Filed under: Drugs & Devices, Health Insurance, Health Law, Health Reform, Litigation and Liability, Patient Protection and Affordable Care Act, Public Health, Seton Hall Law, Women's Health Issues
We are very pleased to welcome Angela Carmella, a Professor here at Seton Hall Law, to the blog today. Professor Carmella’s intellectual focus is the intersection of law and religion, specifically the First Amendment’s religion clauses, religious land use, and Catholic social thought.
By Angela Carmella
On Monday, June 30, the U.S. Supreme Court issued its path-breaking decision in Burwell v. Hobby Lobby Stores, Inc. In a 5-4 ruling, the Court held that HHS’s contraception mandate violates the rights under the Religious Freedom Restoration Act (RFRA) of closely-held, for-profit corporations that object to providing this coverage. The mandate requires employers to provide their female employees with insurance coverage for all twenty FDA-approved contraceptives without cost-sharing. Justice Alito, writing for the majority, repeatedly notes the decision’s narrow applicability to the mandate alone; Justice Ginsburg, in dissent, criticizes the decision for its “startling breadth,” fearing that for-profits will now seek exemptions from other requirements of the Affordable Care Act and from other federal laws, to the detriment of employees and customers.
Critical to the Court’s decision is the “accommodation” currently available to religious nonprofits—charities, colleges, hospitals and the like—that object to providing contraceptive coverage to their female employees (and students). In contrast to the targeted exemption given specifically to churches and their close affiliates, which leaves employees without this coverage, the accommodation requires the nonprofit’s insurer (or third party administrator for self-insured plans) to provide coverage directly and separately to employees. Thus, the accommodation attempts to respect the twin goals of religious liberty and women’s health.
Justice Alito and Justice Kennedy (who joined the majority opinion but also wrote a separate concurrence) regarded the accommodation as evidence that the government had already devised a mechanism to address the religious objections of employers while advancing its public health goals. For the Court, extending this accommodation to for-profits was an obvious and straightforward way for the government to satisfy RFRA’s requirement that it use the least restrictive means to advance its objectives.
Hobby Lobby consolidated two challenges to the mandate, one brought by the Green family, evangelical Christian owners of the Hobby Lobby arts and crafts stores and Mardel religious book stores, and the other brought by the Hahn family, Mennonite owners of cabinet manufacturer Conestoga Wood Specialties. They refuse to provide their employees with coverage for four (out of twenty) contraceptives that might interfere with implantation of a fertilized ovum, because to do so would involve them in facilitating abortions. (Some of the other businesses that have brought similar challenges oppose providing coverage for all contraceptives.)
RFRA prohibits government from “substantially burden[ing] a person’s exercise of religion even if the burden results from a rule of general applicability” unless it “demonstrates that application of the burden to the person—(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. Secs.2000bb-1(a), (b). RFRA applies to “any exercise of religion, whether or not compelled by, or central to, a system of religious belief.” Sec.2000cc-5(7)(A).
The opinion takes a pragmatic approach, but its driving vision is RFRA’s overarching purpose in this context: to prevent government from excluding religious people “from full participation in the economic life of the Nation” (Alito 46) and to protect the right “to establish one’s religious (or nonreligious) self-definition in the political, civic, and economic life of our larger community.” (Kennedy 2). The Court first determines that for-profit corporations are “persons” capable of “exercising religion” under RFRA. “[A]llowing Hobby Lobby, Conestoga and Mardel to assert RFRA claims protects the religious liberty of the Greens and the Hahns,” (Alito 21). Their religious liberty here consists in being able to “run their businesses as for-profit corporations in the manner required by their religious beliefs” (Alito 2, emphasis supplied).
Next, rejecting HHS’s argument that the connection between the mandate and any immoral act is too “attenuated,” the Court finds that the “mandate imposes a substantial burden on the ability of the objecting parties to conduct business in accordance with their religious beliefs.” (Alito 36, emphasis in original) Given the prospect of fines against Hobby Lobby of up to $475 million per year, the answer for the majority is clear. The Court refused to scrutinize the claimants’ arguments regarding complicity in immoral conduct, noting that “it is not for us to say that their religious beliefs are mistaken or insubstantial.” (Alito 37)
The majority opinion assumes that the mandate fulfills a compelling governmental interest, while Justice Kennedy’s concurrence makes clear that the government has demonstrated it. But both opinions focus on the accommodation as the least restrictive alternative to further the government’s compelling interest. Although government provision of contraceptives might be an alternative, the Court concludes that “we need not rely on the option of a new, government-funded program in order to conclude that the HHS regulations fail the least-restrictive means test. HHS itself has demonstrated that it has at its disposal an approach that is less restrictive than requiring employers to fund contraceptive methods that violate their religious beliefs.” (Alito 43) The Court notes that under such an accommodation, female employees of Hobby Lobby, Mardel and Conestoga would receive the contraceptive coverage to which they are entitled under the regulations.
