Last Monday, the U.S. Supreme Court will hear Kennedy v. Braidwood Management, a case which The Advocatefirst broke news of in 2022, that could dismantle one of the most widely used and life-saving provisions of the Affordable Care Act: the guarantee that insurers must cover preventive services—like HIV prevention medication, cancer screenings, and maternal health care—at no cost to patients.

While the case began as a religious objection to PrEP coverage by a group of conservative Christian business owners in Texas, it’s evolved into a full-blown challenge to the ACA’s preventive care mandate. A ruling against the government could jeopardize no-cost access to cancer screenings, STI testing, contraception, diabetes care, and more.

What exactly is the Supreme Court being asked to decide?

At the center of the case is whether the U.S. Preventive Services Task Force—a nonpartisan body of health experts that recommends what services insurers must cover under the ACA—was constitutionally established. The plaintiffs argue that because the Senate doesn’t confirm its members, its authority is invalid.

José Abrigo, HIV project director and senior attorney at Lambda Legal said the case is “about whether science or politics will guide our nation’s public health policy.”

“The plaintiffs in this case are not challenging the medical effectiveness of PrEP or other preventive services—they are attacking the legitimacy of the U.S. Preventive Services Task Force, an expert, nonpartisan body created by Congress to make evidence-based recommendations about what kinds of care should be covered,” Abrigo told The Advocate. “Allowing ideological or religious objections to override scientific consensus would set a dangerous precedent.”

He noted that similar tactics are being used to try to dismantle access to gender-affirming care and warned, “We cannot afford to repeat those mistakes.”

Who is behind the Braidwood case?

The lawsuit is being spearheaded by Jonathan Mitchell, a former Texas solicitor general and architect of some of the most extreme legal strategies targeting marginalized communities in recent memory. Mitchell is perhaps best known for writing Texas’s Senate Bill 8, the 2021 law that effectively banned abortion and deputized private citizens to enforce it with lawsuits.

In the Braidwood case, Mitchell represents a group of Christian employers who argue that covering PrEP encourages “homosexual behavior” and thus violates their religious freedom. He has made clear that his goal is not only to challenge individual mandates but to dismantle the federal government’s ability to enforce health care protections more broadly.

LGBTQ+ legal experts say this case fits a pattern. Mitchell has openly stated his goal is to unwind decades of civil rights and privacy protections rooted in Supreme Court precedents, many of which form the legal basis for LGBTQ+ equality.

Isn’t this just about PrEP?

No—and that misunderstanding is precisely what advocates say is most dangerous. Although the case started as a challenge to HIV prevention drugs, its outcome could affect everyone.

“It would be a serious mistake to think this only affects LGBTQ people,” Abrigo said. “The real target is one of the pillars of the Affordable Care Act: the preventive services protections. That includes cancer screenings, heart disease prevention, diabetes testing, and more. If the plaintiffs succeed, the consequences will be felt across every community in this country by anyone who relies on preventive care to stay healthy.”

“This case exemplifies the other side’s tactic of using marginalized communities as wedge issues to attack all of our rights,” he added. “We as a country are only as healthy as our neighbors, and an attack on one group’s rights is an attack on all.”

What would happen if the Court rules against the government?

A ruling favoring the plaintiffs could strip insurance coverage mandates for a wide range of preventive services recommended by the USPSTF, leaving insurers to decide whether they’ll cover services and at what cost to the patient.

“Losing these protections for full coverage of PrEP and other preventive services would have an enormous impact on all Americans, including LGBTQ+ individuals,” said Jeremiah Johnson, executive director of PrEP4All.

“Over 150 million people could suddenly find themselves having to dig deep into already strained household budgets to pay for care that they had previously received for free,” he said. “Even small amounts of cost-sharing lead to drops in access to preventive services. For PrEP, just a $10 increase in the cost of medication doubled PrEP abandonment rates in a 2024 modeling study.”

The ruling could also come at a particularly pivotal time. “Loss of PrEP access would be devastating with so much recent progress in reining in new HIV infections in the U.S. This would also be a particularly disappointing time to lose comprehensive coverage for PrEP with a once-every-six-month injectable version set to be approved this summer,” Johnson said.

Why hasn’t this case gotten more attention?

Johnson said the lack of widespread coverage may be because of how the case was initially framed.

“It’s possible this case hasn’t received more widespread coverage because it started as an attack on LGBTQ+ communities,” he said. “But Braidwood has been a bit of a Trojan horse scenario: an attack on a subset of the population has morphed into something much broader that threatens preventive health care access for over 150 million Americans.”

“If mainstream media outlets treat this case as primarily an LGBTQ+ issue and fail to alert more Americans to the threat this case poses to them, the general public may end up paying a very steep price.”

What do PrEP users say is at stake?

The ruling is personal for Michael Chancley, communications and mobilization manager at PrEP4All. He’s been on PrEP for over a decade and has helped others access it, too.

“A big part of what PrEP4All has done is fight for the access to PrEP for uninsured individuals,” Chancley said in a video released by the group. “If the ruling is upheld by the Supreme Court… now we’ll have to also fight for people who actually are paying into insurance because their insurance companies may revoke the right for them to be able to access these preventive care services.”

Chancley said he’s often heard people say, “I wish I had access to PrEP. I wish somebody had taught me about PrEP. I wish I knew how to get PrEP,” only after receiving a positive HIV test result.

Jason Watler, an HIV activist and Medicaid recipient, said PrEP “has changed and revolutionized my life in a way where I am able to have less anxiety.”

“I’m also taking back the narrative that society has placed onto Black and brown queer and trans folks,” he said. “This would have a really, really negative effect if this actually backfires.”

Edric Figueroa, a program director at the Latino Commission on AIDS, said the financial impact would be immediate and devastating. “What’s at stake is the cost for my preventive medication would go up,” he said. “And I would have to make the decision between staying on PrEP and paying for it myself, or not using it and using that money for my savings, for my rent.”

He noted that the outcome of the case reaches beyond HIV prevention. “This isn’t just an LGBTQ issue. Preventive care saves lives, period, and we need to value public health over any ideology and protect the ACA.”

The Supreme Court is expected to issue a ruling by the end of June. The Biden administration initially defended the ACA’s preventive care mandate in court, but the case has continued under the Trump administration, which supports the legal challenge.