# U ni te d S ta te s Co ur t of A pp ea ls For the Eig hth Circu it

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No. 1 4- 15 07

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Sh arp e Hol di ng s, In c. a Mi ss ou ri C or po rat io n; Rit a Jo an ne W il so n, a M is so ur i

res id en t; Ju di Dian e Sch aefe r, a Mi ss ou ri r es id en t; Ch arl es N. Shar pe , a Mi ss ou ri

res id en t; CNS Co rp or at io n, a M is so ur i Co rp or at io n; Ozark Nati on al Life In su ran ce Co m

pa ny, a Mis so ur i Co rp or at io n; N.I.S. Fin an ci al Serv ic es , Inc . a Mi ss ou ri C or

po rat io n; CNS In te rn at io na l M in is tri es , A Mis so ur i No n- Pro fit Co rp or at io n; Heart la nd Ch ris ti an Co ll eg e, A Mis so ur i No n- Pro fit Co rp or at io n

ll ll ll ll ll ll ll ll ll ll l Pla in ti

ff s - Ap pe ll ees

v.

Uni te d S ta te s Dep art m en t o f Heal th an d Hu m an Serv ic es ; Sylvi a Ma th ews Bu rwel l, i n h er o ffi ci al cap aci ty as th e Sec ret ary of th e Uni te d S ta te s Dep art m en t of Heal th an d Hu m an Serv ic es ; Un it ed Sta te s Dep art m en t o f th e Treas ur y ; Un it ed St at es Depa rtment o f Lab or ; J aco b J . Lew, in hi s o ffi ci al cap aci ty as th e Sec ret ary of th e Uni te d S ta te s Dep art m en t o f th e Treas ur y ; Th om as E. Perez, i n h is off ic ia l
cap aci ty as th e Sec ret ary of th e Uni te d S ta te s Dep art m en t o f Lab or 1

ll ll ll ll ll ll ll ll ll ll l Defe nd

an ts - App el la nt

s

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Am eri can Civ il Lib ert ie s Un io n; Am eri can Civ il Lib ert ie s Un io n o f Mi ss ou ri; Ju li an Bo nd ; Nat io na l Wom en ’s Law Cen te r; Am eri can Ass oc ia ti on of Un iv ers it y W om en ; Am eri can Fed erat io n o f St at e, Co un ty and Mu ni ci pa l Em pl oyees; Bla ck W om en ’s Healt h Imperat iv e; Fem in is t M ajor it y Fo un da ti on ; Ib is Rep ro du ct iv e Heal th ; Leg al Mo m en tu m ; M erg erWatch ; NARAL Pro -Ch oi ce Am eri ca; NARAL Pro -Ch oi ce M in ne so ta ; NARAL Pro -Ch oi ce M is so ur i; NARAL Pro- Ch oi ce So ut h

S e c ret ary of Heal th an d Hum an Serv ic es Sy lv ia Mat he ws Bu rwel l is 1

su bs ti tu te d fo r he r pr ed eces so r, Kath le en Seb el iu s. See Fed . R. App . P. 43 (c)( 2)

.Dak ot a; Nati on al Orga ni zat io n fo r W om en Fo un da ti on ; Nat io na l Pa rtn ers hi p fo r

W om en an d F am il ie s; Pla nn ed Pare nt ho od of t he Heart la nd ; Pl an ne d P aren th oo d of Kans as & Mi d- Mi ss ou ri; Pla nn ed Pare nt ho od Mi nn es ot a, Nor th Dako ta , Sou th Dak ot a; Pla nn ed Pare nt ho od of t he St. Lo ui s R eg io n a nd So ut hwe st Mi ss ou ri; Po pu la ti on Co nn ect io n; Rai si ng W om en ’s Voi ces for th e Heal th Care W e Need ; Serv ic e Em

pl oyees’ Int ern at io na l Un io n; Nati on al Heal th Law Pro gr am ; Am eri can Pu bl ic Heal th Ass oc ia ti on ; Nat io na l Fa m il y Pla nn in g & Rep ro du ct iv e Heal th Ass oc ia ti on ; Nat io na l Wom en ’s Healt h Net wor k; Nati on al Lati na Ins ti tu te for Rep ro du ct iv e Heal th ; Nat io na l As ia n P aci fic Am eri can W om en ’s For um ; As ia n Am eri can s Ad va nc in g J us ti ce; Asi an Am eri can s Ad va nc in g J us ti ce - Lo s An ge le s; Asi an & Pac ifi c Is la nd er Am eri can Heal th Fo ru m ; Fo rward Tog et he r; I pa s; Sex ua li ty Info rm at io n a nd Edu cat io n C ou nc il of t he U.S.; HIV Law Pro ject; 30 for 30 Cam pa ig n; Cal ifo rn ia W om en ’s Law Cen te r

ll ll ll ll ll ll ll ll ll ll l

Amici on Beha lf

of App el la nt (s

)

Lib ert y , Life, an d Law Fo un da ti on ; As so ci at io n o f Gos pe l Re sc ue Mi ss io ns ; Pri so n F el lo wsh ip Mi ni st rie s; Ass oc ia ti on of C hr is ti an Sch oo ls Int ern at io na l; Nati on al Ass oc ia ti on of Ev an ge li cal s; Eth ic s an d R el ig io us Lib ert y Co m m is si on of th e So ut he rn Bap ti st Co nv en ti on ; Am eri can Bib le So ci et y ; Th e Lut he ran Ch ur ch -Mi ss ou ri S y no d; Ins ti tu ti on al Rel ig io us Free do m All ia nc e; Ch ris ti an Leg al So ci et y

ll ll ll ll ll ll ll ll ll ll l

Amici on Beha lf

of App el le e(s

)

__ __ __ __ __ __ App eal fro m

Uni te d S ta te s Di st ric t Co ur t fo r th e Eas te rn Dis tri ct of M is so ur i - Han ni ba l

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Su bm it te d: Decem

be r 10 , 20 14 Fil ed : Se pt em

be r 17 , 20 15

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Befo re WOL LMAN, COLLOTON , and BENTON, Circu it Ju dg es

.

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-2

-W OLLMAN, Circ ui t J ud ge

.

Co nt en di ng th at th e di st ric t co ur t ab us ed i ts di sc ret io n, th e Dep art m en ts of 2

Heal th a nd Hum an Serv ic es (HHS), Lab or (DOL), an d Treas ur y , as well as th ei r

res pe ct iv e Secr et ari es , (co ll ect iv el y , th e go ve rn m en t) ap pe al f r o m th e en try of a
pr el im in ary in

jun ct io n en

joi ni ng th e go ve rn m en t fro m en fo rci ng cert ai n p ro vi si on s of th e P at ie nt Pro te ct io n an d Affo rd ab le Care Act (ACA), 42 U.S.C. § 30 0g g- 13
, ag ai ns t CNS In te rn at io na l Mi ni st rie s, In c. (CNS) an d Heart la nd Ch ris ti an Co ll eg e (HCC)

, each of whi c h i s a no np ro fit rel ig io us or ga ni zat io n th at of fers he al th care

co ve rag e to em

pl oyees th ro ug h a se lf- in su red pl an

. W e affi rm th e or de r gr an ti ng th e 3

pr el im in ary in

jun ct io n.

CNS, a Mi ss ou ri no np ro fit co rp or at io n wit h m or e th a n f i f t y em pl oyees,
pr ov id es fu ll -ti m e res id en ti al se rv ic es to m en , wom en , an d ch il dr en wit h be ha vi or al

pr ob le m s or who su ffer fro m al co ho l or dr ug de pe nd en ci es , an d it op erat es a sc ho ol
th at se rv es th e ch il dr en of in di vi du al s in it s reco ve ry pr og ram , as well as it s

em pl oyees’ ch il dr en

. HCC, al so a Mi ss ou ri no np ro fit co rp or at io n bu t wit h fewer th an fif ty em pl oyees, pr ov id es po st -s ec onda ry hig he r ed

uc at ion to em

plo y ee s an d resid en ts
of CNS an d th ei r de pe nd en ts

. Ch ris ti an be li ef an d pr a c t i c e a r e i nt eg ral to th e id en ti ti es of bo th CNS an d H C C
, an d th ey st riv e “ to pr om ot e cert ai n m or al an d

et hi cal st an da rd s i n t h e i r e m pl oyees, in cl ud in g

. . . a be li ef in th e sa nc ti ty of li fe
whi ch pr ecl ud es ab or ti on on de m an d.” As pa rt of th ei r rel ig io us m is si on to pr om ot e

The Hon or ab le Dav id D. Noc e, Uni te d St at es Mag is tra te Ju dg e fo r th e East ern 2 Dis tri ct of Mi ss ou ri (h erei na fte r th e di st ric t co ur t), to who m th e cas e was as si gn ed by

co ns en t o f th e p art ie s u nd er 2 8 U.S.C. § 63 6( c).

In se pa rat e or de rs th at are no t at is su e in th is ap pe al

, th e di st ric t co ur t gr an te d 3 (1 ) a te m po rary res tr a i n i n g o r de r fo r App el la nt s Sh arp e Hol di ng s, In c.; Ch arl es N. Sh arp e; Ri ta Jo an ne W il so n; an d Ju di Dian e Sch aefe r an d (2 ) a pr el im in ary in jun ct io n fo r App el la nt s CNS Co rp or at io n; Ozark Nati ona l L if e In sur an ce Co m

pa ny; an d N.I.S. Fi na nc ia l Se rv ic es , Inc

.
-3

-th e well -b ei ng an d he al th of th ei r em pl oyees, b o t h C N S a nd HCC of fer he al th care

co ve rag e to em

pl oyees th ro ug h se lf- in su red gr ou p he al th pl an s, al th ou gh HCC, wit h
fewer th an fif

ty em pl oyees, is no t req ui red by th e ACA to of fer he al th care co ve rag e.

Und er au th or it y gr an te d by th e ACA, HHS pr om ul ga te d reg ul at io ns req ui rin g

“ gr ou p he al th pl an [s ]” an d “ he al th in su ran ce is su er[s ] of feri ng gr ou p or in di vi du al
he al th in su ran ce co ve rag e” to co ve r, “ [w]ith res pe ct to wom en , . . . pr ev en ti ve care

an d sc reen in gs pr ov id ed f o r i n bi nd in g co m

pr eh en si ve he al th pl an co ve rag e
gu id el in es su pp or te d by th e Heal th Res ou rces an d Serv ic es Ad mini st rat io n.” 45
C.F.R. § 14 7.1 30 (a)( 1) (iv ). At th e reco m m en da ti on of th e In st it ut e of Med ic in e, HHS
ad op te d gu id el in es pr ov id in g th at no ne xe m pt em pl oyers ge ne ral ly m

us t pr ov id e

“ co ve rag e, wit ho ut co st sh ari ng , fo r ‘[a] ll Fo od an d Dru g Adm in is tra ti o n [ ( F D A ) ]

ap pr ov ed co nt race pt iv e m et ho ds

, st eri li zat io n pr oc ed ur es , an d pa ti en t ed uc at io n an d

co un se li ng fo r al l wom en wit h rep ro du ct iv e cap aci ty’ ” (th e co nt race pt iv e m an da te ).

