PrEP: Obamacare can’t require coverage for certain HIV drugs, federal judge rules

The ruling came as part of a broader decision that was a partial victory for opponents of Obamacare who challenged the Affordable Care Act’s mandate for coverage of preventive services at no charge.

US district judge Reed O’Connor ruled that the requirement that employers offer insurance plans that cover HIV prevention pills, known as PrEP medications, violates the Religious Freedom Restoration Act.

Braidwood Management, a Texas-based company that employs 70 people, argued that the mandate facilitated behavior to which it has religious objections.

The mandate, the plaintiffs argued in its initial complaint, “it forces religious patterns to cover drugs that facilitate and encourage homosexual behavior, prostitution, sexual promiscuity and the use of intravenous drugs.”

It is unclear if the ruling will apply only to Braidwood Management or if it will affect Americans across the country. O’Connor did not issue a nationwide injunction or strike down the rule. He has asked both parties to file additional briefs related to the scope of the repair before Friday.

“What happens next remains an open question about who will be affected,” said Tim Jost, professor emeritus at Washington and Lee University School of Law.

The decision could “cripple” HIV prevention efforts, particularly among communities of color and Americans living in poverty, said Paul Kawata, executive director of NMAC, a national organization that works for health equity and justice. race to end the HIV epidemic. It could also set back the bipartisan effort to end the HIV epidemic by 2030.

“For many people at higher risk for HIV, employer-provided insurance is often the only way to access these vital medications,” he said. “This decision has the potential to deprive millions of Americans of the medicines they need to protect their lives.”

O’Connor also asked both sides to file supplemental briefs on claims related to the Affordable Care Act’s contraceptive mandate, a long-standing goal of conservatives. the trump administration extended exemptions for employers who have religious or moral objections to the mandate, that the Supreme Court confirmed in 2020. The Biden administration has indicated that it would amend the rule.

The Department of Health and Human Services is reviewing the opinion, a spokesman said. Since no national court order has been issued, the provisions of the Affordable Care Act remain in effect for now.

Free preventive services at risk

As part of the ruling, O’Connor declared unconstitutional part of the broader preventive services mandate, which requires insurers and employers to cover free cancer and heart disease screenings, as well as smoking cessation programs, among many others. .

However, the judge upheld certain free preventive services for children, such as autism and vision screenings and well-baby visits, and for women, such as mammograms, well-woman visits and breastfeeding support programs.

O’Connor also ratified the mandate that provides free immunizations against the flu, hepatitis, measles, shingles and chicken pox.

At issue is whether the US Preventive Services Task Force, an independent volunteer panel of national experts in disease prevention and evidence-based medicine, could determine what general preventive services would be covered for adults under the mandate.

The judge ruled that the task force violates the Appointments Clause of the US Constitution because its members are not appointed by the president and that the HHS secretary you have no control over their recommendations.

It remains to be seen whether O’Connor will attempt to enforce his ruling across the country, but if he does, it could have a major impact on Americans’ ability to receive important health services free of charge.

“If this holds up, it’s going to be devastating for preventive care,” said Katie Keith, director of health policy and legal initiative at the O’Neill Institute for National and Global Health Law in Georgetown.

More than 150 million people with private insurance can receive preventive services with no cost-sharing under the Affordable Care Act, according to a report released earlier this year by HHS.

“The free preventive care guaranteed by the ACA for more than 150 million Americans has become the foundation of the American health care system, improving health outcomes, reducing disparities in care, and cutting health care costs for the consumer,” said Leslie Dach, president of Protect Our Care, an advocacy group.

O’Connor did not expand her decision to covered services for women and children, as well as immunizations, because that is determined by other federal agencies.

This story has been updated with additional details.

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