On this past Wednesday, September 7, a Texas federal judge ruled that businesses are not required to cover, through their insurance plan, a medication known as PrEP that prevents HIV infection. The lawsuit was brought by Braidwood Management Inc., a Christian for-profit corporation owned by Steven Hotze, on the grounds that compulsory coverage under the Affordable Care Act substantially burdens his religious freedoms.
The Affordable Care Act requires that health insurance group plans provided by employers must pay for coverage of PrEP drugs for HIV, HPV vaccination, screenings for STDs, and behavioral counseling for drug use. Hotze objects to providing coverage for PrEP drugs because he believes that the Bible condemns sexual activity outside marriage between one man and one woman, as well as homosexual conduct; therefore, providing coverage for PrEP drugs violates his religious beliefs by making him complicit in encouraging homosexual behaviors, drug use, and sexual promiscuity, and infringing on his free exercise rights under the First Amendment. With this claim, Braidwood Management Inc. challenged the legality of the preventive-care mandates of the Affordable Care Act, under the Constitution and the Religious Freedom Restoration Act, with the desire to lawfully provide health insurance for employees that excludes the coverage of HIV drugs.
To expound on the facts of this case, the Religious Freedom Restoration Act of 1993 put into law the Sherbert test, which was a Supreme Court precedent set in the ruling of Sherbert v. Verner (1963). The Sherbert test and the RFRA, respectively, deem that the government can burden an individual’s free exercise of religion only if there is a demonstrated compelling state interest and the application is the least restrictive means of achieving this government interest. Judge O’Connor of the Texas District Court used this test to rule in favor of Hotze.
In my initial reading of the case brief, I was opposed to the court’s decision. If PrEP drugs reduce the spread of HIV, a potentially fatal infectious disease, then it seems obvious that the government has a compelling interest in public health and under the ACA, can require employers to cover this drug in group insurance plans. However, the real question lies in the contention of a substantial burden. Hotze believes it is a burden to his religious beliefs to cover PrEP in employee insurance plans because it facilitates homosexual behavior. But is providing this drug endorsing sexual conduct or simply allowing it?
Hotze claims that covering the PrEP endorses or facilitates homosexual and sexual behavior in his employees. This drug is preventive, meaning it is taken pre-exposure to reduce the risk of future exposure to HIV, so the employer providing PrEP insurance coverage is not influencing employees to take that action but allowing the health of the employee to be protected if they so choose to. The substantial burden placed on Hotze’s religious beliefs is sincerely a moral burden in that there is ongoing dignitary harm; providing coverage in Braidwood’s self-insurance plan would make him feel as though he were complicit in behaviors that directly violate his religious beliefs and would place a burden on his conscience. These beliefs are absolute and protected under the free exercise clause, regardless of the fact that providing PrEP may not be directly endorsing sexual behavior. An employee has the choice, dependent on their religious views, to take the preventive drug or not use the coverage in the policy, but Hotze was not given that choice, as the coverage is compulsory. Does that infringe on his free exercise of religion, while allowing employees the free exercise of theirs?
Furthermore, while there is a compelling government interest in public health–controlling the transmission of HIV–requiring employers to achieve this interest through the ACA’s compulsory coverage places the government’s interest on the shoulders of the employer rather than the state. In a very similar Supreme Court case, Burwell v. Hobby Lobby, the Court ruled that a less restrictive means of achieving the government interest of the Affordable Care Act would be for the government to assume the cost of providing the service to employees due to the employer’s religious objections against contraceptives. The Sherbert test provided a clean-cut decision to that case, and led to the same conclusion that Judge O’Connor reached: Hotze should receive an exemption from coverage of PrEP under the ACA because of his sincere religious beliefs.
A reasonable question to pose, following this decision is: Could this jeopardize access to many other preventive health services that the Affordable Care Act requires employers to cover? Although it is unclear what the impact of this ruling will be outside of the plaintiff company, I feel that it will not affect employee access to preventive care, but rather protect the employer’s free exercise of their religious beliefs by not requiring them to provide coverage of medication that they deem morally corrupt to their employees.
https://www.oyez.org/cases/2013/13-354
I disagree with the outcome of the case. I do not believe the court ruled correctly because I doubt the sincerity of his religious beliefs. He is allowed to operate his business in accordance to his religious beliefs, meaning he can operate his business discouraging homosexuality and sexual activity outside of marriage. I believe that this is different than for example, the Hobby Lobby case because Hobby Lobby has a religious objection to contraception itself. In this case, Hotze is not objecting to PrEP itself, but to the activities that he believes follows the use of PrEP, which in many cases are not even accurate. I also believe that the government has a compelling state interest to require private companies to cover PrEP regardless of their religious beliefs because it protects national health by preventing the spread of a potentially dangerous disease. In regards to the second portion of the Sherbert test, I believe that this is the best way for the government to make sure PrEP is covered by insurance, as there currently is no existing federal healthcare program that would provide this coverage to every individual.
ReplyDeleteWell written post, Molly! I view the ruling of this case as adequate, as the company is private. Being that the company is private, I see Hotze having the right to object the use of PrEP on insurance coverage. Hortze has religious views that differ from the ideologies of PrEP, and does not want to sponsor it for his employees. He never stated that his employees could not get PrEP, he just does not want it to be company sponsored. To answer your question about jeopardizing access to preventive health services, I do not think this case will jeopardize companies for providing secular health services, I rather see it as companies would not provide access to certain health services that have religious factors, such as birth control.
ReplyDeleteI think you raise an important point at the end of your response about the slippery slope of this case. If an employer is allowed to not pay for a preventative medicine to prevent a fatal disease because of their religious beliefs, it makes me worried about what other life-saving measures or medicines may be restricted from healthcare coverage in the future. Additionally, would a pharmacist then be able to not full a prescription for PrEP if they feel it goes against their religious beliefs? Additionally, PrEP is not only used by gay individuals. While it may be largely used by that population, it is at its core a preventative measure to prevent a deadly and incurable disease, which is a compelling state interest.
ReplyDeleteI agree with your argument that the ruling of this case was unjust. You make a good point that there is a compelling state interesting in providing coverage for drugs that are potentially life saving. I think in this case specifically, the compelling state interest should outweigh Hotze's right to free exercise here, because the AIDS epidemic is a serious public health situation. Additionally, PrEP does not promote sexual promiscuity or homosexuality, it is merely a preventative measure to avoid a deadly disease, so I don't think allowing PrEP to be covered even violates Hotze's right to free exercise.
ReplyDeleteAlthough I do understand the reasoning and morality behind your argument that the ruling of this case is unjust, along with the other comments left, I do not think that the ruling is incorrect. I think that because Hotze is operating a private company, he is entitled to exercise his beliefs in the way he wants; none of his employees are required to work at Hotze's business and they are not being denied these treatments or barred from certain lifestyle choices. Hotze is not denying employment to any group of people, just choosing not to offer support to lifestyle choices that stray from his personal beliefs. I believe that there is no compelling state interest here because those employed by Hotze are not being denied medical treatment, they are just being denied the insurance to cover the costs of treatments and have the freedom to chose to work at another establishment that would offer them this coverage.
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