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A Texas judge rules coverage of anti-HIV medicine violates religious freedom


In Texas, a federal judge has ruled that businesses are not required to cover a medication that prevents HIV infection. That medication is best known as PrEP. Experts say this decision could also jeopardize access to many other preventative health services that the Affordable Care Act requires employers to cover. Sergio Martínez-Beltrán covers politics and government for the Texas Newsroom. Sergio, so tell us how this case got started.

SERGIO MARTÍNEZ-BELTRÁN, BYLINE: Sure. So this lawsuit was brought by a group of Christian business owners who claimed that requiring them to cover certain preventive services violated their religious freedoms. And those services include PrEP, the anti-HIV drug, contraceptives, drug addiction counseling and STD screening. One of those who sued the federal government is a Christian-operated corporation called Braidwood Management, which is owned by Texas Republican megadonor Steven Hotze. Hotze claimed the Affordable Care Act requirement that health plans cover PrEP would make his company, quote, "facilitate and encourage homosexual behavior." And so this federal judge in Texas, Reed O'Connor, sided with Hotze. In his ruling, the judge said that Hotze was able to prove that the PrEP mandate substantially burdens his religious freedoms.

MARTÍNEZ: So how did this ruling go over?

MARTÍNEZ-BELTRÁN: I mean, I think it certainly created some waves yesterday when the decision came down. Judge O'Connor was appointed by President George W. Bush. He is a former aide to a Texas Republican senator, active in conservative circles. In 2018, for instance, he ruled that the Affordable Care Act was unconstitutional. However, the U.S. Supreme Court overturned his decision a few years later. And also, you know, the main attorney representing the plaintiffs is Jonathan Mitchell. He's the mastermind behind Texas anti-abortion law that empowers citizens to sue those who aid an abortion. So he's been somewhat successful with these types of lawsuits and laws. I don't think it was a surprise, you know? But it still moved many people because of the potential implications his decision could have not only for access to PrEP, but for all kinds of other health care services.

MARTÍNEZ: On those implications, tell us more about how other services or medications might be impacted.

MARTÍNEZ-BELTRÁN: Well, the ruling took aim at a popular provision of the Affordable Care Act, which mandates free coverage of many preventive services, including birth control, breast cancer and heart disease screenings and vaccines. And that's because Judge O'Connor also ruled that the panel of experts who help decide what preventive services needed to be covered by health insurers were actually appointed unconstitutionally. So this ruling could jeopardize many other types of health care, like cancer screenings, that people depend on. You know, in fact, the American Medical Association estimates that just in 2020, more than 151 million people received free preventive care because of this mandate in the ACA.

MARTÍNEZ: Then what does this mean for Americans who currently have these health care services covered?

MARTÍNEZ-BELTRÁN: Unfortunately, we don't quite know yet. It's a broad ruling. The judge has yet to specify how his decision should be implemented. You know, it's likely the federal government will appeal because of the potential impact on the lives of millions of Americans.

MARTÍNEZ: Sergio Martínez-Beltrán covers politics and government for the Texas Newsroom. Thanks a lot.

MARTÍNEZ-BELTRÁN: Thanks for having me. Transcript provided by NPR, Copyright NPR.

A Martínez is one of the hosts of Morning Edition and Up First. He came to NPR in 2021 and is based out of NPR West.
Sergio Martínez-Beltrán is Nashville Public Radio’s political reporter. Prior to moving to Nashville, Sergio covered education for the Standard-Examiner newspaper in Ogden, Utah. He is a Puerto Rico native and his work has also appeared on NPR station WKAR, San Antonio Express-News, Inter News Service, GFR Media and WMIZ 1270 AM.