Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 59.0

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

3 

GINSBURG, J., dissenting 

such  out-of-pocket  costs  as  copays  or  deductibles.2    Those  
enumerated services did not, in the original draft bill, in-
clude  preventive  care  specific  to  women.  “To  correct  this 
oversight,  Senator  Barbara  Mikulski 
introduced  the 
Women’s  Health  Amendment,”  now  codified  at  §300gg–
13(a)(4).  Burwell v. Hobby Lobby Stores, Inc., 573 U. S. 682, 
741  (2014)  (GINSBURG,  J.,  dissenting);  see  also  155  Cong. 
Rec. 28841.  This provision was designed “to promote equal-
ity  in  women’s  access  to  health  care,”  countering  gender-
based discrimination and disparities in such access.  Brief 
for  186  Members  of  the  United  States  Congress  as  Amici 
Curiae 6 (hereinafter Brief for 186 Members of Congress).
Its proponents noted, inter alia, that “[w]omen paid signifi-
cantly more than men for preventive care,” and that “cost
barriers  operated  to  block  many  women  from  obtaining
needed  care  at  all.”  Hobby  Lobby,  573  U. S.,  at  742 
(GINSBURG, J., dissenting); see, e.g., 155 Cong. Rec. 28844
(statement of Sen. Hagan) (“When . . . women had to choose 
between feeding their children, paying the rent, and meet-
ing other financial obligations, they skipped important pre-
ventive  screenings  and  took  a  chance  with  their  personal
health.”).

Due to the Women’s Health Amendment, the preventive
health services that group health plans must cover include,
“with  respect  to  women,”  “preventive  care  and  screenings 
. . . provided for in comprehensive guidelines supported by 

—————— 

2 This requirement does not apply to employers with fewer than 50 em-
ployees,  26  U. S. C.  §4980H(c)(2),  or  “grandfathered  health  plans”—
plans in existence on March 23, 2010 that have not thereafter made spec-
ified changes in coverage, 42 U. S. C. §18011(a), (e); 45 CFR §147.140(g)
(2018). “Federal statutes often include exemptions for small employers,
and  such  provisions  have  never  been  held  to  undermine  the  interests 
served by these statutes.”  Hobby Lobby, 573 U. S., at 763 (GINSBURG, J., 
dissenting).    “[T]he  grandfathering  provision,”  “far  from  ranking  as  a 
categorical exemption, . . . is temporary, intended to be a means for grad-
ually  transitioning  employers  into  mandatory  coverage.”    Id.,  at  764 
(internal quotation marks omitted).