Univ. of Notre Dame v. Sebelius, No. 13-3853 (7th Cir. 2014)Annotate this Case
The court issued a subsequent related opinion or order on May 19, 2015.
In the United States Court of Appeals For the Seventh Circuit ____________________ No. 13 3853 UNIVERSITY OF NOTRE DAME, Plaintiff Appellant, v. KATHLEEN SEBELIUS, Secretary of U.S. Department of Health & Human Services, et al., Defendants Appellees, and JANE DOE 1, et al., Intervening Appellees. ____________________ Appeal from the United States District Court for the Northern District of Indiana, South Bend Division. No. 3:13 cv 01276 PPS CAN Philip P. Simon, Chief Judge. ____________________ ARGUED FEBRUARY 12, 2014 DECIDED FEBRUARY 21, 2014 ____________________ Before POSNER, FLAUM, and HAMILTON, Circuit Judges. POSNER, Circuit Judge. The Affordable Care Act requires providers of health insurance (including companies that administer self insured employer health plans) to cover cer 2 No. 13 3853 tain preventive services without cost to the insured, includ ing, with respect to women, such additional preventive care and screenings ¦ as provided for in comprehensive guide lines supported by the Health Resources and Services Ad ministration. 42 U.S.C. § 300gg 13(a)(4); see also 45 C.F.R. § 147.130(a)(iv), 76 Fed. Reg. 46621, 46623 (Aug. 3, 2011). Guidelines specifying such preventive care have now been promulgated, and they include all Food and Drug Admini stration approved contraceptive methods, sterilization pro cedures, and patient education and counseling for all women with reproductive capacity. Health Resources & Services Administration, Women s Preventive Services Guidelines, www.hrsa.gov/womensguidelines (visited Feb. 21, 2014, as were the other websites cited in this opinion). To simplify exposition, we ll refer to all methods of female pre vention of pregnancy as contraceptives. (Male contracep tives are not covered by the guideline.) The health concerns that motivated the inclusion of con traception in the guidelines on needs of women for preven tive care begin with the fact that about half of all pregnancies in the United States are unintended, and 40 percent of them end in abortion and many others in premature births or oth er birth problems. Institute of Medicine, Clinical Preventive Services for Women: Closing the Gaps 102 03 (2011), www.nap.edu/catalog.php?record_id=13181; Lawrence B. Finer & Mia R. Zolna, Shifts in Intended and Unintended Pregnancies in the United States, 2001 2008, 104 Am. J. Pub. Health S43, S44 (2014). Many of the unintended pregnancies are teen pregnancies; contraceptive use has been found to be positively correlated with decreased teen pregnancy. John S. Santelli & Andrea J. Melnikas, Teen Fertility in Transition: Recent and Historical Trends in the United States, 31 Ann. No. 13 3853 3 Rev. Pub. Health 371, 375 76, 379 (2010). Because out of pocket expenditures on female contraceptives can be sub stantial for many women, see Su Ying Liang et al., Wom en s Out of Pocket Expenditures and Dispensing Patterns for Oral Contraceptive Pills Between 1996 and 2006, 83 Con traception 528, 531 (2011), the provision of such contracep tives without cost to the user can be expected to increase contraceptive use and so reduce the number both of unin tended pregnancies and of abortions. See Jeffrey F. Peipert et al., Preventing Unintended Pregnancies by Providing No Cost Contraceptives, 120 Obstetrics & Gynecology 1291, 1295 96 (2012). Furthermore, women who can successfully delay a first birth and plan the subsequent timing and spac ing of their children are more likely than others to enter or stay in school and to have more opportunities for employ ment and for full social or political participation in their community. Susan A. Cohen, The Broad Benefits of Invest ing in Sexual and Reproductive Health, 7 Guttmacher Rep. on Public Policy, March 2004, pp. 5, 6; see also Martha J. Bai ley et al., The Opt in Revolution? Contraception and the Gender Gap in Wages, pp. 19, 26 (National Bureau of Econ. Research Working Paper No. 17922, 2012), www.nber.org/ papers/w17922.pdf. Like other universities, the University of Notre Dame provides health benefits to both its employees and its stu dents. It self insures its employees medical expenses, but has hired Meritain Health, Inc. to administer the employee health plan without providing any insurance coverage (Mer itain is therefore what is called a third party administrator of a health plan). To take care of its students medical needs, Notre Dame has a contract with Aetna (which happens to be Meritain s parent) that gives the students the option of ob 4 No. 13 3853 taining health insurance from Aetna. Meritain administers coverage for some 4600 employees of Notre Dame (out of a total of 5200) and 6400 dependents of employees. Aetna in sures 2600 students and 100 dependents; Notre Dame has about 11,000 students. But many of them have coverage un der their parents health insurance policies. Because Catholic doctrine forbids the use of contracep tives (the rhythm method of avoiding pregnancy, which is permitted, is a form of abstention, not of contraception), Notre Dame has never paid for contraceptives for its em ployees or permitted Aetna to insure, under the Aetna Notre Dame Health Plan, Notre Dame students for the expense of contraceptives. Cognizant of the religious objections of Catholic institutions to contraception, and mindful of the dictate of the Religious Freedom Restoration Act, 42 U.S.C. §§ 2000bb 1(a), (b), that Government shall not substantially burden a person s exercise of religion even if the burden re sults from a rule of general applicability, unless it demon strates that application of the burden to the person (1) is in furtherance of a compelling governmental interest; and (2) is the least restrictive means of furthering that compelling gov ernmental interest, the government, some months after the enactment of the Affordable Care Act, created by adminis trative regulation a religious exemption from the guidelines. See Group Health Plans and Health Insurance Issuers Re lating to Coverage of Preventive Services, 76 Fed. Reg. 46621, 46626 (Aug. 3, 2011) (codified at 45 C.F.R. § 147.130(a)(1)(iv)); see also 77 Fed. Reg. 8725, 8727 29 (Feb. 15, 2012). But at first it was narrowly drafted and as a result excluded Catholic institutions that, like Notre Dame, are in corporated as nonprofit rather than religious institutions. That precipitated the filing in 2012 of a federal suit by Notre No. 13 3853 5 Dame against the government, claiming that the contracep tive regulations infringed rights conferred on the university by both the First Amendment and the Religious Freedom Restoration Act, 42 U.S.C. § 2000bb 1. That suit was dis missed on standing and ripeness grounds, the government having promised that Notre Dame wouldn t have to comply with the regulations for one year, during which time new regulations would be issued. University of Notre Dame v. Se belius, 2012 WL 6756332, at *3 4 (N.D. Ind. Dec. 31, 2012); see Certain Preventive Services Under the Affordable Care Act, 77 Fed. Reg. 16501, 16502 03 (Mar. 21, 2012). The new regulations were issued as promised and, as expected, they enlarged the exemption. See Coverage of Certain Preventive Services Under the Affordable Care Act, 78 Fed. Reg. 39870, 39875 90 (July 2, 2013); 29 C.F.R. § 2590.715 2713A(a); 45 C.F.R. § 147.131(b). As a result, Notre Dame now came within its scope. To exercise its right thus conferred to opt out of having to pay for coverage for con traceptives, either directly or through a health insurer, such as Aetna, the university had to fill out EBSA Form 700 Certification. See 45 C.F.R. § 147.131(b)(4). The form (www. dol.gov/ebsa/pdf/preventiveserviceseligibleorganizationcer tificationform.pdf) is short, its meat the following sentence: I certify that, on account of religious objections, the organi zation opposes providing coverage for some or all of any contraceptive services that would otherwise be required to be covered; the organization is organized and operates as a nonprofit entity; and the organization holds itself out as a religious organization. The form states that the organiza tion or its plan must provide a copy of this certification to the plan s health insurance issuer (for insured health plans) or a third party administrator (for self insured health plans) 6 No. 13 3853 in order for the plan to be accommodated with respect to the contraceptive coverage requirement. So Notre Dame was required to give copies both to Aetna and to the employee plan s third party administrator, Meritain. The Affordable Care Act requires providers of health in surance (including third party administrators of self insured health plans, even though they are conduits rather than ul timate payors of plan benefits) to pay for contraceptives for women, see 45 C.F.R. §§ 147.131(c)(2)(i)(B), (ii); 29 C.F.R. § 2590.715 2713A(b)(3); the form alerts Aetna and Meritain that since Notre Dame is not going to pay, they will have to pay. The companies have neither religious objections to pay ing for contraception nor financial objections. The govern ment will reimburse at least 110 percent of the third party administrator s (Meritain s) costs, 45 C.F.R. § 156.50(d)(3), and Aetna can expect to recoup its costs of contraceptive coverage from savings on pregnancy medical care, since there will be fewer pregnancies if contraception is more broadly available, at no cost, to Notre Dame s female em ployees and students, as well as from other regulatory off sets. See Coverage of Certain Preventive Services Under the Affordable Care Act, supra, 78 Fed. Reg. at 39877 78. The regulations require Aetna and Meritain, but not Notre Dame, to inform the university s female employees and students that those companies will be covering their contraceptive costs. See 26 C.F.R. § 54.9815 2713A(d); 29 C.F.R. § 2590.715 2713A(d). The companies may either pro vide payments for contraceptive services themselves or, al ternatively, arrange for an issuer or other entity to provide payments for those services; either way, they may not im pos[e] any cost sharing requirements (such as a copayment, No. 13 3853 7 coinsurance, or a deductible), or impos[e] a premium, fee, or other charge, or any portion thereof, directly or indirectly, on the eligible organization, the group health plan, or plan participants or beneficiaries. 