How a bigoted physician, an extremist decide, and the Supreme Court docket all mixed to offer the secretary a robust new strategy to undermine public well being.
Persist with me. How does a 40-plus-year campaign by a virulently anti-gay, racist doctor in Texas—one who hawks quack cures and was charged in 2022 with aggravated theft and arranged prison exercise in a weird and faux election dispute—find yourself endangering entry to mammograms, colorectal and cervical most cancers screening, folic acid supplementation for pregnant girls, diabetes screening, and medicines to forestall HIV an infection? And the place does Robert F. Kennedy Jr. come into this?
Let me introduce you to Steven Forrest Hotze. If you happen to had been writing a film script about this man and advised his story straight-up with out embellishment, you’d be accused of caricature. Fortunately, Sam Levin wrote a profile of Hotze for The Guardian final Could. My quick description above doesn’t do justice to this man’s drama.
However earlier than we get to the risk Hotze poses to the well being of nearly all of American adults, I’ve to introduce you to a different character: Decide Reed Charles O’Connor of the US District Court docket for the Northern District of Texas, the go-to bench for conservative plaintiffs searching for favorable rulings for conservative causes. Decide O’Connor reliably returns judgments favoring right-wing litigants, and has teed up main circumstances for the ever-more-radical Supreme Court docket, together with Dobbs v. Jackson Girls’s Well being Group, which stripped pregnant individuals within the US of the constitutional proper to abortion.
Hotze and O’Connor have come collectively in a authorized marriage made in hell round a case referred to as Braidwood v. Becerra. Hotze and different plaintiffs argued that offering pre-exposure prophylaxis (PrEP) to forestall HIV to their staff as a part of their medical health insurance, violates the plaintiffs’ non secular freedom, as PrEP “facilitate[s] and encourage[s] gay habits,” and mandating the protection of PrEP forces them to assist “sexual promiscuity.”
By no means thoughts that Hotze had no employees who asked for PrEP, and that the case is constructed on hypotheticals quite than an “harm in truth,”—that’s, hurt that’s “precise or imminent, not conjectural or hypothetical,” which has historically been required to represent authorized standing beneath earlier rulings by the Supreme Court docket.
O’Connor delivered his ruling in 2022, claiming that requiring personal insurers to cowl HIV PrEP violated the plaintiffs’ rights beneath the Spiritual Freedom Restoration Act. In an evaluation printed shortly after the ruling, my colleagues and I suggested that even in probably the most benign state of affairs:
For each 1% decline in PrEP protection amongst US MSM [men who have sex with men], we anticipate a further 114 HIV infections the next yr. We estimate that, at a minimal, the Braidwood ruling will lead to greater than 2000 totally preventable major HIV infections amongst MSM—and plenty of extra infections in different populations at excessive danger of HIV transmission—in 1 yr alone.
Present Problem
And right here is the place all of it will get worse. In his ruling, O’Connor didn’t merely go after HIV PrEP. He went after the US Preventive Companies Activity Drive (USPSTF), the federal panel that made the binding suggestion to insurers to cowl PrEP. O’Connor likes to hate the ACA—he tried to strike it down in its entirety in 2018—and in his Braidwood ruling, he determined that the USPSTF was improperly established and thus that every one the preventive companies mandates beneficial by the duty drive beneath the ACA had been all null and void. (Learn Elie Mystal’s piece in The Nation from March 2023 for the small print.)
All of this was in limbo as O’Connor’s preliminary ruling was appealed to the Supreme Court docket. The courtroom handed down the last word on this case, now referred to as Kennedy v. Braidwood Administration, only a few weeks in the past, because the Kaiser Household Basis reported:
On June 27, 2025, the U.S. Supreme Court docket issued the opinion for Kennedy v. Braidwood Administration, discovering that the ACA requirement that the majority personal insurers and Medicaid enlargement applications cowl preventive companies beneficial by the US Preventive Companies Preventive Activity Drive (USPSTF) with no cost-sharing is constitutional. In its resolution, the Court docket affirmed that USPSTF members are appointed constitutionally, and the Secretary of Well being and Human Companies can take away USPSTF members at-will and straight overview and block Activity Drive suggestions earlier than they take impact.
