ACA Case May Be Bigger Than Birth Control


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WASHINGTON -- A case that will be argued before the Supreme Court on Tuesday could open the door for employers to object to covering a host of health services otherwise mandated by the Affordable Care Act, legal scholars said.

The justices will hear arguments in a case that asks whether employers must provide birth control in employee health plans despite religious objections. Businesses must pay fines -- in some cases millions of dollars a year -- if they don't comply with the law and instead stand their religious ground.

But a victory for private companies who have sued the federal government to make themselves exempt from the law -- including arts-and-crafts giant Hobby Lobby and its sister company Mardel, a Christian bookstore chain -- could allow others to make similar arguments about other services.

"If we get a very broad opinion in favor of Hobby Lobby's position, it isn't just contraception, but a host of other federal regulations that may be challenged based on the idea that they substantially burden a person's religious exercise," Darrell Miller, JD, law professor at Duke University, told MedPage Today in an email. "Corporations, or their owners or directors, may assert that they can refuse to cover HIV treatment, or blood transfusions, or vaccinations."


Nearly a hundred lawsuits have been filed on the issue, and courts have issued varying opinions.

While the issue at hand is whether or not a private business is free to exercise its religious freedoms, "the issue it raises could apply to other cases," Tim Jost, JD, law professor at Washington and Lee University in Lexington, Va., told MedPage Today.

Jost said that the federal government will have a tough time proving that providing birth control is a compelling public health issue to supersede religious freedoms because it has created a number of special exemptions for nonprofit religious organizations already; he noted that the court could expand those exemptions to for-profit companies like Hobby Lobby.

"The government can't really get into deciding whether someone's religious beliefs are sincere or rational or deeply held," Jost said. "What do you do then when someone steps forward and says 'I have a religious objection to Obamacare?'"

Marcia Boumil, JD, associate professor of public health and community medicine at the Tufts University School of Medicine in Boston, has a different opinion on a possible outcome. She too has studied this case.

Boumil believes the Court will make every effort to provide an unambiguous opinion on the issue of whether or not employers will have to provide contraceptive coverage.

"I also think the opinion will be narrow, not attempting to rule -- or allow an opinion that offers interpretation -- beyond religion and birth control," Boumil told MedPage Today in an email.

Her reasoning? The court -- particularly Chief Justice John Roberts -- drew a great deal of heat over its June 2012 opinion on the ACA, and they don't want to provide future fodder for more claims of partisanship.

Justices are expected to release their opinion by June.