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Religious Institutions and the Battle Over the Affordable Care Act’s Contraception Mandate

The Patient Protection and Affordable Care Act, better known as the Affordable Care Act (ACA), was signed into law by President Barack Obama on March 23, 2010, and later upheld by the United States Supreme Court on June 28, 2012. The law was written to accomplish a number of things, among them to increase health insurance access and quality. One major point of contention with the law was a contraception mandate – a requirement for all employers and educational institutions to provide female contraception coverage. The law noted one exception to those under its influence – churches and houses of worship. The law provided four requirements to be considered a religious employer and to receive the exemption:

(1) The inculcation of religious values is the purpose of the organization.

(2) The organization primarily employs persons who share the religious tenets of the organization.

(3) The organization serves primarily persons who share the religious tenets of the organization.

(4) The organization is a nonprofit organization as described in section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.

Much to the disapproval of many religious organizations, the requirements to be exempt from the mandate did not cover religious schools, religious hospitals, religious charities, and other businesses and organizations owned and controlled by religious groups. Even though many private religious schools’ missions cover more than simply the inculcation (teaching) of religious values, their exemption status was not granted. Organizations that failed to provide health coverage would be subjected to a fee. By mandating contraception coverage, many of these organizations felt their religious tenets were being compromised.

The Obama Administration offered an opt-out compromise allowing religious nonprofits to explicitly state their opposition to the contraception mandate and to have the organizations’ insurance companies cover the cost of the contraceptives at no financial burden to the nonprofit. Several religious nonprofits still felt this compromise was not satisfactory as they felt responsible for the providence of contraceptives. This resulted in multiple lawsuits.

Colorado Christian University (CCU), a private religious institution in Denver, Colorado, filed a lawsuit in 2011 against the United States Department of Health and Human Services (HHS) related to the contraception mandate. The case was rejected but then renewed again in 2013. In 2014 CCU was granted an injunction from the contraception mandate by the Colorado district court. The result was that CCU would not have to pay a fee for failing to provide contraception health care until later court rulings affected the lawsuit.

The 10th U.S. Circuit Court of Appeals heard a lawsuit against the contraception mandate by a private corporation, Hobby Lobby. Burwell v. Hobby Lobby was heard by the United States Supreme Court and a decision was rendered in 2014. The court ruled 5-4 in favor of Hobby Lobby allowing closely held for-profit religious corporations to be exempt from the contraception mandate if there was a less restrictive means of accomplishing the law’s intent. The decision cited the Religious Freedom Restoration Act of 1993 as evidence.

In Oklahoma an appeal of a similar lawsuit to CCU’s was rejected in 2015. The 10th U.S. Circuit Court of Appeals ruled against four Oklahoma Christian universities who were seeking an exemption from the contraception mandate. The court decided that the law and its religious exemptions do not violate the schools’ religious freedom. This ruling upheld the accommodation created by the Obama Administration.

With the contraception mandate still in effect and the compromise offering the best alternative for many religious institutions, dissenting schools were forced to utilize a few different options: compliance with the law, lawsuits challenging the law and seeking injunctions, or not paying the fee. On July 31, 2015, Wheaton College, a private Christian institution, ended their student health insurance, utilized by a quarter (approximately 3,000 individuals) of the student population due to conflicts with their centrally held religious beliefs.

Currently both sides of the issue appear to be at an impasse. In May of 2016, the Supreme Court sent the case back to the appellate courts, asking the federal appeals courts to reach a compromise on the issue. With the new Trump administration coming into power, there are likely to be some significant changes to how the law exists and gets enforced during his tenure. Provided a 9th Justice is still yet to be added, the Supreme Court might still decide on the contraception mandate in the future.

This post was co-authored by Mr. Andy Hieber and Dr. David Nguyen. Mr. Hieber is a Hall Director at the University of North Dakota and a masters student in the UND Higher Education program.

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Reader Comments (12)

It is interesting how different religious institutions have handled the Affordable Care Act. I find it unique that one school stopped offering health insurance altogether to its students since it did not agree with the policy. This probably had a major impact on the student population since they could not get health insurance from their university anymore. Another compelling aspect was how there were two cases in different states that were similar but had different outcomes.

February 17, 2017 | Unregistered CommenterDylan Ruffra

I appreciate the different approach you've taken to ACA. Religious institutions are not within the traditional realm, and it's interesting to see their response. I will be curious to see what happens with this case as it gets sent back down. As you mentioned, when the new Supreme Court Justice is elected, I wonder if similar cases will be brought forth for the court to decide on.

