德克薩斯州法官稱 HIV 藥物授權違反了宗教自由
埃里克·拉爾森 / 2022 年 9 月 7 日 / 彭博社 / 財團法人台灣紅絲帶基金會編譯
德克薩斯州聯邦法院的裁決涉及吉利德藥廠之 PrEP 藥物
某公司表示不想補貼「同性戀行為」
攝影師:賈斯汀沙利文/蓋蒂圖片社
一名聯邦法官在德克薩斯州的裁定,《平價醫療法案》要求免費承保由吉利德科學公司(Gilead Sciences Inc.)生產的開創性愛滋病毒預防藥物,這對一家基督徒擁有的公司的宗教自由「造成重大負擔」。
週三,沃思堡的美國地方法院法官奧康納 (Reed O’Connor) 對布雷德伍德公司 (Braidwood Management Inc.) 就其對 Gilead 的 Truvada 和 Descovy兩種藥物的給付所提出的質疑作出了簡易判決。這兩種暴露前預防藥物,通常稱為 PrEP,每天被數十萬美國人服用,尤其是男男性行為者。
該訴訟由律師喬納森·米切爾(Jonathan Mitchell)牽頭,他是共和黨前德克薩斯州檢察總長,以努力限制該州的墮胎獲取而聞名。米切爾認為,強制性的 PrEP 保險涵蓋迫使基督徒補貼「同性戀行為」
喬治·W·布希總統任命的奧康納說,國家對提供藥物的涵蓋上未能呈現出政府的利益克服了原告宗教上之反對。
法官寫道:「訴訟中的政府被告」概述了一項打擊愛滋病毒傳播的普遍政策,但他們沒有提供將該政策與布雷德伍德公司等雇主聯繫起來的證據。 「因此,被告並沒有承擔起責任來證明 PrEP的授權促進了令人信服的政府利益」
該裁決是支持對《宗教自由恢復法》進行廣泛解釋的保守派的最新勝利,該法是 1993 年的一項法律,曾被用來挑戰獲得墮胎和避孕的機會,並阻止對 LGBTQ 社區的平等保護。
「這項裁決是有關強加的極端之宗教信仰,而不是像它聲稱的那樣,係有關保護宗教自由」,南方平等運動的社區健康計畫主任艾薇希爾說。「極右翼極端主義法官正在攻擊隱私和獲得醫療保健的機會」。
美國衛生與公眾服務部 (HHS) 發言人雷切爾·西格拒絕置評或說明政府是否會對該裁決提出上訴。她在一份聲明中說,衛生與公眾服務部「繼續努力確保人們能夠不受歧視地獲得醫療保健」。
法官保留了解決索賠的「適當補救措施」決定,目前尚不清楚該裁決將對擁有約 70 名員工的原告公司產生什麼影響。他說,沒有證據顯示政府不能承擔向無法從宗教雇主那裡獲得藥物的人提供 PrEP 藥物的費用。
根據裁決,PrEP 藥物每年的費用可能高達 20,000 美元。
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專案工作組違憲
在原告的另一場勝利中,奧康納裁定美國預防服務工作組 (US Preventive Services Task Force , PSTF) 違憲,因為它就《平價醫療法案》(Affordable Care Act , ACA) 規定的預防措施涵蓋資格提出建議,這是違憲的,因為它「擁有類似於立法權威的強制私人行動的權力」。「有權強迫私人行動,類似於立法權」。
「由於 PSTF 成員是主要官員,他們必須由總統任命並由參議院確認」,奧康納說。「毫無疑問,PSTF 成員不符合憲法要求」。
法官還保留了對處理涉嫌違規行為的適當補救措施的裁決。
奧康納駁回了一項對預防性授權本身提出質疑的主張,儘管目前尚不清楚該規定會如何地受到裁決的其餘部分之影響。
米切爾試圖阻止《平價醫療法案》下的整個預防服務授權,認為這些是無效的,因為管理該授權表項目的政府僱員擁有太多權力,無法得到參議院的確認。這可能會在全國範圍內產生深遠的影響,使免費獲得其他服務(如孕婦和嬰兒護理)的要求面臨風險,這取決於奧康納在此案中的補救措施。
奧康納並不完全站在米切爾一邊。法官裁定,參與 《平價醫療法案》預防服務的另外兩個機構,即衛生資源和服務管理局 (the Health Resources and Services Administration) 和疫苗諮詢委員會 (the Advisory Committee on Immunization Practices),根據憲法獲得了適當的授權。法官還裁定,預防服務工作組不違反憲法的一項單獨規定。
該案是 Braidwood Management Inc. 公司訴 Becerra案,4:20-cv-00283,美國地方法院,德克薩斯州北區(沃思堡)。
Texas Judge Says HIV Drug Mandate Violates Religious Freedom
By Erik Larson / 2022年9月7日 / Bloomberg
•Ruling in federal court in Texas concerns Gilead PrEP drugs
•Company said it didn’t want to subsidize ‘homosexual behavior’
Photographer: Justin Sullivan/Getty Images
A federal judge in Texas ruled that the Affordable Care Act’s mandate for free coverage of groundbreaking HIV prevention drugs made by Gilead Sciences Inc. “substantially burdens” the religious freedom of a Christian-owned company.
