The US Supreme Court has heard arguments in a case that could determine whether private businesses are required to offer insurance for HIV-preventative medication to its staff.
A case about objections to the prescribing of pre-exposure prophylaxis (PrEP) was brought before a court in Texas in 2022 and has since evolved into a national suit that threatens to dismantle life-saving provisions in the Affordable Care Act (ACA), also known as Obamacare.
Under the legislation, health insurers and group health plans must cover “preventive health services” at no additional cost to the patient. However, the act does not specify what those services are. Instead, the law gives the US Preventive Services Task Force (PSTF) – an independent panel of experts – the power to determine what insurers must cover.
Braidwood Management originally filed a suit after refusing, on religious grounds, to subsidise the medication for employees through its health insurance, saying it “encourage[d] homosexual behaviour, intravenous drug use and sexual activity outside marriage between one man and one woman”.
It was eventually brought before the supreme court and has expanded to include almost all ACA prevention coverage requirements, including cancer screening, heart disease prevention and testing for diabetes.
If the court rules in favour of Braidwood, it would rescind the preventative service protections clause of ACA, essentially stripping back the requirement for insurers to fund life-saving treatment for many diseases and conditions.
Obamacare ‘should not be subject to political pressure’
Acting on behalf of Braidwood, lawyer Jonathan Mitchell, who has represented president Donald Trump, argued that the PSTF, a panel of primary care clinicians funded by the Department of Health, should be “independent” and not “subject to political pressure”.
Some of the justices questioned the merits of Mitchell’s claim, with Sonia Sotomayor saying he had misinterpreted the word “independent” to mean separate rather than autonomous. Her law clerks were “independent,” but it didn’t mean she was required to accept their judgements.
Justice Neil Gorsuch floated the idea of sending the case back to a lower court to decide whether secretary of health Robert F Kennedy Jnr had the power to appoint and remove PSTF members.
Lambda Legal HIV project director Jose Abrigo said Kennedy vs Braidwood Management Inc boiled down to “whether science or politics will guide our nation’s public health policy”.
Abrigo went on to say: “Allowing ideological or religious objections to override scientific consensus would set a dangerous precedent. It would be a serious mistake to think this only affects LGBTQ+ people. The real target is one of the pillars of the Affordable Care Act.”
GLAAD chief executive and president Sarah Kate Ellis, meanwhile, described the hearing as a “pivotal moment” for the rights of all Americans, adding that the case was “rooted in discriminatory objections” to life-saving healthcare.
Religious exemptions should not be sufficient to “erode healthcare protections and restrict medically necessary, life-saving preventative healthcare for every American”, she added.
PrEP4All executive director Jeremiah Johnson remained hopeful that ACA protections would be preserved but the fight was far from over, he warned. If those rights were removed, more than 150 million people could “find themselves having to dig deep” to fund vital healthcare.
“Just a $10 (£7.50) increase in the cost of medication doubled PrEP abandonment rates in a 2024 modelling study,” he added. “Loss of PrEP access would be devastating with so much recent progress in reining in new HIV infections in the US.”
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