This is big news from a court house in Texas:
BREAKING: The conservative business plaintiffs challenging the ACA preventative care coverage mandate in a Texas case — the PrEP case — ask US District Judge Reed O’Connor to toss out ALL of the Preventative Services Task Force “A and B” coverage recommendations made since 2010. pic.twitter.com/WmTq4sPK79
— Chris “Subscribe to Law Dork!” Geidner (@chrisgeidner) October 25, 2022
The plaintiffs won an order from a consistently anti-ACA judge that insurers could not be required to pay for PrEP medications that minimize HIV infection risk as a violation of religious liberty. There were other complaints that the plaintiffs also won on different grounds. The judge asked for remedies and the plaintiffs are asking that all preventive care mandates be thrown out.
The ACA mandates insurers cover at no cost-sharing a set of preventive care services that are recommended by a private board. These services include vaccines, birth control and a whole lot of different screenings for different groups. Insurers are mandated to do these things as the business case for paying for prevention is bad.
Prevention is almost never cost-saving. It is often very cost-effective but it is not cost-saving. There are exceptions but they are rare. More importantly, even if a preventive service is cost-saving, the next question is who can internalize the cost-savings? Usually it is either the patient or society in general. It is very seldom the insurer that can collect the gains through lower claims to make up for the expense of treating or screening a lot of people to avoid one event.
We should not expect insurers to create externalities or non-internalized gains.
If this request is granted and survives appeals, insurers will have very aggressive incentives to offer no preventive care that does not directly correlate to well risk adjusted diagnosis codes or have longer pay-offs than a flu shot.
sab
I know the Hobby Lobby case was a while ago, but I am still having a hard time wrapping my head around protecting the religious concerns of corporations.
Sure Lurkalot
It has ever been thus. Best advice from the R party…don’t get sick and if you are stupid enough to, get very and exit quickly.
Ohio Mom
I always took Pelosi’s somewhat cryptic comment about the ACA, “We’ll have to pass it to see what’s in it,” to mean that many wonderful results would take decades to emerge.
Certainly the results of more widespread preventative care would not be obvious for many years but I thought we might see things like fewer deaths from colon cancer because more people would be having colonoscopies.
Oh well. Republicans ruin everything.
Another Scott
Thanks for staying on top of these things for us.
It’s infuriating that these RWNJs will continue to judge-shop and continue to come up with ridiculous “religious” arguments to destroy the commonweal. Last I looked, all of our rights come with responsibilities, and none of our rights trump all the others. Maybe it will take a SCOTUS artist setting up a throne for Baal on the dais and leading some “voluntary” prayer while wearing a couple of AR-15s for all in attendance for the RWNJs to realize that…
The battle is never over. We have to fight them every single day.
Forward!!
Cheers,
Scott.
Dorothy A. Winsor
What kind of religion requires you to subject people to a potentially deadly disease?
Eolirin
@Dorothy A. Winsor: One that assumes HIV is a gay disease and a punishment from God that it would be immoral to interfere with.
That one’s sincerely held religious beliefs fly in the face of all actual evidence of how things work hasn’t been an issue for federalist society judges.
Guarantee if things continue down these lines, eventually there’ll be a challenge to desegregation on religious grounds. They’ve been chipping at the edges using the LGBTQ community as their targets.
It all comes from the same place. Religious freedom as a mask for bigotry.
Gin & Tonic
@Dorothy A. Winsor: Republicanism.
gene108
@Another Scott:
More pertinent would be a devout Hindu working at a steakhouse restaurant refusing to handle beef, because it violates their religious practices or better yet a Jewish person objecting to some imposition from conservative Christians because it violates Jewish doctrine.
@Eolirin:
I think challenging desegregation is part of it. It’s not a big leap to go from Christianity objects to homosexuality to Christianity objects to race-mixing, given this country’s history.
But I think a bigger issue is to undo whatever gains women and minorities have made, especially with regards to work place harassment and discrimination laws. If it’s okay to not give out birth control because of religious beliefs or not provide services for LGBTQ+ folks, then it’s not a big jump to extend that acceptance of discrimination to acceptance and tolerance of other sorts of discrimination.
I think the ultimate goal is to roll everything back to white men unquestionably running everything.
