Michigan Catholic Conference v. Sebelius, et al

Filing 40

OPINION; signed by Judge Gordon J. Quist (Judge Gordon J. Quist, jmt)

UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF MICHIGAN
SOUTHERN DIVISION
__________________________

MICHIGAN CATHOLIC CONFERENCE,
et al.,
Plaintiffs,
v.

Case No. 1:13-CV-1247

KATHLEEN SEBELIUS, et al.,

HON. GORDON J. QUIST

Defendants.
___________________________________/

OPINION
Plaintiffs, the Michigan Catholic Conference (MCC) and Catholic Family Services, d/b/a
Catholic Charities Diocese of Kalamazoo (Catholic Charities), have sued Defendants, the
Department of Health and Human Services and its Secretary, Kathleen Sebelius, the Department of
Labor and its Secretary, Jacob J. Lew, and the Department of Treasury. Plaintiffs seek to enjoin
Defendants from enforcing provisions of the Patient Protection and Affordable Care Act (the ACA)
related to contraceptive coverage.
This is one of many cases filed by religious nonprofits challenging the ACA’s contraceptive
coverage requirement. As far as this Court is aware, ten courts have ruled on challenges to the final
version of the regulations. Six courts have ruled in favor of the plaintiffs. Southern Nazarene
University, et al., v. Sebelius, et al., No. 5:13-cv-1015, 2013 WL 6804625 (W.D. Okl. Dec. 23,
2013); Geneva College, et al. v. Sebelius, et al., 2:12-cv-00207 (W.D. Pa. Dec. 23, 2013); Legatus,
et al., v. Sebelius, et al., No. 12-1206, 2013 WL 6768607 (E.D. Mich. Dec. 20, 2013); Reaching
Souls, Int’l, Inc., et al. v. Sebelius, et al., No. CIV-13-1092-D, 2013 WL 6804259 (W.D. Okl. Dec.

20, 2013); Roman Catholic Archdiocese of N.Y., et al. v. Sebelius, et al., No. 12civ2542, 2013 WL
6579764 (E.D.N.Y. Dec. 16, 2013); Zubik v. Sebelius, No. 13cv1459, 2013 WL 6118696 (W.D. Pa.
Nov. 21, 2013). Three courts have ruled in favor of the defendants. Catholic Diocese of Nashville,
et al. v. Sebelius, et al., No. 3:13-cv-1303 (M.D. Tenn. Dec. 26, 2013); Univ. of Notre Dame v.
Sebelius, et al., No. 3:13cv-01276-PPS-CAN (N.D. Ind. Dec. 20, 2013); Priests for Life v. Sebelius,
et al., No. 13-1261 (EGS), 2013 WL 6672400 (D.D.C. Dec. 19, 2013). And one court ruled in favor
of the plaintiffs in part and the defendants in part. Roman Catholic Archbishop of Washington v.
Sebelius, et al., No. 1:13cv-01441-ABJ, 2013 WL 6729515 (D.D.C. Dec. 20, 2013).
Plaintiffs have moved for a preliminary injunction, requesting that the Court issue a decision
before January 1, 2014. Defendants oppose the motion for preliminary injunction, and have moved
to dismiss Plaintiffs’ complaint. The Court has reviewed the parties’ submissions and has held oral
argument. Plaintiffs’ motion for preliminary injunction is now ready for decision.
Background
1.

The Plaintiffs
Plaintiff MCC is a nonprofit corporation that sponsors and administers the MCC Second

Amended and Restated Group Health Benefit Plan for Employees (the MCC Plan). (Compl. ¶ 16.)
The MCC Plan is a self-funded “church plan,” and is administered by separate third party
administrators (TPAs). (Id. ¶¶ 16, 41.) The MCC Plan provides health benefits to clergy, as well
as to lay employees of Catholic schools, institutions, and other organizations (the covered units).
(Id. ¶¶ 31, 41.) Catholic Charities, a nonprofit subsidiary of the Roman Catholic Diocese of
Kalamazoo, is a covered unit under the MCC Plan. (Id. ¶¶ 17, 50.)
Plaintiffs believe that the use of contraceptives is immoral and that abortion and sterilization
are prohibited. (Byrnes Decl. ¶¶ 8, 9.) In accordance with these beliefs, the MCC Plan has
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historically not offered coverage for contraceptives, sterilization, abortion-inducing drugs, or related
counseling services. (Long Decl. ¶ 17.) In the past, the MCC has specifically notified its TPA that
it would not cover such services. (Id. ¶ 18.)
2.

