The U.S. Justice Department (DOJ) is appealing a judge’s decision to nullify a section of the Affordable Care Act (ACA) that requires insurance companies to cover the HIV prevention drug regimen PrEP. 

Last week, U.S. District Juge Reed O’Connor struck down a section of the ACA requiring coverage of certain preventive health care services, which, in addition to PrEP, includes some cancer screenings, contraception, immunizations, and more. O’Connor’s decision leaves over 150 million people vulnerable to the added costs of this care. 

A coordinated effort by right-wing media and lawmakers has decimated community-based programs addressing healthcare for LGBTQ+ people in Tennessee

O’Connor’s decision came about in response to a lawsuit filed by two Christian business owners and six individuals who felt being required to cover PrEP promotes “homosexual behavior” and is a violation of religious freedom. The plaintiffs also argued that being required to cover other preventive services makes them “complicit in facilitating… drug use, and sexual activity outside of marriage between one man and one woman.”

In a statement on the appeal, out White House Press Secretary Karine Jean-Pierre said President Joe Biden “is glad to see the Department of Justice is appealing the judge’s decision” and that the case “is yet another attack on the Affordable Care Act, which has been the law of the land for 13 years and survived three challenges before the Supreme Court.”
 
“Preventive care saves lives, saves families money, and protects and improves our health,” she continued. “Because of the ACA, millions of Americans have access to free cancer and heart disease screenings. This decision threatens to jeopardize critical care. The administration will continue to fight to improve health care and make it more affordable for hard-working families, even in the face of attacks from special interests.”

Michael Weinstein, the founder and president of the Aids Healthcare Foundation, said O’Connor’s decision “will have dangerous consequences” for millions of Americans. 

 “While we expect this unconstitutional ruling ultimately will fail, the decision creates uncertainty and is a threat to public health,” Weinstein said. 

This is not the first ruling O’Connor has made against PrEP and the ACA. In September 2022, he ruled that a provision of the act requiring employee health insurance plans to provide full coverage of HIV-prevention drugs (as well as other preventive health care services) is a violation of religious freedom. That ruling only applied to the companies of the plaintiffs in the case. 

Long known as an anti-LGBTQ+ extremist, O’Connor also ruled in 2021 that businesses that say they’re religious can fire LGBTQ+ people, chipping away at the protections granted by the Supreme Court’s decision in Bostock v. Clayton Co. 

He ruled the same year that a Catholic hospital doesn’t have to follow federal anti-discrimination laws when it comes to the provision of health care because of the chance that they’d be forced to provide care for a transgender person that affirms their gender, even if the procedure is not one the hospital objects to. His reasoning for the sweeping religious exemption for the Catholic hospital was that Biden and Barack Obama have a “pattern” of religious animus, so they can’t be trusted to enforce the law correctly.

In 2015, O’Connor blocked federal benefits for Texas workers married to spouses of the same sex.