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PrEP pills
The defendants in the case previously argued that requiring insurance coverage of PrEP access was similar to supporting homosexuality.
The U.S. Supreme Court on Friday upheld a key provision of the Affordable Care Act, ruling in Kennedy v. Braidwood that health insurance companies must continue covering preventive services recommended by a federal task force — including HIV prevention medication, cancer screenings, and vaccines.
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The Court ruled 6-3, in an opinion written by Justice Brett Kavanaugh, concluding that the U.S. Preventive Services Task Force operates constitutionally and that the Secretary of Health and Human Services has the authority to appoint its members as inferior officers. That means the ACA’s mandate, requiring insurers to cover preventive services, remains intact. Justices Clarence Thomas, Samuel Alito, and Neil Gorsuch dissented.
The majority rejected arguments that the Task Force’s structure violated the Appointments Clause of the Constitution, emphasizing that Congress had provided for the Secretary’s oversight and removal authority, making the Task Force’s members “inferior officers.”
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Related: Texas Judge Rules PrEP Coverage Violates Religious Freedom
At issue was whether insurers could be compelled to cover services such as pre-exposure prophylaxis, or PrEP, which prevents HIV transmission. Public health experts say PrEP access is especially vital for Black and Latine gay and bisexual men and transgender women, who are disproportionately impacted by HIV.
Other services potentially on the chopping block included screenings for cancer, depression, hepatitis B and C, and sexually transmitted infections, as well as a range of vaccines and counseling interventions.
The plaintiffs, a group of Christian business owners, argued that being required to cover PrEP violated their religious beliefs, claiming the medication “encourages homosexual behavior.” A lower court had previously sided with them, sparking concern that the ruling could jeopardize nationwide access to dozens of preventive health services.
Medical experts and LGBTQ+ advocates emphasized that PrEP is used by people of all backgrounds and sexual orientations, and that HIV “does not discriminate.”
Friday’s decision, on the last day of the Supreme Court's term, marks a significant win for LGBTQ+ health equity and for public health more broadly, following years of legal attempts to undermine the ACA’s nondiscrimination and preventive care mandates.
Related: Supreme Court allows Maryland parents to opt their kids out of LGBTQ+ lessons in schools
A joint statement by Lambda Legal, PrEP4All, the Center for Health Law and Policy Innovation, the Center for HIV Law and Policy, and Equality Federation called the ruling “the right decision to reject this assault,” saying it “uphold[s] essential protections for preventive services and affirm[s] that prevention and early detection of diseases save lives, improve health outcomes, and reduce long-term health outcomes.”
They said the Braidwood case “has been not just an attack on HIV prevention or LGBTQ people — it has been a coordinated effort to dismantle access to no-cost preventive healthcare for more than 150 million Americans.”
“This was never about religious liberty,” the statement continued. “It has been about using LGBTQ people as a scapegoat to push a broader agenda that punishes the vulnerable. And the truth is, most of the people harmed by this decision wouldn’t have been queer. They would be working-class families, Black and Brown communities, rural Americans, and anyone who relies on preventive care to stay healthy and alive.”
The groups warned that while the ruling preserves existing protections, vigilance is needed to prevent political interference. “History reminds us that silence is deadly,” they said, invoking the memory of the AIDS crisis and those who “weaponized faith to justify inaction.”
They called on Health Secretary Robert F. Kennedy Jr. to “follow science and not ideology” and urged Congress to be prepared to hold oversight hearings if necessary to protect preventive care.
“This Pride Month, we celebrate this victory as we honor the legacy of those who fought back at Stonewall, who took to the streets with ACT UP, and who demanded dignity at the height of crisis,” the statement said. “We carry that legacy forward now. Join us. Raise your voice. Defend preventive care. Fight back.”
Democracy Forward — which led legal resistance against the Trump administration and filed a friend-of-the-court brief on behalf of 35 of the nation’s leading medical organizations — also welcomed the ruling.
“We welcome the U.S. Supreme Court’s decision today to uphold the preventive care requirements Congress mandated in the Affordable Care Act,” said Skye Perryman, president and CEO of Democracy Forward. “The Court categorically and rightfully rejected baseless theories and efforts to contort the text of the ACA and our Constitution in a manner that would have threatened millions of people’s health care — from cancer screenings to contraception.”
But Perryman echoed others’ warnings, stressing that “a win in this case should not overshadow our continued concern that anti-science special interests represented by far-right legal organizations are filing frivolous cases in handpicked courts that put the health and wellbeing of millions of Americans at risk.”
Gay California U.S. Rep. Mark Takano, chair of the Congressional Equality Caucus, praised the decision. “After several terrible, anti-LGBTQI+ rulings, the Supreme Court today got at least one thing right — and both LGBTQI+ peoples’ and the wider public’s health will be safer because of it,” he said in a statement.
This story is developing...
