Chissa Rivaldi never expected to be in a fight with her university over birth control. Four years ago, when she was deciding where to pursue a doctoral degree in biology, she had two key things in mind: a supportive adviser and an institution with a robust research program. She found what she was looking for in the University of Notre Dame. “This program was the best thing for me in terms of the research I wanted to do and the pace and how it incorporated the work I’d done previously,” she said.

That the university is a Catholic institution didn’t really enter the equation. Rivaldi is not Catholic, but she didn’t see that as a reason not to pursue her education there — even though she was aware of the church hierarchy’s positions on various issues, including reproductive rights and access to birth control. After all, the university actively champions its diversity and “spirit of inclusion.” And where her access to health care was concerned, there was the Affordable Care Act’s mandate that a host of core women’s health services be provided without cost sharing, including contraceptives — a coverage requirement that would apply to the insurance benefits the university offered to students.

To Rivaldi, it all seemed pretty straightforward. But that’s not how it turned out.

Instead, Notre Dame has balked at the birth control mandate, waging a protracted legal battle in an effort to exempt itself from having to provide insurance for services that it says violate its religious beliefs. The university’s efforts so far have been unsuccessful in court.

But according to a recent lawsuit, the Trump administration did an end run around the judicial system to negotiate a settlement with Notre Dame and 73 other institutions that allows them to deny birth control coverage. The suit, filed on behalf of the student-led activist group Irish 4 Reproductive Health, of which Rivaldi is a member, argues that the settlement is illegal and demonstrates flagrant disregard for due process and equal protection. The Trump administration is expected to file its answer to the lawsuit on October 11.

Rivaldi is frustrated by the university’s backdoor dealings and unrelenting quest to deny her full health coverage. “Notre Dame has this whole persona and relationship with its students,” she said. “They’re all about doing the right thing and making sure that everybody has a place … and feels comfortable. And then they’re like, ‘Well, except for this.’”

The Fight to Opt Out Without Notice

Before the ACA, women often paid higher insurance premiums while still paying out of pocket for things like contraceptives. The ACA created parity, prohibiting sex discrimination in health care and requiring that a suite of preventive services for women be covered without cost-sharing, including guaranteed access to all 18 Food and Drug Administration-approved forms of birth control.

Early on, churches were exempted from having to provide the coverage and affiliated institutions wanted the same treatment. The Obama administration refused and instead devised a workaround: A religious affiliate could opt out of providing coverage by submitting a form to its insurance company or to the federal government voicing its objection, which would then allow the insurance company or a third-party administrator to work with the government to provide birth control coverage directly.

The accommodation did not satisfy Notre Dame, which along with a number of other organizations filed a series of lawsuits claiming that having to notify anyone of its objection to birth control coverage put it in a position of serving as a conduit for the coverage it objected to, impinging on its religious freedom. Federal appellate courts roundly rejected that argument — including the 7th U.S. Circuit Court of Appeals, which considered Notre Dame’s case.

The “record contains no evidence to support the conduit theory,” the court wrote. “Although Notre Dame is the final arbiter of its religious beliefs, it is for the courts to determine whether the law actually forces Notre Dame to act in a way that would violate those beliefs. As far as we can determine … the only ‘conduit’ is between the [insurance] companies and Notre Dame students and staff; the university has stepped aside.”

The U.S. Supreme Court considered the cases in 2016 before sending them back to the lower courts. The government and the organizations should work together to find an equitable solution, the court wrote — one that accommodates the religious organizations while “at the same time ensuring” that women covered by their health plans “receive full and equal health coverage, including contraceptive coverage.”

Meanwhile, as Notre Dame was fighting in court for its chance to deny contraceptive coverage, it had already signed the accommodation form, so coverage was still being provided to those insured by Notre Dame — in all, more than 17,000 students, faculty, and staff. Graduate students like Rivaldi were still largely unaffected by the controversy.

The Supreme Court’s direction that an acceptable accommodation be found went unmet. After negotiations and a period of public comment, the Obama administration concluded that there was “no feasible” way to devise an alternate accommodation that would also ensure coverage.

The Obama-era workaround remained in place until early October 2017, when the Trump administration announced new rules that extended the ability to object to providing coverage to almost any employer based on religious belief or “moral conviction,” and made the accommodation optional — meaning that employers could simply refuse to cover contraceptives without providing any notice.

In South Bend, Indiana, the news was well received by Notre Dame’s president, Rev. John Jenkins, who said in a statement that he welcomed “this reversal” and applauded the government’s discernment that “except in the narrowest circumstances, no one should be forced to choose between living out his or her faith and complying with the law.” Before long, Jenkins would announce that the university was formally opting out of coverage.

Protests and U-Turns

Not everyone was as pleased, and on a sunny Tuesday afternoon the same month, doctoral candidate Kate Bermingham and some three dozen other members of the university community gathered outside its golden-domed main building, which houses the administration offices, for a peaceful protest. They carried signs and Bermingham held a megaphone as the group chanted its support for contraceptive coverage.

As long as Bermingham had been at Notre Dame, her birth control had been covered. Like Rivaldi, she is not Catholic, and she understood the church’s stance on contraceptives, but given the ACA’s protections, she didn’t consider that attending Notre Dame would put her access to health care in jeopardy. When she began her graduate studies six years ago, she was just 24 and still covered by her parents’ insurance (another benefit conferred by the ACA). When she aged out, she moved over to Notre Dame’s carrier.

Under the accommodation, Bermingham had two insurance cards — one for her main health insurance coverage and a second for her birth control benefits. Navigating the layers of insurance bureaucracy was a challenge (at least in part because “Notre Dame’s HR people weren’t really empowered to help us,” she said), but certainly it was better than having to figure out how to access coverage if the school opted out altogether.

“Notre Dame does not have a just claim to saddle me or other individuals it employs with the expenses of its conscience,” Bermingham told the student newspaper after the protest. “It is impossible to overlook the gendered implications of Notre Dame’s claims to be exercising religious freedom in this instance.”

But then, just days after the university announced that it would opt out of coverage, Jenkins pivoted, saying that Notre Dame would continue to provide care under the accommodation. Addressing the faculty in early November 2017, Jenkins said that the university’s interest had “never been in preventing access to those who make conscientious decisions to use contraceptives.” The university had been confused, thinking that the Trump administration rules meant the Obama-era accommodation was no longer available.

The following month, two courts blocked the Trump rules from taking effect.

Bermingham was relieved. “It was heartening to think that the administration had listened to the current community members, rather than some of its more ideological donors,” she wrote to The Intercept.

It would be a short-lived victory.