29 C.F.R. §§ 2590.715 2713A(b)(2), (c)(2). The regulations thus seek an accommoda tion between the secular interests that motivate the mandate to provide contraceptive services to women free of charge and the interests of religious institutions that provide health services. Accommodation is consistent with the balancing act required by the Religious Freedom Restoration Act ( substantial burden, compelling governmental interest, least restrictive means ). When the new regulations were promulgated in July of last year, Notre Dame did not at first bring a new suit (re member that its previous suit, brought when the university was excluded from opting out of contraceptive coverage, had been dismissed on jurisdictional grounds, and those grounds are irrelevant to a suit challenging the new regula tions). Months passed. Not until December did the univer sity file the present suit. The delay in suing was awkward, since the regulations were to take effect with respect to the employee health plan and did take effect on January 1 of this year. Coverage of Certain Preventive Services Under the Affordable Care Act, supra, 78 Fed. Reg. at 39889. (The student health plan, however, the Aetna plan, has until Au gust of this year to comply. See id.; University of Notre Dame, 2013 2014 Student Injury and Sickness Insurance Plan 3, 5, http://uhs.nd.edu/assets/108455/nd_brochure_1314.pdf.) With the January deadline for compliance with the regu lations applicable to the employee plan looming, the univer sity, less than a week after filing its second suit on December 8 No. 13 3853 3, moved for the entry of a preliminary injunction. The dis trict court denied the motion on December 20, and Notre Dame filed its appeal from that denial the same day. On De cember 31, the last day before it would be penalized for vio lating the regulations, Notre Dame signed EBSA Form 700 and thereby opted out of paying for contraceptive coverage for its employees. Because the appeal asks us to reverse the district court s denial of a preliminary injunction, we need to emphasize the limitations on our consideration of the appeal that result from its interlocutory character (that is, from the fact that it was before completion of the litigation in the district court). The lawsuit was only a few weeks old when the district judge suspended all proceedings in his court pending our consideration of the appeal. The parties have thus had little opportunity to present evidence. So the question before us is not whether Notre Dame s rights have been violated but whether the district judge abused his discretion in refusing to grant a preliminary injunction. That depends on such con siderations as whether Notre Dame will experience irrepara ble harm if denied preliminary relief that is, harm that cannot be eliminated by a final judgment in favor of Notre Dame as well as on the likelihood that the university will win its case when the case is finally tried in the district court. Kraft Foods Group Brands LLC v. Cracker Barrel Old Country Store, Inc., 735 F.3d 735, 740 41 (7th Cir. 2013). We empha size that with the evidentiary record virtually a blank, every thing we say in this opinion about the merits of Notre Dame s claim and the government s (and intervenors ) re sponse is necessarily tentative, and should not be considered a forecast of the ultimate resolution of this still so young liti gation. No. 13 3853 9 An initial puzzle is that the university hasn t told us what exactly it wants enjoined at this stage in the litigation. It has gone ahead and signed the EBSA Form 700 and sent copies to Aetna and Meritain, and the latter has notified Notre Dame s employees of the contraceptive coverage that it is offering them. (Aetna has not notified the students; remem ber that it has until August to do so.) The university has thus complied with the statute, albeit under duress. The penalties for violating the applicable regulations are indeed stiff: $100 per day for each individual to whom such failure relates, 26 U.S.C. § 4980D(b)(1), which would cost Notre Dame roughly $685,000 per day, assuming plausibly that half the 13,700 covered employees, students, and dependents are women thus $250 million per year. There is an annual cap on such penalties of $500,000, but it is applicable only to un intentional violations of the regulations. § 4980D(c)(3). If Notre Dame dropped its employee health plan, the penalty would be only $2,000 per full time employee per year, 26 U.S.C. §§ 4980H(a), (c)(1), or roughly $10 million a year. That is well within Notre Dame s ability to pay but is still a num ber large enough to capture a university administrator s at tention. But we are left with the question: what does Notre Dame want us to do? Tell it that it can tear up the form without in curring a penalty for doing so, even though the govern ment s regulations require the religious institution to retain it after signing it, 26 C.F.R. § 54.9815 2713A(a)(4), though not to submit it to the government? But what effect would that have except to rescind the university s exemption from the requirement of paying for the contraceptive services that Meritain is now offering as a consequence of Notre Dame s choosing to exempt itself from the contraception regula 10 No. 13 3853 tions? No certification, no exemption. We imagine that what the university wants is an order forbidding Aetna and Mer itain to provide any contraceptive coverage to Notre Dame staff or students pending final judgment in the district court. But we can t issue such an order; neither Aetna nor Meritain is a defendant (the university s failure to join them as defen dants puzzles us), so unless and until they are joined as de fendants they can t be ordered by the district court or by this court to do anything. Furthermore, while a religious institu tion has a broad immunity from being required to engage in acts that violate the tenets of its faith, it has no right to pre vent other institutions, whether the government or a health insurance company, from engaging in acts that merely of fend the institution. Lyng v. Northwest Indian Cemetery Protec tive Ass n, 485 U.S. 439, 450 51 (1988); Bowen v. Roy, 476 U.S. 693, 699 700 (1986). The regulation to which Notre Dame takes the sharpest exception states that the copy of the self certification [EBSA Form 700] provided by the eligible [to opt out] organization [Notre Dame] to a third party administrator [Meritain] (in cluding notice of the eligible organization s refusal to admin ister or fund contraceptive benefits) ¦ shall be an instru ment under which the plan is operated, [and] shall be treated as a designation of the third party administrator as the plan administrator under section 3(16) of ERISA for any contraceptive services required to be covered under § 2590.715 2713(a)(1)(iv) of this chapter to which the eligible organization objects on religious grounds. 29 C.F.R. § 2510.3 16. Notre Dame treats this regulation as making its mailing the certification form to its third party administrator the cause of the provision of contraceptive services to its em ployees, in violation of its religious beliefs. Not so. Since No. 13 3853 11 there is now a federal right, unquestioned by Notre Dame, to female contraceptive services, the effect of the university s exercise of its religious exemption is to throw the entire bur den of administration of the right on the entities (Aetna and Meritain) that provide health services to Notre Dame s stu dents and staff. The university is permitted to opt out of providing federally mandated contraceptive services, and the federal government determines (enlists, drafts, con scripts) substitute providers, and naturally they are the pro viders who are already providing health services to the uni versity personnel. Fearing the penalties for violating the contraceptive regu lation, the university has complied and as a result Aetna and Meritain have been designated to provide the Notre Dame staff and students with female contraceptive services. Unlike the Little Sisters of the Poor, who filed their suit in Septem ber of last year, well before the January 1 deadline for com pliance with the contraceptive regulation, and obtained a stay pending appeal equivalent to a preliminary injunc tion before having to comply, see Little Sisters of the Poor Home for the Aged v. Sebelius, 134 S. Ct. 893 (Dec. 31, 2013), Notre Dame filed suit at the last minute. It could have sued in July, when the regulations were amended to include Notre Dame as a religious organization entitled to continue refusing to pay for contraceptive services. Still, Notre Dame s compliance has not mooted the case. One can imagine an alternative form of relief