For more than a decade, the battle over whether religious organizations must comply with the Affordable Care Act’s contraception mandate has been a flashpoint in America’s broader culture wars. The latest chapter unfolded in Philadelphia on August 13, 2025, when District Judge Wendy Beetlestone issued a sweeping summary judgment that blocked the Trump administration’s 2017 religious and moral carve-outs to the ObamaCare contraception coverage requirement. According to reporting by Nexstar Media, Judge Beetlestone ruled that the rules were “arbitrary, capricious and an overreach of the authority of the agencies that wrote them.”
This ruling reignites a national debate that has pitted religious liberty advocates against supporters of comprehensive women’s health coverage, with the Little Sisters of the Poor—a Catholic order of nuns who provide end-of-life care to the elderly—once again at the center of the legal storm. The Little Sisters, represented by the Becket Fund for Religious Liberty, have already announced plans to appeal the decision in the coming weeks.
The controversy dates back to the Obama administration’s implementation of the Affordable Care Act (ACA). The ACA required that employer health plans cover at least one of 18 forms of birth control approved by the Food and Drug Administration at no cost to employees. Notably, the original mandate included no explicit religious exemption, a move that quickly drew lawsuits from religious groups and employers who argued that the requirement forced them to act against their faith.
In 2014, the Supreme Court ruled 5-4 that the contraceptive mandate violated the Religious Freedom Restoration Act (RFRA) rights of closely held corporations whose owners had religious objections. This decision, as chronicled by Nexstar Media, established a legal precedent but left open questions about how far exemptions should extend and who should qualify for them.
The Trump administration sought to resolve these questions in 2017 by issuing broad exemptions. Under the new rules, any for-profit or nonprofit employer or insurer could exempt themselves from the birth control mandate on moral or religious grounds. Publicly traded companies could claim religious, but not moral, exemptions. Importantly, the rules did not require employers to apply for an exemption, as the administration argued that such a requirement would itself violate religious rights.
This broad expansion of exemptions drew swift legal challenges from Pennsylvania, New Jersey, and dozens of other states. The states argued that the rules undermined women’s access to preventative health care and represented an unlawful overreach by executive agencies. The dispute eventually reached the Supreme Court in 2020, which upheld the Trump rules on technical grounds but declined to address the underlying merits of the case. The case was then sent back to the lower courts, where the Little Sisters of the Poor joined the lawsuit alongside the federal government in seeking summary judgment.
Judge Beetlestone, an appointee of former President Obama, concluded that the Trump administration’s rules failed to resolve the purported conflict between the contraceptive mandate and RFRA. In her decision, she wrote, “The rule exemptions to organizations that are ‘unlikely, if ever, to be capable of maintaining a religious objection, raising further doubts as to any ‘rational connection’ between the Rule and remedying potential conflicts with RFRA.’” This, she argued, meant the rules lacked a rational basis for remedying the legal issues at hand.
The ruling means that religious nonprofits and businesses will once again have to apply for special accommodations from the Department of Health and Human Services if they wish to avoid paying for contraceptives, including those they believe act as abortifacients. As The Daily Signal noted, “Even if the Trump administration grants every one of them, one day there will be authoritarians in charge who won’t.” The article further criticized the legal requirement to seek exemptions as an affront to religious liberty, stating, “The very idea that an American citizen should be impelled to ask the state for an ‘exemption’ to practice their faith is an assault on the fundamental idea of liberty.”
The judge’s decision is not her first involvement in this saga. As reported by The Daily Signal, Beetlestone had previously issued a nationwide injunction against the contraception exemption back in 2017, arguing it was “difficult to think of any rule that intrudes more into the lives of women.” That injunction was overturned by the Supreme Court in 2020 by a 7-2 majority, but the legal fight has persisted, with each side digging in on deeply held principles.
Supporters of the contraception mandate argue that access to birth control is a fundamental component of women’s health and equality. They contend that allowing broad exemptions undermines the ACA’s goal of providing comprehensive preventative care and shifts the burden onto female employees, particularly those working for religious nonprofits or closely held businesses. Critics, meanwhile, see the mandate as an overreach that tramples on First Amendment rights and forces religious organizations to violate their beliefs.
The Little Sisters of the Poor have become a symbol for those fighting what they see as government overreach into religious practice. The Daily Signal described their years-long struggle as “reminiscent of the travails of Jack Phillips, the Colorado baker who refuses to create unique message cakes for gay weddings.” The article drew parallels to other religious liberty battles, including Catholic Charities adoption agencies that shuttered in several states over same-sex adoption policies.
The legal debate hinges on the requirements of the Religious Freedom Restoration Act. As The Daily Signal put it, “The Religious Freedom Restoration Act holds that the state must have a ‘compelling interest’ and use the least restrictive means when burdening religious practice. Free birth control isn’t a compelling interest. And fining religious organizations millions of dollars to pressure them into abandoning their beliefs is perhaps the most restrictive means of action, short of throwing nuns in prison.”
On the other side, advocates for the mandate argue that the state’s interest in ensuring equal access to healthcare for women is indeed compelling, and that the exemptions create unnecessary barriers and stigma for those seeking contraception. They point out that even with exemptions, employees are still guaranteed contraception through health plans paid for by employers, though the process may become more complicated or stigmatized.
Ultimately, the case underscores the enduring tension between religious liberty and the state’s interest in providing comprehensive health coverage. As the legal battle moves to the appeals court, both sides are preparing for another round in what has become one of the most contentious and closely watched religious liberty cases in recent memory. For now, the Little Sisters of the Poor and other religious organizations must once again navigate a legal landscape that seems far from settled.
With each new ruling, the contours of religious liberty and women’s health rights in America are being redrawn—sometimes subtly, sometimes in sweeping strokes. The only certainty is that the debate is far from over, and the outcome will shape the lives and beliefs of millions across the country.