Legal counsel for the Little Sisters of the Poor presented arguments to the U.S. Court of Appeals for the Third Circuit on July 7, defending federal exemptions from the contraception coverage mandate that has consumed fifteen years of litigation.
The dispute traces to a 2011 regulation issued by the Department of Health and Human Services, which required employers to include contraceptive coverage in their health insurance plans under the Affordable Care Act. The Little Sisters, a religious community dedicated to serving elderly and dying poor people, challenged the requirement as a violation of their religious conscience.
The organization has won two prior cases before the Supreme Court on the issue. However, a lower federal court recently ruled in favor of Pennsylvania and New Jersey, which challenged the exemptions the federal government had granted. That court found the exemptions to be arbitrary and capricious under administrative law.
Scope of the Exemptions
The contested federal exemptions allow both religious organizations and employers with moral objections to decline participation in the contraceptive coverage requirement. Employers who object may opt into an accommodation arrangement in which the federal government subsidizes contraception coverage separately. Alternatively, employers can sidestep the mandate entirely if they object to the accommodation itself.
Mark Rienzi, legal counsel for the Little Sisters, argued before the appeals court that the regulatory framework was rational and consistent. “Nothing about that is even close to arbitrary and capricious,” Rienzi said, challenging the lower court’s reasoning.
The Mission at Stake
Mother Loraine Marie Maguire, superior of the Little Sisters of the Poor, underscored the stakes for the community. “For nearly 200 years we have welcomed the elderly poor and dying into our homes, and with the population of seniors rapidly growing we cannot allow a government lawsuit to stop us from carrying out our mission,” she said.
The Little Sisters have operated in the United States for two centuries, operating residential facilities and providing care to vulnerable elderly populations. The contraception mandate dispute has forced the organization to defend its freedom to operate according to its religious principles while managing the costs and obligations of employee health insurance.
Federal Support and Next Steps
The Department of Justice is supporting the Little Sisters in the Third Circuit appeal, backing the legality and reasonableness of the exemptions.
The Third Circuit’s decision will likely determine whether the exemptions survive legal challenge or whether the lower court’s ruling stands, potentially requiring the Little Sisters and similar religious employers to comply with the contraception coverage mandate or face penalties. The outcome may also influence how broadly religious exemptions to federal health regulations are interpreted going forward.
The case represents the latest chapter in a sustained legal struggle over the intersection of religious liberty, employer mandates, and healthcare policy. The Little Sisters have demonstrated their willingness to pursue the matter through the appellate system, and depending on the Third Circuit’s ruling, further Supreme Court review remains possible.