s direct funding to religious organizations without insurance and it's going for secular activities in a non neutral manner and designated beneficiaries with respect to their religion the reason that we have so many establishment organization as the sole provider of a government benefit to a set of people who have a particular religious belief that's unprecedented in the history of our country be shared across religious lines when you inevitably in order to accommodate those religious beliefs have to if not single out at least make provision for that that was an issue that was troubling to judge prior the united states supreme court has never addressed that the closest it's come is a state of vs killed or where it's so that you can't just give a benefit to cemetery the supreme court has never specific unique beliefs so then you've got to adopt specific unique programs to everybody who's got unique beliefs that that to me doesn't seem a test that's practical test it's a consequence public activities such as sports stadiums or museums does that mean that we can accommodate those whose religious beliefs doesn't allow them to attend the museum or attend the sports facility by simply funding the the direct funding part of it too because in addition to being a discrimination here on the basis of sex you also got a clear violation of the new principles or the door of the prohibition against direct training principles that the court has has laid down over the years you know it would be constitutional if the law were phrases like the amish in other words that christian scientists don't have to with an exemption from taxation possibly they could do it we don't know for sure but we know all we know that the test for direct funding is that no tax large or small can be used to finance any religious parochial schools can be the recipient of certain types of things such as a textbook or launch textbook grants testing reimbursement of testing expenses things that can't be diverted to a religious purpose three terms we've had this rule announced three times that when you're dealing with the neutral things that can be diverted to a religious use you have to meet a number of factors you must be neutral with respect to religion you can identify the beneficiaries by reference to it on to the other side good morning your honor my name is lol sturgeon i'm here from the department of justice representing the government i like to begin if i may by trying to address some of the questions the court has asked and i'd like to first begin with you and your question about the nature of accommodating a single religious belief and i think the curiosity and well opinion from the supreme court gives you the roadmap that answers that and i think here yes joelle says it is permissible for the government to accommodate what it understands to be unique belief of a group as long as it does so in religiously neutral terms and that's what section forty four fifty four does here it accommodates the christian scientists and any other group or any other person who has a religious objection unconstitutional motives especially here what congress has done is on its face religiously neutral again section four fifty four is the benefit to any individual who has a sincerely held religious belief that forbids them from getting medical care now in fact we don't know exactly what kinds of religious groups or religious individual beliefs might fit within that exception and there could be numerous groups that believe the same way in fact given the nature of religious belief it's not hard to believe that there could be numerous individuals who for their own particular religious reasons hold that very same beliefs so i think again it's critical to first grant congress the benefit of the specific provisions that led to the demise of the prior statute with a religiously neutral benefit so it again if you scrutinize the legislative history congress did what it was doing and i think they're entitled to the benefit of the doubt again when they  that accommodation along with similar exemptions for non religious individuals and the notion is that where religious people are being specially burdened by government programs because of their religion it's permissible and it's neutral wanted any given time choose to participate in the government's job is to write congress's job is to write the program in religiously neutral terms which is what we've done here and finally on this this general of this first notion the first issue that you w new the uniqueness of the benefit i think it's important to note that in the dros case this court upheld an exemption from the social security laws that basically benefits it's not exclusively almost only the amish institute and the government's position is that congress was intending to accommodate individual beliefs of those who are a futile and need medical care in fact so much so that they would merit this that far into the religious institution or maybe you can telling one well i guess our response is that first of all that it's perfectly permissible for the government to involve religious institutions in providing secular services as long as that's what they're doing and as long as that's the only thing the government is paying for and here it's clear from the statute that the government is only paying for secular medical care not medical care or health care services have scuse me so the fact that we're using religious institutions to provide those services is permissible the second point is that it's kind of odd because basically in an institution that doesn't believe in medical care they're making a medical judgment as to whether or not the again i think it's critical to realize that only secular services are being paid for and second