Supreme Court will decide if insurance companies must cover PrEP for HIV prevention, cancer screenings

TheU.S. Supreme Court has agreed to hear a pivotal case that could significantly impact access to preventivehealth care under the Affordable Care Act, including life-saving HIV prevention drugs like pre-exposure prophylaxis or PrEP. The court granted the petition on Friday. The case, which the federal government petitioned for the court’s intervention, is set to be argued this spring, with a decision expected before the Court’s term ends in June.

Related: Conservative Texas Lawyer Targets PrEP Access After Abortion Rights

The Advocate was the first to report on the existence of this case back in 2022 when it was revealed that conservative attorney Jonathan Mitchell was representing Braidwood Management, Inc., aTexas-based business, and other plaintiffs in challenging the ACA’s requirement that insurers cover preventive services like PrEP without cost-sharing. The plaintiffs, claiming that coverage of PrEP violates their religious beliefs, argue that it promotes “homosexual behavior.”

A rollercoaster of rulings

Initially, U.S. District Judge Reed O’Connor sided with the plaintiffs, ruling that the ACA mandate violated their religious rights. However, the Department of Justice swiftly appealed, and the Fifth Circuit Court upheld the district court’s decision butlimited the scope of its effect. The decision meant that while the plaintiffs are exempted, the broader mandate requiring insurance providers to cover preventive services, including PrEP, remains in effect nationwide.

Related: Appeals court maintains PrEP coverage under Obamacare in win for HIV prevention

The case is now headed to the Supreme Court, where it will be argued that the ACA’s coverage requirements, which have been instrumental in reducing HIV transmission and improving public health, should be upheld.

At the heart of the case is the structure of the U.S. Preventive Services Task Force, which issues recommendations for preventive services like PrEP. The Fifth Circuit Court of Appeals ruled that the Task Force’s structure violated the Appointments Clause of the U.S. Constitution.

Preserving the ACA

The government maintains that the Task Force operates within constitutional bounds, with members serving as “inferior officers” under the secretary’s supervision, that this structure is consistent with constitutional requirements, and that it is vital to ensure that essential preventive services are covered under the ACA.

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The case also raises the specter of rolling back coverage for a range of other critical preventive services, including cancer screenings, diabetes prevention, and vaccinations—services that have long been proven to save lives and reduce health care costs. If the court upholds the Fifth Circuit’s ruling, the federal mandate requiring insurers to cover Task Force recommendations could be significantly weakened, disrupting the health care protections millions of Americans currently rely on.