77 Fed

. Reg

. 87 25
, 87 25 (Feb

. 15
, 20 12 ); se e 29 C.F.R. § 25 90 .71 5- 27 13 (a). 4

Co nt race pt iv e m et ho ds ap pr ov ed by th e FDA in cl ud e in t r a ut eri ne de vi ces (IUDs ),
le vo no rg es tre l (Pl an B), an d ul ip ris ta l acet at e (el la ), each o f w h ic h “ m ay ha ve th e effe ct of pr ev en ti ng an al read y fert il iz ed eg g fro m de ve lo pi ng an y fu rth er by
in hi bi ti ng it s at ta ch m en t t o t he ut eru s.” Bu rwel l v. Hob by Lo bb y , 1 34 S. Ct . 2 75 1,
27 62 -6 3 (2 01 4)

. In ge ne ral

, an y em pl oyer th at of

fers em pl oyees a gr ou p he al th pl an

m us t co m pl y w i t h t h e co nt race pt iv e m an da te or face pe na lt ie s of $1 00 pe r da y pe r aff e c t e d “ in di vi du al .” 26 U.S.C. § 49 80 D(b ). An em pl oyer wit h m or e th an fif ty

em pl oyees th at fai ls to pr ov id e em pl oyees wit h a gr ou p he al th pl an is ge ne ral ly

su bjec t t o p en al ti es of $ 2,0 00 pe r y ear p er fu ll -ti m e em pl oyee. Id. § 49 80 H(a), (c)

.

The ACA pr ov id es a n ex em pt io n fro m th e co nt race pt iv e m an da te fo r

“ gr an df at he red ” he al th pl an s, i.e.
, th os e in ex is te nc e at th e ti m e o f t h e A CA’s

Treas ur y an d HHS reg ul at io ns were si m il arl y rev is ed

, bu t we ci te on ly to DOL 4

reg ul at io ns un le ss ot he rwis e in di cat ed

.
-4

-ad op ti on

. 42 U.S.C. § 18 01 1; 29 C.F.R. § 25 90 .71 5- 12 51

. The ACA al so pr ov id es

an ex em pt io n fro m th e co nt race pt iv e m an da te fo r gr ou p he al t h p l a n s s po ns or ed by
rel ig io us em

pl oyers. 45 C.F.R. § 14 7.1 31 (a) (HHS). The te rm “ rel ig io us em pl oyer”
is de fin ed na rro wly by refe ren ce to th e In te rn al Rev en ue Co de to in cl ud e “ ch ur ch es , th ei r in te gr at ed au xi li ari es , an d co nv en ti on s or as so ci at io ns of ch ur ch es ,” as well as

“ th e ex cl us iv el y rel ig io us act iv it ie s of an y rel ig io u s o r d e r.” Id

. (ci ti ng th e In te rn al

Rev en ue Co de

, 26 U.S.C. § 60 33 (a)( 3) (A)(i ), (ii i))

. Und e r t h es e ex em pt io ns ,

em pl oyers wit h gr an df

at he red pl an s an d rel ig io us em pl oyers m ay co nt in ue to of fer
th ei r em pl oyees h eal th care co ve rag e th at do es no t i nc lu de co nt race pt iv es

.

The reg ul at io ns al so pr ov id e an “ acco m m od at io n” fo r c e rta in rel ig io us

or ga ni zat io ns th at ha ve rel ig io us ob jecti on s to th e co nt race pt iv e m an da te bu t do no t

qu al ify fo r th e rel ig io us -em pl oyer ex em

pt io n. 78 Fed

. Reg

. 39 ,87 0, 39 ,87 1 (J ul y 2,

5

2 0 13 ); se e al so 29 C.F.R. § 25 90 .71 5- 27 13 A. The acco m m od at io n is in t e n d e d t o
pr ot ect rel ig io us or ga ni zat io ns “ fro m ha vi ng to c on tra ct , arra ng e, pa y , or refe r fo r”

co nt race pt iv e co ve rag e. 78 Fed

. Reg

. at 39 ,87 2. It is av ai la bl e fo r a r e l i g i o us

or ga ni zat io n th at (1 ) ha s rel ig io us ob jecti on s to pr ov id in g he a l t h c a r e co ve rag e fo r

so m e o r a l l c o n tra cep ti ve se rv ic es , (2 ) “ is or ga ni zed an d op erat es as a no np ro fit

en ti ty,” (3 ) “ ho ld s it se lf ou t as a rel ig io us or ga ni zat io n,” an d (4 ) co m pl ie s wit h a se lfcert ifi cat io n pr oc es s. 2 9 C .F.R. § 25 90 .71 5- 27 13 A(a). A se lf- in su red rel ig io us 6

Afte r th e Su pr em e Co ur t’s de ci si on in Hob by Lob by, th e go ve rn m en t rev is ed 5 th e rel ev an t reg ul at io ns effe ct iv e Sep te m be r 14
, 20 15
, to ex te nd th is acco m m od at io n to cert ai n cl os el y he ld fo r-p ro fit en ti ti es th at ha ve a rel ig io us ob jecti on to pr ov id in g

co ve rag e fo r so m e o r al l o f th e FDA-ap pr ov ed co nt race pt iv e m et ho ds . See 8 0 F ed

. Reg . 41 ,31 8 (J ul y

14 , 20 15 ).

A se lf- in su red e mp l o ye r be ars th e fin an ci al ris k of pa y in g it s em pl oyees’ 6 he al th -in su r a n c e c la im s rat he r th an co nt ract in g wit h a se pa rat e in su ran ce co m pa ny to p r o v i d e th e co ve rag e an d be ar th e fin an ci al ris k. A se lf- in su red em pl oyer of te n hi res a th ird -p art y ad m in is tra to r to m an ag e ad m in is tra ti ve fu nc ti on s li ke pr oc es si ng cl ai m s. See, e.g ., 1A St ev en Pl it t, et al

., Co uc h on In su ran ce § 10 :1 n.1 (3 d ed

. 20 13 ).

-5

-or ga ni zat io n, aft er “ co nt ract [in g] wit h on e or m or e th ird pa rty ad m in is tra to rs ,” 29

C.F.R. § 25 90 .71 5- 27 13 A(b )(1 )(i ), com plies wit h th e se lf- cert ifi cat io n pr oc es s in on e of two way s.

The or ga ni zat io n m ay se lf- cert ify by co m pl et in g an d su bm it ti ng di rect ly to it s th ird -p art y ad m in is t r a t o r (TPA) an EBSA Fo rm 70 0– Cert ifi cat io n (Fo rm 70 0)

, cert ifyin g t h a t it is a rel ig io us no np ro fit en ti ty th at ha s rel ig io us ob jecti on s to

pr ov id in g co ve rag e fo r so m e or al l of th e co nt race pt iv es req ui red by th e m an da te

. 29
C. F. R. § 2590

. 71 5- 27 13 A(a)-( b)

. The or ga ni zat io n m ay al so se lf- cert ify by pr ovi din g

no ti ce to HHS st at in g th e or ga ni zat io n’s na m e; th e ba si s on whi ch it qu al ifi es fo r an

acco m m od at io n; it s r e l i gi ou s ob jecti on s to pr ov id in g co ve rag e fo r so m e or al l

co nt race pt iv es , in cl ud in g th e sp eci fic co nt race pt iv es to whi ch it ob jects ; it s in su ran ce pl an na m e an d type; an d it s TPA’ s na m e an d co nt act in fo rm at io n (HHS Not ic e). See 7

79 Fed

. Reg

. 51 ,09 2, 51 ,09 4- 95 (Au g. 27
, 20 14 ); 80 Fed

. Reg

. 41 ,31 8, 41 ,32 3 (J ul y 14
, 20 15); 29 C. F. R. § 2590

. 715- 2713 A(b )(1 )(i i)( B). The rel ig io us or ga ni zat io n m us t

Bec au se CNS a n d HCC of fer se lf- in su red pl an s, we fo cu s ou r di sc us si on on reg ul at io ns ap pl ic ab le to th os e p la ns

.
Thi s se lf- cert ifi cat io n m et ho d was ad de d to th e reg ul at io ns aft er th e Su pr em e 7 Co ur t’s or de r i n W he at on Co ll eg e v. Bu rwel l, 13 4 S. Ct

. 28 06 (2 01 4)

. W he at on Co ll eg e, a rel ig io us or ga ni zat io n, ch al le ng ed th e ac c o mm o d at io n pr oc es s, arg ui ng th at co m pl et in g Fo rm 70 0 an d fo rward in g th e Fo rm to it s in su ran ce is su er m ad e it

co m pl ic it in th e pr ov is io n of co nt race pt iv e co ve rag e in vi ol at io n of it s rel ig io us be li efs

. The Su pr em e Co ur t gr an te d in jun ct iv e rel ie f, en

joi ni ng th e go ve rn m en t fro m

en fo rci ng th e co nt race pt iv e m an da te whi le th e co ll eg e’s c h al le ng e to th e

acco m m od at io n pr oc es s was pe nd in g, pr ov id ed th at th e c o l l eg e in fo rm HHS “ in writ in g th a t i t i s a no np ro fit or ga ni zat io n th at ho ld s it se lf ou t as rel ig io us an d ha s rel ig io us ob

jecti on s t o p ro vi di ng co ve rag e fo r co nt race pt iv e se rv ic es .” Id. a t 2 80 7. The co ll eg e was no t req ui red to se lf- c e r t i f y u s in g Fo rm 70 0. Id

. The Co ur t al so st at ed

, “ Not hi ng in th is or de r pr ecl ud es th e Gov ern m en t fro m rel y in g on th is no ti ce, to th e ex te nt it co ns id ers it ne ces sa ry , to faci li ta te th e pr ov is io n of fu ll co nt race pt iv e

co ve rag e u nd er t he ” ACA to W he at on Co ll eg e’s em pl oyees a nd st ud en ts . Id.

-6

-al so up da te it s HHS Not ic e “ [i]f th ere is a ch an ge in an y of th e in fo rm at io n req ui red

to be in cl ud ed .” 29 C.F.R. § 25 90 .71 5

- 2 7 1 3A( b) (1 )(i i)( B). Acco rd in g to th e
go ve rn m en t, th is in fo rm at io n is “ th e m in im um in fo rm at io n ne ces sa ry

. . . to de te rm in e whi ch en ti ti es are co ve red by th e acco m m od at io n, to ad m in is te r th e acco m m od at io n,

an d to im pl em en t” go ve rn m en t po li cy

. 79 Fed

. Reg

. 51 ,09 2, 51 ,09 5 (Au g. 27
, 20 14 );
80 Fed

. Reg

. 41 ,31 8, 41 ,32 3 (J ul y 1 4
, 20 15 ). Afte r HHS rece iv es th e Not ic e, it

pr ov id es th e in fo rm at io n to DOL, whi ch se nd s a se pa rat e no ti fic at io n to th e rel ig io us

or ga ni zat io n’s TPA. See id

.

