Senate Introduces Better Care Reconciliation Act

Here is the text of the Senate version of the Republican efforts to “repeal and replace” the Affordable Care Act, to be titled the Better Care Reconciliation Act. The draft bill has quite a number of differences with H.R. 1628, the American Health Care Act, which was passed by the House on May 4, 2017.

The bill still does not have a number nor analysis by the Congressional Budget Office. It is expected to be considered by the full Senate, without any committee hearings, as early as this week (before the July 4 recess).

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International Rescue Committee v. Trump: U.S. Supreme Court Grants Partial Stay Against Injunctions and Grants Review

The U.S. Supreme Court has granted review of both the 4th Circuit and 9th Circuit injunctions against President Donald Trump’s revised executive order banning the travel and entry of individuals from six Muslim-majority countries (Iraq, Libya, Somalia, Sudan, Syria, and Yemen) and suspending all refugee admissions. And in a highly unusual action, the Court also granted a partial stay of those injunctions, allowing a partial implementation of the executive order during the Court’s review of the lower court decisions. While the executive order will continue to be enjoined for any individuals from the six countries “who have a credible claim of a bona fide relationship with a person or entity in the United States” (for example, family members, students, other temporary nonimmigrants coming for a business reason, etc.) but may be implemented against any other individuals from the six named countries. In an unnecessary aside, the Court also states that “a nonprofit group devoted to immigration issues may not contact foreign nationals from the designated countries, add them to client lists, and then secure their entry by claiming injury from their exclusion.” Even more confusing, the Court also applies this “relationship” test to refugee admissions, continuing to permit entry for refugees who can establish such relationships to individuals or entities in the U.S., but allowing the implementation of the executive order temporarily suspending admission for refugees who cannot.

The action is unusual because rather than granting President Trump’s requests to stay both injunctions pending review (which would have been the action that Justices Thomas, Alito, and Gorsuch would have taken, as they outline in their concurring and dissenting opinion), the Court reaches into the merits of the injunctions and the lower court decisions to separate out which sections of the executive order remain enjoined and which sections can be implemented.  For a court dominated by justices with conservative judicial philosophies of not making or re-writing laws, this action reflects extreme judicial activism, essentially re-writing the executive order for the President (which incidentally, all the lower courts declined to do, citing the flaws in drafting as part of the rationale for the injunctions).

The Court ordered hearing on the cases at its first week of October 2017 session but will not otherwise expedite its consideration of the cases.

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Center on Budget and Policy Priorities: House Health Bill – Tax Cuts for Wealthy, Insurers, and Drug Companies Paid for by Low- and Middle-Income Families

This policy brief from the Center on Budget and Policy Priorities describes the massive tax cuts for the wealthiest of Americans, health insurance plans, pharmaceutical companies, and medical device manufacturers included in the House Republican-enacted American Health Care Act (H.R. 1628). On the other hand, the bill reduces billions of dollars in tax credits for low- and middle-income Americans that now subsidize their health insurance premiums and costs such as co-payments and deductibles. Accordingly, the policy brief characterizes the legislations as one of the largest shifts in taxes in American history, with billions of dollars in cuts for the wealthiest and billions of dollars in increased tax burdens (from the loss of the tax credits) for low- and middle-income Americans.

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Congressional Budget Office: American Health Care Act Would Result in 23 Million Americans Uninsured

The Congressional Budget Office (CBO) has finally had the opportunity to analyze the final version of H.R. 1628, the American Health Care Act (AHCA), passed by the House of Representatives on May 4, 2017. It is highly unusual for a bill. especially a budget reconciliation bill with impacts on millions of Americans and hundreds of billions of dollars in the federal budget, to be acted upon by the House without a CBO analysis but the Republicans in the House pushed through the vote along party lines earlier this month.

The CBO concludes that the bill would result in 23 million Americans, or over 18 percent of the total population, without health insurance by 2020. This would mean that all the increases in health insurance coverage resulting from the Affordable Care Act (ACA), enacted in 2010, would be undone, returning our national uninsured rate to pre-ACA levels. About 14 million Americans currently insured through the expansions of Medicaid under the ACA would lose their health insurance by 2020.

