Braidwood Mgmt. Inc. v. Becerra

• Court: U.S. District Court — Northern District of Texas
• Writing for the Court: Reed O'Connor, UNITED STATES DISTRICT JUDGE
• Citation: Braidwood Mgmt. Inc. v. Becerra, 666 F.Supp.3d 613 (N.D. Tex. 2023)
• Docket Number: Civil Action No. 4:20-cv-00283-O
• Decision Date: 30 March 2023
• Parties: BRAIDWOOD MANAGEMENT INC., et al., Plaintiffs, v. Xavier BECERRA, et al., Defendants.

666 F.Supp.3d 613

BRAIDWOOD MANAGEMENT INC., et al., Plaintiffs, v. Xavier BECERRA, et al., Defendants.

Civil Action No. 4:20-cv-00283-O

United States District Court, N.D. Texas, Fort Worth Division

Signed March 30, 2023

Jonathan F. Mitchell, Austin, TX, Charles W. Fillmore, H. Dustin Fillmore, III, The Fillmore Law Firm LLP, Fort Worth, TX, Gene Patrick Hamilton, America First Legal Foundation, Washington, DC, for Plaintiffs.

Christopher M. Lynch, Jordan Landrum Von Bokern, U.S. Department of Justice, Washington, DC, Brian Walters Stoltz, U.S. Attorney's Office, Dallas, TX, for Defendants.

John T. Lewis, Pro Hac Vice, Democracy Forward Foundation, Washington, DC, for Amici American Medical Association, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, American Medical Womens Association, American Academy of Family Physicians, National Medical Association, Infectious Diseases Society of America.

SECOND MEMORANDUM OPINION & ORDER ON REMEDIES IN RELATION TO PLAINTIFFS' MOTION FOR SUMMARY JUDGMENT

Reed O'Connor, UNITED STATES DISTRICT JUDGE

Before the Court are Plaintiffs' Supplemental Brief in Support of Plaintiffs' Motion for Summary Judgment (ECF No. 98), filed October 24, 2022; Defendants' Response to Plaintiffs' Supplemental Motion for Summary Judgment and Supplemental Cross-Motion for Summary Judgment (ECF No. 99) and Supplemental Appendix in Support (ECF No. 100), filed November 23, 2022; Plaintiffs' Reply Brief in Support of Supplemental Motion for Summary Judgment and Response to Defendants' Supplemental Cross-Motion for Summary Judgment (ECF No. 111), filed January 6, 2023; and Defendants' Reply in Support of Supplemental Cross-Motion for Summary Judgment (ECF No. 112), filed January 27, 2023. Also before the Court are the Amici Curiae Brief for the American Cancer Society, et al. (ECF No. 107), filed December 1, 2022; and the Brief of Amici Curiae American Medical Association, et al. (ECF No. 108), filed December 1, 2022.

On September 7, 2022, this Court resolved the parties' cross-motions for summary judgment on the merits partly in favor of Plaintiffs and partly in favor of Defendants. Mem. Op. 41-42, ECF No. 92. The Court ordered supplemental briefing regarding standing for the non-Braidwood Plaintiffs, the non-Braidwood religious objector Plaintiffs' Religious Freedom Restoration Act claim with respect to the PrEP coverage mandate, and the appropriate scope of relief for the successful parties. Id. Having considered the parties' briefing and applicable law on those issues, and in light of its prior decision on the merits in favor of Defendants, the Court DISMISSES with prejudice the religious objector Plaintiffs', including Braidwood Management Inc.'s, contraceptive mandate claim. The non-religious objector Plaintiffs' contraceptive mandate claim is DISMISSED without prejudice for lack of subject matter jurisdiction. Because the Court concludes that the PrEP coverage mandate violates RFRA, the Court GRANTS the non-Braidwood religious objector Plaintiffs' summary judgment motion and DENIES Defendants' summary judgment motion on this claim.

Therefore, the Court GRANTS all religious objector Plaintiffs', including Braidwood Management Inc.'s, request for declaratory and injunctive relief as to this claim. Finally, in light of its prior ruling that 42 U.S.C. § 300gg-13(a)(1)'s compulsory preventive care coverage requirements in response to an "A" or "B" rating by the U.S. Preventive Services Task Force made on or after March 23, 2010 violates the Appointments Clause, the Court GRANTS Plaintiffs' request for declaratory and injunctive relief with respect to this claim, VACATES any and all agency actions implementing or enforcing that provisions' mandatory coverage requirements, and ENJOINS Defendants and their officers, agents, servants, and employees from implementing or enforcing the compulsory preventive care coverage mandate in the future.

