Diocese of Cheyenne et al v. US Department of Health and Human Services Secretary et al

Filing 42

OPINION & ORDER by the Honorable Scott W Skavdahl denying 23 Motion for Preliminary Injunction. (Court Staff, sds)

IN THE UNITED STATES DISTRICT COURT

^

_

IJ.". M:'ViT..O'! C'jURI

FOR THE DISTRICT OF WYOMINQ ;:

OT Cr" V/VCK.IflG

-/yri Fiii'f 13 PPl 1 H6
o t i-i"

DIOCESE OF CHEYENNE,

CATHOLIC CHARITIES OF WYOMING,
ST. JOSEPH'S CHILDREN'S HOME,
ST.

ANTHONY

TRI-PARISH

• 1

gas?::r

CATHOLIC

SCHOOL,
JOHN PAUL II CATHOLIC SCHOOL AT ST.

Case No. 14-CV-21-SWS

MATHEWS, and
WYOMING CATHOLIC COLLEGE,
Plaintiffs,
vs.

KATHLEEN

SEBELIUS,

in

her

official

capacity as Secretary of the U.S. Department of
Health and Human Services, et ai.
Defendants.

OPINION AND ORDER DENYING PRELIMINARY INJUNCTION

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.
BACKGROUND

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).

A.

The Parties and the Issue

Plaintiffs are several Catholic groups in Wyoming. Defendants are the Secretary of the

United States Department of Health and Human Services^ and various other federal
governmental departments and their heads (collectively, "the Govemmenf'),

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 or
counseling about such products or services. (ECF No. 24 at p. 8.) Historically, Plaintiffs have
exercised this belief by offering a health insurance plan to their employees that omits the

objectionable products and services from coverage. Plaintiff Diocese of Cheyenne offers a

health plan through a self-insurancetrust established by the Catholic bishops of California.
(ECF No. 24 at p. 6.) Plaintiffs Catholic Charities, St. Joseph's Children's Home, St. Anthony
Tri-Parish Catholic School, and John Paul II Catholic School also offer coverage through the

Diocese's self-insurance plan. {Id.) Plaintiff Wyoming Catholic College offers health coverage

through a self-funded church plan provided bythe Christian Brothers Employee Benefit Trust. ^
' Plaintiffs named Kathleen Sebelius inher official capacity asSecretary ofthe U.S. Department ofHealth and
Human Services as the lead defendant. However, in early April 2014, Sebelius resigned her position, and President
Obama nominated Sylvia Burwell to replace her. As of this writing, Burwell is awaiting confirmation vote by the
Senate. This change will not substantively affect this lawsuit, though. See Fed. R. Civ. P. 25(d).

^The Government concedes Wyoming Catholic College already iscovered bythe injunction pending appeal issued
by the United States Supreme Court in Little Sisters ofthe Poor v. Sebelius, 134 S. Ct. 1022 (Jan. 24, 2014). (ECF
No. 31 at p. 2.) At oral argument, though, Plaintiffs asserted that even if Wyoming Catholic College is covered by
the Little Sisters injunctionpending appeal, they seek a preliminary injunction pending the instant litigation because
it is unlikely to conclude at the same time as the Little Sisters litigation. Therefore, the Court includes Wyoming
Catholic College, though part of a different insurance plan, within this Order.

Page 2 of 19

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 RPRA because it forces Plaintiffs to "offer health plans that serve as a

conduit for the delivery ofthe objectionable products and services.^ (ECF No. 24 atp. 12.) This
requirement applies to Plaintiffs beginning July 1, 2014, the date their insurance plan year

begins. Plaintiffs seek a preliminary injunction to prevent the ACA provisions at issue from
applying to them pending the final disposition of this case.
B.

Relevant Provisions of the Affordable Care Act

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.Sd 1114, 1122 (10 Cir. 2013) (en banc),
cert, granted, 134 S. Ct. 678 (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-l 3(a)(4)). The guidelines that were adopted require health insurance

coverage for, among other preventive care, '"[a]ll Food and Drug Administration approved
contraceptivemethods, 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

' Plaintiffs complaint also alleges causes ofaction imder the Free Exercise Clause ofthe First Amendment, the Free
Speech Clause of the First Amendment, the Establishment Clause of the First Amendment, and the Administrative
Procedures Act. However, Plaintiffs limit their request for preliminary injunction to their RFRA claim. (Pis.' Br. at
9 n.9.)
Page 3 of 19

approved twenty women's contraceptive methods, "ranging from oral contraceptives to surgical
sterilization."^ Id.