to turning the clock back; and being able to imagine an alternative form of relief is all that s required to keep a case alive after the pri mary relief sought is no longer available. Hoosier Environ mental Council v. U.S. Army Corps of Engineers, 722 F.3d 1053, 12 No. 13 3853 1057 58 (7th Cir. 2013). For example, the university could ask the district court (because the case is before us on an in terlocutory appeal, our ruling will not end the litigation) to order the government to notify all of Notre Dame s students and employees of the university s exemption from having to provide contraception and of its opposition to having to no tify Aetna and Meritain of their duties under the Affordable Care Act with regard to contraceptive services. But here we need to remind the reader that the only issue before us is whether Notre Dame is entitled to a preliminary injunction. It faces an uphill struggle for that relief. One rea son is that because of the uncertainty involved in balancing the considerations that bear on the decision whether to grant a preliminary injunction an uncertainty amplified by the unavoidable haste with which the district judge must strike the balance we appellate judges review his decision defer entially. Planned Parenthood of Wisconsin, Inc. v. Van Hollen, 738 F.3d 786, 795 (7th Cir. 2013). Another obstacle is that a sine qua non for such relief is proof of irreparable harm if the injunction is denied: A plaintiff seeking a preliminary injunction must establish that he is ¦ likely to suffer irrepa rable harm in the absence of preliminary relief. Winter v. Natural Resources Defense Council, Inc., 555 U.S. 7, 20 (2008). For if the harm can be fully repaired in the final judgment, there is no reason to hurry the adjudicative proc ess. Kraft Foods Group Brands LLC v. Cracker Barrel Old Coun try Store, Inc., supra, 735 F.3d at 740. As we cannot figure out what Notre Dame wants in the way of preliminary relief, we cannot make a determination that it will suffer irreparable harm if we affirm the denial of such relief. No. 13 3853 13 Another requirement for preliminary relief is that the plaintiff be likely to win its suit in the district court. The Su preme Court s decision in the Winter case states flatly that a plaintiff seeking a preliminary injunction must establish that he is likely to succeed on the merits. 555 U.S. at 20. So hav ing explained the other objections to the appeal let s turn to the merits. Notre Dame s principal claim is that by requiring the university to fill out EBSA Form 700 and give copies to Aet na and Meritain, the government has substantially bur den[ed] a person s exercise of religion (the university is a nonprofit corporate person ; cf. 1 U.S.C. § 1; Korte v. Se belius, 735 F.3d 654, 674 (7th Cir. 2013)), and that no compel ling governmental interest justifies that burdening. Reli gious Freedom Restoration Act, supra. But the university has not yet shown that there is a substantial burden. The form is two pages long 737 words, most of it boring boilerplate; the passages we quoted earlier, the only ones of conse quence, consist of only 95 words. Signing the form and mail ing it to Meritain and Aetna could have taken no more than five minutes. The university claims that there are other pa perwork requirements; there aren t. The only colorable bur den it complains about has nothing to do with time or cost; it is that by filling out the form and sending it to the compa nies it triggers their coverage of the contraception costs of the university s female employees and students, and that this makes the university an accomplice in the provision of contraception, in violation of Catholic doctrine, which in the name of avoiding scandal forbids the encouragement (equivalent to aiding and abetting) of sinful acts. 14 No. 13 3853 The trigger theory was stated clearly, which is not to say convincingly, in a recent district court decision where we read that the self certification form requires the [religious] organizations to do much more than simply protest or ob ject. The purpose of the form is to enable the provision of the very contraceptive services to the organization s employees that the organization finds abhorrent. East Texas Baptist University v. Sebelius, 2013 WL 6838893, at *20 (S.D. Tex. Dec. 27, 2013). The key word is enable, and it s inaccurate. Fed eral law, not the religious organization s signing and mailing the form, requires health care insurers, along with third party administrators of self insured health plans, to cover contraceptive services. By refusing to fill out the form Notre Dame would subject itself to penalties, but Aetna and Merit ain would still be required by federal law to provide the ser vices to the university s students and employees unless and until their contractual relation with Notre Dame terminated. (Obviously if they were no longer providing any health benefits to the university s students and staff they would not be providing them with any contraceptive services or cover age.) Notre Dame says no that had it not filled out the form, Meritain and Aetna wouldn t have been authorized to pro vide contraceptive services because neither would have been a plan administrator under section 3(16) of ERISA, 29 U.S.C. § 1002(16), and thus would not have been plan fiduci aries entitled to make expenditures (as for costs of contra ceptives) on behalf of the plan. As the plan s sponsor, Notre Dame is alone authorized to designate a plan fiduciary, 29 U.S.C. § 1102(a)(2), and it made that designation in the form and thus is complicit in the provision of contraceptives to the university s students and staff. No. 13 3853 15 This argument was made for the first time at oral argu ment, and so has been forfeited. In any event it s unconvinc ing. For one thing it fails to distinguish between Meritain and Aetna the latter is the students health insurer and so already a plan fiduciary, 29 U.S.C. § 1002(21)(A), and there fore required by the Affordable Care Act to provide (come August) contraceptive coverage to plan members whether or not Notre Dame signs the form. 45 C.F.R. §§ 147. 130(a)(1)(iv), 147.131(f). Even as to Meritain, although many agreements between third party administrators and plan sponsors prohibit third party administrators from serving as fiduciaries, Coverage of Certain Preventive Services Un der the Affordable Care Act, supra, 78 Fed. Reg. at 39879, many is not all or even most. Notre Dame has pre sented no evidence that its contract with Meritain forbids the latter to be a plan fiduciary. Moreover, the university has not been told to name Mer itain as a plan fiduciary. Rather, the signed form shall be treated as a designation of the third party administrator as the plan administrator under section 3(16) of ERISA for any contraceptive services required to be covered. 29 C.F.R. § 2510.3 16(b) (emphasis added). Treated and designated by whom? By the government. The delivery of a copy of the form to Meritain reminds it of an obligation that the law, not the university, imposes on it the obligation to pick up the ball if Notre Dame decides, as is its right, to drop it. Notre Dame s signing the form no more triggers Meritain s obli gation to provide contraceptive services than a tortfeasor s declaring bankruptcy triggers his co tortfeasors joint and several liability for damages. Meritain must provide the ser vices no matter what; signing the form simply shifts the fi nancial burden from the university to the government. 16 No. 13 3853 The parties have not told us the terms of Notre Dame s contracts with these providers. For all we know, the con tracts permit the university at any time to disable them from providing medical services, including contraceptive services, simply by ceasing to do business with them. Stu dents and employees would make their own health insur ance arrangements most students already do (76 percent), and so do many staff (12 percent). Notre Dame would be off the hook without having to sign the certification form. The following example may help make clear the fallacy in Notre Dame s triggering metaphor. Suppose the United States, like Canada and many other foreign nations, had a single payer health care system. That means the govern ment pays the cost of covered medical services (if the United States had such a system, it would be the equivalent of Med icare for everyone), rather than employers, health insurers, and patients, though patients may in a single payer system be charged directly for some of the expense of the medical care provided by the system, as distinct from indirectly through taxes. Now suppose our hypothetical single payer system paid the full expense of female contraceptives. We don t think Notre Dame would argue that the system placed a substantial burden on the university s compliance with Catholic doctrine. Notre Dame does not deny the existence of legitimate secular interests, some noted at the outset of this opinion, that can justify a federal program of paying for medical expenses, including contraceptive expenses. (For a summary of those interests, see Coverage of Certain Pre ventive Services Under the Affordable Care Act, supra, 78 Fed. Reg. at 39872 73.) In fact we know it wouldn t object, at least on religious grounds, because it advised the district court that one method by which the government could No. 13 3853 17 achieve its asserted interests without forcing Notre Dame to violate its religious beliefs would be for the government to directly provide contraceptive[s] to the university s staff and students