Miller v. McDonald

24-681
Miller v. McDonald


                                           In the
                     United States Court of Appeals
                               For the Second Circuit
                                     _________________

                                    August Term 2024
                                Argued: November 18, 2024
                                  Decided: March 3, 2025

                                     Docket No. 24-681

       JOSEPH MILLER, EZRA WENGERD, JONAS SMUCKER, DYGERT ROAD SCHOOL,
                  PLEASANT VIEW SCHOOL, SHADY LANE SCHOOL,

                                                         Plaintiffs-Appellants,

                                              v.

    JAMES V. MCDONALD, in his official capacity as Commissioner of Health of the
                               State of New York,

                                                          Defendant-Appellee,

BETTY A. ROSA, in her official capacity as Commissioner of Education of the State
                                   of New York,

                                                          Defendant. *

                                     _________________

Before:                CABRANES, WESLEY, and LEE, Circuit Judges.
                                     _________________

    In 2019, New York repealed the religious beliefs exemption to its school
immunization law. The law now applies to all students attending public, private,

*   The Clerk of Court is respectfully directed to amend the caption as set forth above.
or parochial schools, except those who qualify for the law’s medical exemption.
Two parents of Amish students, three Amish “community schools,” and an elected
representative of all Amish schools in New York sued New York officials under

, claiming that the school immunization law infringes on their free
exercise rights under the First and Fourteenth Amendments. The parents view
their claims as similar to the combined parental and free exercise rights brought
by Amish parents in Wisconsin v. Yoder, 

 (1972). Plaintiffs moved for a
preliminary injunction; Defendants opposed the preliminary injunction and
moved to dismiss. The United States District Court for the Western District of
New York (Elizabeth A. Wolford, Chief Judge) granted the motion to dismiss,
concluding that Plaintiffs failed to allege a constitutional violation, and denied the
preliminary injunction request as moot. We agree with the district court’s sound
reasoning and therefore AFFIRM.
                                 _________________

             SHANNON G. DENMARK, Lehotsky Keller Cohn LLP, Austin, TX (Kyle
                 Hawkins, Lehotsky Keller Cohn LLP, Austin, TX; Christopher
                 D. Wiest, Covington, KY; Hiram Sassar, Justin Butterfield, First
                 Liberty Institute, Plano, TX; Elizabeth A. Brehm, Walker D.
                 Moller, Siri & Glimstad LLP, New York, NY, on the brief), for
                 Plaintiffs-Appellants.

             MARK S. GRUBE, Senior Assistant Solicitor General (Barbara D.
                 Underwood, Solicitor General, Andrea Oser, Deputy Solicitor
                 General, on the brief), for Letitia James, Attorney General of the
                 State of New York, New York, NY.

             Steve Marshall, Alabama Attorney General, Edmund G. LaCour Jr.,
                   Alabama Solicitor General, Robert M. Overing, Alabama
                   Deputy Solicitor General, for Amici Curiae State of Alabama and
                   19 Other States.
                                _________________




                                          2
PER CURIAM:

         New York has long regulated immunization in schools. In 1860, New York

“directed and empowered” school officials to deny the admission of unvaccinated

students, 1 making it the second state in the nation to mandate school vaccination. 2

In 1966, New York enacted a school immunization law in which students who

could not be vaccinated for medical reasons or students whose parents held

religious objections to vaccines were exempted. 3

         New York maintained both exemptions until 2019. During 2018 and 2019,

the United States experienced the worst measles outbreak in over twenty-five

years; New York was the epicenter. Most cases occurred in communities with

clusters of unvaccinated individuals. Following that outbreak, the legislature

repealed the religious beliefs exemption while retaining the medical exemption.

         Plaintiffs-Appellants are three “Amish community schools”—Dygert Road

School, Pleasant View School a/k/a Twin Mountain School, and Shady Lane

School—that have been fined for failing to comply with New York’s immunization



1   Ch. 438 § 1, 

, 761.
2See John Duffy, School Vaccination: The Precursor to School Medical Inspection, 33 J. Hist.
Med. & Allied Scis. 344, 346 (1978).
3   Ch. 994 § 2, 

, 3332–33.
                                                 3
law; Ezra Wengerd, an elected representative of all Amish schools in New York;

and Jonas Smucker and Joe Miller, board members of their children’s Amish

community schools (collectively, “Plaintiffs”).          The schools do not require a

certificate of immunization to attend because the parents “have sincerely held

religious beliefs which do not permit them to inject” their children with vaccines. 4

J.A. 13.