The ACA Framework
The ACA, Pub. L. No. 111-148, 124 Stat. 119 (2012), was enacted in 2010. The ACA

requires that employers with 50 or more full-time employees provide health insurance for their fulltime employees or pay a penalty on their federal tax return. 26 U.S.C. § 4980H. Employers with
fewer than 50 full-time employees are not required to provide their employees with health insurance.
Id. If these employers offer health coverage to their employees, however, they are generally subject
to the other requirements of the ACA. 42 U.S.C. § 300gg–13.
The ACA also requires that group health plans provide coverage for certain preventative
services without cost-sharing requirements. These preventative services include “with respect to
women, such additional preventative care and screenings . . . as provided for in comprehensive
guidelines supported by the Health Resources and Services Administration [HRSA]. . . .” 42 U.S.
C. § 300gg–13(a)(4).
Plans that are “grandfathered” under the ACA are not required to meet all the requirements
for coverage, including that for women’s preventative care services. 42 U.S.C. § 18011. A plan
loses its “grandfathered” status if it cuts benefits or increases out-of-pocket spending for consumers.
26 C.F.R. § 54.9815-1251T. The government projects that the majority of plans will lose their
“grandfathered” status by the end of 2013. See 75 Fed. Reg. 34552. The MCC plan is not a
“grandfathered” plan under the ACA. (Compl. ¶ 43.)

3

3.

Rulemaking under the ACA
On February 15, 2012, the government published final rules pursuant to the ACA specifying

that plans cover, among other things, “[a]ll [FDA] approved contraceptive methods, sterilization
procedures, and patient education and counseling for women with reproductive capacity” (the
contraceptive mandate). 77 Fed. Reg. 8725. The rule contained an exemption for certain religious
employers. Id. at 8727. The goal of the exemption was to “respect[] the unique relationship
between a house of worship and its employees in ministerial positions.” 76 Fed. Reg. 46,621,
46,623. The rule provided a safe harbor for nonprofit organizations that had religious objections to
contraceptive coverage but did not qualify for the exemption, and expressed the government’s
intention to develop new regulations to accommodate these organizations. 77 Fed. Reg. 8725, 872628.
On July 2, 2013, the government issued a final rule (the 2013 final rule) addressing the
requirements for religious nonprofits and clarifying the religious employer exemption. 45 C.F.R.
§ 147.131(b). The rule establishes an accommodation (the accommodation) for organizations that
meet the following criteria:
(1) The organization opposes providing coverage for some or all of the contraceptive
services required to be covered under § 147.130 (a)(1)(iv) on account of religious objections.
(2) The organization is organized and operates as a nonprofit entity.
(3) The organization holds itself out as a religious organization.
(4) The organization self-certifies, in a form and manner specified by the Secretary, that it
satisfies the criteria in paragraphs (1) through (3) of this section, and makes such selfcertification available for examination upon request by the first day of the first plan year to
which the accommodation in paragraph (c) of this section applies. The self-certification
must be executed by a person authorized to make the certification on behalf of the
organization, and must be maintained in a manner consistent with the record requirements
under section 107 of [ERISA].
4

Id. The rule also clarified that the religious employer exemption applies to nonprofit organizations
referred to in section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code, which refers to
churches, their integrated auxiliaries, conventions and associations of churches, and the exclusively
religious activities of any religious order. 45 C.F.R. § 147.131(a).
Under the 2013 final rule, an organization that meets the criteria for the accommodation is
not required to “contract, arrange, pay, or refer for contraceptive coverage.” 78 Fed. Reg. 39874.
To avoid those obligations, the organization must submit a self-certification form to its health
insurer or, if the organization has a self-insured plan, to a TPA. Id. at 39875. In the case of an
organization with a self-insured plan, the TPA will provide or arrange for separate payments for
contraceptive services for plan participants. Id. at 39880. The TPA will be reimbursed through
adjustments to certain federal user fees. Id. The accommodation applies to plan years beginning
on or after January 1, 2014. Id. at 39,872.
MCC qualifies for the exemption for religious employers. Catholic Charities does not
qualify for the exemption, but does qualify for the accommodation. As such, Catholic Charities will
have to self-certify in order to avoid being required to comply with the contraceptive mandate.
Legal Standard
A preliminary injunction is an “extraordinary remedy” that is warranted only upon a clear
showing that the movant is entitled to relief. Winter v. Natural Res. Defense Council, Inc., 555 U.S.
7, 22, 129 S. Ct. 365, 376 (2008). A plaintiff seeking a preliminary injunction must demonstrate
that: (1) it is likely to succeed on the merits; (2) it is likely to suffer irreparable harm in the absence
of preliminary relief; (3) the balance of equities tips in its favor; and (4) an injunction is in the public
interest. Id. at 20, 129 S. Ct. at 374. “[I]n the First Amendment context, the other [preliminary

5

injunction] factors are essentially encompassed by the analysis of the movant’s likelihood of success
on the merits.” Am. Freedom Def. Initiative v. Suburban Mobility Auth. for Reg’l Transp., 698 F.3d
885, 890 (6th Cir. 2012).
Discussion
1.

Standing
Under the ACA regulations, Defendants may enforce the contraceptive mandate against

TPAs through ERISA’s enforcement authority. See 78 Fed. Reg. at 39,879-39,880. However,
church plans, including the MCC Plan, are specifically excluded from ERISA. See 29 U.S.C §
1003(b)(2). Defendants argue that, because they lack enforcement power over the TPA of the MCC
Plan, there is no guarantee that the TPA will provide contraceptive coverage. Accordingly,
Defendants argue, Plaintiffs lack standing because the harm alleged — the facilitation of access to
contraceptive services — does not exist.
Defendants’ argument is flawed. Regardless of whether the government can force the TPA
to take any action, the 2013 final rule requires Catholic Charities to take some action — provide
contraceptive coverage or self-certify. Plaintiffs object to taking either of these actions and allege
that the act of self-certification, itself, violates their religious beliefs because it requires them to be
involved in a “scheme” aimed at providing contraceptives. Whether the end result involves the
provision of contraceptive services or not, Plaintiffs have alleged an injury-in-fact.
2.