Dodged a bullet there, proper? Not so quick. It’s that final sentence that’s the coup de grâce. The courtroom gave Robert F. Kennedy Jr. the fitting to take away USPSTF members at will and rescind the panel’s suggestions by fiat. And he could just do that.
Lower than two weeks after the SCOTUS ruling, RFK Jr. abruptly canceled a USPSTF meeting set to happen that week. It’s clear that the fitting nonetheless has the duty drive in its crosshairs, as The American Conservative printed a chunk the exact same day referred to as “Time for Kennedy to Kill the USPSTF.” What’s prone to occur now’s that the USPSTF will likely be “ACIP”-ed. In different phrases, as he did with the Advisory Committee for Immunization Practices (ACIP), Kennedy is prone to make a clear sweep of present members and substitute them together with his cronies, unqualified and conflicted.
Whereas the duty drive will nonetheless be there in title, its credibility—based mostly on each the vigorous vetting means of its members and the detailed, rigorous overview of proof that takes years to finish—will likely be shot. As with ACIP, the brand new members are unlikely to undergo any actual choice course of, and as with the latest ACIP suggestions on vaccines press their very own opinions as suggestions towards scientific truth.
Extra worrisome is that these charlatans will now have their thumbs on the scales of what will get paid for by insurers in the US. Consider somebody like RFK Jr. adviser Calley Means, who rails towards the “corrupt” US healthcare system whereas hawking dietary dietary supplements, natural treatments, and different wellness merchandise on the facet. Think about him or any variety of related individuals in RFK Jr.’s orbit on the USPSTF. The grift is robust with these individuals.
In style
“swipe left beneath to view extra authors”Swipe →
The USPSTF’s suggestions are vital for insurers and protection of a large set of preventive interventions, but in addition signify essential steering for major care physicians throughout the US. Breaking this belief can have horrible penalties. My considerations should not simply my very own. Three former chairs of the USPSTF have spoken out about latest occasions: “What we do know is that it’s vital that the duty drive is preserved—the lives of individuals throughout the nation rely on it.” I’d go additional, undermining the duty drive—even whether it is preserved in title—will equally endanger the well being of all Individuals.
Hotze and O’Connor have to be happy with themselves. They put all this in movement 5 years in the past. Whereas HIV PrEP and different prevention interventions could have been spared in idea from the axe, now your entire edifice of preventive companies within the US is reliant on the whims of RFK Jr. It’s sufficient to make you sick.
My colleagues at Stanford earlier this yr put these risks in stark perspective. For these adults on employer-sponsored medical health insurance, near a 3rd (and near half amongst girls) had been receiving at the least one intervention for free of charge beneath the ACA mandate for preventive companies beneficial by the duty drive.
Again in Texas, the place Hotze and O’Connor reside, greater than 3 million individuals have benefited from these no-cost companies by their medical health insurance. That is the present Hotze and O’Connor have introduced dwelling to the Lone Star State with them from their journey. Of their zealotry and fervor, they’re flattening the home throughout them. The struggling these males will trigger is their legacy.
Extra from The Nation
The ruling makes clear, nevertheless, that cops can nonetheless cease and frisk an individual for present whereas Black.
Migrants who present up for his or her courtroom dates now routinely face arrest by ICE. However failing to seem triggers a deportation order.
The sentencing of police officer Brett Hankison to 33 months in jail by a Trump-appointed decide is a travesty—even when it’s higher than the DOJ’s request for in the future.
Trump is asking for the Washington Commanders to alter their title again to a racial slur.
Philly employees went out on strike—and got here again with a deal that no one appears to love.
The community claims it’s canceling The Late Present for monetary causes, however the actual backside line right here is Trump appeasement.
