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The Guardian
23-05-2025
- Health
- The Guardian
This doctor calls LGBTQ+ rights ‘satanic'. He could now undo healthcare for millions
Steven Hotze, a Republican donor from Texas, has spent decades fighting against LGBTQ+ rights, with campaigns seeking to roll back protections for people he has deemed 'termites', 'morally degenerate' and 'satanic'. The Houston-area physician is not well-known in mainstream politics, and his efforts targeting queer and trans people have generally been local, with limited impact. His latest cause could be different. Hotze, 74, has sued the federal government to roll back healthcare coverage for pre-exposure prophylaxis (PrEP), the HIV prevention medication. The case is now before the US supreme court, which is expected to rule in the coming weeks. A decision in his favor could upend healthcare access for LGBTQ+ people across the country – and derail a wide array of preventive treatments for tens of millions in the process. 'People will die,' said Kae Greenberg, staff attorney with the Center for HIV Law and Policy, which filed a brief in the case. 'Preventive healthcare saves lives, and this case is about whose lives we consider worth protecting. It's about cutting off people's care based on them being gay or substance users or living their lives in a way the plaintiffs do not approve of. It's using the law to legitimize bigotry.' The case, Kennedy v Braidwood, originated with Hotze's Christian healthcare firm, Braidwood Management, which filed a lawsuit in 2020 objecting to the federal requirement that his company's insurance plan cover PrEP. Braidwood, another Christian business and two individuals argued the daily PrEP medications 'facilitate and encourage homosexual behavior', saying the government violated their religious beliefs by making them support 'sexual promiscuity'. Braidwood challenged the requirement under the Affordable Care Act, also known as Obamacare, that insurers and group health plans cover preventive services, a provision that includes diabetes and cancer screenings, medications to reduce heart disease risks, contraception and vaccinations. Along with opposing PrEP, Hotze explicitly objected to STI screenings, counseling for alcohol use and childhood obesity interventions. A Texas district court sided with Braidwood, saying the US violated the firm's religious freedom. The ruling also found that a taskforce of medical experts that recommended the preventive services covered by the ACA was unconstitutional because the experts hadn't been confirmed by the Senate, and therefore health plans should not be required to cover the care. The US government appealed the ruling on the taskforce, which is the issue now before the supreme court. The coverage mandates have remained in effect as the case has progressed, though the individual plaintiffs have been shielded from covering the services. The Trump administration has continued to defend the taskforce's constitutionality, and the supreme court is not weighing religious objections. If the supreme court sides with Braidwood, it could lead to widespread loss of access to free preventative healthcare, with one study finding 39 million people received the threatened services. A 2023 Yale study estimated the loss of free PrEP could result in more than 2,000 preventable HIV infections within one year. The outcome of the case could threaten coverage for every service recommended by the taskforce, not just the provisions opposed by the right. 'We're talking about people who cannot afford this care, who will have to choose between a mammogram and rent,' added Susan Polan, associate executive director of the American Public Health Association. The high-stakes case, and Hotze's role in it, have flown under the radar. But research from progressive watchdog organization which shared its findings with the Guardian, reveal the rightwing activist's long history of pushing fringe ideologies before getting a signature cause before the supreme court. Hotze and his lawyers did not respond to requests for comment. In 1982, 31-year-old Hotze launched a petition in the city of Austin to legalize housing discrimination against gay people, the AP reported at the time. Heading a group called Austin Citizens for Decency, Hotze called gay residents 'criminals' and 'sodomites', saying: 'The issue is not housing. The issue is whether we allow our city council to grant public sanction to homosexual activity.' He said protecting LGBTQ+ people from discrimination is 'like thieves or murderers trying to gain political power'. Hotze said in one interview he was less concerned about 'property rights' and more worried about the 'deviant, perverted lifestyle'. Voters overwhelmingly rejected his referendum. In 1985, Hotze backed a group of eight 'anti-homosexual' Houston city council candidates identified as the 'straight slate'. On ABC News, he stated, 'We're intolerant of those who participate in homosexual activity.' All eight candidates lost. Hotze runs the Hotze Health & Wellness Center, which has been in operation since 1989; Braidwood is his management firm that employs the center's staff. He has marketed hormone therapies to treat a wide range of conditions and sold a vitamin product called Skinny Pak, the New York Times reported. Over the years, he has donated extensively to the Republican party and Texas politicians, including Senator Ted Cruz. Hotze's public anti-LGBTQ+ activism picked up after the supreme court legalized gay marriage nationwide