The Advocate asks a very interesting question in light of the Hobby Lobby case. That case said that a closely-held company could do away with contraception coverage in their health insurance if they have religious objections to it. But could they also eliminate coverage of preventive anti-retroviral drugs that protect gay men from getting HIV?
Last June the Supreme Court ruled that religious-minded business owners could essentially line-item veto some forms of birth control out of their employees’ health care plans. Does that mean that antigay bosses can target queer employees by doing the same with HIV prevention pills?
The Hobby Lobby decision was a major victory for religious conservatives, who in recent years have increasingly sought exemptions from laws designed to protect LGBT people. And while the case focused on birth control, the decision could have significant implications when it comes to health care for workers who are at elevated risk of acquiring HIV, such as sexually active gay men.
PrEP is a daily regimen of the drug Truvada, which when taken daily as prescribed can reduce the risk of transmission by 99 percent, according to studies. Although Truvada has been approved as HIV treatment for more than a decade, it’s only relatively recently that it’s been adapted as a preventive measure. And the number of prescriptions is still small.
There are some differences between this and the Hobby Lobby case, most obviously that Hobby Lobby was challenging a rule in the Affordable Care Act requiring that contraception be covered in all insurance policies at no cost to the insured. But PrEP is preventive care, which is also required in all insurance policies, just not specifically that type. And there’s another question:
Although both the use of Truvada as PrEP and the Hobby Lobby decision are recent developments, LGBT nonprofits are prepared to defend access to health care.
“We’ve heard about some doctors who are reluctant to prescribe PrEP,” says Schoettes. “I think that’s problematic and something that will need to be addressed,” potentially through litigation. “A person’s health care should not be dependent on their doctor’s viewpoints on their sex lives.”
And of course, a refusal to cover treatment or preventive measures would have significant public health consequences.
“Any type of barrier to treatment runs counter to very sound public health policies,” says Espinosa-Madrigal. “If an employer is using moral or religious beliefs to deny people access to health care … it would contribute to the epidemic.”
Fortunately, there have been, so far, no documented cases of antigay employers trying to use the Hobby Lobby decision as a weapon against queer health care. But the possibility still exists.
Can doctors invoke Hobby Lobby to justify denying PrEP coverage to patients on religious grounds? It’s an unsettled question, which is itself rather unsettling. Lives are literally at stake here.