The US Supreme Court has agreed to hear a legal challenge from religious business owners who argue that being required to provide insurance coverage for HIV prevention medication, PrEP, under the Affordable Care Act (Obamacare) infringes on their religious freedoms.
The plaintiffs contend that the US Preventive Services Task Force, which recommends preventive care services like PrEP, was unlawfully constituted because its members were not confirmed by the Senate, violating the Appointments Clause of the US Constitution.
Additionally, they claim that mandating employer-sponsored health insurance to cover PrEP contravenes their religious beliefs under the 1993 Religious Freedom Restoration Act. The business owners argue that covering PrEP conflicts with their faith as they believe the medication promotes homosexuality.
The case was initially filed in 2022 in the US District Court for Northern Texas, where a judge ruled in favour of the plaintiffs, stating that the requirement infringed upon their religious rights. The Biden administration appealed the decision, and in May 2023, the 5th Circuit Court of Appeals issued an administrative stay. However, the appeals court ultimately upheld previous rulings supporting the plaintiffs.
Both the Biden administration and the plaintiffs acknowledge that the 5th Circuit’s ruling could lead to further legal challenges on the issue. As a result, they have jointly requested the Supreme Court to make a definitive ruling.
In her petition to the Supreme Court, US Solicitor General Elizabeth Prelogar warned that the lower court’s decision could have widespread consequences. “The [Supreme] Court’s review is warranted because the court of appeals has held an Act of Congress unconstitutional, and its legal rationale would inflict immense practical harms,” she wrote. She further stressed that the ruling “jeopardises healthcare protections that have been in place for 14 years and that millions of Americans currently enjoy.”
A final decision from the Supreme Court is expected by the end of its current term in June 2025.