Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, 591 U.S. ___ (2020), was a United States Supreme Court case involving ongoing conflicts between the Patient Protection and Affordable Care Act (ACA) and the Religious Freedom Restoration Act (RFRA) over the ACA's contraceptive mandate. The ACA exempts nonprofit religious organizations from complying with the mandate, to which for-profit religious organizations objected. The case is a result of prior court actions in Burwell v. Hobby Lobby Stores, Inc., in 2014, and Zubik v. Burwell, in 2016, which left the United States Department of Health and Human Services (HHS) to promulgate new regulations on the mandate. President Donald Trump issued an Executive Order to the HHS to bypass the traditional regulatory process, leading HHS to devise new rules in late 2017 to give for-profit groups exemptions for religious or moral objections to the mandate. Several states sued the federal government, and multiple Circuit Courts placed injunctions on the new rules as arbitrary and capricious and required by neither the ACA or the RFRA, violating the Administrative Procedure Act (APA). This case was a consolidation of two appeals from the injunction placed by the United States Court of Appeals for the Third Circuit. The Supreme Court ruled on July 8, 2020, in a 7–2 decision that the new rules were valid, as the associated departments had the authority to promulgate the exemptions, and that the process to put the rules in place did not violate the APA. Background Burwell v. Hobby Lobby Stores, Inc. The Patient Protection and Affordable Care Act (ACA) passed in 2010 under President Barack Obama. The ACA did not displace the system then in effect whereby most of the U.S. population receives health insurance under plans that their employers arrange through the private market. Instead it sought to expand the number who are insured and improve and subsidize insurance coverage. Regulations within the ACA and its Women's Health Amendment imposed a range of requirements on group health plans, which included that they cover "essential health benefits", including "preventative and wellness services" from health care providers without imposing cost sharing on patients. The Obama administration, through the United States Department of Health and Human Services (HHS) as directed through the Health Resources and Services Administration (HRSA), decided that to meet "compelling health and gender equity goals", the ACA's "preventative and wellness services" included contraceptives. This contraceptive mandate