       Plaintiffs brought a claim pursuant to 

 against Defendant-

Appellee Dr. James V. McDonald, in his official capacity as the Commissioner of

Health of the State of New York (“the State”), alleging that the immunization law

infringes on their free exercise rights under the First and Fourteenth

Amendments. 5 The parents also argue that the law is unconstitutional because it

impairs Amish parents’ right to control the religious upbringing of their children

as recognized in Wisconsin v. Yoder, 

 (1972). Plaintiffs moved to




4For purposes of reviewing the district court’s decision on the motion to dismiss, we
accept as true the facts alleged in the complaint. Phillips v. City of New York, 

 (2d Cir. 2015) (per curiam).
5Plaintiffs also brought official-capacity claims against Dr. Betty A. Rosa, the current
Commissioner of Education of the State of New York. The district court granted the
State’s motion to dismiss those claims for lack of standing. Because Plaintiffs do not
appeal that aspect of the district court’s decision, we do not address it.
                                              4
preliminarily enjoin the law’s enforcement against them; the State moved to

dismiss. Chief Judge Elizabeth A. Wolford granted the State’s motion to dismiss,

concluding that Plaintiffs failed to plausibly allege a constitutional violation. The

court denied Plaintiffs’ request for a preliminary injunction as moot. We affirm.

                                  BACKGROUND 6

      New York Public Health Law § 2164 requires that children who attend

public, private, or parochial schools for more than fourteen days be immunized

against certain diseases. 

(1), (2)(a), (7). As noted

above, New York previously allowed two exemptions from that requirement: if a

licensed physician certified that immunization would be “detrimental to a child’s

health,” 

 § 2164(8), or if a child’s parent or guardian held “genuine and sincere

religious beliefs which are contrary to the [vaccination] practices,” id. § 2164(9)

(repealed 2019).

      The legislature repealed the religious beliefs exemption on June 13, 2019.

The legislature recognized that “sustaining a high vaccination rate among school




6The following facts are drawn from Plaintiffs’ verified complaint and the legislative and
administrative records. See Goe v. Zucker, 

 (2d Cir. 2022). Consistent with
the parties’ briefs, we also draw from the preliminary injunction record.
                                            5
children is vital to the prevention of disease outbreaks, including the

reestablishment of diseases that have been largely eradicated in the United States,

such as measles.” N.Y. Bill Jacket at 4A, 2019 A.B. 2371, Ch. 35. 7 Immunization

rates in New York had plummeted “far below the [Centers for Disease Control and

Prevention]’s goal of at least a 95% vaccination rate to maintain herd immunity.” 8

 Data from 2013 and 2014 indicated that “at least 285 schools in New York” had

“an immunization rate below 85%, including 170 schools below 70%.” 

      Shortly before its repeal, the percentage of students invoking the religious

exemption in private and parochial schools increased from 0.54% to 1.53%. N.Y.

Senate, Tr. Floor Proceedings, 242d Sess. 5250, 5389 (June 13, 2019) (“Senate Tr.”).

Indeed, its use tripled or quadrupled in some areas. 

 In six schools in Rockland

County—the hotspot of the measles outbreak—up to 20% of students had religious

exemptions. N.Y. Assembly, Tr. Floor Proceedings, 242d Sess. 1, 58–59 (June 13,




7 We accord “contemporaneous interpretation of a statute . . . considerable weight in
discerning legislative intent.” Brokamp v. James, 

, 398 n.22 (2d Cir. 2023)
(quoting Vatore v. Comm’r of Consumer Affs., 

 (1994)).
8“Herd immunity” refers to the percentage of individuals in a community who must be
vaccinated to reduce the likelihood of a vaccine-preventable disease’s transmission. J.A.
584.
                                           6
2019) (“Assembly Tr.”). Religious exemptions far outpaced medical exemptions—

five to one. Id. at 70.

       In November and December 2021, New York’s Department of Health

(“DOH”) audited Plaintiff schools’ compliance with the immunization law. In

March 2022, the DOH concluded that students went to those schools for more than

fourteen days during the 2021–2022 school year without a certificate of

immunization, documentation of immunity, or a signed medical exemption. It

therefore charged the schools with violating § 2164(7)(a). After an administrative

hearing, the Commissioner of Health sustained the charges and imposed fines

totaling $118,000. 9




9Each violation of § 2164 is subject to a fine of up to $2,000. The DOH considers each day
that an unvaccinated student attends school to be a violation. The Commissioner of
Health concluded the total fines were “principled and conservative under the
circumstances.” J.A. 127. More specifically, the Commissioner of Health’s order imposed
a $52,000 fine against Dygert Road School, a $46,000 fine against Twin Mountains School,
and a $20,000 fine against Shady Lane School. To calculate the fines against Dygert Road
and Twin Mountains, the DOH multiplied the number of out-of-compliance students in
each school by the maximum penalty (under the modest assumption that each of those
students was out of compliance for only one day). Because Shady Lane provided no
documentation for its students, the DOH assumed that one student was not compliant
for at least ten days.


