religious employers to sponsor group health plans for their employees that provide contraceptive services could impinge upon those employers’ religious freedom. 76 Fed, Reg. 46,621, 46,624 (Aug. 3, 2011). In light of these comments, the Departments determined that:

it is appropriate that HRSA, in issuing these Guidelines, takes into account the effect on the religious beliefs of certain religious employers if coverage of contraceptive services were required in the group health plans in which employees in certain religious' positions participate. Specifically, the Departments seek to provide for a religious accommodation that respects the unique relationship between a house of worship and its employees in ministerial positions. Such an accommodation would be consistent with the policies of States that require contraceptive services coverage, the majority of which simultaneously provide for a religious accommodation.

Id.

To qualify for the religious employer exemption as it was set forth in the 2011 regulations, an employer was required meet criteria consistent with the exemptions adopted in most states. A religious employer was required to: (1) have as its [427] purpose the inculcation of religious values; (2) primarily employ persons who share its religious tenets; (3) primarily servé persons who share'its religious tenets; and (4) be a non-profit organization under Section 6033(a)(1) and Section 6033(a)(3)(A)(i) or (iii) of the Code.5 Id.

Though the religious employer exemption went into effect immediately,6 the Departments requested comments on this definition, as well as alternative definition submissions. Id. The Departments also noted that “[bjecause the HRSA’s discretion to establish an exemption applies only to group health plans sponsored by certain religious employers and group health insurance offered in connection with such plans, health insurance issuers in the individual health insurance market would not be covered under any such exemption”.Id. at 46,623-24.

In February 2012, the Departments formally adopted the exemption set forth in the 2011 interim final regulations.7 77 Fed. Reg. 8,725 (Feb. 15, 2012). The Departments also provided a “temporary enforcement safe harbor,” a one-year period of non-enforcement for non-exempted, nonprofit organizations with religious objections to providing coverage for contraceptive services, ' and whose group health plans were not grandfathered. Id. During the safe harbor period, the Departments announced that they would “plan to develop and propose changes to these final regulations that would meet -two goals — providing contraceptive coverage without cost-sharing -to individuals who would want it and accommodating non-exempted, nonprofit organizations’ religious objections to covering contraceptive services — ” Id.

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Real Alternatives, Inc. v. Burwell, 150 F. Supp. 3d 419, 2015 WL 8481987, 2015 U.S. Dist. LEXIS 165495 (M.D. Pa. 2015).

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