SCOTT W. SKAVDAHL, District Judge.
This matter comes before the Court on Plaintiffs' Motion for Preliminary Injunction (ECF No. 23). Defendants filed an opposition to preliminary injunction (ECF No. 31), and, with the Court's leave, the American Civil Liberties Union (ACLU) filed an amicus curiae brief opposing preliminary injunction (ECF No. 37). The Court heard oral argument on the matter on May 7, 2014. Having considered the parties' briefs, the arguments of counsel, the record herein, and being otherwise fully advised, the Court finds the motion should be denied.
This case pits certain provisions of the Patient Protection and Affordable Care Act of 2010(ACA) against the Religious Freedom Restoration Act of 1993 (RFRA).
Plaintiffs are several Catholic groups in Wyoming. Defendants are the Secretary of the United States Department of Health and Human Services
Plaintiffs are non-profit religious organizations whose work is guided by Roman Catholic doctrine, which includes the firm conviction that sexual union must be reserved to married couples who are open to the creation of life, and any artificial interference with the creation of life is contrary to church doctrine. (ECF No. 1 at p. 3.) Accordingly, they contend they are prohibited by Catholic belief from providing, paying for, or facilitating access to products or services that limit a woman's natural reproductive capacity, including even education
Plaintiffs take issue with the ACA provisions that require health insurance coverage for products and services limiting women's natural reproductive capacity, including women's contraception, sterilization, and related education and counseling. Plaintiffs contend this ACA requirement violates the RFRA because it forces Plaintiffs to "offer health plans that serve as a conduit for the delivery of the objectionable products and services.
Under the ACA, "employment-based group health plans covered by the Employee Retirement Income Security Act (ERISA) must provide certain types of preventive health services." Hobby Lobby Stores, Inc. v. Sebelius, 723 F.3d 1114, 1122 (10 Cir.2013) (en banc), cert. granted, ___ U.S. ___, 134 S.Ct. 678, 187 L.Ed.2d 544 (2013) (citing 42 U.S.C. § 300gg-13; 29 U.S.C. § 1185d). The provision of the ACA at issue here "mandates coverage, without cost-sharing by plan participants or beneficiaries, of `preventive care and screenings' for women `as provided for in comprehensive guidelines supported by the Health Resources and Services Administration.'" Id. (citing 42 U.S.C. § 300gg-13(a)(4)). The guidelines that were adopted require health insurance coverage for, among other preventive care, "`[a]ll Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity,' as prescribed by a provider." Id. at 1123 (quoting 77 Fed.Reg. 8725, 8725 (Feb. 15, 2012)). In turn, the Food and Drug Administration (FDA) has approved twenty women's contraceptive
The provision exempts "religious employers" from its mandate. Id. at 1123. This exemption is limited, though, and protects only "the unique relationship between a house of worship and its employees in ministerial positions." 78 Fed.Reg. 8456, 8461 (Feb. 6, 2013). Currently, this exemption includes only "churches, synagogues, mosques, and other houses of worship, and religious orders."
In addition to the "religious employer" exemption, the provision also includes an "accommodation," which is central to the instant case. Only eligible organizations are provided the accommodation, which is intended to eliminate (or substantially reduce) any burden the contraceptive coverage requirement imposes upon their religious beliefs and practices. The parties here agree Plaintiffs (other than the Diocese) are eligible for the accommodation. To take advantage of the accommodation, an entity must satisfy four requirements:
45 C.F.R. § 147.131(b); see also 29 C.F.R. § 2590.715-2713A(a); 78 Fed.Reg. 39869, 39873-74 (July 2, 2013). The eligible organization must provide the self-certification form to its insurance company or, if the organization has a self-insured health plan (as is the case here), to its third-party administrator (TPA). 29 C.F.R. § 2590.715-2713A(b). The law then requires the TPA to provide or arrange payments for the objectionable contraceptive products and services, without participation, payment, or interference from the eligible organization. Id. Thus, under the ACA, the TPA holds the responsibility to arrange contraceptive coverage for the organization's employees and covered dependents. The purpose of this accommodation is "to route the contraceptive coverage for these organizations through a middleman insurer or insurance plan administrator, allowing the organization to avoid directly providing contraceptive coverage." Hobby Lobby, 723 F.3d at 1124 (citing 78 Fed. Reg. 8458-68 (Feb. 6, 2013)). Significantly,
Plaintiffs offer a health insurance plan to their employees that omits the objectionable products and services from coverage. (See, e.g., Etienne Aff. ¶¶ 8, 12.) Plaintiff Diocese of Cheyenne offers a health plan through a self-insurance trust, known as the RETA Trust, which was established by the Catholic bishops of California in 1999 for the purpose of providing medical coverage consistent with Catholic teaching. (Id. at ¶ 8.) The Diocese's health plan also covers the other Plaintiffs (except Wyoming Catholic College). (Id. at ¶ 11.)
