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Lawsuit against Affordable Care Act targets PrEP

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

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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.

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Michigan

Progressives score victory as El-Sayed wins Mich. Senate primary

Democratic newcomer will face Rogers in November

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Democratic Senate candidate Abdul El-Sayed (Screen capture via MS NOW/YouTube)

Michigan held its primary on Tuesday, allowing the two major political parties to select their nominees to go head-to-head for the state’s U.S. Senate seat.

NBC News called the Democratic race early, giving the victory to physician Abdul El-Sayed over incumbent U.S. Rep. Haley Stevens (D-Mich.) in an extremely close primary. El-Sayed won 48.5 percent of the primary vote, with Stevens trailing by just one percentage point at 47.5 percent.

Both candidates have campagined on supporting the LGBTQ community through different avenues— for El-Sayed he focused on his past promoting HIV and PrEP funding and research. Stevens focused on her legislative history working to support transgender rights in the state.

This is a major win for progressive Democrats, who have been bearing the brunt of political attacks from President Donald Trump, the Republican Party, and centrist Democrats.

El-Sayed, a former health director in Detroit, ran his campaign largely on making life in the Great Lakes State more affordable amid rising costs. His policies include promoting “Medicare for All,” pushing health policy that targets the regressive efforts of the Trump-Vance administration that rolls back funding for both Women and LGBTQ people, minimizing the growing amount of money in politics, and he was very vocal in his criticism of Stevens for supporting aid to Israel. He was endorsed by two major progressives — U.S. Sen. Bernie Sanders (I-Vt.) and U.S. Rep. Alexandria Ocasio Cortez (D-N.Y.).

Stevens, the four-term congresswoman, is much closer to establishment Democrats on policy than El-Sayed.

During her time in the federal government, she has consistently supported the Equality Act, which would add sexual orientation and gender identity as protected classes under the Civil Rights Act of 1964. She has also emphasized supporting local manufacturing and lowering housing costs in the state.

She was named to Advocates for Trans Equality’s 118th Congressional Champions list for her pro-trans policies and was endorsed by establishment heavy hitters Michigan Gov. Gretchen Whitmer and Senate Minority Leader Chuck Schumer (D-N.Y.).

The contentious race boiled down not only to Michigan affairs but also extended to international conflicts — namely Palestine. (South Africa has filed a case in the International Court of Justice in The Hague that accuses Israel of committing genocide in the Gaza Strip after Oct. 7.) This primary also acted as one of the first major races that pushed back against AIPAC, a lobbying group that works to promote pro-Israel candidates in U.S. elections. The group has been involved in domestic politics since 1954.

AIPAC devoted a massive amount of money to this race.

The Associated Press reported that the pro-Israel lobbying group spent more than $30 million on ads against El-Sayed because of his vocal denunciation of Israel and his continued criticism of its policies towards Palestine.

Michigan has a large Muslim and Arab American population, which could, in part, explain how El-Sayed was able to win.

The Republican side was far less competitive. Former U.S. Rep. Mike Rogers (R-Mich.) ran unopposed and clinched the GOP nomination. He has consistently held anti-LGBTQ positions, going as far as voting multiple times for a federal constitutional amendment to ban same-sex marriage, voting against repealing the military’s “Don’t Ask, Don’t Tell” policy, and supporting efforts to directly target the attempted expansion of Title IX protections to include trans people.

El-Sayed will face off against Rogers in November for Michigan’s Senate seat — one that could have lasting impacts not only on the state’s politics but also on the Republicans’ narrow Senate majority and Trump’s political agenda.

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White House orders warning signs at Smithsonian over gender identity exhibits

Administration criticizes National Museum of American History

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Secretary of the Interior Doug Burgum is expected to install warning signs outside the National Museum of American History warning visitors of supposedly anti-American content. (Photo courtesy of the Office of the Governor of North Dakota)

The Trump administration will install temporary warning signs outside the Smithsonian’s National Museum of American History after releasing a report accusing the museum of promoting what it calls “radical” gender ideology and other politically biased content.

According to the Executive Order, “For purposes of policy formulation under EO 14253, this review of the National Museum of American History concludes that NMAH, by the intention and at the direction of current Museum and Smithsonian leadership, has become subject to institutional capture by a radical, activist ideology that is fundamentally opposed to telling the noble, honest story of the great country we know and love.”

