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On Texas Affordable Care Act Ruling

DENVER — On Wednesday, a federal judge in Texas ruled that, under the Affordable Care Act, a Christian-owned company is not required to cover HIV preventative medication for its employees because it was a violation of the company owner’s religious freedom.

In his ruling, U.S. District Judge Reed O’Connor for the Northern District of Texas wrote that, “the PrEP mandate substantially burdens the religious freedom” of Dr. Steven Hotze, the company owner, who believes that preventative HIV care “facilitates and encourages homosexual behavior, intravenous drug use and sexual activity outside of marriage between one man and one woman.” However, defendants and plaintiffs in the suit have until Friday to file supplemental briefings before Judge O’Connor makes a final determination on whether PrEP, the drug in question, violates the Religious Freedom Restoration Act as a whole.

Judge O’Connor also ruled that the U.S. Preventive Services Task Force (USPSTF), which determines preventative care coverage under the Affordable Care Act, violated the Constitution. The judge concluded that, because USPSTF members are not appointed by the President or confirmed by the Senate, it does not have the authority to determine employer-sponsored preventative services on behalf of private companies.

The judge’s ruling puts millions of Americans’ access to preventative services in jeopardy, including sexual and reproductive health care, cancer screenings, mental health screenings, hypertension screenings and alcohol abuse counseling. 

The ruling will not take effect immediately. White House press secretary Jean-Pierre referred to the ACA as “law of the land for over 10 years” and reiterated the administration’s commitment to Americans’ access to free preventative health care. The Biden administration has also indicated it intends to appeal the decision. 

Voices of Health Care Action Founder and Affordable Care Act Advocate Laura Packard issued the following statement: 

As the law of the land for the last ten years, studies have shown that the effects of the Affordable Care Act\’s provision of free preventive care have been significant for marginalized populations, specifically the disabled, LGBTQIA+, and people of color. Reversing course to yet again restrict access to preventive care for these communities means unnecessary suffering for millions of Americans, and many more lives lost due to avoidable circumstances.

Judge Reed O’Connor is just one of many ultra-conservative, radical judges attempting to restrict access to life-saving care. Decades of deep organizing by the far-right have led the courts to this crisis point. Restoring the legitimacy of the judiciary and, in effect, our democracy, depends on the active participation of every American who believes in affordable and accessible health care. We must fight for the preventive care we deserve by electing health care champions on the ballot this November.”

Laura Packard is the founder of Voices of Health Care Action, executive director of Health Care Voter, and a stage-4 cancer survivor. The Affordable Care Act saved her life. She is a co-host of Care Talk, a call-in health care show on to answer America’s health insurance questions about the ACA, Medicare and Medicaid (airing Mondays at 4:30pm ET). If you’d like to connect with Laura about the ACA, the cost of health care, or her 2023 plans, please reach out to Charlotte Bennett at