and another method would be for it to di rectly offer insurance coverage for contraceptive services : in either case a single payer system, at least for contraceptives. The main difference between such a system and the Afford able Care Act is that under the Act the government instead of providing medical services directly uses private insur ance providers and health plan administrators, such as Aetna and Meritain, as its agents to provide medical ser vices, subsidized by the government. If the government is entitled to require that female con traceptives be provided to women free of charge, we have trouble understanding how signing the form that declares Notre Dame s authorized refusal to pay for contraceptives for its students or staff, and mailing the authorization docu ment to those companies, which under federal law are obli gated to pick up the tab, could be thought to trigger the provision of female contraceptives. Consider this further example illustrative of our doubts. Suppose it is wartime, there is a draft, and a Quaker is called up. Many Quakers are pacifists, and their pacifism is a tenet of their religion. Suppose the Quaker who s been called up tells the selective service system that he s a conscientious ob jector. The selective service officer to whom he makes this pitch accepts the sincerity of his refusal to bear arms and ex cuses him. But as the Quaker leaves the selective service of fice, he s told: you know this means we ll have to draft someone in place of you and the Quaker replies indig nantly that if the government does that, it will be violating 18 No. 13 3853 his religious beliefs. Because his religion teaches that no one should bear arms, drafting another person in his place would make him responsible for the military activities of his replacement, and by doing so would substantially burden his own sincere religious beliefs. Would this mean that by exempting him the government had forced him to trigger the drafting of a replacement who was not a conscientious objector, and that the Religious Freedom Restoration Act would require a draft exemption for both the Quaker and his non Quaker replacement? That seems a fantastic suggestion. Yet confronted with this hypothetical at the oral argument, Notre Dame s counsel acknowledged its applicability and said that drafting a replacement indeed would substantially burden the Quaker s religion. Another way to see the error of thinking that by signing the certification form Notre Dame was enabling Aetna and Meritain to violate its religious freedom is to ask what would happen if the university refused to sign the form while adhering to its long standing refusal to pick up any part of the cost of contraceptives. The answer is that the fe male employees and students would still have a federal right to free contraceptives from Meritain and Aetna unless Notre Dame stopped offering health services to its students en tirely. Health groups would lose no time in acquainting those employees and students with their federal rights. To nail down the fallacy of the trigger or enablement interpretations of the certification form we need only parse carefully its instructions the statement that the organiza tion or its plan must provide a copy of this certification to the plan s health insurance issuer (for insured health plans) or a third party administrator (for self insured health plans) No. 13 3853 19 in order for the plan to be accommodated with respect to the con traceptive coverage requirement (emphasis added). Remember that accommodation in this context means accommodat ing the Affordable Care Act to religious beliefs. The accom modation in this case consists in the organization s (that is, Notre Dame s) washing its hands of any involvement in con traceptive coverage, and the insurer and the third party ad ministrator taking up the slack under compulsion of federal law. Notre Dame is telling Aetna and Meritain: we re ex cused from the new federal obligation relating to contracep tion, and in turn, the government tells those insurance companies but you re not. This is a warning, not a trigger. It enables nothing. The sole enabler is the federal statute that Notre Dame has been allowed to opt out of. The university argues alternatively that if the form isn t a trigger, its health plans are the conduit through which the employees and students obtain contraceptive coverage, mak ing Notre Dame complicit in sin. But the university s lawyer told us at oral argument that his client would have no prob lem if each of its female employees signed and mailed to Meritain (and its students mailed to Aetna) a form saying I have insurance through Notre Dame, but the university won t cover contraceptive services, so now you must cover them. We can t see how that would make the health plan less of a conduit. The university has still another argument: that the con traception regulation imposes a substantial burden on it by forcing the university to identify and contract with a third party willing to provide the very services Notre Dame deems objectionable. It s true that Meritain could exit its contract with Notre Dame without liability if it didn t want 20 No. 13 3853 to provide contraceptive services. See Coverage of Certain Preventive Services Under the Affordable Care Act, supra, 78 Fed. Reg. at 39880. But as Meritain does not object to pro viding them and is doing so already, the burden alleged by Notre Dame is entirely speculative and so not a ground for equitable relief. See City of Los Angeles v. Lyons, 461 U.S. 95, 104 05 (1983). The novelty of Notre Dame s claim not for the exemp tion, which it has, but for the right to have it without having to ask for it deserves emphasis. United States law and pub lic policy have a history of accommodating religious beliefs, as by allowing conscientious objection to the military draft and now exempting churches and religious institutions from the Affordable Care Act s requirements of coverage of con traceptive services. What makes this case and others like it involving the contraception exemption paradoxical and vir tually unprecedented is that the beneficiaries of the religious exemption are claiming that the exemption process itself im poses a substantial burden on their religious faiths. The clos est analogues we have found are cases in which churches seeking rezoning or variances claim that the process for ob taining permission is so cumbersome as to constitute a sub stantial burden on religious practice. E.g., Saints Constantine & Helen Greek Orthodox Church, Inc. v. City of New Berlin, 396 F.3d 895, 901 (7th Cir. 2005), and cases cited there. Consider also United States v. Friday, 525 F.3d 938, 947 48 (10th Cir. 2008), in which a member of a tribe had been prosecuted for killing, without a permit to do so, a bald eagle, for use in a religious ceremony. The court expressed skepticism that the permitting process itself might have imposed a substantial burden on a religious exercise. Cf. United States v. Oliver, 255 F.3d 588, 589 (8th Cir. 2001) (per curiam). No. 13 3853 21 The process of claiming one s exemption from the duty to provide contraceptive coverage is the opposite of cumber some. It amounts to signing one s name and mailing the signed form to two addresses. Notre Dame may consider the process a substantial burden, but substantiality like com pelling governmental interest is for the court to decide. Mahoney v. Doe, 642 F.3d 1112, 1121 (D.C. Cir. 2011). Other wise there would have been no need for Congress in the Re ligious Freedom Restoration Act to prefix substantial to burden. Notre Dame can derive no support from our decision in Korte v. Sebelius, 735 F.3d 654 (7th Cir. 2013), heavily cited in the university s briefs. The question in that case was whether two for profit companies that had health plans for their em ployees could refuse, because of the religious beliefs of their Catholic owners, to comply with the contraceptive regula tion. We ordered the district court to enter a preliminary in junction against enforcing the mandate against the employ ers. But Notre Dame is authorized to refuse, and it has re fused. Provided it overcomes the intervenors sincerity at tack in the district court when the litigation resumes there (see below), it will be in the same position that we allowed the company owners in the Korte case to occupy pending the resolution of their case: fully entitled to thumb its nose at the contraceptive regulation. We need to say something about the three Notre Dame students whom we have allowed to intervene. They had filed a timely motion in the district court to intervene in that court under Fed. R. Civ. P. 24. Having stayed the litigation pending the resolution of this appeal, the district judge did not rule on it, so the students moved for leave to intervene in 22 No. 13 3853 this court. Although the Federal Rules of Appellate Proce dure do not provide for intervention other than in cases in volving review of certain administrative rulings, interven tion is permitted in other cases as a matter of federal com mon law, with Rule 24 supplying the standard for determin ing whether to permit intervention in a particular case. Au tomobile Workers v. Scofield, 382 U.S. 205, 217 n. 10 (1965); Si erra Club, Inc. v. EPA, 358 F.3d 516, 517 18 (7th Cir. 2004). The student intervenors in our case express concern that the university is seeking to obtain a ruling from this court that may thwart their right to contraception under the Affordable Care Act. The concern is natural though perhaps exagger