Executive Order 14253 refers to what the White House has deemed the “Restoring Truth and Sanity to American History” order. Therefore, the Trump administration has said it will take all available steps to ensure that the issues in the report are addressed and rectified.

Without specifying, the White House has stated that warnings will be posted along NMAH to alert visitors to sections of the museum it has deemed are in violation according to the report.

“The Secretary of the Interior, acting through the Director of the National Park Service (NPS) and in coordination with the Assistant to the President for Domestic Policy, shall install temporary signage along the NPS-maintained sidewalks and walkways used by the public to access the Museum, informing visitors of the findings of the Report and of the policy set forth in section 1 of this order,” the Executive Order states.

The warnings were raised in a 162-page report issued by the Domestic Policy Council. The report detailed ways in which the National Museum of American History (NMAH) has “poorly” portrayed American history and insufficiently highlighted the founding story during America 250th celebrations.

The report outlined key findings of the NMAH. One of these findings was the Center for Restorative History within the museum, which has stated its purpose is to “encourage systemic change” by highlighting diverse groups. However, the report states that it highlights every group of Americans except for straight and white Americans.

The Domestic Policy Council accused the museum of engaging in “transgender activism.” According to the report, examples include referring to “biological men” as women or girls, displaying what it describes as sexually suggestive content, and incorporating discussions of gender fluidity, gender identity, and gender nonconformity into the museum’s educational curriculum, “Becoming US.”

The report also criticizes the curriculum for using the term “transgender” when discussing gender-nonconforming people and encouraging individuals to ask a person’s pronouns when meeting them. It further objects to exhibits stating that “transgender, nonbinary, and cisgender female athletes” continue to struggle for and demand equality.

It also condemns what it refers to as explicit content in an exhibition, “Girlhood (It’s Complicated)”, such as chest binders, questioning gender testing in women’s sports, and referring to biological females as “people inhabiting female bodies.”

Additionally, the report accuses the museum of no longer participating in flag-celebrating ceremonies because it was “too busy” preparing for June Pride and WorldPride events. It states, “As Director Hartig explained in a June 2024 presentation, all her attention was focused on flying the Smithsonian Pride Alliance’s ‘intersexual pride flag during June’ in 2023 and 2024.”

On July 9, the American Historical Association issued a statement rejecting the report’s findings.

In regard to the report, it states, “Its anonymous authors overlook a central lesson of the nation’s founding: the United States was forged by finding common purpose amid intense divisions, conflicts, and disagreements.” They argue that only “honest history” can tell the true history of the nation.

House Republicans led a subcommittee hearing that questioned Smithsonian Director Hartig extensively. A main focus of the questions was on the exhibits related to gender identity and whether they were appropriate. In the hearing, Rep. Nancy Mace asked: “When was your gender revealed to you, Dr. Hartig?”

In response to questioning, Hartig stated that the institution is nonpartisan and does not push a specific agenda.

Hartig published a two-page statement ahead of her hearing outlining her thoughts on the situation. In the report, she states that the institution is always open to criticism and will continue to look for ways to improve, but she sees the report as misleading.

“I can attest that the report does not fairly characterize the full body of work at this museum. I am familiar with the depth and breadth of our collections, exhibits, and programming. And while I recognize there is always room for improvement, I also know the beauty, inspiration, and expertise that exists in our museum,” Hartig wrote.

Democrats created their own 16-page report as a rebuttal to the Domestic Policy Council’s report. It argued that the attacks by the current Trump administration are another example of its attempt to rewrite history. Additionally, the report states that no policy changes were included in the Executive Order, as that is beyond the President’s role. “The Report recommends nothing. That is no accident. To recommend an action, the Report would need to identify who is legally empowered to take it, and its own opening chapter concedes the President’s only power is to ‘urge’,” House Democrats wrote.

It is still unclear when the temporary warnings will be installed or what form they will take beyond the requirements outlined in the executive order.