Likelihood of success on the merits
Plaintiffs’ claims arise under the Religious Freedom Restoration Act (RFRA), 42 U.S.C. §

2000bb et seq., the First Amendment to the U.S. Constitution, and the Administrative Procedures
Act (APA), 5 U.S.C. § 1001 et seq. The Court will address each of these claims in turn.

6

A.

RFRA

RFRA provides that the government shall not “substantially burden a person’s exercise of
religion,” even under a “rule of general applicability,” unless the government 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. § 2000bb-1.1 A law substantially burdens an exercise of religion if it puts “substantial
pressure on an adherent to modify his behavior and to violate his beliefs.” Thomas v. Review Bd.
of Indiana Emp’t Sec. Div., 450 U.S. 707, 718, 101 S. Ct. 1425, 1432 (1981). “An inconsequential
or de minimis burden on religious practice does not rise to this level, nor does a burden on activity
unimportant to the adherent’s religious scheme.” Kaemmerling v. Lappin, 553 F.3d 669, 678 (D.C.
Cir. 2008). The burden of demonstrating a substantial burden is high, and determining its existence
is fact intensive. Living Water Church of God v. Charter Twp. of Meridian, 258 F. App’x 729, 734
(6th Cir. 2007).
Plaintiffs argue that the contraceptive mandate imposes a substantial burden on their exercise
of religion because it forces them to facilitate access to contraceptives and thus prevents them from
bearing witness to their religious beliefs, causing “scandal.”2

Plaintiffs argue that the

accommodation does nothing to alleviate the burdens imposed upon them for several reasons.
Plaintiffs state that the accommodation requires Catholic Charities to contract with a TPA which will

1

The purpose of RFRA was to “restore the compelling interest test” abandoned by the Supreme Court in Emp’t
Div. v. Smith, 494 U.S. 872, 110 S. Ct. 1595 (1990). 42 U.S.C. § 2000bb. Thus, the Supreme Court’s pre-Smith cases
discussing the Free Exercise Clause are instructive in evaluating RFRA claims.
2

The pleadings in this case do not define “scandal.” Testimony in Zubik, 2013 W L 6118696, was that, in the
Roman Catholic faith, scandal “means cooperation with an objectionable practice that goes against the faith or teaching
one thing and behaving in another manner.” Id. at *34, fn. 15 (internal quotations omitted). This is consistent with the
discussion of scandal during oral argument in this case.

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provide contraceptive services to Catholic Charities’ employees as long as they remain on the health
plan.3

Catholic Charities must complete the self-certification form, which constitutes its

“designation” of the TPA as the administrator for contraceptive benefits. By these acts, Plaintiffs
assert that they will be forced to participate in a “scheme specifically designed to lure women to
engage in” the use of contraceptive services. (Pls.’ Br. Supp. Mot. for Prelim. Inj. (Pls.’ Br.) at 22)
(emphasis in original).4 In essence, Plaintiffs argue that the accommodation requires Catholic
Charities to take actions that trigger its TPA to provide contraceptive coverage, which then provides
a means for Plaintiffs’ employees to access contraceptive services. Thus, Plaintiffs argue, these acts
constitute facilitation of objectionable services, and this facilitation is prohibited by their religious
beliefs.
In response, Defendants point out that Catholic Charities may avoid the requirement to
provide contraceptive coverage by self-certifying, i.e., signing a one-page form stating its objection
to providing contraceptives, and submitting this form to its TPA. Defendants argue that this is not
materially different from actions that Plaintiffs have taken in the past when they informed their TPA
that they objected to such services in order to exclude the services from the plan. Because the
regulation does not require Plaintiffs to “modify [their] behavior,” Thomas, 450 U.S. at 718, 101
S. Ct. at 1432, Defendants argue that any burden is de minimis. See Kaemmerling, 553 F.3d at 679.
The threshold issue before the Court concerns how to determine whether a burden is
substantial. The Tenth and Seventh Circuits, in cases brought by for-profit companies challenging
3

At oral argument, Plaintiffs argued that the law would require them to seek out a TPA to provide contraceptive
services. It is undisputed that Plaintiffs already have a contractual relationship with a TPA. (Compl. ¶ 41.) Plaintiffs
have not provided any evidence to indicate that their present TPA would refuse to provide these services.
4

Plaintiffs also argue that the costs of providing contraceptive services will be passed back to religious
organizations. The law, however, expressly prohibits this. 78 Fed. Reg. at 39,875-77. Any argument that TPAs will
violate the law is speculative.