in 2015, with Hotze launching a 'Faith Family Freedom Tour' and using the same homophobic language from his activism decades prior. Hotze said he was fighting a 'wicked, evil movement' that celebrates anal sex, telling the Houston Chronicle: 'Kids will be encouraged to practice sodomy in kindergarten.' During the tour, he said 'satanic cults' were behind gay rights, brandished a sword during a speech, and likened his fight to battling Nazis, the Texas Observer reported. That year, he and other rightwing activists successfully campaigned to repeal an equal rights Houston ordinance. At a 2016 evangelical conference, Hotze was filmed describing the LGBTQ+ rights movement as 'termites [that] get into the wood of the house and … eat away at the moral fabric'. In 2017, Hotze rallied for Roy Moore, the failed Alabama senate candidate accused of sexually coercing teenagers in the 1970s. Hotze has also recently promoted anti-trans causes, testifying in 2023 in favor of a school district policy requiring staff to notify parents if students change their names or pronouns. Trans people, he said, 'have a reprobate, perverted and morally degenerate mind'. His ACA case was not his first effort to undo federal civil rights protections. In a case that began in 2018, Braidwood sued the Equal Employment Opportunity Commission (EEOC), challenging a ban on anti-LGBTQ+ discrimination in the workforce. Braidwood said it enforces a 'sex-specific dress code that disallows gender-non-conforming behavior', the courts summarized, prohibiting women from wearing ties and men from wearing nail polish. Hotze said he won't employ candidates engaged in 'sexually immoral' behaviors. In 2023, an appeals court ruled that a religious freedom law protected Hotze's rights to enforce dress codes and refuse to hire LGBTQ+ people. In that case, and in the one now before the supreme court, Hotze has been represented by America First Legal, the rightwing legal group co-founded by Stephen Miller, Donald Trump's influential adviser. The organization has brought a string of lawsuits, including efforts to undo trans rights and complaints accusing companies of discriminating against white men. Hotze has also been represented by Jonathan Mitchell, an anti-abortion lawyer behind Texas's so-called 'bounty hunter law' that allows private citizens to sue providers or people who 'aid or abet' the procedure. American First Legal and Mitchell did not respond to inquiries. Gabbi Shilcusky, senior investigative specialist, noted that Hotze's supreme court case was founded on hypotheticals: 'He's not hiring men who wear nail polish or are asking for PrEP. This is manufactured to build upon his most fringe beliefs and not about actual issues he's being confronted with in his company.' Hotze has in recent years made headlines outside of anti-LGBTQ+ advocacy. In 2020, during George Floyd protests, he left a voicemail for the Texas governor urging that he 'kill the son of a bitches', referring to demonstrators. Later that year, the Food and Drug Administration sent his company a warning advising it was promoting 'unapproved and misbranded products' for Covid. In 2022, Hotze was charged with unlawful restraint and aggravated assault with a deadly weapon in an elections dispute. Hotze hired a contractor who claimed a local air conditioner repairman was holding fraudulent ballots in his truck. The contractor ran his vehicle into the man's car and held him at gunpoint, according to prosecutors, who said the voter fraud claims were false. Hotze was later charged with aggravated robbery and organized criminal activity from the incident. Hotze pleaded not guilty, and this week, a newly elected DA dropped the charges, accusing his predecessor of bringing a politically motivated case. The criminal case did not stop his attacks on voting rights; in October, just before the election, he filed a lawsuit against the local registrar seeking to invalidate tens of thousands of voters. It's unclear if Hotze will succeed at the supreme court. In oral arguments last month, some justices, including conservatives, appeared skeptical of the arguments by Hotze's lawyers. The case hinges on whether the taskforce members who make ACA recommendations are akin to department heads requiring Senate approval or are 'inferior' officers. Brett Kavanaugh and Amy Coney Barrett at times appeared sympathetic to the notion that the experts are not sufficiently independent so as to merit a congressional vote. The case is part of longstanding attacks against the ACA, with legal strategies focused on religious claims as well as objections to how the law was crafted. Hotze previously challenged the ACA in a failed lawsuit that began in 2013, an effort he promoted with a bizarre original song called 'God Fearing Texans Stop Obamacare'. Even if Hotze fails, the threats to PrEP and LGBTQ+ healthcare will continue, said Jeremiah Johnson, executive director of advocacy group PrEP4All, noting the Trump administration's continued funding cuts and dismantling of HIV prevention, and ongoing rightwing efforts to attack civil rights under the guise of religious liberty. The case also comes as the FDA is considering a new injectable PrEP considered a major prevention breakthrough, he said. 'We're at the precipice of science delivering real pathways to ending this epidemic, but if we turn our backs now on all these protections, including private insurance through the ACA, we're not just going to backtrack on progress, we're going to lose out on that promise for the future.'
