Judge Reed O’Connor’s Ruling On Obamacare’s Requirement To Cover Preventive Care Reveals An Implicitly Pro-Death Stance

In a ruling issued September 7^th, District Judge Reed O’Connor voided a mandate under the Affordable Care Act (ACA) which requires employers cover certain preventive healthcare products and services if these violate their religious beliefs. Here, Reed O’Connor reveals an implicitly pro-death stance, coupled with a fundamental misunderstanding of health insurance.

O’Connor is no stranger to controversy. As a federal judge on the U.S. District Court for the Northern District of Texas, he has issued several rulings against Obamacare, on the grounds of what the judge deemed to the unconstitutionality of the Act as well as its purported violation of religious freedom.

In this instance, O’Connor is striking down an ACA requirement that insurers cover pre-exposure prophylaxis, or PrEP, which prevents transmission of the HIV virus, as well as contraception, the HPV vaccine (which prevents cervical cancer), and screenings and behavioral counseling for illicit drug use as well as sexually transmitted diseases (STDs). According to O’Connor’s opinion, “compulsory coverage for [these] services violates [employers’] religious beliefs by making them complicit in facilitating homosexual behavior and [illegal] drug use.”

Remarkably, O’Connor states that requiring insurers to cover PrEP, HPV vaccines, and screenings and counseling for illicit drug use and STDs, has no “compelling government interest.” Surely, the government has a compelling interest in protecting people from disease and harm. Is there anything more compelling than saving lives?

HIV is a life-threatening virus, cervical cancer is deadly, and illicit drug use (overdoses, in particular) is a very serious problem that is leading to tens of thousands of deaths every year in America. Combating these diseases and conditions is integral to a functioning public health system that prioritizes saving lives.

The ACA was designed with this principle in mind. Under the ACA, insurers must cover thousands of healthcare items and services, from smoking cessation products like nicotine gum to breastfeeding supplies to PrEP. The law’s provisions guarantee coverage of interventions which have been shown empirically to improve health outcomes, and in many instances, save lives.

The Biden Administration is mulling its options, as it seeks to guarantee coverage of what it considers to be “critical preventive medical services.” It will likely appeal O’Connor’s decision.

What O’Connor’s opinion further manifests is an elementary misunderstanding of the concept of health insurance. With insurance, there’s invariably some form of collective responsibility for all members who participate in a plan, whether as employers or employees. Insurers cover large baskets of healthcare items and services. To be sure, these can be tailored to some degree, particularly with respect to exclusions of life-enhancing products from coverage. But, when it comes to life-threatening diseases and conditions, insurers generally don’t balk at coverage. Though they may impose conditions of reimbursement, such as prior authorization, they do this based on clinical and sometimes economic criteria, not a belief system, religious or otherwise.

When we pay premiums it lands in a pool of funds from which insurers can draw to reimburse healthcare services included in a benefits package. As individual members of a plan – and as employers sponsoring a plan – we can’t know for sure which of the covered set of healthcare services and products will be needed in future: Some we may require now or perhaps at some point in our lives; some we won’t ever need; and some we may object to for whatever reason. For example, non-smokers may oppose coverage of smoking cessation products, or even lung cancer therapies.

It’s hard, if not impossible to custom design health insurance based strictly on, in O’Connor’s words, “an employer’s sincerely held beliefs,” without there being undue discrimination against members of the plan.

Furthermore, just because we have sincerely held beliefs about certain things that are included in the benefits package, doesn’t mean we can exempt ourselves from paying for insurance coverage. Similarly, pacifists must pay income taxes, even though more than half of the federal government’s discretionary budget goes towards defense.

Ultimately, we are our brother’s keeper. Our own well-being is bound to the well-being of everyone. And that includes those who may not share our beliefs and may not lead a life that we do.

Undoubtedly, across the U.S., the vast majority of employers and insurers will continue to cover most empirically validated cancer screening tests, but also PrEP, HPV vaccines, and illicit drug use and STD counseling, because they recognize that such services improve health outcomes and save lives.

But, the fact that people now have to worry they may not have coverage to treatments that can save their lives is preposterous. As Jay Michaelson stated so eloquently, Judge O’Connor struck “down a scientifically grounded public health rule on the basis of tendentious, implausible, and simply wrong readings of law, politics, and even religion.”