Under the Affordable Care Act’s preventive services regulations, group health plans are required to provide access to certain preventive services and screenings, including contraceptives, to employees at no cost sharing. HHS, however, provided an exemption to the mandate for religious nonprofits, such as churches and schools. For these excluded organizations, health plans must exclude contraceptives from the employer’s plan and provide participants with separate coverage for contraceptive services at zero cost sharing.

At issue in this case is whether for-profit employers may deny employees contraceptive coverage based on religious objections of the corporation’s owners. Specifically, the plaintiffs cited religious objections to intrauterine devices (IUDs) and certain emergency contraceptives. Ultimately, the Supreme Court held that the coverage mandate was not the “least restrictive means” of ensuring broad access to contraception and that there are other ways in which Congress or HHS could equally ensure that every woman has access to all FDA-approved contraceptives at no cost-sharing. The Court split on “ideological” lines with Justice Alito writing the majority opinion that included Chief Justice Roberts and Justices Scalia, Thomas, and Kennedy.

The Court’s ruling applies to closely held, for-profit corporations and non-publicly traded corporations. The scope of this decision is squarely on contraceptives and does not extend to other insurance mandates, such as blood transfusions or vaccinations. However, advocates have raised concerns about whether other religious groups may file separate suit to oppose coverage for other essential health benefits, including mental health benefits (which are not recognized by the church of Scientology, for example). While the decision holds implications for certain employers, without further action it could also expose women and their dependents to higher costs and administrative barriers to access contraceptives.

In response to the Court’s decision, Democratic lawmakers have committed to pursuing a legislative remedy allowing access to FDA-approved contraceptives for all women, with additional details forthcoming. It remains to be seen how the administration will carry out this ruling with respect to HHS’s religious exemptions process.