United States District Court, W.D. Missouri, Southern Division
THE SCHOOL OF THE OZARKS, INC., d/b/a COLLEGE OF THE OZARKS, Plaintiff,
UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, et al., Defendants
[Copyrighted Material Omitted]
For The School of the Ozarks, Inc., doing business as College of the Ozarks, Plaintiff: Ashley Lowe Norgard, LEAD ATTORNEY, Ginger K. Gooch, Husch Blackwell LLP - Spfd, Springfield, MO; JoAnn T Sandifer, LEAD ATTORNEY, Husch Blackwell LLP - StL, St. Louis, MO; Virginia L Fry, Husch, Blackwell, Sanders, LLP, Springfield, MO.
For United States Department of Health and Human Services, Kathleen Sebelius, Secretary of the United States Department of Health and Human Services, United States Department of Labor, Seth Harris, United States Department of Treasury, Jack Lew, Secretary of the United States Department of the Treasury, Defendants: Jacek Pruski, LEAD ATTORNEY, U.S. Department of Justice, Washington, DC.
For American Civil Liberties Union, American Civil Liberties Union of Missouri, Amici: Anthony E. Rothert, LEAD ATTORNEY, American Civil Liberties Union of Missouri Foundation-StL, St. Louis, MO; Brigitte Amiri, LEAD ATTORNEY, PRO HAC VICE, New York, NY; Daniel Mach, LEAD ATTORNEY, PRO HAC VICE, Washington, DC; Jennifer Lee, LEAD ATTORNEY, PRO HAC VICE, New York, NY.
BETH PHILLIPS, UNITED STATES DISTRICT JUDGE.
This matter comes before the Court on Plaintiff's Motion for Summary Judgment, (Doc. 31); Defendants' Motion to Dismiss, or Alternatively Motion for Summary Judgment, (Doc. 35); and American Civil Liberties Union's and American Civil Liberties Union of Missouri's (collectively " ACLU" ) Motion for Leave to File Amici Curiae Brief, (Doc. 38). For the following reasons, Defendants' Motion is GRANTED, Plaintiff's Motion and the ACLU's Motion are DENIED.
Plaintiff is the School of the Ozarks, Inc. (" School" ), a " four year liberal arts co-educational college located in Lookout, Missouri." (Doc. 32, p. 8.) The School has a " five-fold emphasis" which focuses on academic, vocational, Christian, patriotic, and cultural education to develop students' character. ( See id.) Further, the School was originally established by a Missouri charter granted to the Missouri Synod of the Presbyterian Church. The School became a not-for-profit corporation pursuant to Missouri law in 2003. Currently, the School has more than 270 full-time employees and contracts to provide a group health insurance plan through an insurance company.
Defendants are the government agencies which administer the Patient Protection and Affordable Care Act (" ACA" ), 42 U.S.C. § 300gg-13(a)(4), namely the Department of Health and Human Services (" HHS" ), the Department of Treasury and
the Department of Labor (" Labor" ), as well as the secretary for each agency, (collectively " Departments" ).
B. ACA and Contraceptive Mandate
Under the ACA, an employer with more than 50 full-time employees must provide qualifying health insurance coverage to its employees. If such an employer does not provide health insurance coverage, it may be liable for assessable payments under 26 U.S.C. § 4980H(a) if one or more of its employees qualifies for a premium tax credit on the Health Insurance Marketplace.
One issue the ACA sought to address was the underutilization of preventative services due largely to the costs associated with such preventative services. As a part of the law's overall goal of encouraging preventative care, the ACA requires coverage of certain preventative services to women without cost-sharing, including copayments, coinsurance, or deductibles. With respect to contraception coverage, HHS requested the Institute of Medicine (" IOM" ) conduct research to determine which preventative services should be required.
The research indicated that negative health consequences for the mother and child may occur in cases when a pregnancy is unintended. Further, unintended pregnancy can result in delayed prenatal care, continuation of behaviors which create risks for the fetus, as well as depression and anxiety. Contraceptives also help space pregnancies, which avoids the risk associated with closely-spaced pregnancies. In addition, contraceptives may be used by women for whom pregnancy is contraindicated and to treat or prevent other conditions, such as menstrual disorders, acne, and certain cancers. Further, the research indicated women in reproductive years spend 68 percent more on out-of-pocket health care costs than men.
The Health Resources and Services Administration (" HRSA" ) guidelines for preventative care and screening were created based upon the recommendations from the IOM. The guidelines require all FDA-approved contraceptives be covered, as well as patient education and counseling regarding those contraceptives, for women. This portion of the guidelines has been referred to as the Contraceptive Mandate (" Mandate" ).
The Mandate applies to all non-grandfathered plans offered either by employers or on the Health Insurance Marketplace, except " religious employers." The religious employer generally applies to houses of worship. Specifically a religious employer " is one that: (1) [h]as the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a nonprofit organization described in section 6033(a)(1) and (a)(3)(A)(i) or (iii) of the Code." Coverage of Certain Preventive Services Under the Affordable Care Act, 78 Fed.Reg. 39,870, 39,873-74; 45 C.F.R. § 147.131(a).
The School is considered a religious nonprofit under the ACA. Religious nonprofits may receive an accommodation as an eligible organization. In order to qualify, an eligible organization must: (1) have a religious objection to some or all contraceptive services required; (2) be a nonprofit entity; (3) hold itself out as a religious organization; and (4) self-certify the above either through EBSA Form 700 (" Form 700" ) sent to the insurance provider ...