Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 64.0

8 

LITTLE SISTERS OF THE POOR SAINTS PETER 
AND PAUL HOME v. PENNSYLVANIA 
GINSBURG, J., dissenting 

employers’  religious  beliefs,  although  that  course  harms 
women who do not share those beliefs?  The District Court 
answered “no,” and preliminarily enjoined the blanket ex-
emption  nationwide.  281  F. Supp.  3d  553,  585  (ED  Pa. 
2017).  The Court of Appeals affirmed.  930 F. 3d 543, 576 
(CA3 2019).  The same question is now presented for ulti-
mate decision by this Court. 

II 

Despite  Congress’  endeavor,  in  the  Women’s  Health 
Amendment to the ACA, to redress discrimination against
women  in  the  provision  of  healthcare,  the  exemption  the
Court today approves would leave many employed women 
just where they were before insurance issuers were obliged 
to cover preventive services for them, cost free.  The Gov-
ernment urges that the ACA itself authorizes this result, by 
delegating  to  HRSA  authority  to  exempt  employers  from 
the  contraceptive-coverage  requirement.    This  argument
gains the Court’s approbation.  It should not. 

A 
I begin with the statute’s text.  But see ante, at 17 (opin-
ion  of  the  Court)  (overlooking  my  starting  place).  The 
ACA’s preventive-care provision, 42 U. S. C. §300gg–13(a), 
reads in full: 

“A group health plan and a health insurance issuer 
offering group or individual health insurance coverage
shall, at a minimum provide coverage for and shall not 
impose any cost sharing requirements for— 

“(1) evidence-based items or services that have in ef-
fect  a  rating  of  ‘A’  or  ‘B’  in  the  current  recommenda-
tions  of  the  United  States  Preventive  Services  Task 
Force; 

“(2) immunizations that have in effect a recommen-
dation from the Advisory Committee on Immunization