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Page Number: 68

12 

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

based disparities in access to preventive care.  See supra, at 
3.  Overlooked  by  the  Court,  see  ante,  at  14–18,  and  the 
opinion concurring in the judgment, see ante, at 2–3 (opin-
ion  of  KAGAN,  J.),  HRSA’s  expertise  does  not  include  any 
proficiency in delineating religious and moral exemptions.
One  would  not,  therefore,  expect  Congress  to  delegate  to 
HRSA  the  task  of  crafting  such  exemptions.  See  King  v. 
Burwell, 576 U. S. 473, 486 (2015) (“It is especially unlikely 
that  Congress  would  have  delegated  this  decision  to  [an
agency] which has no expertise in . . . policy of this sort.”).14 
In  fact,  HRSA  did  not  craft  the  blanket  exemption.    As 
earlier observed, see supra, at 7, that task was undertaken 
by  the  IRS,  EBSA,  and  CMS. 
  See  also  45  CFR 
§147.132(a)(1), 147.133(a)(1) (direction by the IRS, EBSA,
and  CMS  that  HRSA’s  guidelines  “must  not  provide  for”
contraceptive  coverage  in  the  circumstances  described  in 
the blanket exemption (emphasis added)).  Nowhere in 42 
U. S. C. §300gg–13(a)(4) are those agencies named, as ear-
lier  observed,  see  supra,  at  8–9,  an  absence  the  Govern-
ment,  the  Court,  and  the  opinion  concurring  in  the  judg-
ment do not deign to acknowledge.  See Brief for HHS et al. 
15–20;  ante,  at  14–18  (opinion  of  the  Court);  ante,  at  2–3 
(opinion of KAGAN, J.). 

C 
If the ACA does not authorize the blanket exemption, the
Government urges, then the exemption granted to houses
of worship in 2011 must also be invalid.  Brief for HHS et al. 
19–20.  As the Court of Appeals explained, however, see 930 
—————— 

14 A  more  logical  choice  would  have  been  HHS’s  Office  for  Civil 
Rights  (OCR),  which  “enforces  . . .  conscience  and  religious  freedom 
laws”  with  respect  to  HHS  programs.    HHS,  OCR,  About  Us, 
www.hhs.gov/ocr/about-us/index.html.    Indeed,  when  the  Senate  intro-
duced an amendment to the ACA similar in character to the blanket ex-
emption, a measure that failed to pass, the Senate instructed that OCR
administer the exemption. 158 Cong. Rec. 1415 (2012) (proposed amend-
ment); id., at 2634 (vote tabling amendment).