8

the contraceptive mandate, have focused solely on the extent of government pressure imposed by
the law. See Korte v. Sebelius, 735 F.3d 654 (7th Cir. 2013); Hobby Lobby Stores, Inc. v. Sebelius,
723 F.3d 1114 (10th Cir. 2013). The Tenth Circuit found that, once the court identified the religious
belief and found that it was sincere, the only remaining question was whether the government
exerted “substantial pressure on the religious believer.” Hobby Lobby, 723 F.3d at 1140. Similarly,
the Seventh Circuit found that the inquiry focused on the “coercive effect of the governmental
pressure.” Korte, 735 F.3d at 684. Under the approach advocated by Plaintiffs, if a plaintiff shows
that it has a sincerely held belief that performing an act would violate its religious beliefs, the only
remaining inquiry for the court is whether the government exerts substantial and coercive pressure
on the plaintiff to perform the act.
Defendants argue that this misinterprets the substantial burden standard. They assert that
a plaintiff is entitled to its sincerely held beliefs but is not entitled to determine what constitutes a
substantial burden on the exercise of these beliefs. Although courts may not evaluate the merits of
a plaintiff’s beliefs, courts must examine the impact of a regulation on such beliefs. This approach
finds support in some district court opinions evaluating the contraceptive mandate as applied to forprofit corporations. Conestoga Wood Specialities Corp. v. Sebelius, 917 F. Supp. 2d 394, 413 (E.D.
Pa. 2013), aff’d on other grounds, 724 F.3d 377 (3d Cir. 2013) (“[W]e reject the notion . . .that a
plaintiff shows a burden to be substantial simply by claiming it is so.”); Autocam Corp. v. Sebelius,
No. 1:12-CV-1096, 2012 WL 6845677, at *8 (W.D. Mich. Dec. 24, 2012) aff’d on other grounds,
730 F.3d 618 (6th Cir. 2013) (explaining that, although the court did not question the plaintiffs’
sincerely held belief, it remained a “separate question whether the sincerely held belief amounts, in
fact, to a substantial burden on the exercise of religion”).

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Defendants’ argument is persuasive. RFRA requires heightened scrutiny of only those laws
that place a “substantial” burden on an individual’s exercise of religion. Thus, the Court “has a duty
to assess whether the claimed burden — no matter how sincerely felt — really amounts to a
substantial burden on a person’s exercise of religion.” Autocam, 2012 WL 6845677 at * 6. To make
this assessment, the Court must necessarily evaluate how the burden affects an individual’s ability
to exercise his religion. “Without venturing into the content and merit of the plaintiffs’ religious
beliefs, [the Court] may still consider the nature of the act that the plaintiffs are called upon to
perform, the connection between their beliefs and the compelled action, and the extent to which their
ability to practice their religion is interfered with by the action.” Korte, 735 F.3d at 710 (Rovner,
J., dissenting).
In evaluating whether the burden is substantial, a court must determine whether it puts
“substantial pressure on an adherent to modify his behavior and to violate his beliefs.” Thomas, 450
U.S. at 718, 101 S. Ct. at 1432. The ACA and its regulation require Catholic Charities to sponsor
a plan, to contract with a TPA for this plan, and to notify the TPA that it opposes contraceptive
coverage on religious grounds. Plaintiffs have acknowledged that they already sponsor a plan, that
they contract with a TPA to administer this plan, and that they have previously notified the TPA that
they oppose contraceptives. Thus, they have no objection to these actions per se.5 Plaintiffs argue,
however, that the actions are now different because they will have the effect of authorizing the TPA
to provide contraceptive services rather than preventing it from doing so, and that this difference is
the key to determining the morality of their actions.
At oral argument, Plaintiffs made an analogy to a hypothetical law that required Roman
Catholics to sign a document stating their opposition to the death penalty in order for an executioner

5

Plaintiffs have never asserted that they object to the act of signing a statement attesting to their objection to
contraceptives.

10

to proceed with the execution. Under this hypothetical law, the executioner would be required to
proceed as soon as he received the document. Plaintiffs asserted that a Roman Catholic could not
sign this document, even though it accurately stated his belief regarding the death penalty, because
the document would effectively authorize the executioner to proceed with the execution. Similarly,
Plaintiffs argued that they could not sign the self-certification form stating their beliefs about
contraceptives because it would trigger coverage of contraceptive services.
Plaintiffs’ analogy does not hold up. If the ACA provided that, upon the completion of the
self-certification form, employees would be forced to use contraceptives, the analogy might be apt.
But that is not what the ACA requires.
In sticking with the death penalty theme, a more apt analogy might involve a law that
required potential jurors in capital cases to state whether they would be unable to impose the death
penalty based on their religious beliefs. If a potential juror said “yes,” he would be excused for
cause, and a different potential juror whose religion would not prohibit her from imposing the death
penalty would be selected. That jury, after hearing the evidence, might or might not choose to
impose the death penalty. Assume that there is a potential juror who is Roman Catholic and whose
religion prohibits her from imposing the death penalty or facilitating the imposition of the death
penalty. Does asking her to state her opposition to the death penalty — which will eventually result
in the selection of a jury that may choose to impose the death penalty — constitute a substantial
burden? This Court does not believe so.
Similarly, the accommodation in this case requires Catholic Charities to attest to its religious
beliefs and step aside. It is true that, once it steps aside, another person may step in and provide
coverage of contraceptive services for Catholic Charities’ employees. These employees may then
make a completely independent decision to utilize such services. In any case, the action that

