Fort Worth, Texas (KTRK) – A federal judge in Fort Worth on Wednesday agreed with a group of conservative Christians that the Affordable Care Act’s requirements to cover HIV prevention drugs violate their religious freedom.
U.S. District Judge Reed O’Connor also agreed that aspects of the federal government’s system of deciding preventive care covered by the ACA violated the Constitution.
The video above is about the PrEP HIV prevention pill that is covered by most insurance plans.
O’Connor’s ruling could threaten access to sexual and reproductive health care for the more than 150 million American workers who work in employer-sponsored health care plans. It will likely be appealed by the federal government.
This lawsuit is the latest in a decade of legal challenges to the Affordable Care Act, many of which have passed in O’Connor’s courtroom. In 2018, O’Connor ruled that The entirety of the ACA Act was unconstitutional, A decision overturned by the US Supreme Court.
The subject of the class action is a 2020 mandate that requires health care plans to cover HIV-preventing drugs, known as PrEP, for free as preventative care.
In the lawsuit, a group of self-described Christian Christian business owners and employees in Texas argue that protective care mandates violate their constitutional right to religious freedom by requiring companies and policyholders to pay for coverage that goes against their faith and personal values.
The lawsuit was filed in 2020 by Austin attorney Jonathan Mitchell, the legal mind behind the six-week civil-enforced abortion ban in Texas. In the lawsuit, Mitchell also challenges the entire framework within which the federal government decides which preventive services are covered.
O’Connor dismissed many of Mitchell’s arguments but agreed that the US Preventive Services Task Force’s system of deciding which health care services required to be fully covered under the ACA would violate the appointments clause of the US Constitution.
“At a high level, this lawsuit is part of a larger opposition to the government’s ability to regulate,” said Alison Hoffman, professor of law at the University of Pennsylvania’s Ben Carey Law. “Then they also ask what happens when regulations and religion conflict.”
one of the plaintiffs, Dr. Stephen Hotez From Katie, he often sues government and elected officials over politically charged issues, including battles with GOP state leaders over COVID-19 emergency orders and trying to prevent Harris County from expanding voter access.
In the complaint, Hotze said he was not willing to pay for his employees’ health insurance plan that covers HIV prevention drugs like Truvada and Descovy, commonly known as PrEP, “because these drugs facilitate or encourage homosexual behavior, which is inconsistent with Dr. .Hotzi’s Sincere Religious Beliefs.”
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PrEP reduces the risk of HIV infection by 99% when taken as recommended, according to the US Centers for Disease Control and Prevention. Despite assurances from the Texas Christian group, the CDC says so too 1 in 5 new cases In women and not men who have sex with men.
“The virus doesn’t choose who it infects, it can infect anyone,” said Dr. Satish Mushirla, an infectious disease specialist at Legacy Community Health Services in Dallas. “So why targeting a particular demographic is a mystery to us.”
Contrary to what the lawsuit asserts, PrEP does not “facilitate or encourage same-sex sexual behavior,” said John Carlo, chief executive of Prism Health North Texas and former director of public health for Dallas County. “PrEP prevention research shows that its use does not increase risky behaviors or cause more sex or more intravenous drug use when used,” Carlo said. “This is well thought out.”
Other plaintiffs, including Tarrant County orthodontist John Kelly, claim that they “don’t need or want contraceptive coverage in their health insurance. They don’t want or need a free STD test that is covered by their health insurance because they’re in Single marriage relationships with their spouses. They do not want or need health insurance that covers Truvada or PrEP medications because neither they nor any of their family members engage in HIV-transmitting behavior.”
Kelly was previously the plaintiff named in the case, but the name was changed last month “because media coverage of this case sparked a wave of threats and cyber-bullying” against Kelly, as per suggestion.
wide-ranging consequences
The lawsuit specifically addresses PrEP, but O’Connor’s ruling, which addresses how the federal government can decide what preventive care covers employers’ health care plans, could end up with wide-ranging consequences, Hoffman said.
“We’re talking about vaccines, we’re talking about mammograms, we’re talking about basic preventative healthcare that has been completely covered,” she said. “This opens the doors to the things that the ACA has tried to eliminate, in terms of which health plans have to pick and choose which of these services they have fully covered.”
And the American Medical Association, along with 60 leading medical organizations, issued a statement condemning the lawsuit.
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“With a negative judgment, patients will lose access to vital preventive healthcare services, such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, diabetes, pre-eclampsia, and hearing, as well as access to vaccinations essential to maintaining a healthy population.” organizations wrote.
While implementation has not been as universal as hoped, preventative care fully funded through the ACA has been shown to be highly effective in improving health outcomes, reducing healthcare spending and Increasing demand for these services.
“The idea that an employer can shop a la carte for policy coverage runs counter to what we have learned over the past decade trying to end the HIV epidemic,” said Carlo, a former Dallas County Health Director. “This leads us in the wrong direction, and we’re just starting in the right direction.”
At Legacy Community Health Services in Houston, where patients include a large number of those receiving PrEP, the lawsuit is beginning to worry those who rely on their insurance to cover their treatment — and these patients are not limited to members of the LGBTQ community, Mocherla said.
These include people with hemophilia and others at risk of contracting HIV, Moscherla said. He said the incidence rate since the introduction of pre-exposure prophylaxis has declined in nearly every demographic.
Allowing companies to drop free coverage would prevent many Legacy patients from being able to afford treatment, and would reverse the historic trend of lower HIV rates, Mocherla said.
He said closing access for now, while “we’re on the cusp of a breakthrough,” would hamper efforts to eradicate the deadly virus for decades.
“Without prevention, how can the disease be treated?” Mocherla said. “It’s just awful… and if ending the HIV epidemic is so dear to anyone’s heart, we can’t leave prevention aside. That’s why we’re so confused. We’re all so upset.”
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