The Supreme Court has ruled that certain “closely held” for-profit businesses can cite religious objections in order to opt out of a requirement in the Affordable Care Act (ACA) to provide free contraceptive coverage for their employees.

In a 5-to-4 decision, the Supreme Court has ruled that requiring family-owned corporations to pay for insurance coverage for contraception under the Affordable Care Act (ACA) violates a federal law protecting religious freedom.

As part of the ACA, the federal government issued a rule that requires health plans to cover contraception without a co-pay. Under the final rule, the administration has allowed exceptions for nonprofits with religious objections to covering contraceptives. The rule was designed to ensure that employees could receive contraception coverage, but that a nonprofit employer with religious objections would not bear the cost or otherwise have any connection to it.

However, on November 26, 2013, the Supreme Court announced it would hear two challenges to the contraception rule: one from an Oklahoma-based craft supply chain store (Sebelius v. Hobby Lobby Stores, Inc., 13-354), and another from a Pennsylvania-based furniture manufacturer (Conestoga Wood Specialties Corp. v. Sebelius, 13-356).

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Justice Samuel A. Alito Jr., wrote for the majority that a federal religious freedom law applied to for-profit corporations controlled by religious families, and that the requirement that the companies provide contraception coverage imposed a substantial burden on the companies’ religious liberty, according to a report in the New York Times.

Justice Ruth Bader Ginsburg said in a written dissent that the contraception coverage requirement was vital to women’s health and reproductive freedom. Justices Stephen G. Breyer and Elena Kagan joined Justicce Ginsburg in almost all of the dissent, but they said there was no need to take a position on whether corporations may bring claims under the religious liberty law, said the New York Times report.

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In March, Healthline reported from a joint press conference that the American Civil Liberties Union (ACLU), the National Women’s Law Center, the Planned Parenthood Action Fund (PPAF), and NARAL Pro-Choice America were opposed to for-profit companies challenging the ACA’s requirement that employers cover contraception costs for employees because of the religious objections of their owners.

Commenting on the Supreme Court’s decision, Cecile Richards, president of PPAF, said in a press statement, “Today, the Supreme Court ruled against American women and families, giving bosses the right to discriminate against women and deny their employees access to birth control coverage. This is a deeply disappointing and troubling ruling that will prevent some women, especially those working hourly-wage jobs and struggling to make ends meet, from getting birth control.”

Emphasizing that the ruling does not strike down the Affordable Care Act’s birth control benefit, Richards added, “Today, more than 30 million women are eligible for birth control with no co-pay thanks to this benefit, and the vast majority of them will not be affected by this ruling. But for those who are affected, this ruling will have real consequences.”

Richards said that despite this and other political conflicts on the subject of reproductive health, birth control is not a controversial issue for the majority of women.

“Birth control is basic healthcare – and it’s only a ‘social issue’ if you’ve never had to pay for it. We hope most businesses will do the right thing and let women make their own healthcare decisions. We urge Congress to act and protect women’s access to birth control, regardless of the personal views of their employers,” urged Richards.

According to Planned Parenthood, 99 percent of American women between the ages of 15 and 44 who are sexually active have used birth control at some time. Other methods of contraception, such as IUDs, can cost several hundred dollars, even with health insurance. For the first time, under the birth control benefit, IUDs are now fully covered by insurance companies, without additional out-of-pocket expense.

Dr. David A. Fleming, FACP, president of the American College of Physicians (ACP), issued a statement that said the ACP is deeply concerned about the adverse impact on healthcare that may result from today’s Supreme Court ruling. “We believe this decision will make it more difficult for women to access affordable contraceptives, and potentially open the door for for-profit employers to seek additional exemptions from other evidence-based coverage requirements established by the ACA,” he said.

Fleming said that according to the U.S. Department of Health and Human Services, 71 million Americans received expanded evidence-based preventive coverage with no out-of-pocket costs in 2011 and 2012 as a result of the ACA. “Since implementation of the women’s preventive health benefit, women have saved millions of dollars in out-of-pocket costs for contraception and may now access a wider variety of high-quality care options,” he said.

Fleming went on to say that the ACP is concerned that allowing employers to carve out exemptions to the ACA’s requirement that health insurance plans cover evidence-based preventive services will create substantial barriers to patients receiving medical care. The Supreme Court has stated that their decision applies only to the contraception mandate, and not to other potential religious exceptions for vaccinations or blood transfusions, for example.

Fleming concluded, “We urge the administration, Congress, and other policymakers to work together to develop a remedy that ensures that women are not denied access to no-cost contraception as a result of the Supreme Court’s ruling, and more broadly, to ensure that all Americans will have access to coverage for evidence-based medical care as recommended by their physicians.”