A federal judge in Pennsylvania has struck down a Trump-era rule that allowed employers with religious or moral objections to opt out of an Affordable Care Act (ACA) mandate requiring health insurance plans to cover abortion and contraceptives. The decision, issued on August 13, 2025, by U.S. District Court Judge Wendy Beetlestone, declared the 2018 rules “arbitrary and capricious” and in violation of federal law, delivering a significant blow to religious liberty advocates.
The ruling, detailed in a 55-page opinion from the Eastern District of Pennsylvania, vacates both the religious and moral exemption rules enacted during President Donald Trump’s first administration. These rules permitted employers, including religious organizations, to exclude coverage for contraceptives and abortion services from employee health plans based on sincerely held beliefs. Judge Beetlestone’s decision came in response to lawsuits filed by Pennsylvania and New Jersey, which argued that the exemptions undermined access to essential healthcare services.
Beetlestone’s ruling hinged on the Religious Freedom Restoration Act (RFRA), a 1993 law prohibiting the government from substantially burdening religious exercise unless it meets strict criteria. The judge concluded that the exemption rules were not rationally connected to addressing RFRA violations. “The Rule is not arbitrary and capricious because it draws imprecise lines,” she wrote. “It is arbitrary and capricious because the Agencies identified a problem (RFRA violations) and then proposed a solution that is not rationally connected to solving that problem (exempting organizations whose compliance with the Accommodation posed no potential conflict with RFRA to begin with).”
The decision favors Pennsylvania and New Jersey, with a spokesperson for the New Jersey Attorney General’s Office telling The Epoch Times via email: “We are gratified that a federal court has agreed with us that the Trump Administration violated the law by exempting certain entities from the requirement to provide health insurance coverage for contraceptives.” The White House declined to comment on the ruling.
The case has drawn sharp criticism from religious organizations and their legal advocates, particularly the Little Sisters of the Poor, a Catholic nonprofit that has been a defendant-intervenor in the litigation. Mark Rienzi, president of Becket, a public interest legal institute, called the decision an “out-of-control effort by Pennsylvania and New Jersey to attack the Little Sisters and religious liberty.” He criticized the court for issuing a nationwide ruling without addressing constitutional issues or holding a hearing after five years of litigation. “It is absurd to think the Little Sisters might need yet another trip to the Supreme Court to end what has now been more than a dozen years of litigation over the same issue,” Rienzi said, vowing to continue the fight to protect the group’s right to serve the elderly without violating their religious convictions.
The dispute traces back to the ACA, commonly known as Obamacare, which mandates that employer-sponsored health plans cover preventive services, including contraceptives, at no cost to employees. The 2018 rules were designed to address concerns from religious groups, like the Little Sisters, that compliance with the mandate violated their beliefs. A 2020 Supreme Court decision, written by Justice Clarence Thomas, upheld the authority of federal agencies to create such exemptions, stating, “The plain language of the statute clearly allows the Departments to create the preventive care standards as well as the religious and moral exemptions.” Justice Samuel Alito, in a concurring opinion, argued that the exemptions were not arbitrary or capricious, though the Court remanded the issue to lower courts for further review.
Litigation stalled as the Biden administration drafted narrower exemption rules in 2024, only to withdraw them shortly before President Trump’s second term began. Judge Beetlestone noted that with the 2018 rules still in effect, the case was “ripe for resolution.”
The ruling reignites a contentious debate over balancing religious liberty with access to healthcare. For states like Pennsylvania and New Jersey, the decision reinforces the ACA’s mandate to ensure comprehensive coverage. For religious organizations, it raises concerns about government overreach into matters of conscience. As the Little Sisters and their advocates consider an appeal, the case may once again escalate to the Supreme Court, prolonging a legal battle that has spanned over a decade.
