Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 62

6 

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

“Under  th[e]  accommodation,  [an  employer]  can  self-
certify that it opposes providing coverage for particular
contraceptive  services.    See  45  CFR  §§147.131(b)(4),
(c)(1)  [(2013)];  26  CFR  §§54.9815–2713A(a)(4),  (b).    If 
[an  employer]  makes  such  a  certification,  the  [em-
ployer’s] insurance issuer or third-party administrator
must ‘[e]xpressly exclude contraceptive coverage from
the  group  health  insurance  coverage  provided  in  con-
nection with the group health plan’ and ‘[p]rovide sep-
arate payments for any contraceptive services required 
to  be  covered’  without  imposing  ‘any  cost-sharing  re-
quirements  . . .  on  the  [employer],  the  group  health 
plan,  or  plan  participants  or  beneficiaries.’  45  CFR 
§147.131(c)(2); 26 CFR §54.9815–2713A(c)(2).”  Id., at 
731 (some alterations in original).8 

The self-certification accommodation, the Court observed 
in Hobby Lobby, “does not impinge on [an employer’s] belief 
that providing insurance coverage for . . . contraceptives . . . 
violates [its] religion.”  Ibid.  It serves “a Government inter-
est of the highest order,” i.e., providing women employees 
“with cost-free access to all FDA-approved methods of con-
traception.”  Id.,  at  729.    And  “it  serves  [that]  stated  in-
teres[t] . . . well.”  Id., at 731; see id., at 693 (Government 
properly accommodated employer’s religion-based objection 
to  covering  contraceptives  under  employer’s  health  insur-
ance plan when the harm to women of doing so “would be 
precisely zero”).  Since the ACA’s passage, “[gainfully em-
ployed] [w]omen, particularly in lower-income groups, have 
reported greater affordability of coverage, access to health 
—————— 

8 This  opinion  refers  to  the  contraceptive-coverage  accommodation 
made in 2013 as the “self-certification accommodation.”  See ante, at 6 
(opinion of the Court).  Although this arrangement “requires the issuer 
to  bear  the  cost  of  [contraceptive]  services,  HHS  has  determined  that 
th[e] obligation will not impose any net expense on issuers because its
cost will be less than or equal to the cost savings resulting from th[ose] 
services.”  Hobby Lobby, 573 U. S., at 698–699.