State of California v. the Little Sisters of the Poor

911 F.3d 558
CourtCourt of Appeals for the Ninth Circuit
DecidedDecember 13, 2018
Docket18-15144
StatusPublished
Cited by233 cases

This text of 911 F.3d 558 (State of California v. the Little Sisters of the Poor) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State of California v. the Little Sisters of the Poor, 911 F.3d 558 (9th Cir. 2018).

Opinion

FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS DEC 13 2018 MOLLY C. DWYER, CLERK U.S. COURT OF APPEALS FOR THE NINTH CIRCUIT

STATE OF CALIFORNIA; STATE OF No. 18-15144 DELAWARE; COMMONWEALTH OF VIRGINIA; STATE OF MARYLAND; D.C. No. 4:17-cv-05783-HSG STATE OF NEW YORK,

Plaintiffs-Appellees, OPINION

v.

ALEX M. AZAR II, Secretary of the United States Department of Health and Human Services; U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES; R. ALEXANDER ACOSTA, in his official capacity as Secretary of the U.S. Department of Labor; U.S. DEPARTMENT OF LABOR; STEVEN TERNER MNUCHIN, in his official capacity as Secretary of the U.S. Department of the Treasury; U.S. DEPARTMENT OF THE TREASURY,

Defendants,

and

THE LITTLE SISTERS OF THE POOR JEANNE JUGAN RESIDENCE,

Intervenor-Defendant- Appellant.

STATE OF CALIFORNIA; STATE OF No. 18-15166 DELAWARE; COMMONWEALTH OF VIRGINIA; STATE OF MARYLAND; D.C. No. 4:17-cv-05783-HSG STATE OF NEW YORK,

Plaintiffs-Appellees,

ALEX M. AZAR II, Secretary of the United States Department of Health and Human Services; U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES; R. ALEXANDER ACOSTA, in his official capacity as Secretary of the U.S. Department of Labor; U.S. DEPARTMENT OF LABOR; STEVEN TERNER MNUCHIN, in his official capacity as Secretary of the U.S. Department of the Treasury; U.S. DEPARTMENT OF THE TREASURY,

MARCH FOR LIFE EDUCATION AND DEFENSE FUND,

STATE OF CALIFORNIA; STATE OF No. 18-15255 DELAWARE; COMMONWEALTH OF VIRGINIA; STATE OF MARYLAND; D.C. No. 4:17-cv-05783-HSG STATE OF NEW YORK,

2 ALEX M. AZAR II, Secretary of the United States Department of Health and Human Services; U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES; R. ALEXANDER ACOSTA, in his official capacity as Secretary of the U.S. Department of Labor; U.S. DEPARTMENT OF LABOR; STEVEN TERNER MNUCHIN, in his official capacity as Secretary of the U.S. Department of the Treasury; U.S. DEPARTMENT OF THE TREASURY,

Defendants-Appellants.

Appeals from the United States District Court for the Northern District of California Haywood S. Gilliam, Jr., District Judge, Presiding

Argued and Submitted October 19, 2018 San Francisco, California

Before: J. Clifford Wallace, Andrew J. Kleinfeld, and Susan P. Graber, Circuit Judges.

Opinion by Judge Wallace

WALLACE, Circuit Judge:

The Affordable Care Act (ACA) and the regulations implementing it require

group health plans to cover contraceptive care without cost sharing. Federal

agencies issued two interim final rules (IFRs) exempting employers with religious

and moral objections from this requirement. Several states sued to enjoin the

enforcement of the IFRs, and the district court issued a nationwide preliminary

3 injunction. We have jurisdiction under 28 U.S.C. § 1292, and we affirm in part,

vacate in part, and remand.

I.

A.

To contextualize the issues raised on appeal, we briefly recount the history

of the ACA’s contraceptive coverage requirement. The ACA provides that:

a group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for . . . with respect to women, such additional preventive care and screenings . . . as provided for in comprehensive guidelines supported by the Health Resources and Services Administration [HRSA] . . . .

42 U.S.C. § 300gg–13(a)(4). HRSA established guidelines for women’s

preventive services that include any “[FDA] approved contraceptive methods,

sterilization procedures, and patient education and counseling.” Group Health

Plans and Health Insurance Issuers Relating to Coverage of Preventive Services

Under the Patient Protection and Affordable Care Act, 77 Fed. Reg. 8,725-01,

8,725 (Feb. 15, 2012). The three agencies responsible for implementing the

ACA—the Department of Health and Human Services, the Department of Labor,

and the Department of the Treasury (collectively, agencies)—issued regulations

requiring coverage of all preventive services contained in HRSA’s guidelines. See,

e.g., 45 C.F.R. § 147.130(a)(1)(iv) (DHSS regulation).

The agencies also recognized that religious organizations may object to the

4 use of contraceptive care and offering health insurance that covers such care. For

those organizations, the agencies provided two avenues. First, group health plans

of certain religious employers, such as churches, are categorically exempt from the

contraceptive coverage requirement. Coverage of Certain Preventive Services

Under the Affordable Care Act, 78 Fed. Reg. 39,870, 39,874 (July 2, 2013).

Second, nonprofit “eligible organizations” that are not categorically exempt can

opt out of having to “contract, arrange, pay, or refer for contraceptive coverage.”

Id. To be eligible, the organization must file a self-certification form stating (1)

that it “opposes providing coverage for some or all of any contraceptive services

required to be covered under [the regulation] on account of religious objections,”

(2) that it “is organized and operates as a nonprofit entity,” and (3) that it “holds

itself out as a religious organization.” Id. at 39,892. The organization sends a

copy of the form to its insurance provider, which must then provide contraceptive

coverage for the organization’s employees and cannot impose any charges related

to the coverage. Id. at 39,876. The regulations refer to this second avenue as the

“accommodation,” and it was designed to avoid imposing on organizations’ beliefs

that paying for or facilitating coverage for contraceptive care violates their

religion. Id. at 39,874.

The agencies subsequently amended the accommodation in response to

several legal challenges. First, certain closely-held for-profit organizations became

5 eligible for the accommodation. Coverage of Certain Preventive Services Under

the Affordable Care Act, 80 Fed. Reg. 41,318-01, 41,343 (July 14, 2015); see also

Burwell v. Hobby Lobby Stores, Inc., 134 S. Ct. 2751, 2785 (2014). Second,

instead of directly sending a copy of the self-certification form to the insurance

provider, an eligible organization could simply notify the Department of Health

and Human Services in writing, and the agencies then would inform the provider

of its regulatory obligations. 80 Fed. Reg. at 41,323; see also Wheaton Coll. v.

Burwell, 134 S. Ct. 2806, 2807 (2014).

Various employers then challenged the amended accommodation as a

violation of the Religious Freedom Restoration Act (RFRA). Zubik v. Burwell,

136 S. Ct. 1557, 1559 (2016) (per curiam). The actions reached the Supreme

Court, but, instead of deciding the merits of the claims, the Supreme Court vacated

and remanded to afford the parties “an opportunity to arrive at an approach going

forward that accommodates petitioners’ religious exercise while at the same time

ensuring that women covered by petitioners’ health plans receive full and equal

health coverage, including contraceptive coverage.” Id. (internal quotation marks

and citation omitted). The agencies solicited comments on the accommodation in

light of Zubik, but ultimately declined to make further changes to the

accommodation.

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Bluebook (online)
911 F.3d 558, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-of-california-v-the-little-sisters-of-the-poor-ca9-2018.