Judge rules Colorado’s SB 23-190 violates Free Exercise Clause in case brought by Catholic clinic Bella Health
On August 1, 2025, a federal judge permanently barred Colorado officials from enforcing a state law that effectively prohibited “abortion pill reversal” treatment against a Catholic health provider, ruling that the law infringed on religious liberty rights protected by the U.S. Constitution.
U.S. District Judge Daniel D. Domenico’s 27-page opinion granted a permanent injunction to Bella Health and Wellness, a Catholic medical clinic based in Englewood and Denver, concluding that Colorado Senate Bill 23-190, passed in April 2023, failed strict scrutiny and was not generally applicable to comparable secular conduct.
SB 23-190 had classified “medication abortion reversal” (MAR)—typically involving progesterone—as unprofessional conduct unless state medical boards found the practice met generally accepted standards. No such approval was issued. Bella Health, which regards offering MAR as a religious obligation, sued immediately after the law’s passage, arguing the law targeted faith-based providers and burdened their sincerely held religious beliefs.
Judge Domenico had previously granted a preliminary injunction in October 2023. Following discovery and cross-motions for summary judgment, the court found the evidence confirmed key facts: Bella Health had provided MAR treatment to several women with no documented adverse effects, including at least 11 who went on to deliver babies after receiving the therapy.
The court held that SB 23-190 “targets one particular, FDA-approved, drug for differential regulation” and permits other off-label uses of progesterone—such as in gender-affirming care or fertility treatment—without similar restrictions. That disparity, the court said, disqualified the law from being deemed “generally applicable” and thus triggered strict scrutiny under the Free Exercise Clause. Colorado, the court concluded, had not shown a compelling interest narrowly tailored enough to justify the law’s burdens on Bella’s religious practice.
The decision also rejected Colorado Attorney General Phil Weiser’s argument that he was immune from suit under the Eleventh Amendment, citing his statutory obligation to prosecute disciplinary actions referred by medical boards.
However, the court dismissed Bella Health’s challenge to the law’s restrictions on advertising, finding the clinic lacked standing. The Attorney General had never investigated or prosecuted any provider under that portion of the law and had “no plans” to do so.
The ruling applies only to Bella Health and its affiliates. Judge Domenico emphasized he had no power to enjoin the statute itself, only its enforcement against the plaintiffs in the case. He declined to address whether the law could be enforced against other providers not before the court.
State officials have not announced whether they intend to appeal. For now, Bella Health may continue offering abortion pill reversal treatment without risk of disciplinary action. No further hearings have been scheduled.
Analysis:
The ruling by Judge Domenico offers a textbook application of how the Free Exercise Clause functions post-Fulton v. City of Philadelphia and Tandon v. Newsom. The key move in the opinion is the determination that SB 23-190 is not “generally applicable,” which automatically triggers strict scrutiny—a standard that very few laws survive when applied robustly.
That conclusion stems from two related factors. First, Colorado allows other off-label uses of progesterone, including in controversial or uncertain contexts such as gender-affirming care or fertility treatment. Second, the law includes mechanisms for case-by-case exemptions, which courts have repeatedly said undermines the neutrality and general applicability of a statute. In combination, those factors opened the door to strict scrutiny and made the law vulnerable.
Once in the realm of strict scrutiny, the state needed to show both a compelling interest and that its law was narrowly tailored to advance that interest. Judge Domenico found the law overbroad and underinclusive—targeting religiously motivated conduct (abortion pill reversal) while leaving comparable secular conduct (other off-label uses of progesterone) untouched. This is exactly the sort of regulatory inconsistency that Lukumi Babalu Aye warned against.
Importantly, the court didn’t opine on whether abortion pill reversal is medically effective. Instead, the opinion emphasized that religious practice cannot be disfavored even when the state questions the underlying medical rationale—especially when other, equally speculative treatments remain permitted. This ruling reinforces that governments must regulate religious and secular conduct evenhandedly and not selectively invoke medical uncertainty when religion is involved.
While narrow in scope—limited to Bella Health and those acting in concert with it—the decision sends a clear signal that religious providers may prevail when laws single out their conduct without robust, evenhanded justification. Whether an appeal alters that outcome will depend in large part on how the Tenth Circuit and possibly the Supreme Court interpret neutrality and tailoring in similarly fact-intensive contexts.
Tags: abortion pill reversal, Bella Health, Colorado SB 23-190, religious liberty, federal court ruling