RFK Jr. Has Been Handed a Very Dangerous Weapon

Stick with me. How does a 40-plus-year crusade by a virulently anti-gay, racist physician in Texas—one who hawks quack cures and was charged in 2022 with aggravated robbery and organized criminal activity in a bizarre and fake election dispute—end up endangering access to mammograms, colorectal and cervical cancer screening, folic acid supplementation for pregnant women, diabetes screening, and drugs to prevent HIV infection? And where does Robert F. Kennedy Jr. come into this?

Let me introduce you to Steven Forrest Hotze. If you were writing a movie script about this guy and told his story straight-up without embellishment, you’d be accused of caricature. Thankfully, Sam Levin wrote a profile of Hotze for The Guardian last May. My short description above doesn’t do justice to this man’s drama.

But before we get to the threat Hotze poses to the health of the majority of American adults, I have to introduce you to another character: Judge Reed Charles O’Connor of the United States District Court for the Northern District of Texas, the go-to bench for conservative plaintiffs seeking favorable rulings for conservative causes. Judge O’Connor reliably returns judgments favoring right-wing litigants, and has teed up major cases for the ever-more-radical Supreme Court, including Dobbs v. Jackson Women’s Health Organization, which stripped pregnant people in the US of the constitutional right to abortion.

Hotze and O’Connor have come together in a legal marriage made in hell around a case called Braidwood v. Becerra. Hotze and other plaintiffs argued that providing pre-exposure prophylaxis (PrEP) to prevent HIV to their employees as part of their health insurance, violates the plaintiffs’ religious freedom, as PrEP “facilitate[s] and encourage[s] homosexual behavior,” and mandating the coverage of PrEP forces them to support “sexual promiscuity.”

Never mind that Hotze had no employees who asked for PrEP, and that the case is built on hypotheticals rather than an “injury in fact,”—that is, harm that is “actual or imminent, not conjectural or hypothetical,” which has historically been required to constitute legal standing under previous rulings by the Supreme Court.

O’Connor delivered his ruling in 2022, claiming that requiring private insurers to cover HIV PrEP violated the plaintiffs’ rights under the Religious Freedom Restoration Act. In an analysis published shortly after the ruling, my colleagues and I suggested that even in the most benign scenario:

For every 1% decline in PrEP coverage among US MSM [men who have sex with men], we expect an additional 114 HIV infections the following year. We estimate that, at a minimum, the Braidwood ruling will result in more than 2000 entirely preventable primary HIV infections among MSM—and many more infections in other populations at high risk of HIV transmission—in 1 year alone.

And here is where it all gets worse. In his ruling, O’Connor didn’t simply go after HIV PrEP. He went after the US Preventive Services Task Force (USPSTF), the federal panel that made the binding recommendation to insurers to cover PrEP. O’Connor loves to hate the ACA—he tried to strike it down in its entirety in 2018—and in his Braidwood ruling, he decided that the USPSTF was improperly established and thus that all the preventive services mandates recommended by the task force under the ACA were all null and void. (Read Elie Mystal’s piece in The Nation from March 2023 for the details.)

All of this was in limbo as O’Connor’s initial ruling was appealed to the Supreme Court. The court handed down the last word on this case, now called Kennedy v. Braidwood Management, just a few weeks ago, as the Kaiser Family Foundation reported:

On June 27, 2025, the U.S. Supreme Court issued the opinion for Kennedy v. Braidwood Management, finding that the ACA requirement that most private insurers and Medicaid expansion programs cover preventive services recommended by the United States Preventive Services Preventive Task Force (USPSTF) with no cost-sharing is constitutional. In its decision, the Court affirmed that USPSTF members are appointed constitutionally, and the Secretary of Health and Human Services can remove USPSTF members at-will and directly review and block Task Force recommendations before they take effect.