I. BACKROUND

A. Legal Background

On March 23, 2010, Congress enacted the Patient Protection and Affordable Care Act (ACA), which dictates four categories of preventive care services most private health insurance companies must cover. 42 U.S.C. § 300gg-13. The Act empowers three agencies—the U.S. Preventive Services Task Force (PSTF), the Health Resources and Services Administration (HRSA), and the Advisory Committee on Immunization Practices (ACIP)—to unilaterally determine what kinds of preventive care fall within each category of mandatory coverage by issuing guidelines or recommendations that, by operation of the statute, carry the force of law. Id. Specifically, PSTF recommends "A" or "B" ratings for specific evidence-based items and services for all patient demographics; HRSA issues "comprehensive guidance" regarding preventive care and screening for infants, children, adolescents, and women; and ACIP recommends certain immunizations. Id. § 300gg-13(a)(1)-(4). Private health insurers must cover and cannot impose cost sharing requirements for these recommended services. Id. § 300gg-13(a).

While all three agencies are affiliated with the U.S. Department of Health and Human Services (HHS), they are not all identically structured. ACIP and HRSA were created by the Secretary of HHS to provide vaccine recommendations and guidance on programs and activities within the agency.¹ See 42 U.S.C. § 217a(a) (authorizing HHS Secretary to create advisory councils or committees). Both ACIP and HRSA are ultimately subject to the "supervision and direction" of the HHS Secretary. 42 U.S.C. §§ 202, 243, 247b.² By contrast, PSTF is a volunteer body of non-federal experts that provides evidence-based recommendations related to preventive care services and health promotion.³ And though the Task Force receives support from AHRQ, an agency within HHS, the Task Force is not itself a part of AHRQ or HHS.⁴ 42 U.S.C. § 299b-4(a)(1). When it created PSTF, Congress specified that the Task Force's recommendations "shall be independent and, to the extent practicable, not subject to political pressure." Id. § 299b-4(a)(6).

Since the ACA's enactment, the agencies have issued several such pronouncements. Among those, and relevant to the case at hand, are HRSA's 2011 guidance compelling insurance companies to cover all FDA-approved contraceptive methods—including certain abortifacients ("contraceptive mandate")—and PSTF's 2019 issuance of an "A" rating for preexposure prophylaxis (PrEP) drugs that are used by persons at high risk of HIV acquisition ("PrEP mandate").⁵ For purposes of this Opinion, the Court refers collectively to agency guidance or recommendations made compulsory through operation of § 300gg-13(a)(1) through (a)(4), and including the contraceptive and PrEP mandates, as the "preventive care mandates."

B. The Parties

Plaintiffs are six individuals and two businesses who challenge the legality of the preventive care mandates as violative of the Constitution and the Religious Freedom Restoration Act (RFRA). Each desires the option to purchase or provide insurance that excludes or limits coverage currently required by the preventive care mandates and argues that Defendants' implementation and enforcement of the preventive care mandates prevents them from doing so. Each Plaintiff objects to the preventive care mandates for religious or personal reasons, or both.⁶

Plaintiffs John Kelley, Joel Starnes, Zach Maxwell, and Ashley Maxwell provide health coverage for themselves and their families. They want the option to purchase health insurance that excludes or limits coverage of PrEP drugs, contraception, the HPV vaccine, and the screenings and behavioral counseling for STDs and drug use.⁷ They say neither they nor their families require such preventive care.⁸ They also claim that 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.⁹

Plaintiff Joel Miller likewise provides health coverage for himself and his family. Like the other Plaintiffs, Miller wants the option to purchase health insurance that excludes or limits coverage of preventive care that "he does not want or need."¹⁰ Miller's wife "is past her childbearing years," and neither he nor his family members "engage in the behaviors that makes [sic] this preventive treatment necessary."¹¹ Plaintiff Gregory Scheideman provides health coverage for himself, his family, and the employees of his company, Fort Worth Oral Surgery. Scheideman wants the option to purchase health insurance that excludes or limits coverage of services currently required by the preventive care mandates.¹² Scheideman says neither he nor his family members require such preventive care.¹³ In addition, Scheideman and his business partners do not want to cover such care for their employees.¹⁴

Plaintiff Kelley Orthodontics provides health insurance for its employees. Kelley Orthodontics is a Christian professional association that wishes to provide health insurance for its employees that excludes coverage of preventive care such as contraceptives and PrEP drugs.¹⁵ Plaintiff John Kelley, the owner of Kelley Orthodontics, says that providing such coverage violates his religious beliefs.¹⁶

Plaintiff Braidwood Management Inc. is a Christian for-profit corporation owned by Steven Hotze.¹⁷ Braidwood provides health insurance to its approximately seventy employees through a self-insured plan, and Hotze wishes to provide health insurance for Braidwood's employees that excludes coverage of preventive care such as contraceptives and PrEP drugs.¹⁸ Hotze, like Plaintiffs Kelley, Starnes, and the Maxwells, objects to coverage of those services on religious grounds.¹⁹ Hotze also wants the option to impose copays or deductibles for preventive care in Braidwood's self-insured plan.²⁰

Defendants are the Secretary of HHS, Xavier Becerra; the Secretary of the...