Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 73.0

Cite as:  591 U. S. ____ (2020) 

17 

GINSBURG, J., dissenting 

funded program instead of one’s regular care provider cre-
ates a continuity-of-care problem, “forc[ing those] who lose
coverage away from trusted providers who know their med-
ical histories.”  NWLC Brief 18. 

The second option for women losing insurance coverage
for contraceptives is to pay for contraceptive counseling and 
devices  out  of  their  own  pockets.    Notably,  however,  “the 
most  effective  contraception  is  also  the  most  expensive.”
ACOG Brief 14–15.  “[T]he cost of an IUD [intrauterine de-
vice],” for example, “is nearly equivalent to a month’s full-
time pay for workers earning the minimum wage.”  Hobby 
Lobby, 573 U. S., at 762 (GINSBURG, J., dissenting).  Faced 
with high out-of-pocket costs, many women will forgo con-
traception, Brief for 186 Members of Congress 11, or resort
to less effective contraceptive methods, 930 F. 3d, at 563. 

As the foregoing indicates, the religious exemption “rein-
troduce[s]  the  very  health  inequities  and  barriers  to  care
that  Congress  intended  to  eliminate  when  it  enacted  the 
women’s preventive services provision of the ACA.”  NWLC 
Brief 5.  “No tradition, and no prior decision under RFRA,
allows a religion-based exemption when [it] would be harm-
ful to others—here, the very persons the contraceptive cov-
erage requirement was designed to protect.”  Hobby Lobby, 
573  U. S.,  at  764  (GINSBURG,  J.,  dissenting).20  I  would 
therefore hold the religious exemption neither required nor 
permitted by RFRA.21 

—————— 

20 Remarkably, JUSTICE ALITO  maintains  that  stripping  women  of  in-
surance coverage for contraceptive services imposes no burden.  See ante, 
at  18  (concurring  opinion).  He  reaches  this  conclusion  because,  in  his 
view, federal law does not require the contraceptive coverage denied to
women  under  the  exemption.  Ibid.   Congress,  however,  called  upon
HRSA to specify contraceptive and other preventive services for women
in  order  to  ensure  equality  in  women  employees’  access  to  healthcare, 
thus safeguarding their health and well-being.  See supra, at 2–5. 

21 As above stated, the Government does not defend the moral exemp-

tion under RFRA.  See supra, at 13.