Case Information
*2 Before WOLLMAN, COLLOTON, and BENTON, Circuit Judges.
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WOLLMAN, Circuit Judge.
The Departments of Health and Human Services (HHS), Labor (DOL), and Treasury, as well as their respective Secretaries, (collectively, the government) appeal from the district court’s order granting a motion for a preliminary injunction that [1]
enjoins the government from enforcing certain provisions of the Patient Protection and Affordable Care Act (ACA), 42 U.S.C. § 300gg-13(a)(4), and its implementing regulations against Dordt College and Cornerstone University, each of which is a nonprofit religious educational institution that offers healthcare coverage to its employees—Dordt through a self-insured plan and Cornerstone through an insured plan. The district court’s order also enjoined the government from enforcing the [2]
*3 challenged provisions against “any insurance provider (including insurance issuers and third-party administrators) offering health insurance to Dordt or Cornerstone.” D. Ct. Order of May 21, 2014, at 8. Dordt and Cornerstone raised objections to the ACA and its implementing rеgulations that are substantially similar to those addressed by this court in the opinion issued today in Sharpe Holdings, Inc. v. U.S. Department of Health and Human Services, No. 14-1507, slip op. (8th Cir. Sept. 17, 2015). For purposes of this opinion, we provide only a brief disсussion of the legislative and administrative background of the ACA and its implementing regulations, as well as an abbreviated summary of the arguments raised by the parties. For a more detailed examination, we direct readers to our opinion in Sharpe Holdings. Dordt and Cornerstone challenged provisions of the ACA and its implementing regulations requiring them either to provide their employees with healthcare coverage for “[a]ll Food and Drug Administration [(FDA)] approved сontraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity” (the contraceptive mandate), or to apply for an accommodation excusing them from providing such coverage. 77 Fed. Reg. 8725, 8725 (Feb. 15, 2012); see 29 C.F.R. § 2590.715-2713(a). Although the ACA provides an exemption from the contraceptive mandate for “grandfathered” health plans, i.e. , those in existence at the time оf the ACA’s adoption, 42 U.S.C. § 18011; 29 C.F.R. § 2590.715-1251, and for health plans sponsored by “religious employers,” i.e. , “churches, their integrated auxiliaries, and conventions or associations of churches,” as well as “the exclusively religious activities of any religious order,” 45 C.F.R. § 147.131(a) (citing the Internal Revenue Code, 26 U.S.C. § 6033(a)(3)(A)(i), (iii)), it does not provide a similar exemption for nonprofit religious organizations like Dordt and Cornerstone.
*4 Instead, the ACA provides an “accommodation” for nonprofit religious organizations that have religious objections to the contraceptive mandate but do not qualify for the religious-employer exemption. 78 Fed. Reg. 39,870, 39,871 (July 2, [3]
2013); see also 29 C.F.R. § 2590.715-2713A. The accommodation is intended to protect religious organizations “from having to contract, arrange, pay, or refer for” contraceptive coverage. 78 Fed. Reg. at 39,872. It is available for a religious organization that (1) has religious objections to providing healthcare cоverage for some or all contraceptive services, (2) “is organized and operates as a nonprofit entity,” (3) “holds itself out as a religious organization,” and (4) complies with a self- certification process. 29 C.F.R. § 2590.715-2713A(a). A religious organization may self-certify by completing and submitting directly to its insurance issuer or third-party administrator (TPA) an EBSA Form 700–Certification (Form 700), certifying that it is a religious nonprofit entity that has religious objections to providing coverage for some or all of the contraceptives required by the mandate, 29 C.F.R. § 2590.715- 2713A(a)-(b), or by providing notice to HHS stating the organization’s name; the basis on which it qualifies for an accommodation; its religious objections to providing coverage for sоme or all contraceptives, including the specific contraceptives to which it objects; its insurance plan name and type; and its insurance issuer’s or TPA’s name and contact information (HHS Notice), see 79 Fed. Reg. 51,092, 51,094-95 [4]
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(Aug. 27, 2014); 80 Fed. Rеg. 41,318, 41,323 (July 14, 2015); 29 C.F.R. § 2590.715-
2713A(b)(1)(ii)(B). After HHS receives the Notice, it provides the information to
DOL, which sends a separate notification to inform the religious organization’s
insurance issuer or TPA of the organization’s objections to certain coverage. Sеe id.