                                            7
      On June 2, 2023, Plaintiffs sued the State under 

, claiming

that New York Public Health Law § 2164 violates their First and Fourteenth

Amendment rights. They allege that the Amish faith commands a self-reliant

lifestyle separate from the modern world. As a consequence of their “commitment

to a century’s old way of life,” “many Amish maintain profound religious

objections to vaccines.” J.A. 11. “Their beliefs also consider abortion murder and

aborted fetuses are inextricably intertwined with vaccine development . . . .” J.A.

35. Consistent with those religious beliefs, Plaintiff schools “do not require proof

of vaccination from students to attend school.” J.A. 11.

      Plaintiffs refuse to comply with § 2164—either by vaccinating or

homeschooling their children. They assert that “a vital part of [Amish] children’s

spiritual development” is to learn “in a group setting.” J.A. 15. They contend the

fines and threat of additional penalties will shutter the Amish community’s

schools and their ability to educate children in a group setting. Plaintiffs sought

an injunction to prohibit the State’s enforcement of § 2164 against them, a

declaration of the law’s unconstitutionality as applied to them, and attorney’s fees.

      Shortly after filing their complaint, Plaintiffs moved for a preliminary

injunction. The State opposed the preliminary injunction request and moved to

                                         8
dismiss Plaintiffs’ complaint pursuant to Federal Rule of Civil Procedure 12(b)(6).

The district court granted the State’s motion to dismiss. 10 Miller v. McDonald, 

, 218 (W.D.N.Y. 2024). It applied this Court’s reasoning in We The

Patriots USA, Inc. v. Connecticut Office of Early Childhood Development, in which we

held that Connecticut’s repeal of the religious exemption to its school

immunization law, while maintaining the medical exemption, did not violate the

Free Exercise Clause. 

 (2d Cir. 2023). The district court explained

that § 2164 was “not materially different” from “Connecticut’s mandatory school

vaccination regime.” Miller, 720 F. Supp. 3d at 203. Therefore, We The Patriots

“compel[led] dismissal” of Plaintiffs’ free exercise claim. Id. at 202.

       The district court also dismissed the free exercise claim that was combined

with the parents’ right “to regulate the upbringing and education of their

children.” Id. at 218. The district court noted it was “not free to disregard Second

Circuit precedent,” which does not apply a heightened standard to such “hybrid

rights” claims. Id. This appeal followed.




10Dismissing all claims, the district court also denied Plaintiffs’ motion for a preliminary
injunction as moot. Miller v. McDonald, 

, 218 (W.D.N.Y. 2024).
                                             9
                                    DISCUSSION

      To survive a motion to dismiss, a complaint must “state a claim to relief that

is plausible on its face.” Ashcroft v. Iqbal, 

 (2009) (quoting Bell Atl.

Corp. v. Twombly, 

 (2007)). We review the district court’s decision

on the motion to dismiss de novo, accepting as true the facts alleged in the

complaint and drawing all reasonable inferences in Plaintiffs’ favor. We The

Patriots, 

. “In addition to the facts alleged in the complaint, ‘as a

fundamental matter, courts may take judicial notice of legislative history.’” 

 at

136 (quoting Goe v. Zucker, 

 (2d Cir. 2022)).

 I.     Free Exercise Claims

      The Free Exercise Clause of the First Amendment applies to the states

pursuant to the Fourteenth Amendment, and provides that the states “shall make

no law . . . prohibiting the free exercise” of religion. However, “the right of free

exercise does not relieve an individual of the obligation to comply with a ‘valid

and neutral law of general applicability on the ground that the law proscribes (or

prescribes) conduct that his religion prescribes (or proscribes).’” Emp. Div., Dep’t

of Hum. Res. of Or. v. Smith, 

 (1990) (quoting United States v. Lee,

, 263 n.3 (1982) (Stevens, J., concurring)).