In the private health insurance markets, the AHCA would only provide $375 million in tax credit subsidies to low- and middle-income Americans to help them pay their health insurance premiums and costs such as co-payments and deductibles.  This is compared to $671 million that is now available under the ACA, which means that low- and middle-income Americans would have to find a way to pay $296 million to keep their health insurance. Since many millions will not be able to afford their health insurance without these tax credit subsidies, they will be among the 23 million that will become uninsured.

The AHCA also cuts $834 billion from the Medicaid program, a significant reason that the legislation results in net tax savings (estimated at $119 billion over ten years, $32 billion lower than the prior version of the bill), even with hundreds of billions of dollars tax cuts for the highest income Americans (at least $231 billion), health plans ($144.7 billion), pharmaceutical companies ($28.5 billion), and medical device manufacturers ($19.6 billion). Another provision allows health plans to take additional business deductions for compensation paid to their highest paid executives, resulting in $500 million less tax revenues.

Buried in the tables accompanying the report is one stark example of how significant the impact the AHCA will have on many Americans. In 2026, ten years after enactment (and full implementation), a 64-year old with an annual income of $26,500 (175% of the federal poverty level) would go from paying $1,700 for health insurance under the ACA to having to pay $16,700 for the same coverage. That individual’s premiums would go up $5,700 while losing $8,700 in tax credits to help pay for those premiums.

The U.S. Senate has yet to take action on H.R. 1628 or any similar legislation.

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International Rescue Committee v. Trump: 4th Circuit Affirms Preliminary Injunction Against Revised Muslim Immigration, Refugee, and Travel Ban

In a 10-3 decision, the 4th Circuit Court of Appeals has affirmed a federal district court’s preliminary injunction against implementation of President Donald Trump’s second attempt to ban Muslim immigrants, refugees, and visitors from the U.S. (Executive Order 13780).  In an opinion by Chief Judge Roger Gregory (appointed to the Court by President George W. Bush), the Court writes:

“The question for this Court, distilled to its essential form, is whether the Constitution… remains ‘a law for rulers and people, equally in war and in peace.’ And if so, whether it protects Plaintiffs’ right to challenge an Executive Order that in text speaks with vague words of national security, but in context drips with religious intolerance, animus, and discrimination. Surely the Establishment Clause of the First Amendment yet stands as an untiring sentinel for the protection of one of our most cherished founding principles—that government shall not establish any religious orthodoxy, or favor or disfavor one religion over another. Congress granted the President broad power to deny entry to aliens, but that power is not absolute. It cannot go unchecked when, as here, the President wields it through an executive edict that stands to cause irreparable harm to individuals across this nation. Therefore, for the reasons that follow, we affirm in substantial part the district court’s issuance of a nationwide preliminary injunction as to Section 2(c) of the challenged Executive Order.”

The Court asserts its important role as the third branch of government:

“Although the Supreme Court has certainly encouraged deference in our review of immigration matters that implicate national security interests,…it has not countenanced judicial abdication, especially where constitutional rights, values, and principles are at stake. To the contrary, the Supreme Court has affirmed time and again that ‘it is emphatically the province and duty of the judicial department to say what the law is.’…This ‘duty will sometimes involve the ‘resolution of litigation challenging the constitutional authority of one of the three branches,’ but courts cannot avoid their responsibility.’

…the Supreme Court has made clear that despite the political branches’ plenary power over immigration, that power is still ‘subject to important constitutional limitations,’ … and that it is the judiciary’s responsibility to uphold those limitations….the political branches’ power over immigration is not tantamount to a constitutional blank check, and that vigorous judicial review is required when an immigration action’s constitutionality is in question.”

