Parents have standing in contraceptive mandate lawsuit

The latest challenge to the enforcement of the contraceptive mandate under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) has been cleared to proceed, as the Eighth Circuit Court of Appeals ruled that parents who sought to enjoin the enforcement of the mandate sufficiently alleged an injury to establish standing in their lawsuit. The parents, who were previously offered an option to opt out of contraceptive coverage in their health insurance plans offered by the State of Missouri, sufficiently alleged that they suffered an injury when they were offered only contraceptive-covering plans that violated their “sincerely held religious beliefs” (Wieland v. HHS, July 20, 2015, Wollman, R.).


Paul Wieland, a member of the Missouri House of Representatives, obtains health care insurance through the State of Missouri’s group health insurance plan, Missouri Consolidated Health Care Plan (MCHCP). Wieland and his wife, Teresa, are parents to three daughters and they claim that, as Roman Catholics, they cannot pay for health care insurance that covers contraceptives. Prior to August of 2013, pursuant to Missouri law, MCHCP allowed the Wielands to opt out of contraceptive coverage in their insurance plans. This option was discontinued after a district court decision in Missouri Insurance Coalition v. Huff, in which the Missouri statute that permitted the opting out was found to be preempted by the ACA (see State contraceptive coverage law preempted by ACA requirement, Health Reform WK-EDGE, March 18, 2013). The state opted not to challenge the decision and, thereafter, the Wielands’ health care plan provided coverage for contraceptives, which they claimed violated their religious beliefs.


The Wielands filed suit against various departments, including HHS, claiming that the department’s enforcement or threatened enforcement of the ACA mandate provision caused the MCHCP to enroll them in a health care insurance plan that included contraceptive coverage, which forced them to provide contraceptive coverage for their daughters. They challenged the ACA provisions as applied to group health plans and health insurance issuers offering group plans. They also challenged the interim final rule that required group health plans and issuers to offer health insurance coverage for contraceptives as violating their rights under various constitutional provisions, the Religious Freedom Restoration Act of 1993 (RFRA) (42 U.S.C. §2000bb et seq.), and the Administrative Procedure Act (5 U.S.C. §706). Their complaint was dismissed based on the court’s finding that they lacked standing to bring suit (see Court rejects parent’s challenge to individual mandate for birth control coverage, Health Reform WK-EDGE, October 17, 2013). The Wielands appealed the dismissal.

Causal connection

The Wielands had standing to bring suit because they sufficiently alleged a chain of causation that ran from the mandate to their inclusion in a health care plan that provided contraceptive coverage. In order to have standing to bring suit, a party must establish that he or she has personally suffered an injury, actual or threatened, caused by the illegal conduct of the defendant. The party must further demonstrate that he or she suffered an “injury in fact,” that is not conjectural and that the injury is causally connected to the illegal conduct of the defendant. Finally, a party must allege sufficient facts to establish that the injury will be “redressed by a favorable decision.”

The Wielands sufficiently alleged that, but for the mandate, they would have been able to have a contraceptive-free health insurance plan. Additionally, the Wielands’ injury was “fairly traceable” from the enforcement of the mandate to MCHCP and to the Wielands because the mandate requires group health plans and issuers to include contraceptive coverage, which caused the state and MCHCP to eliminate all contraceptive-free health insurance plans and to place the Wielands in a contraceptive-covering plan, which caused the Wielands’ claimed injury. The federal law and its mandate were the “but-for cause” of the changes in the Wielands’ health insurance plan because the Wielands alleged that they were placed in a health insurance plan that covered contraceptives, not because of any discretionary actions of the State of Missouri, but rather, due to HHS’s enforcement of the mandate. The state and MCHCP were required under federal law to ensure that all health insurance plans they offered included contraceptive coverage. Therefore, the Wielands established a causal connection between the HHS enforcement of the mandate and their injury. Additionally, the Wielands sufficiently alleged that their injury could be redressed by the relief they sought (an injunction) and that they would be offered a contraceptive-free health insurance plan under Missouri law.

Huff decision

The court concluded that the validity of the Huff decision had to be considered in light of the U.S. Supreme Court’s decision in Burwell v. Hobby Lobby Stores, Inc. If the decision overruled Huff, then the Missouri statutory opt-out provision for contraceptive coverage would again be available to the Wielands.


The court concluded that it was more than speculative that the Wielands’ injury would be redressed if the injunction against the mandate enforcement they sought was granted. Prior to the threatened enforcement of the mandate, MCHCP and the state were willing to offer the Wielands a contraceptive-free health insurance plan, which the court found to be persuasive evidence that such plans would be again available to the Wielands if they obtained their requested relief. As a result, the district court’s dismissal of the case was reversed and the matter was remanded for further proceedings.

The case is No. 13-3528.