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Lawsuit against Affordable Care Act targets PrEP

AIDS groups warn court ruling could lead to ‘explosion’ in new HIV cases



U.S. Secretary of Health and Human Services Xavier Becerra is among the officials in charge of administering the Affordable Care Act. (Photo public domain)

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.


The White House

Biden, Harris, deliver remarks for White House Office of Gun Violence Prevention

Pulse survivor Brandon Wolf among those who spoke



President Joe Biden and Vice President Kamala Harris listen as U.S. Rep. Maxwell Alejandro Frost (D-Fla.) addresses an audience in the Rose Garden including federal, state and local officials, survivors and family members, and gun violence prevention advocates on Sept. 22, 2023. (Photo courtesy of Brandon Wolf)

President Joe Biden, Vice President Kamala Harris, and U.S. Rep. Maxwell Frost (D-Fla.) addressed an audience from the Rose Garden of the White House on Friday to honor the establishment of a first-ever White House Office of Gun Violence Prevention.

In a press release Thursday announcing the move, the administration said its aim is to implement and expand the provisions of last year’s Bipartisan Safer Communities Act along with those contained in the president’s executive orders targeting issues of gun violence.

Additionally, Biden explained in his remarks, the office will coordinate more support for survivors, families and communities, including mental health services and financial aid; identify new avenues for executive action; and “expand our coalition of partners in states and cities across America” given the need for legislative solutions on the local and state level.

Harris, who will oversee the office, pledged to “use the full power of the federal government to strengthen the coalition of survivors and advocates and students and teachers and elected leaders to save lives and fight for the right of all people to be safe from fear and to be able to live a life where they understand that they are supported in that desire and that right.”

The vice president noted her close experiences with the devastating consequences of gun violence in her work as a federal prosecutor, San Francisco district attorney, California attorney general and in her current role.

Biden’s comments also included highlights of his administration’s accomplishments combatting gun violence and a call to action for Congress to do more. “It’s time again to ban assault weapons and high capacity magazines,” he told lawmakers.

The president also credited the the work of advocates including those who were gathered at the White House on Friday: “all of you here today, all across the country, survivors, families, advocates — especially young people who demand our nation do better to protect all; who protested, organized, voted, and ran for office, and, yes, marched for their lives.”

Taking the stage before introducing Biden, Frost noted that “Right before I was elected to Congress, I served as the national organizing director for March for Our Lives, a movement that inspired young people across the nation to demand safe communities.”

“The president understands that this issue especially for young people, especially for marginalized communities, is a matter of survival,” the congressman said. And the formation of this office, “comes from Pulse to Parkland,” he said, adding, “we fight because we love.”

Human Rights Campaign National Press Secretary Brandon Wolf, a survivor of the 2016 Pulse nightclub shooting, which was America’s second deadliest mass shooting and the deadliest against the LGBTQ community, shared a comment with the Washington Blade after Friday’s ceremony:

“Seven years ago, when my best friends and 47 others were murdered at our safe place — Pulse Nightclub — we promised to honor them with action. This is what that looks like. This deep investment in the fight to end gun violence matters, and I cannot wait to see Vice President Harris lead these efforts. We can blaze the path toward a future free of gun violence. And today marked an important step in that direction.”

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U.S. Federal Courts

Federal judge: drag is ‘vulgar and lewd,’ ‘sexualized conduct’

Ruling ‘bristles with hostility toward LGBTQ people’



J. Marvin Jones Federal Building, U.S. Courthouse in Amarillo, Texas (Photo: Library of Congress)

Judge Matthew Kacsmaryk of the U.S. District Court for the Northern District of Texas issued a ruling Thursday denying relief to a group of university students who sought to host a drag show over the objections of their school’s president.

A Trump appointed jurist with deep ties to anti-LGBTQ and anti-abortion conservative legal activists, Kacsmaryk argued that drag performances probably do not constitute speech protected by the First Amendment.

As Slate Senior Writer Mark Joseph Stern wrote on X, this conclusion “conflicts with decisions from Texas, Florida, Tennessee and Montana which held that drag is constitutionally protected expression.”

“It also bristles with undisguised hostility toward LGBTQ people,” he added.

Kacsmaryk’s 26-page decision describes drag performances as lewd and licentious, obscene and sexually prurient, despite arguments the plaintiffs had presented about the social, political, and artistic merit of this art form.

As the Human Rights Campaign recently wrote, “drag artists and the spaces that host their performances have long served as a communal environment for queer expression.”

The group added, “It is a form of art and entertainment, but, historically, the performances haven’t only served to entertain, but also to truly advance the empowerment and visibility of LGBTQ+ people.”

Nevertheless, anti-LGBTQ conservative activists and organizations have perpetuated conspiracy theories about members of the community targeting children for sexual abuse including by bringing them to drag performances.

Among these is a group with ties to the Proud Boys that was cited by Kacsmaryk in his ruling: Gays Against Groomers, an anti-LGBTQ and anti-transgender extremist group, according to the Anti-Defamation League and Southern Poverty Law Center.

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The White House

Harris to oversee White House Office of Gun Violence Prevention

Goal is to implement and expand upon legislation, executive actions



U.S. Vice President Kamala Harris, September 2023. (Official White House photograph by Lawrence Jackson)

The White House announced Thursday evening that President Joe Biden on Friday will establish the first-ever White House Office of Gun Violence Prevention, to be overseen by Vice President Kamala Harris.

The office will focus on implementing and expanding upon executive and legislative actions, including the Bipartisan Safer Communities Act, “to reduce gun violence, which has ravaged communities across the country.”

Serving under Harris will be Stefanie Feldman, “a longtime policy advisor to President Biden on gun violence prevention,” and “leading gun violence prevention advocates Greg Jackson and Rob Wilcox.”

“Every time I’ve met with families impacted by gun violence as they mourn their loved ones, and I’ve met with so many throughout the country, they all have the same message for their elected officials: ‘do something,'” Biden said in a statement.

The president noted his signing of last year’s bipartisan gun violence prevention law, a flagship legislative accomplishment for the administration, along with his issuance of more executive actions than any president in history to address this problem.

Calling these “just the first steps,” Biden said the establishment of the White House Office on Gun Violence Prevention will “build upon these measures and keep Americans safe.”

He also urged Congress to do more by passing legislation requiring universal background checks, and baning assault weapons and high capacity magazines.

In a statement, Harris said, “This epidemic of gun violence requires urgent leadership to end the fear and trauma that Americans experience every day.”

“The new Office of Gun Violence Prevention will play a critical role in implementing President Biden’s and my efforts to reduce violence to the fullest extent under the law,” she said, “while also engaging and encouraging Congressional leaders, state and local leaders, and advocates to come together to build upon the meaningful progress that we have made to save lives.”

“Our promise to the American people is this: we will not stop working to end the epidemic of gun violence in every community, because we do not have a moment, nor a life to spare,” the vice president said.

Then Vice President Biden hugs Brandon J. Wolf as he talks with family members of the victims and survivors in the June 12th mass shooting at the Pulse nightclub in Orlando, at the Amway Center in Orlando, Florida, June 16, 2016.
Wolf, a Pulse survivor, was recently appointed National Press Secretary of the Human Rights Campaign.
(Official White House Photo by David Lienemann)
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