National
Lawsuit against Affordable Care Act targets PrEP
AIDS groups warn court ruling could lead to ‘explosion’ in new HIV cases
More than two dozen HIV/AIDS advocacy organizations and LGBTQ supportive health centers have filed two separate friend-of-the-court or amicus legal briefs supporting the appeal of a Texas court decision earlier this year that the advocacy groups say would greatly reduce health insurance coverage of the HIV prevention medication known as PrEP.
The two amicus briefs filed by the advocacy organizations in June express strong support for the Biden administration’s appeal of a March 30, 2023, ruling by Judge Reed O’Connor for the U.S. District Court for the Northern District of Texas. O’Connor’s ruling struck down a provision of the U.S. Affordable Care Act that requires insurers to provide full coverage of preventive care services without co-pay or cost-sharing fees, including coverage for PrEP.
“As an organization representing thousands of physicians and other health care professionals working on the frontlines of the HIV epidemic in communities across the country, we are deeply concerned about the harmful and far-reaching impacts this decision will have if allowed to stand,” said Dr. Michelle Cespedes, chair of the HIV Medicine Association, one of the groups that filed the second of the two amicus briefs opposing the court ruling.
“Reinstating cost-sharing for PrEP would directly cause tens of thousands of preventable cases of HIV transmission and set back decades of progress toward curbing the epidemic,” she said in a statement.
In response to the appeal of the District court decision filed by the U.S. Department of Justice on behalf of the Department of Health and Human Services, which administers the Affordable Care Act, the U.S. Court of Appeals for the 5th Circuit issued an administrative stay placing the lower court ruling on hold while the appeal process moves forward.
The case is called Braidwood Management Inc. et. al v. Becerra. Court records show that Braidwood, a management services company described as Christian owned, Kelley Orthodontics, also described as Christian owned, and six individuals in Texas jointly filed the lawsuit against the Affordable Care Act in September 2022.
U.S. Secretary of Health and Human Services Xavier Becerra, whose name appears on the case, is among the federal officials in charge of administering the Affordable Care Act. The law is sometimes referred to as “Obama Care” after former President Barack Obama who initiated the expansive healthcare legislation that was passed by Congress.
The Braidwood company and the other plaintiffs that filed the lawsuit seeking to overturn the Affordable Care Act provision related to preventive care argue in court filings that forcing them to provide financial coverage to PrEP, among other things, is unconstitutional and violates their religious rights under the U.S. Religious Freedom Restoration Act.
“Notably, the plaintiffs state the requirement to cover PrEP ‘imposes a substantial burden on the religious freedom of those who oppose homosexual behavior on religious grounds,’ claiming further that PrEP drugs ‘facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use,’” according to KFF, on online independent news publication that covers health policy issues.
The publication, which analyzed the court filings in the case, says the plaintiffs also contend that the Affordable Care Act’s preventive services provision violates the Appointments Clause of the U.S. Constitution, which they argue requires government officials making important health care decisions under the Affordable Care Act be nominated to office by the president and confirmed by the U.S. Senate.
In their lawsuit challenging the preventive services provision, the plaintiffs note that under the Affordable Care Act, decisions on how to define preventive services that must be covered under the act are now made by the U.S. Preventive Services Task Force, whose members are not confirmed by the Senate.
The U.S. government appeal of the Texas District court ruling, and the amicus briefs filed by the AIDS advocacy organizations and other groups, including D.C. ‘s Whitman-Walker Health and the Human Rights Campaign Foundation, strongly dispute the plaintiff’s assertions.
“We must not allow a couple of individuals who want to discriminate against people who use PrEP and don’t support insurance coverage of preventive services, such as HIV and hepatitis B and C testing, to destroy the public health of our country,” said Carl Schmid, executive director of the HIV-Hepatitis Policy Institute, one of 25 advocacy group that filed a joint amicus brief on June 23.
“We filed this amicus brief to emphasize the important role testing for HIV and hepatitis plays in linking people to life-saving medications and, in the case of hepatitis C, curative treatment, along with the importance of helping people know if they have an infectious disease,” Schmid said in a statement.
“We sought to emphasize that purchasing insurance that includes coverage of PrEP for HIV in no way burdens the ability of plaintiffs to exercise their religion,” said Richard Hughes IV, the lead attorney for the joint amicus filing by the 25 advocacy groups. “In fact, we suggest to the court that granting exemptions for PrEP coverage would have far-reaching and absurd consequences for our society,” Hughes said.
The other amicus brief filed June 28 by the HIV Medicine Association (HIVMA) and the National Alliance of State and Territorial AIDS Directors (NASTAD), which represent thousands of physicians and other health care providers throughout the U.S., points out that if the Texas lower court ruling is allowed to stand, tens of thousands of people who rely on preventive care coverage from their health insurance policies will likely lose that coverage.