                                           10
      A neutral and generally applicable law’s burden on religion is constitutional

if the law passes the relatively low hurdle of rational basis review—that the state

has chosen a means for addressing a legitimate government interest rationally

related to achieving that goal. See, e.g., Kane v. De Blasio, 

, 166 (2d Cir.

2021) (per curiam). If a law is not neutral or generally applicable, however, the

government must demonstrate that the law satisfies strict scrutiny, which requires

the law “to further ‘interests of the highest order’ by means ‘narrowly tailored in

pursuit of those interests.’” Tandon v. Newsom, 

, 64–65 (2021) (per

curiam) (quoting Church of Lukumi Babalu Aye, Inc. v. Hialeah, 

(1993)). As the Supreme Court explained in Smith, requiring all laws that burden

religion to satisfy the demands of strict scrutiny “would open the prospect of

constitutionally required religious exemptions from civic obligations of almost

every conceivable kind,” including “compulsory vaccination laws.” 494 U.S. at

888–89. “[A]dopting such a system would be courting anarchy.” Id. at 888.

      Indeed, the Supreme Court and this Court have consistently viewed

immunization laws with approval. In Jacobson v. Massachusetts, the Supreme Court

held that a state had the power to mandate vaccination against smallpox for adults

who were “fit subject[s] of vaccination.” 

, 38–39 (1905). In Zucht v. King,

                                          11
the Supreme Court upheld a city ordinance requiring children to present a

certificate of vaccination before attending school. 

, 175–77 (1922). This

Court has repeatedly upheld neutral and generally applicable immunization laws

in the face of free exercise challenges. 11

        Plaintiffs concede that New York Public Health Law § 2164 satisfies rational

basis review—immunization programs reduce disease. However, they argue this

case is different from the long line of cases upholding immunization laws because

§ 2164 is not neutral or generally applicable. Plaintiffs further argue that the law

cannot withstand strict scrutiny, and therefore it is unconstitutional as applied to

them.




11See, e.g., We The Patriots USA, Inc. v. Conn. Off. of Early Childhood Dev., 

, 147–
48 (2d Cir. 2023) (repeal of Connecticut’s religious exemption to its school immunization
law was a neutral and generally applicable law and survived rational basis review);
Phillips v. City of New York, 

 (2d Cir. 2015) (per curiam) (temporary school
exclusion of children with religious exemptions during chicken pox outbreak not
unconstitutional because “New York could constitutionally require that all children be
vaccinated in order to attend public school”); We The Patriots USA, Inc. v. Hochul, 

, 290 (2d Cir. 2021) (per curiam) (plaintiffs not likely to succeed in showing that
mandatory vaccination of healthcare employees without religious exemption was not
neutral or generally applicable); Kane v. De Blasio, 

, 166 (2d Cir. 2021) (per
curiam) (vaccine mandate for teachers “plainly satisfies” rational basis review).
                                              12
             Neutrality

      Plaintiffs contend that § 2164’s text and the statements of several legislators

reveal a discriminatory motive. Rejecting those arguments, the district court

concluded that the law did not “target[] religious belief,” and that the legislative

record revealed “no evidence of hostility.” Miller, 720 F. Supp. 3d at 210–11. We

agree with the district court.

      A state “fails to act neutrally when it proceeds in a manner intolerant of

religious beliefs or restricts practices because of their religious nature.” Fulton v.

City of Philadelphia, 

 (2021). “[I]t is not enough for a law to simply

affect religious practice; the law or the process of its enactment must demonstrate

‘hostility’ to religion.” We The Patriots, 

.

      New York Public Health Law § 2164 is neutral on its face. It does not target

or affirmatively prohibit religious practices. Cf. Roman Cath. Diocese of Brooklyn v.

Cuomo, 

 (2020) (per curiam) (applying strict scrutiny and enjoining

regulation that “single[d] out houses of worship for especially harsh treatment”);

Cent. Rabbinical Cong. of U.S. & Canada v. N.Y.C. Dep't of Health & Mental Hygiene,

 (2d Cir. 2014) (applying strict scrutiny to regulation that targeted

only “religious actors performing a religious practice, and during a religious

                                           13
ceremony”).       The law simply applies New York’s school immunization

requirements to all schoolchildren who do not qualify for the law’s medical

exemption. Moreover, the act of repealing the religious exemption did not “in and

of itself transmute” this otherwise neutral law into one “that targets religious

beliefs.” We The Patriots, 

 (quoting F.F. ex rel. Y.F. v. State, 

, 478 (Sup. Ct. 2019), aff’d sub nom. F.F. v. State, 

 (3d Dep’t 2021)).

