Amicus Brief on Trump v PA Warns Religious Exemptions Would Harm Individual and Public Health

Coronavirus pandemic highlights friction between religious liberty and public health; yet the Administration still fights for religious exemptions to contraception and other essential, life-saving care. 

On Tuesday, the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) and fifteen other organizations filed an amicus brief warning that religious and moral exemptions to covering essential and life-saving preventive care harm people living with or at risk for HIV, hepatitis C, and other chronic conditions. Even while religious gatherings during the coronavirus pandemic undermine government efforts to “flatten the curve” and protect public health, the Administration continues to push the limits of religious liberty in the U.S. Supreme Court case Trump v. Pennsylvania.

Trump v. Pennsylvania (consolidated with Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania) considers a challenge to the Administration’s rule that expands religious and moral exemptions to the Affordable Care Act’s (ACA) mandate that insurers cover the full cost of contraceptive care. The rule would allow employers and other entities that object to birth control the right to strip away coverage without ensuring alternative arrangements for access. The case was scheduled to be heard by the Supreme Court on April 29, 2020 but has since been postponed.

The brief illustrates how such sweeping exemptions from the mandate would harm people living with chronic conditions. For many people living with HIV, hepatitis C, hypertension, diabetes, and other chronic diseases, contraceptives are an important part of managing their health. “Women and people of transgender experience living with HIV have been denied the bodily autonomy to create families of our choice since the beginning of the epidemic,” commented Venita Ray, Deputy Director of Positive Women’s Network-USA. “These choices should never be limited by another’s personal beliefs. Access to safe, legal, affordable contraception is an integral component of health care, and we condemn any policy, like this one, that seeks to dictate or influence what we can and cannot do with our own bodies.”

The organizations also sound the alarm on a broader concern: expanding religious exemptions in the context of contraceptives would pave the way for objections to other essential preventive care. For people at risk for HIV, for example, pre-exposure prophylaxis (PrEP) is a once-daily pill that is highly effective at preventing HIV. “Coverage for PrEP is itself critical–to promoting individual health and to the Administration’s own plan to end the HIV epidemic by 2030,” noted Rachel Landauer, a Clinical Fellow at CHLPI. Following a recent recommendation statement from the U.S. Preventive Services Task Force, insurers will be required by the ACA’s preventive service mandate to cover PrEP without cost-sharing. This addition is especially significant because, costing as much as $13,000 a year, the financial burden of PrEP is a barrier to access.

PrEP, however, is also vulnerable to religious and moral objection. “HIV continues to be associated with stigmatized activity that religious actors disapprove of,” Landauer added. “While this case focuses on contraception, the Supreme Court could create a scenario that motivates objectors to try to block additional forms of life-saving health care.” 

The brief highlights how the ACA’s preventive services mandate promotes access to essential health care services, and warns of the barriers that inevitably would be erected by extensions of the Administration’s rules. “Uniform coverage of these services is necessary to address the many health disparities we see across race, geography, and socioeconomic class,” said Linda Dixon, Health Law Director at the Mississippi Center for Justice. “When the government allows objectors to block meaningful access to preventive care, people face financial and administrative barriers that discourage preventive care and can result in worsened health outcomes.”

The government plays a central role in promoting public health, and the ACA’s preventive services mandate is sound public health policy. This Supreme Court case underscores the importance of meaningful limits to religious liberty when such liberty exposes others to disastrous consequences.

“These sixteen organizations lend diverse support to the Commonwealth of Pennsylvania and the State of New Jersey, in their fight to defend access to health care,” said Maryanne Tomazic, Senior Clinical Fellow at CHLPI. “Contraception remains a crucial part of health care for many, and rules like that challenged in Trump v. Pennsylvania threaten to undercut progress made in public health.”

The amicus brief was submitted by: the Center for Health Law and Policy Innovation of Harvard Law School; AIDS Alabama; AIDS Foundation of Chicago; AIDS Law Project of Pennsylvania; American Academy of HIV Medicine; Cascade AIDS Project (Portland, Oregon); Community Catalyst, Inc.; Equality California; Hepatitis Education Project; Legacy Community Health; Mississippi Center for Justice; National Viral Hepatitis Roundtable; North Carolina AIDS Action Network; Positive Women’s Network-USA; Southern AIDS Coalition; and Treatment Action Group.

The amicus brief is here: https://bit.ly/CHLPIetalAmicus