Rusty
@Eolirin: It’s step one of the process, use “religious freedom” to allow discrimination. The second step, and one already in process, is to then outsource as much of the government to religious organizations. Think for example religious schools. School vouchers lets you have government funded schools that can discriminate. With a likely Republican wave this election, there will be several states that will enact more wide open school vouchers that can then be used at discriminatory schools. It’s already happening with adoption services. Outsource adoption services to religious organizations, and allow those organizations to exclude gays, Jewish couples, you name it. We already have the SCOTUS stamp of approval for this. Maine, when it lost the recent school voucher case enacted that any school receiving vouchers had to abide by state anti-discrimination laws. I wouldn’t expect that to survive the current SCOTUS for five minutes.
Caphilldcne
this is essentially the court usurping the role of congress. In a healthier society this judge would be impeached.
lowtechcyclist
@sab:
We really need a Constitutional amendment that specifies that for purposes of this Constitution, corporations are not people, and money is not speech.
lowtechcyclist
@Caphilldcne: I’m old enough to remember when conservatives got all pissed off at the thought of judges ‘legislating from the bench.’
How quaint that was. And this is my surprised face that they totally changed their minds about that the moment their judges dominated the courts.
gene108
Anyone who thinks Democrats aren’t doing enough to get European or Canadian style universal healthcare should be forced to read up on all the lawsuits seeking to dismantle and obliterate the ACA, and all the Republican justices happily doing their part to bring about its demise.
Too many people and powerful interests are hostile to the idea of subsidizing anything to help anyone for various reasons. I don’t see how to get to European or Canadian type healthcare while so much of the country believes we give too much “free stuff” to undeserving elements of society.
lowtechcyclist
@gene108:
I at least understand the upset at giving the poors ‘free stuff’ if they imagine that the ‘stuff’ is Cadillacs and T-bone steaks.
But medical care?? Who gets jealous over someone else’s annual checkup or appointment at the local urgent care? I so totally don’t get that.
The one thing I could sort of get, a decade ago, was the uncertainty of whether our medical system could handle the extra load of all those uninsured people suddenly having access to medical care. But that’s been a nonissue for eight years now.
It all comes back to: the cruelty is the point. When you’ve exhausted all the other explanations, that’s the one that’s left.
West of the Cascades
In a world that didn’t include the current 5th Circuit and Supreme Court, there is no way that this requested remedy would be granted (or survive appellate review if granted). One principle of remedy/injunctive relief is that it must be “narrowly tailored” to remedy the precise wrong in the case. As I understand the decision on the merits, this “judge” (if one can use that term for a Federalist Society hack) held that only specific medications — which by preventing gay people from dying encouraged gay sexy time impinged on the supposed religious fee-fees of the plaintiffs — violated their “freedom.” There was nothing in the merits part of this case (as far as I know) that showed or even alleged that ALL of the preventative care coverage recommendations had any effect whatsoever on religious “freedom.”
So in a world where legal principles apply, there should be zero chance that this remedy is granted. In the fucked-up legal world we live in today, I’d give it a 50-50 shot (85% chance granted by district court, 100% upheld by 5th Circuit, but 50% chance that Roberts and Kavanaugh or Coney Barrett deciding it on formal grounds that the remedy was not narrowly tailored to the specific harm alleged and found — but all but inviting the plaintiffs to bring a new case alleging how all of the other preventative care requirements violate their “religious freedom”).
Larch
@gene108: We had a case here in Minnesota several years ago in which Muslim taxi & airport van drivers were refusing on religious grounds to take fares they knew carried alcohol. The state Supreme Court correctly ruled against them. If one takes a job serving the public, one has to serve ALL the public. If your religious scruples get in the way, get a different job.
I haven’t dug into any of these similar cases enough to know if our case is referenced in any way. It’s possible that the ruling was based on Minnesota law in such a way that it can’t be used as a precedent, but the case is out there.
Suzanne
I would have so much respect for social conservatives who accepted that their religious beliefs bind them, not others. They worry so much about others and not themselves. It’s exhausting.
Betsy
It all boils down to one thing. right-wingers define freedom as the freedom to control other people.
The ability to deprive other people of their freedom is how they see the world. “Albion’s Seed” is a great book examining the cultural history of this notion in the US.
It goes back to patrician landowners in early Virginia – came from the notion of a lord at the top of a social hierarchy, exceexising his power over his womenfolk, children, serfs/tenants/slaves/servants, and animals. That was the sole person with FREEDOM who got to vote and exercise autonomy. Everyone else’s place was to fall in line behind their Master/Landlord/Husband/Father/Owner.