       Nor does the legislative history reveal an anti-religious bias. Plaintiffs argue

that statements made by a small number of legislators, some of whom sponsored

the amendments in their respective houses, evidence religious animus.                    But

Plaintiffs have not alleged facts to suggest that those remarks infected “a sizeable

portion” of legislators’ votes or otherwise influenced the law’s enactment. See

United States v. Suquilanda, 

, 143–44 (2d Cir. 2024); see also F.F., 194

A.D.3d at 86 (statements from three percent of the legislature did not “taint the

actions of the whole” in passing § 2164). To the contrary, the legislative record is

full of respectful statements in support of religious freedoms. 12 The final vote


12See, e.g., N.Y. Sponsor’s Memorandum, 2019 S.B. S2994-A, 242d Sess. (acknowledging
that “freedom of religious expression is a founding tenet of this nation”); Senate Tr. at
5414 (“I mean, we’re talking about freedom of religion; . . . [i]t is not an easy decision.”);
id. at 5451 (“I will be recorded in the negative on this vote, but I do appreciate the debate
and the respectfulness with which this issue was approached today.”).
                                             14
passing the legislation—84 to 61 in the Assembly and 36 to 26 in the Senate—

further reflects the “spirited floor debate among the legislators” and their

thoughtful consideration of the interests at stake. F.F., 194 A.D.3d at 86; Bill Jacket

at 3–4.

      These circumstances differ from where discriminatory intent can be

ascribed to a small group of decision-making officials. For example, in Masterpiece

Cakeshop v. Colorado Civil Rights Commission, the Supreme Court held that

statements made by several of seven commissioners were hostile to religion and

therefore “cast doubt on the fairness and impartiality” of the administrative

enforcement proceeding, particularly given that no one disavowed the substance

of the statements. 

, 634–36 (2018). The remarks were made “by an

adjudicatory body deciding a particular case”—“a very different context” from

“statements made by lawmakers.” Id. at 636. Similarly, in M.A. v. Rockland County

Department of Health, this Court remanded for a jury to consider whether

statements made by the two government officials responsible for issuing a

challenged emergency declaration evinced religious animus. 

, 37–38

(2d Cir. 2022).




                                          15
      By contrast, the motives of a small number of legislators cannot be attributed

to the legislative body as a whole. A member of the Assembly speaks for himself

in the well of the chamber, for each legislator has “a duty to exercise their

judgment and to represent their constituents.” Cf. Brnovich v. Democratic Nat’l

Comm., 

, 689–90 (2021). It is “insulting to suggest” that legislators

voting for a bill are simply acting at the bill’s sponsors’ behest. 

. Plaintiffs

have not plausibly alleged that § 2164 is not neutral.

             General Applicability

      A law is not generally applicable in two circumstances: (1) when the law

treats comparable secular conduct more favorably than religious activity, Tandon,

, or (2) when “it ‘invites’ the government to consider the particular

reasons for a person’s conduct by providing ‘a mechanism for individualized

exemptions,’” Fulton, 

 (alteration omitted) (quoting Smith, 

). Plaintiffs argue that both circumstances are present here.

             1.     Treatment of Comparable Secular Activity

      Plaintiffs contend that exempting students for medical reasons treats

comparable secular conduct more favorably than religious beliefs. The district

court concluded that We The Patriots “forecloses the argument that the medical

                                           16
exemption and the repealed religious exemption are comparable.” Miller, 720 F.

Supp. 3d at 217. We agree.

      Secular conduct is not always “comparable” to religious conduct. It is

“comparable” when the secular conduct poses risks “at least as harmful to the

legitimate government interests” justifying the law as posed by the religious

conduct incidentally burdened by the law. See Cent. Rabbinical Cong., 

; see also Tandon, 

.

      New York’s interest in passing § 2164 was in “protect[ing] the health of all

New Yorkers, particularly our children,” N.Y. Sponsor’s Memorandum, 2019 S.B.

S2994-A, from “disease outbreaks” by “sustaining a high vaccination rate among

school children,” Bill Jacket at 4A.    When repealing its religious exemption,

Connecticut identified effectively the same interest: to “protect the health and

safety of Connecticut students and the broader public.” We The Patriots, 

. As such, the same reasons justifying the lack of comparability in We The

Patriots apply here. Repealing the religious exemption decreases “to the greatest

extent medically possible” the number of unvaccinated students and thus the risk

of disease; maintaining the medical exemption allows “the small proportion of

students” who medically “cannot be vaccinated” to avoid the health consequences

                                        17
that “taking a particular vaccine would inflict.” 

