Federal judge strikes down PrEP coverage requirement

[BootmanLA]

Today, Reed O'Connor, a far-right Republican judge appointed by George W. Bush, ruled that the requirement for insurers to cover PrEP because doing so violates the "religious rights" of companies that object to homosexuality. Leaving aside the fact that PrEP protects both gay and straight people from a virus that infects both gay and straight people, the judge struck down the PrEP coverage requirement nationwide.

More on this from a political angle in the Politics forum, so as not to make THIS topic too political. However, there are clearly health aspects to this decision, and that's what this thread should focus on.

Specifically: the ruling found that the ACA (Obamacare)'s requirement that insurers have to cover certain preventative care tests, medications, and so forth is subject to religious freedom objections.

Moreover, he held that the Preventive Services Task Force, a body within the US Dept. of Health and Human Services appointed by an agency within that department, is unconstitutional because he says it's a body that must be appointed in accordance with the Appointments Clause of the US constitution - that is, appointed by the President and confirmed by the Senate. So that means the federal rules that require coverage of those preventative care items are in doubt, at least when they conflict with the "religious rights" of companies or organizations - because they were issued by a body that itself is unconstitutionally created.

Again, this doesn't say that insurers CANNOT cover PrEP, or that companies can't include PrEP as part of their plans. But if this ruling stands - it's certain to be appealed, but the appeal will go to the very conservative US Fifth Circuit - it means that the requirement that PrEP be provided at no cost to the insured person will be gone. Insurers can decide not to offer that coverage at all, or place it in a tier of drugs (like HIV treatment) that has limited coverage with high co-pays, or any number of other possible outcomes.

From a public health perspective, this is a disaster - even if the order is eventually overturned, it's going to cause major disruption in the meantime.

 

[PozBearWI]

Companies are companies.  They aren't people.  How can a non human entity have a religious preference?  

[ErosWired]

2 minutes ago, JimInWisc said:

Companies are companies.  They aren't people.  How can a non human entity have a religious preference?  

That was my first thought. How can a corporate entity hold a spiritual belief? I suppose the answer given would be that companies can be created for the purpose or intent of expressing or advancing the principles of the beliefs of the people involved in it, or for whose benefit it operates, and forcing the company to do something contrary to those principles would violate the beliefs of the human beings responsible for the entity.

But an insurance company is not a church.  It readily writes policies on individuals without discriminating on their personal beliefs, and is only too glad to take their premiums and put them in the bank. Not only are insurance companies not churches, they’re sure as hell not charities, and don’t pay out for anything they aren’t required to. That’s why it’s necessary to regulate the insurance industry.

There is something deeply wrong when a single power-drunk judge in Amarillo - the ass-crack of Texas - is able to dictate how the entire nation must live.

The next thing to come is a ruling that companies have feelings and can sue for emotional distress.

[JamesL100]

Reading from the other side of the pond, a couple of thoughts. Would this apply from now on (for new PrEP payments) or retrospectively (to stop PrEP for existing patients)? Going forward could it lead to a niche insurance sector that (maybe aided by donations or enlightened bosses) is happy to take premiums from subscribers with more colourful sex lives?

[ErosWired]

35 minutes ago, JamesL100 said:

Going forward could it lead to a niche insurance sector that (maybe aided by donations or enlightened bosses) is happy to take premiums from subscribers with more colourful sex lives?

HIV doesn’t selectively target people with ‘colourful’ sex lives. A person doesn’t have to be promiscuous - anyone who fucks without a condom is at risk. Unless by ‘colourful’ you mean ‘homosexual’, and are suggesting that it would somehow be acceptable for the insurance industry to discriminate wholesale against LGBT persons to the extent that they could only obtain insurance through a specialized niche market of providers.

Section 1557 of the Affordable Care Act prohibits discrimination in the provision of health insurance, and this includes sexual orientation. The link below provides some background.

[think before following links] https://www.samhsa.gov/sites/default/files/pep14-lgbtacaenrolla.pdf

Whether a case can be made that refusing to cover PrEP for free (or at all) on religious grounds constitutes discrimination is more than I know.

[BergenGuy]

6 hours ago, JimInWisc said:

Companies are companies.  They aren't people.  How can a non human entity have a religious preference? 

You should note that it is not insurance companies that are claiming a violation of religious freedom.  There's a small group (two or three insureds) formed specifically for this challenge.  They're the ones behind this suit, and they claimed that it is a violation of their religious rights for their premium dollars to go to payments for PrEP.

[BergenGuy]

4 hours ago, JamesL100 said:

Would this apply from now on (for new PrEP payments) or retrospectively (to stop PrEP for existing patients)?

Health insurance contracts are typically written on an annual basis.  Most business coverage renews on January 1, although some private employers renew at other times.  Coverage can't change during the contract period, for most people PrEP coverage is safe through the end of the year.  But, there are some public sector plans (governments, school districts) that renew on July 1 of each year.  Those people could lose their mandated coverage in a few months.    Note that if the order stands, companies are not prohibited from covering PrEP and mandated services, they just wouldn't be REQUIRED to cover them.  But, it could still result in thousands of dollars of out-of-pocket costs for PrEP users.

One would hope that this judge or the appeals court would have the decency to stay this order until appeals are complete (yeah, I know it is a lot of expect "decency" here).  If it is stayed, it could be another year or more before the appeals are complete so coverage would remain unchanged through 2024, at least.

[onlyraw]

6 hours ago, JimInWisc said:

Companies are companies.  They aren't people.  How can a non human entity have a religious preference?  