US District Judge Reed O’Connor in Fort Worth on Wednesday granted summary judgment to Braidwood Management Inc. in its challenge to coverage of Gilead’s Truvada and Descovy. The two pre-exposure prophylactic drugs, commonly known as PrEP, are taken daily by hundreds of thousands of Americans, particularly men who have sex with men.
The suit is being led by attorney Jonathan Mitchell, the Republican former solicitor general of Texas known for his efforts to restrict abortion access in the state. Mitchell argues that mandatory PrEP coverage forces Christians to subsidize “homosexual behavior”
O’Connor, a George W. Bush appointee, said the government failed to demonstrate a state interest in providing coverage of the drugs that overcame the plaintiffs’ religious objections.
“The government defendants in the suit “outline a generalized policy to combat the spread of HIV, but they provide no evidence connecting that policy to employers such as Braidwood,” the judge wrote. “Thus, defendants have not carried their burden to show that the PrEP mandate furthers a compelling governmental interest.”
The ruling is the latest win for conservatives who support a broad interpretation of the Religious Freedom Restoration Act, a 1993 law that has been used to challenge access to abortion and contraception and to block equal protection for the LGBTQ community.
“This ruling is about imposing extreme religious beliefs — not, as it purports, about protecting religious freedom,” said Ivy Hill, community health program director of the Campaign for Southern Equality. “Far-right extremist judges are attacking privacy and access to health care.”
US Department of Health and Human Services spokeswoman Rachel Seeger declined to comment or say whether the government might appeal the ruling. HHS “continues to work to ensure that people can access health care, free from discrimination,” she said in a statement.
The judge reserved deciding the “appropriate remedy” for resolving the claim, and it’s unclear what impact the ruling will have beyond the plaintiff company, which employs about 70 people. He said there was no evidence that the government couldn’t assume the cost of providing PrEP drugs to people who are unable to obtain them from religious employers.
PrEP drugs can cost as much as $20,000 a year, according to the ruling.
Task Force Unconstitutional
In another win for the plaintiffs, O’Connor ruled the US Preventive Services Task Force, or PSTF, which makes recommendations for what qualifies as a covered preventive measure under the ACA, is unconstitutional because it “wields a power to compel private action that resembles legislative authority.”
“Because PSTF members are principal officers, they must be appointed by the President and confirmed by the Senate,” O’Connor said. “The PSTF members indisputably fail that constitutional requirement.”
The judge also reserved ruling on the appropriate remedy for dealing with that alleged violation.
O’Connor dismissed a claim that challenged the preventive mandate itself, though it’s unclear how the provision might be affected by the rest of the ruling.
Mitchell seeks to block the entire preventive services mandate under the ACA, arguing it’s invalid because the government employees who manage the list have too much power to not be confirmed by the Senate. Depending on O’Connor’s remedy in the case, that could have a far-reaching impact nationwide, putting at risk requirements for no-cost access to other services, like care for pregnant women and infants.
O’Connor didn’t entirely side with Mitchell. The judge ruled that two other bodies involved in ACA preventive services, the Health Resources and Services Administration and the Advisory Committee on Immunization Practices, were properly empowered under the constitution. The judge also ruled that the Preventive Services Task Force doesn’t violate a separate provision of the constitution.
The case is Braidwood Management Inc. v. Becerra, 4:20-cv-00283, US District Court, Northern District of Texas (Fort Worth).