Society was conceived of as strictly hierarchical and made up of household with ONE head of household having all the power, both in their personal realm and in the political arena as the person who spoke (via their vote) for their household (which included any servants and dependents) and their land (mere tenants didn’t get a vote; had to own land) and employees, slaves, etc.
Today you still see petty landlords who own a rental house or two try to control their tenants’ behavior, drop in on them and the like. But the big morph is that those “households” turned into corporations and the “servants” are the employees.
You have to understand that IF you hold this worldview, it’s completely rational to try to deprive your employees of their own exercise of freedom. Because this worldview holds that the world is strictly hierarchical, only some people are fit to exercise their freedom, and those are the people on Top. And their freedom IS the right to control those that they hold power over.
Religious freedom in this world view, is the ability to dictate what OTHER people will do with their bodies and which doctors they can see and drugs they can access, according to YOUR personal religious beliefs.
If freedom is the ability to impose your will on others, then it logically follows that religious freedom is the ability to impose your religious beliefs on others.
(One more thought – that’s why the loss of a constitutional right to privacy in Dobbs is EVEN scarier than not being able to terminate a pregnancy.
Where it leads logically is that some people can use the power of the state to tell you you MUST terminate your pregnancy.
remember, they didn’t find that a fetus is a person. They found that there is no constitutional right to privacy.)
Omnes Omnibus
Not yet. Griswold is still law for now.
MattFa
Speaking of preventative care, I had a colonoscopy on Monday. Two small benign polyps, so I am now officially a member of the colonoscopy-every-few-years club. Needless to say, Slate published an article that same day about how colonoscopies were actually unnecessary. The article is a bit behind best practices- I first had a Cologard screening, when that turned up positive, I was directed to the colonoscopy conveyor belt. There are some problems with Cologard— they don’t reveal their algorithm for rating risk and it’s not obvious that ‘positive’ actually means greater risk.
MattF
Speaking of preventative care, I had a colonoscopy on Monday. Two small benign polyps, so I am now officially a member of the colonoscopy-every-few-years club. Needless to say, Slate published an article that same day about how colonoscopies were actually unnecessary. The article is a bit behind best practices- I first had a Cologard screening, when that turned up positive, I was directed to the colonoscopy conveyor belt. There are some problems with Cologard— they don’t reveal their algorithm for rating risk and it’s not obvious that ‘Cologard positive’ actually means greater risk
In any case, I can tell you that enterology is a thriving business.
Matt
If paying for PReP is somehow a “religious exercise”, then so is denying claims and letting people die. Remember “the least of these” bit? Good luck at the pearly gates, assholes.
Goku (aka Amerikan Baka)
@Rusty:
And how do we know this is “likely”?
Redshift
@Ohio Mom:
She actually said “We have to pass the bill so that you can find out what is in it, away from the fog of the controversy,” so yeah, you can either take it that way or just that the public could see the actual bill instead of just what pundits and propagandists were claiming was in it. It’s pretty clear.
The cryptic version was made up by wingnuts.
rikyrah
@gene108:
You tell no lie
StringOnAStick
@MattF: Yeah, this case and the fact that I’m on an ACA plan makes me glad I got a colonoscopy 4 weeks ago. 4 polyps, now on the 5 year plan and by then I’ll be on Medicare. Whether I get that next colonoscopy obviously depends on if the R’s win this election and the 2024 one or not.
StringOnAStick
@Goku (aka Amerikan Baka): Ignore all this “the results are predetermined because it always happens this way” statements, and go write more postcards; you’ll feel better. This stuff is just more R manipulation; you’ll be happier if you stop letting it trigger you. And really, what does allowing yourself to be triggered do for you? Nothing positive, so the choice to let them make you unhappy is up to you. Try reading some Stoic philosophy; it helps! You emotions are for YOU to control, not them but that takes you wresting the control back into our hands and only you can do that.
sab
I spent five years in my 50s uninsured. I was afraid to even do yardwork. What if a bee bit me? I got an infection from some obscure bug bite in the metroparks.
Then ACA. About five years later I had my heart arrythmia thing where I went 5 hours with a 250 heart race. I’d felt that before but only for short periods. I was juat surprised it went on so long. When I finally collapsed my husband took me to urgent care. They sent me to hospital emergency.
If we hadn’t had insurance I might not have made it to the ER. That is the point of Republican medical care. People like me don’t make it to ER.
Wouldn’t want us to be wasting medical resources.
sab
@sab: That is why I don’t talk to my RWNJ brother. He can blather on about family values all he wants, but when my life was on the line he did not care.