UPDATE: Supreme Court Rules 5-4 in Favor of Hobby Lobby on Contraception Mandate

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UPDATE: The Supreme Court has ruled 5-4 in favor of Hobby Lobby, writing that "closely held for-profit corporations can opt out of the Affordable Care Act's provisions for no-cost prescription coverage of contraception in most insurance plans." 

Wait...what happened? The actual SCOTUS decision is 50 pages long. VOX has a really good condensed version of the ruling, but essentially the abridged version is this: SCOTUS has determined that under the RFRA, for-profit corporations basically count as people and can have religious freedoms, so their religious freedoms need protecting. 

The court also ruled that the contraception mandate violates the RFRA because it mandated that corporations "engage in conduct that seriously violates their sincere religious belief that life begins at conception." SCOTUS Blog reports that the government failed to show that the mandate is the least restrictive way to advance its interest in guaranteeing cost-free birth control. 

Lastly, the court has ruled that if the government still wants to increase access to contraceptives, it can and should do so in a way that doesn't violate religious freedoms, such as paying for the distribution itself (which it probably will do). 

So...what does this really mean? It depends. The Supreme Court limited the decision to "closely held" corporations (defined as having 50 percent or more of outstanding stock owned by five or fewer people and is not a personal service corporation), which should blunt the impact a bit—though it's worth noting that the majority of corporations in the U.S. are closely held—and also narrowed the scope of the ruling only to apply to contraception. At least for now, business can't opt out of covering vaccines, blood transfusions, or other medical procedures. The decision also doesn't entirely strike down the BC benefit. The vast majority of women eligible for no-copay birth control won't be affected, but for the ones who are, this ruling could have far-reaching consequences.

Updated 6/30/2014 at 12:20 

The Affordable Care Act (ACA) is almost in full effect. As Americans race to enroll in a health insurance plan by March 31—or pay a penalty for not doing so—one portion of the law is still up in the air.

Starting March 25, the U.S. Supreme Court will begin hearing religious disputes over the contraception mandate, which requires employer health insurance coverage of contraceptive methods (without deductibles or co-pays). The main legal argument goes beyond the ethics of reproductive rights and instead centers around whether the law violates the first amendment right to religious freedom for the relevant parties. If the Supreme Court rules that the mandate does violate religious freedom, then it will not be enforceable against certain employers and Congress (or regulators) will have to make some adjustments if they want women to have free access to contraceptives. If the Supreme Court rules in favor of the mandate, certain employers will have to swallow their religious objections and offer health insurance coverage of all preventive services, including birth control.

To better understand both sides of the argument, we asked Holly Lynch, a health care law and bioethics expert at Harvard Law School's Petrie-Flom Center to break down what to expect.

What exactly is the mandate? The ACA requires employers with 50 or more full-time employees to offer certain levels of health insurance coverage or face penalties that could end up costing them millions. Coverage must include free preventive services, including all FDA-approved contraceptive methods, sterilization procedures, and patient-related education.

Why cover contraceptives? About 99 percent of American women between the ages of 15 and 44 have used birth control at some point in their lives, according to the Guttmacher Institute. More than half between the ages of 18 to 34 have struggled to afford them, which has raised the question: Why do women have to bear the brunt of all the costs?

What is the conflict? Some employers have religious objections to funding anything that prevents a fertilized embryo from implanting in the uterus. Several are refusing to pay for this these services or support any healthcare plan that will do so, even if it means no additional expense to the employer.

I'm confused! The first amendment allows you to exercise your religion free of government interference, unless the government has a very strong reason for doing so. However, some companies such as arts-and-crafts chain Hobby Lobby and woodworking company Conestoga Wood Specialties—for-profit, secular business with religious owners—are arguing that the mandate places a "substantial burden" on their religious freedom under the Religious Freedom Restoration Act of 1993 (RFRA). According to the RFRA, unless "there is a compelling government interest," Congress cannot make any laws that substantially burden a person's free exercise of their religion (and even then, can only do so in the way that is as nonintrusive as possible). The Justice Department will probably do two things in its effort to save the mandate: First, it will argue that regardless of their owners' beliefs, for-profit corporations are not "persons" with first amendment rights; therefore, the mandate can't violate them. It will probably also argue that the government has a vested interest in promoting public health and in making sure that "women have equal access to healthcare services," according to the New York Times

On March 25, Hobby Lobby, Conestoga Wood, and the government will have an hour to make their arguments before the court. The court will then spend a month or so considering each side. So ultimately, there's nothing to do but wait and see what the Supreme Court decides.

Will you be paying attention to this decision? Do you think the contraception mandate should be upheld or struck down? Let us know in the comments below or tweet us @Shape_Magazine!

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