Forbes
04-05-2025
- Health
- Forbes
Under Trump Administration Full Coverage Of HIV PrEP Drugs Uncertain
PrEP is used to prevent HIV infection. The Supreme Court heard oral arguments last month in a case that could affect what kinds of preventive care services, technologies and medicines are covered at no charge to the patient as a result of provisions contained in the Affordable Care Act. This includes cancer screenings such as mammograms and colonoscopies, statins for heart disease, immunizations, counseling on health behaviors related to weight management, alcohol and drug use, prenatal testing and HIV prevention (preexposure prophylaxis) medications. The case was brought by Braidwood Management, a Christian for-profit corporation owned by Steven Hotze, a Texas doctor and Republican activist who has previously filed multiple lawsuits against the ACA. While the Trump administration is defending the ACA law in the case in question, should the federal government win, the precise shape preventive care coverage requirements will take depends on the discretion of Secretary of Health and Human Services, Robert F. Kennedy. This is particularly relevant with respect to PrEP, as the administration has been cutting funds earmarked for HIV prevention, including treatment and research. PrEP is nearly 100% effective at preventing infection. This facilitated it being covered at no cost for millions of people. Moreover, several large trials have demonstrated that a treatment called lenacapavir can also prevent HIV transmission with just two injections annually. The product is expected to be approved by the Food and Drug Administration for prevention later this year. However, it's uncertain whether free access will be guaranteed. The plaintiffs in the Braidwood case challenged the ACA's requirement to cover preventive services, as explained in an issue brief published by KFF. In particular, the plaintiffs object to providing their 70 employees fully reimbursed access to PrEP. They argue that religious beliefs prevent them from doing so. Correspondingly, they allege that the requirement violates the Religious Freedom Restoration Act. They further maintain that the U.S. Preventive Services Task Force is unconstitutional because its members are not appointed by the president or confirmed by the Senate. The Supreme Court is specifically considering whether USPSTF's structure violates the U.S. Constitution's Appointments Clause. USPSTF is an independent entity that makes recommendations regarding whether public health insurance programs should include certain preventive services. And the ACA requires all insurers, including those in the commercial sector as well as self-insured employers, to cover preventive services and technologies that are recommended by the USPSTF with no patient cost-sharing. Besides public programs such as Medicare and Medicaid, a number of ACA requirements extend to the commercial sector. This means that over 150 million Americans with commercial health insurance can gain access to free preventive care through the ACA. Under successive administrations, the federal government has argued that the USPSTF's oversight by the Secretary of Health and Human Services is constitutionally appropriate because HHS may remove members at will and can determine when health insurance issuers must start providing coverage for new recommendations. Should the administration prevail in the current case, it's unclear what Kennedy will do to affect the precise coverage criteria for preventive care, including PrEP. The Secretary of HHS has considerable influence regarding the composition of the USPSTF task force and can support or override its recommendations. This has the potential to determine whether PrEP is available at no cost to patients and how generous the coverage is. For example, does an older, cheaper PrEP product get recommended over a newer, more expensive drug? What may give pause are the large cuts that Kennedy has instituted across HHS agencies, which include substantial reductions in funding for HIV prevention, as reported by Politico. The secretary has also called for an eight-year pause in infectious disease research. And perhaps most notably, past remarks of Kennedy seem to question a causal relationship between HIV and AIDS. Moreover, the President's Emergency Plan for AIDS Relief or PEPFAR, a global health program initiated 20 years ago by President George W. Bush, is presently barred under an order from the Trump administration from providing PrEP to LGBTQ+ people. The program may only provide pregnant and breast-feeding women with PrEP. It's not just the executive branch that is raising questions about the future of PrEP coverage. Republican lawmakers have signaled intentions to cut or alter a variety of healthcare programs that deliver PrEP. Last year, for example, the House of Representatives proposed $770 million in cuts to HIV-specific programs. GOP legislators are also talking about measures such as putting hard caps on Medicaid funding to states or diminishing the federal matching rate. Medicaid is a key payer in the HIV space. Experts suggest that raising access or cost barriers for PrEP would disproportionately harm younger patients, people of color and those with lower incomes. Compounding this problem, the challenge in public health—particularly around diseases such as HIV—is often getting the message across to people in the most vulnerable communities, where disease and treatment awareness may already be subpar. Substantial reductions in funding for HIV prevention efforts could further hamper this public health messaging. Insurance contracts are typically written and defined by calendar year, so whatever happens regarding the court case, people won't see changes until 2026. Also, these services will still likely have to be reimbursed to some degree by health insurers as essential health benefits through a separate provision of the ACA. But they may not be free anymore and the comprehensiveness of coverage could be curtailed as under the essential health benefits clause, usually only one item in each therapeutic class has to be included.
