Court ruling may force Little Sisters to cover abortion and contraceptives

A federal judge in Philadelphia has dealt a fresh legal blow to the Little Sisters of the Poor. The ruling reignites a dispute over contraception mandates that has spanned more than a decade and twice reached the United States Supreme Court.

On 13 August 2025, the U.S. District Court for the Eastern District of Pennsylvania ruled in favour of Pennsylvania and New Jersey, striking down a “religious conscience” rule from Donald Trump’s first term that granted the Little Sisters and other religious organisations exemptions from the Affordable Care Act’s contraceptive requirements. The court declared the exemptions “arbitrary [and] capricious” under the Administrative Procedure Act and vacated them “in their entirety”.

The decision reopens the possibility that the Little Sisters, an international congregation of Catholic women religious founded in 1839 by Saint Jeanne Jugan to care for the elderly poor, could face a stark choice: provide abortion-inducing drugs in employee health plans or incur millions of dollars in fines.

The legal conflict began in 2011, when the U.S. Department of Health and Human Services, under the Affordable Care Act, required employer-provided health insurance to include “preventive care” for women, encompassing contraceptives and certain abortifacients. The Obama administration granted broad exemptions for “grandfathered” health plans and some secular employers, but no permanent accommodation for religious orders such as the Little Sisters.

In 2016, in Zubik v. Burwell, the Supreme Court ordered the federal government to find a solution that respected both women’s access to contraceptives and employers’ religious freedom. A year later, the Trump administration created a clear religious exemption, which Pennsylvania and New Jersey promptly challenged.

In 2020, the Supreme Court ruled in Little Sisters of the Poor v. Pennsylvania that the Trump administration acted within its authority. The 7–2 decision was hailed as a decisive victory for the nuns, but the August ruling shows the matter is far from settled.

“The district court blessed an out-of-control effort by Pennsylvania and New Jersey to attack the Little Sisters and religious liberty,” said Mark Rienzi, president of Becket and lead counsel for the nuns, in a statement on their website. “It’s bad enough that the district court issued a nationwide ruling invalidating federal religious conscience rules. But even worse is that the district court simply ducked the glaring constitutional issues in this case, after waiting five years and not even holding a hearing. 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.”

Diana Thomson, senior counsel at Becket, accused the states of reviving “cutting-floor arguments” they had previously abandoned. Speaking to CNA, she said: “Instead of dropping the case, Pennsylvania and New Jersey revitalised their cutting-floor arguments that they chose not to pursue at the Supreme Court last time… The court is trying to find a loophole to the 2020 Supreme Court ruling.”

The Little Sisters, who operate homes for the elderly across the United States, say the decision threatens their mission. “As Little Sisters of the Poor, we dedicate our lives to caring for the elderly poor until God calls them home,” said Mother Loraine Marie Maguire, the congregation’s U.S. superior, in a statement on 13 August. “We will continue to fight for the right to carry out our mission without violating our faith, and we pray Pennsylvania and New Jersey will end this needless harassment.”

The nuns have confirmed they will appeal to the U.S. Court of Appeals for the Third Circuit, with Rienzi vowing to take the matter “all the way to the Supreme Court if we have to.”