The third-party administrator (TPA) for the health insurance plan is Aetna, Inc. (Id. at ¶ 8.) There has been no evidence presented to suggest Aetna holds any religious objections to providing or arranging for contraceptive coverage.
Under the ACA provisions at issue in this case, Plaintiffs have the following options: (1) ensure that their health insurance plan directly offers contraceptive coverage to their female employees, (2) complete and submit the self-certification form to take advantage of the accommodation, (3) refuse to comply with the ACA's contraceptive coverage requirement and incur substantial, potentially ruinous fines for their non-compliance, or (4) cease offering health insurance to their employees altogether. Plaintiffs argue every option is undesirable because the first two options violate their religious beliefs, the third would prevent them from providing charitable services to those in need, and the fourth would inhibit their ability to attract well-qualified employees while preventing them from providing fully for their current employees.
Specific to this case, Plaintiffs refuse to complete and submit the self-certification form to their TPA. They "believe that submitting the self-certification violates their religious beliefs, because doing so makes them `complicit in an immoral act.'" (Pls.' Br. at 11-12 (quoting Hobby Lobby, 723 F.3d at 1142).) "Plaintiffs cannot, consistent with their religious beliefs, offer health plans that serve as a conduit for the delivery of the objectionable products and services." (Pls.' Br. at 12.) Succinctly, Plaintiffs argue that completing the self-certification makes them complicit in their female employees having access to the objectionable contraceptive products and services, which Plaintiffs contend violates their sincerely-held religious belief against providing or enabling access to artificial interference with the creation of life.
With this backdrop in place, the Court turns to the applicable legal principles that must be considered in determining whether a preliminary injunction in Plaintiffs' favor is warranted.
For a preliminary injunction to issue, the moving party must prove that four equitable factors weigh in its favor:
Beltronics USA, Inc. v. Midwest Inventory Distrib., LLC, 562 F.3d 1067, 1070 (10th Cir.2009) (citing Westar Energy, Inc. v. Lake, 552 F.3d 1215, 1224 (10th Cir.2009)).
Where, as here, a plaintiff alleges a deprivation of RFRA rights, the likelihood of success on the merits and irreparable harm prongs merge. Hobby Lobby, 723 F.3d at 1146 ("establishing a likely RFRA violation satisfies the irreparable harm factor") (citing Kikumura v. Hurley, 242 F.3d 950, 963 (10th Cir.2001)). Moreover, "because a showing of probable irreparable harm is the single most important prerequisite for the issuance of a preliminary injunction, the moving party must first demonstrate that such injury is likely before the other requirements for issuance of an injunction will be considered." Dominion Video Satellite, Inc. v. Echostar Satellite Corp., 356 F.3d 1256, 1260 (10th Cir. 2004) (quoting Reuters Ltd. v. United Press Int'l, Inc., 903 F.2d 904, 907 (2d Cir.1990)).
Plaintiffs rely on the RFRA as the basis for their preliminary injunction request. The RFRA holds the government shall not "substantially burden a person's exercise of religion" unless the substantial burden "(1) is in furtherance of a compelling governmental interest, and (2) is the least restrictive means of furthering that compelling governmental interest." 42 U.S.C. § 2000bb-1.
As the first step for proving their need for a preliminary injunction, Plaintiffs must show a likelihood of success on the merits of their RFRA claim. The Tenth Circuit set forth the test for a preliminary injunction based on the RFRA in Hobby Lobby:
723 F.3d at 1125-26.
Broken down, the RFRA analysis involves two steps, and each step has two requirements. In the first step, the plaintiff has the burden of showing (1) their asserted religious beliefs are sincere and (2) the law in question substantially burdens the exercise of those sincere religious beliefs. 42 U.S.C. § 2000bb-1(a); see also Kikumura v. Hurley, 242 F.3d 950, 960 (10th Cir.2001). If a plaintiff carries their burden in step one, the burden shifts to the government to show (1) the challenged law advances a compelling governmental interest, and (2) the law is the least restrictive means of furthering that compelling interest. 42 U.S.C. § 2000bb-1(b); see also Hobby Lobby, 723 F.3d at 1143. To successfully obtain relief from the offensive provision, a plaintiff must carry their burden and the government must fail to carry its burden.
