Mandated PrEP coverage ruled unconstitutional. What it means

A ruling in Texas might jeopardize people’s access to the lifesaving drug, pre-exposure prophylaxis (PrEP), which has been prescribed to reduce the chances of contracting HIV from sex or injection drug use. 

In 2018, Judge Reed O’Connor, a George W. Bush appointee, ruled the Affordable Care Act (ACA, also known as Obamacare) unconstitutional. Today, he ruled that an Obamacare mandate that requires private insurance plans to cover PrEP drugs at no cost violated the employer’s religious freedom. 

In 2020, a group of religious business owners filed to sue the government for requiring employers to provide healthcare coverage for free PrEP, contraception, and the vaccine for the human papillomavirus (HPV), one of the most common sexually transmitted infections (STI). The suit argued that the mandates violated employers’ religious freedom and made them “complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman.”

In his ruling, O’Connor did not issue a nationwide injunction or vacate the rule, so it is unclear whether the order will apply only to the plaintiff, Braidwood Management; he has requested both sides file additional briefs by Friday.

With the religious right gaining legal momentum, especially after the overturning of Roe v. Wade, O’Connor’s courtroom is expected to see more legal wins for fundamentalists. Along with PrEP, several other ACA mandates have been deemed unconstitutional in O’Connor’s ruling, including contraceptives and other free preventive services, screenings for cancer, and other diseases.