11

Plaintiffs’ find objectionable — the use of contraceptives — is several steps removed from any
action taken by Plaintiffs. It is difficult to see how a substantial burden exists when the relationship
to the objectionable act is so attenuated. See Conestoga, 917 F. Supp. 2d at 414-15 (noting that a
“series of events must first occur before the use of an abortifacient would come into play”);
Autocam, 2012 WL 6845677 at *6 (finding that any burden imposed on the individual plaintiffs’ free
exercise rights was “probably too attenuated to be substantial”).
More importantly, the contraceptive mandate requires Catholic Charities to do what it has
always done — sponsor a plan for its employees, contract with a TPA, and notify the TPA that it
objects to providing contraceptive coverage. Thus, Plaintiffs are not require to “modify [their]
behavior.” Thomas, 450 U.S. at 718, 101 S. Ct. at 1432. Rather, it is the TPA that is required to
modify its behavior and take action by providing contraceptive services — without the assistance
of Catholic Charities. See 78 Fed. Reg. 39874. (eligible organizations may not be required to
contract, arrange, pay, or refer for contraceptive coverage). Although the TPA’s action may be
deeply offensive to the religious beliefs of Plaintiffs, RFRA does not allow a plaintiff to restrain the
behavior of a third party that conflicts with the plaintiff’s religious beliefs.
Courts have previously rejected RFRA claims in which plaintiffs objected to the activities
undertaken by a third party. See Bowen v. Roy, 476 U.S. 693, 106 S. Ct. 2147 (1986); Kaemmerling,
553 F.3d 669. In Kaemmerling, the D.C. Circuit faced the issue of whether a prisoner could object
to the government’s collection, extraction, and storage of his DNA information. The court found
that, “[a]lthough the government’s activities with his tissue or fluid sample after the [prison] takes
it may offend Kaemmerling’s religious beliefs, they cannot be said to hamper his religious exercise
because they do not ‘pressure [him] to modify his behavior and to violate his beliefs.’” Id. at 679
(quoting Thomas, 450 U.S. at 718, 1015 S. Ct. at 1432.) Similarly, in Roy, the Supreme Court

12

rejected the claim of the plaintiffs, who believed that the use of their child’s social security number
would harm her spirit. Roy, 476 U.S. 693, 106 S. Ct. 2147. The Court explained that the plaintiffs
could “not demand that the Government join in their chosen religious preference by refraining from
using a number to identify their daughter.” Id. at 700, 106 S. Ct. at 2152.
Plaintiffs sincerely believe that the use of contraceptives is immoral, and that they may not
facilitate a practice that they find morally objectionable. See Thomas, 450 U.S. at 714, 101 S. Ct.
at 1430 (“courts are not arbiters of scriptural interpretation”). The Court must look beyond these
beliefs, however, and determine whether the law at issue substantially burdens Plaintiffs’ exercise
of their religious beliefs. An objection to the activities of third parties — no matter how sincere or
deeply felt — does not constitute a substantial burden. “[A]lthough [a] plaintiff may have a
religiously-based objection to what the government or another third party does with something that
the law requires the plaintiff to provide . . . [RFRA] does not necessarily permit him to impose a
restraint upon another’s decision.” Korte, 735 F.3d at 713-14 (Rovner, J., dissenting).
Moreover, although Plaintiffs assert that the accommodation requires them to participate in
a scheme to provide contraceptives, in fact, it just does the opposite. It provides a mechanism for
employers with religious objections to contraceptives, like Catholic Charities, to opt out of that
scheme. This mechanism simply requires Plaintiffs to state that they choose to opt out based on
their religious beliefs. The fact that the scheme will continue to operate without them may offend
Plaintiffs’ religious beliefs, but it does not substantially burden the exercise of those beliefs.
Plaintiffs may exercise their religious beliefs regarding contraceptives in a number of ways.
They may refuse to provide coverage of contraceptives or pay for such coverage. They may speak
out against the use of contraceptives, and encourage their employees not to use contraceptives. They
may engage in political action to change the laws regarding access to contraceptives and

13

contraceptive coverage. What they may not do, however, is block a third party from providing their
employees with contraceptive coverage. Under these circumstances, the Court finds that the law
does not place a substantial burden on Plaintiffs’ exercise of their religion. Accordingly, their
RFRA claim fails.
B.

Free Exercise Clause

The Free Exercise Clause prohibits laws that discriminate against religious beliefs or regulate
or prohibit conduct because it is undertaken for religious purposes. Church of Lukumi Bablu Aye,
Inc. v. City of Hialeah, 508 U.S. 520, 532, 113 S. Ct. 2217, 2226 (1993). The Free Exercise Clause
does not require heightened scrutiny of laws that are neutral and generally applicable. Emp’t Div.
v. Smith, 494 U.S. 872, 879, 110 S. Ct. 1595, 1600 (1990). “[I]f the object of a law is to infringe
upon or restrict practices because of their religious motivation, the law is not neutral.” Lukumi, 508
U.S. at 533, 113 S. Ct. at 2227. A law is not generally applicable if its burdens are imposed “in a
selective manner . . . only on conduct motivated by religious belief.” Id. at 543, 113 S. Ct. at 2232.
Plaintiffs argue that the contraceptive mandate is not generally applicable because it includes
exemptions. However, “[t]hat categorical exemptions exist does not mean that the law does not
apply generally.” Autocam, 2012 WL 6845677 at * 5 (citing United States v. Lee, 455 U.S. 252,
260-61, 102 S. Ct. 1051, 1057 (1982) (finding that social security tax requirements were generally
applicable although there were categorical exemptions)). See also Olsen v. Muaksey, 541 F.3d 827,
832 (8th Cir. 2008) (“General applicability does not mean absolute universality.”). Because the
“secular” exemptions cited by Plaintiffs apply to all employers, including religious employers, the
burdens of the law are not imposed selectively against conduct motivated by religious belief. See
Lukumi, 508 U.S. at 533, 113 S. Ct. at 2227. Accordingly, the law is generally applicable.