. Exempting religious

objectors, however, detracts from that interest. Religious exemptions increase “the

risk of transmission of vaccine-preventable diseases among vaccinated and

unvaccinated students alike.” 

      The two exemptions also are meaningfully different in scope and duration.

The medical exemption is granted only with “sufficient” documentation of the

child’s contraindication to “a specific immunization.” N.Y. Comp. Codes R. &

Regs. 10 § 66-1.3(c) (emphasis added). It has limits; it lasts only “until such

immunization is found no longer to be detrimental to the child’s health,” 

(8), and “must be reissued annually,” 

(c). Meanwhile, the religious exemption was generalized to all

vaccines for the duration of that child’s school admission.         The religious

exemption’s sweep had a far greater ability to undermine the State’s interest in

preventing the spread of disease.

      Plaintiffs argue that analyzing risk in the aggregate, as we did in We The

Patriots, misses the point: They note that the risk of transmission of the “tiny”

Amish population, who live “in isolated, remote communities,” “pales in

comparison” to the “sum total of medically unvaccinated children statewide.”

                                        18
Appellants’ Br. 34–35.    To begin with, we have rejected the notion that the

comparability analysis should be governed by a “one-to-one comparison.” Hochul,

17 F.4th at 287; see We The Patriots, 76 F.4th at 152–53 (explaining that the Supreme

Court in Tandon compared “gatherings that were religious or secular, private or

commercial” and that the focus is on “aggregations of individual behaviors, not

individual behaviors themselves”). A closer look at the State’s interest in passing

§ 2164 exposes the flaw in Plaintiffs’ argument.

      New York passed § 2164 in response to the 2018 to 2019 measles outbreak.

Legislators felt particularly concerned about the concentration of unvaccinated

children with religious exemptions in the same schools. See, e.g., Senate Tr. at 5385

(noting that the New York City Department of Health traced 44 measles cases,

including 26 students with religious exemptions, to one child with a religious

exemption); Assembly Tr. at 34; Bill Jacket at 4A. Plaintiffs allege that nearly all

Amish schoolchildren are unvaccinated. That means their schools are made up of

a clustered population of almost 100% unvaccinated students—precisely the

circumstances that most concerned the State. The examples included in the record

of measles, pertussis, tetanus, and/or polio recently spreading in certain Amish

communities across the nation and in New York demonstrate that Amish isolation

                                         19
does not protect their communities from disease. Thus, the unique attributes of

Amish communities do not present a lesser risk as it pertains to the State’s interest

in protecting New Yorkers from disease. 13 Plaintiffs have not plausibly alleged

that the law favors comparable secular conduct.

             2.     Individualized Exemptions

      A law also is not generally applicable when it extends broad discretion to

government officials to grant exemptions based on their assessment of “which

reasons for not complying” with the law “are worthy of solicitude.” Fulton, 

 (explaining that allowing an official “sole discretion” to grant an

exemption “renders a policy not generally applicable”). Plaintiffs contend § 2164’s

medical exemption creates just that kind of problem. Again, we disagree.

      The medical exemption works as follows: A child whose physician certifies

that a vaccine “may be detrimental to [the] child’s health” does not have to receive

that vaccine “until such immunization is found no longer to be detrimental to the

child’s health.” 

(8). “May be detrimental to the


13Plaintiffs also allege there are 66,000 unvaccinated students without an exemption and
other unvaccinated people in schools, such as teachers and maintenance staff. They argue
these allegations demonstrate the law is significantly underinclusive. But these wholly
speculative allegations, stripped of any context, do not raise an inference of unfavorable
treatment towards religious conduct.
                                           20
child’s health” means “that a child has a medical contraindication or precaution to

a specific immunization consistent with [Advisory Committee on Immunization

Practices] guidance or other nationally recognized evidence-based standard of

care.” N.Y. Comp. Codes R. & Regs. 10 § 66-1.1(l). The child’s parent must provide

a completed medical exemption certification form, “containing sufficient

information to identify a medical contraindication to a specific immunization and

specifying the length of time the immunization is medically contraindicated.” Id.

§ 66-1.3(c). School officials are authorized to ask for “additional information

supporting the exemption.” Id.

      New York’s medical exemption fits neatly within the contours of other

exemptions to immunization that we have held to be constitutionally permissible.