Once an insurance issuer or TPA receives Form 700 from the religious
organization or the separate notification from DOL it must “provide or arrange
payments for contraceptive services” for beneficiaries of thе organization’s group
health plan either by providing those payments itself or by arranging for another party
to do so. 29 C.F.R. § 2590.715-2713A(b)(2) (TPA); 45 C.F.R. § 147.131(c)(1)(i)
(insurance issuer). With respect to TPAs, Form 700 or HHS notice also designates
the TPA “plan administrator and claims administrator for contraceptive benefits” for
the religious organization.
“in writing that it is a nonрrofit organization that holds itself out as religious and has
religious objections to providing coverage for contraceptive services.”
*6
Dordt and Cornerstone, in accordance with their sincerely held religious
beliefs, oppose the use, funding, provision, or support of abortion, and they believe
that certain contraceptives required under the contraсeptive mandate—Plan B, ella,
and copper IUDs—are functionally equivalent to abortion. See Burwell v. Hobby
Lobby,
The gоvernment raises arguments for reversal of the district court’s order that are substantially similar to those asserted by the government in Sharpe Holdings. Specifically, the government argues that the contraceptive mandate and aсcommodation process do not substantially burden Dordt and Cornerstone’s exercise of religion, that it has compelling interests in safeguarding public health and ensuring equal access to health care for women, and that the сontraceptive mandate and accommodation process are the least restrictive means to further those compelling interests. For the reasons set forth in Sharpe Holdings, we conclude that by coercing Dordt and Cornerstone to participate in the contraceptive mandate and accommodation process under threat of severe monetary penalty, the government has substantially burdened Dordt and Cornerstone’s exercise of religion. Also for the *7 reasons set forth in Sharpe Holdings, we conclude that, even assuming that the government’s interests in safeguarding public health and ensuring equal access to health care for women are cоmpelling, the contraceptive mandate and accommodation process likely are not the least restrictive means of furthering those interests. Thus, based on our reasoning in Sharpe Holdings, we affirm the order granting injunctive relief.
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Notes
[1] The Honorable Mark W. Bennett, United States District Judge for the Northern District of Iowa.
[2] A self-insured employer bears the financial risk of paying its employees’ health-insurance claims and often hires a third-party administrator to managе administrative functions like processing insurance claims. An insured employer, by contrast, contracts with a separate insurance company to provide healthcare coverage, bear the financial risk of insuranсe claims, and manage related administrative functions. See, e.g., 1A Steven Plitt, et al., Couch on Insurance § 10:1 n.1 (3d ed. 2013).
[3] After the Supreme Court’s decision in Burwell v. Hobby Lobby, 134 S. Ct. 2751 (2014), the government revised the relevant regulations effective September 14, 2015, to extend this accommodation to certain closely held for-profit entities that have a religious objection to providing coverage for some or all of the FDA-approved contraceptive methods. See 80 Fed. Reg. 41,318 (July 14, 2015).
[4] Self-certification using HHS Notice was included in the regulations after the Supreme Court’s order in Wheaton College v. Burwell, 134 S. Ct. 2806 (2014). Wheaton College, a religious organization, challenged the accommodation procеss, arguing that completing Form 700 and forwarding the Form to its insurance issuer made it complicit in the provision of contraceptive coverage in violation of its religious beliefs. The Supreme Court granted injunctive relief, enjoining the government from enforcing the contraceptive mandate while the college’s challenge to the accommodation process was pending, provided that the college inform HHS
[5] Dordt and Cornerstone argue that the government’s asserted “compelling
interests” are fatally undermined in light of the exemptions to the contraceptive
mandate and accommodation process granted to grandfathered healthcare plans аnd
religious employers—exemptions that result in thousands of women without access
to contraceptive coverage through their employers’ healthcare plans. Because we
affirm the district court’s grant of injunctive relief on the basis that the government
has failed to establish that the contraceptive mandate and accommodation process are
the least restrictive means to accomplish their stated compelling intеrests, we decline
to address Dordt and Cornerstone’s assertions regarding the insufficiency of the
government’s compelling interests. See Hobby Lobby,