Texas Judge Rules Employers Shouldn’t Be Required to Cover HIV PrEP

Yesterday, a Texas federal judge ruled that employers are not required to cover HIV pre-exposure prophylaxis (PrEP) if it violates their religious beliefs.

The judge, Reed O’Connor, said that employers are exempt from paying for HIV prevention medication if they feel doing so makes them “complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and woman.”

Even though the US Centers for Disease Control and Prevention (CDC) recommends HIV PrEP for all people at risk of HIV through sex or injection drug use (excluding people at risk through receptive vaginal sex), the preventative medication is still highly stigmatized.

The plaintiff, Braidwood Management Inc., is a Christian company that objected to paying for Truvada and Descovy, 2 PrEP medications approved by the US Food and Drug Administration (FDA).

The lawsuit was filed on Braidwood’s behalf by Jonathan Mitchell, the conservative former Texas solicitor general. The law in question was the Patient Protection and Affordable Care Act (ACA), which requires most private health insurers to cover “preventative care.”

Braidwood provides health insurance to approximately 70 employees and owner Steven Hotez sought to exclude covering preventive care, including HIV PrEP and contraception, on religious grounds.

O’Connor’s decision could still be reversed on appeal, as law commentator Chris Geidner noted on Twitter, “his rulings have repeatedly been reversed on appeal or effectively overturned by contrary SCOTUS opinions.”

In 2018, O’Connor ruled the ACA was unconstitutional. This decision was overruled by the US Supreme Court, reifying the Obama-era landmark law that granted health insurance coverage.

Judge O’Connor was appointed by former president George W. Bush. In response to his decision, US House of Representatives Speaker Nancy Pelosi stated, “a radical, Republican-appointed federal judge ruled that employers can deny coverage for PrEP: a drug proven to save lives from HIV/AIDS and a key strategy for ending the epidemic. This disturbing decision amounts to open homophobia.”

The HIV Medical Association (HIVMA) also used “disturbed” to describe O’Connor’s ruling, calling it, “one more instance of unacceptable interference in scientific, evidence-based health care practices that must remain within the sanctity of the provider-patient relationship.”

On behalf of the HIVMA, chair Marwan Haddad, MD, MPH, said in a statement: “Denying access to PrEP threatens the health of the more than 1.2 million Americans who could benefit from this potentially lifesaving intervention. Religious refusal laws allowing the personal beliefs of employers or health care providers to dictate access to prevention, care and treatment services are discriminatory and dangerous. These laws ultimately hurt everyone.”