February 21, 2017 | Unregistered CommenterKatie Fulmer

You've done a nice job pointing out that the exemptions under the Obama Administration were far more strenuous for some religious organizations regarding the contraception mandate.
It sounds as if the Trump administration will be more lenient and allow more exemptions to businesses and organizations that claim a religious objection to covering contraception for their employees with the support from conservatives. I think you are right in indicating that the Trump administration could definitely impact the "legal impasse" and settle some of the impending lawsuits.

March 1, 2017 | Unregistered CommenterHeather Helgeson

I struggle with this opt-out concept as a whole for anyone. The battle to include contraceptive methods on health insurance policies was a valid, long fought effort. While many individuals and organizations may not agree with it, I believe that the power to control ones self is ours as adults. Further, the decision to use contraceptive methods often times can be related to other medical issues in which this is the best treatment option. Dictating this as all or nothing, complicates treatment methods for these individuals. Nevertheless, the subject was well covered and documented. Thank you Andy, but because this is still an ongoing debate, with placement currently in the courts, as well as the beliefs and the opinions of our new administration yet to be weighted, this controversy is likely still in it's infancy with more to come.

April 4, 2017 | Unregistered CommenterTina Monette

This is quite an interesting topic, Andy! As someone who is non-religious, it is hard for me to empathize with the corporations who are arguing that their religion should make them exempt from providing contraception. Contraception is a common sense solution to family planning and there are also many other medical uses for various contraceptive methods. I hope that institutions, and all organizations, can realize that although you may have your views, it does not mean that everyone has to share those same views. Thank you for covering a broad and difficult topic in an informative way, Andy.

April 6, 2017 | Unregistered CommenterMegan Leonard

Good job, Andy! This is a topic that few people probably consider (including me). Obviously, private, religious-oriented institutions of higher education are not held to the same expectations as public colleges and universities. It is most definitely a sticky subject when health care is involved, especially with such varying views on specific areas like contraception. You incorporated in cases very nicely!

April 8, 2017 | Unregistered CommenterTara Lulla

Interesting topic! As someone who was working at a one of Hobby Lobby's competitors during that lawsuit, I had heard a lot about the case. Although, I never considered the effect ACA would have outside of the commercial industry and in higher education. I am surprised that one institution decided to cut their student health insurance programs altogether. Health insurance is a major stressor for many college students, especially older students who are aging out of their parent's insurance program or students who move outside of their parent's health insurance network. I can imagine this was difficult for the students who were effected. I am interested to see what comes of this issues over the next few years.

April 10, 2017 | Unregistered CommenterLindsay Stack

I find this topic to be incredibly intriguing and your post to be informative with minimal bias (thank you!). First, I learned a lot about the Affordable Care Act that I previously did not know about; specifically, I was unaware that religious schools did not qualify for exemption while religious businesses, etc. did. Additionally, I am not the least bit surprised at all of the issues that have risen in response to institutions feelings that their religious standards and beliefs were being violated. Thank you for sharing different cases and outcomes in relationship to this topic. Like I said, it was very informative without much emotion so I felt the facts were laid out well. Great writing!

April 15, 2017 | Unregistered CommenterSetareh Campion

Very interesting topic, and something that I struggle with because I do not necessarily agree with many of the issues that are presented in these cases. Religion is and will continue to be a controversial topic when it intersects with laws, policies, and government issues. I am interested to see where the case ends up with our new administration and the future for these laws and policies with more conservative power.

April 19, 2017 | Unregistered CommenterKatheen Kittridge

When the comprise was proposed, did health insurance cover their general cost to cover extra cost of covering contraception without universities paying. As a women I believe that my insurance should cover contraception. Specifically this is yet another gender issue where women are affected while men remain unaffected.

May 3, 2017 | Unregistered CommenterAbbey Lane

Thanks for the details you included on this subject, Andy! This is a very intersting topic. As someone who went to a small Christian school, we did not hand out contraceptives at all. We honestly did not even talk about this topic. I would have felt a little odd handing them out to my residents while telling them to remain abstinent, but at the same time I see the argument for safety. It's a tough subject.

May 5, 2017 | Unregistered CommenterIsaac Hale

I definitely struggle with this topic for a few reasons. While I try to be very understanding of religious beliefs held by others and working alongside both a person's personal and professional ethics, I ultimately feel that contraception boils down to being a positive thing for sexual and overall health of both males and females. If institutions want to promote safe environments and healthy students, why is making some compromises to encourage those so difficult and worth so much of a battle?

May 5, 2017 | Unregistered CommenterShannon Sniegolski

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