The ruling by U.S. District Judge Audrey Fleissig cites a provision in the U.S. Constitution declaring that federal laws take precedence over contradictory state laws. But Fleissig emphasized that she was taking no position on the merits of the Obama administration policy, which requires insurers to cover contraception at no additional cost to women.
Missouri Attorney General Chris Koster did not say on Monday whether he would appeal the ruling, which was dated Thursday but not publicized.
The anti-abortion group Campaign Life Missouri distributed an email Monday denouncing the ruling as "a radical departure from America's tradition of religious freedom" and imploring people to contact Koster's office in support of an appeal. Some backers of Missouri's law said the court ruling could result in churches and other religious organizations having to accept insurance policies that include contraception coverage.
The Missouri law requires insurers to issue policies without contraception coverage if individuals or employers assert that the use of birth control violates their "moral, ethical or religious beliefs." The state's Republican-led Legislature overrode the veto of Democratic Gov. Jay Nixon last September to enact the law, which appeared to be the first in the nation to directly rebut the Obama administration's contraception policy.
Fleissig had issued a temporary restraining order against Missouri's law last December. The law had been challenged by insurance providers, who feared they could be caught in legal quagmire by the differing federal and state requirements.
In her ruling, Fleissig wrote that the state law "is in conflict with, and pre-empted by, existing federal law" and "could force health insurers to risk fines and penalties by choosing between compliance with state or federal law."
The judge noted that the federal law includes penalties of $100 per day per employee and an annual tax surcharge of $2,000 per employee for violations of its provisions. The state insurance department already issued orders seeking civil penalties against two insurers for not offering plans excluding contraception coverage as required by the Missouri law.
The ruling "clears up what law they have to write the policies under, and that's all we were asking," said Brent Butler, the government affairs director for the Missouri Insurance Coalition, an industry trade group that was one of the plaintiffs.
Although she struck it down, Fleissig did not issue a permanent injunction against Missouri's law because she said the state insurance department had agreed not to enforce it and to withdraw its administrative complaints against the health insurers.
Among those supporting the Missouri law was Our Lady's Inn, a St. Louis area nonprofit that provides homes and counseling for pregnant women. The organization had filed a court document saying it wanted to use the Missouri law to opt out of contraception coverage for its employees' insurance policies.
"The point of the law was to tell health insurance companies that they're supposed to honor the wishes -- pro or con -- of people who have religious or ethical objections to what's in the policy," said Timothy Belz, a St. Louis attorney who represented Our Lady's Inn.
Under the Obama administration policy, churches are exempt from the contraception coverage requirement, but it would extend to insurers who provide policies to religiously affiliated nonprofits such as hospitals, colleges or charities.
Before last year's legislation, Missouri had been operating under a 2001 law that required birth control prescriptions to be covered under policies that include pharmaceutical benefits at the same co-payment as other medications. That law also had allowed insurers to offer policies without contraception coverage to people or employers who say it violated their moral or religious beliefs. Fleissig's ruling left in place in the wording requiring contraception to be included in pharmaceutical coverage but struck down the section containing the opt-out provisions.
"Now you've got a situation where the Missouri law requires more in the way of contraceptive coverage than Obamacare does," Belz said.
Peter Brownlie, president and CEO of Planned Parenthood of Kansas and Mid-Missouri, praised the ruling for ensuring "that all Missouri women --no matter who their boss is -- have access to basic preventive health care without a co-pay, including birth control."
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