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”.