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."^ Id. In this case, the parties agree this exemption applies to
PlaintiffDioceseof Cheyenne, but the Dioceseoperates a self-insured grouphealth plan that
encompasses its employees along with the employees of several other Plaintiffs (all other
Plaintiffs except Wyoming Catholic College). Consequently, Plaintiffs assert the Diocese is a

proper party in interest subject to the ACA's contraceptive coverage requirement.
In addition to the "religious employer" exemption, the provision also includes an

"accommodation," which is central to the instant case. Only eligibleorganizations are provided
the accommodation, which is intended to eliminate (or substantiallyreduce) 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:
(1)
(2)
(3)
(4)

The organization opposes providing coverage for some or all of any
contraceptive services required to be covered under § 147.130(a)(l)(iv) on
account of religious objections.
The organization is organized and operates as a nonprofit entity.
The organization holds itself out as a religious organization.
The organization self-certifies, in a form and manner specified by the
Secretary, that it satisfies the criteria in paragraphs (b)(1) through (3) of

^The Court will refer to health insurance coverage for these FDA-approved contraceptive methods as "contraceptive
coverage" throughout this Order.

^The Tenth Circuit has noted the definition of"religious employer" might change as a new rule has been proposed
that would enlarge the category. Hobby Lobby, 723 F.3d at 1123-24.
Page 4 of 19

this section, and makes such self-certification 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.

45 C.F.R. § 147.131(b);

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 contraceptiveproducts 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 ofthis accommodation is "to route the

contraceptive coverage for these organizations througha middleman insurer or insurance plan

administrator, allowing the organization to avoid directly providing contraceptive coverage."
Hobby Lobby^ 723 F.3d at 1124 (citing78 Fed. Reg. 8458-68 (Feb. 6, 2013)). Significantly, the
eligibleentity (the employer) does not bear any director indirect cost associated with providing
the contraceptive coverage. 29 C.F.R. § 2590.715-2713A(b)(2); Univ. ofNotre Dame v.

Sebelius, 743 F.3d 547, 551 (7th Cir. 2014). Thus, oncethe eligible entitysupplies the selfcertification to its TPA, the eligible entityplays no further role in arranging for, providing, or
paying for contraceptive coverage for its female employees.
C.

Plaintiffs' Position

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 Catholicbishops of Califomia in 1999 for the purpose of providing

Page 5 of 19

medical coverage consistent with Catholic teaching. {Id. at H8.) The Diocese's health plan also
covers the other Plaintiffs (except Wyoming Catholic College). {Id. at H11.)
The third-party administrator (TPA) for the health insurance plan is Aetna, Inc. {Id. at H
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 wellqualified 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.'" (Pis.' 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." (Pis.'
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.

Page 6 of 19

APPLICABLE LAW

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.
A.

Standard for Preliminary Injunction

For a preliminary injunction to issue, the moving party must prove that four equitable
factors weigh in its favor:

(1) it is substantially likely to succeed on the merits; (2) it will suffer irreparable
injury if the injunction is denied; (3) its threatened injury outweighs the injury the
opposing party will suffer under the injunction; and (4) the injunction would not
be adverse to the public interest.
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 RPRA 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)).
B.

The Religious Freedom Restoration Act (RFRAI

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)
Page 7 of 19

is the least restrictive means of furthering that compelling governmental interest." 42 U.S.C. §
2000bb-l.

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 RPRA in Hobby Lobby:

A plaintiff makes a prima facie case under RFRA by showing that the government
substantially burdens a sincere religious exercise. Kikumura v. Hurley, 242 F.3d
950, 960 (10th Cir. 2001). The burden then shifts to the government to show that
the "compelling interest test is satisfied through application of the challenged law
'to the person'—^the particular claimant whose sincere exercise of religion is
being substantially burdened." Gonzales v. O Centro Espirita Beneficente Uniao
do Vegetal, 546 U.S. 418, 420 (2006) (quoting 42 U.S.C. § 2000bb-l(b)). This
burden-shifting approach applies even at the preliminary injunction stage. Id, at
429, 126 S.Ct. 1211.
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-l(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. § 2000bb1(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.
ANALYSIS

The Court begins the preliminary injunction analysis by keeping in mind that a

preliminary injunction is an "extraordinary equitable remedy." Fed. Lands Legal Consortium v.

Page 8 of 19

United States, 195 F.3d 1190,1194 (10th Cir. 1999).
A.

Likelihood of Success on the Merits and Irreparable Injury

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.

1.

