This paper explores continuity and change in the American Catholic hierarchy’s promotion of and later reliance on religious freedom. With an analysis spanning more than 50 years, it first traces the pressures for reform that created the Declaration more than 50 years ago, demonstrating that American bishops were crucial actors in the Declaration’s existence and passage, and that this was the case because of the strong legitimacy pressures they were under as Roman Catholic leaders in a predominantly Protestant country. The paper then turns to a summary of how the Birth Control Mandate of the Affordable Care Act once again created pressures for legitimacy for the American Catholic hierarchy, pressures which were again articulated in terms of critiques of hypocrisy. It demonstrates that although the specific critique changed, accusations of hypocrisy remain central in discussions of the Catholic Church’s stance on the Birth Control Mandate in the Affordable Care Act.