ated, since Notre Dame has complied fully with the Act, but we decided that the concern was sufficient to warrant inter vention. And we decided to permit the intervenors to par ticipate under pseudonyms because of the privacy interest involved in contraceptive use and their concern that they might be subjected to harassment were their identities re vealed. When the litigation in the district court resumes, they presumably will be allowed to intervene in the district court. In the brief they ve filed in this court they say they in tend, when litigation in the district court resumes, to press the issue of sincerity. To obtain the contraceptive exemp tion, or other exemptions from secular requirements, the leadership of a religious organization must actually believe, not simply pretend, that its religious teachings require the exemption. See, e.g., Gonzales v. O Centro Espirita Beneficente Uniao do Vegetal, 546 U.S. 418, 428 29 (2006); International So ciety for Krishna Consciousness, Inc. v. Barber, 650 F.2d 430, 441 (2d Cir. 1981). Although the government has not questioned Notre Dame s sincerity, the intervenors brief has. It inti No. 13 3853 23 mates that a plausible inference from the timing and tactics employed by Notre Dame in this litigation is that in chal lenging the contraception regulation the university is re sponding to outside pressures. We express no opinion on whether the intervenors will be able to substantiate their doubts about the sincerity of Notre Dame s opposition to the use of contraceptives, when, upon the resumption of the liti gation in the district court, they have an opportunity to pre sent evidence. For now the important point is that Notre Dame has failed to demonstrate a substantial burden. We find support for this conclusion in Judge David Tatel s dissent from the grant (made without accompanying explanation) of an in junction pending appeal in Priests for Life v. U.S. Dep t of Health & Human Services, No. 13 5368, and Roman Catholic Archbishop of Washington v. Sebelius, No. 13 5371 (D.C. Cir. Dec. 31, 2013) (per curiam): Because Congress has imposed an independent obliga tion on insurers to provide contraceptive coverage to Ap pellants employees, those employees will receive contra ceptive coverage from their insurers even if Appellants self certify but not because Appellants self certify. ¦ In other words, it was Congress that authorized insurers to pro vide contraceptive coverage to Appellants employees services those employees will receive regardless of wheth er Appellants self certify. ¦ Although we must accept Appellants assertion that the scheme itself violates their religious beliefs, we need not accept their legal conclusion that their purported in volvement in that scheme qualifies as a substantial burden under RFRA. Cf. Kaemmerling v. Lappin, 553 F.3d 669, 679 (D.C. Cir. 2008) ( Accepting as true the factual allegations 24 No. 13 3853 that Kaemmerling s beliefs are sincere and of a religious nature but not the legal conclusion, cast as a factual alle gation, that his religious exercise is substantially bur dened we conclude that Kaemmerling does not allege facts sufficient to state a substantial burden on his religious exercise. ). Appellants participation is limited to comply ing with an administrative procedure that establishes that they are, in effect, exempt from the very requirements they find offensive. See id. at 678 ( An inconsequential or de minimis burden on religious practice does not rise to [the level of a substantial burden under RFRA], nor does a burden on activity unimportant to the adherent s religious scheme. ). At bottom, then, Appellants religious objec tions are to the government s independent actions in man dating contraceptive coverage, not to any action that the government has required Appellants themselves to take. But Appellants have no right to require the Government to conduct its own internal affairs in ways that comport with the religious beliefs of particular citizens. Bowen v. Roy, 476 U.S. 693, 699 (1986). Religious organizations are required to file many forms with the government, such as applications for tax exemptions, even though they may have religious objections to a whole host of government policies and programs. Id. at 3 4 (emphases in original). See also Judge Jackson s district court decision in the Roman Catholic Archbishop case, denying preliminary relief. 2013 WL 6729515 (D.D.C. Dec. 20, 2013). Notre Dame doesn t place all its eggs in the RFRA sub stantial burden basket, but only two of its other arguments warrant discussion. (The rest add nothing to its RFRA ar guments.) The first is that the exemption for religious em ployers (essentially churches, as distinct from other religious No. 13 3853 25 organizations, such as Catholic universities, see 45 C.F.R. § 147.130(a)(1)(iv)(B)) violates the establishment clause of the First Amendment because it favors certain types of religious organizations (churches or other houses of worship) over others (like Notre Dame). The religious employer doesn t have to sign or mail a certification form in order to claim its exemption; its exemption from the contraceptive guideline appears to be automatic. See, e.g., 45 C.F.R. § 147.130 (a)(1)(iv)(A); U.S. Health Resources & Services Administra tion, Women s Preventive Services Guidelines, supra; U.S. Department of Labor, Affordable Care Act Regulations and Guidance, www.dol.gov/ebsa/healthreform/regulations/ coverageofpreventiveservices.html. But religious employers, defined as in the cited regulation, have long enjoyed advan tages (notably tax advantages) over other entities, 26 U.S.C. §§ 6033(a)(3)(A)(i), (iii), without these advantages being thought to violate the establishment clause. See, e.g., Walz v. Tax Commission of City of New York, 397 U.S. 664, 666, 672 73 (1970). The establishment clause does not require the gov ernment to equalize the burdens (or the benefits) that laws of general applicability impose on religious institutions. A law exempting churches or other religious property from prop erty taxes will benefit religious denominations that own a great deal of property, to the disadvantage of denominations with modest property holdings (such as storefront churches). This unequal effect does not condemn the law. Notre Dame s second non RFRA claim, which is more substantial, is that the regulations violate the free speech clause of the First Amendment by providing that an exempt organization, such as Notre Dame, must not, directly or in directly, seek to interfere with a third party administrator s arrangements to provide or arrange separate payments for 26 No. 13 3853 contraceptive services for participants or beneficiaries, and must not, directly or indirectly, seek to influence the third party administrator s decision to make any such arrange ments. 29 C.F.R. § 2590.715 2713A(b)(1)(iii); 26 C.F.R. § 54.9815 2713A(b)(1)(iii). Obviously there are forms of in fluence that are not protected by the speech, press, or peti tion for redress of grievances clauses of the First Amend ment. But most speech or writing intended to influence someone s decision to persuade someone to do or not do something is protected. There is a great variety of female contraceptives, see U.S. Food & Drug Administration, Birth Control; Medicines To Help You, www.fda.gov/forconsumers/byaudience/forwo men/freepublications/ucm313215.htm, including a great va riety just of contraceptive pills. Mayo Clinic, Choosing a Birth Control Pill, www.mayoclinic.org/best birth control pill/art 20044807. Notre Dame s student health service might have views concerning the relative medical risks of different female contraceptives; it would certainly be entitled to communicate those views to its third party administrator, Meritain. It s true that the regulation requires provision of all FDA approved female contraceptives, but the health service could try to persuade the administrator to recom mend to the physicians in its network one FDA approved drug over another, such as progestin IUDs over copper ones, or even to advise the FDA to alter its list of approved female contraceptives. The university has a responsibility for the health and safety of its students and staff. A footnote in the commentary to the regulation states that nothing in these final regulations prohibits an eligible organization from expressing its opposition to the use of No. 13 3853 27 contraceptives. Coverage of Certain Preventive Services Under the Affordable Care Act, supra, 78 Fed. Reg. at 39880 n. 41. That s not very reassuring. The example we gave was not of a statement of opposition to the use of contraceptives, but of a statement intended to influence the choice of contra ceptives that the third party administrator or the health in surance provider would cover. The footnote is an unsatisfac tory afterthought. Against this it can be argued that the regulation is only about payments, and not about the provision of contracep tives, as in our example of student health services being concerned with the safety of particular contraceptives. At the oral argument the government s lawyer said that the regula tion, despite its wording, is not limited to wrangling over payments; that it also concerns the provision of contracep tives, as in our example of an attempt at influence that can not be prohibited without infringing freedom of speech. The regulations specify the contraceptives that health plans must provide for women namely all Food and Drug Admini stration approved contraceptive methods, sterilization pro cedures, and