Bloomberg
24-04-2025
- Health
- Bloomberg
RFK Jr. Is the Real Wild Card in Protecting Obamacare
The US Supreme Court appears likely to preserve a key component of the Affordable Care Act (Obamacare) that requires insurers to fully cover preventive care such as colon and lung cancer screenings. That's a huge relief. The case, Kennedy v. Braidwood Management, has enormous consequences for the health of millions of Americans.
New York Times
21-04-2025
- Health
- New York Times
Supreme Court Wrestles With Challenge to Affordable Care Act Over Free Preventive Care
The Supreme Court appeared divided during arguments on Monday over the constitutionality of a provision of the Affordable Care act that can require insurance companies to offer some types of preventive care for free. At issue is a part of the 2010 health care law that established a task force that determines certain kinds of preventative health measures that insurance companies are required to cover. Two small Christian businesses that provide health insurance to their employees, along with some Texas residents, had sued the federal government, challenging the constitutionality of the task force. In particular, they had objected on religious grounds to the task force's approval of no-cost H.I.V. medications, claiming the drugs 'encourage and facilitate homosexual behavior.' But the case, Kennedy v. Braidwood Management, could have broader implications for tens of millions of Americans who receive a wide array of free health care services, including cancer and diabetes screenings, medications to reduce heart disease and strokes, and eye ointment for newborns to prevent infections causing blindness. A ruling in favor of the challengers could mean that insurers would no longer be required to offer these health services for free. Want all of The Times? Subscribe.
Yahoo
21-04-2025
- Health
- Yahoo
Trump Admin Ends Up In Odd Position Of Defending ACA Against Attempt To Slash Free Services
In a surreal pairing to anyone who's been politically cognizant for the past decade, the Trump administration defended the Affordable Care Act at the Supreme Court Monday against a religious company seeking to end its free preventative care requirements. It was an odd bedfellows pairing, given that President Trump has long despised former President Obama's signature legislative achievement, and tried to overturn it for months in 2017 before failing, despite having a Republican trifecta. Still, the Trump administration's motivation for supporting the law aligns with its greater mission of crafting a muscular presidency with virtually no constraints on its power. It sees the secretary of health and human services' ability to appoint task force members as an explicit outgrowth of that presidential power it seeks to protect. 'All officers who wield executive power on the President's behalf must operate within 'a clear and effective chain of command' leading up to the President,' the administration wrote in a brief. 'The President must be able to hold all his subordinates fully accountable, and the President, in turn, is fully accountable to the People.' Braidwood Management, represented by former Texas Solicitor General Jonathan Mitchell (author of the infamous bounty hunter-style abortion ban), is targeting the structure of the task force that makes the recommendations of services insurers must offer for free. 'One thing we all agree on is that the task force was unconstitutionally appointed for the 13-year period that began in March of 2010, when the Affordable Care Act was first enacted into law, through June of 2023 when Secretary Becerra reappointed the task force,' Mitchell said Monday. 'And everyone agrees, I would think, that recommendations they issued during that 13-year period cannot be enforced until the task force reissued those recommendations after receiving a constitutional appointment.' That would leave a lapse of uncertain duration for the free health care services, including cancer and diabetes screenings, statin medications, physical therapy for older adults and blindness prevention in newborns, per the administration's brief. The justices battled over the status of the members of the task force, debating the extent of their independence. Exchanges got testy at points, with Justice Samuel Alito remarking after Justice Sonia Sotomayor tried to define the independence of the task force members: 'That's an incredibly strained interpretation of the term 'independent.'' Monday's case bubbled up to the Court while other cases more squarely addressing independent agencies wing that way as well. One, stemming from the unlawful firings of members of the National Labor Relations Board and Merit Systems Protection Board, may end with the Supreme Court knocking down one of the last means of protecting agency members from political retribution. Justice Elena Kagan seemed to gesture to that landscape Monday, as well as the more localized one of the Roberts Court's consistent hostility to and chipping away at independent executive branch agencies. 'We don't go around just creating independent agencies — more often, we destroy independent agencies,' she quipped, prompting laughter in the courtroom.
