Earlier this week, in Roman Catholic Archdiocese of New York v. Sebelius, U.S. District Judge Brian Cogan in the Eastern District of New York permanently enjoined the government from enforcing regulations mandating coverage for contraceptive and sterilization services by religious organization health plans.

The Patient Protection and Affordable Care Act requires health insurance plans to provide preventative medical services.  HHS regulations require these preventative services to include services such as contraception, sterilization and related counseling (the “HHS Mandate”).  In response to objections by religious organizations, the government promulgated a regulation it presented as an accommodation, which required those organizations to self-certify their religious objection, after which a third party administrator would have to provide the coverage at no cost to the organization or the individual. 

Several non-profit religious organizations, including Catholic Health Services of Long Island, sued under the Religious Freedom Restoration Act (“RFRA”), arguing that the HHS Mandate forced them to choose between violating their religious beliefs and paying substantial penalties.  They asserted that the HHS Mandate required them to affirmatively act and rendered them complicit by endorsing or facilitating coverage for services to which they have religious objections. 

Under RFRA, the government may only substantially burden a person’s exercise of religion if it demonstrates that the burden: (1) is in furtherance of a compelling governmental interest, and (2) is the least restrictive means of furthering that compelling governmental interest. 

The Court first addressed whether plaintiffs had demonstrated a substantial burden on their exercise of religion.  The Court found it “indisputable” that the substantial burden inquiry does not permit a court to determine the centrality of a particular religious practice to an adherent’s faith.  The Court found it “difficult to comprehend any situation where a court could rule that a plaintiff facing government compulsion to engage in affirmative acts forbidden by his religion has not suffered a substantial burden, without implicitly ruling that the belief he has been forced to violate is just not that important.” 

The religious organizations argued that submitting a self-certification stating their religious objection would make them complicit in a scheme violating their religious beliefs, because it would result in the provision of coverage.  The government did not contest the fact that completing the self-certification violated plaintiffs’ religious beliefs, but argued that the certification was de minimus.  The Court rejected this argument, holding that the religious organizations believed that the self-certification compelled the affirmation of a repugnant belief, and “[i]t is not for this Court to say otherwise.”  The Court concluded that the HHS Mandate compelled plaintiffs to perform acts contrary to their religion, and that the coercive pressure was a substantial burden.

The Court next addressed whether the HHS Mandate is narrowly tailored to serve a compelling governmental interest.  The Court rejected the government’s argument that an exemption for plaintiffs would undermine its ability to enforce the regulations in a rational manner, noting that the Supreme Court has held that a general interest in uniformity is not enough to show a compelling interest, and that tens of millions of people are already exempt from the Mandate.  “Having granted so many exemptions already, the Government cannot show a compelling interest in denying one to these plaintiffs.” 

The Court found that “the Mandate burdens plaintiffs’ religion by coercing them into authorizing third parties to provide this coverage through the self-certification requirement, an act forbidden by plaintiffs’ religion.”  The Court noted that numerous less restrictive alternatives were available, such as the government providing the contraceptive coverage directly to individuals or through tax incentives. 

The Court permanently enjoined the government from enforcing the HHS Mandate against the religious organizations.  Only one other Court, the Western District of Pennsylvania, has addressed whether the HHS Mandate violates RFRA as applied to religious non-profits, and that Court issued a preliminary injunction.  Judge Cogan’s decision is certain to be appealed to the Second Circuit, and thereafter this case or a similar one will be before the Supreme Court.  Next year, in a closely watched case, the Supreme Court will be addressing RFRA challenges to the Mandate brought by several for-profit corporations, and that decision may have a significant impact on the ruling for religious non-profits.