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Health care providers worry judge ruling imperils preventive HIV drug

Truvada is a daily PrEP medication that is nearly 100% effective in preventing an HIV infection if taken as prescribed.
Rich Pedroncelli
Truvada is a daily PrEP medication that is nearly 100% effective in preventing an HIV infection if taken as prescribed.

A federal judge’s ruling last month to eliminate free coverage for many basic preventive care services and medications under the Affordable Care Act has health care providers nationwide concerned about its potential implications for patients.

In South Florida, Stephen Fallon, chief executive officer of Latinos Salud, a health care provider with four clinics in Miami−Dade and Broward counties, told WLRN that he’s especially worried that it could mean insurers may drop the HIV prevention drug known as PrEP, a pill taken daily to prevent infection. South Florida has among the nation’s highest rates of new HIV cases.

"If somebody gets used to being on PrEP and then they stop, their risk of acquiring HIV can actually be higher than if they never started PrEP in the first place," he said. "They carry that feeling of self−assurance that they may not have had before. So retaining patients on PrEP is vitally important."

Latinos Salud caters its services to gay Latino men, people who have HIV and people who identify as transgender.

An ad for PrEP from Latinos Salud.
Latinos Salud
An ad for PrEP from Latinos Salud.

According to Fallon, even before the federal judge’s decision, insurers didn’t always follow the coverage requirement. He said some engaged in “cost− sharing,” a move pushing some expenses to patients who often don't know how to contest the charges.

He said his clinics will “do what it takes to keep people at risk for an HIV infection on the medicine.”

Fallon fears the judge’s ruling, if it remains in place, would hurt the nation’s health care system.

“The impact … could essentially create a caste system of health insurance plans, with some employers choosing insurance plans that would deny their employees access to the very free preventive or screening services that help lower overall medical costs and taxes for all of us," Fallon told WLRN.

Stephen Fallon is the chief executive officer of Latinos Salud in South Florida.
Latinos Salud
Stephen Fallon is the chief executive officer of Latinos Salud in South Florida.

Experts cautioned that insurers are unlikely to stop any coverage immediately. The Justice Department said this week it will file an appeal and seek a stay of the ruling of Texas−based U.S. District Judge Reed O' Connor.

“This is not the potential fatal blow to the ACA like previous court cases, but it would limit a very popular benefit that tens of millions of people use,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.

The decision comes more than four years after O'Connor, a nominee of former President George W. Bush, ruled that the entire health care law also known as “Obamacare" was unconstitutional. The U.S. Supreme Court overturned that ruling.

This time O'Conner blocked only the requirement that most insurers cover a range of preventive care — including screenings for multiple types of cancer — siding with plaintiffs who include a conservative activist in Texas and a Christian dentist who opposed mandatory coverage for contraception and an HIV prevention treatment on religious grounds.

The requirements for coverage are driven by recommendations by the U.S. Preventive Services Task Force, which is made up of volunteers. O'Connor ruled that enforcing the recommendations was “unlawful" and a violation of the Constitution's Appointment Clause, which lays out how government officials can be appointed.

Dr. Michael Barry, chairman of the federal task force, said in a statement following last month's ruling that people with low incomes have been able to get services they need as care has expanded over the past decade because of the law.

“Fundamentally, people across the country deserve the opportunity to receive these important preventive services that have been proven to help them live longer and healthier lives,” Barry said.

White House Press Secretary Karine Jean-Pierre said the Department of Justice and the Department of Health and Human Services has called the case “yet another attack” on the health care law that has been in place for 13 years and survived multiple legal challenges.

The Biden administration previously told the court that the outcome of the case “could create extraordinary upheaval in the United States’ public health system.” More than 20 states, mostly controlled by Democrats, had urged O’Connor against a sweeping ruling that would do away with the preventive care coverage requirement entirely.

The Texas lawsuit in federal court is among the attempts by conservatives to chip away at the Affordable Care Act — or wipe it out entirely — since it was signed into law in 2010.

Verónica Zaragovia was born in Cali, Colombia, and grew up in South Florida. She’s been a lifelong WLRN listener and is proud to cover health care, as well as Surfside and Miami Beach politics for the station. Contact Verónica at vzaragovia@wlrnnews.org
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