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The plain language of 42 U.S.C.S. § 300gg-13(a)(4) clearly allows the Departments of Health and Human Services, Labor, and the Treasury to create the preventive care standards as well as the religious and moral exemptions to the ACA.
The Patient Protection and Affordable Care Act of 2010 (ACA) required covered employers to provide women with preventive care and screenings without any cost sharing requirements, and relied on Preventive Care Guidelines (Guidelines) supported by the Health Resources and Services Administration (HRSA) to determine what preventive care and screenings were included. When the Departments of Health and Human Services, Labor, and the Treasury (Departments) incorporated the Guidelines, they also gave HRSA the discretion to exempt religious employers, such as churches, from providing contraceptive coverage. Under the direction of Zubik v. Burwell and in light of the holding of Burwell v. Hobby Lobby Stores, Inc., the Departments promulgated two interim final rules (IFRs). The first significantly expanded the church exemption to include an employer that would object based on its sincerely held religious beliefs to establishing, maintaining, providing, offering, or arranging for coverage or payments for some or all contraceptive services. The second created a similar moral exemption for employers with sincerely held moral objections to providing some or all forms of contraceptive coverage. Thereafter, Pennsylvania and New Jersey sued, alleging that the IFRs were substantively unlawful because the Departments lacked statutory authority under either the ACA or RFRA to promulgate the exemptions. They also argued that the rules were procedurally defective because the Departments failed to comply with the APA’s notice and comment procedures. The District Court issued a preliminary nationwide injunction against the implementation of the final rules, and the Third Circuit affirmed.
The Court held that the Departments of Health and Human Services, Labor, and the Treasury had the legal authority to exempt certain employers who had religious and conscientious objections from the agency-created contraceptive mandate as the phrase "as provided for" in 42 U.S.C.S. § 300gg-13(a)(4) granted the Health Resources and Services Administration sweeping authority to identify and create exemptions from its own guidelines. The Court further held that the final rules were not procedurally invalid as the APA’s notice requirements and objective criteria were satisfied. The Court noted that the Departments gave interested persons an opportunity to participate in the rule making through submission of written data, views or arguments, and the final rules contained a concise general statement of their basis and purpose, and they were published more than 30 days before they became effective.