An exhibit at the Smithsonian. (Washington Blade photo by Landon Shackelford)

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Trump ends direct HIV prevention funding to community groups

Advocates say transfer of funds to states may disrupt local programs

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The Trump administration will discontinue direct federal funding of community-based organizations that provide HIV prevention services. (Washington Blade file photo by Michael Key)

A decision by the U.S. Office of Management and Budget (OMB) at the request of the Trump administration to discontinue direct federal funding of community-based organizations and clinics that provide HIV prevention services has raised concern among community health advocates, including LGBTQ advocates.

 News surfaced earlier this month that the OMB informed the U.S. Centers for Disease Control and Prevention that it would not renew $46 million in funding for 96 community-based organizations that provide HIV testing, referrals to medical care, and arrangements for obtaining pre-exposure HIV prevention medication known as PrEP that has been shown to be 99 percent effective in preventing HIV infection.

Under the new policy arranged by OMB, the funds will be redirected to the states to be allocated to state and local health departments. The policy calls for states to encourage but not require their respective state and local health departments to allocate some of those funds for community-based organizations. Under the new policy, the funding is scheduled to last until May of 2027, before a renewal decision is made.

Some political observers have speculated that the decision to end direct federal funding to community-based organizations could be motivated by the Trump administration’s hostility to diversity, equity, and inclusion or DEI programs and organizations that promote those programs, with the belief that some of the groups receiving the federal HIV prevention funds are promoting DEI.

Carl Schmid, executive director of the D.C.-based HIV+ Hepatitis Policy Institute, is among the leaders of many AIDS advocacy organizations expressing strong opposition to the OMB action. Schmid said that in places like D.C. and some states, local officials will be willing to redirect the federal funds to local community-based organizations.

A list of the 96 community-based organizations across the country that are currently receiving the federal AIDS funds includes the D.C.-based Whitman-Walker Health, which has a long history of healthcare support for the LGBTQ community, and La Clinica del Pueblo, which reaches out to the Latino community.

 Schmid said Whitman-Walker and La Clinica del Pueblo have longstanding good relationships with the local D.C. government.

“But other states and jurisdictions don’t have that relationship with the community-based organizations,” Schmid said. “It depends on the state,” he said, adding, “Not all states send their money to the communities that really need it most. And not all states are fast in getting money to the community-based organizations.” 

Spokespersons for Whitman-Walker and La Clinica del Pueblo couldn’t immediately be reached for comment on whether they think the Trump administration’s latest action related to funding will adversely impact their respective organizations.  

 Schmid said under the current federal grant program slated to be discontinued, which has been in effect for at least five years, HIV-related health organizations receiving the federal grant funds were eligible for an existing federal policy enabling them to purchase HIV-related medication, including the PrEP prevention medication, at a significant discount from pharmaceutical companies. With the ending of the direct federal HIV funds to community-based organizations, Schmid said it was unclear whether problems may surface in obtaining drug discounts.

“They could still qualify as a sub-grantee from a state,”  Schmid said. “But what if they don’t get that grant again? They would not be able to qualify to obtain the drugs” at the discounted price, he said.

Among the organizations expressing strong concern over the decision to discontinue the direct HIV prevention funding to community-based organizations has been the Federal AIDS Policy Institute and its subgroup called the HIV Prevention Action Coalition.

In a July 22 letter bearing the names of 71 community-based organizations from throughout the country sent to U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Disease Control and Prevention Acting Director Jay Bhattacharya, the group called for the Trump administration to “reconsider” ending the current funding policy.  

 “Ending this program without a clear plan for what comes next would dismantle prevention infrastructure that has taken more than three decades of federal investment to build and do so just as that long record of measurable returns is accelerating,” the letter states.

It says the initiative by President Trump in his first term as president to end the HIV epidemic and reduce new HIV infections by 90 percent by 2030 was moving ahead by the funding program for community-based organizations that the administration now wants to end. 

“Discontinuing this program would also cost far more than it saves,” the letter says. “Every HIV transmission prevented avoids an estimated lifetime treatment cost of roughly half a million dollars per person to the healthcare system – costs that fall heavily on taxpayer-funded programs, including Medicaid, Medicare, and the Ryan White HIV/AIDS program,” the letter continues.

“The choice before the administration is straightforward: a modest, targeted investment in prevention now, or far greater public expense for treatment later,” the letter concludes. 

Spokespersons for the OMB and the Department of Health and Human Services, which oversees the CDC, have not immediately responded to news media requests for comment on the opposition to the funding change policy.

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