The Court finds that there is sufficient evidence that the President’s justification for the Executive Order based on national security was proffered in “bad faith”, namely:

“Plaintiffs here claim that EO-2 invokes national security in bad faith, as a pretext for what really is an anti-Muslim religious purpose. Plaintiffs point to ample evidence that national security is not the true reason for EO-2, including, among other things, then-candidate Trump’s numerous campaign statements expressing animus towards the Islamic faith; his proposal to ban Muslims from entering the United States; his subsequent explanation that he would effectuate this ban by targeting “territories” instead of Muslims directly; the issuance of EO-1, which targeted certain majority-Muslim nations and included a preference for religious minorities; an advisor’s statement that the President had asked him to find a way to ban Muslims in a legal way; and the issuance of EO-2, which resembles EO-1 and which President Trump and his advisors described as having the same policy goals as EO-1….Plaintiffs also point to the comparably weak evidence that EO-2 is meant to address national security interests, including the exclusion of national security agencies from the decisionmaking process, the post hoc nature of the national security rationale, and evidence from DHS that EO-2 would not operate to diminish the threat of potential terrorist activity.”

Accordingly, Court looks beyond the text of the Executive Order to determine whether there was an impermissible purpose to disfavor Muslim individuals on the basis of their religion, which would be an unconstitutional violation of the First Amendment Establishment Clause:

“The evidence in the record, viewed from the standpoint of the reasonable observer, creates a compelling case that EO-2’s primary purpose is religious. Then-candidate Trump’s campaign statements reveal that on numerous occasions, he expressed anti- Muslim sentiment, as well as his intent, if elected, to ban Muslims from the United States….like EO-1, EO-2’s purpose is to effectuate the promised Muslim ban, and that its changes from EO-1 reflect an effort to help it survive judicial scrutiny, rather than to avoid targeting Muslims for exclusion from the United States. These statements, taken together, provide direct, specific evidence of what motivated both EO-1 and EO-2: President Trump’s desire to exclude Muslims from the United States.”

The Court also notes:

“EO-2’s text does little to bolster any national security rationale: the only examples it provides of immigrants born abroad and convicted of terrorism-related crimes in the United States include two Iraqis—Iraq is not a designated country in EO-2—and a Somalian refugee who entered the United States as a child and was radicalized here as an adult.”

While the dissenting opinions attack the majority opinion for reliance on candidate Trump’s statements as relevant to the review of the Executive Order issued by President Trump, the Court responds with the facts:

“For a past statement to be relevant to the government’s purpose, there must be a substantial, specific connection between it and the challenged government action. And here, in this highly unique set of circumstances, there is a direct link between the President’s numerous campaign statements promising a Muslim ban that targets territories, the discrete action he took only one week into office executing that exact plan, and EO-2, the ‘watered down’ version of that plan that ‘get[s] just about everything,’ and ‘in some ways, more.’…To the extent that our review chills campaign promises to condemn and exclude entire religious groups, we think that a welcome restraint.”

The Court states emphatically:

“The Government has repeatedly asked this Court to ignore evidence, circumscribe our own review, and blindly defer to executive action, all in the name of the Constitution’s separation of powers. We decline to do so, not only because it is the particular province of the judicial branch to say what the law is, but also because we would do a disservice to our constitutional structure were we to let its mere invocation silence the call for meaningful judicial review. The deference we give the coordinate branches is surely powerful, but even it must yield in certain circumstances, lest we abdicate our own duties to uphold the Constitution. EO-2 cannot be divorced from the cohesive narrative linking it to the animus that inspired it. In light of this, we find that the reasonable observer would likely conclude that EO-2’s primary purpose is to exclude persons from the United States on the basis of their religious beliefs.”

The Court has a final constitutional law lesson on the three branches of government:

“…we reject the notion that the President, because he or she represents the entire nation, suffers irreparable harm whenever an executive action is enjoined. This Court has held that the Government is ‘in no way harmed by issuance of a preliminary injunction which prevents [it] from enforcing restrictions likely to be found unconstitutional.’… ‘If anything,’ we said, ‘the system is improved by such an injunction.’…Because Section 2(c) of EO-2 is likely unconstitutional, allowing it to take effect would therefore inflict the greater institutional injury.”

