Trump administration can allow employers to deny birth control, Supreme Court rules

Challenge to Affordable Care Act rule exempts religious groups from mandate that guarantees access to women's healthcare

The US Supreme Court has sided with a policy under Donald Trump's administration that allows employers with religious or moral objections to limit access to birth control, a blow to an Affordable Care Act mandate to expand women's access to preventative healthcare.

Rule changes could impact as many as 126,000 people, according to government estimates.

Justices Ruth Bader Ginsburg and Sonya Sotomayor dissented in the high court's 7-2 decision.

In her dissent, Justice Ginsburg wrote: "In accommodating claims of religious freedom, this Court has taken a balanced approach, one that does not allow the religious beliefs of some to overwhelm the rights and interests of others who do not share those beliefs. Today, for the first time, the Court casts totally aside countervailing rights and interests in its zeal to secure religious rights to the nth degree."

Brigitte Amiri, deputy director of the American Civil Liberties Union's Reproductive Freedom Project, called the ruling "shameful".

"Religious liberty is a fundamental right, but it does not grant a licence to discriminate," she said in a statement. "Denying employees and students coverage for birth control will limit their ability to decide whether and when to have a family and make other decisions about their futures. And it will exacerbate existing inequalities, falling hardest on people with the fewest resources and people of colour."

Opponents have argued that appropriate care and screenings should be left to the discretion of the employees, not employers, who establish insurance policies.

The decision in Little Sisters of the Poor Saints Peter and Paul Home vs Pennsylvania follows another 7-2 ruling on Wednesday that exempts teachers at private schools from anti-discrimination rules if the case involves religious instruction.

That ruling effectively expands the definition of "ministerial exception", a legal principle based on First Amendment protections that bars ministers at religious organisations from suing their employers.

Following its passage by former president Barack Obama in 2010, the Affordable Care Act required preventive healthcare and screenings for women, followed by requirements that employers and insurers allow no-cost coverage for contraceptive care approved by the Food and Drug Administration.

While houses of worship were exempt, nonprofit organisations like schools, charities and hospitals that are affiliated with religious groups were not. A work-around policy would also allow employers with religious objections to allow the government to work with insurers to cover those costs directly.

Multiple lawsuits were filed, citing violations of religious freedom. A Supreme Court challenge to the rule was deferred in 2016. But following Mr Trump's election, the administration broadened the policy, changing the rule to allow those organisations to opt out from coverage.

Wednesday's ruling on birth control follows a protracted legal battle among healthcare providers, the federal government and religious groups as well as private companies objecting to the Obama-era policy.

Last year, a three-judge appeals court panel unanimously ruled against the administration's birth control policy and issued an injunction against it. Judge Patty Schwartz argued that the ACA policy would remove significant cost barriers for women's health, and its removal would disproportionately impact poor women from receiving necessary care.

But in the Supreme Court ruling that reverses the lower court's decision, Justice Clarence Thomas, on behalf of the court's majority, wrote that the Sisters in the case's namesake "have had to fight for the ability to continue in their noble work without violating their sincerely held religious beliefs" because of the ACA rule.

"After two decisions from this Court and multiple failed regulatory attempts, the Federal Government has arrived at a solution that exempts the Little Sisters from the source of their complicity-based concerns – the administratively imposed contraceptive mandate," he said. "We hold today that the Departments had the statutory authority to craft that exemption, as well as the contemporaneously issued moral exemption. ... Therefore, we reverse the judgment of the Court of Appeals and remand the cases for further proceedings consistent with this opinion."