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Source & Scope of Public Health Legal Powers

Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania

Overview

Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania (U.S. Supreme Court, July 8, 2020): The U.S. Supreme Court upheld a rule exempting certain employers with religious or moral objections from providing contraception coverage in employer group health plans pursuant to the Affordable Care Act (ACA). The Health Resources and Services Administration (“HRSA”) guidelines require coverage of contraceptive and sterilization methods approved by FDA. It promulgated a “church exemption.” Some religious non-profits and closely held for-profit organizations also became eligible for the “self-certification accommodation” through which they certified to meeting certain standards and providing contraception coverage without employer subsidy. The 2018 exemption at issue: (1) permits for-profit and publicly traded entities to opt out; (2) for religious or moral objections; and (3) does not require contraception coverage without employer subsidy. The Court held that under the ACA covered employers must provide “preventive care and screenings” without cost sharing (the Women’s Health Amendment). The ACA does not define or provide a list of what constitutes preventive care/screenings. It directs that “preventive care and screenings”  must be covered  “as provided for” in HRSA’s guidelines. Interpreting the statute’s plain meaning the term “as provided for” grants HRSA “sweeping authority” to define preventive care/screenings. HRSA is “equally unchecked” in its ability to create exemptions to these requirements. There were concurrences, with two dissents. Read the decision here.

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