Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 33.0

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

3 

ALITO, J., concurring 

include coverage for contraceptives.  Instead, the Act pro-
vided that plans must cover those preventive services found 
to be appropriate by the Health Resources and Services Ad-
ministration  (HRSA),  an  agency  of  the  Department  of 
Health and Human Services.  42 U. S. C. §300gg–13(a)(4).
In  2011,  HRSA  recommended  that  plans  be  required  to
cover  “ ‘[a]ll  . . .  contraceptive  methods’ ”  approved  by  the 
Food and Drug Administration.  77 Fed. Reg. 8725 (2012).
(I  will  use  the  term  “contraceptive  mandate”  or  simply
“mandate” to refer to the obligation to provide coverage for
contraceptives under any of the various regimes that have 
existed since the promulgation of this original rule.)  At the 
direction  of  the  relevant  Departments,  HRSA  simultane-
ously  created  an  exemption  from  the  mandate  for 
“churches, their integrated auxiliaries, and conventions or 
associations  of  churches,”  as  well  as  “the  exclusively  reli-
gious activities of any religious order.”  76 Fed. Reg. 46623
(2011); see 77 Fed. Reg. 8726. (I will call this the “church 
exemption.”)  This narrow exemption was met with strong 
objections on the ground that it furnished insufficient pro-
tection for religious groups opposed to the use of some or all
of the listed contraceptives. 

The Departments responded by issuing a new regulation 
that  created  an  accommodation  for  certain  religious  non-
profit employers.  See 78 Fed. Reg. 39892–39898 (2013).  (I
will call this the “accommodation.”)  Under this accommo-
dation, a covered employer could certify its objection to its
insurer  (or,  if  its  plan  was  self-funded,  to  its  third-party 
plan administrator), and the insurer or third-party admin-
istrator would then proceed to provide contraceptive cover-
age to the objecting entity’s employees.  Unlike the earlier 
church exemption, the accommodation did not exempt these 
religious  employers  from  the  contraceptive  mandate,  but 
the  Departments  construed  invocation  of  the  accommoda-
tion as compliance with the mandate. 

Meanwhile,  the  contraceptive  mandate  was  challenged