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Steven Hotze, a Republican donor from Texas, has spent decades fighting against LGBTQ+ rights, with campaigns seeking to roll back protections for people he has deemed “termites”, “morally degenerate” and “satanic”.
The Houston-area physician is not well-known in mainstream politics, and his efforts targeting queer and trans people have generally been local, with limited impact.
His latest cause could be different. Hotze, 74, has sued the federal government to roll back healthcare coverage for pre-exposure prophylaxis (PrEP), the HIV prevention medication. The case is now before the US supreme court, which is expected to rule in the coming weeks. A decision in his favor could upend healthcare access for LGBTQ+ people across the country – and derail a wide array of preventive treatments for tens of millions in the process.
“People will die,” said Kae Greenberg, staff attorney with the Center for HIV Law and Policy, which filed a brief in the case. “Preventive healthcare saves lives, and this case is about whose lives we consider worth protecting. It’s about cutting off people’s care based on them being gay or substance users or living their lives in a way the plaintiffs do not approve of. It’s using the law to legitimize bigotry.”
The case, Kennedy v Braidwood, originated with Hotze’s Christian healthcare firm, Braidwood Management, which filed a lawsuit in 2020 objecting to the federal requirement that his company’s insurance plan cover PrEP. Braidwood, another Christian business and two individuals argued the daily PrEP medications “facilitate and encourage homosexual behavior”, saying the government violated their religious beliefs by making them support “sexual promiscuity”.
Braidwood challenged the requirement under the Affordable Care Act, also known as Obamacare, that insurers and group health plans cover preventive services, a provision that includes diabetes and cancer screenings, medications to reduce heart disease risks, contraception and vaccinations. Along with opposing PrEP, Hotze explicitly objected to STI screenings, counseling for alcohol use and childhood obesity interventions.
A Texas district court sided with Braidwood, saying the US violated the firm’s religious freedom. The ruling also found that a taskforce of medical experts that recommended the preventive services covered by the ACA was unconstitutional because the experts hadn’t been confirmed by the Senate, and therefore health plans should not be required to cover the care.
The US government appealed the ruling on the taskforce, which is the issue now before the supreme court. The coverage mandates have remained in effect as the case has progressed, though the individual plaintiffs have been shielded from covering the services. The Trump administration has continued to defend the taskforce’s constitutionality, and the supreme court is not weighing religious objections.
If the supreme court sides with Braidwood, it could lead to widespread loss of access to free preventative healthcare, with one study finding 39 million people received the threatened services. A 2023 Yale study estimated the loss of free PrEP could result in more than 2,000 preventable HIV infections within one year.
The outcome of the case could threaten coverage for every service recommended by the taskforce, not just the provisions opposed by the right. “We’re talking about people who cannot afford this care, who will have to choose between a mammogram and rent,” added Susan Polan, associate executive director of the American Public Health Association.
A decades-long mission
The high-stakes case, and Hotze’s role in it, have flown under the radar. But research from progressive watchdog organization Accountable.US, which shared its findings with the Guardian, reveal the rightwing activist’s long history of pushing fringe ideologies before getting a signature cause before the supreme court.
Hotze and his lawyers did not respond to requests for comment.
In 1982, 31-year-old Hotze launched a petition in the city of Austin to legalize housing discrimination against gay people, the AP reported at the time. Heading a group called Austin Citizens for Decency, Hotze called gay residents “criminals” and “sodomites”, saying: “The issue is not housing. The issue is whether we allow our city council to grant public sanction to homosexual activity.” He said protecting LGBTQ+ people from discrimination is “like thieves or murderers trying to gain political power”. Hotze said in one interview he was less concerned about “property rights” and more worried about the “deviant, perverted lifestyle”. Voters overwhelmingly rejected his referendum.
In 1985, Hotze backed a group of eight “anti-homosexual” Houston city council candidates identified as the “straight slate”. On ABC News, he stated, “We’re intolerant of those who participate in homosexual activity.” All eight candidates lost.
Hotze runs the Hotze Health & Wellness Center, which has been in operation since 1989; Braidwood is his management firm that employs the center’s staff. He has marketed hormone therapies to treat a wide range of conditions and sold a vitamin product called Skinny Pak, the New York Times reported. Over the years, he has donated extensively to the Republican party and Texas politicians, including Senator Ted Cruz.
Hotze’s public anti-LGBTQ+ activism picked up after the supreme court legalized gay marriage nationwide in 2015, with Hotze launching a “Faith Family Freedom Tour” and using the same homophobic language from his activism decades prior. Hotze said he was fighting a “wicked, evil movement” that celebrates anal sex, telling the Houston Chronicle: “Kids will be encouraged to practice sodomy in kindergarten.”
