Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 45.0

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

15 

ALITO, J., concurring 

program would be “minor.”  Id., at 729.11 

The Government argued that we should not take this op-
tion  into  account  because  it  lacked  statutory  authority  to 
create such a program, see ibid., but we rejected that argu-
ment,  id.,  at  729–730.  Certainly,  Congress  could  create 
such a program if it thought that providing cost-free contra-
ceptives to all women was a matter of “paramount” concern.
As the Government now points out, Congress has taken
steps in this direction.  “[E]xisting federal, state, and local 
programs,” including Medicaid, Title X, and Temporary As-
sistance for Needy Families, already “provide free or subsi-
dized contraceptives to low-income women.”  Brief for Peti-
tioners in No. 19–454, at 27; see also 83 Fed. Reg. 57548,
57551  (discussing  programs).12   And  many  women  who 

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11 In 2019, the Government is estimated to have spent $737 billion sub-
sidizing health insurance for individuals under the age of 65; $287 billion
of that went to employment-related coverage.  CBO, Federal Subsidies 
for Health Insurance for People Under Age 65: 2019 to 2029, pp. 15–16
(2019).  While the cost of contraceptive methods varies, even assuming 
the most expensive options, which range around $1,000 a year, the cost
of providing this coverage to the 126,400 women who are estimated to be
impacted by the religious exemption would be $126.4 million.  See Ko-
sova, National Women’s Health Network, How Much Do Different Kinds 
of  Birth  Control  Cost  Without  Insurance?  (Nov.  17,  2017),  http:// 
nwhn.org /much-different-kinds-birth-control-cost-without-insurance/
(discussing contraceptive methods ranging from $240 to $1,000 per year); 
83 Fed. Reg. 57581 (estimating that up to 126,400 women will be affected
by the religious exemption). 

12 The Government recently amended the definitions for Title X’s fam-
ily  planning  program  to  help  facilitate  access  to  contraceptives  for 
women who work for an employer invoking the religious and moral ex-
emptions.  See 84 Fed. Reg. 7734 (2019).  These definitions now provide 
that “for the purpose of considering payment for contraceptive services 
only,” a “low income family” “includes members of families whose annual 
income”  would  otherwise  exceed  the  threshold  “where  a  woman  has 
health  insurance  coverage  through  an  employer  . . .  [with]  a  sincerely 
held religious or moral objection to providing such [contraceptive] cover-
age.”  42 CFR §59.2(2).