Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 58

2 

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

Health Resources and Services Administration (HRSA), au-
thority  to  designate  the  preventive  care  insurance  should 
cover.  HRSA included in its designation all contraceptives
approved by the Food and Drug Administration (FDA).

Destructive  of  the  Women’s  Health  Amendment,  this 
Court leaves women workers to fend for themselves, to seek 
contraceptive  coverage  from  sources  other  than  their  em-
ployer’s  insurer,  and,  absent  another  available  source  of 
funding, to pay for contraceptive services out of their own
pockets.  The Constitution’s Free Exercise Clause, all agree, 
does not call for that imbalanced result.1  Nor does the Re-
ligious  Freedom  Restoration  Act  of  1993  (RFRA),  42 
U. S. C. §2000bb et seq., condone harm to third parties oc-
casioned by entire disregard of their needs.  I therefore dis-
sent from the Court’s judgment, under which, as the Gov-
ernment  estimates,  between  70,500  and  126,400  women 
would immediately lose access to no-cost contraceptive ser-
vices.  On  the  merits,  I  would  affirm  the  judgment  of  the
U. S. Court of Appeals for the Third Circuit. 

I 
A 
Under  the  ACA,  an  employer-sponsored  “group  health 
plan”  must  cover  specified  “preventive  health  services” 
without “cost sharing,” 42 U. S. C. §300gg–13, i.e., without 

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1 In Employment Div., Dept. of Human Resources of Ore. v. Smith, 494 
U. S. 872 (1990), the Court explained that “the right of free exercise does 
not  relieve  an  individual  of  the  obligation  to  comply  with  a  valid  and
neutral law of general applicability on the ground that the law proscribes 
(or prescribes) conduct that his religion prescribes (or proscribes).”  Id., 
at 879 (internal quotation marks omitted).  The requirement that insur-
ers cover FDA-approved methods of contraception “applies generally, . . . 
trains  on  women’s  well-being,  not  on  the  exercise  of  religion,  and  any 
effect  it  has  on  such  exercise  is  incidental.”   Burwell  v.  Hobby  Lobby 
Stores, Inc., 573 U. S. 682, 745 (2014) (GINSBURG, J., dissenting).  Smith 
forecloses  “[a]ny  First  Amendment  Free  Exercise  Clause  claim  [one]
might assert” in opposition to that requirement.  573 U. S., at 744.