Onc e a TPA rece iv es Fo rm 70 0 fro m th e rel ig io us or ga ni zat io n or th e se pa rat e

no ti fic at io n fro m DOL “ an d ag rees to en te r in to or rem ai n in a co nt ract ua l
rel at io ns hi p wit h” th e rel ig io u s o r g an iz at io n, th e TPA m us t “ pr ov id e or arra ng e
p a ym e n t s fo r co nt race pt iv e se rv ic es ” fo r be ne fic ia rie s of th e or ga ni zat io n’s gr ou p he al th pl an ei th er by pr ov id in g th os e pa y m en ts it se lf or by arra ng in g fo r an ot he r pa rty

to do so

. 29 C.F.R. § 25 90 .71 5- 27 13 A(b )(2 ). The TPA is al so “ de si gn at [ed ]

. . . pl an ad m in is tra t o r an d cl ai m s ad m in is tra to r fo r co nt race pt iv e be ne fit s” fo r th e rel ig io us

or ga ni zat io n. 78 Fed

. Reg

. at 39 ,87 9. If a se lf- i n s u r e d r el ig io us or ga ni zat io n us es Fo rm 70 0, th e fo rm be co m es “ an in st ru m en t un de r whi ch th e pl an is op erat ed [an d
is ] tre at ed as a de si gn at io n of th e [TPA] as th e pl an ad m in is tra to r un de r se ct io n 3( 16 )
of ERISA[, 29 U.S.C. § 10 02 (3 3) ,] fo r an y co nt race pt iv e s erv ic es req ui red to be

co ve red .” 2 9 C.F.R. § 25 10 .3-1 6( b)

. Fo rm 70 0 au th or iz es th e TPA to “ pr ov id e or

arra ng e pa y m en ts fo r co nt race pt iv e se r v i ces ” an d req ui res th e TPA to pr ov id e

se pa rat e no ti ce reg ard in g th os e se rv ic es to pa rti ci pa nt s an d be ne fic ia rie s en ro ll ed in
th e rel ig io us org an iz at io n’s gro up he al th pl an

. 29 C.F.R. § 25 90 .71 5- 27 13 A(b )(2 ).
If th e se lf- in su red rel ig io us or ga ni zat io n in st ead se lf- cert ifi es by HHS Not ic e, DOL’ s

en su in g no ti fic at io n to th e TPA al so op er a t e s t o “ de si gn at e” th e TPA “ as pl an ad m in is tra to r” un de r ERISA fo r co nt race pt iv e be ne fit s. 79 Fed

. Reg

. at 51 ,09 5; se e al so 29 C.F.R. § 25 10 .3-1 6( b)

. Onc e th e TPA rece iv es Fo rm 70 0 or no ti fic at io n fro m DOL, it al so be co m es el i g i b l e t o be rei m bu rs ed fo r th e fu ll co st of co nt race pt iv e

co ve rag e, pl us an ad di ti on al al lo wan ce of “ no le ss th an 10 pe rcen t.” 45 C.F.R.

-7

-§ 15 6.5 0 (HHS); 79 F e d

. R e g

. 13 ,74 4, 13 ,80 9 (Ma r. 11
, 20 14 ) (n ot in g th at HHS

sp eci fie s th e am ou nt of th e y earl y al lo wan ce an d se tt in g th at am ou nt at fif te en pe rcen t
fo r 20 15 ). The TPA m

us t pr ov id e or arra ng e fo r se pa rat e pa y m en ts fo r co nt race pt iv e

co ve rag e fo r a rel ig io u s or ga ni zat io n’s pl an be ne fic ia rie s “ so lo ng as [th e be ne fic ia rie s] are en ro ll ed in [th e or ga ni zat io n’s] gr ou p he al th pl an .” 29 C.F.R. § 2 59 0.7 15 -2 71 3A( d) ; s ee 4 5 C .F.R. § 1 47 .13 1( c)(2 )(i )(B) (HHS). 8

CNS an d HCC, in acco rd a n c e w it h th ei r si nc erel y he ld rel ig io us be li efs

, op po se th e us e, fu nd in g, p r o v i s io n, or su pp or t of ab or ti on on de m an d, an d th ey be li ev e th at cert ai n con tra cep ti ve s requ ire d un de r th e co nt race pt iv e m an da te —Pl an B, el la

, an d co pp e r I UDs— are fu nc ti on al ly eq ui va le nt to ab or ti on on de m an d. As
ha ve a nu m

be r of ot he r rel ig io us or ga ni zat io ns th at do no t qu al ify fo r th e rel ig io us

em pl oyer ex em

pt io n fro m th e co nt race pt iv e m an da te , CNS an d HCC br ou gh t su it

ag ai ns t t h e g o v ern m en t, arg ui ng th at bo th th e co nt race pt iv e m an da te an d th e

acco m m od at io n pr oc es s im

po se a su bs ta nt ia l bu rd en on th ei r ex erci se of rel ig io n in

v i o l a t i on of th e Rel ig io us Free do m Res to rat io n Act of 19 93 (RFR A), 42 U.S.C

. §§ 20 00 bb to 20 00 bb -4
, an d th e Free Exe rci se Cl au se of th e Fi rs t Am en dm en t to th e

It is no t cl ear whe th er th e ACA’s im pl em en ti ng reg ul at io ns im po se a se pa rat e 8 le ga l ob li ga ti on on a TPA to pr ov id e co nt r a c e p t i v e co ve rag e to a rel ig io us

or ga ni zat io n’s em

pl oyees an d pl an be ne fic ia rie s or w he the r tha t obl iga tio n arise s on ly aft er th e TPA rece iv es a co py of th e or ga ni zat io n’s Fo rm 70 0 or DOL no ti fic at io n an d is th ereb y de si gn at ed as a pl an ad m in is tra to r fo r pu rp os es of ERISA. See Pri es ts fo r Life v. U.S. Dep ’t of Hea lt h & Hum an Serv s., No . 13 -5 36 8, s li p o p. at 12 n.3 (D.C. Ci r. May 2 0
, 2 0 1 5 ) ( Bro wn, J., di ss en ti ng fro m de ni al of reh eari ng en ba nc ); Lit tl e Si st e r s of th e Po or Hom e fo r th e Age d, Den ve r, Co lo

. v. Bu rwel l, 79 4 F.3 d 11 51
, 12 08 (1 0t h Ci r. 20 15 ) (Bal do ck

, J., di ss en ti ng i n pa rt) (d is cu ss in g effe ct of

acco m m od at io n reg ul at io ns in co nt ex t o f se lf- in su red no np ro fit rel ig io us

or ga ni zat io ns ), pe ti ti on fo r cert

. fil ed

, 84 U.S.L.W

. 30 56 (U.S. Ju ly 23
, 20 1 5 ) (No

. 15 -1 05 ); se e al so W he at on Co ll eg e v. Bu rwel l, 13 4 S. Ct

. 28 06
, 28 14 n.6 (2 0 1 4 ) (So to m ay or , J., di ss en ti ng ) (ex pl ai ni ng th at a TPA do es no t h a v e an in de pe nd en t ob li ga ti on to pr ov id e co nt race pt iv e c o v e r a g e bu t “ be ars th e le ga l ob li ga ti on to
pr ov id e co nt race pt iv e co ve rag e o nl y up on rece ip t o f a v al id sel f-ce rti fic at io n” ).

-8

-U.S. Con st it ut io n. CNS a nd HCC co nt en d t ha t t he go ve rn m en t is co erci ng th em to
vi ol a te th ei r rel ig io us be li efs by th reat en in g to im po se se ve re m on et ary pe na lt ie s

un le ss th ey ei th er di rect ly pr ov id e co ve rag e fo r ob jecti on ab le co nt race pt iv es th ro ug h
th ei r gr ou p he al th pl an s or in di rect ly pr ov id e, tri gg er, an d faci li ta te th at ob jecti on ab le

co ve rag e th ro ug h th e Fo rm 70 0/ HHS Not ic e acco m m od at io n pr oc es s

. The y

acco rd in gl y m ov ed fo r a te m po rary res tra in in g or de r an d a pr el im in ary in jun ct io n to

en joi n en fo rcem en t of th e co nt race pt iv e m an da te an d th e acco m m od at io n reg ul at io ns
ag ai ns t th em

. The di st ric t co ur t gr an te d in jun ct iv e rel ie f, rel y in g on an earl ie r or de r 9

en joi ni ng en fo rcem en t of “ th e ACA Man da te reg ul at io ns reg ard i n g a b or ti faci en t
de vi ces an d rel at ed co un se li ng ” ag ai ns t th e fo r-p ro fit pl ai nt iff s, D. Ct

. Ord er of Dec.
31
, 20 12
, at 9, an d reas on in g th at “ th e arg um en ts fo r th os e pl ai nt iff s are su bs ta nt ia ll y si m il ar to th e arg um en ts ” rai se d by th e no np ro fit rel ig io us or ga ni zat io ns , D. Ct

. Ord er of Dec. 30 , 20 13 , at 5

.

Afte r th e no ti ce of ap pe al wa s f i l e d

, th e Su pr em e Co ur t is su ed it s or de r in

W he at on Co ll eg e v. Bu rwel l, 13 4 S. Ct

. 28 06 (2 01 4)

, an d th e go ve rn m en t rev is ed th e

acco m m od at io n reg ul at io ns to pe rm it rel ig io us or ga ni zat io ns to se lf- cert ify u s in g
H H S Not ic e, as well as Fo rm 70 0. W e gr an te d th e pa rti es ’ joi nt m ot io n fo r
pe rm is si on to fil e su pp le m en ta l br ie fs reg ard in g th e im pa ct of th e rev is ed reg ul at io ns

on th e is su es pr es en te d in th is ap pe al

. CNS an d HCC as se rt th at th e ad di ti on of HHS
Not ic e as an al te rn at iv e m et ho d to ap pl y fo r acco m m od at io n do es no t al le vi at e th e

su bs ta nt ia l bu rd en im

po se d on th ei r rel ig io us ex erci se , be cau se it do es “ no th in g m or e th an co erce [th em ] in to an ot he r av en ue th at vi ol at es th ei r rel ig io n.” The y arg ue th at
th ey “ m us t st il l su bm it a do c u men t t h at th ey be li ev e wro ng fu ll y faci li ta te s th e de li ve ry of s uc h c ov erag e.”

The di st ric t co ur t d id no t sp eci fy whe th er it s ru li ng was ba se d o n t he RFRA 9

or th e Fre e Exe rci se cla im . Becau se we co nc lu de th at CNS an d HCC were en ti tl ed
to rel ie f ba se d on th ei r RFRA cl ai m , we de cl in e to ad dr es s th ei r Free Exe rci se cl ai m

.
-9

-The go ve rn m en t as se rts —as it di d wit h res pe ct to Fo rm 70 0— th at HHS Not ic e

do es no t su bs ta nt ia ll y bu rd en CNS an d HCC’s ex erci se of rel ig io n, be cau se th e Not ic e do es no t faci li ta te th e pr ov is io n of co nt race pt iv e co ve rag e by CNS an d HCC’s TPAs, whi ch ha ve a se pa rat e an d in de pe nd en t le ga l ob l i g a t i o n u nd er th e ACA to

pr ov id e co nt race pt iv e co ve rag e to CNS an d HCC’s em pl oyees. The go ve rn m en t al so
arg ue s th at ev en if th ere were a su bs ta nt ia l bu rd en on th e ex erci se of rel ig io n, it has

em pl oyed th e le as t res tri ct iv e m ean s to acco m pl is h it s co m

pe ll in g in te res t in en su rin g

acce ss to no -co st co nt race pt iv e co ve rag e.