RFRA Step One: Substantial Burden on a Sincere Exercise of Religion

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-l(a). Under
this first step, a law substantially burdens a claimant's exercise of religion if it:
(1) "requires participation in an activity prohibited by a sincerely held religious
belief," (2) "prevents participation in conduct motivated by a sincerely held
religious belief," or (3) "places substantial pressure on an adherent... to engage in
conduct contrary to a sincerely held religious belief."
Hobby Lobby, 723 F.3d at 1138

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. ofNotre 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
Page 9 of 19

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.
1.1

The Form Designates TPA as Administrator of Contraceptive Coverage

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. (Pis.' Br. at 12 (quoting 78 Fed. Reg. at 39,879).)
Indeed, the self-certification "shall be treated as a designation of the third party administrator as
the plan administrator... for any contraceptive services." 29 C.F.R. § 2510.3-16. Plaintiffs
argue, "In other words, under the accommodation. Plaintiffs are required to amend the
documents governing their health plans to designate a third party to provide the objectionable
coverage." (Pis.' Br. at 12.) Plaintiffs contend the very act of completing the self-certification

form authorizes and even obligates the TPA to provide the objectionable contraceptive coverage.
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

Page 10 of 19

TPA to arrange such coverage. As Judge Posner recently explained in the similar case of Univ.
ofNotre Dame v. Sebelius, 743 F.3d 547 (7th Cir. 2014),
Notre Dame treats this regulation as making its mailing the certification form to
its third-party administrator the cause of the provision of contraceptive services to
its employees, in violation of its religious beliefs. Not so. Since there is now a
federal right, unquestioned by Notre Dame, to female contraceptive services, the
effect of the university's exercise of its religious exemption is to throw the entire
burden of administration of the right on the entities (Aetna and Meritain) that
provide health services to Notre Dame's students and staff. The university is
permitted to opt out of providing federally mandated contraceptive services, and
the federal government determines (enlists, drafts, conscripts) substitute
providers, and naturally they are the providers who are already providing health
services to the university personnel.
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

Page 11 of 19

unconvincing. It does not demonstrate a substantial burden upon their religious exercise. The
burden is placed on the TPA to comply with the ACA.
1.2

Complicity in an Immoral Act

Plaintiffs also argue that completingthe 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. (Pis.' Br. at 15 (quoting
Gilardi v. U.S. Dep't ofHealth & Human Servs., 733 F.3d 1208, 1218 (D.C. Cir. 2013).) The
accommodation, though, permits Plaintiffs to refuse to be complicit. By completing the self-

certification,Plaintiffs inform the TPA they refuse to provide contraceptivecoverage, and

federal law in turn forces the third party to take up the ACA-imposed contraceptive coverage
requirement. While Plaintiffs hold very strong religious views that the TPA should not provide
(or be forced by federal law to provide) contraceptive coverage, the TPA's provision of such
coverage cannot be said to be a substantial burden on Plaintiffs religious exercise. The
conscientious objector example in Notre Dame is demonstrative:

Consider this further example illustrative of our doubts. Suppose it is wartime,
there is a draft, and a Quaker is called up. Many Quakers are pacifists, and their
pacifism is a tenet of their religion. Suppose the Quaker who's been called up
tells the selective service system that he's a conscientious objector. The selective
service officer to whom he makes this pitch accepts the sincerity of his refusal to
bear arms and excuses him. But as the Quaker leaves the selective service office,
he's told: "you know this means we'll have to draft someone in place of you"—
and the Quaker replies indignantly that if the government does that, it will be
violating his religious beliefs. Because his religion teaches that no one should
bear arms, drafting another person in his place would make him responsible for
the military activities of his replacement, and by doing so would substantially
bxirden his own sincere religious beliefs. Would this mean that by exempting him
the government had forced him to "trigger" the drafting of a replacement who was
not a conscientious objector, and that the Religious Freedom Restoration Act
would require a draft exemption for both the Quaker and his non-Quaker
replacement? That seems a fantastic suggestion.

Notre Dame, 743 F.3d at 556. The same reasoning applies here. Through the ACA's

Page 12 of 19

accommodation, Plaintiffshave the right to be exempted from participating in, providing, or
paying for the costs associatedwith the objectionable contraceptive coveragebased 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, —F.Supp.2d ™, 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 plaintiffs
beliefs"). Although the TPA's activitiesmay deeply insult Plaintiffs' genuine religiousbeliefs,
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. ofIndiana Emp't Sec. Div.,
450 U.S. 707,718(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 contraceptive coverage.^ Second, the
evidence shows Plaintiffs here have contracted with the same TPA (Aetna) since before being
subject to the ACA's requirements. {See, e.g., Etienne Aff.

