A Fort Worth federal judge agreed Wednesday with a group of Christian conservatives that the Affordable Care Act requirements to cover HIV prevention drugs violate their religious freedom.
US District Judge Reed O’Connor also agreed that aspects of the federal government’s system for deciding which preventative care is covered by the ACA violates the Constitution.
O’Connor’s ruling could threaten access to sexual and reproductive health care for more than 150 million American workers on employer-sponsored health plans. It is likely to be challenged by the federal government.
This lawsuit is the latest in a decade of legal challenges to the Affordable Care Act, many of which have gone through O’Connor’s courtroom. In 2018, O’Connor ruled that the entirety of the ACA was unconstitutional, a decision that was overturned by the US Supreme Court.
At issue in the class-action is a 2020 mandate that requires health plans to cover HIV prevention drugs, known as PrEP, for free as preventative care.
In the lawsuit, a group of self-appointed Christian business owners and employees in Texas argue that preventive care mandates violate their constitutional right to religious freedom by requiring companies and policyholders to pay for coverage that conflicts with their faith and values. personal.
The lawsuit was filed in 2020 by Austin attorney Jonathan Mitchell, the legal mastermind behind Texas’s six-week abortion ban. In the lawsuit, Mitchell also challenges the whole framework through which the federal government decides which prevention services to cover.
O’Connor dismissed many of Mitchell’s arguments, but agreed that the U.S. Preventive Services Task Force’s system for deciding which health services should be fully covered by the ACA violates the dating clause of the United States Constitution.
“At a high level, this lawsuit is part of a broader pushback against the government’s ability to regulate,” said Allison Hoffman, a professor of law at Penn Carey Law at the University of Pennsylvania. “And then also ask what happens when norms and religion collide”.
One of the plaintiffs, Katy’s Dr. Steven Hotze, often sues the government and elected officials over politically accused issues, including struggles with GOP state leaders over COVID-19 emergency orders and an attempt to prevent the county from Harris to expand access to voters.
In the complaint, Hotze said he was unwilling to pay for a health insurance plan for his employees that covers HIV prevention drugs such as Truvada and Descovy, generally known as PrEP, “because these drugs facilitate or encourage homosexual behavior. , which is contrary to Dr. Hotze’s sincere religious convictions. “
PrEP reduces the risk of contracting HIV by 99% when taken as recommended, according to the U.S. Centers for Disease Control and Prevention. Despite claims from the Christian group in Texas, the CDC also claims that 1 in 5 new cases involve women, not men who have sex with men.
“The virus doesn’t choose who to infect, it can infect anyone,” said Dr. Satish Mocherla, an infectious disease specialist at Legacy Community Health Services in Dallas. “So why a particular demographic group is targeted is a mystery to us.”
And contrary to what the lawsuit claims, PrEP does not “facilitate or encourage homosexual behavior,” said John Carlo, CEO of Prism Health North Texas and former Dallas County director of public health. “Research on PrEP prevention shows that its use does not increase risky behaviors or cause people to have more sex or use more intravenous drugs when they use it,” said Carlo. “This is well researched.”
The other plaintiffs, including John Kelley, a Tarrant County orthodontist, say they “don’t need or want contraceptive coverage in their health insurance. They don’t want or need free sexually transmitted disease tests covered by their health insurance because they are monogamous relationships with their respective spouses. And they don’t want or need health insurance covering Truvada or PrEP because neither they nor any of their family members are involved in HIV-transmitting behaviors. “
Kelley was previously the named plaintiff in the case, but the name was changed last month “because media coverage of this case triggered a wave of threats and cyberbullying” against Kelley, according to a motion.
The lawsuit is specifically about PrEP, but O’Connor’s ruling, which addresses how the federal government can decide which preventative care is covered by employers’ health care plans, could end up having far more far-reaching consequences. broad, Hoffman said.
“We are talking about vaccines, we are talking about mammograms, we are talking about primary preventive health care that has been fully covered,” he said. “This is opening the door to things that the ACA has been trying to eliminate, in terms of health plans that have had to choose which services to fully cover.”
The American Medical Association, along with 60 major medical organizations, issued a condemnation of the lawsuit.
“With an adverse ruling, patients would lose access to vital preventive health services, such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, diabetes, preeclampsia and hearing, as well as access to essential vaccinations to maintain a healthy population, the organizations wrote.
While implementation has not been as universal as hoped, preventive care fully funded through the ACA has proven to be largely effective in improving healthcare outcomes, reducing healthcare spending, and increasing uptake of these services.
“The idea that an employer can buy a la carte for policy coverage goes against what we have learned over the past decade in an effort to end the HIV epidemic,” said Carlo, the former health director. of Dallas County. “This takes us in the wrong direction and we are just starting to head in the right one.”
At Legacy Community Health Services in Houston, where patients include a large population of those who receive PrEP, the lawsuit has begun to worry those who rely on their insurance to cover their care, and those patients aren’t limited to community members LGBTQ, Mocherla said.
They include hemophiliacs and others who are vulnerable to HIV infection, Mocherla said. The rate of infection since the introduction of pre-exposure prophylaxis has decreased in almost all demographic groups, she said.
Allowing companies to eliminate free coverage would prevent many of Legacy’s patients from being able to afford the treatment, Mocherla said, and reverse that historic trend of declining HIV rates.
Closing access right now, while “we’re on the verge of a breakthrough,” would delay the effort to eradicate the deadly virus by decades, he said.
“Without prevention, how can the disease be cured?” Mocherla said. “It is simply shocking. … And if ending the HIV epidemic is dear to someone, we cannot leave prevention aside. And that is why we are disoriented. We are all very dismayed.”
Disclosure: Legacy Community Health Services and Prism Health North Texas have been financial advocates of The Texas Tribune, a nonprofit, non-partisan news organization funded in part by donations from members, foundations and corporate sponsors. Financial advocates play no role in Tribune journalism. Find a full list of them here.
The Texas Tribune is a nonprofit, non-partisan media organization that informs Texans – and engages with them – on issues of public order, politics, government and across the state.
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