US health law rolls out but legal skirmishes continue

BMJ 2014; 348 doi: (Published 03 January 2014) Cite this as: BMJ 2014;348:g35
  1. Michael McCarthy
  1. 1Seattle

The Affordable Care Act went into effect Wednesday 1 January as legal skirmishes challenging provisions of the law continued to work their way through the courts.

In the latest judicial action, US Supreme Court Justice Sonia Sotomayor temporarily halted the enforcement of a provision of the law that requires insurers to provide contraceptive services at no additional cost to patients.

Similar injunctions have been issued in other cases by lower courts, but this was the first action involving the Supreme Court, which will likely be called on to ultimately resolve the issue.

Under the provision, non-profit religious organizations that have religious objections to contraception can choose not to pay for contraceptive coverage,1 but they must file papers certifying their objection.

Contraceptive services that health plans must cover include birth control pills, sterilization procedures, and “morning after pills,” but not abortion or abortifacients.

Because the provision stipulates that insurers, not employers, must provide the coverage, employees of organizations that choose to opt out would still have access to contraceptive services, but the costs would fall to the insurer, not the employer.

Nonetheless, many religious organizations argue that simply requiring them to complete the forms certifying their objection forces them to facilitate their employees’ access to contraceptive services and that this makes them complicit in an act they deem immoral and contrary to their religious beliefs.

Sotomayor’s order came in response to a lawsuit filed by the Little Sisters of the Poor Home for the Aged, a facility for elderly people run by a Roman Catholic order of nuns.

Sotomayor signed the order late Tuesday 31 December, a day before the organizations failing to comply with the mandate would become subject to financial penalties. The justice gave the administration until Friday 3 January to respond.

Later this year the Supreme Court will hear arguments in two cases involving for-profit companies that have also cited religious objections to the law’s mandate on contraceptive services. At issue is whether for-profit companies have religious rights similar to those guaranteed to individuals by law and by the US Constitution. A decision by the court is expected by June.

Meanwhile, the administration reported a surge in the numbers of people obtaining coverage through the Affordable Care Act. It reported that 2.1 million people had signed up for private insurance coverage on the healthcare insurance exchanges since they opened for business on 1 October; another 3.9 million had determined that they qualify for coverage through Medicaid or the Children’s Health Insurance Plan; and three million young adults had been insured under a provision of the law that allows them to remain on their parents’ plans until age 26.


Cite this as: BMJ 2014;348:g35