Nuns with the Little Sisters of The Poor rally outside the Supreme Court on Wednesday as the court hears arguments to allow birth control in health-care plans. (AP Photo/Jacquelyn Martin)

For the second time in two years, the Supreme Court justices tangled over a question about personal beliefs and birth control: Must employers who are religiously opposed to it cover it in their health plans?

A prominent group of pediatricians hopes the answer will be yes.

Erecting hurdles to the pill, in this case, could jeopardize the health of America’s children, said Benard Dreyer, president of the the American Academy of Pediatrics. It could even encourage the next Disneyland measles outbreak.

The link, he acknowledges, isn’t immediately obvious.

“There’s no discernible difference between a religious objection to contraception and a religious objection to a vaccine,” said Dreyer, also a pediatrics professor at New York University. "If [the Supreme Court] entitles an employer to be totally exempt from contraceptive coverage, it would presumably allow an employer to do the same for vaccination coverage.”

In other words, a church-run school that condemns intrauterine devices, for example, could more easily say it won’t fund a chickenpox vaccine. And a low-income worker, unsure of how to find another expense-free avenue or come up with the $94 to pay for the vaccine, might have trouble getting that shot for their first-grader.

Religious resistance to vaccinations in American law can be traced back to the British Vaccination Act of 1898, which provided a “conscience clause” to allow exemptions to the mandatory smallpox vaccination. Most states already allow parents to reject vaccinations for their kids for nonmedical reasons. Some offer “personal belief” exemptions, while others allow for a religious exemption.

Though some people simply don’t like vaccines — one prominent Baltimore Rabbi called them a hoax — only two religions have close to an official negative stance on them: Christian Scientists, who pray first to treat illnesses, and members of the Dutch Reformed Church, who worry the shots could affect their relationship with God.

The case before the court Wednesday, Zubik v. Burwell, mirrors 2014’s Burwell v. Hobby Lobby Stores, which said that forcing family-owned corporations to pay for birth-control coverage violated the Religious Freedom Restoration Act of 1993.

On Wednesday, the justices heard arguments on what the government has offered as a compromise: Religious colleges and advocacy groups will not have to pay for the drugs they oppose. Instead, such groups could inform the government that, because of religious reasons, they’re opting out — and public money would go to cover the cost.

But the petitioners, including East Texas Baptist University and Denver’s Little Sisters of the Poor, argued that allowing birth control to be covered under their plans, regardless of who’s footing the bill, implicates them in sin. Providing their information to the government, they say, makes them complicit.

Supreme Court Justice Anthony M. Kennedy, the case’s likely swing vote, appeared to side with the challengers. He told Solicitor General Donald B. Verrilli Jr. that the government seemed to be “hijacking” their insurance plans. Instead, he said, the administration should offer an alternative that does not involve the organizations.

Justice Sonia Sotomayor disagreed with Kennedy’s logic. If everyone who said laws violated their beliefs chose not to follow them, she said, “how will we ever have a government that functions?”

Under the Affordable Care Act, insurance plans on the individual and company level must fully cover vaccines, just like contraceptives. The law has technically ended out-of-pocket pay for these “preventive services,” though not all pharmacists and insurers have yet complied.

The American Academy of Pediatrics, which represents roughly 64,000 physicians who treat children, filed an amicus brief earlier this year, urging the court to consider “effects far beyond the facts of this case.” (The organization files briefs when the court considers family-related cases, Dreyer said.)

“Future objectors,” the document reads, “could prevent children from obtaining critical, life-saving preventive care.”

More on Wonkblog:

The odd thing Justice Kennedy noticed about abortions in Texas

Why Republicans are pushing for over-the-counter birth control

Why pregnant women in Mississippi keep dying

Here are some of the most common arguments for and against vaccination. (The Washington Post)