patient education and counseling for all wom en with reproductive capacity, U.S. Health Resources & Services Administration, Women s Preventive Services Guidelines, supra and the government s lawyer seemed (no stronger word is possible) to imply that for Notre Dame to urge a plan not to provide a specific such contraceptive, even because of a sincere health concern by the university, would violate the influence regulation. We re troubled by the seeming vagueness of the regula tion as drafted and as further muddied by the footnote in the commentary (why isn t it in the regulation itself?), and we 28 No. 13 3853 fear that it may have pernicious consequences if understood to forbid or inhibit the kind of discussion between the uni versity and the contraceptives providers sketched in the pre ceding paragraphs. But the parties have failed to place the issue in focus. Notre Dame hasn t told us what it wants to say but fears to say (except that it at least wants to be able to tell Meritain not to provide contraceptive coverage at all which sounds like urging civil disobedience) and the gov ernment hasn t clearly embraced an interpretation of the regulation that would give rise to the concerns we ve ex pressed. The issue must, for now, be left for further explora tion in the district court. Two loose ends remain to be tied up. They relate to mo tions that Notre Dame filed in this court after filing its ap peal but before oral argument. First was a motion it filed on January 20, six days after the students motion to intervene was granted, asking us to dismiss its appeal or in the alterna tive to order a limited remand to the district court; the stated purpose of either alternative was to provide Notre Dame with an opportunity to depose the three student intervenors. We took the motion under advisement, the appeal having been scheduled for imminent oral argument with expedited briefing underway and the intervenors having not yet filed their brief, which made the motion premature. It was appar ent that the appeal would be refiled after discovery relating to the intervenors or resumed if we ordered a limited re mand in lieu of dismissal. So dismissal or remand would be an interruption rather than a termination a source of delay harmful to both parties and disruptive of this court s sched ule. No. 13 3853 29 We have the authority to dismiss an appeal at the appel lant s request. Fed. R. App. P. 42(b); United States v. Hager man, 549 F.3d 536, 538 (7th Cir. 2008). But it is authorization, not command. E.g., Albers v. Eli Lilly & Co., 354 F.3d 644, 646 (7th Cir. 2004) (per curiam). As in the case just cited, here we have thought it best ¦ to carry through so that the invest ment of public resources already devoted to this litigation will have some return. So the motion has remained pend ing, and is now moot in light of our affirming the denial of preliminary relief to Notre Dame. On January 28 the university filed a renewed motion for an injunction pending appeal it had filed such a motion on December 23, but we had denied that motion a week later when we ordered expedited briefing of the appeal. The sole ground for the renewed motion was the Supreme Court s order of January 24 in the Little Sisters case, 2014 WL 272207. That ground was an odd one for Notre Dame to assert, be cause the university disagrees with the Court s order. The Court s order conditioned the injunction pending appeal in that case on the Little Sisters sending a letter to the govern ment declaring its opposition to paying for contraceptive services and at the oral argument of our case Notre Dame told us that it would consider sending such a letter an in fringement of its religious freedom. Another distinction be tween that case and this one is that unlike Meritain, Little Sisters third party administrator, Christian Brothers, is a church plan administrator and so wouldn t provide con traceptive services anyway, or be required to do so. We now deny the renewed motion for an injunction pending appeal as moot because the appeal has been resolved. 30 No. 13 3853 Chief Judge Simon s denial of preliminary relief in the district court is AFFIRMED. No. 13 3853 31 FLAUM, Circuit Judge, dissenting. While Notre Dame s ap peal from the district court s denial of a preliminary injunc tion was pending before this court, we granted the students motion to intervene. Notre Dame then moved to dismiss the appeal in order to conduct additional discovery in the dis trict court. Dismissal would not prejudice the government or the student intervenors. Nor would it inhibit this court s re view of the ultimate issues at a later stage in the proceed ings. Because I see no reason not to accept plaintiffs deci sion to proceed to trial without interim relief, Creaton v. Heckler, 781 F.2d 1430, 1431 (9th Cir. 1986), I would grant Notre Dame s motion and dismiss this appeal. The majority does not agree, however, and so the appeal remains before us. Faced with the merits, I conclude that Notre Dame has made out a credible claim under the Reli gious Freedom Restoration Act. I therefore would grant the university a preliminary injunction forbidding the govern ment from penalizing Notre Dame for refusing to comply with the self certification requirement. I. Notre Dame filed an emergency motion for an injunction pending appeal on December 23, 2013. At that point, its at tention was fixed on the looming January 1, 2014 deadline, the date that the mandate and relevant regulations would go into effect. The court denied the motion on December 30 and ordered expedited briefing. The following day, the universi ty forced, in its words, to choose between potentially ruinous fines and compliance with the Mandate opted to submit its self certification form while it continued to litigate this appeal. See Notre Dame Issues Statement on Contraceptive Care Injunction Denial, WNDU.com (Dec. 31, 2013), available 32 No. 13 3853 at http://tinyurl.com/kyhn6op (last visited Feb. 20, 2014). On January 14, the day after Notre Dame filed its opening brief, the court granted the students motion to intervene. The stu dents intended to, and in fact later did, advance a number of arguments that the government had not pursued in the dis trict court. Shortly thereafter, Notre Dame moved to dismiss its appeal. The government took no position on the motion for voluntary dismissal, and the students opposed it. The motion was taken under advisement. Federal Rule of Appellate Procedure 42 permits us to dismiss an already docketed appeal on the appellant s mo tion on terms agreed to by the parties or fixed by the court. Fed. R. App. P. 42(b). Even where the parties do not agree on terms, we apply a presumption in favor of dismissal, Al bers v. Eli Lilly & Co., 354 F.3d 644, 646 (7th Cir. 2004) as well we should, for normally it makes very little sense to force an appellant into court against his will. This presump tion would appear to be stronger when the appeal is an in terlocutory one. Such a dismissal will not prejudice any fu ture determination on the merits and will put the appellee in no worse position than if the appellant had not taken an ap peal to begin with. At the same time, however, this presump tion may be overcome by other prudential considerations. Appellate review is not a bargaining chip to be played and then casually conceded after a bad card is dealt. Id. (citing U.S. Bancorp Mortgage Co. v. Bonner Mall P ship, 513 U.S. 18 (1994)). Invoking the Albers case, the student intervenors accuse Notre Dame of procedural gamesmanship for moving to dismiss the appeal after its pleas for urgent relief earlier in the litigation. But for Notre Dame, the circumstances of this No. 13 3853 33 case changed significantly on January 1, by which point the expedited briefing schedule had already been set. They changed yet again on January 14, when the student intervenors entered the case. Certainly Notre Dame is not the first party to reassess the wisdom of taking an appeal in light of later developments. Cf. Tyndale House Publishers, Inc. v. Sebelius, No. 13 5108, 2013 WL 2395168 (D.C. Cir. May 3, 2013) (granting the government s opposed motion for volun tary dismissal in a contraceptive mandate case brought by a for profit religious employer). In my judgment, if the univer sity is willing to return to the district court and forego any chance at a preliminary injunction, we should not hold it to an expedited schedule that it did not request and to an ap peal involving parties and arguments that it did not antici pate. Importantly, Notre Dame has not sought dismissal for the purpose of evading appellate determination. United States v. Wash. Dep t of Fisheries, 573 F.2d 1117, 1118 (9th Cir. 1978). To the contrary, the university tells us that it fully ex pects to be back in this Court either from its appeal or the Government s appeal ¦ following the district court s ruling on a permanent injunction. This is a far cry from a case like Albers, where counsel for the appellant essentially conced[ed] that he decided after oral argument to dismiss the appeal for opportunistic reasons, in order to try again, with a different client, at a different time or in a different court. 354 F.3d at 646. This case is also very much unlike United States v. Hager man, where we denied an imputed motion for voluntary dismissal because it arose with the appeal fully briefed and the merits free from doubt. 549 F.3d 536, 538 (7th Cir. 2008). 