Why Texas health care decision will have major impact on affordable care – The Hill

Affordable health care in the United States lags notably behind other developed countries. Inaccessible For some racial minorities and low-income Americans. A new decision to leave Texas could make matters worse.

Federal Judge Reid O’Connor struck it down. Wednesday A key provision of the Affordable Care Act (ACA) required employer-sponsored insurance to cover certain preventive services — pre-exposure prophylaxis (PrEP), a drug that greatly reduces the risk of HIV — to ensure patients don’t lose out-of-pocket costs.

The judge ruled that the provision violates the Religious Freedom Restoration Act by forcing people to wear veils that conflict with their beliefs or personal beliefs. The expected decision ChallengedIt puts individual health decisions at greater risk 13 million Texans And 150 million Americans Generally those with employer-sponsored health insurance.

higher Costs and additional barriers for patients

Even before Wednesday’s decision, most Americans at risk of HIV infection used PrEP at a relatively low cost. in general, 25 percent of the 1.2 million people For whom PREP was prescribed in 2020 – this is up from 3% in 2015. And the coverage is uneven, according to the Centers for Disease Control and Prevention (CDC).

White Americans represent 66 percent of PREP coverage, while Black Americans represent 6 percent of coverage and Latino Americans represent 16 percent of coverage. This is despite weighing black and Latino Americans. 42 and 27 percent of new HIV diagnoses in 2021. White Americans account for 26 percent of new HIV diagnoses.

Gay, bisexual, and other men who have sex with men are at high risk for HIV, and this is especially true for Black and Latino communities. HIV particularly affects black women, transgender women, and people who inject drugs.

Heterosexual men account for 7 percent of new HIV diagnoses, while homosexual women account for 16 percent. In 2019

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New HIV infections in southAmericans generally have less access to reproductive health care, birth control, abortion, and gender-affirming care for HIV and sexually transmitted diseases. In TexasIn 2020, more than 22,000 people were diagnosed with HIV and more than 123,000 people were at risk of HIV.

A Monthly supply Brand-name PrEP costs about $2,000 without insurance, while the generic version costs $30 to $60 a month. Most insurance packages provide the drug free.

If the ruling is upheld, communities most at risk for HIV infection — many of which already face discrimination and stigma — will face another financial barrier to accessing preventive treatment, Perry N. Halkitis, dean and professor at the Rutgers School of Public Health, told Change America.

Halkitis is a public health psychologist who has focused most of his career on infectious disease and is the founder and director of the Center for Health, Identity, Behavior, and Prevention Studies at Rutgers University.

“The last thing you want to do is put up another barrier, and if that other barrier is now financial, then there’s a chance that it’s going to be reduced even more,” Halkitis said.

Financial pressure on workplaces and thE. Economy

The new ruling could make medical expenses more expensive for workers, employers and the economy, Halkitis said.

This is because it is ultimately cheaper. Prevention Treating HIV and managing chronic conditions is more valuable to employers Defense services. A company spends more to cover chronic diseases like HIV than it covers Preventive care Something to encourage them to do not only to reduce costs but also to ensure the health of their employees.

“You take PrEP, so what happens is that part of your workplace becomes infected with HIV,” Halkitis said. “So, in turn, you’re paying for a lifetime of drugs. The burden on the economy and the company is greater in preventing HIV than in treating HIV, and that is a clear argument for PREP, and a clear argument that encourages this organization and this judge to support access to PREP.

The Texas decision also risks opening the door for employers to deny coverage to any preventive services they feel violates their religious beliefs. For example, it threatens affordability of cancer and heart disease screenings.

“To me, it speaks to the need for a more universal health care system in our country,” Halkitis said. “Where such decisions are not made by employers, my health decisions are made by me and not by the person I work for, job seekers can go to work without fear of repercussions from their employers.” Tell them who to have sex with, how to have sex, and what to do with their bodies.

The future of HIV and preventive care

While it’s unclear whether the decision will apply outside of Texas or to employers who oppose the ACA’s provision, it will have significant implications for all forms of preventive care.

In the ruling, O’Connor ruled out requiring coverage for other preventive services, such as screening for colorectal and other cancers, depression and high blood pressure — a system the U.S. Preventive Services Task Force argued was unconstitutional for determining which services should be fully covered.

In addition to affecting the ACA, the Texas decision could affect the nation’s goal of eliminating new HIV infections by the end of the decade.

In the lawsuit, Texas employers argued that paying for health plans that cover PREP “could facilitate or encourage homosexual behavior,” that they don’t want the coverage themselves because they are “in a monogamous relationship with their spouse” and “neither. Nor are any of their family members engaged in HIV-transmitting behavior.

But access to PrEP doesn’t lead to homosexual behavior, Halkitis said, comparing it to arguments in the 1990s that putting condoms in schools encouraged adolescent sex.

“The idea that because we give someone a drug that prevents them from getting sick that we somehow make them gay is probably the most ridiculous, anachronistic, homophobic, and completely undemocratic way of thinking about sexuality,” he said.

HIV can be transmitted from positive mothers to their children and by sharing needles.

In particular, it prevents patients from transmitting the virus from the time they start taking PrEP and other antiviral drugs. The rate of new HIV infections has decreasedEspecially high reception areas like new york.

In the year It was introduced in 2019 by former President Trump’s administration Plan In the year To eliminate the spread of HIV in America by 2030.

But if this decision is confirmed, it could harm the mission, but “the goal of not having a new HIV infection by 2030 is completely, completely unrealistic,” said Halkitis. “It’s the last thing to control this virus.”