➤ OPT-OUT NIXED, from p.21
simply lied, claiming there had
been a substantial increase in
complaints by healthcare employees
about being forced to perform
objectionable procedures or being
disciplined for refusing to do so.
Reviewing the complaints offered
in evidence, Engelmayer found that
“virtually none address the Conscience
Provisions at all, let alone
indicate a defi ciency in the agency’s
enforcement capabilities as to
these laws.”
He pointed out that the large
majority of religiously-connected
complaints received by HHS had to
do with vaccinations, “which HHS
admits fall outside the scope of
the Conscience Provisions and the
Rule.”
Though Engelmayer did not accept
the plaintiffs’ establishment
clause constitutional argument, he
did fi nd violations on both separation
of powers and spending clause
provisions of the Constitution. The
termination of all HHS funding,
he found, is inconsistent with the
Congress’ constitutional power to
appropriate funding and with requirements
for unambiguous and
not unduly coercive funding conditions
under the spending clause.
The far-reaching violations he
found led Engelmayer to vacate the
regulation in its entirety. And he
also rejected HHS’s suggestion —
common to many Trump administration
arguments when courts
fi nd its executive actions invalid
— that his order be limited in effect
to the Southern District of New
York or just to the named plaintiffs
in the case. This would lead, he
said, to a proliferation of litigation
around the country.
Noting that conscience provisions
can protect “undeniably important
rights,” Engelmayer wrote
that his decision “leaves HHS at
liberty to consider and promulgate
rules governing these provisions.
In the future, however, the agency
must do so within the confi nes of
the APA and the Constitution.”
Two days after Engelmayer’s ruling,
Judge Stanley A. Bastian of
the Eastern District of Washington
also found the HHS regulation invalid,
promising to issue an opinion
soon. And on November 19, Judge
William Alsup of the Northern District
of California issued an opinion
focusing entirely on the APA.
Alsup wrote that his order “holds
that the new rule sets forth new
defi nitions of statutory terms that
confl ict with the statutes themselves
— expansive defi nitions that
would upset the balance drawn by
Congress between protecting conscientious
objectors versus facilitating
the uninterrupted provision
of healthcare to Americans.”
➤ ENDING EPIDEMIC, from p.5
its Medicaid-eligible clients, includes
the medication, counseling,
education, HIV risk assessment,
lab testing, and more and is provided
to members regardless of
income status. Those enrolled are
not asked to pay fees. Twenty-fi ve
percent of Amida Care’s transgender
members who are HIV-negative
are accessing PrEP, which Wirth
described as a “good starting
point” but said the number needs
to improve considering that trans
women of color are 59 times more
likely to be HIV-positive than the
general population.
Among those on Medicaid, there
are daunting challenges. Wirth
noted that 6,000 New Yorkers who
have Medicaid are using PrEP, but
that “our own data tells us that we
need to increase the number to at
least 30,000 in the Medicaid program
by the end of 2020.”
“I think it’s a real challenge to
achieve that barrier in the next
year,” he said.
Those realities emphasize the
need to cut costs where possible.
For every infection prevented,
$400,000 to $500,000 is saved
across that person’s lifetime, Wirth
pointed out.
“If you think about in New York,
for every 2,000 infections we prevent,
we save the New York State
Medicaid program billions of dollars
in future costs,” he said. “This
is about putting resources towards
prevention and treating HIV now,
because it will cost us so much
more in the long run.”
Whether the state will address
the lingering issues to meet its
timeline is yet to be seen. Gains in
New York’s effort to eradicate the
epidemic are clear, but in the face
of profound gaps, as Torres said,
“not everyone is reaping the benefi
ts of the Truvada revolution.”
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November 28 - December 4 22 , 2019 | GayCityNews.com
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