“Copays and deductibles deter people from accessing healthcare,” said Ben Klein, Senior Director of Litigation and HIV Law at the GLBTQ Legal Advocates & Defenders, known as GLAD, which is representing the two groups that filed the second amicus brief. “PrEP is nearly 100 percent effective at preventing transmission of HIV, but it is already underutilized, particularly among Black and Latino communities,” Klein said in a statement.
“As the brief filed today by HIVMA and NASTAD demonstrates, allowing the lower court’s ruling in Braidwood v. Bacerra to stand will exacerbate racial health disparities, increase new HIV diagnoses by the tens of thousands, and have devastating consequences on our efforts to end the epidemic,” Klein said.
Klein told the Washington Blade that the District court ruling, if not overturned on appeal, will adversely impact people at risk for other diseases, not just HIV. He points out that the higher copays and insurance deductible costs will impact cancer prevention screenings, including colonoscopies, by greatly raising the insurance related costs for people who may not be able to afford to pay those costs.
“So, we’re talking about a staggering impact that when you look at the range of harms and costs, it’s unfathomable,” he said. “And so that’s why a lot of the amicus briefs focused on that.”
Klein said a decision on the appeal by the 5th Circuit U.S. Court of Appeal, which covers the states of Texas, Louisiana, and Mississippi, was not expected to take place until sometime next year, with oral arguments by the attorneys likely to take place later this year.
U.S. Supreme Court
LGBTQ legal leaders to Supreme Court: ‘honor your president, protect our families’
Experts insist Kim Davis case lacks merit
The U.S. Supreme Court considered hearing a case from Kim Davis on Friday that could change the legality of same-sex marriage in the United States.
Davis, best known as the former county clerk for Rowan County, Ky., who defied federal court orders by refusing to issue marriage licenses to same-sex couples — and later, to any couples at all — is back in the headlines this week as she once again attempts to get Obergefell v. Hodges overturned on a federal level.
She has tried to get the Supreme Court to overturn this case before — the first time was just weeks after the initial 2015 ruling — arguing that, in her official capacity as a county clerk, she should have the right to refuse same-sex marriage licenses based on her First Amendment rights. The court has emphatically said Davis, at least in her official capacity as a county clerk, does not have the right to act on behalf of the state while simultaneously following her personal religious beliefs.
The Washington Blade spoke with Karen Loewy, interim deputy legal director for litigation at Lambda Legal, the oldest and largest national legal organization advancing civil rights for the LGBTQ community and people living with HIV through litigation, education, and public policy, to discuss the realistic possibilities of the court taking this case, its potential implications, and what LGBTQ couples concerned about this can do now to protect themselves.
Loewy began by explaining how the court got to where it is today.
“So Kim Davis has petitioned the Supreme Court for review of essentially what was [a] damages award that the lower court had given to a couple that she refused a marriage license to in her capacity as a clerk on behalf of the state,” Loewy said, explaining Davis has tried (and failed) to get this same appeal going in the past. “This is not the first time that she has asked the court to weigh in on this case. This is her second bite at the apple at the U.S. Supreme Court, and in 2020, the last time that she did this, the court denied review.”
Davis’s entire argument rests on her belief that she has the ability to act both as a representative of the state and according to her personal religious convictions — something, Loewy said, no court has ever recognized as a legal right.
“She’s really claiming a religious, personal, religious exemption from her duties on behalf of the state, and that’s not a thing.”
That, Loewy explained, is ultimately a good thing for the sanctity of same-sex marriage.
“I think there’s a good reason to think that they will, yet again, say this is not an appropriate vehicle for the question and deny review.”
She also noted that public opinion on same-sex marriage remains overwhelmingly positive.
“The Respect for Marriage Act is a really important thing that has happened since Obergefell. This is a federal statute that mandates that marriages that were lawfully entered, wherever they were lawfully entered, get respect at the federal level and across state lines.”
“Public opinion around marriage has changed so dramatically … even at the state level, you’re not going to see the same immediate efforts to undermine marriages of same-sex couples that we might have a decade ago before Obergefell came down.”
A clear majority of U.S. adults — 65.8 percent — continue to support keeping the Obergefell v. Hodges decision in place, protecting the right to same-sex marriage. That support breaks down to 83 percent of liberals, 68 percent of moderates, and about half of conservatives saying they support marriage equality. These results align with other recent polling, including Gallup’s May 2025 estimate showing 68 percent support for same-sex marriage.
“Where we are now is quite different from where we were in terms of public opinion … opponents of marriage equality are loud, but they’re not numerous.”
Loewy also emphasized that even if, by some chance, something did happen to the right to marry, once a marriage is issued, it cannot be taken back.
