Reducing, and ultimately eliminating, new HIV transmissions—even as health care providers, advocates and community members already have many components of the needed toolkit already available—remains a formidable challenge for communities across the nation. Even in states and municipalities, largely respectful of their LGBTQ+ populations, funding difficulties can result in diminished funds allocated for HIV prevention and care, as we saw in Illinois this past winter.
But folks living with HIV/AIDS, or who are at risk for HIV transmission, living within constituencies hostile to its LGBTQ+ residents, are moving into a new period of uncertainty about their health care availability—and there’s a possibility that that uncertainty may extend further to all Americans.
At the end of March, a federal judge in Texas blocked a requirement that insurance plans cover medications used for PrEP, or pre-exposure prophylaxis, be covered by health insurance plans without cost-sharing by the consumer.
That decision, issued as an order in Braidwood v. Becerra, indeed blocked coverage requirements for all preventative health care services given an A or B rating by the United States Preventative Services Task Force. The case targets PrEP, which has largely been available through oral medications such as Truvada or Descovy, as well as contraception, HPV vaccines and STD and drug testing, which a group of dentists felt that their employer-sponsored insurance plans should not have to cover.
The Affordable Care Act had previously required such coverage. Some plaintiffs in this case objected to the coverage because of their supposed religious principles, and the judge in the case agreed.
Judge Reed O’Connor wrote in his decision that, “In short, these Plaintiffs have a cognizable interest in being able to purchase a product that does not obligate them to violate their religious beliefs. Though the Government may disagree with those beliefs, it is in no position to dictate whether the Plaintiffs’ interests in adhering to their religious convictions is a core or merely ancillary component of their decision to abstain.”
Other plaintiffs objected to the ACA rules not on religious grounds, but rather, because they did not want to pay to help cover the preventative services they would never need as individuals, which of course defeats the point of having group insurance.
The Biden administration planned to appeal the decision, but not before alarm bells went off for advocates and service providers across the country. Omar Martinez-Gonzalez, senior manager of Policy & Advocacy at AIDS Foundation of Chicago, told Windy City Times that the decision was “just another injury to our communities and bringing them access to life-saving medication.”
Illinoisans who count on their insurance to cover PrEP are safe for now. Governor JB Pritzker signed HB 4664, which mandated that the insurers doing business in the state cover PrEP and various other preventative services, in January.
But Martinez-Gonzalez warned: “In the immediate future, PrEP is covered for Illinoisans, but, as you can imagine, that can change if decision-makers change in the future. Elected officials who oppose PrEP could potentially repeal that law. Without robust federal protection, access to PrEP could be jeopardized in the long-term.”
Judge Matthew Kacsmaryk’s order to immediately remove mifepristone from pharmacy shelves, though stayed at least temporarily, was a chilling reminder that our legal system will likely be abused on a regular basis in the near future, as right-wing elements grapple for new ways to curtail the rights of marginalized groups; depriving those groups of medicine and healthcare is no doubt a tantalizing and powerful prospect.
Of course, the rest of society could more easily recognize this peril if health care in the U.S. were treated as a right of every individual and a responsibility for the community at large. As health costs and insurance premiums both rise, the government does appreciably little to make sure that those costs are contained, privileging the needs of health systems, big Pharma and insurance industry CEOs rather than the patients they care for. That economic vulnerability for most patients leaves an especially big gap for opponents of LGBTQ+ folks to exploit.
The prescription (pardon the pun) is not an easy one. Community advocates will have to ensure that funding, at least in progressive states and cities, remains stable. Legal experts and allied politicians will need to strengthen laws and regulations that work in our favor so that they cannot be easily undone by the stroke of a judge’s pen. Most of all, though, we’ll need a great sea change so that perceptions of our health, and decisions about our health care, are emphatically divorced from the moral judgments of others.
Matt Simonette is the executive editor of the Windy City Times.