14

Plaintiffs also argue that the law is not neutral because it “is specifically targeted at
Plaintiffs’ religious practice of refusing to provide or facilitate access to contraception.” (Pls.’ Br.
at 34.) Plaintiffs argue that most secular employers previously provided coverage, and that the law
was enacted to fill any gap in coverage by forcing religious groups to provide it. There is no
evidence, however, that the law was specifically targeted at the Plaintiffs’ or anyone else’s religious
practices. In fact, the inclusion of an exemption for houses of worship and an accommodation for
other religious groups indicates just the opposite. Furthermore, the contraceptive mandate requires
many employers that have historically provided contraceptive coverage to expand that coverage by
eliminating cost-sharing. The contraceptive mandate thus requires a wide range of employers —
including many that are not religious— to offer their employees new benefits related to
contraceptive coverage. Accordingly, there is no evidence supporting Plaintiffs’ claim that the law
is not neutral.
Finally, Plaintiffs argue that the contraceptive mandate is subject to strict scrutiny because
it infringes on Plaintiffs’ rights of free speech and association, and thus implicates Plaintiffs’
“hybrid” rights. Because the Sixth Circuit has rejected the hybrid rights theory advanced by
Plaintiffs, Kissinger v. Bd. of Trs. of Ohio State Univ., 5 F.3d 177, 180 (6th Cir. 1993), this argument
must fail.
C.

Free Speech Clause

Plaintiffs argue that the contraceptive mandate violates their free speech rights in several
ways. Plaintiffs first argue that the regulations violate their rights against compelled speech. “It is
. . . a basic First Amendment principle that freedom of speech prohibits the government telling
people what they must say.” Agency for Int’l Dev. v. Alliance for Open Soc’y Int’l, Inc., – U.S. – ,
133 S. Ct. 2321, 2327 (2013) (internal quotation marks omitted); see also United States v. United
15

Foods, Inc., 533 U.S. 405, 410, 121 S. Ct. 2334, 2338 (2001). Similarly, the government may not
compel a person to subsidize speech with which he or she disagrees. See Johanns v. Livestock Mktg.
Ass’n, 544 U.S. 550, 557–58, 125 S. Ct. 2055, 2060–61 (2005).