34 No. 13 3853 Notre Dame requested dismissal a week before the govern ment s and intervenors briefs were due; Notre Dame s reply brief (which addressed a number of the intervenors new ar guments) was due a week after that. More to the point, and with respect for my colleagues views, I do not find the ques tion in this case to be clear cut. There have been nineteen cases challenging the application of the mandate to religious nonprofits to date, and every plaintiff besides Notre Dame has received an injunction.1 In contrast to Hagerman, the mer 1 Most plaintiffs received a preliminary injunction in the district court. See Ave Maria Found. v. Sebelius, No. 13 cv 15198, 2014 WL 117425 (E.D. Mich. Jan. 13, 2014); Catholic Diocese of Beaumont v. Sebelius, No. 1:13 cv 709, 2014 WL 31652 (E.D. Tex. Jan. 2, 2014); Roman Catholic Diocese of Fort Worth v. Sebelius, No. 4:12 cv 314 (N.D. Tex. Dec. 31, 2013) (Doc. 99); Sharpe Holdings, Inc. v. U.S. Dep t of Health & Human Servs., No. 2:12 cv 92, 2013 WL 6858588 (E.D. Mo. Dec. 30, 2013); Diocese of Fort Wayne S. Bend v. Sebelius, No. 1:12 cv 159, 2013 WL 6843012 (N.D. Ind. Dec. 27, 2013); Grace Schs. v. Sebelius, No. 3:12 cv 459, 2013 WL 6842772 (N.D. Ind. Dec. 27, 2013); E. Tex. Baptist Univ. v. Sebelius, No. H 12 3009, 2013 WL 6838893 (S.D. Tex. Dec. 27, 2013); S. Nazarene Univ. v. Sebelius, No. 13 1015, 2013 WL 6804265 (W.D. Okla. Dec. 23, 2013); Geneva Coll. v. Sebelius, No. 12 0207, 2013 WL 6835094 (W.D. Pa. Dec. 23, 2013); Reaching Souls Int l, Inc. v Sebelius, No. 13 1092, 2013 WL 6804259 (W.D. Okla. Dec. 20, 2013); Legatus v. Sebelius, No. 12 12061, 2013 WL 6768607 (E.D. Mich. Dec. 20, 2013); Roman Catholic Archdiocese of N.Y. v. Sebelius, No. 12 2542, 2013 WL 6579764 (E.D.N.Y. Dec. 16, 2013); Zubik v. Sebelius, No. 2:13 cv 1459, 2013 WL 6118696 (W.D. Pa. Nov. 21, 2013). A handful lost in the district court but later received an injunction on appeal. See Little Sisters of the Poor v. Sebelius, No. 13 cv 2611, 2013 WL 6839900 (D. Colo. Dec. 27, 2013), injunction pending appeal granted, No. 13A691 (U.S. Jan. 24, 2014); Mich. Catholic Conf. v. Sebelius, No. 1:13 CV 1247, 2013 WL 6838707 (W.D. Mich. Dec. 27, 2013), injunction pending appeal granted, No. 13 2723 (6th Cir. Dec. 31, 2013); Catholic Diocese of Nashville v. Sebelius, No. 3:13 1303, 2013 WL 6834375 (M.D. Tenn. Dec. 26, 2013), injunction pending appeal granted, No. 13 6640 (6th Cir. Dec. 31, 2013); Roman Catholic Archbishop of Wash. v. No. 13 3853 35 its in this case are hardly free from doubt. Id. I suggest that granting the motion to dismiss the appeal is the more pru dential approach. II. On the merits, I believe that Notre Dame has made out a credible claim that the Patient Protection and Affordable Care Act and accompanying regulations are a substantial burden on its exercise of religion. Accordingly, I would grant the university s request for a preliminary injunction. See Ezell v. City of Chicago, 651 F.3d 684, 694 (7th Cir. 2011) (setting forth the legal standard for a preliminary injunc tion); cf. ACLU of Ill. v. Alvarez, 679 F.3d 583, 589 (7th Cir. 2012) (noting that the loss of First Amendment freedoms, for even minimal periods of time, constitutes an irreparable injury for which damages are not an adequate remedy). The Religious Freedom Restoration Act provides that a federal law may not substantially burden a person s exer cise of religion unless the government demonstrates that application of the burden to the person ¦ is in furtherance of a compelling governmental interest and is the least re strictive means of furthering that compelling governmental interest. 42 U.S.C. § 2000bb 1. For purposes of this litiga tion, the government concedes that the least restrictive means exception does not apply, so we need only decide Sebelius, No. 13 1441, 2013 WL 6729515 (D.D.C. Dec. 20, 2013), injunction pending appeal granted, No. 13 5371 (D.C. Cir. Dec. 31, 2013); Priests for Life v. U.S. Dep t of Health & Human Servs., No. 13 1261, 2013 WL 6672400 (D.D.C. Dec. 19, 2013), injunction pending appeal granted, No. 13 5371 (D.C. Cir. Dec. 31, 2013). 36 No. 13 3853 whether the burden that the Affordable Care Act imposes on Notre Dame is substantial. In Korte v. Sebelius, this court said that a substantial bur den arises when the government put[s] substantial pres sure on an adherent to modify his behavior and to violate his beliefs. 735 F.3d 654, 682 (7th Cir. 2013) (quoting Thomas v. Review Bd. of Ind. Emp t Div., 450 U.S. 707, 718 (1981)). Put another way, government action substantially burdens reli gious exercise if it necessarily bears direct, primary, and fundamental responsibility for rendering religious exer cise ¦ effectively impracticable. Civil Liberties for Urban Be lievers v. City of Chicago, 342 F.3d 752, 761 (7th Cir. 2003) (in terpreting a parallel provision in the Religious Land Use and Institutionalized Persons Act). It is clear that if Notre Dame were forced to pay for con traceptive coverage against its religious beliefs or else incur significant monetary penalties, this would be a substantial burden. See Korte, 735 F.3d at 682 85. Unlike the for profit plaintiffs in Korte, however, the university has an additional choice: a specially crafted accommodation whereby the ob jecting employer gives notice to its insurance carrier and the insurer issues a separate policy with the mandated cover age. Id. at 662. This accommodation permits a religious or ganization to discharge its obligations to provide contracep tive coverage by self certif[ying], in a form and manner specified by the [government], that the organization op poses providing coverage for some or all ¦ contraceptive services ¦ on account of religious objections, is organized and operates as a nonprofit entity, and holds itself out as a religious organization. 26 C.F.R. § 54.9815 2713A(a). Among other things, the organization must provide a copy No. 13 3853 37 of the self certification form, known as EBSA Form 700, to its insurance issuer or third party administrator; those entities are then required to offer segregated contraceptive services directly to plan participants and beneficiaries. Id. § 54.9815 2713A(b) (c). However, if the organization does not self certify and also does not provide the required, religiously objectionable coverage it continues to face the same ruin ous fines that constituted a substantial burden in Korte. 735 F.3d at 684. I do not question that the accommodation is the govern ment s good faith attempt to meet religious objectors half way, and it makes this a somewhat closer case than Korte. Nevertheless, by putting substantial pressure on Notre Dame to act in ways that (as the university sees it) involve the university in the provision of contraceptives, I believe that the accommodation still runs afoul of RFRA. The district court reasoned that the self certification scheme is not a substantial burden because the scheme does not require the university to modify its behavior in any way. According to the court, Notre Dame need only step aside from contraception coverage, as it has always done and most assuredly would always do. Similarly, the government tells us that by self certifying, the university is simply complet ing a form conveying that the University does not intend to provide contraceptive coverage. I do not view the required act so mechanistically. The ac commodation does not merely require the religious organi zation to step aside from contraceptive coverage. It re quires the organization to perform a new act that it did not have to perform before: completing and delivering to its in surer or third party administrator the official EBSA Form 38 No. 13 3853 700. In the university s eyes, this form s purpose and ef fect evident from the face of the regulations is to ac complish what the organization finds religiously forbidden and protests. E. Tex. Baptist Univ. v. Sebelius, No. H 12 3009, 2013 WL 6838893, at *20 (S.D. Tex. Dec. 27, 2013). As to health plans administered by third party administrators in particular, the form flatly states that it is an instrument un der which the plan is operated. Having to submit the EBSA Form 700, Notre Dame maintains, makes it complicit in a grave moral wrong by involving it with a system that de livers contraceptive products and services to its employees and students. The majority has trouble accepting this position, in part due to the university s statement that its signature will trigger contraceptive coverage, because the majority un derstands federal law to require contraceptive coverage re gardless of what Notre Dame signs or does not sign. But see Roman Catholic Archbishop of Wash. v. Sebelius, No. 13 1441, 2013 WL 6729515, at *17, *22 (D.D.C. Dec. 20, 2013) (distin guishing between group health insurers, which have an in dependent obligation under the regulations to provide con traceptive coverage, and third party administrators, which do not). Yet we are judges, not moral philosophers or theo logians; this is not a question of legal causation but of reli gious faith. Notre Dame tells us that Catholic doctrine pro hibits the action that the government requires it to take. So long as that belief is sincerely held, I believe we should defer to Notre Dame s understanding.2 2 The intervenors insinuate that sincerity is at issue, hinting at the possi bility of last minute influence by a group called the Sycamore Trust. While the district court may find a warrant for this suggestion once dis No. 13 3853 39 The district court relied in part on Bowen v. Roy, 476 U.S. 693 (1986), and derivatively Kaemmerling v. Lappin, 553 F.3d 669 (D.C. Cir. 2008), which the court thought foreclosed