Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 67

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

11 

GINSBURG, J., dissenting 

that in §300gg–13(a)(3), the provision addressing children’s 
preventive health services.  Not contesting here that HRSA
lacks authority to exempt group health plans from the chil-
dren’s  preventive-care  guidelines,  the  Government  at-
tempts  to  distinguish  paragraph  (a)(3)  from  paragraph 
(a)(4).  Brief  for  HHS  et al.  16–17.    The  attempt  does  not 
withstand inspection. 

The Government first observes that (a)(4), unlike (a)(3),
contemplates guidelines created “for purposes of this para-
graph.”  (Emphasis added.)  This language does not speak 
to  the  scope  of  the  guidelines  HRSA  is  charged  to  create. 
Moreover, the Government itself accounts for this textual 
difference:  The  children’s  preventive-care  guidelines  de-
scribed in paragraph (a)(3) were “preexisting guidelines . . . 
developed  for  purposes  unrelated  to  the  ACA.”    Brief  for 
HHS et al. 16.  The guidelines on women’s preventive care, 
by  contrast,  did  not  exist  before  the  ACA;  they  had  to  be
created  “for  purposes  of ”  the  preventive-care  mandate.
§300gg–13(a)(4).  The Government next points to the modi-
fier  “evidence-informed”  placed  in  (a)(3),  but  absent  in 
(a)(4).  This omission, however it may bear on the kind of 
preventive  services  for  women  HRSA  can  require  group
health insurance to cover, does not touch or concern who is 
required to cover those services.12 

HRSA’s  role  within  HHS  also  tugs  against  the  Govern-
ment’s, the Court’s, and the opinion concurring in the judg-
ment’s construction of §300gg–13(a)(4).  That agency was a 
logical  choice  to  determine  what  women’s  preventive  ser-
vices should be covered, as its mission is to “improve health 
care access” and “eliminate health disparities.”13  First and 
foremost, §300gg–13(a)(4) is directed at eradicating gender-

—————— 

12 The Court does not say whether, in its view, the exemption authority 
it claims for women’s preventive care exists as well for HRSA’s children’s 
preventive-care guidelines. 

13 HRSA,  HHS,  Organization,  www.hrsa.gov/about/organization/

index.html.