Texas judge rules government can't mandate employers offer HIV prevention drugs in coverage
A federal judge in Texas on Wednesday ruled against a mandate requiring employers to provide health care coverage for drugs that prevent the transmission of HIV, finding it is unconstitutional and that it violates the religious rights of employers.
Why was the mandate struck down? The 2020 mandate is part of the Affordable Care Act and requires employers offer insurance plans that cover HIV-prevention pills, known as PrEP drugs. Those behind the suit argued the mandate forced them to sponsor health care coverage that they object to on religious grounds.
Why it matters: 167.5 million Americans are covered under ACA-compliant private health plans, according to a recent survey by the Urban Institute think tank. HIV/AIDS advocates say the ruling would create financial hurdles for access to drugs preventing HIV and increase HIV infections, with virus already disproportionately affecting marginalized communities.
What could happen next: The ruling could be appealed by the Department of Health and Human Services, the defendant in the case.
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Breaking down the lawsuit
The 2020 lawsuit that led to the ruling originated from Texas business owners and residents, who argued that the mandate violates the Religious Freedom Restoration Act.
The lawsuit said this mandate required religious employers to provide coverage for drugs that would “facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use," according to the suit.
HIV activists dismissed that notion. "Limiting and prohibiting a preventative medication ... will not prohibit homosexual behavior or drug use or sexual activity," Gary McCoy, an HIV positive advocate in San Francisco, told USA TODAY. "Those are things that are going to happen regardless of one's religious beliefs."
The suit was led by Austin attorney Jonathan Mitchell, who also drafted Texas' six-week abortion ban. Judge Reed O'Connor, who delivered the ruling, has delivered multiple Obamacare-dismantling decisions in the past, including a decision that the entirety of the Affordable Care Act was unconstitutional — a ruling that was overturned by the U.S Supreme Court.
"This was not a surprising ruling, given the individuals behind bringing this case and the jurisdiction in which they brought it," Kenyon Farrow, managing director for advocacy and organizing at PrEP4ALL, told USA TODAY.
The ruling found HHS didn't provide "compelling" evidence behind the argument that private religious employers should be mandated to cover PrEP, "with no cost-sharing and no religious exemptions." The judge declared unconstitutional a section of the preventive services mandate, which could also impact coverage of other services and medications, including screenings for cancer and heart disease.
"Today's decision basically says you could subject your employees to a higher risk of HIV transmission simply because you just have a disdain for their identity," Anthony Michael Kreis, assistant professor of constitutional law at Georgia State University told USA TODAY. "That is just noxious, not only to the American Civil Rights tradition but to basic tenants of public health as well."
The importance of PrEP drugs in HIV prevention
PrEP, short for pre-exposure prophylaxis, is a drug that reduces the likelihood of HIV infection during exposure.
Gay, bisexual and other men who have sex with men, as well as transgender women who have sex with men are among the groups at highest risk for HIV infection, according to the U.S. Department of Health & Human Services. Black and Hispanic Americans are disproportionately affected by the virus.
Employer-provided insurance is often the only way for those at high risk for HIV to access PrEP medications, according to the National Minority AIDS Council.
“While not a surprise, this decision is deeply disappointing and could cripple HIV prevention efforts, particularly among communities of color and communities of poverty," the organization wrote in a statement Wednesday.
Hurdles to access to HIV medication could lead to a decrease in the utilization of PReP, and ultimately an increase in HIV infections, according to Farrow. PReP4ALL, which has been working to decrease new infections through HIV preventative care and treatment, could see its work reversed with the outcome of the ruling, he said.
"This is yet another example of why the fights for LGBTQ+ equality and bodily autonomy are intrinsically linked," Joe Hollendoner, CEO of the Los Angeles LGBT Center, told USA TODAY in a statement. "Conservative judges continue to set a dangerous precedent: that the government can support the refusal of coverage for health services based on individual religious beliefs."
This article originally appeared on USA TODAY: Texas judge: HIV prevention drugs don't have to be covered by employers