Plaintiffs argue that the

contraceptive mandate violates the prohibition against compelled speech in two respects. First, they
argue that because it requires them to “provide, pay for, and/or facilitate access to ‘counseling,’”
(Pls.’ Br. at 36), they are being forced or compelled to support speech with which they disagree.
Plaintiffs argue that they are thus “forced to act as mouthpieces in the Government’s campaign to
expand access to abortion and contraception.” (Id. at 37.) Second, Plaintiffs assert that the
“certification” requirement, which in turn designates and obligates Plaintiffs’ TPA to provide the
objectionable services, compels Plaintiffs to engage in speech with which they disagree and deprives
them of the freedom to speak on issues of abortion and contraception on their own terms.
Contrary to Plaintiffs’ assertion, the contraceptive mandate does not require or compel them
to support or advocate for abortion or the use of contraceptives. As already noted, supra, Plaintiffs
are not required to provide or pay for contraceptive services. Moreover, even if Plaintiffs’ acts are
deemed as facilitating the provision of contraceptive services, including counseling, there is no
compelled speech violation because Plaintiffs are not required to support or advocate a particular
viewpoint or result. See Geneva Coll. v. Sebelius, 929 F. Supp. 2d 402, 441 (W.D. Pa. 2013) (“To
the extent that the Hepler plaintiffs in the present case are being called upon to fund speech—in the
form of education and counseling—the content of that speech is not defined by the mandate’s
requirements.”). As one court has observed, “the speech subsidized is an unscripted conversation
between a doctor and a patient, not political propaganda in favor of one candidate, an amicus brief
espousing one side of an issue, or advertisements in favor of a particular product.” O’Brien v.
United States Dep’t of Health & Human Servs., 894 F. Supp. 2d 1149, 1166 (E.D. Mo. 2012).
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Hence, the regulations do not compel Plaintiffs to convey any particular message or speech in
violation of the First Amendment.
Plaintiffs’ argument that the certification constitutes compelled speech fails because any
speech involved in the execution of a certification is appropriately considered merely incidental to
the regulation of conduct. As many courts have recognized in disposing of similar First Amendment
challenges, Rumsfeld v. Forum for Academic and Inst. Rights, Inc. (FAIR), 547 U.S. 47, 126 S. Ct.
1297 (2006), is particularly instructive as to whether the certification constitutes speech. In FAIR,
the Court considered whether the Solomon Amendment, which conditioned law schools’ funding
on their provision of access to military recruiters at a level equal to that provided to the nonmilitary
recruiter receiving the most favorable access, violated law schools’ First Amendment rights. The
Court held that requiring law schools to accommodate military recruiters on campus did not affect
their free speech rights because hosting a recruiter is not speech:
In this case, accommodating the military’s message does not affect the law
schools’ speech, because the schools are not speaking when they host interviews and
recruiting receptions. Unlike a parade organizer’s choice of parade contingents, a
law school’s decision to allow recruiters on campus is not inherently expressive.
Law schools facilitate recruiting to assist their students in obtaining jobs. A law
school’s recruiting services lack the expressive quality of a parade, a newsletter, or
the editorial page of a newspaper; its accommodation of a military recruiter’s
message is not compelled speech because the accommodation does not sufficiently
interfere with any message of the school.
Id. at 64, 126 S. Ct. at 1309–10. Moreover, the Court observed that any speech in which the law
schools were required to engage was “plainly incidental to the Solomon Amendment’s regulation
of conduct.” Id. at 62, 126 S. Ct. at 1308; see also United States v. O’Brien, 391 U.S. 367, 376, 88
S. Ct. 1673, 1678 (1968) (“We cannot accept the view that an apparently limitless variety of conduct
can be labeled ‘speech’ whenever the person engaging in the conduct intends thereby to express an
idea.”). Similarly, in the instant case, any speech in which Plaintiffs must engage in completing the
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certification is incidental to regulation of conduct. See e.g., Autocam, 2012 WL 6845677, at *8
(“Including contraceptive coverage in a health care plan is not inherently expressive conduct,
particularly when the coverage is included to comply with a neutral, generally applicable law.”); MK
Chambers Co. v. Dep’t of Health & Human Servs., No. 13-11379, 2013 WL 1340719, at *6 (E.D.
Mich. Apr. 3, 2013) (same).

Accordingly, the act of self-certifying eligibility for the

accommodation is not inherently expressive conduct entitled to First Amendment protection.
Finally, Plaintiffs argue that 26 C.F.R. § 54.9815-2713A(b)(iii) constitutes an unlawful “gag
order” on their freedom to express their beliefs that contraception is immoral. That regulation
provides:
The eligible organization must not, directly or indirectly, seek to interfere with a
third party administrator’s arrangements to provide or arrange separate payments for
contraceptive services for participants or beneficiaries, and must not, directly or
indirectly, seek to influence the third party administrator’s decision to make any such
arrangements.
Plaintiffs argue that this regulation precludes them from expressing their views to fellow citizens
that contraception is immoral. (Pls.’ Br. at 38.) The Court disagrees. The regulation does not
prohibit Plaintiffs from expressing their views. Rather, it precludes Plaintiffs from interfering with
a TPA’s decision or efforts to provide contraceptive services once Plaintiffs have provided a
certification. In other words, Plaintiffs may still convey their views about contraception, but they
may not do so in a way that threatens or interferes with employees’ attempts to obtain coverage from
a third party. See 78 Fed. Reg. at 39,880 n.41 (“Nothing in these final regulations prohibit an
eligible organization from expressing its opposition to the use of contraceptives.”).
D.