The Court begins the preliminary injunction analysis by keeping in mind that a
The likelihood of success on the merits factor (which merges with the irreparable harm factor in RFRA claims such as this) requires the Court to weigh the parties' assertions in light of the RFRA test.
The first question to address is whether the ACA's contraceptive coverage requirement substantially burdens Plaintiffs' sincere religious exercise. See 42 U.S.C. § 2000bb-1(a). Under this first step, a law substantially burdens a claimant's exercise of religion if it:
Hobby Lobby, 723 F.3d at 1138 (quoting Abdulhaseeb v. Calbone, 600 F.3d 1301, 1315 (10th Cir.2010)). The parties, and the Court, agree the third prong, related to "substantial pressure," applies to this case. See id. at 1138-40. In considering substantial pressure, the Court's "only task is to determine whether the claimant's belief is sincere, and if so, whether the government has applied substantial pressure on the claimant to violate that belief." Hobby Lobby, 723 F.3d at 1137. Whether substantial pressure exists, though, is for this Court to determine, not for Plaintiffs to pronounce. "[S]ubstantiality—like compelling governmental interest—is for the court to decide." Univ. of Notre Dame v. Sebelius, 743 F.3d 547, 558 (7th Cir.2014) (citing Mahoney v. Doe, 642 F.3d 1112, 1121 (D.C.Cir.2011)); see also Yellowbear v. Lampert, 741 F.3d 48, 56 (10th Cir.2014) (stating that "a reasonable finder of fact could conclude the prison has substantially burdened Mr. Yellowbear's religious exercise"); Wisdom Import Sales Co., L.L.C. v. Labatt Brewing Co., Ltd., 339 F.3d 101, 108 (2d Cir.2003) (noting the district court is the fact finder when considering a request for preliminary injunction).
The Government has not disputed that Plaintiffs' asserted beliefs are sincere and religious in nature. See United States v. Meyers, 95 F.3d 1475, 1482 (10th Cir.1996) (stating a claimant must establish his or her beliefs to be both religious, rather than philosophical and held sincerely). The Court finds for purposes of this preliminary injunction analysis that Plaintiffs hold a sincere religious belief that the contraceptive products and services at issue are immoral and Catholic doctrine prevents them from providing, paying for, or facilitating access to such objectionable products and services.
The real meat of Plaintiffs' preliminary injunction request hinges on whether the ACA's requirement that Plaintiffs complete and submit the self-certification form substantially pressures Plaintiffs to violate their sincerely-held religious beliefs.
Plaintiffs' sharpest criticism is that completing and submitting the self-certification violates their religious beliefs because it designates the TPA (Aetna) to be the plan and claims administrator for contraceptive coverage. (Pls.' Br. at 12 (quoting
Plaintiffs are mistaken, though. The self-certification does not authorize or obligate the TPA to provide the objectionable contraceptive coverage; the ACA authorizes and obligates the TPA to arrange such coverage. As Judge Posner recently explained in the similar case of Univ. of Notre Dame v. Sebelius, 743 F.3d 547 (7th Cir.2014),
Id. at 553.
It is not Plaintiffs' self-certification that authorizes or obligates the TPA to ensure the objectionable contraceptive coverage; it is the ACA that does so. "Federal law, not the religious organization's signing and mailing the form, requires health-care insurers, along with third-party administrators of self-insured health plans, to cover contraceptive services." Id. at 554. The accommodation allows Plaintiffs to place the ACA-imposed burden of providing contraceptive coverage on the TPA, who in this case has no objections (religious or otherwise) to providing such coverage. The ACA does not force Plaintiffs to offer a health insurance plan with objectionable contraceptive coverage; it forces the TPA (a non-religious third party) to arrange and offer such coverage. The self-certification "enables nothing. The sole `enabler' is the federal statute that [Plaintiffs] ha[ve] been allowed to opt out of." Id. at 557. Completing and submitting the form to the TPA "simply shifts the financial burden from [Plaintiffs] to the government." Id. at 555.
Consequently, Plaintiffs' argument that completing the self-certification form requires them to enable access to objectionable contraceptive products and services is inaccurate and unconvincing. It does not demonstrate a substantial burden upon their religious exercise. The burden is placed on the TPA to comply with the ACA.