The Court quotes a 1967 U.S. Supreme Court ruling to turn the President’s national security argument on its head:

“Implicit in the term ‘national defense’ is the notion of defending those values and ideals which set this Nation apart…[O]ur country has taken singular pride in the democratic ideals enshrined in its Constitution, and the most cherished of those ideals have found expression in the First Amendment. It would indeed be ironic if, in the name of national defense, we would sanction the subversion of one of those liberties . . . which makes the defense of the Nation worthwhile.”

The Court concludes:

“…the Government’s asserted national security interest in enforcing Section 2(c) appears to be a post hoc, secondary justification for an executive action rooted in religious animus and intended to bar Muslims from this country. We remain unconvinced that Section 2(c) has more to do with national security than it does with effectuating the President’s promised Muslim ban….on balance, we cannot say that the Government’s asserted national security interest outweighs the competing harm to Plaintiffs of the likely Establishment Clause violation. For similar reasons, we find that the public interest counsels in favor of upholding the preliminary injunction. As this and other courts have recognized, upholding the Constitution undeniably promotes the public interest….when we protect the constitutional rights of the few, it inures to the benefit of all.”

The Court has a final admonition for the President:

“Improper government involvement with religion ‘tends to destroy government and to degrade religion,’…encourage persecution of religious minorities and nonbelievers, and foster hostility and division in our pluralistic society. The risk of these harms is particularly acute here, where from the highest elected office in the nation has come an Executive Order steeped in animus and directed at a single religious group.”

The Trump Administration has stated that it would appeal this latest decision to the U.S. Supreme Court.

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ACT TODAY: Send Comments to Office of Management and Budget Supporting Disaggregated Race and Ethnicity Data

This coming Sunday April 30 is the deadline for submitting comments to the Office of Management and Budget in support of its proposed changes to the federal classifications of race and ethnicity data that include additional disaggregation of each race and ethnicity category.

The Heritage Foundation and other conservative organizations have mobilized hundreds of comments in opposition to the proposed changes. The Asian & Pacific Islander Health Forum has created an easy tool to submit comments (it only takes two minutes to fill in your contact information).

Please submit a comment today and share widely with your networks!

Posted in Asian American, Native Hawaiian and Pacific Islander Health, Demographic Data, Demographic Data: Race and Ethnicity, The iBau Blog | Leave a comment

County of Santa Clara and City and County of San Francisco v. Donald Trump: Preliminary Injunction Against Defunding of Sanctuary Cities

Here is the preliminary injunction issued today, April 25, 2017, by U.S. District Court Judge William Orrick against the section of President Donald Trump’s Executive Order 13786 that threatened to withhold federal funding from “sanctuary jurisdictions”. This was one of the first executive orders issued by President Trump days after his inauguration, on January 25, 2017.

Both jurisdictions have had long-standing policies to limit their communication and cooperation with federal Immigration and Customs Enforcement (ICE) officials about individuals arrested and detained by Santa Clara and San Francisco law enforcement authorities. Federal courts have made clear that requests from ICE to continue to detain individuals in order to pursue potential federal immigration enforcement against them (“ICE detainers”) are voluntary requests that do not have to be honored by local jurisdictions.  Accordingly, Santa Clara conditioned its cooperation on reimbursement from ICE for any additional detention costs for individuals ICE would want detained, and when ICE declined to provide such reimbursements, Santa Clara declined to comply with the ICE requests. San Francisco has a city policy not to expend city funds to enforce federal immigration law and so it also declines to comply with ICE requests to continue to detain individuals solely for potential immigration enforcement.

There are three federal criminal justice grant programs that are explicitly conditioned on honoring ICE detainer requests. Santa Clara does not receive those federal grant funds and San Francisco is challenging those conditions as part of its lawsuit.

However, Santa Clara County estimates that it receives a total of $1.7 billion in federal funding each fiscal year and the City and County of San Francisco estimates that it receives $1.2 billion in federal funding each fiscal year. The local jurisdictions seek relief from against the executive order’s threat against all this federal funding. The Court ruled that the local jurisdictions had standing to seek the preliminary injunction and were likely to succeed on the merits of their claims.

The court notes statements by President Trump, Attorney General Jeff Sessions, and White House Press Secretary Sean Spicer characterizing the executive order as a “weapon”, to “claw back” federal funds already awarded, and its clear intent to specifically defund California cities such as San Francisco. This is yet another case in which the statements of the President and his key staff have been used to support an injunction against one of his executive orders.