Establishment Clause

Plaintiffs argue that the religious employer exemption violates the Establishment Clause of
the First Amendment. That clause provides that “Congress shall make no law respecting an
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establishment of religion.” U.S. Const. amend. I. Under this clause, the government may neither
officially promote religion nor harbor “an official purpose to disapprove of a particular religion or
of religion in general.” Lukumi, 508 U.S. at 532, 113 S. Ct. at 2226. Courts typically use the Lemon
test [Lemon v. Kurtzman, 403 U.S. 602, 91 S. Ct. 2105 (1971)] as a guide to resolve Establishment
Clause issues. See Satawa v. Macomb Cnty. Road Comm’n, 689 F.3d 506, 526 (6th Cir. 2012).
Under that test, a court asks: (1) whether the government’s predominant purpose was secular; (2)
whether the government action has the purpose or effect of endorsing religion; and (3) whether the
action fosters an excessive entanglement with religion. Id.
Plaintiffs argue that the mandate favors some religions over others by creating an official
category of “religious employer” that includes only “churches, synagogues, mosques, and other
houses of worship, and religious orders.” 78 Fed. Reg. at 8,461. Plaintiffs argue that such definition
favors religious groups that fit into the traditional categories of “houses of worship” while
disadvantaging other religious organizations, like Catholic Charities, that express their faith through
the provision of charitable and social services. Plaintiffs’ argument fails because the regulation does
not refer to any particular denomination, nor is there any indication that it was designed to favor any
particular religion. See Cutter v. Wilkinson, 544 U.S. 709, 723–24, 125 S. Ct. 2113, 2123 (2005)
(holding that the Religious Land Use and Institutionalized Persons Act does not run afoul of the
Establishment Clause because it does not “differentiate among bona fide faiths” and “confers no
privileged status on any particular religious sect, and singles out no bona fide faith for
disadvantageous treatment”). As several courts have observed, the Establishment Clause does not
prohibit governmental line drawing when granting religious accommodations. See O’Brien, 894 F.
Supp. 2d at 1164. “[T]he Establishment Clause does not prohibit the government from making such
distinctions when granting religious accommodations as long as the distinction drawn by the
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regulations between exempt and non-exempt entities is not based on religious affiliation.” Grote
Indus., LLC v. Sebelius, 914 F. Supp.2d 943, 953 (S.D. Ind. 2012) (citing Walz v. Tax Comm’n of
City of N.Y., 397 U.S. 664, 90 S. Ct. 1409 (1970), and Droz v. Comm’r of IRS, 48 F.3d 1120, 1124
(9th Cir. 1995)); see also Geneva Coll., 929 F. Supp. 2d at 438 (concluding that the religious
employer exemption does not make distinctions that violate the Establishment Clause).
Plaintiffs also argue that the exemption fosters excessive entanglement because the IRS
applies an “intrusive” 14-factor test to determine whether an organization is a church. Plaintiffs
argue that any application of the 14-factor test will constitute improper scrutiny of whether an
organization is sufficiently religious to qualify for the exemption. Plaintiffs’ argument lacks merit
because there is no indication that the 14-factor test has ever been applied to them. See United
States v. Will, 671 F.2d 963, 967 (6th Cir. 1982) (noting that a guideline contained in an IRS internal
manual was “adopted solely for the internal administration of the IRS, rather than for the protection
of the taxpayer, [and did] not confer any rights upon the taxpayer”). Moreover, as Defendants note,
the requirements for an organization to qualify as a “religious employer” are set forth in the
pertinent regulation, 45 C.F.R. § 147.131(a), and require no intrusive inquiry by the government to
determine whether an organization qualifies as a “religious employer.”
Citing Hosanna-Tabor Evangelical Lutheran Church and School v. EEOC, – U.S. – , 132
S. Ct. 694 (2012), Plaintiffs also argue that the mandate interferes with the internal governance of
the Catholic Church by artificially splitting the church into two segments and precluding the church
from exercising supervisory authority over its subordinate components to ensure compliance with
church teachings. This Court agrees with Justices Alito’s and Kagan’s concurrence that the
“ministerial” exception in employment law “should apply to any ‘employee’ who leads a religious
organization, . . . or serves as a messenger or teacher of its faith.” Id. at 712 (Alito, J., concurring)
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(emphasis added). The principle of no governmental interference with the religious functions of a
church goes beyond the employment context. In the instant case, this Court believes that Catholic
Charities would qualify as messengers or teachers of the Roman Catholic faith. For example, while
any secular organization might render aid to the sick, poor, or oppressed, a Roman Catholic
organization would render such aid as part of its religious duty and message. As pointed out in this
concurring opinion, “the mere adjudication of such questions [e.g., whether a particular doctrine “is
a central and universally known tenet of Lutheranism”], would pose grave problems for religious
autonomy . . . .” Id. at 715. All of that being said, Hosanna-Tabor is inapposite. In Hosana-Tabor,
the Court adopted the so-called “minister exception” to employment discrimination suits. The Court
reasoned that requiring a church to retain an unwanted minister would do more than intrude on an
employment decision. Id. at 706. Rather, it would “interfere[] with the internal governance of the
church, depriving the church of control over the selection of those who will personify its beliefs.”
Id. The regulations at issue in the instant case do not interfere with internal church governance.
Rather, for the reasons stated in the “substantial burden analysis,” they relieve the Plaintiffs from
a law that would otherwise cause them to violate their religious beliefs.
E.

APA

Plaintiffs argue that the 2013 final rule discriminates against them based on their refusal to
provide coverage for “abortion-inducing products.” Plaintiffs argue that the rule therefore violates
the Weldon Amendment, which prohibits federal agencies from discriminating against any health
care entity on the basis that it does not provide coverage for abortions. Thus, Plaintiffs argue, the
rule is contrary to law.
Plaintiffs believe that FDA-approved emergency contraceptives are “abortion-inducing
products” — as is their right. However, federal law does not define them as such. See 62 Fed. Reg.
8610. Accordingly, the regulations are not contrary to law, and Plaintiffs’ APA claim fails.
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3.

Other Preliminary Injunction Factors
Because Plaintiffs’ claims are premised on the First Amendment and RFRA, the analysis of

Plaintiffs’ likelihood of success encompasses the other factors for determining whether a
preliminary injunction is warranted. See Autocam Corp. v. Sebelius, 730 F.3d 618, 624 (noting that
the likelihood of success is often the determinative factor for RFRA and First Amendment claims).
Because Plaintiffs have not demonstrated that they are likely to succeed on the merits, the Court
need not analyze the other factors.
Conclusion
For the foregoing reasons, the Court will deny Plaintiffs’ motion for preliminary injunction.
An Order consistent with this Opinion will be entered.

Dated: December 27, 2013

/s/ Gordon J. Quist
GORDON J. QUIST
UNITED STATES DISTRICT JUDGE

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