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Viewpoint | Health Care Reform

The Supreme Court Decision in the Hobby Lobby Case:  Conscience, Complicity, and Contraception

R. Alta Charo, JD1,2
[+] Author Affiliations
1Warren P. Knowles Professor of Law and Bioethics, University of Wisconsin Law School, Madison
2School of Medicine and Public Health, University of Wisconsin–Madison
JAMA Intern Med. 2014;174(10):1537-1538. doi:10.1001/jamainternmed.2014.4200.
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In June 2014, the US Supreme Court ruled that some employers can decide for themselves whether the contraceptive mandate in the Affordable Care Act (ACA) is a substantial burden on the exercise of religious freedom (Box)2 and sue for an exemption on that basis. What are the broader implications of this decision for medical care?

Box Section Ref ID

Box. The Hobby Lobby Case
  • The Affordable Care Act (ACA) requires larger employers (those with more than 50 employees) to include coverage for the full range of preventive care, including contraceptives, in their employees' health insurance plan. Hobby Lobby, a for-profit secular company, challenged this rule. Although the company has hundreds of stores and many thousands of employees, it is “closely held,” that is, owned by very few people. The family that owns Hobby Lobby is deeply religious and does not want to include certain kinds of birth control—intrauterine devices and emergency contraception—in its health insurance coverage because they believe that this would make them complicit in abortion. The company also declined to take advantage of an option in the ACA: to pay $2000 per employee and have their workers purchase insurance on the public, subsidized exchanges. Instead, the company challenged the contraceptive requirement, citing the Religious Freedom Restoration Act of 1993,1 which prohibits the federal government from imposing a “substantial burden” on the ability of a person to practice his or her religion unless that burden advances an important government interest and does so in the least restrictive way possible. On June 30, 2014, the Supreme Court, in a 5-4 decision in Burwell vs Hobby Lobby et al, ruled that the contraceptive mandate was an unnecessary and substantial burden on Hobby Lobby's corporate exercise of religious freedom.2

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