Catholic Charities v. Superior Court

• Decision Date: 02 July 2001
• Docket Number: No. C037025.,C037025.
• Citation: 90 Cal.App.4th 425,109 Cal.Rptr.2d 176
• Court: California Court of Appeals Court of Appeals
• Parties: CATHOLIC CHARITIES OF SACRAMENTO, INC., Petitioner, v. The SUPERIOR COURT of Sacramento County, Respondent; Department of Managed Health Care et al., Real Parties in Interest.

109 Cal.Rptr.2d 176

90 Cal.App.4th 425

CATHOLIC CHARITIES OF SACRAMENTO, INC., Petitioner, v. The SUPERIOR COURT of Sacramento County, Respondent Department of Managed Health Care et al., Real Parties in Interest.

No. C037025.

Court of Appeal, Third District.

July 2, 2001.

As Modified on Denial of Rehearing July 26, 2001.

Review Granted September 26, 2001.

Law Office of James Francis Sweeney, Sacramento, James Francis Sweeney; Law Office of Tobin & Tobin, Paul Edward Gaspari, and Lawrence R. Jannuzzi, San Francisco, for Petitioner.

Gaglione, Coleman & Greene, Robert J. Gaglione, Sacramento; and Michael D. Ramsey for Catholic Charities USA as Amici Curiae on behalf of Petitioner.

Diepenbrock & Costa, Daniel P. Costa, Sacramento; and William Wood Bassett for California Catholic Conference as Amici Curiae for Petitioner.

Law Offices of Daniel P. Costa and Daniel P. Costa, Sacramento, for California Catholic Conference as Amicus Curiae for Petitioner.

Richard D. Ackerman, Corona, and Gary G. Kreep, Escondido, for Life Legal Defense Fund as Amici Curiae on behalf of Petitioner.

Alan Jay Reinach, Westlake Village, for The California Interfaith Coalition etc. et al. as Amicus Curiae for Petitioner.

Sidley & Austin, Rebecca K. Smith, Michael S. Lee, San Francisco, Gene C. Schaerr, Jeffrey A. Berman, and James M. Harris, Los Angeles, for Loma Linda University et al. as Amici Curiae on behalf of Petitioner.

No appearance for Respondent.

McCutchen, Doyle, Brown & Enersen, Beth Harrison Parker, San Francisco; Donna Lee, San Francisco; and Eve C. Gartner for Catholics for a Free Choice et al. as Amici Curiae on behalf of Respondent.

Bill Lockyer, Attorney General, Manuel M. Medeiros, Senior Assistant Attorney General, Kenneth R. Williams, Supervising Deputy Attorney General, Kathleen W. Mikkelson, and Daniel G. Stone, Deputy Attorneys General for Real Parties in Interest.

Catherine Weiss, Julie Sternberg, Margaret C. Crosby, Ann Brick for American Civil Liberties Union Reproductive Freedom Project et al. as amici curiae for Real Parties in Interest.

Lilly Spitz; Bebe J. Anderson; and Deborah Baumgarten for California Planned Parenthood Education Fund et al. as Amici Curiae for Real Parties in Interest.

McCutchen, Doyle, Brown & Enersen, Beth Harrison Parker, San Francisco; Donna Lee, San Francisco; and Eve C. Gartner for Catholics for a Free Choice et al. as Amici Curiae on behalf of Real Parties in Interest.

SCOTLAND, P.J.

Asserting that, under the religious tenets of Catholicism, the use of contraception is extrinsically evil and a grave sin, Catholic Charities of Sacramento, Inc. (Catholic Charities), raises constitutional challenges to a statutory scheme which requires that, with an exception not applicable to Catholic Charities, California employers who provide their employees with health insurance coverage or disability insurance coverage that includes prescription drug benefits must also include prescription contraceptives in the coverage. (Health & Saf.Code, § 1367.25; Ins.Code, § 10123.196.)

Catholic Charities is a California public benefit corporation that provides social services to the poor, disabled, elderly, and otherwise vulnerable members of society, regardless of their religious beliefs. It has health insurance coverage with prescription drug benefits for its employees, who represent a diverse group of religious faiths. Catholic Charities believes that, by forcing it to provide prescription contraceptive coverage, the statutory scheme impermissibly burdens its sincerely held religious beliefs, thereby violating the religious freedom guarantees of both the United States Constitution and California Constitution.

Thus, Catholic Charities filed an action for declaratory and injunctive relief, and sought a preliminary injunction permitting it, pending trial, to provide its employees with health insurance that does not cover prescription contraceptives. When the superior court refused to issue a preliminary injunction, Catholic Charities sought relief in this court. We issued an alternative writ to address this issue of first impression.

