Federal judge strikes down PrEP coverage requirement

[ErosWired]

1 minute ago, Cumpigmelb said:

i heard they want to ban the statue of David? 

No, that’s a reference to a case in which a school employee was sacked for not providing notice to parents that the statue would be discussed in the classroom. The educator apparently did not follow policy on other matters as well.

It’s ludicrous, of course, and in the US we’re facing a dangerous social trend of conservative attempts to ‘sanitize’ public education, ban books, and legislate speech. I personally think it’s the last scream of a dying generation trying desperately to stop the inevitable change in the world around them; they may triumph for a day, but they cannot prevail against time. The generation that is coming into adulthood does not think as they do, and will in time reshape the world to their own liking. It has always been so - it will always be so.

One might also point out that David has been standing around in the nude in public for twice as long as the United States of America has existed. I don’t think anyone here is going to have much luck banning him.

[BergenGuy]

1 hour ago, Cumpigmelb said:

i heard they want to ban the statue of David? 

So far, only in Florida.  I think the heat and humidity have finally driven them crazy down there.  

This country is rapidly being split in two by regressives who can't stand the idea that straight male WASPs are no longer in the majority.

[BergenGuy]

1 hour ago, ErosWired said:

The generation that is coming into adulthood does not think as they do, and will in time reshape the world to their own liking.

Which is why the regressives are so frantic to sanitize education.  They are desperately trying to get the next generation to think as they do.  Their plan would have a good chance of succeeding if it wasn't for the internet and the "woke" media allowing the "outside world" to seep in.  That's why I expect the regressives to turn their attention to both very soon.  Utah has already passed a law requiring teens under 18 to have their parent's consent to use social media sites.  As usual, it is couched as "protecting the children."

[ErosWired]

4 hours ago, Cumpigmelb said:

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? 

Actually, in the news today we read that an Australian swim club now has a ban on being naked in the dressing rooms and showers.

The whole world’s gone dog-barking mad.

[ytowndaddybear]

Most insurance companies are in the business of making profits by reducing risks, therefore they are unlikely to stop covering PrEP (cheap) unless doing so reduces their future risk of having patients come down with HIV (very expensive).    Without any assurance that stopping coverage of PrEP would reduce their exposure to HIV+ patients it is unlikely that any non-religious affiliated insurer would stop coverage, doing so is simply illogical.

[funpozbottom]

If I read the summary of the ruling correctly, the decision goes far beyond coverage of prep.  The federal mandate to fully cover preventive services was found to be unconstitutional. That means things like cancer screenings would also be affected.  The ruling doesn't mean preventive care would be dropped from coverage, however, insurance companies may start requiring co-pays on preventive services. This, of course, undermines the reason the mandate was put in place in the first place. Adding co-pays would make health screenings more expensive and potentially out of reach of some people even though they have insurance.

[BergenGuy]

On 4/1/2023 at 10:01 AM, ytowndaddybear said:

Without any assurance that stopping coverage of PrEP would reduce their exposure to HIV+ patients it is unlikely that any non-religious affiliated insurer would stop coverage, doing so is simply illogical.

Actually, it isn't illogical at all.  For the insurance industry as a whole, it would be illogical to end coverage.  But, for any one company, it could make sense.  Since many employers tend to change carriers every two to three years, an ininsurance company might assume that, on average, a number of the HIV infections that result from the non-coverage of PrEP would actually be the problem of another insurer.

But, I agree with you, that isn't likely.  Most, if not all, commercial insurance plans covered PrEP even before it was designated preventative.  But, PrEP was subject to the standard deductibles and copays.  A return to those days is the real problem.  Many people can't afford a $3,000 deductible before the cost of PrEP and associated labs is covered.

[BootmanLA]

On 4/1/2023 at 9:54 AM, funpozbottom said:

If I read the summary of the ruling correctly, the decision goes far beyond coverage of prep.  The federal mandate to fully cover preventive services was found to be unconstitutional. That means things like cancer screenings would also be affected.  The ruling doesn't mean preventive care would be dropped from coverage, however, insurance companies may start requiring co-pays on preventive services. This, of course, undermines the reason the mandate was put in place in the first place. Adding co-pays would make health screenings more expensive and potentially out of reach of some people even though they have insurance.

It's not that the mandate to cover preventative care, per se, has been struck down.

What's been struck down is allowing a board that was not appointed by the President nor confirmed by the Senate to determine what is a "preventative care" service that must be covered. Right now, those decisions are made by a non-political board of career health scientists in the Department of Health and Human Services.

What the court is saying - and to be fair, this is in line with a growing string of cases from many other departments - is that decisions with that much discretion, which amount to major policy choices, have to be made by officials appointed under the Appointments Clause of the constitution. That clause is found in Article II, Section 2, which gives the president the power to appoint (along with judges, ambassadors, etc.) "all other Officers of the United States" as long as it is "with the Advice and Consent of the Senate." The clause also provides that Congress has to create all such positions (meaning there has to be some statutory authority for the existence of an agency or department), and that Congress can, by passing a law to that effect, give the president power to create such positions on his own authority or give the heads of departments that same power.

Thus, there are three types of government people, under the constitution: Officers (who must be confirmed by the Senate - such as department secretaries and deputy secretaries, for instance), "Inferior" officers (who may be appointed by a principal officer), and regular governmental employees - essentially, the last group are the "civil servants". The key distinction making an official a "principal" rather than "inferior" official is when the position exercises "significant authority" under federal law, and this is analyzed typically looking at three main factors:

-whether a Senate-confirmed official (ie "Officer") can review and reverse the decisions of the purportedly "inferior" official;
-how much direct supervision the Senate-confirmed official has over the "inferior"; and
-does the Senate-confirmed official have the power to remove the inferior official.

The more power another Senate-confirmed official has over the "inferior" official, the more likely he is actually an inferior official who does not have to be confirmed by the Senate. But the board that decides what preventative services must be covered for free under the ACA presents the typical problem: the board isn't appointed by the president and confirmed by the Senate, yet it exercises considerable authority to act on its own, it's not subject to review by a Senate-confirmed official, nor is it supervised by one. That means the board should be required to be confirmed by the Senate after being appointed by the President. And since it's not, their decisions are likely null and void because they're exercising a power they can't possess.

That isn't to say I think PrEP shouldn't be covered - of course it should. It makes financial sense. But that doesn't mean the way the mandate was implemented was entirely legal.

[1stimebare]

Excellent analysis.  Thank you.

[hntnhole]

Geez ... step away for a few days, and a really interesting (and important) subject gets dissected, fileted, roasted and toasted,  Thanks for the interesting discourse, you guys.