State law goes down

Healthcare Mandate Judge strikes down Missouri’s attempt to offer protection for religious objections to the contraceptive mandate | Emily Belz

State law goes down

Missouri Attorney General Chris Koster
Associated Press/Photo by Kelley McCall (file)

A federal judge struck down critical portions of a Missouri law that gave employers and employees an exemption from the health insurance contraceptive mandate based on religious objections. Missouri’s law, the first of its kind to address the federal contraceptive mandate, passed last fall after the Republican state legislature overrode Democratic Gov. Jay Nixon’s veto. 

On Friday, U.S. District Judge Audrey Fleissig struck down the parts of the law that provided an exemption from the contraceptive mandate on the grounds that the state law conflicted with federal law. Fleissig said she was not addressing the constitutionality of the contraceptive mandate itself. (Download a PDF of the ruling.)

“Here, the federal law and regulations, with limited exceptions, provide that insurers must provide contraceptive coverage, without cost-sharing by an insured,” Fleissig wrote. “The state law says that insurers cannot provide contraceptive coverage to any person or entity that objects to such coverage based on any moral, ethical, or religious objection. The court is hard-pressed to see how this does not create a direct conflict for Missouri health insurers.”

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The Missouri law requires insurers to provide plans without contraceptive coverage if employers or individual employees object on religious grounds. The law also requires insurers to allow individuals who want contraceptive coverage if their employers don’t offer it to purchase it individually. The law’s defenders said that provision would actually expand contraceptive coverage in the state, in compliance with the federal healthcare law’s goal, and would mean that an individual at a church, exempt from the mandate, could purchase contraceptive coverage on their own.

Unsurprisingly, health insurance companies objected to the law because it would require extensive tailoring of policies. They also argued they could face conflicting fines from Missouri and the federal government. They sued last year, and Fleissig issued a temporary restraining order against the law in December.

The law’s backers said that Fleissig’s latest ruling would perversely require even employers that were exempt from the federal mandate, like churches, to cover contraceptives. The judge let the part of the law stand that requires contraceptive coverage for any employer who offers health insurance, but struck down the part that offers exemptions based on religious freedom. The judge didn’t issue a permanent restraining order against the law, but noted that the state had agreed not to enforce the portions of the law that she deemed unconstitutional.

Planned Parenthood of Missouri applauded the decision. Campaign Life Missouri called it a “radical departure from America’s tradition of religious freedom” and urged its supporters to contact the state attorney general to push him to appeal the decision. 

Even though the Democratic governor vetoed the law, his attorney general, Chris Koster, had to defend the law in court. Still Campaign Life Missouri said Koster “ably defended” the law in court. The attorney general hasn’t indicated whether he will appeal the decision.

The U.S. Department of Health and Human Services (HHS) is supposed to be issuing final revisions to the contraceptive mandate this summer, before the mandate goes into effect for all religious organizations in August. Despite issuing several proposed religious exemptions, HHS hasn’t changed its position that most religious employers must offer contraceptive coverage. The latest proposal indicated that organizations affiliated with a church might gain an exemption, but other objecting organizations would still have to have plans that included contraceptive coverage.

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