Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania

The Patient Protection and Affordable Care Act (ACA) provision granted the Health Resources and Services Administration (HRSA) virtually unbridled discretion to recognize and craft exemptions from its Guidelines and Congress “declined to expressly require contraceptive coverage in the ACA itself.”

The ACA relies on Guidelines set by HRSA to determine what is included in “preventive care and screenings” under the ACA’s contraceptive mandate. 42 U.S.C. §300gg–13(a)(4). The Departments of Health and Human Services, Labor, and the Treasury (the Departments)—which jointly administer the relevant ACA provision—crafted two interim final rules (IFRs) promulgating HRSA’s exemptions from its own Guidelines: the first significantly expanded the definition of exempt religious employers and the second created a similar “moral exemption.” Respondents sued the Federal Government, alleging that the Departments lacked the requisite statutory authority to create those exemptions. The Third Circuit affirmed the district court’s nationwide preliminary injunction against implementing the IFRs. The Supreme Court held that the ACA provided the Departments with the requisite statutory authority to craft both exemptions. The Court concluded that, on its face, the ACA provision granted HRSA virtually unbridled discretion to recognize and craft exemptions from its Guidelines. The Court recognized that where Congress has done so elsewhere, the statute does not “provide an exhaustive or illustrative list” requiring certain preventive care and screenings, provide any criteria or standards guiding HRSA’s selections, or require HRSA to refrain from consulting with or to consult with any party in forming Guidelines. Congress deliberately chose to issue an impressively broad general directive for HRSA to craft their Guidelines, and also declined to explicitly require contraceptive coverage within the ACA itself. REVERSED AND REMANDED.