“First, the Respect for Marriage Act is an important reason why people don’t need to panic,” she said. “Once you are married, you are married, there isn’t a way to sort of undo marriages that were lawfully licensed at the time.”
She continued, explaining that LGBTQ people might feel vulnerable right now as the current political climate becomes less welcoming, but there is hope — and the best way to respond is to move thoughtfully.
“I don’t have a crystal ball. I also can’t give any sort of specific advice. But what I would say is, you know, I understand people’s fear. Everything feels really vulnerable right now, and this administration’s attacks on the LGBTQ community make everybody feel vulnerable for really fair and real reasons. I think the practical likelihood of Obergefell being reversed at this moment in time is very low. You know, that doesn’t mean there aren’t other, you know, case vehicles out there to challenge the validity of Obergefell, but they’re not on the Supreme Court’s doorstep, and we will see how it all plays out for folks who feel particularly concerned and vulnerable.”
Loewy went on to say there are steps LGBTQ couples and families can take to safeguard their relationships, regardless of what the court decides. She recommended getting married (if that feels right for them) and utilizing available legal tools such as estate planning and relationship documentation.
“There are things, steps that they can take to protect their families — putting documentation in place and securing relationships between parents and children, doing estate planning, making sure that their relationship is recognized fully throughout their lives and their communities. Much of that is not different from the tools that folks have had at their disposal prior to the availability of marriage equality … But I think it behooves everyone to make sure they have an estate plan and they’ve taken those steps to secure their family relationships.”
“I think, to the extent that the panic is rising for folks, those are tools that they have at their disposal to try and make sure that their family and their relationships are as secure as possible,” she added.
When asked what people can do at the state and local level to protect these rights from being eroded, Loewy urged voters to support candidates and initiatives that codify same-sex marriage at smaller levels — which would make it more difficult, if not impossible, for a federal reversal of Obergefell to take effect.
“With regard to marriage equality … states can be doing … amend state constitutions, to remove any of the previous language that had been used to bar same-sex couples from marrying.”
Lambda Legal CEO Kevin Jennings echoed Loewy’s points in a statement regarding the possibility of Obergefell being overturned:
“In the United States, we can proudly say that marriage equality is the law,” he said via email. “As the Supreme Court discusses whether to take up for review a challenge to marriage equality, Lambda Legal urges the court to honor what millions of Americans already know as a fundamental truth and right: LGBTQ+ families are part of the nation’s fabric.
“LGBTQ+ families, including same-sex couples, are living in and contributing to every community in this country: building loving homes and small businesses, raising children, caring for pets and neighbors, and volunteering in their communities. The court took note of this reality in Obergefell v. Hodges, citing the ‘hundreds of thousands of children’ already being raised in ‘loving and nurturing homes’ led by same-sex couples. The vows that LGBTQ+ couples have taken in their weddings might have been a personal promise to each other. Still, the decision of the Supreme Court is an unbreakable promise affirming the simple truth that our Constitution guarantees equal treatment under the law to all, not just some.”
He noted the same things Loewy pointed out — namely that, at minimum, the particular avenue Davis is attempting to use to challenge same-sex marriage has no legal footing.
“Let’s be clear: There is no case here. Granting review in this case would unnecessarily open the door to harming families and undermine our rights. Lower courts have found that a government employee violates the law when she refuses to grant marriage licenses to same-sex couples as her job requires. There is no justifiable reason for the court to revisit settled law or destabilize families.”
He also addressed members of the LGBTQ community who might be feeling fearful at this moment:
“To our community, we say: this fight is not new. Our community has been fighting for decades for our right to love whom we love, to marry and to build our families. It was not quick, not easy, not linear. We have lived through scary and dark times before, endured many defeats, but we have persevered. When we persist, we prevail.”
And he issued a direct message to the court, urging justices to honor the Constitution over one person’s religious beliefs.
“To the court, we ask it to honor its own precedent, to honor the Constitution’s commands of individual liberty and equal protection under the law, and above all, to honor the reality of LGBTQ families — deeply rooted in every town and city in America. There is no reason to grant review in this case.”
Kenneth Gordon, a partner at Brinkley Morgan, a financial firm that works with individuals and couples, including same-sex partners, to meet their legal and financial goals, also emphasized the importance of not panicking and of using available documentation processes such as estate planning.
“From a purely legal standpoint, overturning Obergefell v. Hodges would present significant complications. While it is unlikely that existing same-sex marriages would be invalidated, particularly given the protections of the 2022 Respect for Marriage Act, states could regain the authority to limit or prohibit future marriage licenses to same-sex couples. That would create a patchwork of laws across the country, where a couple could be legally married in one state but not recognized as married if they moved to or even visited another state.
