A federal appeals court upheld New York’s repeal of religious exemptions for school vaccination requirements, setting up a possible Supreme Court clash over religious liberty, parental rights and vaccine mandates.

By yourNEWS Media Newsroom

A federal appeals court has ruled against Amish families challenging New York’s school vaccination law, a decision that could move the dispute closer to a U.S. Supreme Court review with potential nationwide implications for religious exemptions.

The 2nd U.S. Circuit Court of Appeals last week rejected the challenge in Miller v. McDonald, finding that New York’s repeal of religious exemptions from school vaccination requirements is neutral, generally applicable and does not single out religious practices for discrimination. The court also said the law advances the state’s interest in protecting the public from disease.

The case was brought by Amish parents and representatives of Amish schools in New York who sued the state Department of Health and Department of Education in 2023. They argued that the law violates the Free Exercise Clause of the First Amendment and the 14th Amendment.

The families face $118,000 in fines for failing to comply with New York’s school vaccination rules.

The decision marked the second time the 2nd Circuit ruled against the plaintiffs. The court previously dismissed the suit in 2024, affirming an earlier federal court ruling.

The case returned to the 2nd Circuit after the Supreme Court sent it back in December 2025 for further review in light of constitutional questions raised by its ruling in Mahmoud v. Taylor. In that case, the Supreme Court found that parents may seek religious exemptions for their children from LGBTQ curriculum.

The latest ruling in Miller v. McDonald may now “set the stage for a potential Supreme Court battle over vaccine mandates,” The Washington Post reported, citing legal experts who said the high court may be likely to take up the case because of the constitutional issues and the Mahmoud decision.

Lawrence Gostin, a Georgetown University health law professor and vaccine supporter, told the Post that if the Supreme Court reviews the case, he expects it to “reverse the appellate court’s decision.”

A Supreme Court ruling in favor of the Amish plaintiffs could “allow religious vaccine exemptions nationwide,” the Post reported. The newspaper also reported last month that the Supreme Court has indicated it “may be open to a constitutional claim based on the lack of a religious exemption for vaccine mandates in New York.”

The Post wrote that a ruling for the Amish plaintiffs would be “the anti-vaccine movement’s biggest win.”

Aaron Siri, an attorney for the Informed Consent Action Network and one of the lawyers representing the plaintiffs, told the Post last week, “We look forward to vindicating the rights of the Amish at the Supreme Court so that they can live in peace and without religious persecution.”

New York ended religious exemptions in 2019 after state health officials cited a 2018-2019 measles outbreak among students in an Orthodox Jewish community in Rockland County.

New York is now one of four U.S. states that do not recognize religious vaccine exemptions, along with California, Connecticut and Maine. In West Virginia, the issue remains tied up in litigation and political debate. Other states, including Massachusetts, are considering proposals to remove religious vaccination exemptions.

The American Academy of Pediatrics, the country’s largest pediatric trade group, called last year for religious exemptions to be eliminated.

In its decision, the 2nd Circuit said medical exemptions remain meaningfully different from religious exemptions. The court said medical exemptions require “sufficient” documentation of a child’s medical condition and are limited to specific vaccines, while religious exemptions apply broadly to all vaccines otherwise required for schoolchildren.

Greg Glaser, general counsel for Physicians for Informed Consent, said the court reached the wrong conclusion. His group filed an amicus brief with the Supreme Court supporting the plaintiffs.

“The State of New York actively favors secular exemptions (medical) while concurrently prohibiting religious exemptions. This unequal treatment directly violates the Equal Protection Clause,” Glaser said.

Michael Kane, director of advocacy for Children’s Health Defense, said the Supreme Court specifically asked the 2nd Circuit to reconsider its prior ruling in light of Mahmoud v. Taylor, but he said the appellate court largely avoided the implications of that decision.

“I find it very unlikely that the Supreme Court is going to allow that to be the final word,” Kane said.

The Post reported last month that Miller v. McDonald, along with challenges to religious exemption bans in California and West Virginia, could produce a “national legal win” for opponents of vaccine mandates.

Leslie Manookian, president and founder of the Health Freedom Defense Fund, said the reach of any Supreme Court decision would depend on how broadly the justices rule.

“If the court does rule in favor of religious exemptions to vaccines, unless there is some caveat to the ruling, a Supreme Court ruling would be binding nationwide and thereby eliminate state action to remove religious exemptions,” Manookian said.

Kane said one possible limitation would be a ruling that applies only to the Amish or another specific group rather than all religious objectors. Still, he said that kind of narrow decision may be difficult.

“You can’t rule in favor of one religious group to have the right to an exemption but then declare another religious group does not share that same right,” Kane said. “There is a chance the court could rule narrowly on the specifics of this case, but that will be hard in my view. A win for the Amish is likely to be a win for all.”

Manookian said the Supreme Court’s willingness to take a vaccine-related case remains uncertain.

“I would hope that case ends up at the Supreme Court, but find it difficult to predict what the court will do as it seems committed to avoiding the vaccine issue,” Manookian said.

Glaser said the current legal environment has become difficult for both families and lawyers to navigate as exemption disputes continue across several states.

“The Miller case highlights a chaotic legal landscape where lawyers and families face direct legislative confusion,” Glaser said. “Lower courts will continue splitting over the Equal Protection Clause until the Supreme Court provides the explicit clarity required.”

The debate has also expanded beyond New York. Last month, the Post cited efforts by CHD and ICAN, both of which have pursued legal challenges against efforts to restrict religious exemptions.

Siri is also representing plaintiffs in West Virginia, where a case is challenging efforts to maintain a ban on religious exemptions. That dispute pits state education authorities against Gov. Patrick Morrisey, who issued an executive order last year recognizing religious and philosophical exemptions.

The West Virginia case, now pending before the Supreme Court of West Virginia, “could be a contender for Supreme Court review,” the Post reported.

In May, CHD filed an amicus brief urging West Virginia’s Supreme Court to closely review submissions from organizations including the AAP and the Infectious Diseases Society of America, which filed briefs supporting West Virginia’s vaccine mandate policies.

Siri told the Post last month that the purpose of the cases is to bring the “five outlier states in alignment with the other forty-five in respecting religious liberty.”

Members of Congress have also joined the dispute. Earlier this year, federal lawmakers urged the U.S. Department of Justice to investigate New York, California, Maine and Connecticut over their refusal to allow religious exemptions from school vaccine mandates.

Glaser said the dispute ultimately concerns medical decision-making and parental rights.

“Informed consent and informed refusal are the bedrock of medical ethics,” Glaser said. “Banning religious exemptions effectively legalizes medical bullying by proxy, forcing families to forfeit their children’s education if they choose to exercise informed refusal.”

A 2025 survey found that public support for religious exemptions in the United States nearly doubled compared with 2019.