Opinion ID: 2034198
Heading Depth: 1
Heading Rank: 1

Heading: The Challenged Legislation

Text: In 2002, the Legislature enacted what is known as the Women's Health and Wellness Act (WHWA), mandating expanded health insurance coverage for a variety of services needed by women, including mammography, cervical cytology and bone density screening (L 2002, ch 554). At issue here are provisions of the WHWA requiring that an employer health insurance contract which provides coverage for prescription drugs shall include coverage for the cost of contraceptive drugs or devices (Insurance Law § 3221 [ l ] [16]; § 4303 [cc]). The legislative history makes clear that the WHWA in general, and the provisions relating to contraception in particular, were designed to advance both women's health and the equal treatment of men and women. The Legislature was provided with extensive information showing the need for the legislation. For example, the Legislature had before it a study showing that women paid 68% more than men in out-of-pocket expenses for health care, and that the cost of reproductive health services was a primary reason for the discrepancy. The American College of Obstetricians and Gynecologists advised the Legislature that better access to contraception would mean fewer abortions and unplanned pregnancies, and that the ability to time and space pregnancies was important to women's health. These conclusions are supported by studies contained in the record of this litigation, showing among other things that unintended pregnancies are often associated with delayed prenatal care; that such conditions as diabetes, hypertension, arthritis and coronary artery disease can be aggravated by pregnancy; that children born from unintended pregnancies are at risk of low birth weight and developmental problems; and that there are 3 million unintended pregnancies in the United States each year, of which approximately half end in abortion. At the heart of this case is the statute's exemption for religious employers. Such an employer may request an insurance contract without coverage for ... contraceptive methods that are contrary to the religious employer's religious tenets (Insurance Law § 3221 [ l ] [16] [A]; § 4303 [cc] [1]). Where a religious employer invokes the exemption, the insurer must offer coverage for contraception to individual employees, who may purchase it at their own expense at the prevailing small group community rate (Insurance Law § 3221 [ l ] [16] [B] [i]; § 4303 [cc] [2] [A]). A religious employer, as defined in the statute, is: an entity for which each of the following is true: (a) The inculcation of religious values is the purpose of the entity. (b) The entity primarily employs persons who share the religious tenets of the entity. (c) The entity serves primarily persons who share the religious tenets of the entity. (d) The entity is a nonprofit organization as described in Section 6033 (a) (2) (A) i or iii, of the Internal Revenue Code of 1986, as amended. (Insurance Law § 3221 [ l ] [16] [A] [1]; see § 4303 [cc] [1] [A] [i]-[iv].) Plaintiffs say that this definition is unconstitutionally narrow. The Legislature debated the scope of the religious employer exemption intensely before the WHWA was passed. A broader exemption was proposed, one that would have been available to any group or entity ... supervised or controlled by or in connection with a religious organization or denominational group or entity (2001 NY Senate Bill S 3, § 14). Supporters of this version of the exemption argued, as do plaintiffs here, that religious organizations should not be forced to violate the commands of their faith. Those favoring a narrower exemption asserted that the broader one would deprive tens of thousands of women employed by church-affiliated organizations of contraceptive coverage. Their view prevailed.