What's Happening
A divided U.S. appeals court has rejected a renewed challenge from a Seattle-area church seeking to invalidate Washington state's requirement that health insurers providing maternity coverage also provide coverage for abortion.
The 9th U.S. Circuit Court of Appeals ruled 2-1 against Cedar Park Assembly of God, a Pentecostal church in Kirkland, Washington. The court found that the church had not shown that Washington's abortion-coverage law targeted religious conduct or demonstrated hostility toward religion. (Reuters)
The ruling keeps Washington's Reproductive Parity Act of 2018 in place. The law requires health plans that cover maternity care to also include abortion coverage.
The appeals court simultaneously rejected the church's challenge to a separate 1995 Washington conscience-protection law.
What Washington's Law Requires
Insurance mandate ensures reproductive care access without direct employer purchasing
Washington's Reproductive Parity Act requires health insurers that offer maternity benefits to also provide abortion coverage.
The law applies to insurance coverage rather than requiring individual employers or religious organizations to personally purchase abortion services.
That distinction was central to the dispute.
Cedar Park provides health insurance to about 140 people and argued that even if it personally objects to abortion and avoids purchasing abortion coverage, the state's requirements still effectively associate the church with abortion because its employees must be informed about how they can obtain the service. (Reuters)
The Church's Religious Objection
First Amendment challenge against indirect facilitation of abortion
Cedar Park argues that abortion conflicts with its religious beliefs and that Washington's laws violate its First Amendment right to freely exercise religion.
The church challenged both:
- The requirement that insurers include abortion coverage when maternity coverage is offered.
- The requirement that insurance carriers tell employees how they can access abortion services even when an employer has a religious or moral objection.
Cedar Park said these requirements force it to indirectly facilitate a procedure that it considers sinful.
The church originally brought its lawsuit in 2019, after Kaiser Permanente began requiring abortion coverage under its group health plan. (Reuters)
The Court's Decision
Majority rules state interest in healthcare access outweighs religious claims
The majority concluded that Washington had a legitimate governmental interest in ensuring access to reproductive healthcare.
Circuit Judge Susan Graber, writing for the majority, said the state's law was rationally connected to improving access to reproductive healthcare while continuing to protect religious and conscience rights.
The court therefore rejected Cedar Park's argument that the law was designed to discriminate against religious beliefs.
Judge Lucy Koh joined Graber in the majority.
The Dissent
Appeals court split highlights moral and religious friction
Circuit Judge Consuelo Callahan disagreed.
Callahan argued that the abortion-coverage law was not sufficiently neutral toward religion because it effectively favored secular interests over Cedar Park's religious objections.
Her dissent emphasized that abortion remains an issue involving significant moral and religious disagreement in the United States.
Callahan was the only member of the three-judge panel to side with Cedar Park.
The Earlier Legal Fight
Procedural hurdles clear the path for a substantive ruling
This was not the first time the church's case reached the 9th Circuit.
In March 2025, the appeals court dismissed Cedar Park's appeal, concluding that the church did not have legal standing to challenge the Reproductive Parity Act.
The court later withdrew that decision and heard new arguments in January 2026, leading to Monday's ruling. (Reuters)
The latest decision therefore represents a substantive ruling on Cedar Park's constitutional arguments rather than another dismissal based on standing.
A Balance Between Healthcare Access and Religious Rights
Conscience protections allow employers to decline purchases while maintaining employee communication
Washington defended the laws as an attempt to balance two competing interests: maintaining access to reproductive healthcare while preserving protections for employers and organizations with religious or moral objections.
The state's conscience law allows employers such as Cedar Park to decline to purchase coverage for healthcare services they oppose on moral or religious grounds.
However, insurers are still required to inform covered employees how they can obtain those services.
That distinction allows the state to maintain broader insurance access without directly requiring an objecting employer to pay for the service itself. (Reuters)
Broader Significance
The case illustrates the continuing legal conflict between abortion access, employer-sponsored health insurance and religious-liberty protections.
Following the U.S. Supreme Court's 2022 decision overturning the constitutional right to abortion, states have taken substantially different approaches to abortion regulation.
Some states have imposed extensive restrictions, while others have enacted protections intended to preserve access.
Washington's approach is significant because it incorporates abortion coverage into the broader framework of maternity and reproductive healthcare insurance.
Why This Matters
The ruling allows Washington's current insurance framework to remain in place and provides another appellate-level decision supporting the state's ability to require abortion coverage from insurers offering maternity benefits.
For healthcare organizations, employers and insurers operating in states with abortion-specific insurance laws, the case demonstrates how reproductive healthcare requirements can intersect with religious-liberty claims.
It also shows that the distinction between an employer purchasing a healthcare service and an insurer providing access to that service can be legally important.
Looking Ahead
Potential appeals and ongoing state-level legal battles
Cedar Park could potentially seek further review, including asking the full 9th Circuit to reconsider the case or petitioning the U.S. Supreme Court.
For now, however, the appeals court's decision leaves Washington's Reproductive Parity Act and the relevant conscience-protection framework intact.
The broader legal debate over abortion coverage is likely to continue as states take different approaches to reproductive healthcare and religious organizations continue challenging requirements they believe conflict with their beliefs.
Key Takeaways
- The 9th U.S. Circuit Court of Appeals ruled 2-1 against Cedar Park Assembly of God.
- Washington's Reproductive Parity Act of 2018 requires insurers providing maternity coverage to also provide abortion coverage.
- The church argued that the law violated its First Amendment religious-liberty rights.
- The court found that Cedar Park failed to demonstrate that the law targeted religion or reflected hostility toward religious beliefs.
- The court also upheld Washington's 1995 conscience-protection law.
- That law allows religious or morally objecting employers to avoid purchasing coverage for services they oppose while requiring insurers to explain how employees can access those services.
- The dispute began in 2019 after Kaiser Permanente required abortion coverage in the church's group health plan.
- The decision keeps Washington's current abortion-coverage framework in effect. (Reuters)
What This Means for Healthcare Marketers
For healthcare marketers, this case highlights how state-level reproductive healthcare rules can directly affect insurance products, employer benefits and patient access.
Insurers and healthcare organizations operating across multiple states may need different communications, benefits positioning and compliance strategies depending on each state's abortion and reproductive-health requirements.
It also reinforces the importance of understanding the difference between coverage availability, employer purchasing decisions and individual patient access, particularly when communicating benefits in politically and legally sensitive areas.