The statutory exemption is “mandatory,” We The Patriots, 

, and

applies to an “objectively defined” group, Hochul, 17 F.4th at 289. In addition, the

authority conferred to physicians is not discretionary; a physician’s use of her

professional medical judgment is limited by the statute and regulations. Id. The

same is true of the authority conferred upon school officials. Even though school

officials have the authority to conclude that the documents submitted in support

of a medical exemption contain sufficient (or insufficient) information, they do not

                                        21
have “discretion to approve or deny exemptions on a case-by-case basis” for any

reason. 14 We The Patriots, 

; cf. Fulton, 593 U.S. at 536–37.

       Practically speaking, Plaintiffs argue that school officials have “the power

to press the red or green light on each medical exemption request.” J.A. 31. For

example, they allege that up to 50% of students had medical exemptions in one

school while zero students had a medical exemption in another school in the same

community and that medical exemptions are granted inconsistently year to year.

Those allegations do not change our conclusion. Without information about a

student population and its medical needs, there is no way to infer a discretionary

element from the school officials’ acceptance of medical exemption requests.

Moreover, for the reasons explained, the statute does not create a system in which

school officials are given improper discretion to evaluate the reasons given for a

requested medical exemption.

                                      …




14Plaintiffs argue this conclusion is at odds with Goe v. Zucker, in which we described the
delegation of “authority to grant a medical exemption” to school officials. 

(2d Cir. 2022). The power to accept a child’s application is beside the point. The statute
does not allow school officials to “decide which reasons for not complying with the policy
are worthy of solicitude.” Fulton v. City of Philadelphia, 

 (2021).
                                            22
      In sum, Plaintiffs have failed to allege that § 2164 is anything but neutral

and generally applicable. The district court therefore did not err in applying

rational basis review. As noted, Plaintiffs have conceded that the law satisfies

rational basis review. See also Zucker, 

 (finding the protection against

disease through immunization a “legitimate” state interest); We The Patriots, 

 (immunization requirement rationally limited to schools “because

only at school is attendance mandated by law”). Accordingly, we affirm the

district court’s holding that Plaintiffs have failed to allege a free exercise claim.

II.     Hybrid Rights Claims

      The Supreme Court has implied that a neutral and generally applicable law

may nonetheless be subject to heightened scrutiny if a free exercise claim is

brought “in conjunction with other constitutional protections.” Smith, 

. This Court has characterized that language describing so-called “hybrid

rights claims” as dicta, Knight v. Conn. Dep't of Pub. Health, 

, 167 (2d

Cir. 2001), and has declined to apply a heightened standard of review, Leebaert v.

Harrington, 

 (2d Cir. 2003).

      Plaintiffs agree with the district court that hybrid rights claims are generally

not viewed as viable in this Circuit. See Miller, 720 F. Supp. 3d at 218. Yet, they

                                          23
contend their claims should not have been dismissed because they are essentially

the same as the claims in Wisconsin v. Yoder, 

 (1972). 15 There, the

Supreme Court invalidated a Wisconsin law under the Free Exercise Clause that

mandated conventional school attendance until the age of sixteen. 

.

Members of the Amish faith challenged the law, seeking to educate their fourteen-

and fifteen-year-olds through their “long-established program of informal

vocational education.” 

. The Supreme Court held that Wisconsin

failed to demonstrate an “interest of sufficient magnitude” to overcome “the

interests of parenthood” when “combined with a free exercise claim of the nature

revealed by this record.” 

.

       We have observed that the Supreme Court in Yoder “took pains explicitly to

limit its holding.” 16 Leebaert, 

. The trial record demonstrated that



15The hybrid rights claims here focus on Plaintiffs’ ability to direct the upbringing of their
children. We therefore assume that these claims are asserted on behalf of only the parent
Plaintiffs.
16Our sister circuits also have highlighted Yoder’s limitations. See, e.g., Mahmoud v.
McKnight, 

 (4th Cir. 2024) (“As the Supreme Court itself recognized in
Yoder, its holding was tailored to the specific evidence in that record regarding how
Wisconsin’s compulsory secondary education law would have ‘inescapabl[y]’ coerced
the Amish to act or believe in violation of their religious views.” (quoting Wisconsin v.
Yoder, 

 (1972))); Combs v. Homer-Ctr. Sch. Dist., 

 (3d Cir.
2008) (per curiam) (“Yoder’s reach is restricted by the Court’s limiting language and the

