As we finish the holiday season and look forward to a new year, I’d like to tell you a bit about my background and its influence on my thoughts of the treatment of others. My father was a prominent Baptist Preacher in Indianapolis, Indiana—to many, he was an imposing figure. Rev. Hicks was a six-feet tall, 250-pound military veteran with a deep voice that attracted attention with minimal effort. What became clear to most, after getting to know him, was he was a gentle giant. For every memory I have of him speaking passionately from the pulpit, I can recall him bringing others to laughter while sharing experiences focused on the commonalities between us as opposed to highlighting our differences. I recall the numerous times my family provided free room and board for members of the community. My parents would often open our home to people rejected by others in the church because of sexual orientation, being unwed and pregnant, or struggling with substance use. I write this column about my family so you can clearly understand my perspectives on the evil of unequal treatment. In my house, all were welcome, and I was taught that all people are deserving of love.
As a result of my upbringing, I am saddened by the current challenges we face to the provision of safe and effective health care. I was surprised and disheartened by the information provided by one of our committee chairs during a meeting a few weeks ago. Six plaintiffs had petitioned a court in Texas to overrule a provision in the Affordable Care Act (ACA) that requires employer-based insurers provide full coverage for HIV prophylaxis medication (PrEP). A few plaintiffs objected to the provision on religious grounds, arguing that the ACA mandate requires that they as employers incur excess costs to cover medication that promotes homosexual promiscuity and that unconstitutionally incumbered their religious freedom. In early September, a U.S. district judge agreed with the plaintiffs and set a course for appeals and further litigation that will likely reach the Supreme Court (SCOTUS).1,2
In his decision, Judge Reed O’Connor ruled that the ACA cannot mandate insurance coverage for proven preventative therapies like PrEP. The basis of the judge’s decision is his statement that the members of the nation’s recommending body, the United States Preventative Task Force (USPTF), are unconstitutionally appointed and thus have no authority to mandate insurance coverage for preventative services.2 Over the years, the USPTF has consistently been populated with respected SGIM members who dedicate their efforts to rigorously examining the literature prior to making recommendations. If SCOTUS were to uphold Judge O’Connor’s decision, several measures proven to promote health (e.g., cancer screening, prenatal care, vaccination) may require patient copayment and will have the potential of being too costly for many of our nation’s most vulnerable populations to access. To be clear, I believe this to be one of several current threats to a just system of care and is a risk to further inequity in access to proven preventative testing and therapies.1
Religion has been a key factor influencing health policy for many years, with both healthcare advocates and groups that object to governmental intrusion in health care, utilizing religious arguments for their cases.3 However, in the case of mandated preventative services, I believe political ideology about the role government in achieving a system of equitable health care is the greater motivation for the legal challenges. The question we must answer as a society is how do we best respond to these sorts of challenges?
In a prior issue of the Forum, I reviewed the SGIM values articulated in our credo.4 In my opinion, one role of professional societies, such as SGIM, is to advocate for policies supported by a scholarly examination of best evidence. Knowledge of content experts, as in the case of the USPTF, should guide policy decisions by utilizing more objective standards. Currently, our Health Policy Committee and SGIM Council are hard at work strategizing ways to more effectively work at both federal and local levels to advocate for a just health system. I also hope we have maximal attendance at #SGIM23 in Colorado because I am enthusiastic about the role our #SGIM23 Program Committee has taken in examining ways to build local advocacy efforts into this year’s annual meeting. This year, we are also hosting a special forum at #SGIM23 where participants will be able to join in on a guided discussion with medical ethicists, health policy researchers, division chiefs and past SGIM presidents to discuss the ways in which we may be more supportive of our members who live in states with policies counter to our organizational values. Please attend the annual meeting and provide your input. I hope that everyone who can attend #SGIM23 in Colorado this year will be there, eager to participate in discussion.