“ A di st ric t co ur t ha s br oa d di sc ret io n whe n ru li ng on [a] req ue st [] fo r [a]

pr el im in ary in

jun ct io n[ ], an d we wil l rev ers e on ly fo r cl ear l y e r ro ne ou s fact ua l
d e t e r mi n at io ns , an erro r of la w, or an ab us e of th at di sc ret io n.” Med

. Sh op pe In t’l

, In c. v. S.B.S. Pi ll Dr., In c., 33 6 F.3 d 80 1, 80 3 (8 th Ci r. 20 03 ) (q uo ti ng Uni te d In du s. Co rp

. v. Clo ro x Co., 140 F.3 d 11 75
, 11 79 (8 th Ci r. 19 98 )). In de te rm in in g whe th er

to gr an t in

jun ct iv e rel ie f, a di st ric t co ur t ge ne ral l y c o ns id ers “ (1 ) th e th reat of
irr ep arab le ha rm to th e m ov an t; (2 ) th e ba la nc e be twee n th e po te nt ia l h arm an d a ny ha rm th at gr an ti ng th e in

jun ct io n will cau se to ot he r pa rti es to th e li ti ga ti on ; (3 ) th e
pr ob ab il it y th at th e m ov an t wil l su ccee d on th e m eri t s ; a nd (4 ) th e pu bl ic in te res t.”
Id

. (ci ta ti on s om it te d) ; se e al so Data ph as e Sy s., In c. v. C.L. Sy s., In c., 64 0 F.2 d 10 9,
11 3 (8 th Ci r.19 81 )). Alt ho ug h “ no si ng le fact or is de te rm in at iv e,” Data ph as e, 64 0
F.2 d at 11 3
, t h e pr ob ab il it y -o f-s uc ces s fact or is th e m os t si gn ifi can t, se e Hom e
In st ead , Inc . v. Fl or an ce, 7 21 F.3d 49 4, 4 97 (8t h C ir. 2 01 3)

.

RFRA pr ov id es th at a fed eral la w m ay no t “ su bs ta nt ia ll y bu rd e n a p e r so n’s

ex erci se of rel ig io n” un le ss th e go ve rn m en t “ de m on st rat es th at ap pl i c a t i o n of th e bu rd en to th e pe rs on

. . . is in fu rth eran ce of a co m pe ll in g go ve rn m en ta l in te res t” an d

“ is th e le as t re st ric ti ve m ean s o f fu rth eri ng th at co m pe ll in g go ve rn m en ta l in te res t.”

-1 0-42 U.S.C. § 20 00 bb -1

. To st at e a cl ai m un de r R FRA, a rel ig io us ob jecto r m us t 1 0

sh ow th at th e go ve rn m en t su bs ta nt ia ll y bu rd en s a si nc ere rel ig io us ex erci se or be li ef.
See Gon zal es v. O Cen tro Esp iri ta Ben efi cen te Uni ao do Veg et al

, 54 6 U.S. 41 8, 42 8 (2 00 6)

. The bu rd en th en sh ift s t o t he go ve rn m en t to sh ow th at it ha s a “ co m pe ll in g in te res t” in ap pl y in g “ th e ch al le ng ed la w ‘to th e p e r so n’—t he pa rti cu la r cl ai m an t
who se si nc ere ex erci se of rel ig io n i s b e i ng su bs ta nt ia ll y bu rd en ed .” Id

. at 42 9- 30 (q uo ti ng 42 U.S.C. § 20 00 bb -1 (b )). To sa ti sf y th e co m pe ll in g- in te res t req ui rem en t,
th e go ve rn m en t m

us t do m or e th an id en ti fy “ br oa dl y fo rm ul at ed in te res ts jus ti fy in g th e ge ne ral ap pl ic ab il it y of go ve rn m en t m an da te s.” Id

. at 43 1. The go ve rn m en t al so be ars th e bu rd en of

sh owi ng th at “ ap pl ic at io n o f th e b ur de n to th e pe rs on

. . . i s th e le as t res tri ct iv e m ean s o f fu rth eri ng ” it s co m pe ll in g in te res t. Id

. at 42 4. Thi s bu rd en -s hi fti ng ap pr oa ch ap pl ie s ev en at th e pr el im in ary-inju nc ti on st ag e. Id

. at 42 9-
30

.

Und er RFRA, th e go ve rn m en t su bs ta nt ia ll y bu rd en s th e e xe rci se of rel ig io n whe n it “ co nd it io ns rece ip t of an i mp o r t a n t be ne fit up on co nd uc t pr os cri be d by a rel ig io us fai th ” o r “ de ni es su ch a be ne fit be cau se of c on du ct m an da te d b y rel ig io us be li ef, th ereb y pu tt in g su bs ta nt ia l pr es su re on an ad he ren t to m od ify hi s be ha vi or an d

to vi ol at e hi s be li efs .” Tho m as v. Rev ie w Bd

. of In d. Em p’t Sec. Div

., 45 0 U.S. 70 7,
71 7- 18 (1 98 1)

. I n ot he r wor ds

, go ve rn m en ta l act io n su bs ta nt ia ll y bu rd en s th e

ex erci se of rel ig io n whe n it co erce s pr iv at e in di vi du al s in to vi ol at in g th ei r rel ig io us be li efs or pe na li zes th em fo r th os e be li efs by de nyin g th em th e “ rig ht s, be ne fit s, an d

pr iv il eg es en

joy ed by ot he r ci ti zen s.” Ly ng v. Nw. In di an Cem et ery Pro te ct iv e Ass ’n,
48 5 U.S. 4 39 , 44 9 (1 98 8)

.

“ RFRA ex pr es sl y ad op te d th e co m pe ll in g in te res t te st ‘as se t fo rth in Sh erb ert 1 0

v. Vern er, 37 4 U.S. 39 8 (1 96 3) an d W is co ns in v. Yod er, 4 0 6 U

. S. 20 5 (1 97 2) .’ ” Gon zal es v. O Cen tro Esp iri ta Ben efi cen t e U n i a o do Veg et al

, 54 6 U.S. 41 8, 43 1 (2 00 6)

.
-1 1-Here, the su bs ta nt ia l bu rd en im po se d by th e go ve rn m en t o n C NS an d HCC ’s

ex erci se of rel ig io n is th e im po si ti on of si gn ifi can t m on et ary p en al ti es sh ou ld CNS

an d HCC ad he re to th ei r rel ig io us be li efs an d refu se to co m pl y wit h th e co nt race pt iv e

m an da te or th e acco m

m od at io n r e gu la ti on s. Thi s bu rd en m irr or s th e su bs ta nt ia l
bu rd en reco gn iz ed by th e Su pr em e Co ur t in Hob by Lob by. CNS and HCC face the

sa m e co ns eq ue nc es fo r no nc om pl ia nc e as di d th e pl ai nt iff s in Hob by Lob by. 13 4 S.
Ct

. at 27 59
, 27 75 -7 6. Lik e th e pl ai nt iff s in Hob by Lob by, if CNS an d H C C fai l to

co m pl y wit h th e ch al le ng ed reg ul at io ns , th ey wil l be su bjec t to su bs ta nt ia l m on et ary
pe na lt ie s. See id

. at 27 75 -7 6 (ci ti ng 26 U.S.C. §§ 49 80 D, 4 9 8 0 H ). W he n th e
go ve rn m en t im

po se s a di rect m on et ary p e n a l ty to co erce co nd uc t th at vi ol at es rel ig io us be li ef, “ [t]he re ha s ne ve r be en a qu es ti on ” th at th e go ve rn m en t “ im po se s a

su bs ta nt ia l bu rd en on th e ex erci se of r e l i g i o n .” Pri es ts fo r Life v. U.S. Dep ’t of
Heal th & H um an Serv s., No. 13 -5 36 8, sl ip op

. at 6 n.3 (D.C. Ci r. May 20
, 20 15 ) (Kav an au gh

, J., di ss en ti ng fro m de ni al of reh eari ng en ba nc ); se e al so Hob by Lob by,
13 4 S. Ct

. at 27 59 (impos in g pe na lt y fo r refu sa l to pr ov id e co nt race pt iv e co ve rag e);

W is co ns in v. Yod er, 40 6 U.S. 20 5, 20 8, 21 8 (1 97 2) (impos in g pe na lt y fo r refu sa l to

se nd ch il dr en to hi gh sc ho ol ); Sh erb ert v. Vern er, 37 4 U.S. 39 8, 40 4 (1 96 3) (eq ua ti ng de ni al of b en efi ts wit h i m po si ti on of pe na lt y fo r Sat ur da y wor sh ip ); Un iv . of No tre
Dam e v. Bu rwel l, 78 6 F

. 3 d 60 6, 62 8 n.1 (7 th Ci r. 20 15 ) (Fl au m , J., di ss en ti ng ) (“ [O]nce we de te rm in e a rel ig io us be li ef is bu rd en ed , s ub st an ti al it y is m eas u r e d by
th e se ve rit y of th e pe na lt ie s fo r no n- co m pl ia nc e.”). As no te d by th e Co ur t in Hob by
Lob by, “ [i]f th es e co ns eq ue nc es do no t am ou nt to a su bs ta nt ia l b ur de n, i t i s h ard to

se e wha t wo ul d.” 13 4 S . Ct. at 27 59

.

The “ ex erci se of rel ig io n” pr ot ect ed un de r RFRA “ in vo lv es no t on ly be li ef an d

pr of es si on bu t th e pe rfo rm an ce of (o r ab st en ti on fro m ) ph y si cal act s th at are en ga ge d
in [o r fo rb or ne ] f

o r rel ig io us reas on s.” Hob by Lob by, 13 4 S. Ct

. at 27 70 (in te rn al

qu ot at i o n a nd ci ta ti on om it te d)

. “ RFRA was de si gn ed to pr ov id e ve ry br oa d

pr ot ect io n fo r rel ig io us li be rty,” in de ed

, pr ot ect io n “ far beyon d wha t [th e Su pr em e]
Co ur t ha s he ld is co ns ti tu ti o n a l l y req ui red .” Id

. at 27 67

. Si gn ifi can tl y , RFRA

-1 2-pr ot ect s “ an y ex erci se of rel ig io n, whe th er or no t co m pe ll ed by, or cen tra l to , a syste m of rel ig io us be li ef” an d “ m an da te [s ] th at th is co nc ep t be co ns tru ed in fav or of a br oa d

pr ot ect io n of rel ig io us ex erci se. ” Id

. at 27 62 (in te rn al qu ot at io n an d ci ta ti on om it te d)

.

CNS an d HCC su bm it th at th ei r rel ig io us be li efs pr oh ib it th em fro m pr ov id in g he al th car e c o v e r a ge fo r cert ai n co nt race pt iv es

. The y fu rth er as se rt th at th e
go ve rn m en t’s pu rp or te d acco m m od at io n of th ei r rel ig io us be li efs —t he req ui rem en t
th at th ey su bm it Fo rm 70 0 o r HHS Not ic e so th at th ei r TPA can pr ov id e th e ob jecti on ab le c o nt race pt iv es —i s no acco m m od at io n at al l be cau se it

, to o,

su bs ta nt ia ll y bu rd en s th ei r ex erci se of rel ig io n. The go ve rn m en t do es no t di sp ut e th e si nc eri ty of CNS an d HCC ’s rel ig io us be li efs . W he n s in ceri ty i s no t in di sp ut e, we

m us t co ns id er th e rel ig io us be li e f o r ex erci se at is su e an d de te rm in e whe th er th e
go ve rn m en t ha s pl aced su bs ta nt ia l pr es su re, i.e.
, a su bs ta nt ia l bu rd en , on th e rel ig io us ob jecto r to en ga ge in co nd uc t th at vi ol at es th e r e l i g i o u s be li ef or to ab st ai n fro m

en ga gi ng in co nd uc t th at is req ui red by th at be li ef. See Hob by Lob by, 13 4 S. Ct

. at
27 75 -7 6 (co nc lu di ng th at su bs ta nt ia l bu rd en ari se s whe n th e go ve rn m en t “ de m an ds ”
th at a rel ig io us ob

jecto r ei th er “ en ga ge in co nd uc t th at se rio us ly vi ol at es [ h is ]
rel ig io us be li efs ” o r su ffer “ su bs ta nt ia l” “ co ns eq ue nc es ”); Bo wen v. Ro y , 4 76 U.S.
69 3, 70 3 (1 98 6) (s ug ge st in g th at su bs ta nt ia l bu rd en m ay ex is t whe n th e go ve rn m en t

co m pe ls a rel ig io us ob

je c t o r “b y th reat of sa nc ti on s, to refr ai n fro m rel ig io us ly

m ot iv at ed co nd uc t or to en ga ge in co nd uc t th at [h e] fin d[ s] ob jecti on ab le fo r rel ig io us

reas on s” ) (fo ot no te om it te d)

.

