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confidential HIV testing and treatent services
Pre-exposure prophylaxis or PrEP medicine, a powerful HIV prevention tablet is prepared for people who do not have HIV but are at substantial risk of getting the virus.Rungroj Yongrit / EPA-EFE / Shutterstock

Notorious judge rejects coverage of groundbreaking HIV drugs

Reed O’Connor isn’t famous, but the judge who just ruled against the ACA's preventive care benefits is notorious in legal/political circles for a reason.


The Affordable Care Act may be in excellent shape, substantively and politically, but some Republicans are still pursuing a variety of efforts to chip away at existing benefits. NBC News reported this morning, for example, on an important new court ruling.

A federal judge in Texas has ruled that a provision of the Affordable Care Act that mandates free coverage of certain drugs that prevent HIV infections violate the religious beliefs of a Christian-owned company. The ruling by U.S. District Judge Reed O’Connor came in response to a lawsuit filed by former Texas solicitor general and conservative activist Jonathan Mitchell on behalf of Braidwood Management Inc.

The litigation has been pending for more than two years, and from a variety of perspectives, it’s a doozy. As Politico recently reported, a group of Texas residents and employers — backed by former Trump administration officials — filed suit against the ACA’s preventive care mandates. As the plaintiffs argued, requiring people to pay for insurance plans that cover STD screenings and HIV prevention drugs will “facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.”

No, seriously, that’s what the lawsuit said.

In Braidwood Management v. Becerra, the district court judge actually bought this argument and rejected the ACA’s preventive care measures on religious freedom grounds. A Bloomberg report added that in the same ruling, O’Connor rejected the US Preventive Services Task Force, which recommended PrEP be added to the ACA’s list of covered preventive measures.

In terms of the consequences, legal experts can speak to these questions with more authority than I can, and today’s ruling will be appealed to the 6th Circuit, where Republican-appointed jurists dominate.

In the meantime, there are a variety of concerns, not just about affordable public access to groundbreaking HIV treatments — a lifeline to many patients nationwide — but also to ACA coverage of a wide range of other preventive benefits, including vaccines, flu shots, and cancer screenings.

Politico’s report added that a recent analysis from Urban Institute found a far-right ruling in this case could threaten coverage of preventive services for nearly 168 million Americans: “The study predicts that could, in turn, reverse health gains made since Obamacare was enacted, such as the decrease in unintended pregnancies and the increase in cancer screening rates.”

But as the legal, policy, and political worlds digest this new ruling, it’s also worth pausing to acknowledge the jurist responsible for the ruling.

It’s probably safe to assume most Americans have never heard of Judge Reed O’Connor of the Northern District of Texas. But as regular readers may recall, this guy has earned a reputation.

The week before Christmas in 2018, for example, a judge agreed to strike down the entirety of the Affordable Care Act, root and branch. Even many conservatives and ACA critics agreed that the ruling was indefensible, and reactions tended to include words and phrases such as “pretty bananas,” “embarrassingly bad,” and “absurd.”

It was O’Connor, of course, who issued the ruling. The New York Times noted soon after that Republicans had a habit of bringing their cases to this specific district court because of their confidence that O’Connor would give them everything they wanted.

He ruled for Texas in 2015 when it challenged an Obama administration measure extending family leave benefits to married same-sex couples.... He also ruled for Texas in 2016, blocking the Obama administration from enforcing guidelines expanding restroom access for transgender students.

Earlier this year, the same judge, nominated by George W. Bush, undermined the Navy’s vaccine requirements, ignoring generations’ worth of precedent.

If you’re thinking that the plaintiffs in this case filed in the Northern District of Texas, specifically in the hopes that their lawsuit would reach O’Connor, who in turn would deliver a predictable ruling, you’re not alone.