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the state law effected a “severe” and “inescapable” burden on the parents’ ability

to pass onto their children the Amish religion and “the fundamental mode of life

mandated by the Amish religion.” Yoder, 406 U.S. at 217–19. Compulsory high

school attendance would take Amish children away “from their community,

physically and emotionally, during the crucial and formative adolescent period of

life.” Id. at 211. That removal would “substantially interfer[e] with the religious

development of the Amish child and his integration into the way of life of the

Amish faith community.” Id. at 218. One expert opined that compulsory high

school attendance would “result in the destruction of the Old Order Amish church

community as it exists in the United States today.” Id. at 212. Wisconsin also failed

to offer any evidence to support its purported interests in mandating, at most, two

additional years of high school attendance. Id. at 221–22.

      Plaintiffs’ objection to vaccines is premised on the same “fundamental belief

that salvation requires life in a church community separate and apart from the




facts suggesting an exceptional burden imposed on the plaintiffs.”); Parker v. Hurley, 

 (1st Cir. 2008) (“Tellingly, Yoder emphasized that its holding was essentially
sui generis, as few sects could make a similar showing of a unique and demanding
religious way of life that is fundamentally incompatible with any schooling system.”).


                                            25
world and worldly influence.” 

. They claim that the school immunization

law mandates two impossible options: inject their children with vaccines, forcing

conduct against their religious beliefs, or forego educating their children in a

group setting, requiring them to sacrifice a central religious practice.      True,

Plaintiffs have shown that § 2164 burdens their religious beliefs and practices; but

those burdens are not equivalent to the existential threat the Amish faced in Yoder.

Unlike in Yoder, compliance with § 2164 would not forcibly remove Amish

children from their community at the expense of the Amish faith or the Amish way

of life.

       Moreover, Yoder’s holding is limited by the state’s interest in protecting

public health. In fact, in Yoder, the Supreme Court specifically distinguished the

facts from Prince v. Massachusetts, where the Supreme Court upheld a child labor

law against a parent’s free exercise challenge. 

 (1944). The

Supreme Court in Prince found support from the apparently uncontroversial

proposition that a parent “cannot claim freedom from compulsory vaccination for

the child more than for himself on religious grounds” because the “right to practice

religion freely does not include liberty to expose the community or the child to

communicable disease or the latter to ill health or death.” 

 at 166–67. In Yoder,

                                        26
the Supreme Court acknowledged that non-compliance with the school

attendance law would not result in any “harm to the physical or mental health of

the child or to the public safety, peace, order, or welfare.” 

. Given

the State’s interest here—protecting New Yorkers, particularly schoolchildren,

from disease—an analogy to Yoder’s facts is unconvincing.

      Finally, Plaintiffs emphasize that “this case involves the same religious

group” as in Yoder. Appellants’ Br. 58. But the Amish have never been exempted

from all neutral and generally applicable laws that burden religion. For example,

in United States v. Lee, the Supreme Court rejected a claim that an exemption for an

Amish employer from paying social security taxes was constitutionally required. 17

. The Supreme Court noted the tax law challenge was “[u]nlike the

situation presented in Wisconsin v. Yoder,” because permitting religious

exemptions to the tax system would unduly interfere with the government’s




17See also, e.g., Gingerich v. Kentucky, 

 (Ky. 2012) (law mandating the
use of slow moving vehicle emblem “aimed at protecting public safety on the highways”
was at odds with “Amish way of life” but not unconstitutional); In re Miller, 

 (4th Dep’t 1998) (photograph requirement on pistol license incidentally affected
religious beliefs of Amish but did not violate Free Exercise Clause); Slabaugh v. United
States, 

 (6th Cir. 1973) (per curiam) (no exemption from alternate civil
service constitutionally required for Amish man classified as a conscientious objector).
                                           27
significant interest “in maintaining a sound tax system” to the point that it simply

“could not function.” 

 at 259–60.

      Similarly, the system of religious exemptions impeded the immunization

law from functioning; it resulted in clusters of low vaccination rates and an

inability to achieve herd immunity in certain communities.          Re-introducing

religious exemptions would cut directly against the State’s interest in passing

§ 2164, whereas the exemption permitted in Yoder affected only the students who

participated in the alternative schooling. Yoder’s reasoning does not apply to the

circumstances here.

      Therefore, we conclude that the district court properly dismissed Plaintiffs’

hybrid rights claims.

                                 CONCLUSION

      We have considered Plaintiffs’ remaining arguments and find them to be

without merit. For the foregoing reasons, the judgment of the district court is

AFFIRMED.




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