Whether state laws regulating health care sharing ministries must be deemed neutral under Employment Division v. Smith and whether federal ACA exemptions preempt state insurance regulations

Petitioners Breanna Renteria and Laura Smith joined a ministry with fellow Christian believers to share healthcare costs. Petitioners’ religious beliefs compelled them not only to share these costs, but to abstain from health insurance that require s insureds to subsidize religiously objectionable treatment s. The Affordable Care Act (“ACA”) expressly recognizes such ministries, defin ing them as health care sharing ministries ( “HCSMs ”). By participat ing in their ACA allowed HCSM , Petitioners are not only exempt from the ACA’s individual mandate to obtain minim um essential coverage , they also enjoy statutory protections for their religious exercise . This protection was suddenly threatened , however, when the New Mexico Office of the Superintendent of Insurance ordered Petitioners’ ministry to either cease in-state operations or comply with the New Mexico Insurance Code —an act that would effectively kill the HCSM . Petitioners sought a preliminary injunction , which the district court denied. On review, the Tenth Circuit, over the dissent of Judge Carson, imposed heightened requirements on Petitioners to prove the law was not neutral or generally applicable under Employment Division v. Smith , 494 U.S. 87 2 (1990 ), and determined that New Mexico’s decision to block ACA -exempt organizations from operating in in its borders was not preempted by federal law. Ultimately, it found Petitioners unlikely to succeed on the merits of their claims. The questions presented are: 1. Under Smith , whether state laws must always be deemed “neutral” unless plaintiffs prove officials acted against them with subjective religious animus and discriminatory motive . ii 2. Under Smith , whether courts determining a law’s “general applicability ” must disregard the law’s preference for secular over religious organizations on the grounds that secular and religious organizations are inherently motivated by different purposes and thus incomparable , or alternatively, whether courts must consider the law’s preference for secular over religious organization s so long as their activities pose a similar risk to the government’s asserted interest in the law. 3. Whether hostile statements of government actors against religious adherents are sufficient to establish a First Amendment free exercise violation, or whether state s may try to justify their hostility by satisfying strict scrutin y. 4. Whether the ACA ’s exemption for individuals who participate in HCSMs preempts New Mexico’s determination that those individuals’ HCSMs may not operate in New Mexico until they forfeit their federal status es as HCSMs under the ACA.