Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 72

16 

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

and  126,400  women  of  childbearing  age,  the  Government 
estimates, will experience the disappearance of the contra-
ceptive  coverage  formerly  available  to  them, 83  Fed.  Reg.
57578–57580;  indeed,  the  numbers  may  be  even  higher.18 
Lacking  any  alternative  insurance  coverage  mechanism, 
see supra, at 7, the exemption leaves women two options, 
neither satisfactory.

The first option—the one suggested by the Government 
in its most recent rulemaking, 82 Fed. Reg.  47803—is for 
women to seek contraceptive care from existing government-
funded programs.  Such programs, serving primarily low-
income individuals, are not designed to handle an influx of
tens of thousands of previously insured women.19  Moreo-
ver,  as  the  Government  has  acknowledged,  requiring 
women “to take steps to learn about, and to sign up for, a 
new  health  benefit” 
“additional  barriers,” 
imposes 
“mak[ing]  that  coverage  accessible  to  fewer  women.”    78 
Fed. Reg. 39888.  Finally, obtaining care from a government-
—————— 

18 The Government notes that 2.9 million people were covered by the 
209 plans that previously utilized the self-certification accommodation.
83 Fed. Reg. 57577.  One hundred nine of those plans covering 727,000 
people,  the  Government  estimates,  will  use  the  religious  exemption,
while 100 plans covering more than 2.1 million people will continue to use 
the  self-certification  accommodation.  Id.,  at  57578.  If  more  plans,  or  
plans covering more people, use the new exemption, more women than
the Government estimates will be affected. 

19 Title X “is the only federal grant program dedicated solely to provid-
ing individuals with comprehensive family planning and related preven-
tive  health  services.”    HHS,  About  Title  X  Grants,  www.hhs.gov/opa/
title-x-family-planning/about-title-x-grants/index.html.    A  recent  rule 
makes women who lose contraceptive coverage due to the religious ex-
emption eligible for Title X services.  See 84 Fed. Reg. 7734 (2019).  Ex-
panding eligibility,  however,  “does  nothing  to  ensure  Title  X  providers 
actually have capacity to meet the expanded client population.”  Brief for 
National Women’s Law Center et al. as Amici Curiae 22.  Moreover, that 
same rule forced 1,041 health providers, serving more than 41% of Title
X  patients,  out  of  the  Title  X  provider  network  due  to  their  affiliation
with  abortion  providers.    84  Fed.  Reg.  7714;  Brief  for  Planned 
Parenthood Federation of America et al. as Amici Curiae 18–19.