Texas federal judge agrees that employers don’t have to cover PrEP

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Truvada pills

A federal judge in Fort Worth, Texas, agreed on Wednesday that employers don’t have to cover HIV prevention drugs.

The Texas Tribune reported that U.S. District Judge Reed O’Connor agreed with a group of Christian conservatives that Affordable Care Act requirements that they cover pre-exposure prophylaxis (PrEP) violated their religious freedom.

He also agreed that aspects of the federal government’s system for deciding what preventive care is covered by the ACA violates the Constitution.

The action could threaten access to sexual and reproductive healthcare for people on employer-provided health insurance. The online news site said the federal government was likely to appeal.

In the suit, according to the Tribune, a group of self-described Christian business owners and employees argued that the preventive care mandates violate their constitutional right to religious freedom by requiring companies and policyholders to pay for coverage that conflicts with their faith and personal values.

The lawsuit was filed in 2020 by Austin attorney Jonathan Mitchell. Mitchell, the Tribune reported, is also one of the people behind SB8, the Texas law that bans abortion after six weeks.

The news site said that one of the plantiffs, Dr. Steven Hotze, regularly sues the government over political issues. He’s sued the state over COVID-19 restrictions and Harris County, where Houston is, over their attempts to expand voter access.

In the complaint, Hotze said he is unwilling to pay for a health insurance plan for his employees that covers HIV prevention drugs such as Truvada and Descovy “because these drugs facilitate or encourage homosexual behavior, which is contrary to Dr. Hotze’s sincere religious beliefs.”

The U.S. Centers for Disease Control and Prevention has said PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed. It can be taken by men and women.

John Carlo, CEO of Prism Health North Texas and former public health director of Dallas County, told the Tribune that PrEP doesn’t encourage risky behavior.

“PrEP prevention research shows that its use does not increase risky behaviors or cause people to have more sex or use more intravenous drugs when using it,” Carlo said. “This is well studied.”

As big an impact as the ruling on PrEP could have, the decision that the federal government can decide what preventive care is covered is unconstitutional could have an even larger effect.

“We’re talking about vaccines, we’re talking about mammograms, we’re talking about basic preventative health care that was being fully covered,” said Allison Hoffman, a law professor at Penn Carey Law at the University of Pennsylvania. “This is opening the doors to things that the ACA tried to eliminate, in terms of health plans that got to pick and choose what of these services they fully covered.”

A coalition of medical organizations, including the American Medical Association, the American Academy of Family Physicians, the American Academy of Pediatrics and another 58 national medical associations condemned the ruling.

“With an adverse ruling, patients would lose access to vital preventive health care services, such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, obesity, diabetes, preeclampsia, and hearing, as well as well child visits and access to immunizations critical to maintaining a healthy population,” the association said in their statement.

The statement said that the ACA mandate gave access to preventative care for more than 150 million people, including 37 million children.

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