Notre Dame s objection to a mere administrative tool, used to relieve Notre Dame of liability for not providing contra ceptive payments. I do not read Roy as cutting so broadly. In fact, five justices in that case expressed the view that the plaintiffs were entitled to an exemption from an analogous administrative requirement that welfare recipients pro vide a social security number on their application. Michael W. McConnell, Free Exercise Revisionism and the Smith Deci sion, 57 U. Chi. L. Rev. 1109, 1127 (1990) (emphasis added). Roy involved a Free Exercise Clause challenge to federal regulations governing state run food stamp programs. The plaintiff Roy, a member of the Abenaki tribe, had sought benefits for his two year old daughter. Roy objected to two distinct aspects of the regulations. First, he objected to a re quirement that each applicant furnish a social security num ber on the application. Second, he challenged a requirement that states utilize social security numbers in administering the program (principally to prevent abuse or waste). See 476 U.S. at 699. Roy refused to furnish his daughter s number because he feared its use would rob her spirit and dimin ish her spiritual purity. Id. at 696. During the litigation, it be came clear that the government had somehow obtained a social security number for Roy s daughter independently. Id. at 697. The government argued that the case had become moot, but Roy disagreed. Id. covery proceeds, so far as I can determine, there is currently no basis in the record for concluding that Notre Dame has been insincere in advanc ing this litigation. 40 No. 13 3853 As the district court in this case correctly noted, the Court squarely rejected Roy s free exercise challenge to the state s use of the social security number, concluding that the First Amendment does not require the Government to conduct its own internal affairs in ways that comport with the reli gious beliefs of particular citizens. 476 U.S. at 699. But a ma jority of justices indicated that the requirement that appli cants furnish a social security number was a different matter. Five justices either concluded or strongly suggested that the government could not require an applicant to provide the number on a benefits application if the applicant had a sin cere religious objection to doing so. Justice O Connor, joined by Justices Brennan and Mar shall, determined that the requirement burdened Roy s exer cise of religion, and that the government had failed to show that granting a religious exemption to those who legitimate ly object to providing a Social Security number will do any harm to its compelling interest. 476 U.S. at 732 (O Connor, J., concurring in part and dissenting in part). Justice White agreed; he would have enjoined both the provision and use requirements. Id. at 733 (White, J., dissenting). Finally, Jus tice Blackmun would have remanded the case to determine whether the issue was moot. However, he stated that if the issue were squarely presented, he would have agreed with Justice O Connor and held that the government could not deny assistance based on a parent s religious refusal to pro vide a social security number. Id. at 714 16 (Blackmun, J., concurring in part). To be sure, because only four justices actually reached the question, this conclusion does not constitute part of Roy s No. 13 3853 41 holding. Nevertheless, it provides a useful framework for analyzing the facts of this case.3 Under Roy s approach, it is clear that RFRA does not au thorize religious organizations to dictate the independent actions of third parties, even if the organization sincerely disagrees with them. See 476 U.S. at 700 (noting that Roy could no more prevail on his religious objection to the Gov ernment s use of a Social Security number for his daughter than he could on a sincere religious objection to the size or color of the Government s filing cabinets ). That is true whether the third party is the government, an insurer, a stu dent, or some other actor. Cf. Korte, 735 F.3d at 684 ( [I]t goes without saying that [the plaintiffs] may neither inquire about nor interfere with the private choices of their employees on these subjects. ); Roman Catholic Archdiocese of N.Y. v. Sebe lius, No. 12 2542, 2013 WL 6579764, at *13 (E.D.N.Y. Dec. 16, 2013) ( [I]t seems unlikely that placing new legal obligations on the third parties with whom plaintiffs contract could be a substantial burden on plaintiffsÊ¹ religion. ). So long as the government does not require the university itself to take ac tion, RFRA does not give Notre Dame a right to prevent the government from providing contraceptives to its students and employees. Indeed, at oral argument, counsel for Notre Dame acknowledged that the university would have no ob jection if the students or employees had to opt in to receive contraceptive coverage from insurers. 3 Although Roy is a Free Exercise Clause case, not a RFRA case, Con gress was clear that RFRA codifies pre Smith free exercise jurispru dence. Korte, 735 F.3d at 679 (referring to Employment Division v. Smith, 494 U.S. 872 (1990)). 42 No. 13 3853 But the self certification requirement is different. It is one thing for the government to take independent action. It is quite another for the government to force the university to cooperate actively with the Government by themselves providing the EBSA Form 700 a form that, in Notre Dame s view, endorses the provision of contraceptives to its students and employees. Roy, 476 U.S. at 714 (Blackmun, J., concurring in part). That type of compulsion takes this case out of the realm of independent action and into the sort of direct, primary, and fundamental pressure that renders religious exercise ¦ effectively impracticable. Civil Liber ties for Urban Believers, 342 F.3d at 761. The Supreme Court s recent decision to grant a tempo rary injunction in a similar RFRA challenge suggests to me that a majority of justices may continue to hold this view of free exercise rights (although now as a statutory matter, and not a constitutional one). See Little Sisters of the Poor v. Sebe lius, No. 13 cv 2611, 2013 WL 6839900 (D. Colo. Dec. 27, 2013), injunction pending appeal granted, No. 13A691, 2014 WL 272207 (U.S. Jan. 24, 2014). Notably, the burden on the plain tiffs in Little Sisters appears less significant than the one on Notre Dame. The government tells us that Little Sisters pro vides group health insurance through a self insured church plan that, because of a peculiar twist in ERISA, is itself ex empt from the requirement to assume responsibility for con traceptive coverage. Under the current regime, the form that Little Sisters refuses to sign is entirely unconnected to the actual provision of contraceptive services, yet the Supreme Court still granted the requested injunction. Should the mandate be enforced in this case, by contrast, Notre Dame will continue to self certify as part of a scheme that will ac tually deliver products and services to which the university No. 13 3853 43 has a religious objection. I am well aware that the order in Little Sisters should not be construed as an expression of the Court s views on the merits. 2014 WL 272207, at *1. Howev er, I believe the Court s action strengthens the case for a pre liminary injunction here, where the burden is, if anything, more concrete. Now that Notre Dame has signed the self certification form, the majority doubts whether we could grant the uni versity any form of meaningful relief. I agree that we cannot enjoin the university s insurers from providing contraceptive coverage or require the government to forbid the insurers from doing so. However, this only underscores the point that Notre Dame does not (and cannot) take issue with the independent actions of third parties. Meaningful relief fol lows from what Notre Dame does object to: a regulation that requires it either to pay for contraceptive services or self certify that it has a religious objection in order to avoid sub stantial fines. I would therefore enjoin the government from enforcing the penalty against Notre Dame for not providing contraceptive coverage even if Notre Dame revokes or fails to maintain its EBSA Form 700, refuses to make the form available for examination upon request, or takes any action otherwise inconsistent with 26 C.F.R. § 54.9815 2713A. III. My conclusion is not intended to disparage the govern ment s efforts at accommodation in this difficult area. Espe cially after Employment Division v. Smith, 494 U.S. 872 (1990), how best to accommodate the twin demands of religious faith and secular policy has become a challenging political problem as much as a legal one. Our interpretation of RFRA can only go so far in solving it. Cf. Lyng v. Nw. Indian Ceme 44 No. 13 3853 tery Protective Ass n, 485 U.S. 439, 452 (1988) ( [L]egislatures and other institutions, not courts, must reconcile the vari ous competing demands on government, many of them rooted in sincere religious belief, that inevitably arise in so diverse a society as ours. ). Whatever the eventual outcome of this litigation, it would be unfortunate if it dissuaded ei ther the government or religious institutions from taking further steps toward mutually acceptable accommodation. * * * Because dismissal of this appeal is no longer an option, I conclude that Notre Dame has shown a likelihood of success on the merits, and that it has met the other requirements for a preliminary injunction. I would therefore reverse the dis trict court s order denying relief. I respectfully dissent.