Religious liberty and pluralism are democratic principles that sometimes clash and that our nation must balance. We think that a federal district court in Fort Worth got that balance wrong and imperiled health care access with its recent ruling in Braidwood Management v. Becerra. In that case, the court found that a federal mandate to cover preventive HIV medication violates employers’ religious freedoms.
The decision follows a 2014 U.S. Supreme Court ruling in Burwell v. Hobby Lobby, in which the high court sided with employers who objected to offering contraceptives through their health plans because of religious beliefs. At the time, we expressed concerns that the Supreme Court was extending religious exemptions to nonreligious, for-profit companies that could then impose their leaders’ religious views on employees.
We warned then that the Hobby Lobby case set a dangerous precedent with consequences for both secular and religious freedoms, and we see that playing out before us now.
The HIV epidemic has killed more than 700,000 Americans since it started in the 1980s. Preexposure prophylaxis, known as PrEP, are medications that reduce sex-related HIV transmission by about 99% and are credited with helping lower HIV infection rates in recent years.
But the price tag of the drugs can be exorbitant, costing as much as $20,000, according to court documents. The Affordable Care Act requires most private health plans to cover the drug for free.
A Houston-area for-profit company named Braidwood Management is at the center of the recent court case. The company is owned by Dr. Steven Hotze, a physician who describes himself as a Christian who operates his business “according to Christian principles and teaching.” According to court records, Braidwood is a management company that employs the people who work at a wellness center owned by Hotze.
Hotze’s legal team argued that he did not want his company’s health insurance plan to cover HIV prevention medication because the coverage would make him complicit in gay sex, which he said conflicts with his religious beliefs. But Hotze’s company is not a church or an organization affiliated with one. It should not be entitled to religious exemptions.
We worry that continuing down this path will open the door for just any business to object to certain types of care on the grounds that the care violates the owner’s beliefs. Think about cancer screenings and vaccines. And it’s not difficult to see how granting these exemptions to secular businesses may result in discriminatory conditions for LGBT workers.
Moreover, this is bad policy on economic grounds. Treating a disease is usually a lot more expensive than preventing it. According to federal officials, for every HIV infection avoided, the cost savings of not having to provide lifetime HIV treatment amount to more than half a million dollars.
This case is less about religious freedoms than it is about access to health care and saving lives. The ultimate loser is not the federal government that imposed the coverage requirements but the American public.
