The U.S. Supreme Court is expected to issue its ruling this week in the case of two companies against the Patient Protection and Affordable Care Act and its contraception coverage mandate. What, exactly, is at stake for the law?
The PPACA requires employers to include a set of preventive services in their employees' healthcare plans, if they offer healthcare benefits. The Obama administration included FDA-approved contraceptives in the list of mandatory preventive services, and the government has argued that requiring effective contraception in health plans is justified as a matter of gender equality.
Thus, under the law, employers (except churches and those that are strictly religious) must include all FDA-approved contraceptives in their health plans, and there is no cost-sharing for employees. The law gave an alternative to groups with religious affiliations, like a Catholic charity, to provide contraceptives to employees through a third party. There is no provision in the law that exempts for-profit companies from providing contraceptives, even if they are owned by religious families.
Craft chain Hobby Lobby and Conestoga Wood Specialties, a furniture store, claim the mandate violates their religious liberty under the First Amendment and a 1993 federal law called the Religious Freedom Restoration Act. Here are five things to keep in mind in anticipation of a SCOTUS decision this week.
1. The core question in the case is whether a for-profit corporation can have a fundamental right to exercise religion. Both companies are family-owned: The Evangelical Christian Green family owns Hobby Lobby, which employs about 21,000. The Mennonite Hahn family owns Conestoga, a furniture company that employs about 1,000. If the court sides with them, Hobby Lobby and Conestoga would exercise their First Amendment right to religion by refusing to cover birth control in their employees' healthcare plans.
2. If the courts issue a First Amendment proclamation of corporations' right to exercise religion, this would be the most sweeping outcome. Any corporation could potentially avoid the contraception mandate. Sam Baker, writer for The National Journal, wrote that this outcome "would be almost a sequel to the Citizens United case on campaign finance laws and free speech." A decision such as this would have implications not only for women and their reproductive health, but for a bevy of other medical services. Fifteen states filed a brief arguing that businesses would be able to deny coverage for blood transfusions, psychiatric care and treatment with stem cells, for example. 
3. No matter what happens, SCOTUS will not strike down the entire contraception mandate. The aforementioned (point No. 2) would be the most extreme outcome of the case. Hobby Lobby nor Conestoga have asked the justices to strike the entire mandate. This week's ruling will not alter the PPACA.
4. SCOTUS may take a more moderate approach by ruling in favor of Hobby Lobby and Conestoga, but limiting the right to religious freedom to closely held companies, which have a limited number of shareholders, or privately-held companies, which are controlled either entirely or almost entirely by their owners. This decision would not set as large a precedent for all for-profit corporations, but it would still permit these employers from excluding birth control from health plans.
5. The court could decide against the employers and with the government, and in a few ways. The Religious Freedom Restoration Act states that the government cannot "substantially burden religious exercise" unless there is a compelling interest met in the least restrictive means. The government has argued the mandate advances a compelling government interest — it is part of comprehensive healthcare reform, and granting companies exemption would deprive some Americans of important benefits provided by said reform. In this case, many women would not receive free contraceptive services, which would interfere with the government's public health goal for all women to have adequate access to effective birth control.
And what about that "least restrictive means" clause? The government has argued that any alternative to the insurance mandate would mean upending the PPACA's model, which revolves around employment-based health insurance. Such an overhaul would be "highly impractical," according to the government.
The SCOTUS may also side against the employers by saying they don't have to provide health insurance at all, Emily Martin, vice president and general counsel for the National Women's Law Center, told Salon. "That was an issue that court paid a lot of attention to in oral arguments, the notion that if providing contraception is so objectionable to Hobby Lobby and Conestoga Wood, maybe they should just get out of the health insurance business, and that's an option that they have." If the companies opt to do so, they would have to pay a tax, which acts as a penalty for not supplying insurance. Ms. Martin said the cost of that tax is probably lower than the cost they already bear by providing health insurance.
But the plaintiffs have argued the fine they face for noncompliance with the mandate would be a substantial burden. And this is what the court's decision will ultimately rest on: How large of a burden the contraception mandate — or noncompliance with it — is on these for-profit corporations.
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