During the tour, he said “satanic cults” were behind gay rights, brandished a sword during a speech, and likened his fight to battling Nazis, the Texas Observer reported. That year, he and other rightwing activists successfully campaigned to repeal an equal rights Houston ordinance.
At a 2016 evangelical conference, Hotze was filmed describing the LGBTQ+ rights movement as “termites [that] get into the wood of the house and … eat away at the moral fabric”. In 2017, Hotze rallied for Roy Moore, the failed Alabama senate candidate accused of sexually coercing teenagers in the 1970s.
Hotze has also recently promoted anti-trans causes, testifying in 2023 in favor of a school district policy requiring staff to notify parents if students change their names or pronouns. Trans people, he said, “have a reprobate, perverted and morally degenerate mind”.
His ACA case was not his first effort to undo federal civil rights protections. In a case that began in 2018, Braidwood sued the Equal Employment Opportunity Commission (EEOC), challenging a ban on anti-LGBTQ+ discrimination in the workforce. Braidwood said it enforces a “sex-specific dress code that disallows gender-non-conforming behavior”, the courts summarized, prohibiting women from wearing ties and men from wearing nail polish. Hotze said he won’t employ candidates engaged in “sexually immoral” behaviors.
In 2023, an appeals court ruled that a religious freedom law protected Hotze’s rights to enforce dress codes and refuse to hire LGBTQ+ people.
In that case, and in the one now before the supreme court, Hotze has been represented by America First Legal, the rightwing legal group co-founded by Stephen Miller, Donald Trump’s influential adviser. The organization has brought a string of lawsuits, including efforts to undo trans rights and complaints accusing companies of discriminating against white men.
Hotze has also been represented by Jonathan Mitchell, an anti-abortion lawyer behind Texas’s so-called “bounty hunter law” that allows private citizens to sue providers or people who “aid or abet” the procedure.
American First Legal and Mitchell did not respond to inquiries.
Gabbi Shilcusky, Accountable.US senior investigative specialist, noted that Hotze’s supreme court case was founded on hypotheticals: “He’s not hiring men who wear nail polish or are asking for PrEP. This is manufactured to build upon his most fringe beliefs and not about actual issues he’s being confronted with in his company.”
Hotze has in recent years made headlines outside of anti-LGBTQ+ advocacy. In 2020, during George Floyd protests, he left a voicemail for the Texas governor urging that he “kill the son of a bitches”, referring to demonstrators. Later that year, the Food and Drug Administration sent his company a warning advising it was promoting “unapproved and misbranded products” for Covid.
In 2022, Hotze was charged with unlawful restraint and aggravated assault with a deadly weapon in an elections dispute. Hotze hired a contractor who claimed a local air conditioner repairman was holding fraudulent ballots in his truck. The contractor ran his vehicle into the man’s car and held him at gunpoint, according to prosecutors, who said the voter fraud claims were false. Hotze was later charged with aggravated robbery and organized criminal activity from the incident.
Hotze pleaded not guilty, and this week, a newly elected DA dropped the charges, accusing his predecessor of bringing a politically motivated case. The criminal case did not stop his attacks on voting rights; in October, just before the election, he filed a lawsuit against the local registrar seeking to invalidate tens of thousands of voters.
It’s unclear if Hotze will succeed at the supreme court. In oral arguments last month, some justices, including conservatives, appeared skeptical of the arguments by Hotze’s lawyers. The case hinges on whether the taskforce members who make ACA recommendations are akin to department heads requiring Senate approval or are “inferior” officers. Brett Kavanaugh and Amy Coney Barrett at times appeared sympathetic to the notion that the experts are not sufficiently independent so as to merit a congressional vote.
The case is part of longstanding attacks against the ACA, with legal strategies focused on religious claims as well as objections to how the law was crafted. Hotze previously challenged the ACA in a failed lawsuit that began in 2013, an effort he promoted with a bizarre original song called “God Fearing Texans Stop Obamacare”.
Even if Hotze fails, the threats to PrEP and LGBTQ+ healthcare will continue, said Jeremiah Johnson, executive director of advocacy group PrEP4All, noting the Trump administration’s continued funding cuts and dismantling of HIV prevention, and ongoing rightwing efforts to attack civil rights under the guise of religious liberty.
The case also comes as the FDA is considering a new injectable PrEP considered a major prevention breakthrough, he said. “We’re at the precipice of science delivering real pathways to ending this epidemic, but if we turn our backs now on all these protections, including private insurance through the ACA, we’re not just going to backtrack on progress, we’re going to lose out on that promise for the future.”
