Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 18

14 

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

We granted certiorari.  589 U. S. ___ (2020). 

II 

Respondents contend that the 2018 final rules providing 
religious and moral exemptions to the contraceptive man-
date are both substantively and procedurally invalid.  We 
begin  with  their  substantive  argument  that  the  Depart-
ments lacked statutory authority to promulgate the rules. 

A 

The Departments invoke 42 U. S. C. §300gg–13(a)(4) as 
legal authority for both exemptions.  This provision of the 
ACA states that, “with respect to women,” “[a] group health
plan and a health insurance issuer offering group or indi-
vidual health insurance coverage shall, at a minimum pro-
vide . . . such additional preventive care and screenings not 
described in paragraph (1) as provided for in comprehensive 
guidelines supported by [HRSA].”  The Departments main-
tain, as they have since 2011, that the phrase “as provided
for” allows HRSA both to identify what preventive care and
screenings must be covered and to exempt or accommodate
certain  employers’  religious  objections.  See  83  Fed.  Reg.
57540–57541; see also post, at 3 (KAGAN, J., concurring in 
judgment).    They  also  argue  that,  as  with  the  church  ex-
emption, their role as the administering agencies permits 
them to guide HRSA in its discretion by “defining the scope 
of  permissible  exemptions  and  accommodations  for  such
guidelines.”  82 Fed. Reg. 47794.  Respondents, on the other 
hand, contend that §300gg–13(a)(4) permits HRSA to only 
list  the  preventive  care  and  screenings  that  health  plans 
“shall  . . .  provide,”  not  to  exempt  entities  from  covering 

—————— 
Federal Government clearly had standing to invoke the Third Circuit’s 
appellate jurisdiction, and both the Federal Government and the Little
Sisters  asked  the  court  to  dissolve  the  injunction  against  the  religious 
exemption.    The  Third  Circuit  accordingly  erred  by  inquiring  into  the 
Little Sisters’ independent Article III standing.