Should employers be required to cover birth control in health insurance plans, even if they have religious objections?

Background

The Affordable Care Act requires most private health insurance plans to cover all FDA-approved contraceptive methods without cost-sharing, a provision that has benefited tens of millions of women since it took effect in 2012. However, the question of whether employers with religious objections must comply has been one of the most litigated issues under the ACA, reaching the Supreme Court three times. In the landmark 2014 Burwell v. Hobby Lobby decision, the Court ruled that closely held for-profit corporations could refuse to provide contraceptive coverage for sincerely held religious reasons. Then in 2020, in Little Sisters of the Poor v. Pennsylvania, the Court upheld broad Trump-era rules allowing virtually any employer with religious or moral objections to opt out entirely. As recently as August 2025, a federal district court in Philadelphia issued a nationwide ruling against the Little Sisters of the Poor over the contraceptive mandate, and ongoing litigation continues. Meanwhile, the Supreme Court's June 2025 decision in Kennedy v. Braidwood upheld the broader ACA preventive services framework as constitutional, keeping contraceptive coverage requirements intact for employers that do not claim exemptions.

Supporters of requiring employers to cover contraception regardless of religious objections argue that health care decisions should be between a patient and a doctor, not subject to an employer's beliefs. According to the Commonwealth Fund, nearly eight in ten women and eight in ten Catholics agree that birth control should be a required benefit for all health insurance plans. Research published in Obstetrics and Gynecology found that after the ACA eliminated cost-sharing for contraception, out-of-pocket spending dropped from an average of roughly ninety dollars per year to approximately five dollars, and both pregnancy and abortion rates declined. Opponents counter that the government cannot compel employers to act against deeply held religious convictions without violating the Religious Freedom Restoration Act and the First Amendment. They argue the accommodation process itself burdens religious exercise, and that the government should find other means to deliver contraceptive coverage rather than forcing objecting employers to participate.

The stakes are significant. According to the Commonwealth Fund, the Supreme Court's 2020 ruling immediately affected between roughly 70,500 and 126,400 women's access to low-cost contraceptives, and could potentially impact up to 2.9 million more if additional employers choose to claim exemptions. KFF reports that one in four privately insured contraceptive users still pay out of pocket for some or all of their birth control. With thirty-one states and Washington, D.C., maintaining their own contraceptive coverage laws, the patchwork of federal exemptions and state requirements means that where a woman works and lives may determine whether she can access affordable contraception — a reality with direct consequences for reproductive autonomy, economic security, and public health.