Our in qu iry i n th is reg ard is ne ces sa ril y co ns tra in ed be cau se “ it is no t wit hi n th e jud ic ia l fu nc ti o n ” t o de te rm in e whe th er a rel ig io us be li ef or pr act ic e co m po rts
wit h th e te ne ts of a pa r t ic ul ar rel ig io n. Tho m as , 45 0 U.S. at 71 6 (“ Co ur ts are no t
arb it ers of sc rip tu ral in te rp ret at io n.” ). In st ead

, we m us t acce pt a rel ig io us ob

jecto r’s
de sc rip ti on of hi s rel ig io us be li efs , r eg ard le ss of whe th er we c on si de r th os e be li efs

“ acce pt ab le

, lo gi cal

, co ns is te nt , or co m pr eh en si bl e.” Id

. at 7 1 4

. I n o th er wor ds

, a rel ig io us ob

jecto r is en ti tl ed to “ dr [a]w a li ne ” reg ard in g th e co nd uc t th at hi s rel ig io n

-1 3-de em s pe rm is si bl e, an d on ce th at li ne is dr awn , “ it is no t fo r [a co ur t] to sa y th at th e

li n e

. . . was

. . . un reas on ab le .” Id

. at 71 5. “ [O]ur ‘narro w fu nc ti on

. . . in th is

co nt ex t,’” th eref

or e, “ ‘is to de te rm in e’ whe th er th e li ne dr awn refl ect s ‘an ho ne st

co nv ic ti on .’ ” Hob by Lob by, 13 4 S. Ct

. at 27 79 (q uo ti ng Tho m as , 45 0 U.S. at 71 6)

.

CNS an d HCC as se rt th at th ei r rel ig io us be li efs di ct at e th at th ey ab st ai n fro m

co nd uc t th at fu rth ers th e go ve rn m en t’s reg ul at or y sc he m e to pr ov id e th ei r em pl oyees

an d pl an be ne fic ia rie s wit h co ve rag e fo r ob ject i o na bl e co nt race pt iv es

. The y arg ue th at th e acco m

m od at io n pr ov id ed vi a th e Fo rm 70 0/ HHS Not ic e pr oc ed ur e do es no t
el im i n a t e th e su bs ta nt ia l bu rd en im po se d on th ei r rel ig io us be li efs be cau se th e

acco m m od at io n pr oc es s it se lf tri gg ers th e pr ov is io n of ob jecti on ab le co ve rag e by
th ei r TPAs, m ak in g t he m co m pl ic it in co nd uc t t ha t v io la te s t he ir r el ig io us be li efs

.

The go ve rn m en t argu es th at th e acco m m od at io n pr oc es s can no t su bs ta nt ia ll y bu rd en CNS and HCC’s exerc is e of rel ig io n bec au se , as a m at te r of law, i t do es no t
tri gg er, faci li ta te , or m ak e CNS an d HCC co m pl ic it in th e pr ov is io n of th at co ve rag e. Thi s is tru e, th e go ve rn m en t sa y s, be cau se th e ACA al read y im po se s an ob li ga ti on on TPAs t o p ro vi de co nt race pt iv e co ve rag e to th ei r em pl oyees a nd pl an be ne fic ia rie s.

The go ve rn m en t’s arg um en t ha s pr ev ai le d in se v eral cas es , in each of whi ch
th e co ur ts co nc lu de d as a m at te r of la w th at be cau se th e acco m m od at io n pr oc es s do es

no t tri gg er co nt race pt iv e co ve rag e or m ak e th e rel ig io us ob ject o r c o mp l i ci t in th e
pr ov is io n of th at co ve rag e, th e acco m m od at io n pr oc es s can no t im po se a su bs ta nt ia l
bu rd en on th e ex erci se of r el ig io n. See Cath ol ic Heal th Care Sy s. v. Bu rwel l, No. 1 1

In reac hi ng th is co nc lu si on , th e co ur ts ha ve reas on ed th at “ [i]t is fed eral la w, 1 1

rat he r th an t he rel ig io us or ga ni zat io n’s si gn in g an d m ai li ng [Fo rm 70 0 or HHS Not ic e], tha t re qu ire s h eal th -car e in su rers , al on g with [TPAs] of se lf- in su red he al th pl an s, to cov er con tra cep ti ve se rv ic es

. By refu si ng to fil l ou t th e fo rm [th e rel ig io us ob jecto r] wou ld su bjec t it se lf to pe na lt ie s, bu t [it s in su rer an d TPA] wou ld st i l l be
req ui red to pr ov id e [c o n t r acep ti ve ] se rv ic es to ” em pl oyees an d pl an be ne fic ia rie s.

-1 4-14 -4 27
, 20 15 W L 46 65 04 9, at *7 (2 d Ci r. Aug

. 7, 20 15 ) (n ot in g th at whi le th e co ur t

wil l accep t th e si nc eri ty of an ob jecto r’s rel ig io us be li efs

, “ it m us t as se ss th e na tu re of a cl ai m ed bu rd en on rel ig io us ex erci se to de te rm in e whe th er, as an ob jecti ve le ga l

m at te r, th at bu rd en is ‘sub st an ti al ’ un de r RFRA” ); Lit tl e Si st ers of th e Po or Hom e fo r

t h e Age d, Den ve r, Co lo

. v. Bu rwel l, 79 4 F.3 d 11 51
, 11 76 (1 0t h Ci r. 20 15 ) ( n o t i n g th at “ co ur ts —n ot pl ai nt iff s— m us t de te rm in e if a la w or po li cy su bs ta nt ia ll y bu rd en s rel ig io us ex erci se ”), pe ti ti on fo r cert

. fil ed

, 84 U.S.L.W

. 30 56 (U.S. Ju ly 23
, 20 15 ) (No

. 15 -1 05 ); E. Tex

. Bap ti st Uni v. v. Bu rwel l, 79 3 F.3 d 44 9, 45 7- 59 (5 th Ci r. 20 15 ) (ci ti ng Bo wen , 47 6 U

. S

. 69 3, an d Ly ng , 48 5 U.S. 43 9, as bi nd in g au th or it y to

“ de ci d[ e], as a qu es ti on of la w, whe th er th e ch al le ng ed la w pr es su res th e ob jecto r to

m od ify hi s rel ig io us ex erci se ), pe ti ti on fo r cert

. fil ed

, 84 U.S.L.W

. 30 50 (U.S. Ju ly

Uni v. of Not re Dam e v. Bu rwel l, 78 6 F.3 d 60 6, 61 4 (7 th Ci r. 20 15 ); se e al so Cat ho li c Heal th Care Sy s. v. Bu rwel l, No. 14 -4 27
, 20 15 W L 46 65 04 9, at *1 2- 13 (2 d Ci r. Aug

. 7, 20 15 ); Lit tl e Si st ers of th e Po or , 79 4 F.3 d 11 51
, 11 80 -8 1; E. Tex

. Bap ti st Uni v. v. Bu rwel l, 7 93 F.3d 44 9, 4 58 -6 2 (5 th Cir . 20 15 ), pe ti ti on fo r cert . f il ed , 84 U.S.L.W

. 30 50 (U.S. Ju ly 8, 20 15 ) (No

. 15 -3 5) ; Gen ev a Co ll

. v. Sec’y U.S. Dep ’t of Heal th & Hum an Serv s., 77 8 F.3 d 42 2, 44 1- 42 (3 d Ci r. 20 15 ), pe ti ti on fo r cert

. fil ed su b no m

. Zub ik v. Bu rwel l, 83 U.S.L.W

. 38 94 (U.S. May 29
, 20 15 ) (No s. 14 -1 41 8, 14 A10 65 ),

an d pe ti ti on fo r cert

. fil ed

, 84 U.S.L.W

. 30 9 6 ( U

. S

. Aug

. 11
, 20 15 ) (No s. 15 -1 91
, 15 A1) ; Pries ts fo r Life v. U.S. D ep ’t of Hea lt h & Hum an Serv s., 772 F.3 d 22 9, 25 6 (D.C. Ci r. 20 14 ) pe ti ti on for cert . fil ed , 83 U.S.L.W . 39 18 (U.S. Ju ne 9, 2 01 5) (No. 14 -1 45 3)

, an d pe ti ti on fo r cert

. fil ed su b no m

. Ro m an Cat ho li c Arch bi sh op of W as h.

v. Bu rwel l, 83 U.S.L.W . 3 93 6 (U.S. Ju ne 19 , 2 01 5) (No . 1 4- 15 05 ); Mi c h

. C a t h o l ic Co nf eren ce & Cat ho li c Fam il y Serv s. v. Bu rwel l, 75 5 F.3 d 37 2, 38 7- 88 (6 th Ci r. 20 14 ), cert

. gr an te d an d ju dg m en t va cat ed

, 13 5 S. Ct

. 19 14 (2 01 5) (v acat in g an d

r e man di ng fo r fu rth er co ns id erat io n in li gh t of Hob by Lob by), an d rei ss ue d a n d reaf fir m ed on rem an d, Nos

. 13 -2 72 3, 13 -6 64 0, 20 15 W L 49 79 69 2 (6 th Ci r. Aug

. 21
, 20 15 ); bu t se e Eter na l W or d Tele vi si on Netwo rk

, In c. v. Sec’y
, U.S. Dep ’t of Heal th & Hum an Serv s

. , 75 6 F.3 d 13 39
, 13 47 (1 1t h Ci r. 20 14 ) (Pryor, J., sp eci al ly

co nc ur rin g in or de r gr an ti ng in jun ct io n pe nd ing ap pe al ) (d is ag reei ng wit h co nc lu si on of Si xt h an d Sev en th Ci rcu it s th at “ m an da te im po se s an in de pe nd en t ob li ga ti on on ” TPAs t ha t “ do es no t co ns ti tu te a su bs ta nt ia l b ur de n” ).

