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contraceptive, ACA, health insurance, mandate


This article explores the U.S. Supreme Court’s 2020 decision in Little Sisters of the Poor v. Pennsylvania. In a 7-2 decision, the Court upheld the two broad blanket exemptions to the Affordable Care Act’s “contraceptive mandate,” which is a regulatory requirement of the ACA and requires employers to provide contraceptive coverage to their employees through their employer-based health insurance plans. The blanket exemptions allow employers and educational institutions to exempt themselves of the mandate due to their religious or conscientious beliefs. The Court’s decision turned on its interpretation of the ACA’s language, specifically the language in 42 U.S.C. § 300gg-13(a)(4). The upheld exemptions now extend to private and for-profit employers.

This paper begins by describing the Little Sisters case, including its procedural history. This paper also explores the case’s legal background, including an overview of the ACA and precedent cases, such as Burwell v. Hobby Lobby Stores, Inc. and Zubik v. Burwell. This paper also discusses the Court’s reasoning behind its decision, including why the majority found that the exemptions were both statutorily and procedurally valid.

This paper finally analyzes the Court’s holding and argues why the Court was wrong in its decision to uphold the exemptions, which now deny tens of thousands of women seamless access to no-cost contraceptive coverage under the ACA. This paper argues that the decision was wrong for different reasons: 1) the Court failed to adequately weigh the exemptions’ detrimental impact on women; 2) the Court should have given greater weight to the history of the Women’s Health Amendment, the role of gender in shaping policy, and legal precedent; 3) the Court should have utilized the Administrative Procedure Act’s arbitrary and capricious standard when analyzing the exemptions; and 4) the Court’s decision leaves many legal questions unanswered, which may have broader implications in the areas of constitutional law, civil rights law, and gender rights law.


Administrative Law | Civil Rights and Discrimination | Constitutional Law | First Amendment | Health Law and Policy | Law | Law and Gender

Recommended Citation

21 University of Maryland Law Journal of Race, Religion, Gender & Class 338 (2021)