Over the past few weeks, the Supreme Court and various lower courts have issued important rulings and decisions that will, if they have not already, impact the lives of people living with HIV. Below you will find brief summaries of these cases and their impact on people living with HIV. AIDS United will continue to monitor these cases and provide updates as they progress.
Braidwood Management v. Becerra
Braidwood is a lawsuit filed in a Texas federal court that is seeking to challenge the constitutionality of the Affordable Care Act’s (ACA) preventive services mandate. This mandate requires private insurers to cover certain preventive services with no cost-sharing, based on a grade rating from the U.S. Preventive Services Task Force (USPSTF) measuring medical benefit and efficacy.
While the suit called into question the legality of the Advisory Committee for Immunization Practices (ACIP) and the Health Resources and Services Administration (HRSA), the ultimate focus fell on the USPSTF as appointees to the task force are not nominated by the President or confirmed by the Senate. The plaintiffs in this case used this lack of Presidential nomination and Senate confirmation as a way to invalidate the preventative services mandate recommendations made by USPSTF, claiming that it violated the appointments clause of the Constitution.
Additionally, Braidwood argued that by requiring plaintiffs to offer insurance to their employees including coverage of pre-exposure prophylaxis (PrEP) their religious freedom was violated. On June 21, 2024, the U.S. Court of Appeals for the Fifth Circuit issued its ruling. In the short-term, the court agreed that the preventative services recommended by the USPSTF cannot be constitutionally enforced, however that decision was limited to the plaintiffs.
In the long-term, the court’s decision leaves the possibility for future litigation which might affect the mandate’s application nationwide. Furthermore, since the case has been sent back to the district court, it leaves an opportunity for additional legal arguments as to why preventative services recommended by ACIP and HRSA could also not be enforced.
The mandate has ensured that vital preventative services, such as access to PrEP and screening for HIV, has remained available to more than 150 million people with private insurance, 20 million Medicaid enrollees and 61 million Medicare beneficiaries. The ACA mandate has led to improved health outcomes for people living with HIV; eliminating coverage of PrEP will pose a serious health risk to individuals most vulnerable to HIV unable to cover the cost of PrEP and will detrimentally impact efforts to combat the HIV epidemic.
Loper Bright Enterprises v. Raimondo
The case Loper Bright Enterprises v. Raimondo questioned whether the Chevron deference established by the Chevron v National Resources Defense Council (1984) should be overruled. The doctrine established that in instances of vaguely worded regulations, the Courts should defer to federal agencies for interpretation as those agencies are subject matter experts.
Last month, the Supreme Court ruled to undo this precedent, which is expected to imperil the federal government’s ability to enforce nearly all regulatory actions. In the health care sector, this could impact the Health Insurance Portability and Accountability Act, the Affordable Care Act, and FDA safety calls – actions that impact the health of people living with HIV.
Additionally, the ruling could affect the Affordable Care Act marketplace plans and how the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) establish and enforce rules. An estimated 40% of adults living with HIV are covered by Medicaid and at least 28% of adults living with HIV are covered by Medicare.
Under this decision, the regulatory actions set forth by these federal agencies are now open to legal challenge. This leaves our collective future uncertain, particularly because of our reliance on equitable and safe health care.
City of Grants Pass, Oregon v. Johnson
In addition to the Braidwood case, the Supreme Court also issued its ruling for the City of Grants Pass, Oregon v Johnson case. Through their ruling, the Supreme Court has now made it legal to arrest and ticket unhoused people for sleeping outside, even when adequate shelter or housing is not available.
Housing instability remains a significant barrier to ending the HIV epidemic. For people living with HIV, unstable housing means a greater risk for inadequate HIV care and treatment. Despite research showing that stable housing is associated with better health outcomes, the Supreme Court has decided to criminalize houselessness. This decision will not solve homelessness, nor will it aid any efforts to support those living with HIV who are unhoused. It will create a hostile environment for people who are currently unhoused while also making it more difficult for unhoused people to find stable housing.
Moyle v. United States and Idaho v. United States
Abortion access continues to be under threat as the Supreme Court issued their decision in the Moyle v. United States and Idaho v. United States cases, where the Court considered whether the federal Emergency Medical Treatment and Labor Act (EMTALA) requiring hospitals to provide stabilizing care to anyone who needs it, such as abortion care to pregnant persons facing a medical emergency, supersedes Idaho’s abortion ban.
SCOTUS dismissed the appeal and sent it back to the lower courts. For nearly six months, as a direct result of the Supreme Court’s actions, Idahoans have been denied access to emergency abortion care.
Millions of Americans continue to live without access to any abortion care. The ruling has implications for a similar case, Texas v. Becerra, challenging the application of EMTALA to emergency abortion care, which Texans remain without. The Supreme Court’s ruling is not a victory, but a temporary reprieve for Idahoans, as the Court did not affirm the right to emergency care for pregnant people, including a right to an abortion, in every state — regardless of a state’s abortion ban — under federal law. It remains to be seen if the case out of Texas or this case will return to Court next term.
L.W. v. Skrmetti
The Supreme Court has agreed to take up L.W. v. Skrmetti, a case challenging a 2023 Tennessee state law banning gender-affirming care for transgender youth. The plaintiffs in the lawsuit – including a group of transgender youth, their parents, a medical provider and more recently, the Biden administration argue that the ban is a violation of the Equal Protection Clause of the 14th Amendment.
The Supreme Court has agreed to review a lower court ruling which upheld the ban, with oral arguments set for Fall 2024, with an expected decision in Summer 2025.
HHS enacted a rule recognizing that Section 1557 of the ACA entitles people to civil rights protections of their gender identity or sexual orientation, which provides protections against discrimination for transgender youth seeking gender-affirming medical care. However, Judge Louis Guirola Jr. of the US District Court for the Southern District of Mississippi blocked HHS from enforcing the rule nationwide – citing Loper Bright Enterprises v. Raimondo, effectively eliminating any non-discrimination protections.
Stigma and discrimination against transgender youth also poses a significant barrier to receiving care and treatment for HIV. Research shows that transgender youth were more likely to miss HIV care appointments if they were treated negatively because of their gender identity. Ensuring transgender youth have access to gender-affirming care and protections against discrimination makes for more effective HIV care and treatment.
