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Texas judge rules coverage of anti-HIV medicine violates religious freedom

Blue Truvada pills clumped together on a counter.
National Institute of Allergy and Infectious Diseases
Truvada is a prescription drug commonly known as PrEP, taken daily to lower the risk of HIV infection.

A federal judge in Texas ruled on Wednesday that a mandate requiring most health insurance companies to cover medicine that prevents HIV infection violates the religious freedom of certain businesses.

The ruling from U.S. District Judge Reed O’Connor partially resolves a lawsuit brought by Braidwood Management Inc., a Christian for-profit corporation owned by Republican mega-donor Steven Hotze that employs about 70 people.

Hotze claimed that forcing his company to cover pre-exposure prophylaxis drugs, more commonly known as PrEP, under the Affordable Care Act would make the company “facilitate and encourage homosexual behavior.”

According to the Centers for Disease Control and Prevention, PrEP “reduces the risk of getting HIV from sex by about 99% … [and] the risk of getting HIV from injection drug use by at least 74%.”

The CDC recommends the use of PrEP to people at high risk of contracting HIV, including men who have sex with men.

Five counties in Texas — Bexar, Dallas, Harris, Tarrant, and Travis — have been designated by the federal government as priority areas for preventing new transmissions because of their high number of HIV diagnoses. Only Florida and California have more counties designated as priority areas.

In his ruling, O’Connor said that Braidwood and Hotze have “shown that the PrEP mandate substantially burdens its religious exercise.”

He said the defendants — the U.S. Department of Health and Human Services and Secretary Xavier Becerra — have not shown how mandating the coverage of the drug “furthers a compelling governmental interest and is the least restrictive means of furthering that interest.”

It’s unclear whether the ruling applies to other businesses beside the ones named as plaintiffs.

HHS didn’t immediately return a request for comment. The decision is likely to be appealed.

In July, the American Medical Association warned that the lawsuit could threaten more than 100 preventive health services for millions of Americans.

The attorney representing the plaintiffs, former Texas Solicitor General Jonathan Mitchell, was the mind behind Senate Bill 8 — the state law that bans abortions after six weeks and allows citizens to sue anyone who “aids or abets” an abortion.

In a July interview with the Dallas Morning News, Mitchell said he was going to challenge court rulings he sees as improperly decided, including same-sex marriage.

O’Connor also ruled that the U.S. Preventive Services Task Force, a panel of experts in disease prevention who recommended in 2019 mandating health insurance to cover PrEP, is unconstitutional.

The Texas Newsroom's Julián Aguilar contributed to this report.

Sergio Martínez-Beltrán is the former Texas Capitol reporter for The Texas Newsroom.
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