Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 1.0

(Slip Opinion) 

OCTOBER  TERM,  2019 

1 

Syllabus 

NOTE:  Where  it  is  feasible,  a  syllabus  (headnote)  will  be  released,  as  is 
being  done  in  connection  with  this  case,  at  the  time  the  opinion  is  issued. 
The  syllabus  constitutes  no  part  of  the  opinion  of  the  Court  but  has  been 
prepared  by  the  Reporter  of  Decisions  for  the  convenience  of  the  reader. 
See United States v. Detroit Timber & Lumber Co., 200 U. S. 321, 337. 

SUPREME COURT OF THE UNITED STATES 

Syllabus 

LITTLE SISTERS OF THE POOR SAINTS PETER AND 
PAUL HOME v. PENNSYLVANIA ET AL. 

CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR 
THE THIRD CIRCUIT 

No. 19–431.  Argued May 6, 2020—Decided July 8, 2020* 

The Patient Protection and Affordable Care Act of 2010 (ACA) requires
covered employers to provide women with “preventive care and screen-
ings” without “any cost sharing requirements,” and relies on Preven-
tive Care Guidelines (Guidelines) “supported by the Health Resources
and Services Administration” (HRSA) to determine what “preventive 
care  and  screenings”  includes.    42  U.  S.  C.  §300gg–13(a)(4).    Those 
Guidelines  mandate  that  health  plans  provide  coverage  for  all  Food
and Drug Administration approved contraceptive methods.  When the 
Departments of Health and Human Services, Labor, and the Treasury
(Departments) incorporated the Guidelines, they also gave HRSA the
discretion  to  exempt  religious  employers,  such  as  churches,  from 
providing contraceptive coverage. Later, the Departments also prom-
ulgated a  rule accommodating qualifying religious organizations that
allowed  them  to  opt  out  of  coverage  by  self-certifying  that  they  met 
certain criteria to their health insurance issuer, which would then ex-
clude  contraceptive  coverage  from  the  employer’s  plan  and  provide
participants with separate payments for contraceptive services with-
out imposing any cost-sharing requirements. 

Religious entities challenged the rules under the Religious Freedom 
Restoration  Act  of  1993  (RFRA).    In  Burwell  v.  Hobby  Lobby  Stores, 
Inc.,  573  U.  S.  682,  this  Court  held  that  the  contraceptive  mandate
substantially  burdened  the  free  exercise  of  closely  held  corporations 
with  sincerely  held  religious  objections  to  providing  their  employees
with certain methods of contraception.  And in Zubik v. Burwell, 578 

—————— 

* Together with 19–454, Trump, President of the United States, et al. 

v. Pennsylvania et al., on certiorari to the same Court.