-1 5-8, 20 15 ) (No

. 15 -3 5) ; Uni v. of Not re Dam e, 78 6 F.3 d at 61 2 (“ Alt ho ug h Not re Dam e

is th e fin al arb it er of it s rel ig io us be li efs

, it is fo r th e co ur ts to de te rm in e whe th er th e la w act ua ll y fo rces Not re Dam e to act in a way th at wou ld vi ol at e th os e be l i e f s

. ” );
Gen ev a Co ll

. v. Sec’y U.S. Dep ’t of Heal th & Hum an Serv s., 77 8 F.3 d 42 2, 43 5 (3 d
Ci r. 20 15 ) (“ W it ho ut te st i n g t h e ap pe ll ees ’ rel ig io us be li efs

, we m us t no ne th el es s ob jec t i v e l y as se ss whe th er th e ap pe ll ees ’ co m pl ia nc e wit h th e se lf- cert ifi cat io n
pr oc ed ur e do es , in fact

, tri gg er, faci li ta te , or m ak e th em co m pl ic it in th e pr ov is io n of

c o n tra cep ti ve co ve rag e.”), pe ti ti on fo r cert

. fil ed su b no m

. Zub ik v. Bu rwel l

, 8 3
U.S.L.W

. 38 94 (U.S. May 29
, 20 15 ) (No s. 14 -1 41 8, 14 A10 65 ), an d pe ti ti on fo r cert

. fil ed

, 84 U.S.L.W

. 30 96 (U.S. Aug

. 11
, 20 15 ) (No s. 15 -1 91
, 15 A1) ; Pries ts fo r Life

v. U.S. Dep ’t of Heal th & Hum an Serv s., 77 2 F.3 d 22 9, 24 7 (D

. C

. Ci r. 20 14 ) (“ Accep ti ng th e si nc eri ty of Pl ai nt iff s’ be li efs

, ho wev er, doe s no t reli ev e th is Co ur t
of it s res po ns ib il it y to ev al ua te th e su bs ta nt ia li ty of an y bu rd en on Pl ai nt iff s’ rel igi ous

ex erci se

. . . . W he th er a la w su bs ta nt ia ll y bu rd en s rel ig io us ex erci se un de r RFRA is

a qu es ti on of la w fo r co ur ts to de ci de

, no t a qu es ti on of fact .”), pe ti ti on fo r cert

. fil ed

, 83 U.S.L.W

. 39 18 (U.S. Ju ne 9, 20 15 ) (No

. 14 -1 45 3)

, an d pe ti ti on fo r cert

. fil ed su b

no m

. Ro m an Cat ho li c Arch bi sh op of W as h. v. Bu rwel l, 83 U.S.L.W

. 39 36 (U.S. Ju ne 19
, 2 0 1 5) (No

. 14 -1 50 5) ; Mi ch

. Cat ho li c Co nf eren ce & Cat ho li c Fam il y Serv s. v. Bu rwel l, 75 5 F.3 d 37 2, 38 5 (6 th Ci r. 20 14 ) ( “[A ]lth ou gh we ack no wled ge th at th e

a p p e l l an ts be li ev e th at th e reg ul at or y fram ewo rk m ak es th em co m pl ic it in th e
pr ov is io n of co nt race pt io n, we wil l in de pe nd en tl y de te rm in e wha t th e reg ul at or y
pr ov is io ns req ui re an d whe th er th ey im po se a su bs ta nt ia l bu rd en on ap pe ll an ts ’

ex erci se o f r e l i g i on .”), cert

. gr an te d an d jud gm en t va cat ed

, 13 5 S. Ct

. 19 14 (2 01 5) (v acat in g an d rema n d i n g f or fu rth er co ns id erat io n in li gh t of Hob by Lob by) an d
rei ss ue d an d reaf

fir m ed on rem an d, Nos

. 13 -2 72 3, 13 -6 64 0, 20 15 W L 49 79 69 2 (6 th
Ci r. Aug

. 21
, 20 15 ); bu t cf. Eter na l W or d Tele vi si on Netwo rk

, In c. v. Sec’y
, U.S. Dep ’t of Heal th & Hum an Serv s., 75 6 F.3 d 13 39
, 13 40 (1 1t h Ci r. 2 01 4) (g ran ti ng

m ot io n fo r in

jun ct io n pe nd in g ap pe al ag ai ns t en fo rcem en t of co nt race pt iv e m an da te
in li gh t o f Hob by Lobb y ).

-1 6-A s Hob by Lob by in st ru ct s, ho wev er, we m us t acce pt CNS an d HCC’s as se rt ion
th at sel f-ce rti fic at io n u nd er t he acco m m od at io n pr oc es s— us in g ei th er Fo rm 70 0 o r HHS Not ic e—wo ul d vi ol at e th ei r si nc erel y he ld rel ig io us be li efs

. See Hob by Lob by,
13 4 S. Ct

. at 27 78 ; see a ls o Her na nd ez v . Com m ’r, 49 0 U.S. 6 80 , 69 9 (1 98 9) (“ It is

no t wit hi n th e jud ic ia l ke n to qu es ti on th e cen tra li ty of pa rti cu la r be li efs or pr act ic es

to a fai th

, or th e va li di ty of pa rti cu la r li ti ga nt s’ in te rp ret at io ns of th os e cree ds .”). It
is no t ou r ro le to se co nd -g ue ss CNS an d HCC’s ho ne st as se ss m en t of a “ di ffi cu lt an d
im por ta nt que sti on of relig io n an d m or al ph il os op hy, na m el y , th e ci rcu m sta nc es unde r whi ch it is wro ng fo r a pe rs on to pe rfo rm an act th at is in no cen t in it se lf bu t th at ha s th e eff ect of e na bl in g o r fac il it at in g t he co m m is si on of a n i m

m or al act by ano th er.”
Hob by Lob by, 13 4 S. Ct

. at 27 78

. As di sc us se d ab ov e, Fo rm 70 0 or HHS Not ic e wil l
in fo rm CNS an d HCC’s TPA of it s ob li ga ti on s to faci li ta te co nt race pt iv e c ov erag e fo r CNS an d HCC’s em

pl oyees an d pl an be ne fic ia rie s an d th us wil l pl ay a pa rt in

pr ov id in g th e ob

jecti on ab le co nt race pt iv es

. As in Hob by Lob by, CNS an d HCC
si nc erel y be li ev e th at th e act io ns “ de m an de d b y th e . . . regu la ti on s [are ] co nn ect ed

to ” il li ci t co nd uc t “ in a way th at is su ffi ci en t t o m ak e it im m or al fo r th em to ” ta ke
th os e act io ns

. Id

. CNS an d HCC ha ve dr awn a li ne be twee n act io ns th ey fin d “ to be

co ns is te nt wit h [th ei r] rel ig io us be li efs ” an d act io ns th ey co ns id er “ m or al ly
ob jecti on ab le .” Id

. (ci ti ng Tho m as , 45 0 U.S. at 71 5)

. And it is no t fo r us “ ‘to sa y th at
th e li ne [th ey ] dr ew wa s an un reas on ab le on e.’” Id

. (q uo ti ng Tho m as , 45 0 U.S. at
71 5) ; se e al so Pri es ts fo r Life , s li p o p. at 12 (Kav an au gh , J., di ss en ti ng fro m de ni al
of reh eari ng en ba nc ) (“ Ju di ci al ly se co nd -g ue ss in g th e co rrec tn es s or reas on ab le ne ss (as op po se d to th e si nc eri ty) of pl ai nt iff s’ rel ig io us be li efs is ex ac tl y wha t th e Su pr em e Co ur t i n Ho bb y Lob by tol d u s n ot to do .”).

The go ve rn m en t in si st s th at be cau se th e A C A ’s req ui rem en t th at in su ran ce is su ers an d gr ou p he al th pl an s in cl ud e co nt race pt iv e co ve rag e is who ll y in de pe nd en t
of CNS an d HCC’s se lf- cert ifi cat io n, th ei r ex erci se of rel ig io n can no t be su bs ta nt ia ll y bu rd en ed by t he a cco m

m od at io n pr oc es s. Eve n if th e ACA req ui res th at in su ran ce is su ers an d gr ou p he al th pl an s in cl ud e co nt race pt iv e co ve rag e reg ard le ss of whe th er

-1 7-CNS an d HCC se lf- cert ify, it al so co m pe ls CNS an d HCC to act in a m an ne r th at th ey si nc erel y be li ev e wou ld m ak e th em co m pl ic it in a gr av e m or al wro ng as th e pr ic e of

av oi di ng a ru in ou s fin an ci al pe na lt y

. If on e eq ua te s th e se lf- cert ifi cat io n pr oc es s wit h, sa y , th at of o b t a i n i ng a pa rad e pe rm it

, th en in de ed th e bu rd en m ig ht well be

co ns id ered li gh t. Bu t if on e si nc erel y be li ev es th at co m pl et in g Fo rm 70 0 o r HHS
Not ic e wil l resu lt in co ns ci en ce-v io la ti ng co ns eq ue nc es , wha t so m e m ig ht co ns id er

an ot he rwis e ne ut ral act is a bu rd en to o he av y to be ar. “ The Su pr em e Co ur t ha s

em ph as iz ed th at jud ge s in RFRA cas es m ay qu es ti on on ly th e si nc eri ty of a pl ai nt iff ’s
rel ig io us be li ef, no t th e co rrec tn es s or reas on ab le ne ss of th at rel ig io us be li ef.” Pri es ts
fo r Life , s li p op . a t 8 (Kav an au gh , J ., d is s e n t i n g f r om de ni al of reh eari ng en ba nc );

se e al so Eter na l W or d, 7 5 6 F

. 3 d a t 13 47 (Pryor, J., sp eci al ly co nc ur rin g in or de r
gr an ti ng in

jun ct io n pe nd in g ap pe al ) (n ot in g th at rel ig io us ob jecto r’s “ le ga l
in te rp ret at io n is be si de th e po in t” be cau se “ [w]hat m at te rs is whe th er th e [o bjec to r’s]

pa rti ci pa ti on in th e co nt race pt io n sc he m e—h owe ve r m in im al —v io la te s it s rel ig io us be li efs ”); Lit t l e S i s t e r s of th e Po or Hom e fo r th e Age d, Den ve r, Co lo

. v. Bu rwel l,

Nos

. 13 -1 54 0, 14 -6 02 6, 14 -6 02 8, 20 15 W L 51 66 80 7, at *2 (1 0t h Ci r. Sep t. 3, 20 15 ) (Hart z, J., di ss en ti ng fro m de ni al of reh eari ng en ba nc ) (“ I am aware of no pr eced en t
ho ld in g th at a pe r so n’s free ex erci se was no t su bs ta nt ia ll y bu rd en ed whe n a si gn ifi can t pe na lt y w a s im po se d fo r refu si ng to do so m et hi ng pr oh ib it ed by th e
pe rs on ’s si nc ere rel ig io us be li efs (h owe ve r st ran ge , or ev en si ll y , th e co ur t m ay

co ns id er th os e be li efs ).”); Grace Sch s. v. Bu rwel l, Nos

. 14 -1 43 0, 14 -1 43 1, 20 15 W L
51 67 84 1, at * 18 (7t h C ir. Se pt . 4, 2 01 5) (Man io n, J ., di ss en ti ng ). Rel ig io us be li efs

ne ed no t be “ acce pt ab le

, lo gi cal

, co ns is te nt , or co m pr eh en si bl e to ot he rs ” to de se rv e
pr ot ect io n. Tho m as , 45 0 U.S. a t 7 1 4

. Th e qu es ti on he re is no t whe th er CNS an d
HCC ha ve co rrec tl y in te rp ret ed th e la w, bu t whe th er th ey ha ve a si nc ere rel ig io us be li ef th at th ei r pa rti ci pa ti on in th e acco m m od at io n pr oc es s m ak es th em m or al ly an d

sp iri tu al ly co m

pl ic it in pr ov id in g ab or ti fac i e n t co ve rag e. The ir affi rm at iv e an swe r

to th at qu es ti on is no t fo r us to di sp ut e.

