As part of the Affordable Care Act's implementing regulations, group health plans are required to include coverage for various forms of preventative care, including all FDA-approved methods of contraception. Houses of worship are exempt from these requirements, and the Department of Health and Human Services later created a broader accommodation for certain nonprofit organizations.
In November 2004, Oklahoma amended its state constitution to limit the state’s recognition of marriage to heterosexual marriage and making it a crime to issue a marriage license to a same-sex couple. The amendment was supported with religious arguments and appeals to scripture. In response, two lesbian couples sued to invalidate the amendment.
After nearly a decade of litigation, the federal trial court held that Oklahoma’s marriage ban is unconstitutional. The state appealed that decision to the U.S. Court of Appeals for the Tenth Circuit.