Texas judge says HIV drug coverage requirement violates religious freedom

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A federal judge on Wednesday ruled against a key piece of the Affordable Care Act that requires insurers to cover certain preventative services, finding that it violates religious freedoms of a Christian-owned company.

Texas Judge Reed O’Connor ruled in favor of Steven Hotze, owner of Braidwood Management, who objected to being forced to buy health insurance that covers preventative services including coverage of medicines used to prevent HIV infections, known as preexposure prophylaxis drugs, and commonly referred to as PrEP drugs.

O’Connor previously ruled the entire ACA was unconstitutional in 2018. The Supreme Court heard the case and ruled last summer in favor of the Affordable Care Act in a 7-2 decision. The ruling came amid the COVID-19 pandemic and cemented access to care for millions as the lawsuit was seeking to tear down the landmark health bill that ushered in coverage gains for many and reshaped the healthcare industry. 

In the current lawsuit, Hotze and other plaintiffs wanted coverage that excludes or limits the preventive care requirements. They are seeking insurance that allows them to exclude or limit coverage of PrEP drugs, contraception, HPV vaccines and screenings and behavior counseling for sexually transmitted diseases and drug use.

The plaintiffs argued that compelling them to purchase this kind of coverage violates their religious beliefs “by making them complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman,” according to the court filing. 

“The PrEP mandate substantially burdens the religious exercise of Braidwood’s owners,” O’Connor wrote.

Advocacy groups decried O’Connor’s ruling, though some said they were not surprised given his prior opinions. 

HIV + HEP Policy Institute said the decision is “plain wrong, highly discriminatory, and impedes the public health of our nation.”

O’Connor has asked the parties to submit briefs on how he should proceed in terms of a relief for the plaintiffs and claims relating to the contraceptive mandate.