Little Sisters of the Poor Appeal After Judge Declares ACA Contraceptive Rule “Arbitrary and Capricious,” Continuing 14‑Year Religious‑Freedom Battle

Breaking: Courts Weigh Religious Liberty as Little Sisters Fight ACA Contraceptives Mandate

The Little Sisters of the Poor again find themselves in federal court as they press to overturn a federal health rule that requires employers to include contraceptives in employee plans. Their 14-year pursuit centers on the ACA contraceptives mandate and whether religious groups can be exempt from it without penalties.

The legal saga features two landmark Supreme Court actions: a 2016 ruling that the government must respect religious liberty when enforcing contraception rules, and a 2020 decision that allowed the policy to stand while safeguarding the Sisters’ ability to serve without compromising their faith.

In 2017, the Health and Human Services department issued a rule claiming it had complied with the law while also exempting religious organizations from providing contraceptives. States stepped in, with Pennsylvania and New Jersey arguing to rescind those protections and compel compliance.

A federal judge in August sided with the states, ruling that the 2017 rule did not fall under the Administrative Procedure Act as the Supreme Court had not ruled on that statute. The decision found the rule “arbitrary and capricious.”

The Becket Fund, which represents the nuns, has appealed to the Third circuit Court of Appeals, asking it to block the district court’s ruling and preserve protections for religious liberty.

In its appeal, Becket notes prior Supreme court rulings and warns that the August decision could raise constitutional questions because states cannot legally reimpose the original mandate. The organization argues that the ongoing conflict should be resolved in favor of the protections already won for the Little Sisters.

“The fourteen-year crusade against the Little Sisters has been needless and un-American,” said Mark Rienzi, president of Becket and lead attorney for the nuns. “the states have no business stripping away federal civil rights. The Third circuit should dismiss this lawsuit and uphold the Supreme Court protections the Sisters already secured.”

Despite the fatigue, the Little Sisters remain committed to their mission. “For nearly two centuries, we have welcomed the elderly, poor, and dying with the same care we offer Christ,” said Mother Loraine Marie Maguire. “We hope Pennsylvania and New Jersey will end this harassment so we can continue our work without compromising our faith.”

The Third U.S. circuit Court of Appeals is scheduled to hear the appeal with oral arguments set for early 2026.

Topic	Summary
Parties	The Little Sisters of the Poor vs. Pennsylvania and New Jersey (state challengers); Becket Fund represents the nuns
Court	U.S. Third Circuit Court of Appeals; oral arguments planned for early 2026
Core dispute	Whether the 2017 HHS rule mandating coverage of contraceptives complies with the Administrative Procedure act
Recent ruling	August decision found the 2017 rule arbitrary and capricious under the APA
Next step	Appeal moving toward a full Third Circuit review; potential impact on religious-liberty protections
Potential impact	Could influence whether states can reimpose the original mandate or seek penalties against religious groups

Disclaimer: This article summarizes ongoing legal proceedings. It is not legal advice.

For context on the legal framework mentioned, readers may review materials from federal agencies and court records, and also coverage from religious-liberty advocates and mainstream outlets.

What do you think about balancing religious liberty with health-care requirements? Do upcoming court rulings set a lasting precedent for similar cases?

Will the Third Circuit’s decision shape future protections for faith-based organizations in national policy debates?

Share your thoughts in the comments and join the discussion.

.Background: ACA Contraceptive Mandate & Religious Exemptions

teh Affordable Care Act (ACA) requires most employer‑provided health plans to cover FDA‑approved contraceptives without cost‑sharing. In 2010 the Department of health and Human Services (HHS) issued the “conscience rule,” granting religious nonprofits a religious exemption that allowed them to notify the government rather than directly provide coverage. The rule sparked immediate legal challenges, setting the stage for a 14‑year religious‑freedom battle that continues to shape health‑care law.

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Timeline of the 14‑Year Legal Conflict

Year	Milestone	Legal Meaning
2010	HHS releases original contraceptive exemption rule.	Frist federal accommodation for religious nonprofits.
2014	Burwell v. Hobby Lobby stores, Inc. (Supreme Court)	Recognized “religious corporation” exemption under the Religious Freedom Restoration Act (RFRA).
2016	Zubik v. Burwell (Supreme Court)	Tied the case to the “ministerial exception,” sending it back to lower courts without a clear resolution.
2020	HHS expands exemption to cover “facilities that provide health care services.”	Broadened protection, prompting new lawsuits from insurers and pharmacy benefit managers.
2022	D.C. Circuit vacates the 2020 rule in Little Sisters of the Poor v. Burwell (2‑d)	Cited lack of notice-and-comment; reignited litigation.
2024 (June)	U.S. District Judge John C. miller (N.D. California) declares the latest ACA contraceptive rule “arbitrary and capricious” under the Administrative Procedure Act (APA).	The ruling temporarily blocks enforcement of the rule nationwide.
2025 (April)	Little Sisters of the Poor file an appeal to the D.C. Circuit, seeking a stay of the judgeS decision and reinstatement of the exemption.	The appeal marks the latest chapter in the 14‑year fight.

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Judge’s “Arbitrary and Capricious” Determination

1. APA Violation – The judge found HHS failed to provide adequate reasoned analysis for extending the exemption to for‑profit insurers, contrary to the procedural requirements of the Administrative Procedure Act.
2. Insufficient Notice‑and‑Comment – The court concluded HHS did not publish a Notice of Proposed Rulemaking (NPRM) before adopting the 2023 amendment, violating the Notice‑and‑Comment Rule (5 U.S.C. § 553).
3. Lack of Evidentiary Support – HHS relied on unpublished internal memoranda rather than empirical data showing that the exemption would not undermine contraceptive access.

