Since the Supreme Court handed down its landmark Hobby Lobby decision last year, lawyers and activists on both sides of the Obamacare contraception mandate have been trying to outmaneuver each other on the technicalities of exemptions. Four appeals courts have ruled in favor of the government mandate, but until this week, one case served as both a holdout for religious freedom, and a thorn in the Obama Administration’s side.

The Little Sisters of the Poor, an order of Roman Catholic nuns, were granted a temporary exemption from the mandate by the Supreme Court last year. They then went before the 10th Circuit Court of Appeals in an attempt to extend that protection, but were denied. Today, the 10th Circuit upheld that ruling, saying that compliance requirements “do not substantially burden plaintiffs’ religious exercise or violate the plaintiffs’ First Amendment rights.” Now, the Little Sisters are faced with either complying with the mandate, or paying massive IRS penalties.

Via The Hill:

Under the contraceptive mandate, nonprofit religious groups like Little Sisters of the Poor are permitted to opt out of the requirement if they report their concerns to their insurance companies or the federal government.

But that group and others have objected to any extra steps to obtain the exemption. Instead, they are seeking the same treatment as houses of worship, which are not required to fill out additional paperwork in order to avoid fines under the law.

“It is a national embarrassment that the world’s most powerful government insists that, instead of providing contraceptives through its own existing exchanges and programs, it must crush the Little Sisters’ faith and force them to participate,” Mark Rienzi, lead attorney for the Little Sisters of the Poor, wrote in a statement.

Rienzi, who accused federal officials of “hijacking” the nuns’ health plan, said the group’s attorneys are considering whether to appeal the decision to the Supreme Court.

In its opinion, the court compared the exemption process to applying for a parade permit or registering to vote, and rejected the idea that the organization’s participation in the mandate scheme makes it complicit in the overall delivery of contraceptives.

Many outlets are touting this as an “end of the road” ruling for the Little Sisters, and other similar organizations, but Mark Rienzi, Senior Counsel of the Becket Fund for Religious Liberty and lead attorney for the Little Sisters of the Poor, has publicly stated that he will review an appeal to the Supreme Court:

“We’re disappointed with today’s decision. After losing repeatedly at the Supreme Court, the government continues its unrelenting pursuit of the Little Sisters of the Poor. It is a national embarrassment that the world’s most powerful government insists that, instead of providing contraceptives through its own existing exchanges and programs, it must crush the Little Sisters’ faith and force them to participate,” he said. “Untold millions of people have managed to get contraceptives without involving nuns, and there is no reason the government cannot run its programs without hijacking the Little Sisters and their health plan.”

We’ll keep you posted on the status of the appeal.