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The Little Sisters of the Poor Home for the Aged v. Burwell

Attorneys for the conservative Becket Fund for Religious Liberty filed a lawsuit against the Obama administration on behalf of the Little Sisters of the Poor Home for the Aged in Denver and Baltimore and their religiously affiliated insurer, Christian Brothers Employee Benefit Trust, challenging the birth control benefit. The birth control benefit is the provision in the Affordable Care Act (ACA) that requires certain providers of group health insurance plans to cover contraception without charging a co-pay.

Specifically, plaintiffs allege that the process established by the Obama administration for accommodating religious objections to the birth control benefit in the ACA violates their religious exercise under the Religious Freedom Restoration Act (RFRA). The accommodation permits religious nonprofits to self-certify their eligibility for an exemption from the birth control benefit by filling out government paperwork that serves as notice to their insurance company or health insurance plan administrator that they object to contraceptive coverage on religious grounds. At that point, the insurance company steps in and provides contraceptive coverage in the organizations’ stead.

The Little Sisters allege that this self-certification process violates their religious rights because it “triggers” the provision of contraceptive coverage to which they object on religious grounds. The Little Sisters further allege that the paperwork the government requires them to fill out that states their eligibility for a religious exemption from the birth control benefit is, in and of itself, an infringement on their religious freedom in violation of RFRA.


On December 27, 2013, the district court rejected the Little Sisters’ arguments and denied their motion for a preliminary injunction.

Plaintiffs appealed to the Tenth Circuit Court of Appeals and filed an emergency application for an injunction pending appeal. When the Tenth Circuit rejected their emergency application, the Little Sisters filed an emergency application with the U.S. Supreme Court.

On January 24, 2014, the Supreme Court granted the Little Sisters’ emergency application for an injunction and ruled that the Little Sisters were not required to fill out the self-certification form, on the condition that they file a notice with HHS that they are a religious organization and have religious objections to providing contraceptive coverage.

On July 14, 2015, the Tenth Circuit affirmed the district court’s decision denying the preliminary injunction, reasoning that the accommodation does not impose a substantial burden on plaintiffs’ religious exercise or violate plaintiffs’ First Amendment rights.

The Little Sisters appealed to the U.S. Supreme Court, which is scheduled to hear oral arguments on March 23, 2016. The case has been consolidated with six other cases: (1) Zubik v. Burwell; (2) East Texas Baptist University v. Burwell; (3) Priests for Life v. HHS; (4) Southern Nazarene University v. Burwell; (5) Geneva College v. Burwell; and (7) Roman Catholic Archbishop of Washington v. Burwell.

NOTE: Unlike the other six cases pending before the Supreme Court, even if the Little Sisters lose their challenge to the birth control benefit, they still won’t have to provide their employees with contraception, and there’s nothing that the Obama administration can do about it. This is due to the Employment Retirement Income Security Act of 1974 (ERISA), a law which prohibits any government regulation of an employee benefit plan run by a church. This means that the health plan administrator for the Little Sisters (the Christian Brothers Employee Benefit Trust) has no legal duty to provide contraception, irrespective of the outcome of this lawsuit.


**last updated March 17, 2016