Plaintiffs also argue that completing the self-certification will violate their religious beliefs because it will make them "complicit in a grave moral wrong" as the end result will be objectionable contraceptive coverage for their female employees.
Notre Dame, 743 F.3d at 556. The same reasoning applies here. Through the ACA's accommodation, Plaintiffs have the right to be exempted from participating in, providing, or paying for the costs associated with the objectionable contraceptive coverage based on their sincere religious beliefs, but they have no right to prevent a third party (who does not hold those same religious objections) from meeting the ACA's requirements. See Michigan Catholic Conference v. Sebelius, 989 F.Supp.2d 577, 587, 2013 WL 6838707, at *7 (W.D.Mich.2013) ("RFRA does not allow a plaintiff to restrain the behavior of a third party that conflicts with plaintiff's beliefs"). Although the TPA's activities may deeply insult Plaintiffs' genuine religious beliefs, the TPA's activities in providing contraceptive coverage cannot be said to hamper Plaintiffs' religious exercise. See Kaemmerling v. Lappin, 553 F.3d 669, 679 (D.C.Cir.2008) (finding that collection of the claimant's DNA may offend the claimant's religious beliefs but it does not interfere with his religious exercise) (citing Thomas v. Review Bd. of Indiana Emp't Sec. Div., 450 U.S. 707, 718, 101 S.Ct. 1425, 67 L.Ed.2d 624 (1981)).
Something must be said of Plaintiffs' claim that the ACA forces them to contract with a TPA "that is authorized or obligated to provide the objectionable coverage to Plaintiffs' employees." (ECF No. 24 at p. 11 (citing 26 C.F.R. § 54.9815-2713A(b)(2); 78 Fed.Reg. at 39,880).) First, Plaintiffs are mistaken. Nothing in the provisions cited "force" an eligible organization to contract with a third party who will provide
The accommodation permits Plaintiffs to refuse to be complicit in providing contraceptive coverage to their female employees; it does not force them to be complicit. It permits them to object to such coverage and refuse to provide it themselves. Allowing Plaintiffs to refuse to participate in providing contraceptive coverage does not substantially burden their religious exercise. To accept Plaintiffs' argument under these facts would render the RFRA's substantial burden test meaningless.
The self-certification form itself (EBSA Form 700) is two pages long and demands only very basic information, including the eligible organization's name, the representative's name and contact information, and the representative's signature. It requires little different than what Plaintiffs were already doing. Prior to the ACA, Plaintiffs provided a health insurance plan to their employees and informed the plan's TPA (which was Aetna before as well as after they became subject to the ACA) of their refusal to provide contraceptive coverage. Under the ACA, Plaintiffs do the same thing, only on the designated form. See Thomas v. Review Bd. of Indiana Emp't Sec. Div., 450 U.S. 707, 718, 101 S.Ct. 1425, 67 L.Ed.2d 624 (1981) (substantial burden upon religion exists where the government puts substantial pressure on the claimant to modify his behavior and to violate his beliefs). Thus, Plaintiffs are not required to "modify [their] behavior." Id.
But to be fair, Plaintiffs have not argued the form is too demanding. And they do not take issue with possessing the right to refuse to provide contraceptive coverage. Instead, Plaintiffs argument, at its core, is essentially that their objection to the contraceptive coverage requirement should act to prevent third parties from providing, arranging for, or paying for such coverage. While the wisdom of the accommodation and its procedure may be fairly debated (likely for some time to come), the accommodation's failure to prevent the TPA from providing the objectionable contraceptive coverage to Plaintiffs' female employees does not render it a substantial burden on Plaintiffs' religious exercise.
Again, the question of substantiality is determined by the Court. Notre Dame, 743 F.3d at 558; see also Hobby Lobby, 723 F.3d at 1141 (finding a substantial burden was established "as a matter of law"). The ACA does not apply substantial pressure on Plaintiffs' to modify their behavior and violate their beliefs. Instead, the accommodation allows them to continue their preexisting behavior of informing the TPA they refuse to provide contraceptive coverage based on their religious beliefs. The ACA then requires the TPA to arrange for the contraceptive coverage.