-1 8-As it di d in Hob by Lo bb y , t he go v e r n men t arg ue s he re th at CNS an d HCC’s

ob jecti on to th e co nt race pt iv e m an da te is real ly an o bjec ti on to th e co nd uc t of thi rd

pa rti es an d th at “ th e co nn ect io n bet ween wha t [CNS an d HCC] m us t do

. . . an d th e

en d th at th ey fin d t o b e mo r a l l y w ro ng

. . . is si m pl y to o at te nu at ed .” See Hob by
Lob by, 13 4 S. Ct

. at 27 77

. I n H o b b y Lo bb y , th e th ird pa rti es were th e pl ai nt iff s’

em pl oyees who wou ld us e th e co nt r a c e pt iv e be ne fit s pr ov id ed in th e gr ou p he al th pl an

. Here, th e th ird pa rti es are TPAs, who wil l pr ov id e th e ob jecti on ab le co ve rag e

to CNS an d HCC’s em

pl oyees th ro ug h th e gr ou p he al th pl an

. The Su pr em e Co ur t reject ed th is arg um en t in Hob by Lob by, ch arac te riz in g it as ta nt am ou nt to “ te ll [in g]
th e [rel ig io us ob

jecto rs ] th at th ei r be li efs ” ab ou t co m pl ic it y i n th e pr ov is io n of

co nt race pt iv e co ve rag e were “ fla wed ,” “ m is ta ke n[ ,] or in su bs ta nt ia l” —m or al an d ph il os op hi cal jud gm en ts th at are no t fo r th e co ur ts to m ak e. Id

. at 27 78 -7 9. In st ead

, whe n a rel ig io us ob

jecto r de em s th e req ui red co nd uc t to cro ss th e li ne of m or al ly an d
rel ig io us ly acce pt ab le be ha vi or , “ it is no t fo r us to sa y th at th ei r rel ig io us be li efs are

m is ta ke n o r in su bs ta nt ia l.” Id . at 2 77 9.

The go ve rn m en t al so arg ue s th at th e se lf- cer t i fic at io n pr oc es s can no t

su bs ta nt ia ll y bu rd en CNS an d HCC’s ex erci se of rel ig io n be cau se th ey were al read y in st ru ct in g th ei r TPA no t to pr ov id e co nt race pt iv e co ve rag e an d th us h a d a l r e ad y de cl ared th ei r rel ig io us ob jecti on to su ch de vi ces an d pr od uc ts

. W ha t th is arg um en t
fai ls to a p p r e c i a te , ho wev er, is th at se lf- cert ifi cat io n un de r th e acco m m od at io n
pr oc es s acco m

pl is he s wha t C N S a n d HCC’s pr io r in st ru ct io ns ha d sp eci fic al ly

pr ev en te d: th e pr ov is io n of ob jecti on ab le co ve rag e th ro ug h th ei r gr ou p he al th pl an s. W e n eed lo ok no fu rth er tha n to th e go ve rn m en t’s o wn l it ig at io n b eh av io r to ga ug e th e im po rta nc e of se lf- cert ifi cat io n in th e reg ul at or y sc he m e. If T PAs had a who ll y in de pe nd en t ob li ga ti on to pr ov id e co nt race pt iv e co ve rag e to rel ig io us ob jecto rs ’

em pl oyees an d pl an be ne fic ia rie s, th ere wou ld be no ne ed t o in si st on CNS an d
HCC’s co m

pl ia nc e wit h t he acco m

m od at io n p ro ces s.

-1 9-In li gh t of CNS and HCC’s si nc erel y he ld rel ig io us be li efs , we con cl ud e th at

co m pe ll in g th ei r pa rti ci pa ti on in th e acco m m od at io n pr oc es s by th reat of se ve re

m on et ary pe na lt y is a su bs ta nt ia l b u r d e n on th ei r ex erci se of rel ig io n. See Hob by
Lob by, 13 4 S. Ct

. at 27 78 (“ Arro ga ti ng th e au th or it y to pr ov id e a bi nd in g na ti on al

an swe r to th is rel ig io us an d ph il os op hi cal qu es ti on , [th e go ve rn m en t] in effe ct te ll [s ]
th e pl ai nt iff

s th at th ei r be li efs a r e fla wed

. Fo r go od reas on , we ha ve rep eat ed ly
refu se d to ta ke su ch a st ep .”). Tha t th ey th em se lv es do no t ha ve to arra ng e or pa y fo r ob jecti on ab le co nt race pt iv e co ve rag e is no t de te rm in at iv e of whe th er th e req ui red or fo rb id de n act is or is no t rel ig io us ly of fen si ve

. See id

. at 27 78 ; Tho m as , 45 0 U.S. at
71 5. W e th us co nc lu de th at CNS an d HCC ha ve sh own a su bs ta nt ia l li ke li ho od of

su cces s on th e m eri ts of th ei r cl ai m t h a t t h e co nt race pt iv e m an da te an d

acco m m od at io n p ro ces s i m

po se a su bs ta nt ia l b ur de n o n t he ir r el ig io us be li efs

.

The q u e s t i o n rem ai ns whe th er th e go ve rn m en t ha s es ta bl is he d a co m pe ll in g in te res t whi ch it ha s us ed th e le as t res tri ct iv e m ean s to fu rth er. As no te d ab ov e, un de r RFRA, th e “ [g ]ove rn m en t m ay su bs ta n t i a l ly bu rd en a pe rs on ’s ex erci se of rel ig io n

on ly if it de m on st rat es th at ap pl ic at io n of t h e b u r d e n to th e pe rs on

. . . is th e le as t

res tri ct iv e m ean s of fu rth eri ng [a] co m pe ll in g go ve rn m en ta l in te res t.” 42 U.S.C. § 20 00 bb -1 (b ). The go ve rn m en t m us t “ de m on st rat e th at th e co m pe ll in g in te res t te st
is sa ti sf ie d th ro ug h ap pl ic at io n of t h e ch al le ng ed la w to

. . . th e pa rti cu la r cl ai m an t
who se si nc ere exe rci se of rel ig io n is be in g su bs ta nt ia ll y bu rd en ed .” Hob by Lob by,
13 4 S. Ct

. at 27 79 (q uo ti ng O Cen tro , 54 6 U.S. at 43 0- 31 ). “ [B]roa dl y fo rm ul at ed ,”
O Cen tro , 54 6 U.S

. a t 4 3 1
, or “ swe ep in g” go ve rn m en ta l in te res ts are in ad eq ua te , Yod er, 40 6 U.S. at 22 1. Rat he r, th e go ve rn m en t m us t sh ow wit h “ pa rti cu la rit y ho w [ev en ] ad m it te dl y st ro ng in te res t[s ] . . . wo ul d be ad ve rs e l y a f f ect ed by g ran ti ng an

ex em pt io n” to a pa rti cu la r cl ai m an t. Id . at 2 36

.

The go ve rn m en t h a s a ss ert ed th at it s co m pe ll in g in te res ts in sa feg ua rd in g
pu bl ic he al th a n d i n e n s ur in g th at wom en ha ve eq ua l acce ss to he al th care are fu rth ered by th e co nt race pt iv e m an da te an d th e acco m m od at io n pr oc es s. See 78 Fed

.

-2 0-Reg

. at 39 ,87 2. In Hob by Lob by, Ju st ic e Ali to , writ in g fo r th e Co ur t, “ as su m e[d ] th at

th e i n te res t in gu aran te ei ng co st -fre e acce ss to th e fo ur ch al le ng ed co nt race pt iv e

m et ho ds is co m

pe ll in g wit hi n th e m ean in g of RFRA.” 13 4 S. Ct

. at 27 80

. As di d th e Su pr em e Co ur t, we wil l en te rta in th e sa m e as su m pt io n an d pr oc eed to co ns id er whe th er th e go ve rn m en t ha s sh own th at th e co nt race p t i v e m an da te an d

acco m m od at io n pr oc es s are th e le as t res tri ct iv e m ean s of fu rth eri ng th e go ve rn m en t’s

co m pe ll in g i nt eres ts . See Ho bb y Lob by, 134 S. Ct. at 27 80

.

Und er th e “ ex cep ti on al ly de m an di ng ” le as t-r es tri ct i v e -m ean s te st , Hob by
Lob by, 13 4 S. Ct

. at 27 80
, “ if th ere are ot he r, r e a s on ab le way s to ach ie ve th os e [in te res ts ] wit h a le ss er bu rd en on

. . . p ro te ct ed act iv it y , [ th e go ve rn m en t] m ay no t
ch oo se th e way of gr eat er in te rfer e n ce,” Dun n v. Bl um st ei n, 40 5 U.S. 33 0, 34 3 (1 97 2)

. Thu s, a reg ul at io n m ay co ns ti tu te th e le as t res tri ct iv e m ean s of fu rth eri ng th e
go ve rn m en t’s co m

pe ll in g in te res ts if “ no al te rn at iv e fo rms o f r e gu la ti on ” wou ld

acco m pl is h th os e in te res t s w i th ou t in fri ng in g on a cl ai m an t’s rel ig io us -ex erci se rig ht s. See Sh erb ert , 37 4 U.S. at 40 7.

W e fir st rei te rat e th at th e go ve rn m en t be ars th e bu rd en of pr oo f on th is is su e, whi ch req ui res it to co m e fo rward wit h ev id en ce th at th e co nt race pt iv e m an da te an d
th e acco m

m od at io n p r o c e ss are th e on ly feas ib le m ean s to di st rib ut e co st -fre e

co nt race pt iv es to wom en em pl oyed by rel ig io us or ga ni zat io ns an d th at no al te rn at iv e

m ean s wou ld su ffi ce to ach ie v e i t s co m pe ll in g in te res t. It m

us t sh ow “ th at it la ck s

ot he r m ean s o f ach ie vi ng it s d es ire d g oa l wi th ou t im po si ng a su bs ta nt ia l b ur de n o n th e ex erci se of r el ig io n b y ” CNS an d HCC . Hob by Lobb y , 13 4 S . Ct. at 27 80

.

In Hob by Lob by, th e Su pr e me Co ur t de te rm in ed th at th e acco m m od at io n
pr oc es s was “ less res tri ct iv e th an req ui rin g em pl oyers to [d ire ct ly] fu nd co nt race pt iv e

m et ho ds t h at vi ol at e th ei r rel ig io us be li efs .” Id

. at 27 82

. Bu t th e Co ur t al so

em ph as iz ed th at it was sp eci fic al ly “ no t de ci d[ in g] .

. . whe th er an ap pr oa ch of th is
type co m pl ie s wit h RFRA fo r p u r po se s of al l rel ig io us cl ai m s.” Id

. It si m pl y

-2 1-su gg es te d th at th e acco m m od at io n pr oc es s wou ld b e a n acce pt ab le al te rn at iv e fo r

or ga ni zat io ns th at di d no t as se rt a rel ig io us ob jecti on to th e acco m

m od at io n pr oc es s it s e l f. See id

. at 27 82 & n.4 0 (“ The le ss res tri ct iv e ap pr oa ch we de sc rib e

acco m m od at es th e rel ig io us be li efs as se rt ed in th es e ca se s , an d t h a t is th e on ly

qu es ti on we are per m it te d to ad dr es s.” (em ph as is ad de d) ); i d. at 27 86 (Ken ne dy, J.,

co nc ur rin g) (n ot in g th at “ th e pl a i n ti ffs ha ve no t cri ti ci zed [th e acco m m od at io n
pr oc es s] wit h a sp eci fic ob jecti on th at ha s b een co ns id ered in de ta il ”).

