The 8th U.S. Circuit Court of Appeals has ruled against the Affordable Care Act’s contraception mandate, making it likely that the U.S. Supreme Court will revisit the requirement to resolve a split among circuit courts.

The 8th Circuit court is the first to rule that the government’s religious freedom accommodation is not enough, and that forcing organizations to offer contraceptive coverage – even indirectly – violates their religious rights.

The appeals court issued two decisions on Sept. 17 striking down the contraception mandate’s exception. The first opinion revolved around two Missouri nonprofit organizations that provide residential and educational services to people with behavioral problems and dependency conditions. In their lawsuit against the U.S. Department of Health & Human Services, the nonprofits argued that the contraceptive mandate itself, and its accommodation process, impose substantial burdens on their exercise of religion in violation of the Religious Freedom Restoration Act.

The accommodation clause refers to an exception for organizations that oppose coverage for contraceptives, but are not exempted entities such as churches. To get out of the requirement to cover contraception, the companies must send a letter to the government with their objections. Insurers and the government will then provide coverage for birth control without the employer’s assistance.

But the Missouri nonprofits and other religious groups counter that the process serves as a “trigger” that enables contraceptive use and makes the groups complicit. A panel 8th Circuit agreed, ruling that compliance with the mandate’s so-called accommodation violates the organizations’ religious freedoms, and that the exception is “not the least restrictive means of furthering the government’s interests.”

The court applied the same reasoning to a similar case brought by an Iowa college. In both cases, the appeals court temporarily blocked the organizations from having to comply with the contraception mandate while the cases moved forward.

The decisions are at odds with a handful of other circuit courts, including rulings by the 2nd and 5th Circuits. Other judges have ruled that the accommodation relieves, rather than burdens plaintiffs’ religious rights.

The 8th Circuit court’s recent rulings could influence whether the Supreme Court takes up the issue.

Currently, seven petitions requesting that the Supreme Court rereview the contraception mandate process are pending. The cases all have some objection to the mandate, its operation, or some of the contraceptives covered. Sixteen states have also asked the Supreme Court to revisit the mandate.

The cases follow last year’s Supreme Court ruling in Burwell v. Hobby Lobby Stores. In that decision, the justices ruled that for-profit firms owned by religiously devout owners could not be forced to provide birth control coverage to their employees under the ACA.

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