Plaintiffs rely heavily on the Tenth Circuit's opinion in Hobby Lobby, arguing their dilemma "is the exact choice, and the exact penalties, at issue in Hobby Lobby." (Pls.' Br. at 14.) It is not. Hobby Lobby does not control this disposition. Despite Plaintiffs' assertions to the contrary (see id. at 15), it is material that the for-profit plaintiffs in Hobby Lobby were required under the ACA to directly provide contraceptive coverage to their female employees. See Hobby Lobby, 723 F.3d at 1120-21, 1125; id. at 1152 (Gorsuch, J., concurring) ("No one before us disputes that the mandate compels Hobby Lobby and Mardel to underwrite payments for drugs or devices that can have the effect of destroying a fertilized human egg."). The plaintiffs in Hobby Lobby were not eligible for the ACA's accommodation available to these Plaintiffs. Id. at 1124. Moreover, without the ability to request the accommodation, the plaintiffs in Hobby Lobby either directly paid for the objectionable contraceptive coverage or faced millions of dollars in fines. Quite simply, the Tenth Circuit in Hobby Lobby did not address whether the ACA's accommodation creates a substantial burden on religious exercise because the accommodation was not at issue in that case. While Hobby Lobby presents an instructive framework for RFRA claims, the Tenth Circuit's substantial-burden analysis in that case does not demand injunctive relief here.
It is significant in this case that Plaintiffs exercise their sincerely-held religious beliefs by declining to comply with the ACA's accommodation requirements. (See Pls.' Br. at 15.) Plaintiffs have drawn a line at completing and submitting the self-certification form. It is certainly not for the Court to say whether that line is "acceptable, logical, consistent, or comprehensible." Thomas, 450 U.S. at 714, 101 S.Ct. 1425. "Courts are not arbiters of scriptural interpretation." Id. at 716, 101 S.Ct. 1425. However, it is for the Court to say whether the burden placed on Plaintiffs' religion by the ACA is substantial under the RFRA. "[W]e reject the notion... that a plaintiff shows a burden to be substantial simply by claiming that it is." Conestoga Wood Specialties Corp. v. Sebelius, 917 F.Supp.2d 394, 413 (E.D.Pa.2013) aff'd sub nom. Conestoga Wood Specialties Corp. v. Sec'y of U.S. Dep't of Health & Human Servs., 724 F.3d 377 (3d Cir.2013), cert. granted, ___ U.S. ___, 134 S.Ct. 678, ___ L.Ed.2d ___ (2013). Here, Plaintiffs have drawn their line in the sand on the insubstantial side of the substantial-burden test. While it is unfortunate that federal
The ACA's requirement that Plaintiffs complete and submit the self-certification form to qualify for the accommodation (and avoid paying for or providing contraceptive coverage to their female employees) does not violate the RFRA because it does not substantially burden Plaintiffs' religious practice. Any burden beyond a de minimis one is placed instead on the TPA (here, Aetna). Consequently, Plaintiffs have not demonstrated a likelihood of success on the merits of their RFRA claim. Further, Plaintiffs have not shown a likely threat of irreparable harm (which merges with the likelihood of success prong in RFRA claims).
Finding no substantial burden, the Court does not reach the second part of the RFRA analysis—whether the Government can satisfy the compelling interest test. However, were the Court to reach that step of the RFRA analysis, it would agree with the parties that the Tenth Circuit's analysis of that question in Hobby Lobby would be binding. (See Pls.' Br. at 16-17; Defs.' Br. at 16.) In both Hobby Lobby and here, the Government advanced the same two governmental interests: public health and gender equality. Hobby Lobby, 723 F.3d at 1143, (Defs.' Br. at 16). The Tenth Circuit held these governmental interests were not compelling and the ACA was not the least restrictive means available for furthering those interests. 723 F.3d at 1143-44. The same analysis and result would apply here, if a substantial burden existed to trigger the compelling interest test.
A party seeking a preliminary injunction must first demonstrate irreparable injury is likely before the other preliminary injunction factors will be considered by the Court. Dominion Video Satellite, 356 F.3d at 1260. Here, Plaintiffs have not demonstrated their likely success on the merits (which merges with the irreparable harm prong in this RFRA case). Consequently, the Court will not consider the remaining equitable factors for a preliminary injunction. "[I]n First amendment cases, the likelihood of success on the merits will often be the determinative factor." Hobby Lobby, 723 F.3d at 1145 (quoting ACLU of Illinois v. Alvarez, 679 F.3d 583, 589 (7th Cir.), cert. denied, ___ U.S. ___ 133 S.Ct. 651, 184 L.Ed.2d 459 (2012)).
Plaintiffs have not established a likelihood of success on the merits or a likelihood