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Source and Scope of Public Health Legal Powers

State of California v. The Little Sisters of the Poor


State of California v. The Little Sisters of the Poor (9th Cir. Oct. 22, 2019): A federal appellate panel ruled 2-1 to uphold a district court’s preliminary injunction applying to 13 plaintiff states and D.C. The injunction bars enforcement of final rules exempting all entities with either sincerely held religious or moral objections to contraceptives from the Affordable Care Act’s (ACA) requirements to provide contraceptive coverage to employees without cost sharing. The appellate panel agreed that the plaintiffs were likely to succeed on the merits of their claim that the rule was arbitrary and capricious in violation of the federal Administrative Procedure Act (APA). In particular, the district court did not err in concluding the agencies lacked statutory authority to issue the exemption—initial evidence was sufficient to hold that providing free contraceptive services was a core purpose of the Women’s Health Amendment to the ACA. The district court properly concluded that the accommodation process (permitting eligible religious organizations to opt out of arranging for or paying for coverage via self-certification forms) likely does not violate the federal Religious Freedom Restoration Act. Read the decision here. The Third Circuit upheld a similar injunction, accessible here.

View all cases in the Judicial Trends in Public Health – November 15, 2019.

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