US: Publix Grocery Chain Denies PrEP Coverage to Its Employees

Some parts of the country have weather that signals the arrival of the winter holiday season, but the South has Publix commercials. The Florida-based grocery store chain has made a Christmas tradition of its sentimental short films exalting family, fireplaces, and food bought from its stores and prepared with your love. "Whatever your tradition may be, we're grateful to be a part of it," a narrator with a delicate rasp says in the 2017 ad, "Traditions. A Publix Christmas story."

However, Publix is showing a cooler, less compassionate side to some of its 188,000 employees. One of the more prominent supermarket brands in the southeast, it has taken a hard line against including the HIV-prevention medication known as pre-exposure prophylaxis (PrEP) in the insurance coverage it offers workers. But it remains a mystery whether the company is blocking coverage for PrEP due to cost concerns or the growing cry of employers (such as Hobby Lobby) that don't want to cover medical care for issues or people they deem morally objectionable.

Is the "Religious Freedom" to Deny Health Care to Blame?

Such concerns come during an era when more American employers and service providers are asserting their "religious freedom" to set workplace policies on moral grounds. The U.S. Supreme Court's 2014 decision in Burwell v. Hobby Lobby Stores, Inc., ruled that privately held companies can be exempted from the Affordable Care Act (ACA)'s mandate to provide contraception based on their owners' religious views.

"This idea that an employer's religious beliefs may trump an individual employee's well-being and right to access important medical technologies, services, and drugs, I think is absolutely a lasting legacy of that case," said Anne Tucker, associate professor at the Georgia State University College of Law. "The message of that particular case was [that] if employers disagree on personal moral bases and want to make health insurance coverage decisions based on that individual morality, [then] that, when it is sufficiently tied to a religion, can be a justification."

All states set their own mandates for what insurance coverage must include beyond the essential benefits of the ACA. While Georgia requires insurance packages to include a prescription drug plan, insurers and employers determine what medicines are included in that plan, said Glenn Allen, a spokesperson for Georgia's Office of Commissioner of Insurance. The Georgia legislature determines what services are mandated and adding any new mandates, such as PrEP coverage, to the list requires legislative action, Allen said.

Tucker said that if Publix's decision is motivated by morality, it continues "the narrative of Hobby Lobby," but it is not an exact comparison since there is neither a state nor a federal mandate for insurance plans to include PrEP, unlike the ACA's birth control requirements. While U.S. Supreme Court Justice Samuel Alito wrote that the majority opinion in Hobby Lobby "should not be understood to hold that insurance-coverage mandates ... must necessarily fall if they conflict with an employer's religious beliefs[,]" businesses like Publix stand on solid legal ground due to longstanding attitudes toward health care in the United States. Read more via the Body