Dealing a significant blow to the Obama administration, women's health advocates and critics of "corporate personhood," the Supreme Court sided with evangelical business owners on Monday and ruled that the government may not require closely held businesses to provide their employees with health insurance that covers types of birth control that offend the owner's religious beliefs.
The 5-4 decision along ideological lines in Burwell v. Hobby Lobby establishes for the first time that a private corporation - at least one with a limited number of shareholders - can declare a religious belief and be granted exemptions under federal law.
The case is rooted in the objections of two religious, business-owning families to a small portion of the Affordable Care Act that requires many for-profit businesses to provide coverage of a wide range of contraceptives. A wealthy Baptist family that runs the large Hobby Lobby chain of craft stores and a Mennonite family that runs a small cabinet business in Pennsylvania sued the Obama administration, arguing that requiring their businesses to cover four specific contraceptives that they believe could stop a pregnancy after conception violated their religious liberty.
The ruling allows Hobby Lobby and other business to opt out of the requirement that all 20 contraceptives approved by the FDA be covered in health care plans offered to employees. The government and health advocates argued that the requirement was necessary to ensure that woman have equal access to medical services, and that doctors, not employers, guide patients toward the best options.
"This decision lets employers get between women and their doctors," said Susan Berke Fogel, the National Help Law Program's director of reproductive health. "Health care must be based on patient need and good medical practice. And yet, the court has interfered with that by allowing bosses to dictate their employee's health."
Writing for the dissent, Justice Ruth Bader Ginsburg pointed out that the case was not just a battle between business owners and the government, and the decision could "deny legions of women who do not hold their employers' religious beliefs access to contraception coverage."
"Any decision to use contraceptives made by a woman covered under Hobby Lobby's or Conestoga's plan will not be propelled by the government; it will be the woman's autonomous choice, informed by the physician she consults," Ginsburg wrote.
The majority, however, ruled that the plaintiffs' right to exercise deeply held religious beliefs trumped the government's interest in protecting health care access for woman.
Writing for the majority, Justice Samuel Alito argued that the government could provide alternative routes for women to access the four contraceptives that do not infringe on the religious freedom of business owners, so the Obama administration failed to meet the "least restrictive means" standard of the Religious Freedom Restoration Act (RFRA) of 1993. He also pointed out that religious non-profits and churches are already exempt from the requirement.
RFRA protects the First Amendment rights of religious "persons," and the majority opinion delved deep in the territory of "corporate personhood" in establishing Hobby Lobby's right to seek exemption under the federal law.
"[Congress] employed the familiar legal fiction of including corporations within RFRA's definition of 'persons,' but the purpose of extending rights to corporations is to protect the rights of people associated with the corporation, including shareholders, officers, and employees," Alito wrote. "Protecting the free-exercise rights of closely held corporations thus protects the religious liberty of the humans who own and control them."
Alito's argument echoes the majority opinion in the 2010 case Citizens United v. Federal Election Commission, which opened the floodgates for corporate campaign spending and helped make the 2012 election season by far the most expensive in history. The ruling also ignited a movement among progressives to pass legislation and even amend the Constitution to establish that corporations do not have the same rights as real people.
Alito attempted to tailor the majority opinion to the contraception rule and closely held corporations like Hobby Lobby that have a limited number of shareholders. He wrote that the ruling does not impact mandates for other medical procedures, such as vaccinations and blood transfusions, and does not provide a legal "shield" for illegal discrimination based on religious practice.
Ginsburg and the dissenting justices, however, wrote that their colleagues delivered a decision of "startling breadth," and warned, along with many commentators, that the decision could open the door for private companies to seek the privilege of denying a wide-range of medical treatments and even discriminate against employees.
The ruling is likely to make contraception a hot topic in the upcoming election cycle, with Republicans trumpeting the decision as a win for religious freedom and a blow to health care reform, and Democrats in Congress already pledging to take legislative action.
“If the Supreme Court will not protect women’s access to health care, then Democrats will,” said Senate Majority Leader Harry Reid (D-Nevada) in a statement.