“The legal ripple effects could be substantial. Family law issues such as adoption, parental rights, inheritance, health care decision-making, and property division all rely on the legal status of marriage. Without uniform recognition, couples could face uncertainty in areas like custody determinations, enforcement of spousal rights in medical emergencies, or the ability to inherit from a spouse without additional legal steps.
“Courts generally strive for consistency, and creating divergent state rules on marriage recognition would reintroduce conflicts that Obergefell was intended to resolve. From a legal systems perspective, that inconsistency would invite years of litigation and impose significant personal and financial burdens on affected families.”
Finally, Human Rights Campaign President Kelley Robinson issued a statement about the possibility of the Supreme Court deciding to hear Davis’s appeal:
“Marriage equality isn’t just the law of the land — it’s woven into the fabric of American life,” said Robinson. “For more than a decade, millions of LGBTQ+ couples have gotten married, built families, and contributed to their communities. The American people overwhelmingly support that freedom. But Kim Davis and the anti-LGBTQ+ extremists backing her see a cynical opportunity to attack our families and re-litigate what’s already settled. The court should reject this paper-thin attempt to undermine marriage equality and the dignity of LGBTQ+ people.”
U.S. Supreme Court
Supreme Court rules White House can implement anti-trans passport policy
ACLU, Lambda Legal filed lawsuits against directive.
The U.S. Supreme Court on Thursday said the Trump-Vance administration can implement a policy that bans the State Department from issuing passports with “X” gender markers.
President Donald Trump once he took office signed an executive order that outlined the policy. 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 White House only recognizes two genders: male and female.
The American Civil Liberties Union in February filed a 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 in September ruled against the Trump-Vance administration’s motion to delay the move.
A federal judge in Maryland also ruled against the passport policy. (Lambda Legal filed the lawsuit on behalf of seven trans people.)
“This is a heartbreaking setback for the freedom of all people to be themselves, and fuel on the fire the Trump administration is stoking against transgender people and their constitutional rights,” said Jon Davidson, senior counsel for the ACLU’s LGBTQ and HIV Project, in a statement. “Forcing transgender people to carry passports that out them against their will increases the risk that they will face harassment and violence and adds to the considerable barriers they already face in securing freedom, safety, and acceptance. We will continue to fight this policy and work for a future where no one is denied self-determination over their identity.”
Justices Ketanji Brown Jackson, Elena Kagan, and Sonia Sotomayor dissented.
The Supreme Court ruling is here.
The White House
Political leaders, activists reflect on Dick Cheney’s passing
Former VP died on Monday at 84
Dick Cheney, the 46th vice president of the United States who served under President George W. Bush, passed away on Monday at the age of 84. His family announced Tuesday morning that the cause was complications from pneumonia and cardiac and vascular disease.
Cheney, one of the most powerful and influential figures in American politics over the past century, held a long and consequential career in public service. He previously served as White House chief of staff for President Gerald Ford, as the U.S. representative for Wyoming’s at-large congressional district from 1979-1989, and briefly as House minority whip in 1989.
He later served as secretary of defense under President George H.W. Bush before becoming vice president during the George W. Bush administration, where he played a leading behind-the-scenes role in the response to the Sept. 11 attacks and in coordinating the Global War on Terrorism. Cheney was also an early proponent of the U.S. invasion of Iraq, falsely alleging that Saddam Hussein’s regime possessed weapons of mass destruction and had ties to al-Qaeda.
Cheney’s personal life was not without controversy.
In 2006, he accidentally shot Harry Whittington, a then-78-year-old Texas attorney, during a quail hunt at Armstrong Ranch in Kenedy County, Texas — an incident that became the subject of national attention.
Following his death, tributes and reflections poured in from across the political spectrum.
“I am saddened to learn of the passing of former Vice President Dick Cheney,” former Vice President Kamala Harris posted on X. “Vice President Cheney was a devoted public servant, from the halls of Congress to many positions of leadership in multiple presidential administrations,” she added. “His passing marks the loss of a figure who, with a strong sense of dedication, gave so much of his life to the country he loved.”
Harris was one of the Democrats that the Republican had supported in recent years following Trump’s ascent to the White House.
Former President Joe Biden, who served as former President Obama’s vice president, said on X that “Dick Cheney devoted his life to public service — from representing Wyoming in Congress, to serving as Secretary of Defense, and later as vice president of the United States.”
“While we didn’t agree on much, he believed, as I do, that family is the beginning, middle, and end. Jill and I send our love to his wife Lynne, their daughters Liz and Mary, and all of their grandchildren,” he added.
Human Rights Campaign Senior Vice President of Federal and State Affairs JoDee Winterhof reflected on Cheney’s complicated legacy within the LGBTQ community.
“That someone like Dick Cheney, whose career was rife with anti-LGBTQ+ animus and stained by cruelty, could have publicly changed his mind on marriage equality because of his love for his daughter is a testament to the power and necessity of our stories.”
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