Because the Court does not decide whether the accommodation “complies with RFRA for purposes of all religious claims,” (Alito 44) Justice Ginsburg’s dissent largely ignores the majority’s solution and focuses instead on what she views as a radical interpretation of RFRA that allows businesses to “opt out of any law (saving only tax laws) they judge incompatible” with their beliefs (Ginsburg 1) without regard to the impacts on third parties (like the female employees of objecting businesses). Her dissent emphasizes the significance of contraception to women’s health, the expenses associated with contraception, and the compelling nature of the government’s interest in an employer-based insurance system that provides it. She draws a sharp distinction between religious nonprofits, which are accommodated because they “exist to serve a community of believers,” (Ginsburg 29) and commercial entities with diverse workforces. Justice Ginsburg concludes that not only is the claim of burden on religious exercise too attenuated, but “[i]n view of what Congress sought to accomplish, i.e., comprehensive preventive care for women furnished through employer-based health plans, none of the proffered alternatives would satisfactorily serve the compelling interests to which Congress responded.” (Ginsburg 30-31)
In other pending cases many religious nonprofits are challenging the accommodation itself as insufficiently protective of their religious liberty. The Court’s praise for this mechanism as meeting the twin goals of religious liberty and women’s health in the for-profit context might be read as a sign that the nonprofits currently in litigation may be sorely disappointed. But predicting the impact of Hobby Lobby in the nonprofit context became more complicated on July 3, just four days after Hobby Lobby came down, when the Court issued an interim order in Wheaton College v. Burwell.
Wheaton College is a religious nonprofit that is unquestionably eligible for HHS’s accommodation for religiously affiliated institutions. It has challenged the accommodation itself as a violation of RFRA on the grounds that the school will be morally complicit in providing abortifacient coverage when it files the required “self-certification” form; this form, it argues, triggers the third party administrator’s obligations to provide the objectionable coverage. Without deciding the merits, the Court decided 6-3 that the college need not use the government’s form; since the government is already on notice of its objection, HHS (and its third party administrator) can proceed as though the form had been filed.
One can view this as consistent with Hobby Lobby: as in that case, the Wheaton Court finds a solution that both respects the college’s religious exercise (it does not have to sign) and meets the government’s interest (the third party provides the contraceptive coverage). But in her dissent to Wheaton, Justice Sotomayor voiced her frustration: since the Court already found that the accommodation was the least restrictive means of furthering the mandate’s goals—indeed, it “served as the premise” for the decision—the “grant of injunctive relief [in Wheaton] simply does not square with the Court’s reasoning in Hobby Lobby.” (Sotomayor 16, 13)
Although it may be impossible to predict Hobby Lobby’s specific impacts in both commercial and nonprofit contexts, two thing are certain: first, the notion that religious liberty and government interests can be reconciled to avoid harms to third parties is now on the table for further consideration; and second, the Court’s broad reading of RFRA marks a new chapter in free exercise jurisprudence.
Seton Hall Law Awarded Robert Wood Johnson Foundation Grant to Assess ACA Implementation in New Jersey
Filed under: New Jersey, Patient Protection and Affordable Care Act, Seton Hall Law
Yesterday, Seton Hall Law announced that Professor (and Health Reform Watch blogger) John Jacobi has begun work on a two-year Robert Wood Johnson Foundation-funded project that “will use individual advocacy and broad-based information gathering and analysis to call attention to areas in which New Jersey health insurers fall short of the ACA standards and to develop recommendations to bring the plans and services into compliance.” An excerpt from the press release follows:
“The Sentinel Project is designed to create a ‘feedback loop’ between healthcare providers and patients, on the one hand, and insurance plans, government regulators, and the public, on the other,” stated Professor John V. Jacobi, Dorothea Dix Chair of Health Law & Policy and faculty director of the Seton Hall Law Center for Health & Pharmaceutical Law & Policy, who serves as the Project leader.