But the courts have considered corporations as “people” I other cases

In Citizens United they were given the right to unlimited political speech 

companies have been allowed to not make wedding cakes based on religious freedom 

man’s Obama Care can not require birth control to be covered because it infringes on the religious beliefs of of companies 

so - sad but very true 

and this is just the most recent (I was about to say “last” but I doubt it will be the last) case of the courts doing this

 

 

 

 

[BergenGuy]

2 minutes ago, onlyraw said:

companies have been allowed to not make wedding cakes based on religious freedom

Those cases have involved individual bakers.  Hobby Lobby might be a better example of a corporation allowed to make religious claims, although the courts have limited those claims to "closely held" companies.  I think even the current crop of jokers on the Supreme Court would be hard-pressed to argue that publicly-traded companies like CIGNA, Humana, United Health with hundreds of thousands of owners can harbor religious beliefs.

[ErosWired]

2 hours ago, BergenGuy said:

They're the ones behind this suit, and they claimed that it is a violation of their religious rights for their premium dollars to go to payments for PrEP.

!!  Hold the phone. When these people paid their money to purchase their insurance coverage, it stopped being their money, the same as when their money stopped being their money when they subscribed to Netflix. It isn’t a violation of their religious freedom for Netflix to use the money they spent to distribute movies that don’t comport with their religion, and the insurance companies likewise have the right to do whatever they damn well please - or meet whatever requirements the government places on their industry - with the money they’ve earned.

[BergenGuy]

8 hours ago, ErosWired said:

!!  Hold the phone. When these people paid their money to purchase their insurance coverage, it stopped being their money, the same as when their money stopped being their money when they subscribed to Netflix. It isn’t a violation of their religious freedom for Netflix to use the money they spent to distribute movies that don’t comport with their religion, and the insurance companies likewise have the right to do whatever they damn well please - or meet whatever requirements the government places on their industry - with the money they’ve earned.

Look, don't attack me!  I'm simply stating the basis of their actions.  

Netflix isn't a good example because they're not forced to patronize Netflix if they don't like its policies.  They can go to another streaming service or do without altogether.  Their argument is that, because of the coverage requirements imposed by the government, they're unable to find an insurance company that doesn't use premium dollars to fund PrEP and they can't go without insurance because of the ACA mandate.

[ErosWired]

13 minutes ago, BergenGuy said:

Look, don't attack me!  I'm simply stating the basis of their actions.  

Netflix isn't a good example because they're not forced to patronize Netflix if they don't like its policies.  They can go to another streaming service or do without altogether.  Their argument is that, because of the coverage requirements imposed by the government, they're unable to find an insurance company that doesn't use premium dollars to fund PrEP and they can't go without insurance because of the ACA mandate.

No attack on you was intended. The comment was simply an observation that the motivation of these litigants seems misguided. Health insurance is no longer mandatory at the federal level. The tax penalty for not having health insurance was repealed by the Tax Cut and Jobs Act of 2019. Some states may still require it, but it is not a federal requirement. They are not forced to buy it. How strong is their conviction? Is their faith strong enough that they’re willing to forego insurance rather than support something their belief does not?

Nor can they demonstrate that their individual dollars, out of all those paid by millions of others, are the ones being used to subsidize PrEP.

It always boils down to the same thing - this isn’t about freedom to believe what they wish, it’s about them wanting to be able to control how other people live.

[BergenGuy]

10 hours ago, ErosWired said:

No attack on you was intended. The comment was simply an observation that the motivation of these litigants seems misguided.

Sorry .. I took your comment the wrong way.

10 hours ago, ErosWired said:

Health insurance is no longer mandatory at the federal level. The tax penalty for not having health insurance was repealed by the Tax Cut and Jobs Act of 2019.

Technically, insurance is still mandatory.  There's no just no penalty for not having it.  So, I guess their argument is that they have to choose between breaking the law (even if there's no penalty) and observing their beliefs. 

10 hours ago, ErosWired said:

Nor can they demonstrate that their individual dollars, out of all those paid by millions of others, are the ones being used to subsidize PrEP.

Since insurance works off risk pools, mixing all premium dollars together, an insurance company would not be able to show that their individual dollars were NOT being used to subsidize PrEP

 

10 hours ago, ErosWired said:

It always boils down to the same thing - this isn’t about freedom to believe what they wish, it’s about them wanting to be able to control how other people live.

Of course that's it.  They would be furious is a Christian Science (or is it Jehovah Witnesses?) group filed a lawsuit claiming their rights were being violated by the coverage of blood products.  

But, this group managed to go beyond the religious argument by claiming that the administrative structure that created the mandates is unconstitutional.  It is also interesting that the judge didn't strike down all the mandates.  He left things like no-cost baby well-care and immunizations in place.  He struck down the things that conservatives don't like, such as contraception and PrEP.

[ErosWired]

27 minutes ago, BergenGuy said:

So, I guess their argument is that they have to choose between breaking the law (even if there's no penalty) and observing their beliefs. 

These people like to cherry-pick the Establishment Clause of the Constitution, touting the part where it says that no law shall prevent the free expression of religion, but conveniently ignoring the part that says “will make no law respecting an establishment of religion” - in other words, they want laws that affect religion, but only ones that make everyone else follow their religion. Even Jesus understood the difference between the church and the state, when asked whether it was lawful to pay taxes to the Romans:

Render unto Caesar the things that are Caesar’s, and unto God the things that are God’s. - Mark 22:21

[Cumpigmelb]

OMG reading this from Australia 🇦🇺 

I used to think the USA was a progressive country 

it seems it’s a regressive country who lets the church rule its people. 

i heard they want to ban the statue of David?