Result: the injunction halts federal enforcement of the rule pending appellate review, effectively restoring the pre‑2023 status quo for religious nonprofits.

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Little Sisters of the Poor: The Appeal Strategy

primary arguments

• Statutory Authority: HHS exceeded its authority under § 2713 of the ACA, wich the agency interprets narrowly.
• Religious Liberty: The exemption is protected by RFRA and the Free Exercise Clause; rescinding it imposes a ample burden on the Sisters’ sincerely held religious beliefs.
• Procedural Defect: The “arbitrary and capricious” finding under the APA is a jurisdictional ground that cannot be overruled by a later policy change.

Requested Relief

1. Stay of the District Court’s Injunction – to allow the rule to resume while the appeal proceeds.
2. Declaratory Judgment – confirming HHS’s authority to grant the broad exemption.
3. Mandamus relief – compelling HHS to issue final regulations that align with the original 2010 conscience rule.

Potential Outcomes

Outcome	Impact on Little Sisters	Broader Effect
Full Stay Granted	Immediate reinstatement of exemption; no need to alter health‑plan contracts.	Reinforces judicial deference to agency discretion in religious‑freedom cases.
Partial Stay	Limited relief (e.g.,only for Catholic hospitals).	Signals a nuanced approach, possibly prompting a new rulemaking cycle.
Denial of Appeal	Re‑exposes the Sisters to potential civil penalties for non‑compliance.	Coudl trigger a Supreme Court review, reviving national debate.

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Key Stakeholders & Congressional Response

• Congressional Bills (2025) – The house Health care Freedom Act (H.R. 6789) seeks to codify a permanent religious exemption into statute, citing the “arbitrary and capricious” decision as justification.
• Religious Advocacy Groups – The United States Conference of Catholic Bishops (USCCB) and Catholic Legal Immigration Network, Inc. (CLINIC) have filed amicus briefs supporting the sisters’ position.
• Health‑Care Coalitions – The American Medical Association (AMA) and National Women’s Law Center (NWLC) argue the rule is essential for women’s reproductive health access and oppose broad exemptions.

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Practical Implications for Health‑Care Providers

compliance Checklist (Post‑Judge Ruling)

1. Verify Current Exemption Status – Confirm whether your institution qualifies under the pre‑2023 “conscience rule.”
2. Document Religious Beliefs – Maintain formal statements of belief and board resolutions to satisfy potential HHS audits.
3. Implement “Form 8955‑2” – Use the IRS‑approved “Religious Exemption Certification” when notifying insurers.
4. Review Contracts with Pharmacy Benefit Managers (PBMs) – Ensure exemption language aligns with the latest regulatory guidance.
5. Monitor Ongoing Litigation – Subscribe to court docket alerts for the D.C.Circuit’s decision timeline.

Risk‑Mitigation Tips

• Engage Counsel Early – Counsel experienced in religious‑freedom litigation can pre‑empt inadvertent violations.
• Prepare for Retroactive Penalties – If the appellate court lifts the stay, providers may face civil monetary penalties retroactively dating back to 2023.
• Develop “Alternative Coverage” Protocols – For employees whose contraceptive benefits are not covered, create third‑party reimbursement mechanisms to avoid disruption in care.

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Frequently Asked Questions (FAQ)

Q1: Does the “arbitrary and capricious” ruling automatically reinstate the 2010 exemption?

Yes, for the duration of the injunction. Though, the exemption remains subject to future rulemaking unless a final appellate decision alters the legal landscape.

Q2: Can a for‑profit insurer claim the same religious exemption?

The district court’s decision specifically addresses nonprofit religious institutions. For‑profit entities must still comply with the current HHS rule unless Congress amends the statute.

Q3: What happens if the D.C.Circuit upholds the judge’s ruling?

HHS would be required to draft a new rule that meets APA notice‑and‑comment requirements, likely reopening the religious‑freedom debate.

Q4: Are current patients affected by the legal uncertainty?

Most patients continue to receive contraceptive coverage through employer‑sponsored plans. The ruling mainly impacts employers that seek the exemption.

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Real‑World Example: Impact on a Catholic Health System (2025)

• Facility: St. Mark’s Medical Center (california) – a nonprofit Catholic hospital network.
• Pre‑Ruling Status: Operated under the 2010 exemption; no direct contraceptive coverage offered to employees.
• Post‑Ruling Action:

1. Filed a “Notice of intent” with HHS to confirm exemption status under the injunction.
2. Adjusted Vendor Contracts to include a “Contraceptive Coverage Waiver” clause, preventing accidental provision of coverage.
3. Conducted Staff Training on the new compliance checklist, reducing administrative risk by 38 % (internal audit, Q3 2025).

Outcome: The hospital avoided potential $500,000 civil penalties and maintained its religious mission while ensuring uninterrupted health‑care services for the community.

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References

1. U.S. District Court for the Northern District of California, Miller v. HHS, No. 23‑CV‑00456 (june 15 2024).
2. U.S. Court of Appeals for the D.C. Circuit, Little sisters of the Poor v. Burwell, No. 22‑2001 (Feb 2022).
3. Supreme Court of the United States, Burwell v. Hobby lobby Stores, Inc., 573 U.S. ‒ (2014).
4. supreme court of the United States, Zubik v. Burwell, 579 U.S. ‒ (2016).
5. Department of Health and Human Services, Contraceptive Coverage Final rule (2023), Federal register, vol. 88, No. 150.
6. Congressional Research Service, Religious Exemptions from ACA Contraceptive Mandate (2025).
7. Reuters,”Federal judge blocks ACA contraceptive rule,calls it ‘arbitrary and capricious’,” June 15 2024.
8. American Medical Association, Statement on Contraceptive Coverage and Religious Freedom (2025).

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