Any su gg es ti on th at th e Co u r t i n H ob by Lob by sa nc ti on ed th e ex is ti ng

acco m m od at io n pr oc es s fo r al l pu rp os es was di sp el le d on ly da y s la te r whe n th e Co ur t
is su ed it s or de r in W he at on Co ll eg e an d en joi ne d en fo rcem en t of th e co nt race pt iv e

m an da te an d th e Fo rm 70 0 acco m m od at io n reg ul at io ns as lo ng as W he at on Co ll eg e di rect ly no ti fie d HHS of it s rel ig io us ob jecti on

. 13 4 S. Ct

. at 28 07

. The co ll eg e was

no t req ui red to se lf- cert ify by Fo rm 70 0 to ob ta in an acco m m od at io n, an d it was no t

req ui red to pr ov id e th e de ta il ed in fo rm at io n an d up da te s de m an de d un de r th e rev is ed

acco m m od at io n reg ul at io ns es ta bl is hi ng HHS Not ic e. See W he at on Co ll eg e, 13 4 S.
Ct . at 2 80 7; see als o Li tt le Sis te rs of t he Po or Hom e fo r th e Age d, Den ve r, Co lo . v. Seb el iu s, 13 4 S. Ct

. 10 22 (2 01 4) (en joi ni ng go ve rn m en t fro m en fo rcing co ntr ac ep tive

m an da te if writ te n no ti ce is pr ov id ed to HHS st at in g th at ob jecto rs “ are n o n

- p r o f

it

or ga ni zat io ns th at ho ld th em se lv es ou t as reli gi ou s and ha ve rel ig io us ob jecti on s t o
pr ov id in g co ve rag e fo r co nt race pt iv e se rv ic es ”). And on Ju ne 29
, 20 15
, th e Su pr em e Co ur t gr an te d in

jun ct iv e rel ie f fo r th e th ird ti m e in an ot he r cas e in vo lv in g a no np ro fit
rel ig io us or ga ni zat io n. Zub ik v. Bu rwel l, 13 5 S. Ct

. 29 24 (2 01 5) (o rd e r en joi ni ng

en fo rcem en t of th e “ ch al le ng ed pr ov is io ns ” of th e ACA pe nd in g fin al di sp os it io n of
th ei r pe ti ti on fo r cert io rari

, pr ov id ed th at W he at on Co ll eg e no ti ce is su bm it te d to HHS). Thu s, in W he at on Co ll eg e, Lit tl e Si st ers of th e Po or , an d Zub ik

, th e Su pr em e Co ur t ap pr ov ed a m et ho d of no ti ce to HHS th at is arg ua bl y le ss on ero us th an ei th er Fo rm 70 0 or HHS Not ic e y et pe rm it s th e go ve rn m en t to fu rth er it s in te res ts

. Alt ho ug h th e Co ur t’s or de rs were no t fin al ru li ng s on th e m eri ts , th ey at th e ve ry le as t

co ll ect iv el y co ns ti tu te a si g n a l th at le ss res tri ct iv e m ean s ex is t by whi ch th e

-2 2-go ve rn m en t m ay fu rth er it s in te res ts

. See Pri es ts fo r Life

, sl ip op

. at 23 (Kav an au gh

,

J., d i s se nt in g fro m de ni al of reh eari ng en ba nc ) (“ [R]ega rd le ss of whe th er we as a lo wer co ur t are

fo rma ll y bo un d by th e Su pr em e Co ur t st ay or de rs in W he at on Co ll eg e

an d Lit tl e Si st ers of th e Po or , th e no ti ce id en ti fie d by th e Su pr em e Co ur t in th os e two

cas es is un do ub te dl y a le ss res tri ct iv e way fo r th e Gov ern m en t to fu rth er it s in te res t
th an [ F o r m 7 0 0 o r HHS Not ic e].”). If th e em pl oyer’s TPA is kn own to th e
go ve rn m en t, th en th ere sh ou ld be no co st to al lo win g th e le ss on ero us no ti ce. Eve n i f t h e TP A s are no t kn own , th e go ve rn m en t ha s no t sh own at th is st ag e of th e
pr oc e e di ng s th at th e in co nv en ie nc e of id en ti fy in g th e TPAs li ke ly wou ld crea te an ad m in is tra ti ve pr ob le m of su ffi ci en t m ag n it ud e to m ak e th e en ti re sc he m e

un wor ka bl e. See Sh erb ert , 37 4 U.S. at 40 8- 09 ; Bo wen , 47 6 U.S. at 73 1 (O’Con no r, J., co nc ur rin g i n p art an d d is se nt in g i n p art ).

In ad di ti on , no ti ce si m il ar to th at sa nc ti on ed by th e Su pr em e Co ur t in W he at on Co ll eg e an d Zub ik wil l no t affe ct th e ab il it y of CNS an d HCC’s em pl oyees an d pl an be ne f i c ia rie s to ob ta in co nt race pt iv e co ve rag e or “ pr ecl ud e th e Gov ern m en t fro m rel y in g on th [e] no ti ce, to th e ex te nt it co ns id ers it ne ces sa r y, to faci li ta te th e
pr ov is io n of fu ll co nt race pt iv e co ve rag e un de r th e” ACA. W he at on Co ll eg e, 13 4 S.
Ct

. at 28 07 ; Zub ik

, 13 5 S. Ct

. at 29 24 (s am e). The im pa ct a rel ig io us acco m

m od at io n
may h av e on th ird pa rti es is an im po rta nt fact or , be cau se it “ wil l of te n in fo r m t h e

an al y si s of th e Gov ern m en t’s co m pe ll in g in te res t an d th e av ai la bi li ty o f a le ss

res tri ct iv e m ean s of ad va nc in g th at in te res t.” Hob by Lob by, 13 4 S. Ct

. at 27 81 n.3 7;

s e e al so id

. at 27 60 (o bs erv in g th at “ th e effe ct of th e

. . . acco m m od a t i o n o n t h e

wom en em

pl oyed by Hob by Lob by

. . . wou ld be pr eci se ly zero ” be cau se th ey “ wou ld

st il l b e en ti tl ed to all FDA-ap pr ov ed co nt race pt iv es wit ho ut co st sh ari ng ”).

CNS an d HCC al so su gg es t ot he r le ss res tri ct iv e m ean s th at co ul d acco m pl is h
th e go ve rn m en t’s ob

jecti ve s an d rel ie ve th e su bs ta nt ia l bu rd en on th ei r ex erci se of
rel ig io n. The se in cl ud e wha t th e Co ur t in Hob by Lob by ch arac te riz ed as “ [t]he m os t

st rai gh tfo rward way of do in g th is ,” na m el y , “ fo r th e Gov ern m en t to as su m e th e co st

-2 3-of

pro vi di ng th e . . . con tra cep ti ve s at is su e to an y wom en who are un ab le to ob ta in
th em un de r th ei r he al th -in su ran ce po l i ci es du e to th ei r em pl oyers’ rel ig io us

o b je c t io ns .” 13 4 S. Ct

. at 27 80

. “ [C]os t m ay be an im po rta nt fact or in th e l e a s t

res tri ct iv e m ean s an al y si s, bu t bo th RFRA an d it s si st er st at ut e , R LUI PA, m ay in

so m e c i r c um st an ces req ui re th e Gov ern m en t to ex pe nd ad di ti on al fu nd s to

acco m m od at e ci ti zen s’ rel ig io us be li efs .” Id . at 2 78 1. CNS an d HCC ur ge th at th e
go ve rn m en t co ul d pr ov id e su bs id ie s, rei m bu rs em en ts , ta x cred it s, or ta x de du ct io ns

to em pl oyees, or th at th e go ve rn m en t co ul d pa y fo r th e di st rib ut io n of co nt race pt iv es

at co m m un it y he al th cen te rs , pu bl ic cl in ic s, an d ho sp it al s wit h in co m e-b as ed su pp or t.
On th e m in im al reco rd th us far de ve lo pe d, th e go ve rn m en t ha s no t sh own th at th es e al te rn at iv es are in feas ib le

. Se e K o r t e v. Seb el iu s, 73 5 F.3 d 65 4, 68 6- 87 (7 th Ci r. 20 13 ); Uni v. of Not re Dam e, 78 6 F.3 d at 63 0 (Fl au m , J., di ss en ti ng ); E. Tex

. Bap ti st
Uni v. v. Seb el iu s, 98 8 F. Su pp

. 2d 74 3, 77 0 (S.D. Tex

. 20 13 ), rev ’d on ot he r gr ou nd s, 79 3 F .3d 44 9.

CNS an d HCC al so pr op os e t h a t th e go ve rn m en t co ul d m ak e co nt race pt iv es

av ai la bl e to em

pl oyees th ro ug h it s own he al th care ex ch an ge s. Und er th is ap pr oa ch

, th e go ve rn m en t “ co ul d tre at em pl oyees who se em

pl oyers do no t pr ov id e co m pl et e

co ve rag e fo r rel ig io us reas on s th e sa m e as it do es em pl o ye e s w h os e em

pl oyers
pr ov id e no co ve rag e at al l.” Pri es ts fo r Life

, sl ip op

. at 17 (Bro wn, J., di ss en ti ng fro m de ni al of reh eari ng en ba nc ). “ [I]f a le ss res tri ct iv e mea n s i s av ai la bl e fo r th e Gov ern m en t to ach ie ve it s g oa ls , th e Gov ern m en t m us t u se it .” Hol t v . Hob bs , 13 5
S. Ct

. 85 3, 86 4 (2 01 5)

. As the go ve rn m en t m us t pro ve th at it s pro po se d m an da te is
th e on ly feas ib le an d effe ct iv e m ean s of ach ie vi ng th e as se rte d co m pe ll in g in te res ts ,

we c a n n o t sa y on th is li m it ed reco rd th at th e go ve rn m en t ha s el im in at ed th e us e of
he al th care ex ch an ge s as a vi ab le op ti on

.

App lyin g th e su bs ta nt ia l-b ur de n te st se t fo rth in Hob by Lob by, we co nc lu de
th at CNS an d HCC ha ve est ab li sh ed th at th ey are l ik el y to su ccee d o n t he m eri ts of
th ei r RFRA ch al le ng e t o t h e co nt race pt iv e m an da te an d th e acco m m od at io n

-2 4-reg ul at io ns —t he m o s t si gn ifi can t fact or in de te rm in in g whe th er a pr el im in ary

in jun ct io n sh ou ld is su e. See Hom e In st ead

, In c., 72 1 F.3 d at 49 7. The y ha ve al so

es ta bl is he d th at in th e ab se nc e of an i n jun ct io n th ey wil l be fo rced to vi ol at e th ei r si nc erel y he ld rel ig io us be li efs by co m pl y in g with ei th er the co nt race pt iv e m an da te

or th e acco m

m od at io n pr oc es s or to in cu r se ve re m on et ary pe na lt ie s fo r refu si ng to

co m pl y

. Keep in g in m in d th e de f eren ce we owe th e di st ric t co ur t in rev ie win g a de ci si on to gr an t in

jun ct iv e rel ie f, we co nc lu de th at it di d no t abu se it s di sc ret io n in
fin di ng th at CNS an d HCC were su bs ta nt ia ll y li ke ly to su ccee d on th e m eri ts of th ei r cl ai m th at th e co nt race pt iv e m an da te a n d th e acco m m od at io n pr oc es s su bs ta nt ia ll y bu rd en th ei r ex erci se of rel ig io n in vi ol at io n of RFRA an d th at th e cu rren t

acco m m od at io n pr oc es s is no t th e le as t res tri ct iv e m ean s of f u r t h e r in g th e
go ve rn m en t’s in te res ts

. W e th eref or e affi rm th e di st ric t co ur t’s or de r g r a n t i n g in jun ct iv e rel ie f.

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-2 5-