Public health advocates and those vulnerable to contracting HIV worry that a Texas federal judge’s recent ruling against the Affordable Care Act’s mandate on insurance coverage for preventative treatment could cause an explosion of HIV cases across the country.
U.S. District Court Judge Reed O’Connor of the Northern District of Texas ruled in early September that the health law’s mandate that insurers and employers provide coverage for HIV prevention medication is unconstitutional on religious freedom grounds, adding new controversy to the already contentious 12-year-old law.
“We know when there’s a lack of access and barriers placed on people, we see an uptick in cases,” said Fryda Enriquez Pedraza, a policy manager for HIV and Drug User Health at AIDS United, in a virtual interview.
O’Connor ruled in favor of the plaintiffs in the case, composed of two Christian-owned businesses and six individuals. They claimed that the Obamacare mandate requiring most health insurance plans to cover certain preventive services, including HIV prevention medication for adults who are at high risk of contracting the virus, violated the Religious Freedom Restoration Act. The act provides extra protection, in addition to the First Amendment, against the government burdening the free exercise of religion.
The businesses claimed in their lawsuit that the provision “forces religious employers to provide coverage for drugs that facilitate and encourage homosexual behavior, prostitution, sexual promiscuity and intravenous drug use.”
“Jesus didn’t make any distinctions on people based on what their behavior was like before he healed them,” said Episcopal Priest Susan Hill, a reverend at the Church of the Holy Apostles in New York City, in a virtual interview. “I don’t see Christianity as having a right to do that on our own.”
The Centers for Disease Control and Prevention estimates that 1.2 million Americans are eligible for PrEP treatment, a type of HIV prevention medication.
In 2015, only about 3% of those recommended were prescribed PrEP, and in 2020, about 25% of the 1.2 million people recommended were prescribed medication, according to the CDC. This large increase may be attributed to its coverage under the Affordable Care Act.
Now, advocates like Pedraza and those vulnerable to HIV worry that these numbers may drop as a result of O’Connor’s ruling.
The Biden administration will likely appeal the ruling, which could jeopardize access to many preventative services aside from HIV coverage including cancer screenings and alcohol abuse counseling, according to the New York Times.
The Department of Health and Human Services estimated in 2020 that 151.6 million people had access to free preventive care under the landmark health law.
“We know through public health practices that preparation, education and referral work. If we take those options away from people, ultimately their health care will see a negative change,” Pedraza said.
The ruling has the potential to be applied in other states pending appeal, leaving advocates worried about groups who are most vulnerable.
“When you talk about care, it has to be available, accessible and it has to be affordable. When you take away affordability, the people with the least money will be hit the hardest,” Mark Fischer, who has been living with HIV since 1986 and is now a longtime advocate, said in a virtual interview.
This ruling’s reach is unlikely to extend to the Washington, D.C., Maryland and Virginia area.
“D.C. will take care of its people. We always have, and we always will,” said Fischer, adding that in Virginia, the reach “depends upon who’s in charge…there could be some risks with this ruling.”
People of color, particularly in Republican states, are of most concern to experts and dissenters of the ruling.
“Denying people access to lifesaving medication is going to disproportionately affect low income Black and Brown people who are already carrying the burden of the HIV epidemic,” said Sophia Sturiale, an American University student studying public health in an in-person interview.
This ruling continues an already contentious debate about the role of religion in government, heightened by the reversal of Roe v. Wade. “Taking someone’s rights to decide what’s best for their body holds a lot of control and we see a lot of power dynamics with who makes those decisions,” Pedraza said.
“This is a terrible confusion over what religious freedom is…religious freedom is the freedom to worship and believe privately without oppression. It is not the right to dictate policy,” Fischer continued.
To combat these sweeping changes and life-altering effects, Pedraza urges people to take action. “As long as the people’s voices are being heard on what they see as best for themselves, getting out there and voting can enact change in our communities.”