Pennsylvania v. Trump, CIVIL ACTION NO. 17–4540

• Court: United States District Courts. 3th Circuit. United States District Court (Eastern District of Pennsylvania)
• Writing for the Court: WENDY BEETLESTONE, District Judge.
• Citation: 281 F.Supp.3d 553
• Decision Date: 15 December 2017
• Docket Number: CIVIL ACTION NO. 17–4540
• Parties: Commonwealth of PENNSYLVANIA, Plaintiff, v. Donald J. TRUMP, Donald J. Wright, United States Department of Health and Human Services, Steven T. Mnuchin, United States Department of the Treasury, Rene Alexander Acosta and the United States Department of Labor, Defendants.

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Commonwealth of PENNSYLVANIA, Plaintiff,
v.
Donald J. TRUMP, Donald J. Wright, United States Department of Health and Human Services, Steven T. Mnuchin, United States Department of the Treasury, Rene Alexander Acosta and the United States Department of Labor, Defendants.

CIVIL ACTION NO. 17–4540

United States District Court, E.D. Pennsylvania.

Signed December 15, 2017

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Jonathan Scott Goldman, Lauren E. Sulcove, Nicole J. Boland, Nikole Brock, Office of Attorney General, Harrisburg, PA, Michael J. Fischer, Office of Attorney General, Philadelphia, PA, for Plaintiff.

Elizabeth L. Kade, Christopher Healy, Ethan Price Davis, Joel L. McElvain, Justin Michael Sandberg, Rebecca M. Kopplin, U.S. Department of Justice, Washington, DC, Scott Webster Reid, U.S. Attorney's Office, Philadelphia, PA, for Defendants.

OPINION

WENDY BEETLESTONE, District Judge.

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The interests at stake in this litigation are great, but the issues that must be decided here on Plaintiff's Motion for a Preliminary Injunction are narrow. This case implicates access to healthcare, religious freedom, women's rights, and executive power. However, the Court currently addresses only two precise questions: Did the Defendants here follow the proper procedure in issuing new rules that greatly expand exemptions to the law requiring health plans to cover women's preventive services at no cost, and do the new rules contradict the text of the statute that they are meant to interpret?

Plaintiff, the Commonwealth of Pennsylvania ("Commonwealth"), seeks to enjoin enforcement of two Interim Final Rules ("New IFRs"), referred to as the Moral Exemption Rule and the Religious Exemption Rule, modifying the Affordable Care Act. The New IFRs were issued by the Departments of Health and Human Services, the Department of Treasury, and the Department of Labor on October 6, 2017. They permit employers to opt out of providing no-cost contraceptive coverage on the basis of sincerely held religious beliefs or sincerely held moral convictions. The parties here have vastly different perspectives on the import of the New IFRs. The Defendants assert that they are meant to permit a small number of religious objectors to opt out of covering contraceptive services in their employer-sponsored health plans because the requirement to provide contraceptive coverage imposes a substantial burden on their exercise of religion. Quite to the contrary, the Commonwealth argues that the Rules allow almost any employer to withhold insurance coverage for contraceptive services from their female employees, thus impacting millions of women—all in contravention of the Affordable Care Act and the United States Constitution.

The Commonwealth has sued President Donald J. Trump, United States Secretary of Health and Human Services Donald J. Wright,¹ United States Secretary of the Treasury Steven T. Mnuchin, and United States Secretary of Labor Rene Alexander Acosta in their official capacities, as well as each of their agencies (collectively, "Defendants"). It now seeks to enjoin the Defendants from enforcing the New IFRs for a variety of constitutional and statutory violations. For the reasons explained below, the Motion for a Preliminary Injunction shall be granted.

I. Background²

In March 2010, Congress enacted the Affordable Care Act. See Patient Protection and Affordable Care Act (ACA),

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Pub. L. No. 111–148, 124 Stat. 119 (2010). The ACA included a provision called the Women's Health Amendment, which mandated that group health plans and health insurance issuers offering group or individual health insurance provide coverage for preventive health services and screenings for women without cost-sharing responsibilities. The preventive services that must be covered include, "with respect to women, such additional preventive care and screenings ... as provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA)." See 42 U.S.C. § 300gg–13(a)(4). Thus, Congress left the decision about which preventive care and screenings should be covered by the ACA up to the HRSA, which is an agency of the Department of Health and Human Services (HHS).

