Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 7

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

3 

Opinion of the Court 

U. S. C. §300gg–13(a)(4).2 

The statute does not define “preventive care and screen-
ings,” nor does it include an exhaustive or illustrative list 
of such services.  Thus, the statute itself does not explicitly 
require coverage for any specific form of “preventive care.” 
Hobby Lobby, 573 U. S., at 697.  Instead, Congress stated
that coverage must include “such additional preventive care 
and screenings . . . as provided for in comprehensive guide-
lines supported by the Health Resources and Services Ad-
ministration”  (HRSA),  an  agency  of  the  Department  of
Health and Human Services (HHS).  §300gg–13(a)(4).  At 
the time of the ACA’s enactment, these guidelines were not 
yet written.  As a result, no specific forms of preventive care
or screenings were (or could be) referred to or incorporated
by reference.

Soon  after  the  ACA’s  passage,  the  Departments  began
promulgating rules related to §300gg–13(a)(4).  But in do-
ing so, the Departments did not proceed through the notice 
and  comment  rulemaking  process,  which  the  Administra-
tive Procedure Act (APA) often requires before an agency’s 
regulation  can  “have  the  force  and  effect  of  law.”  Perez  v. 
Mortgage Bankers Assn., 575 U. S. 92, 96 (2015) (internal 
quotation marks omitted); see also 5 U. S. C. §553. Instead, 
the Departments invoked the APA’s good cause exception, 
which permits an agency to dispense with notice and com-
ment and promulgate an IFR that carries immediate legal 
force.  §553(b)(3)(B). 

The first relevant IFR, promulgated in July 2010, primar-
ily focused on implementing other aspects of §300gg–13.  75 

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2 The  ACA  exempts  “grandfathered”  plans  from  42  U. S. C.  §300gg– 
13(a)(4)—i.e.,  “those  [plans]  that  existed  prior  to  March  23,  2010,  and 
that have not made specified changes after that date.”  Burwell v. Hobby 
Lobby Stores, Inc., 573 U. S. 682, 699 (2014).  See §§18011(a), (e); 29 CFR 
§2590.715–1251 (2019).  As of 2018, an estimated 16 percent of employ-
ees “with employer-sponsored coverage were enrolled in a grandfathered 
group health plan.”  84 Fed. Reg. 5971 (2019).