FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS DEC 13 2018 MOLLY C. DWYER, CLERK U.S. COURT OF APPEALS FOR THE NINTH CIRCUIT STATE OF CALIFORNIA; STATE OF No. 18-15144 DELAWARE; COMMONWEALTH OF VIRGINIA; STATE OF MARYLAND; D.C. No. 4:17-cv-05783-HSG STATE OF NEW YORK, Plaintiffs-Appellees, OPINION v. ALEX M. AZAR II, Secretary of the United States Department of Health and Human Services; U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES; R. ALEXANDER ACOSTA, in his official capacity as Secretary of the U.S. Department of Labor; U.S. DEPARTMENT OF LABOR; STEVEN TERNER MNUCHIN, in his official capacity as Secretary of the U.S. Department of the Treasury; U.S. DEPARTMENT OF THE TREASURY, Defendants, and THE LITTLE SISTERS OF THE POOR JEANNE JUGAN RESIDENCE, Intervenor-Defendant- Appellant. STATE OF CALIFORNIA; STATE OF No. 18-15166 DELAWARE; COMMONWEALTH OF VIRGINIA; STATE OF MARYLAND; D.C. No. 4:17-cv-05783-HSG STATE OF NEW YORK, Plaintiffs-Appellees, v. ALEX M. AZAR II, Secretary of the United States Department of Health and Human Services; U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES; R. ALEXANDER ACOSTA, in his official capacity as Secretary of the U.S. Department of Labor; U.S. DEPARTMENT OF LABOR; STEVEN TERNER MNUCHIN, in his official capacity as Secretary of the U.S. Department of the Treasury; U.S. DEPARTMENT OF THE TREASURY, Defendants, and MARCH FOR LIFE EDUCATION AND DEFENSE FUND, Intervenor-Defendant- Appellant. STATE OF CALIFORNIA; STATE OF No. 18-15255 DELAWARE; COMMONWEALTH OF VIRGINIA; STATE OF MARYLAND; D.C. No. 4:17-cv-05783-HSG STATE OF NEW YORK, Plaintiffs-Appellees, v. 2 ALEX M. AZAR II, Secretary of the United States Department of Health and Human Services; U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES; R. ALEXANDER ACOSTA, in his official capacity as Secretary of the U.S. Department of Labor; U.S. DEPARTMENT OF LABOR; STEVEN TERNER MNUCHIN, in his official capacity as Secretary of the U.S. Department of the Treasury; U.S. DEPARTMENT OF THE TREASURY, Defendants-Appellants. Appeals from the United States District Court for the Northern District of California Haywood S. Gilliam, Jr., District Judge, Presiding Argued and Submitted October 19, 2018 San Francisco, California Before: J. Clifford Wallace, Andrew J. Kleinfeld, and Susan P. Graber, Circuit Judges. Opinion by Judge Wallace WALLACE, Circuit Judge: The Affordable Care Act (ACA) and the regulations implementing it require group health plans to cover contraceptive care without cost sharing. Federal agencies issued two interim final rules (IFRs) exempting employers with religious and moral objections from this requirement. Several states sued to enjoin the enforcement of the IFRs, and the district court issued a nationwide preliminary 3 injunction. We have jurisdiction under 28 U.S.C. § 1292, and we affirm in part, vacate in part, and remand. I. A. To contextualize the issues raised on appeal, we briefly recount the history of the ACA’s contraceptive coverage requirement. The ACA provides that: a group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for . . . with respect to women, such additional preventive care and screenings ...
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