The HRSA commissioned the Institute of Medicine ("the Institute") to issue recommendations identifying what specific preventive women's health services should be covered under the ACA's mandate. See 77 Fed. Reg. 8725–26. The Institute is an arm of the National Academy of Sciences, an organization that Congress established for the explicit purpose of furnishing advice to the federal government. See Pub. Citizen v. Dep't of Justice , 491 U.S. 440, 460 n.11, 109 S.Ct. 2558, 105 L.Ed.2d 377 (1989). The Institute, in turn, convened a committee of sixteen members (the "Committee"), including specialists in disease prevention, women's health issues, adolescent health issues, and evidence-based guidelines, to formulate specific recommendations. The Committee defined preventive health services to include measures "shown to improve well-being and/or decrease the likelihood or delay the onset of a targeted disease or condition." Institute, Clinical Prevention Services for Women: Closing the Gaps 23 (2011) ("Institute Report").

On July 19, 2011, the Institute, through the Committee, issued a comprehensive report that identified health services that should be covered under the Women's Health Amendment. Id. at 8–12. It recommended that the ACA cover "the full range of [FDA]-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity." Id. at 109–10. The Committee considered: (1) the prevalence of unintended pregnancy in the United States; (2) potential health risks of pregnancy; (3) that decreased intervals between pregnancies lead to an "increased risk of adverse pregnancy outcomes"; (4) the effectiveness of contraceptives in preventing unintended pregnancy; (5) the health benefits of contraceptives for other diseases and conditions; and (6) the barrier to contraceptive access presented by its cost. See id. at 104–10.

Original Religious Exemption

On August 1, 2011, HRSA adopted the Institute's recommendations in guidelines, which required, among other things, that plans must cover all FDA-approved contraceptive methods ("Contraceptive Mandate"). 45 C.F.R. § 147.130(a)(1)(iv) ; 29 C.F.R. § 2590.715–2713(a)(1)(iv) ; 26 C.F.R. § 54.9815–2713(a)(1)(iv). This requirement applied to all health insurers offering individual or group insurance, as well as all group health plans, with the exception of certain "grandfathered" plans. See 29 C.F.R. § 2590.715–1251. Simultaneously, the Departments of HHS, Labor, and the Treasury ("the Agencies" or "Defendant Agencies") also promulgated an Interim Final Rule ("IFR") exempting certain religious employers from providing contraceptive services ("Original Religious

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Exemption"). See 76 Fed. Reg. 46621. To take advantage of that exemption, an employer must: (1) have the inculcation of religious values as its purpose; (2) primarily employ people who share its religious tenets; (3) primarily provide services to persons who share its religious tenets; and, (4) be a church, its integrated auxiliary, or a convention or association of a church, all of which are exempt from taxation under 26 U.S.C. § 501(a). See id. at 46623.

Second Religious Exemption and Accommodation Process

Following several legal challenges to the Contraceptive Mandate, the Agencies began to consider changes to the religious exemptions. In March 2012, they issued an Advanced Notice of Proposed Rulemaking concerning a potential accommodation process for religious objectors to the Contraceptive Mandate. 77 Fed. Reg. 16501. After a comment period, they then issued a Notice of Proposed Rulemaking proposing changes to the definition of religious organizations in the exemption and creating an accommodation process for religious objectors to the Contraceptive Mandate. 78 Fed. Reg. 8456. The Agencies published final regulations on July 2, 2013 ("Second Religious Exemption"). See 78 Fed. Reg. 39870. These regulations redefined a religious employer to only refer to churches, their integrated auxiliaries, and conventions or associations of churches, eliminating the need to fulfill the first three requirements of the prior regulations of the exemption. Upon a covered entity claiming the exemption, the provider or administrator would then have to provide the legally required contraceptive services directly to women covered under the employer's plan ("Accommodation Process").

Third Religious Exemption and Accommodation Process

Following enactment of the ACA and the Second Religious Exemption, the Supreme Court granted certiorari to decide whether the Contraceptive Mandate violated the Religious Freedom Restoration Act, 42 U.S.C. § 2000bb–1 (RFRA). In Burwell v. Hobby Lobby Stores, Inc. , ––– U.S. ––––, 134 S.Ct. 2751, 189 L.Ed.2d 675 (2014), the Supreme Court concluded that applying the Contraceptive Mandate to closely held corporations violated RFRA. In Wheaton Coll. v....