The Supreme Court told a lower court Monday to take another look at whether the health insurance plans of certain religious organizations in New York must include coverage for abortions.

New York requires employer health insurance plans of a certain size to cover medically necessary abortions. There is an exception for religious entities whose purpose is to inculcate religious values and that employ and serve primarily those of the same religion.

But it doesn’t provide the exemption to religious organizations with a broader religious mission, or if they employ and serve those outside the religion.

The case was decided before the court settled a dispute last year in favor of religious groups that had been banned from providing foster care vetting for the city of Philadelphia. The Supreme Court said lower courts should take that into account.

More from the Supreme Court abortion case

Justices Clarence Thomas, Samuel A. Alito Jr. and Neil M. Gorsuch said they would have accepted the case now.

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The challenge brought by the Roman Catholic Diocese of Albany and organizations of other religions says the lack of an exception for such groups requires them to “participate” in abortion.

“The consequences could hardly be more severe,” said the brief from the religious organizations, written by former Trump administration solicitor general Noel Francisco. “New York churches and religious ministries will be forced to cooperate in what they consider to be grave evil — or stop operating.”

The requirement was upheld by New York state courts, and the state told the Supreme Court that the regulation does not violate the organizations’ religious freedom.

The organizations are not required to provide health insurance, it said. And the groups could create their own self-insured plans that would prohibit the coverage. But even regular policies that provide abortion coverage do not cost more than those that do not, the state contends.

“The record thus contains no evidence that by purchasing policies that include the subject coverage, a purchaser funds, even indirectly, medically necessary abortion services,” New York Attorney General Letitia James, D, said in a brief to the court.

But such arguments have not been successful at the Supreme Court. It has said that privately held companies do not have to comply with the contraceptive coverage that is part of the Affordable Care Act, and in 2020 said religious organizations deserved an accommodation so that they did not have to provide contraceptive care that offended their religious beliefs.

The case is Roman Catholic Diocese of Albany v. Lacewell.