U.S. Federal Courts
Federal judge rules insurance companies can refuse to cover PrEP
Braidwood Management challenged Affordable Care Act provision
A federal judge on Wednesday ruled against a federal mandate that requires employer provided health plans to cover PrEP, a drug used for the prevention of HIV.
The mandate, a provision of the Affordable Care Act, violates tenets of the federal Religious Freedom Restoration Act, according to U.S. District Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas.
Insurance plans were required to cover PrEP following a 2019 recommendation from the Department of Health and Human Services for the drug to be prescribed for high-risk patients for the prevention of HIV infection.
Braidwood Management challenged the ACA’s provision the grounds that covering PrEP would conflict with its religious convictions as the medication “facilitates and encourages homosexual behavior, intravenous drug use and sexual activity outside of marriage between one man and one woman.”
O’Connor ruled in favor of Braidwood Management in a separate case last year challenging the 1964 Civil Rights Act’s anti-bias protections for sexual orientation and gender identity, deciding Braidwood had the right to discriminate under the Religious Freedom Restoration Act and the First Amendment.
Representing the company in both cases was former Texas Solicitor General Jonathan Mitchell, a vocal opponent of LGBTQ rights who is credited as the architect of Senate Bill 8, which provides a right of action allowing private citizens to sue those who obtain an abortion.
One of the more conservative judges in one of the most conservative federal district courts, O’Connor ruled in 2018 that the entire ACA was unconstitutional, which the U.S. Supreme Court subsequently overturned in 2021.
Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, told Roll Call he expects Wednesday’s ruling will be appealed. “Preventive services covered by private insurance plans without cost-sharing, such as HIV testing, hepatitis B and C testing, and PrEP, are all critical and well-established public health preventive services that must continue,” he said.
PrEP reduces by roughly 99 percent the risk of contracting HIV. It has been labeled an “essential medicine” by the World Health Organization.
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Puerto Rico
The ‘X’ returns to court
1st Circuit hears case over legal recognition of nonbinary Puerto Ricans
Eight months ago, I wrote about this issue at a time when it had not yet reached the judicial level it faces today. Back then, the conversation moved through administrative decisions, public debate, and political resistance. It was unresolved, but it had not yet reached this point.
That has now changed.
Lambda Legal appeared before the 1st U.S. Court of Appeals in Boston, urging the court to uphold a lower court ruling that requires the government of Puerto Rico to issue birth certificates that accurately reflect the identities of nonbinary individuals. The appeal follows a district court decision that found the denial of such recognition to be a violation of the U.S. Constitution.
This marks a turning point. The issue is no longer theoretical. A court has already determined that unequal treatment exists.
The argument presented by the plaintiffs is grounded in Puerto Rico’s own legal framework. Identity birth certificates are not static historical records. They are functional documents used in everyday life. They are required to access employment, education, and essential services. Their purpose is practical, not symbolic.
Within that framework, the exclusion of nonbinary individuals does not stem from a legal limitation. Puerto Rico already allows gender marker corrections on birth certificates for transgender individuals under the precedent established in Arroyo Gonzalez v. Rosselló Nevares. In addition, the current Civil Code recognizes the existence of identity documents that reflect a person’s lived identity beyond the original birth record.
The issue lies in how the law is applied.
Recognition is granted within specific categories, while those who do not identify within that binary structure remain excluded. That exclusion is now at the center of this case.
Lambda Legal’s position is straightforward. Requiring individuals to carry documents that do not reflect who they are forces them into misrepresentation in essential aspects of daily life. This creates practical barriers, exposes them to scrutiny, and places them in a constant state of vulnerability.
The plaintiffs, who were born in Puerto Rico, have made clear that access to accurate identification is not symbolic. It is a basic condition for moving through the world without contradiction imposed by the state.
The fact that this case is now being addressed in the federal court system adds another layer of significance. This is not a pending policy discussion or a legislative proposal. It is a constitutional question. The analysis is not about political preference, but about rights and equal protection under the law.
This case does not exist in isolation.
It unfolds within a broader context in which debates over identity and rights have increasingly been shaped by the growing influence of conservative perspectives in public policy, both in the United States and in Puerto Rico. At the local level, this influence has been reflected in legislative discussions where religious arguments have begun to intersect with decisions that should be grounded in constitutional principles. That intersection creates tension around the separation of church and state and has direct consequences for access to rights.
