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18 

LITTLE SISTERS OF THE POOR SAINTS PETER 
AND PAUL HOME v. PENNSYLVANIA 
Opinion of the Court 

the  regulatory  mechanism  that  Congress  put  in  place  to
protect  this  assumed  governmental  interest.   As  even  the 
dissent recognizes, contraceptive coverage is mentioned no-
where  in  §300gg–13(a)(4),  and  no language  in  the  statute
itself even hints that Congress intended that contraception 
should or must be covered.  See post, at 4–5 (citing legisla-
tive history and amicus briefs).  Thus, contrary to the dis-
sent’s protestations, it was Congress, not the Departments, 
that declined to expressly require contraceptive coverage in 
the ACA itself.  See 83 Fed. Reg. 57540.  And, it was Con-
gress’  deliberate  choice  to  issue  an  extraordinarily  “broad 
general directiv[e]” to HRSA to craft the Guidelines, with-
out any qualifications as to the substance of the Guidelines 
or  whether  exemptions  were  permissible.  Mistretta  v. 
United States, 488 U. S. 361, 372 (1989).  Thus, it is Con-
gress, not the Departments, that has failed to provide the 
protection  for  contraceptive  coverage  that  the  dissent
seeks.8 

No  party  has  pressed  a  constitutional  challenge  to  the 
breadth  of  the  delegation  involved  here.  Cf.  Gundy  v. 
United States, 588 U. S. ___ (2019).  The only question we 
face today is what the plain language of the statute author-
izes.  And the plain language of the statute clearly allows
the Departments to create the preventive care standards as
well as the religious and moral exemptions.9 

—————— 

8 HRSA has altered its Guidelines multiple times since 2011, always
proceeding without notice and comment.  See 82 Fed. Reg. 47813–47814; 
83 Fed. Reg. 8487; 85 Fed. Reg. 722–723 (2020).  Accordingly, if HRSA 
chose to exercise that discretion to remove contraception coverage from
the next iteration of its Guidelines, it would arguably nullify the contra-
ceptive mandate altogether without proceeding through notice and com-
ment.  The combination of the agency practice of proceeding without no-
tice and comment and HRSA’s discretion to alter the Guidelines, though 
not  necessary for  our  analysis,  provides  yet  another  indication  of  Con-
gress’ failure to provide strong protections for contraceptive coverage. 

9 The dissent does not attempt to argue that the self-certification ac-
commodation can coexist with its interpretation of the ACA.  As for the