The ruling, which would come into effect next year, could help shape the outcome of the presidential race. House Republicans vow to overturn the measure and Republican presidential candidates such as Rick Santorum, a Catholic, are promising to "make it an issue every day of this campaign". Timothy Dolan, Cardinal Archbishop of New York and president of the US Catholic Bishops' Conference, warns of further attacks on religious liberty. "When the government tampers with a freedom so fundamental to the life of our nation," he says, "one shudders to think what lies ahead." Despite token concessions by Obama, the plan looks likely to go ahead.

What lies ahead is an Orwellian legal regime underwritten by a creed of uncompromising secularism. Under the nomenclature of "health", "choice", "access" and "prevention", the sanctity of religious conscience is now up for grabs. The problem is not merely the privatisation of religious belief. By refusing to exempt church-based groups from the law, the state is deciding which bodies carry out a "religious" mission worthy of legal protection and which do not.

Put simply, the Obama administration is prepared to criminalise religious views that fall foul of its social agenda. 

James Madison had a name for that. "The Rulers who are guilty of such an encroachment, exceed the commission from which they derive their authority, and are Tyrants," he warned. "The People who submit to it are governed by laws made neither by themselves nor by an authority derived from them, and are slaves."