8-9.) This suggests Plaintiffs are

far less concerned with their contracting partner than with whether that partner provides
contraceptive coverage to Plaintiffs' female employees.
^The relevant portions of these provisions explain that a TPA who receives a self-certification form must decide
whether "to enter into or remain in a contractual relationship with the eligible organization." 26 C.F.R. §
54.9815.2713A(b)(2); see also 78 Fed. Reg. 39870, 39880 (July 2, 2013) (explaining that a TPA receiving a selfcertification from an eligible organization "and that agrees to enter into or remain in a contractual relationship with
the eligible organization" must then arrange for contraceptive coverage).
Page 13 of 19

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.

13

Completing the Accommodation Form Does Not Materially Change Conduct

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. ofIndiana
Emp't Sec. Div., 450 U.S. 707, 718 (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

Page 14 of 19

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 pre
existing 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. Any burden the ACA places upon Plaintiffs to take advantage of the accommodation

is miniscule and far from substantial. See Kaemmerling, 553 F.3d at 678 ("An inconsequential
or de minimis burden on religious practice does not rise to this level."). Indeed, the initial draft
of the RFRA prohibited the government from imposing any burden on religious exercise, but
Congress added "substantially" to clarify that "the compelling interest required by the Religious

Freedom Act applies only where there is a substantial burden placed on the individual free
exercise ofreligion," and the RFRA "does not require the Government to justify every action
that has some effect on religious exercise." 139 Cong. Rec. S14350-01 (daily ed. Oct. 26,1993)
(statement of Sen. Hatch). "Otherwise there would have been no need for Congress in the
Religious Freedom Restoration Act to prefix *substantial' to 'burden.'" Notre Dame, 743 F.3d at
558. Requiring Plaintiffs to do that which they've always done, only now on a designated form,
does not amount to a substantial burden on religious exercise.

i. 4

Hobby Lobby Does Not Control This Case

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" (Pis.' Br. at 14.)

Page 15 of 19

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 Pis.' 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. "Courts are not arbiters of scriptural interpretation."

Id. at 716. 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 WoodSpecialties Corp. v.
Sebelius, 917 F. Supp. 2d 394,413 (E.D. Pa. 2013) affd sub nom. Conestoga Wood Specialties

Page 16 of 19

Corp. V. Sec'y of U.S. Dep't ofHealth & Human Servs., 724 F.3d 377 (3d Cir. 2013), cert,
granted^ 134 S. Ct, 678 (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 law and

every citizen's religious beliefs fail to align in every instance, "[n]ot all burdens on religion are
unconstitutional." United States v. Lee^ 455 U.S. 252, 257 (1982). The burden placed on
Plaintiffs' religious exercise by the ACA to complete a self-certification form and submit it to

their TPA to avoid the contraceptive coverage requirement is not substantial. It is undoubtedly a

burden, but a rather de minimis one at that. The ACA's accommodation permits Plaintiffs to
object to and refuse to provide the objectionable contraceptive coverage to their employees; it
does not prohibit the provision of such coverage to those same employees by another party (no
matter how much Plaintiffs may wish such to be the case).
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).
2.

RFRA Step Two: Compelling Interest / Least Restrictive Means

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 Pis.' Br. at 16-17;

Page 17 of 19

Defs.* Br. at 16.) In both Hobby Lobby and here, the Government advanced the same two

governmental interests: public health and gender equality. HobbyLobby, 723 F.3d at 1143;

(Defs.' Br. at 16). TheTenth Circuit held these governmental interests were not compelling and
the ACA was not the least restrictivemeans 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.
B.

Remaining Preliminary Injunction Factors

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

ofIllinois v. Alvarez, 679 F.3d 583, 589 (7th

Cir.), cert, denied, —U.S. — 133 S. Ct. 651 (2012)).^ The Court finds such tobe the case here.
CONCLUSION AND ORDER

Plaintiffs have not established a likelihood of success on the merits or a likelihood of

irreparable injury on their RFRA claim because they have not shown the ACA's accommodation

to be a substantial burden upon their religious exercise. A preliminary injunction is an
extraordinary remedy that should not be issued unless the moving party's right to relief is "clear
and unequivocal." Kikumura v. Hurley, 242 F.3d 950, 955 (10th Cir. 2001). Here, Plaintiffs
have failed to show their clear and unequivocal right to preliminary injunctive relief.
' To be clear, RFRA violations arenotconstitutional violations, butCongress has given theRFRA similar
importance by subjecting all subsequent congressional enactments to strict scrutiny. Hobby Lobby, 723 F.3d at 1146
(noting that Tenth Circuit case law analogizes the RFRA, a "super statute," to a constitutional right).
Page 18 of 19

IT IS THEREFORE ORDERED that Plaintiffs' Motion for Preliminary Injunction
(ECF No. 23) is hereby DENIED.
DATED this A5

day of May, 2014.

^ Skavdahl

United States District Judge

Page 19 of 19