How a bigoted physician, an extremist decide, and the Supreme Courtroom all mixed to provide the secretary a strong new solution to undermine public well being.
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Robert F. Kennedy Jr. in a roundtable dialogue on soil well being within the Mike Mansfield Room on the US Capitol on July 15, 2025(Michael M. Santiago / Getty Pictures)
Stick to 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 pretend 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 stop HIV an infection? And the place does Robert F. Kennedy Jr. come into this?
Let me introduce you to Steven Forrest Hotze. In the event you have been writing a film script about this man and instructed 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 Might. My brief 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 Courtroom for the Northern District of Texas, the go-to bench for conservative plaintiffs looking 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 Courtroom, together with Dobbs v. Jackson Ladies’s Well being Group, which stripped pregnant folks 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 known as Braidwood v. Becerra. Hotze and different plaintiffs argued that offering pre-exposure prophylaxis (PrEP) to stop HIV to their workers as a part of their medical 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 help “sexual promiscuity.”
By no means thoughts that Hotze had no workers who requested for PrEP, and that the case is constructed on hypotheticals reasonably than an “damage actually,”—that’s, hurt that’s “precise or imminent, not conjectural or hypothetical,” which has traditionally been required to represent authorized standing below earlier rulings by the Supreme Courtroom.
O’Connor delivered his ruling in 2022, claiming that requiring personal insurers to cowl HIV PrEP violated the plaintiffs’ rights below the Non secular Freedom Restoration Act. In an evaluation revealed shortly after the ruling, my colleagues and I advised that even in essentially the most benign situation:
For each 1% decline in PrEP protection amongst US MSM (males who’ve intercourse with males), we count on an extra 114 HIV infections the next yr. We estimate that, at a minimal, the Braidwood ruling will end in greater than 2000 solely preventable main HIV infections amongst MSM—and plenty of extra infections in different populations at excessive threat of HIV transmission—in 1 yr alone.
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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 Providers Job 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 each one the preventive providers mandates beneficial by the duty pressure below the ACA have 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 Courtroom. The court docket handed down the final phrase on this case, now known as Kennedy v. Braidwood Administration, just some weeks in the past, because the Kaiser Household Basis reported:
On June 27, 2025, the U.S. Supreme Courtroom issued the opinion for Kennedy v. Braidwood Administration, discovering that the ACA requirement that almost all personal insurers and Medicaid enlargement applications cowl preventive providers beneficial by the US Preventive Providers Preventive Job Drive (USPSTF) with no cost-sharing is constitutional. In its determination, the Courtroom affirmed that USPSTF members are appointed constitutionally, and the Secretary of Well being and Human Providers can take away USPSTF members at-will and instantly evaluate and block Job 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 court docket gave Robert F. Kennedy Jr. the correct to take away USPSTF members at will and rescind the panel’s suggestions by fiat. And he could do exactly that.
Lower than two weeks after the SCOTUS ruling, RFK Jr. abruptly canceled a USPSTF assembly set to happen that week. It’s clear that the correct nonetheless has the duty pressure in its crosshairs, as The American Conservative revealed a chunk the exact same day known as “Time for Kennedy to Kill the USPSTF.” What’s prone to occur now’s that the USPSTF will probably 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 exchange them together with his cronies, unqualified and conflicted.
Whereas the duty pressure will nonetheless be there in identify, its credibility—primarily based on each the vigorous vetting means of its members and the detailed, rigorous evaluate of proof that takes years to finish—will probably 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 reality.
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 aspect. Think about him or any variety of related folks in RFK Jr.’s orbit on the USPSTF. The grift is robust with these folks.
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The USPSTF’s suggestions are essential for insurers and protection of a large set of preventive interventions, but additionally characterize essential steerage for main care physicians throughout the US. Breaking this belief can have horrible penalties. My considerations aren’t simply my very own. Three former chairs of the USPSTF have spoken out about latest occasions: “What we do know is that it’s critical that the duty pressure is preserved—the lives of individuals throughout the nation depend upon it.” I’d go additional, undermining the duty pressure—even whether it is preserved in identify—will equally endanger the well being of all People.
Hotze and O’Connor should 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 the whole edifice of preventive providers 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 dangers in stark perspective. For these adults on employer-sponsored medical insurance, near a 3rd (and near half amongst girls) have been receiving no less than one intervention for free of charge below the ACA mandate for preventive providers beneficial by the duty pressure.
Again in Texas, the place Hotze and O’Connor reside, greater than 3 million folks have benefited from these no-cost providers by means of their medical insurance. That is the reward Hotze and O’Connor have introduced residence to the Lone Star State with them from their journey. Of their zealotry and fervor, they’re knocking down the home throughout them. The struggling these males will trigger is their legacy.
Gregg Gonsalves
Nation public well being correspondent Gregg Gonsalves is the codirector of the International Well being Justice Partnership and an affiliate professor of epidemiology on the Yale College of Public Well being.
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