PITTSBURGH (AP) — A federal appeals court has reversed lower-court victories by two western Pennsylvania Catholic dioceses and a private Christian college that challenged birth control coverage mandates as part of federal health care reforms.

The 3-0 ruling Wednesday by the 3rd U.S. Circuit Court of Appeals panel found that the reforms place “no substantial burden” on the religious groups and therefore don’t violate their First Amendment right to religious expression.

All three organizations are mulling whether to appeal to the entire 3rd Circuit Court or the U.S. Supreme Court.

“Such a ruling should cause deep concern for anyone who cares about any First Amendment rights, especially the right to teach and practice a religious faith,” Pittsburgh Bishop David Zubik said in a statement. “This decision says that the church is no longer free to practice what we preach.”

At issue is an “accommodation” written into the Affordable Care Act that says religious organizations can opt out of directly providing and paying to cover medical services such groups would consider morally objectionable. In this case, that refers to all contraceptive and abortion services for the Catholic plaintiffs, and contraceptive services like the “week-after” pill and other medical coverage that Geneva College contends violate its anti-abortion teachings. The school in Beaver Falls is affiliated with the Reformed Presbyterian Church.

Justice Department lawyers have argued the accommodation solves the problem because it allows religious groups to opt out of directly providing such coverage. But the plaintiffs contend that merely filing the one-page form, which puts a religious group’s objections on record with the government, violates their rights because it still “facilitates” or “triggers” a process that then enables third-party insurers to provide the kind of coverage to which they object.

The appellate opinion written by Judge Marjorie O. Rendell rejects that reasoning.

“Federal law, rather than any involvement by the appellees in filling out or submitting the self-certification form, creates the obligation” for third parties to offer the objected-to coverage, Rendell wrote.

The opinion says the form merely provides a way for the religious groups to avoid being penalized for opting not to directly provide the benefits. But the groups have argued the form does more than that if the third-party providers can’t provide the services before the form is filed. That question is expected to be raised in future appeals.

The Catholic plaintiffs raise a second issue. Churches themselves, and their employees, are automatically exempt from the health care mandates. But affiliated organizations — like the college — and charities are not, so the dioceses contend the law essentially divides the church against itself.

The 3rd Circuit, based in Philadelphia, is the fourth federal appeals court to rule that the accommodation is not a burden on the nonprofits’ exercise of religion. The other courts that have ruled are based in Chicago, Cincinnati and Washington, D.C. At least four other appellate courts are considering the same issue, and experts on both sides expect the Supreme Court eventually will settle the matter.

The justices could act on a request by the University of Notre Dame as soon as Feb. 23. The earliest the issue could be argued at the Supreme Court is October, and a decision would not be expected until 2016.

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Associated Press writer Mark Sherman in Washington contributed to this report.