The Supreme Court dealt a setback to the Affordable Care Act on Monday by ruling that employers with religious objections can refuse to pay for contraception.

The 5-4 decision handed down by conservative justice Samuel Alito could lead to other challenges from for-profit corporations who seek to refuse coverage for other medical procedures at odds with religious beliefs.

The Supreme Court case involved Hobby Lobby, an arts and crafts store chain with 13,000 employees, and Conestoga Wood Specialties, a cabinet manufacturer with 950 workers.

The rule at stake under the healthcare overhaul is a provision in the Affordable Care Act that requires all new health insurance plans to pay for contraceptives.

The issue is whether for-profit corporations can refuse to provide all or some contraceptive services on the grounds they are owned by religious families.

Both Hobby Lobby, an arts and crafts chain, and Conestoga Wood Specialties, which makes wood cabinets, challenged that the birth-control mandate was unconstitutional because it violates the Religious Freedom Restoration Act. They said the requirement to cover contraceptives like Plan B and ella violates their religious liberty, since they equate use of the drugs to abortion.

In addition to whether for-profit corporations could claim religious exemptions, the Supreme Court also wrestled with two other questions: Does the birth control mandate of the ACA “substantially burden” the exercise of religion? And if it does, does the government have a compelling interest to do so?

A favorable ruling for Hobby Lobby could lead to more challenges of the law, including provisions that cover blood transfusions or vaccinations.

Gretchen Borchelt, senior counsel at the National Women’s Law Center, which is seeking federal legislation to head off the fallout said, “We think there will be new lawsuits and a campaign by opponents of birth control to get employers to drop coverage,” she said.

Minnesota law professors said the justices’ ruling lacks critical details about who gets to sue and what constitutes protected religious beliefs.

The biggest uncertainty is that the court said its decision applies only to “closely held” businesses. In Minnesota and across the country, that description can be applied to well over 90 percent of all businesses, according to Hamline University law professor Joseph Olsen.