the only mentions of religious institutions in the statute have in our view valid secular purposes we've gone through the center of brief congress mentioned that these institutions these routes these would have to act because of their own religious beliefs in order to prevent the system from being overwhelmed by a likelihood of complying with it would completely overwhelm what is really a very very tiny so part of the medicare medicaid programs as the briefs show only about five or six million dollars a year goes to the payment of these benefits and as you provisions really does have a valid secular basis point you shouldn't strike down the entire statute but you should do is that women need the one provision that says that the green sea has to be acting on the basis of its own particular religious beliefs now again we think that it's permissible provision that has a valid secular purpose in order to avoid basically ruining the entire threaten to ruin the entire accommodation but if you don't believe that religious beliefs this is talk about the institution on the basis of its religious beliefs does not provide through its personnel medical items and services and the plaintiffs have said that the inclusion of the language on the basis of his religious beliefs the same constitutional we think it doesn't but that would be what she would take out and sever from the statute if you disagree with us jews protestants muslims nonbelievers all get their choice of health care providers and many of these religious spittles of course have chaplains they have check chapels and they have religious nurses  the medicare program now congress also made a point in the statute of making clear that this is not just a medical program congress recognized that people have different health care preferences and if they're for included non medical care from providers such as chiropractors an osteopath because americans don't always use medical doctors for their health care needs and congress also made clear in this program that the medicare beneficiary can reject novel medical care completely they can go to the hospital check him get health care services but if their religion dictates that they not have an operation or a transfusion they are free to make the election and that takes care of people such as  other religions this is a classic example of permissible accommodation under a must and under texas monthly because the accommodation doesn't place burdens on any other people because it lifts the burden elderly and under the supreme court's decision in the walters case and the fact that this accommodation doesn't stand alone but rather is part of the general welfare program makes a huge difference to this course analysis because the supreme court has told us again and again aid is permissible if it is part of a program that benefits the public generally and if the aid is dependent on truly private choices in that situation there's no special deal for religion and the purpose and the effect of the law are the secular purpose and effect of the well her statute in this case is a paradigm example because medicare expands hundreds of billions of dollars every year and payments to christian scientists are just a small drop in this large bucket under this program every american is free to make his or her own decision about health care and it's no business of any other beneficiary if some third third beneficiary or some other beneficiary prefers a different system of health care because one hospital and one of the r h are you know one of the alphabet institutions which at least currently i believe your clients perhaps are the only ones that actually have such an institution be the harm or the hazard to simply say that the individual can make the choice but you don't have to go to the effort that institution to receive it and you know there may be some others pop up and there may not well  one hundred times a day and this is true of other religious hospitals and in the american hospital association have agreed the chaplaincy programs are a necessary part of the hospital's provision of total patient care so it can't be the slightest that religious the atmosphere and religious motivation are part and parcel of some of the finest hospitals and nursing homes in the medicare system today the arguments we've heard are not merely arguments of abstract concern because we're talking if the constitution really required that cruel result and it is a cruel result that would be one thing but it doesn't mr grunow hasn't cited a single factually relevant case in these long briefs and the supreme court has held provision of the statute is in paragraph and it's not only that on the basis of religious beliefs it doesn't provide medical care but it's on the basis of its religious creed it doesn't believe in a medical diagnosis or a medical examination connection with the ancillary services or the person must be receiving therapeutic medical care the scientifically proven to be of value and in the healing of that person so the person who checks in the hospital the mine for example  possibly they could but the sanatoriums prohibited from diagnosing what they have which is which prevents i guess an even handed utilization of the program we don't know what these people are suffering from  is what they would be in the in the medical hospital congress rejected that as a requirement there's no requirement that the services be the same the only thing they're relying on here is the description of nursing services statute allows for payment of nursing spiritual intuition and and spiritual impulses in their in their care other drives decision again dealt with a statute that dealt with individuals and not religious organizations or i think it's not a matter of preceden