Carl Schmid, executive director, HIV + Hepatitis Policy Institute, explains how a Supreme Court case could have far reaching implications for greater health screenings and preventative services beyond HIV and hepatitis.
Carl Schmid, executive director, HIV + Hepatitis Policy Institute
Image credit: HIV + Hepatitis Policy Institute
This is the third in a series on the State of HIV today.
There is a lot going on with regards to public policy and legality of HIV care and prevention. For example, there is a case in the Supreme Court regarding HIV prevention and testing that could have far wider ramifications into other areas of health. The case, Kennedy v. Braidwood Management, challenges the Affordable Care Act’s (ACA) preventive services coverage requirement.1
The preventative services coverage requires private insurers to include a range of testing, including for HIV and hepatitis B and C, as well as preventative offerings, including PrEP for HIV and vaccinations for hepatitis A and B, and counseling for sexually transmitted infection prevention.2
This court case originated back in 2023 when 6 Christian-owned businesses in Texas challenged the ACA's preventive services requirement, arguing that the PrEP coverage requirement violated their religious rights.
Last month, 20 HIV and hepatitis organizations filed an amicus brief with the Supreme Court in support of the US government’s position. The HIV + Hepatitis Policy Institute was one of those organizations that was part of the brief.
Carl Schmid, executive director, HIV + Hepatitis Policy Institute spoke to Contagion about the court case, and why everyone should be banding together for all preventative services on order to prevent acute infections in the future as well as the value of testing to get people into the continuum of care and prevent other transmissions.
Contagion: The Affordable Care Act's preventative services requirement mandates most health insurance plans to cover PrEP at no cost. Why is this current requirement so important?
Schmid: Because it's unaffordable for most. People already have problems accessing their prescription drugs due to high deductibles and high coinsurance. The generic drugs for PrEP are very, very cheap, but we have long-acting drugs, and we're going to have newer brand names and longer-acting PrEP on the horizon.
In June, the FDA will hopefully be approving a once-every-6-month injectable PrEP, which will revolutionize HIV prevention, not only here in the United States, but around the world, but it's going to come at a cost. And the beauty of the preventive services requirement from the Affordable Care Act is that they not only have to cover the drug, which is good because if it wasn't required, they may not even cover it. And then the second aspect of the law is that it has to be at no cost to the consumer.
So even if they cover the drug, you still have those high deductibles and the coinsurance and the high patient cost sharing. So it is really beneficial to lower-income people. PrEP is not something you have to be on. It's something that you are choosing to be on to protect yourself against HIV. I think it will definitely benefit a lot of people.
We shouldn't just focus on PrEP. We should all join together and push for the coverage of all preventive services. I think that's a better way of achieving our goals.—Carl Schmid
Contagion: In thinking about the Supreme Court case, Kennedy vs. Braidwood management, what is at stake here?
Schmid: Yeah, so the whole coverage and requirement of zero cost sharing and preventive services is at stake. I know we talk a lot about PrEP, but it's HIV testing, hepatitis testing, and STD testing as well. There's no HIV treatment or hepatitis treatment without first testing. And that would be gone as well. And it affects mental health screenings, screenings for cancer, and a lot of services to prevent illness. It's just not HIV, it's not just hepatitis, and all of that would be gone if the Supreme Court rules in favor of Braidwood.
Now, does that mean insurers will automatically stop covering preventive services? I don't think so. But, some employers may choose not to cover the new long-acting PrEP. They may direct their insurance plans not to cover PrEP, and they say, 'Oh, this doesn't impact our our employees.' That may all be gone. This case is going to the Supreme Court, and oral arguments are April 21.
This is part of an ongoing news series on HIV and looking at various elements around it including funding, policy, prevention, and treatment.
Check out these articles from the series:
HIV Prevention: Discussing PrEP, PEP, and Vaccine Development
The Business Sector's Advocacy to Maintain Funding for HIV Prevention, Research, Treatment
Contagion: In a scenario where the case is lost, how do HIV and hepatitis advocates navigate through this? Does it become like the 1980s again, where the movements become grassroots because there is no government support or help from insurers?
Schmid: Let's hope that the Supreme Court does side with the government, and I think that's the big news recently. First, it was the Biden administration that was upholding the preventive services coverage requirements. The Trump administration is also upholding them. They're taking the same position as the Biden administration and arguing in support of the coverage requirements for preventive services.
It's a little complicated, but I am happy that the Trump administration continued to favorably weigh in, and we submitted a brief as well, making those arguments as well. Hopefully the Supreme Court will decide that these are constitutionally acceptable, and so we'll wait and see. But if they do disagree, insurers can still choose to cover this.
Preventive services save healthcare costs down the road. Also, states have stepped in and passed laws as well, requiring their insurers to cover preventive services without cost sharing. Now those plans are only those that impact plans that are regulated by state insurance commissioners, and so a lot of the large employer plans would not be covered.
We have to work together. We shouldn't just focus on HIV. We shouldn't just focus on PrEP. We should all join together and push for the coverage of all preventive services. I think that's a better way of achieving our goals.
HIV + Hepatitis Policy Institute was one of the organizations that signed the brief. Along with the Institute, the other groups signing on to the brief are: ADAP Advocacy Association, AIDS Alabama, American Academy of HIV Medicine, Caring Ambassadors Program, Community Access National Network, Community Liver Alliance, Community Resource Initiative, Fast Track Cities Institute, Frannie Peabody Center, Georgia AIDS Coalition, Global Liver Institute, Hepatitis B Foundation, Hep B United, Housing Works, International Association of Providers of AIDS Care, Latino Commission on AIDS, NMAC, SIECUS, and Vivent Health.
