Document ID: ./input/supremecourt_opinions/opinions/19pdf/19-431_5i36.pdf
Page Number: 66

10 

LITTLE SISTERS OF THE POOR SAINTS PETER 
AND PAUL HOME v. PENNSYLVANIA 
GINSBURG, J., dissenting 

any  language  in  paragraph  (a)(4)  counteracts  Congress’ 
opening  instruction  in  §300gg–13(a)  that  group  health
plans “shall . . . provide” specified services.  See supra,  at 
8–9. 

The  Court  embraces,  and  the  opinion  concurring  in  the 
judgment adopts, the Government’s argument.  The Court 
correctly acknowledges that HRSA has broad discretion to
determine  what  preventive  services  insurers  should  pro-
vide for women.  Ante, at 15.  But it restates that HRSA’s 
“discretion [is] equally unchecked in other areas, including 
the ability to identify and create exemptions from its own 
Guidelines.”  Ante, at 16.  See also ante, at 2–3 (KAGAN, J., 
concurring  in  judgment)  (agreeing  with  this  interpreta-
tion).  Like the Government, the Court and the opinion con-
curring  in  the  judgment  shut  from  sight  §300gg–13(a)’s
overarching  direction  that  group  health  plans  and  health
insurance issuers “shall” cover the specified services.  See 
supra, at 8–9.  That “ ‘absent provision[s] cannot be supplied 
by the courts,’ ” ante, at 16 (quoting Rotkiske v. Klemm, 589 
U. S.  ___,  ___  (2019)  (slip  op.,  at  5),  militates  against  the 
Court’s  conclusion,  not  in  favor  of  it.  Where  Congress
wanted  to  exempt  certain  employers  from  the  ACA’s  re-
quirements, it said so expressly.  See, e.g., supra, at 3, n. 2. 
Section  300gg–13(a)(4)  includes  no  such  exemption.  See 
supra, at 8–9.11 

B 
The position advocated by the Government and endorsed 
by  the  Court  and  the  opinion  concurring  in  the  judgment
encounters further obstacles. 

Most saliently, the language in §300gg–13(a)(4) mirrors 

—————— 

11 The only language to which the Court points in support of its con-
trary conclusion is the phrase “as provided for.”  See ante, at 15.  This 
phrase  modifies  “additional  preventive  care  and  screenings.”    §300gg– 
13(a)(4).  It therefore speaks to what services shall be provided, not who 
must provide them.