A federal judge decides religious employers need not cover PrEP.

A federal judge decides religious employers need not cover PrEP.

A federal judge decides religious employers need not cover PrEP. On Wednesday, a federal judge in Fort Worth agreed with a group of Christian conservatives that the ACA’s mandate that insurance plans cover HIV preventive medications violates their religious freedom.

Even U.S. District Judge Reed O’Connor concluded that the government’s process for determining whether preventative services are covered by the ACA is unconstitutional.

More than 150 million working Americans who are covered by employer-sponsored health care insurance may be put at risk by O’Connor’s opinion. The administration will almost certainly file an appeal of this ruling.

Over the past decade, numerous lawsuits have challenged the constitutionality of the Affordable Care Act, many of which have passed through O’Connor’s courtroom. The Supreme Court ultimately overturned O’Connor’s 2018 ruling that the entire Affordable Care Act was unconstitutional.

The class action complaint challenges the 2020 requirement that health insurance providers provide PrEP (HIV prophylaxis) at no cost to its policyholders as a form of preventative treatment.

Companies and policyholders are being forced to pay for coverage that goes against their religious beliefs and morals, which is why a group of self-described Christian business owners and employees in Texas have filed a lawsuit.

Texas’ six-week abortion restriction is being challenged in court by Austin attorney Jonathan Mitchell in 2020. Mitchell’s lawsuit also challenges the federal government’s decision-making process for which preventive programs are funded.

Though she rejected several of Mitchell’s points, O’Connor did agree that the process through which the U.S. Preventive Services Task Force determines which medical services are mandated to be completely covered under the Affordable Care Act violates the Appointments Clause of the Constitution.

According to Allison Hoffman, a law professor at Penn Carey Law at the University of Pennsylvania, “at a high level, this action is part of a greater backlash against the government’s capacity to regulate.” And then there’s the question of “what happens when faith and rules clash?”

Dr. Steven Hotze of Katy, one of the plaintiffs, has a history of filing frivolous lawsuits against the government and elected officials over controversial matters like his struggle with GOP state leaders over emergency COVID-19 orders and his attempt to block Harris County from increasing voter access.

Because “these medications facilitate or encourage homosexual activity, which is antithetical to Dr. Hotze’s true religious views,” Hotze claims he cannot afford to provide health insurance coverage for his staff that includes HIV prevention drugs like Truvada and Descovy, collectively known as PrEP.

When used as directed, PrEP reduces the risk of HIV infection by 99 percent, according to the Centers for Disease Control and Prevention in the United States. Contrary to what the Texas Christian group claims, the Centers for Disease Control and Prevention report that women, not men who engage in homosexual activity, account for one-fifth of all new cases.

Dr. Satish Mocherla, an infectious disease specialist at Legacy Community Health Services in Dallas, said, “The virus does not choose who to infect, it can infect anyone.” “We don’t know why a certain group of people is being singled out.”

The CEO of Prism Health North Texas and former public health director for Dallas County, John Carlo, stated that PrEP does not “enable or encourage gay activity,” which is in direct opposition to the claims made in the case. Researchers have found that persons who use PrEP are no more likely to engage in risky behaviors like having more sex or using intravenous drugs. This has been the subject of extensive research.

Other plaintiffs, such as Tarrant County orthodontist John Kelley, have stated that they “do neither need nor desire contraceptive coverage in their health insurance.” Since they are each in monogamous relationships with their spouses, they have no interest in or need for free STD testing provided by their health insurance. And since neither they nor anybody in their family engages in conduct that transmits HIV, they have no interest in or need for health insurance that provides coverage for the HIV prevention medications Truvada and Pre-exposure Prophylaxis.

A request filed last month stated that Kelley, the original plaintiff, had her name changed “because the media coverage of this matter has prompted a wave of threats and cyberbullying” against her.

Implications that will affect many people

Though the lawsuit is focused on PrEP specifically, Hoffman believes that the judgment by O’Connor on how the federal government can select what preventative care is covered in employer health care plans would have far-reaching effects.

She explained that the plan had previously paid for “basic preventative health care,” such as vaccinations and mammograms. “This is allowing health insurance to pick and choose which of these services they completely cover, which is something the ACA attempted to eliminate.”

The American Medical Association and other 60 major medical groups have published statements strongly opposing the action.

“With an adverse ruling, patients will lose access to crucial preventive health care services,” the groups said. “These treatments include screening for breast cancer, colorectal cancer, cervix cancer, heart disease, diabetes, preeclampsia, and hearing.”

Fully financed preventive care through the ACA has been demonstrated to largely improve health outcomes, reduce health care spending, and increase uptake, despite implementation not being as widespread as intended.

“The idea that an employer can shop a la carte for policy coverage goes against what we have learned over the last decade in the battle to address the HIV epidemic,” Carlo, the former health director of Dallas County, said. As we were just starting to travel on the correct path, you’re taking us on the wrong one.

Patients who rely on insurance to finance their treatment at Legacy Community Health Services in Houston, where a big number of individuals using PrEP are seen, have begun to worry as a result of the lawsuit, and Mocherla noted that this is not limited to members of the LGBTQ community.

Hemophiliacs and those at risk of contracting HIV are among them, Mocherla said. Pre-exposure prophylaxis has resulted in a decrease in infection rates across practically all subgroups, he said.

Mocherla said that the historic pattern of lowering HIV rates would be reversed if firms were allowed to discontinue free coverage, which would prohibit many of Legacy’s patients from affording the therapy.

While “we are on the edge of a breakthrough,” he said, cutting off access now would set back efforts to eradicate the deadly virus by decades.

“How can you treat a disease if you don’t prevent it from happening in the first place?” A quote by Mocherla. The shock value is through the roof. And if we truly care about putting a stop to the HIV epidemic, we must prioritize prevention. Because of this, we cannot make sense of it. All of us are shocked and saddened by this news.

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