We conclude, as did the superior court, it is not reasonably probable that Catholic Charities's action will prevail on the merits. As we will explain, the prescription contraceptive coverage statutes, which were enacted to eliminate discriminatory insurance practices that had undermined the health and economic well-being of women, are otherwise valid laws that are generally applicable and neutral with respect to religion. Because the statutes have a secular purpose, do not advance or inhibit religion, and do not foster excessive government entanglement with religion, the incidental effect of the statutes on religious beliefs does not violate the religious guarantees of the United States and California Constitutions.

Accordingly, we shall deny the petition for writ of mandate.

BACKGROUND

The statutory scheme and its purpose

The legislative history submitted by the parties discloses that the statutory scheme was enacted to eliminate discriminatory insurance practices which had undermined the health and economic well-being of women.

According to materials considered by the Legislature and statements made during the legislative hearings, prescription contraceptives statistically are the most effective methods of birth control and are an essential part of women's healthcare during their reproductive years, which span several decades.

Despite their importance to women's healthcare and their availability for four decades, prescription contraceptives are not included in 49 percent of health plan formularies; whereas most drugs approved by the Federal Drug Administration (FDA) appear almost immediately on health plans. Oral contraceptives are the only class of FDA-approved prescriptions routinely excluded from insurance coverage.

Only women are burdened by this health coverage exclusion because prescription contraceptive methods are used only by women; there are no prescription contraceptive methods available for men.

Mainly due to this exclusion, women pay 63 to 68 percent higher out-of-pocket healthcare costs than men. Almost 5 million privately-insured women between the ages of 14 and 44 have out-of-pocket health expenditures exceeding 10 percent of their income. Women who cannot afford these additional costs must forgo using prescription contraceptive methods, which results in an increase in unwanted or unintended pregnancies. The average sexually active woman would have four pregnancies in five years if she did not use contraception.

The American College of Obstetricians and Gynecologists reports that unintended pregnancies can have serious medical, even life-threatening consequences to a woman's health. Unplanned pregnancies cause health problems not only for women, but also for their unplanned babies. Short intervals between pregnancies are associated with high risks of low birth weight and premature deliveries. Oral contraceptives also have nonpregnancy-related health benefits because they reduce the risk of contracting certain forms of cancer.

Hence, cost-effective access to prescription contraceptives results in substantial health benefits for women.

The Legislature also received information indicating that, in order for women to achieve and maintain economic and social parity and independence, it is essential that they have the ability to reliably control their reproductive capacity. Moreover, the ability of women to control reproductive health is a major factor in a nation's economic well being.

In response to these concerns, the Legislature enacted the Women's Contraception Equity Act (Health & Saf.Code, § 1367.25 & Ins.Code, § 10123.196; Stats. 1999, ch. 538, § 1), which requires group and individual health insurance policies and disability insurance policies that include prescription drug benefits to also include coverage for prescription contraceptive methods.¹ Hereafter, we will refer to this legislation as "the prescription contraceptive coverage statutes."

During the legislative process, various Catholic groups asked the Legislature for a "conscience clause" which would enable them to obtain employee health insurance coverage that does not include prescription contraceptive benefits. The groups pointed out that, according to their religious beliefs, using contraception is a sin, and providing prescription contraceptive benefits is the equivalent of facilitating sin, which their religion prohibits. Therefore, they argued, without a "conscience clause" exception, the statutes would impermissibly burden their religious freedom.

The Legislature sought to address this concern without significantly undermining the anti-discrimination and public welfare goals of the prescription contraceptive coverage statutes, and without imposing the employers' religious beliefs on employees who did not share those beliefs. It reached a compromise by enacting an exemption that permits "religious employers," for whom contraception "is contrary to [their] religious tenets," to obtain employee health and disability insurance policies without coverage of prescription contraceptive methods. (Health & Saf.Code, § 1367.25, subd. (b); Ins.Code, § 10123.196, subd. (d).)

The "religious employers" exemption is defined narrowly. It applies only to those who satisfy the following four criteria: "(A) The inculcation of religious values is the purpose of the entity, [¶] (B) The entity primarily employs persons who share the religious tenets of the entity. [¶] (C) The entity serves primarily persons who share the religious tenets of the entity. [¶] (D) The entity is a nonprofit organization pursuant to Section 6033(a)(2)(A) i or iii of the Internal Revenue Code of 1986, as amended [which exempt from certain tax filings churches, their integrated auxiliaries, conventions or associations of churches, and the exclusively religious activities of any religious order]."...