Little Sisters of the Poor defend federal contraceptive mandate exemptions before appeals court amid a 15-year religious freedom dispute.
Newsroom (08/07/2026 Gaudium Press ) The Little Sisters of the Poor returned to federal court on July 7, continuing a legal fight that has spanned more than 15 years over whether religious organizations can be exempted from federal contraception coverage requirements.
The case, now before the U.S. Court of Appeals for the 3rd Circuit, centers on federal exemptions from a contraception mandate introduced through regulations issued by the U.S. Department of Health and Human Services (HHS) in 2011. The rules, implemented under the Affordable Care Act, require employers to include contraception coverage in employee health insurance plans.
Although the Catholic religious society has already prevailed in two Supreme Court cases related to the dispute, the latest challenge focuses on questions the nation’s highest court has not yet addressed. Attorneys general from Pennsylvania and New Jersey argue that the current federal exemptions are unlawful because they are overly broad and were adopted in an arbitrary and capricious manner.
A lower court sided with the two states, ruling against the Little Sisters of the Poor and finding flaws in the federal government’s justification for the exemptions. The religious order subsequently appealed the decision.
States Challenge Breadth of Religious and Moral Exemptions
Representing Pennsylvania and New Jersey, attorney Aimee Thomson argued before the appellate panel that the exemptions extend far beyond the employers who originally raised religious objections to the mandate.
Under current federal rules, employers with religious or moral objections may choose an accommodation through which the federal government subsidizes contraception coverage. Employers that object even to that accommodation can be entirely exempted from providing contraception coverage.
Thomson contended that these broad protections exceed what is required under the Religious Freedom Restoration Act (RFRA). She argued that federal regulators failed to adequately demonstrate that such expansive exemptions were necessary to address religious liberty concerns.
The states also raised concerns about the possibility of employers obtaining exemptions despite lacking sincere religious or moral objections. Thomson said it remains uncertain how many women may have been affected by potentially insincere claims, but argued that requiring employees to investigate and challenge an employer’s motives places an unfair burden on women seeking healthcare coverage.
“That is an incredible burden to place on employees and on women,” Thomson told the court.
Little Sisters Argue Exemptions Reflect Supreme Court Guidance
Mark Rienzi, president of Becket and lead attorney representing the Little Sisters of the Poor, defended the federal policy as a reasonable attempt to balance healthcare objectives with religious liberty protections.
According to Rienzi, federal regulators followed guidance provided by the Supreme Court by creating a system that preserved the contraception mandate while accommodating religious objections.
“The federal government,” he argued, sought to “choose a middle ground” that protected both policy goals and constitutional concerns.
Rienzi rejected the argument that the exemptions were arbitrary and capricious, emphasizing that a regulation does not become unlawful simply because it offers protections broader than the minimum required under RFRA.
“This law is about the federal government … accommodating religion with its own mandate,” he told the judges.
Justice Department Backs the Exemptions
The Little Sisters also received support from the federal government during the hearing.
Deputy Assistant Attorney General Eric McArthur, appearing on behalf of the Department of Justice, argued that RFRA does not require regulators to adopt only the narrowest possible solution when addressing burdens on religious exercise.
McArthur said HHS reviewed the issue comprehensively and ultimately determined that creating exemptions was the most appropriate administrative response to religious and moral objections. He maintained that the agency was entitled to adopt the exemptions as a policy choice, even in circumstances where RFRA might not explicitly compel such action.
Responding to concerns about insincere objections, McArthur argued there is little incentive for employers to seek exemptions dishonestly because an accommodation option already exists at no cost to employers.
He further suggested that if the court concludes portions of the rule are overly broad, it could strike a specific provision rather than invalidate the entire regulatory framework, as requested by Pennsylvania and New Jersey.
Religious Order Says Lawsuit Threatens Its Mission
Following oral arguments, Mother Loraine Marie Maguire of the Little Sisters of the Poor said the ongoing litigation threatens the organization’s religious mission of caring for the elderly poor.
The Catholic order has long maintained that complying with contraception coverage requirements would conflict with its religious beliefs. The sisters argue that preserving the exemptions is essential to allowing them to continue their ministry without government interference.
“This is our God-given mission,” Maguire said in a statement after the hearing.
She emphasized the organization’s nearly 200-year history of serving elderly and dying individuals and warned that continued legal challenges could hinder its work at a time when the senior population is rapidly increasing.
“For nearly 200 years we have welcomed the elderly poor and dying into our homes,” she said. “Pennsylvania and New Jersey can keep fighting if they want. All we want is to keep serving.”
A Legal Battle Far From Over
The latest appeal represents another chapter in one of the most prominent religious liberty disputes arising from the Affordable Care Act. While previous Supreme Court rulings established that the federal government must protect religious objectors and possesses authority to create exemptions, the Third Circuit is now being asked to determine whether the scope of those exemptions was lawfully crafted.
Its eventual ruling could have significant implications for the balance between healthcare access, administrative authority, and religious freedom protections in federal policy.
- Raju Hasmukh with files from NCRegister
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