The court ruled:

“The Constitution vests the spending powers in Congress, not the President, so the Order cannot constitutionally place new conditions on federal funds. Further, the Tenth Amendment requires that conditions on federal funds be unambiguous and timely made; that they bear some relation to the funds at issue; and that the total financial incentive not be coercive. Federal funding that bears no meaningful relationship to immigration enforcement cannot be threatened merely because a jurisdiction chooses an immigration enforcement strategy of which the President disapproves.”

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State of Hawaii v. Trump: Preliminary Injunction Against Revised Muslim Immigration, Refugee, and Travel Ban

U.S. District Court Judge Derrick Kahala Watson has converted his nationwide temporary restraining order against the implementation of President Donald Trump’s revised executive order banning immigration, refugees, and travel from Muslim-majority countries into an indefinite nationwide preliminary injunction. Judge Watson notes:

“…where the ‘historical context’ and ‘the specific sequence of events leading up to’ the adoption of the challenged Executive Order are as full of religious animus, invective, and obvious pretext as is the record here, it is no wonder that the Government urges the Court to altogether ignore that history and context….The Court will not crawl into a corner, pull the shutters closed, and pretend it has not seen what it has. The Supreme Court and this Circuit both dictate otherwise, and that is the law this Court is bound to follow.”

Judge Watson concludes:

“National security is unquestionably of vital importance to the public interest. The same is true with respect to affording appropriate deference to the President’s constitutional and statutory responsibilities to set immigration policy and provide for the national defense. Upon careful consideration of the totality of the circumstances, however, the Court reaffirms its prior finding that the balance of equities and public interest weigh in favor of maintaining the status quo. As discussed above and in the TRO, Plaintiffs have shown a strong likelihood of succeeding on their claim that the Executive Order violates First Amendment rights under the Constitution.”

Judge Watson also specifically ruled that he would not stay his preliminary injunction order if the U.S. government filed any appeals.



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National Academies of Sciences, Engineering, and Medicine: Communities in Action – Pathways to Health Equity

This report from the National Academies of Science, Engineering, and Medicine describes the causes and solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities, as well as the root causes and structural barriers that need to be overcome. Health equity is the state in which everyone has the chance to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or any other defined circumstance. Health equity is inextricably linked with opportunity.

Health disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual’s health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways.

2016.12.09 CommunityEquity

The report is accompanied by a summary of highlights, a compilation of its recommendations, and a social media toolkit.

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International Refugee Assistance Project v. Trump: Preliminary Injunction Against Revised Muslim Immigration, Refugee, and Travel Ban

Here is the opinion issued today by U.S. District Court Judge Theodore Chuang explaining his injunction against President Donald Trump’s revised Muslim immigration, refugee, and travel ban.

Among his findings, Judge Chuang concludes that the revised executive order still has an impermissible purpose of discriminating against Muslims:

“…explicit, direct statements of President Trump’s animus towards Muslims and intention to impose a ban on Muslims entering the United States, present a convincing case that the First Executive Order was issued to accomplish, as nearly as possible, President Trump’s promised Muslim ban. In particular, the direct statements by President Trump and Mayor Giuliani’s account of his conversations with President Trump reveal that the plan had been to bar the entry of nationals of predominantly Muslim countries deemed to constitute dangerous territory in order to approximate a Muslim ban without calling it one – precisely the form of the travel ban in the First Executive Order….the history of public statements continues to provide a convincing case that the purpose of the Second Executive Order remains the realization of the long-envisioned Muslim ban. The Trump Administration acknowledged that the core substance of the First Executive Order remained intact….Defendants do not directly contest that this record of public statements reveals a religious motivation for the travel ban….all of the public statements at issue here are fairly attributable to President Trump, the government decisionmaker for the Second Executive Order, because they were made by President Trump himself, whether during the campaign or as President, by White House staff, or by a close campaign advisor who was relaying a conversation he had with the President.”