To date, much of the media focus surrounding the ACA has been on issues and challenges related to enrolling people in health insurance plans. “The ACA’s benefits are achieved not upon enrollment, but upon the connection of enrolled consumers with necessary health benefits,” Professor Jacobi said. He concluded, “It would be a Pyrrhic victory to enroll millions of consumers and fail to connect them to quality care.”
The full press release is here. New Jersey consumers who believe that they may have been denied coverage by their individual or small group plan can contact the Sentinel Project by email at firstname.lastname@example.org, or by leaving a message at 973-991-1190.
Filed under: Compliance, Health Law, Seton Hall Law
At Seton Hall Law’s website, Victoria Dorum reports that Seton Hall Law students Lindsey Borgeson, Joyce Crawford, and Phillip DeFedele (pictured above, from left), along with alternate Cynthia Frumanek, recently came in first at the University of Maryland Francis King Carey School of Law’s Health Law Regulatory and Compliance Competition.
Not only did the team members distinguish themselves among other top schools, they also made a profound impression on the judges. Virginia Rowthorn, Managing Director of the Law & Health Care Program at the University of Maryland School of Law, wrote a note to [Seton Hall Law Professor Tara Adams Ragone] to commend the team and their teachers for the team’s excellent presentation. She wrote, “One of the judges who heard them told me they knocked it out of the ballpark with their knowledge, and also with the professional way they presented their ‘case’.”
This has been a great academic year for Seton Hall Law, which also won the National Health Law Moot Court Competition in November. Dorum covered that victory as well, here.
Seton Hall Law’s John Jacobi Named One of New Jersey’s Top 10 Healthcare Policy Analysts and Experts
NJ Spotlight has named Seton Hall Law Professor John Jacobi one of New Jersey’s top ten healthcare policy experts.
Reporter Andrew Kitchenman writes:
Jacobi is the state’s foremost expert on the intersection of health law and policy, and he knows state government from the inside and out, having served in Gov. Jon Corzine’s counsel’s office. Jacobi’s research outlined many of the challenges and opportunities of having a state-based health insurance exchange. While Gov. Chris Christie opted against it, Jacobi remains a top voice on health law and policy.
The complete list is here.
HEALTH LAW STUDENT SCHOLARSHIPS
This award recognizes promising health law students with an aptitude for and commitment to a career in health law with a focus on the legal and compliance issues facing bio/pharmaceutical and/or medical technology industries.
Each nominee must qualify under the following criteria:
- The nominee shall be a second or part-time third year law student currently enrolled in an accredited North American law school* on a full or part-time basis who through his/her law school academic and clinical work and other related activities demonstrates his/her aptitude for and commitment to a legal career in health care law within the bio/pharmaceutical and/or medical technology industries.
- The nominee must be available to attend the June Healthcare Compliance Certification Program.
- Multiple nominations per law school may be made.
- The following materials must be submitted by the nominee (the submission of additional material is discouraged):
- A signed letter from the Dean, clinical program director, or law school professor teaching in a related area nominating the candidate and setting forth the basis for the nomination, including a description of the purposes and content of the class or clinical program in which the student is enrolled (PDF copy acceptable).
- The nominee’s current resume including most recent GPA (electronic copy required).
- A brief personal statement (maximum two (2) typewritten pages) highlighting the nominee’s background, experience, and other relevant information that qualifies him/her for the scholarship (electronic copy required).
All applications will be judged by members of the Seton Hall Law School Faculty. All decisions are final. Applications will be judged on the strength of the eligibility criteria, letter of nomination and personal statement. No scholarship will be awarded if the faculty members determine that no application meets the scholarship standards.
A maximum of two full scholarships shall be awarded each year. Scholarship recipients will attend the June Healthcare Compliance Certification Program. The scholarship covers program tuition, educational materials, meals during the program, and parking. Please note that transportation and hotel costs are not included.
SUBMISSION DEADLINE: February 7, 2014.
Entries must be submitted:
- Via email to HealthLaw@shu.edu; or
- Mailed to:
Center for Health & Pharmaceutical Law
Attn: Catherine Finizio
Seton Hall Law School
One Newark Center
Newark, NJ 07102
Please contact Catherine Finizio at email@example.com or 973-642-8871.