Texas-based corporate management firm seeks exemption from HIV prevention drug coverage, invoking religious freedom protections similar to—but potentially broader than—Hobby Lobby case.
On April 21, 2025, the U.S. Supreme Court heard oral arguments in Kennedy v. Braidwood Management, a case testing the extent to which religiously motivated employers can seek exemptions from preventive care mandates under the Affordable Care Act (ACA). The dispute concerns whether Braidwood Management Inc. must provide insurance coverage for HIV pre-exposure prophylaxis (PrEP), and whether the U.S. Preventive Services Task Force (USPSTF)—the body responsible for recommending such services—is lawfully constituted under the Constitution’s Appointments Clause.
Braidwood Management is a for-profit, closely held corporate management firm based in Katy, Texas. It provides contract-based services and self-insures health coverage for approximately 70 employees. The company is owned through a trust by Dr. Steven F. Hotze, who argues that mandating PrEP coverage forces him to subsidize behaviors, including premarital and homosexual sex, that conflict with his Christian beliefs.
The case invites comparison to Burwell v. Hobby Lobby Stores, Inc. (2014), where the Court held that closely held corporations could claim religious exemptions from the ACA’s contraceptive mandate under the Religious Freedom Restoration Act (RFRA). In Braidwood, however, the objection targets a different type of care—preventive medication related to sexual activity—and raises a separate constitutional claim: that the USPSTF, whose recommendations trigger coverage requirements, lacks lawful appointment because its members are not confirmed by the Senate.
Jonathan Mitchell, representing Braidwood, argued that the USPSTF exercises final authority and thus must consist of principal officers. He also claimed that the PrEP mandate imposes a substantial burden on religious exercise and does not meet RFRA’s “least restrictive means” test. “Their preventive care coverage mandates are neither directed nor supervised by the Secretary of Health and Human Services,” Mitchell told the Court.
In response, Department of Justice attorney Hashim Mooppan asserted that the Secretary retains adequate authority over the Task Force, including the ability to remove members and block implementation of their recommendations. “No final decision could be made that binds the public unless the Secretary approves it,” he said.
Several justices raised concerns about whether that oversight is meaningful. Justice Gorsuch questioned whether the Secretary actually has appointment authority, a threshold issue that was not directly addressed by the Fifth Circuit. Justice Thomas noted the statute’s silence on who appoints Task Force members. Chief Justice Roberts asked whether a cabinet secretary is realistically positioned to overrule scientific experts, raising doubts about how practical that supervision is.
Justice Alito expressed skepticism that a group described as “independent” could be considered subordinate if its members are removable at will. “If somebody’s removable at will, that person is not in any ordinary sense of the term ‘independent,’” he said. Justice Kavanaugh asked whether the Task Force’s independence could be reconciled with the Secretary’s influence, suggesting a tension between the statutory language and the government’s interpretation.
Other justices appeared less persuaded by Braidwood’s challenge. Justice Sotomayor compared the Task Force’s role to that of advisors who provide independent input but remain accountable. “That’s the nature of asking people to advise you, correct?” she asked. Justice Jackson pointed to legal presumptions supporting at-will removal where the statute is silent, implying that the Task Force’s structure may already align with constitutional norms.
The Court will also likely examine the differences between this case and Hobby Lobby. In that case, the objection was to specific contraceptive methods believed to cause abortions. Here, the objection centers on broader moral opposition to behaviors associated with the use of PrEP. Additionally, Braidwood incorporates a structural challenge to the regulatory process, whereas Hobby Lobby focused solely on RFRA.
The Fifth Circuit previously ruled in Braidwood’s favor, holding that both the PrEP coverage requirement and the USPSTF’s structure violate RFRA and the Appointments Clause. A decision from the Supreme Court is expected by late June 2025. The ruling could affect how preventive services are recommended and required, and clarify the scope of religious exemptions under federal healthcare law.
On the Kennedy v. Braidwood Management case, while the case is put up in terms of some kind of “religious freedom” right not to pay for particular medications that prevent the spread of disease, in reality, it seems that the for-profit organization in question wants to avoid paying for medication that would lessen the risk of death from behavior that the corporation apparently wants to discourage.
In other words, the organization apparently sees unprevented death or disease as a guardian of morality. This is a problematic position for obvious reasons.