Judge Chuang, who is a former Deputy General Counsel for the U.S. Department of Homeland Security and a former trial attorney for the U.S. Department of Justice, then rejects any “secular” rationale for the executive order based on national security interests:

“…courts should afford deference to national security and foreign policy judgments of the Executive Branch….The Court thus should not, and will not, second-guess the conclusion that national security interests would be served by the travel ban. The question, however, is not simply whether the Government has identified a secular purpose for the travel ban. If the stated secular purpose is secondary to the religious purpose, the Establishment Clause would be violated….

In this highly unique case, the record provides strong indications that the national security purpose is not the primary purpose for the travel ban. First, the core concept of the travel ban was adopted in the First Executive Order, without the interagency consultation process typically followed on such matters. Notably, the document providing the recommendation of the Attorney General and the Secretary of Homeland Security was issued not before the First Executive Order, but on March 6, 2017, the same day that the Second Executive Order was issued. The fact that the White House took the highly irregular step of first introducing the travel ban without receiving the input and judgment of the relevant national security agencies strongly suggests that the religious purpose was primary, and the national security purpose, even if legitimate, is a secondary post hoc rationale.

Second, the fact that the national security rationale was offered only after courts issued injunctions against the First Executive Order suggests that the religious purpose has been, and remains, primary….

Third, although it is undisputed that there are heightened security risks with the Designated Countries, as reflected in the fact that those who traveled to those countries or were nationals of some of those countries have previously been barred from the Visa Waiver Program….the travel ban represents an unprecedented response. Significantly, during the time period since the Reagan Administration, which includes the immediate aftermath of September 11, 2001, there have been no instances in which the President has invoked his authority…to issue a ban on the entry into the United States of all citizens from more than one country at the same time, much less six nations all at once….The Second Executive Order does not explain specifically why this extraordinary, unprecedented action is the necessary response to the existing risks. But while the travel ban bears no resemblance to any response to a national security risk in recent history, it bears a clear resemblance to the precise action that President Trump described as effectuating his Muslim ban. Thus, it is more likely that the primary purpose of the travel ban was grounded in religion, and even if the Second Executive Order has a national security purpose, it is likely that its primary purpose remains the effectuation of the proposed Muslim ban. Accordingly, there is a likelihood that the travel ban violates the Establishment Clause.

…the Supreme Court has stated that ‘no governmental interest is more compelling than the security of the Nation.’…Defendants, however, have not shown, or even asserted, that national security cannot be maintained without an unprecedented six-country travel ban, a measure that has not been deemed necessary at any other time in recent history. Thus, the balance of the equities and the public interest favor the issuance of an injunction.”

Having served in all three branches of the federal government (he also served as counsel to the House Oversight and Government Reform Committee and the House Energy and Commerce Committee), Judge Chuang also rejects the argument that this presidential action is beyond review by the courts: “Even when exercising their immigration powers, the political branches must choose ‘constitutionally permissible means of implementing that power.’…Thus, although ‘[t]he Executive has broad discretion over the admission and exclusion of aliens,’ that discretion ‘may not transgress constitutional limitations,’ and it is ‘the duty of the courts’ to ‘say where those statutory and constitutional boundaries lie.'”

Judge Chuang concludes: “While Plaintiffs would likely face irreparable harm in the absence of an injunction, Defendants are not directly harmed by a preliminary injunction preventing them from enforcing an Executive Order likely to be found unconstitutional…. Preventing an Establishment Clause violation has significant public benefit beyond the interests of the Plaintiffs. The Supreme Court has recognized the ‘fundamental place held by the Establishment Clause in our constitutional scheme.’… The Founders ‘brought into being our Nation, our Constitution, and our Bill of Rights with its prohibition against any governmental establishment of religion’ because they understood that ‘governmentally established religions and religious persecution go hand in hand.’… When government chooses sides among religions, the ‘inevitable resul’ is ‘hatred, disrespect, and even contempt’ from those who adhere to different beliefs….Thus, to avoid sowing seeds of division in our nation, upholding this fundamental constitutional principle at the core of our Nation’s identity plainly serves a significant public interest.”

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