Recognizing this context is not an attack on faith or religious practice. It is an acknowledgment that when certain perspectives move into the realm of public authority, they can shape outcomes that affect specific communities.
From within Puerto Rico, this is not a distant debate. It is a lived reality. It is present in the difficulty of presenting identification that does not match one’s identity, and in the consequences that follow in workplaces, schools, and government spaces.
The progression of this case introduces the possibility of change within the applicable legal framework. Not because it resolves every tension surrounding the issue, but because it establishes a legal examination of a practice that has long operated under exclusion.
Eight months ago, the conversation centered on ongoing developments. Today, there is already a judicial finding that identifies a violation of rights. What remains is whether that finding will be upheld on appeal.
That process does not guarantee an immediate outcome, but it shifts the ground.
The debate is no longer theoretical.
It is now before the courts.
Maryland
4th Circuit dismisses lawsuit against Montgomery County schools’ pronoun policy
Substitute teacher Kimberly Polk challenged regulation in 2024
A federal appeals court has ruled Montgomery County Public Schools did not violate a substitute teacher’s constitutional rights when it required her to use students’ preferred pronouns in the classroom.
The 4th U.S. Circuit Court of Appeals in a 2-1 decision it released on Jan. 28 ruled against Kimberly Polk.
The policy states that “all students have the right to be referred to by their identified name and/or pronoun.”
“School staff members should address students by the name and pronoun corresponding to the gender identity that is consistently asserted at school,” it reads. “Students are not required to change their permanent student records as described in the next section (e.g., obtain a court-ordered name and/or new birth certificate) as a prerequisite to being addressed by the name and pronoun that corresponds to their identified name. To the extent possible, and consistent with these guidelines, school personnel will make efforts to maintain the confidentiality of the student’s transgender status.”
The Washington Post reported Polk, who became a substitute teacher in Montgomery County in 2021, in November 2022 requested a “religious accommodation, claiming that the policy went against her ‘sincerely held religious beliefs,’ which are ‘based on her understanding of her Christian religion and the Holy Bible.’”
U.S. District Judge Deborah Boardman in January 2025 dismissed Polk’s lawsuit that she filed in federal court in Beltsville. Polk appealed the decision to the 4th Circuit.
U.S. Federal Courts
Federal judge in Md. rules against White House passport policy
Lambda Legal represents transgender, nonbinary people in lawsuit
A federal judge in Maryland on Tuesday ruled in favor of six transgender people who are challenging the Trump-Vance administration’s passport policy.
President Donald Trump once he took office signed an executive order that banned the State Department from issuing passports with “X” gender markers. A memo the Washington Blade obtained directed State Department personnel to “suspend any application where the applicant is seeking to change their sex marker from that defined in the executive order
pending further guidance.”
The Trump-Vance administration only recognizes two genders: male and female.
The lawsuit that Lambda Legal filed in U.S. District Court for the District of Maryland in Baltimore in April alleges the policy “has caused and is causing grave and immediate harm to transgender people like plaintiffs, in violation of their constitutional rights to equal protection.”
Seven trans people — Zander Schlacter, Jill Tran, Lia Hepler-Mackey, David Doe, Robert Roe, Peter Poe, and Kris Koe — filed the lawsuit.
Roe is a U.S. Foreign Service Officer who currently lives in Europe. Lambda Legal, who represents him and the six other plaintiffs, notes Chief Judge George L. Russell III dismissed Roe’s case because the State Department has yet to deny him “an accurate passport.”
“Like every other court that has considered this executive order, the court finds its stated purpose does not serve an important governmental interest that is exceedingly persuasive; further, the discriminatory means employed are not substantially related to the achievement of those objectives,” said Russell in his ruling.
Lambda Legal Counsel Carl Charles described Russell’s decision as “a crucial victory for our clients and transgender people nationwide who have been trapped by this administration’s cruel and discriminatory policy.”
“The court recognized that forcing inaccurate identity documents on transgender Americans causes immediate and irreparable harm,” said Charles in a press release. “Our clients can now travel with dignity and safety while we continue fighting to overturn this discriminatory policy entirely.”
The American Civil Liberties Union earlier this year filed a separate lawsuit against the passport directive on behalf of seven trans and nonbinary people.
A federal judge in Boston in April issued a preliminary junction against it. A three-judge panel on the 1st U.S. Circuit Court of Appeals last week ruled against the Trump-Vance administration’s motion to delay the move.
