Healthcare in America Grows Increasingly Unstable

On September 7th, Judge Reed O’Connor of northern Texas ruled it unconstitutional for employers to be required to provide health care coverage for HIV-preventing drugs called PrEP because their mandatory distribution violated the Religious Freedom Restoration Act. Various Texan business owners such as Braidwood Management and Kelley Orthodontics had sued, arguing the Affordable Care Act’s (ACA) requirement for these drugs to be provided was “conduct that is contrary to their sincere religious beliefs,” as their lawyer and former Texas solicitor general, Jonathan Mitchell, phrased it.

Given that Judge O’Connor ruled other aspects of Obamacare unconstitutional in 2018, some argue that the decision to end PrEP coverage perpetuates a conservative bias. Furthermore, many HIV and LGBTQ+ advocates argue that this ban will only create more health obstacles for marginalized communities, namely gay men, bisexual men, and transgender women, who are at the highest risk for infection. Black and Hispanic people, who according to the CDC make up 42% and 27% of new HIV diagnoses, are likely to be disproportionately affected as well.

These advocates suggest the lawsuit was filed out of homophobia by employers who, in their own words, did not want to “facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.” Similar to pro-abortion advocates after the overturn of Roe v. Wade, HIV activists say that reducing access to PrEP won’t end or limit homosexual behavior; it will just be much more dangerous. 

Although the Supreme Court’s 2014 Burwell v. Hobby Lobby case established that private employers were not required to insure contraception on the basis of religious freedom, O’Connor’s ruling takes this a massive step further. His decision is significant to the 167.5 million Americans who are covered by ACA-compliant health plans, whose medical insurance could now depend on their employers’ religious beliefs. 

Currently, there are no clear lines drawn to determine what constitutes violating religious beliefs, so O’Connor’s ruling could be used to block access to sexual and reproductive healthcare and other medical services for people who rely on employer-based healthcare plans mandated by the ACA. These services include screenings for various types of cancer, heart disease, diabetes, depression, and many more.  

On the same day Judge O’Connor’s decision was finalized, the Biden administration announced their intent to review his ruling, signaling the possibility of an appeal. The White House press secretary, Karine Jean-Pierre, tweeted:

With these advances, it is possible that this case will be taken all the way to the Supreme Court, where it will be ultimately get settled.