A federal appeals court in Washington has rejected a challenge to Obamacare regulations that allow religious nonprofits to opt out of providing birth control coverage.

The Catholic Archbishop of Washington and nonprofits affiliated with the Roman Catholic Church challenged the regulations, contending they do not go far enough.

The regulations at issue were adopted by the Obama administration to accommodate religious nonprofits that object to including birth control in their health insurance plans.

Purely religious organizations are automatically exempt from the birth control mandate. But religious nonprofits — including universities, hospitals, social service organizations and charities — are not because many of their employees, and students, do not subscribe to the same religious beliefs. To deal with that dilemma, the regulations allow religious nonprofits to opt out of birth control coverage by certifying their objections to their insurers with a letter or single-page form. That allows the insurance companies to offer such coverage independently to employees and students who want the coverage.

Those challenging the regulations contend that the simple act of opting out burdens their faith by activating substitute coverage. The court rejected that claim, calling it "extraordinary and potentially far reaching."

The decision is the first since the U.S. Supreme Court last June ruled that some for-profit companies may, like religious nonprofits, opt out of providing birth control coverage in their insurance plans. In the cases that have followed, various religious nonprofits have maintained, as they did in the Washington case, that the opt-out provision itself is a "substantial burden" on religion, and thus, that it violates the Religious Freedom Restoration Act, a federal law enacted to enhance religious rights.

In rejecting that claim, the U.S. Court of Appeals for the District of Columbia said that "Religious objectors do not suffer substantial burdens ... where the only harm to them is that they sincerely feel aggrieved by their inability to prevent what other people would do ... "

These religious objectors have no right, the court said, "to be free from the unease, or even anguish" of knowing that others are legally entitled to receive or provide birth control. The court noted that birth control coverage was added to the Affordable Care Act because it accounts for a large part of women's preventive health care costs.

Writing for the 3-0 court panel, Judge Cornelia Pillard said the challengers' argument that the opt out harms them by triggering substitute coverage makes little sense in light of the government's need to carry out a duly enacted program. Using the same theory, she said, a religious conscientious objector to the draft would not have to identify himself as a religious objector on a Selective Service form because that would "trigger" the drafting of another person in his place and "thereby implicate the objector in facilitating war."

Neither the draft requirement nor the opt-out requirement imposes a substantial burden on religion, she said.

"A substantial burden exists when government action puts substantial pressure on an adherent to modify his behavior and to violate his beliefs," Pillard said. "A burden does not rise to the level of being substantial when it places an inconsequential or de minimis burden on an adherent's religious exercise."

The regulations at issue here, she said, in no way involve the challengers in providing contraception services. To the contrary, the opt-out mechanism "fastidiously relieves" them of "any obligation" to contract or pay for, arrange, or in any other way provide contraception services; it provides a "simple, one-step form for ... washing their hands" of all birth control matters.

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