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Texas Federal Judge Rules Employers Should Not Be Required to Cover HIV-Prevention Medication

On September 7, a federal judge in Texas ruled that a provision of the Affordable Care Act (“ACA”) is unconstitutional. According to the Court in Braidwood Management, Inc. v. Becerra,[1] an ACA provision[2] that requires most group health plans and health insurers to cover certain HIV-prevention medications violates the statutory rights of employers on religious grounds.

The named plaintiff in the case is Braidwood Management, a Christian for-profit corporation. Plaintiffs argued that providing compulsory medication coverage makes them “complicit in facilitating homosexual behavior.”[3] The Court agreed with the plaintiffs’ complaint, which states that the ACA provision violates the protections of the Religious Freedom Restoration Act of 1993 (“RFRA”).

The RFRA “ensure[s] that interests in religious freedom are protected”[4] by prohibiting the government from substantially burdening a person’s exercise of religion. To defeat an RFRA claim, the government must show (1) the burden furthered a compelling government interest; and (2) it is the least restrictive means of furthering that interest. The Court held that the defendant—the U.S. federal government—failed to show a compelling interest for the ACA provision.

The judge also ruled that the group of expert volunteers who make healthcare-related recommendations, including the recommendation to provide HIV-prevention medications, was unconstitutionally appointed.

The Braidwood Management decision comes a little over two years since the decision in Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania,[5] where the Supreme Court upheld two Trump Administration regulations that expanded an employer’s ability to claim an exemption from the ACA’s contraceptive mandate on the basis of religious or moral beliefs.


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