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Bush-Nominated Judge Strikes Down Free HIV, Cancer Screenings in Major Ruling

The decision is a huge blow to the Affordable Care Act.

A federal judge in Texas has struck down a major preventive care rule set by the Affordable Care Act (ACA) that has allowed millions of Americans to access critical health care like cancer screenings, immunizations, and HIV treatment cost-free, in a decision that experts are saying will have devastating impacts across the country if upheld.

Judge Reed O’Connor, a George W. Bush nominee, ruled on Thursday that it is unconstitutional for the government to require insurers to cover services and products recommended by the U.S. Preventive Services Task Force because the expert members of the panel aren’t appointed by the president.

The decision is a huge blow to health care access. It will mean that services like screenings for breast, cervical and lung cancer, domestic violence, STIs, heart disease, HIV, and the wellbeing of pregnant people and children, among other things, will no longer be mandated to be cost-free.

The ACA’s preventive care provisions have previously been championed by health advocates, and research has found that these provisions are a major factor in helping people detect cancer early or prevent it, for instance. If the decision is upheld, access to health care will be even further out of reach for millions of Americans and health outcomes will likely worsen across the country.

The ruling is somewhat of an extension of a ruling O’Connor handed down in September, in a case brought a prominent anti-gay lawyer. O’Connor ruled then that “private, religious corporations” have the right to deny health coverage of lifesaving HIV prevention drug PrEP because of the homophobic notion that it is bad that the drug “encourages” people to engage in same-sex intercourse, which is against the employer’s beliefs.

Homophobia also played a large role in Thursday’s decision. O’Connor sided with religious plaintiffs who argued that they should not have to cover PrEP and birth control, writing that “the PrEP mandate substantially burdens the religious exercise” of the plaintiffs. Though the mandate for insurers to cover contraceptives will remain for now, O’Connor found merit in claims made by the plaintiffs, who argued that their religious beliefs were infringed by these requirements.

O’Connor summarized their argument as such: “The preventive care mandates requiring compulsory coverage for those services violates their religious beliefs by making them complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman as a condition of purchasing health insurance.”

Legal analysts have said that it is hard to overstate the significance of the ruling.

“I anticipated this decision in September when O’Connor first telegraphed it. It is nothing short of catastrophic to the U.S. health care system,” wrote Mark Joseph Stern, legal writer for Slate. “Millions of Americans, including many pregnant women, will have to forgo basic care if it is upheld.”

Experts have said that O’Connor’s reasoning on the unconstitutionality of the panel is ahistoric and have noted that the judge is so extremist in his judgements that even far right justices on the Supreme Court will disagree with them.