AUSTIN, Texas (AP) — A federal judge ruled Wednesday that required coverage of an HIV prevention drug under the Affordable Care Act violates a Texas employer’s religious beliefs and undercut the broader system that determines which preventive drugs are covered in the U.S.

The ruling was handed down by U.S. District Judge Reed O’Connor, whose courtroom in Fort Worth is a favored venue for conservative opponents of the federal health care law that’s also known as “Obamacare.” He ruled in 2018 that the entire law is invalid but was later overturned by the U.S. Supreme Court.

O’Connor’s latest ruling targets a requirement that employer-provided insurance cover the HIV prevention treatment known as PrEP, which is a pill taken daily to prevent infection.

The challenge was brought by a company owned by Steven Hotze, a conservative activist in Texas who helped defeat proposed nondiscrimination protections for gay and transgender people in Houston and pushed Republicans for a law mandating that public school students use only the bathroom of the sex listed on their birth certificate. He is described in the lawsuit as operating Braidwood Management “according to Christian principles and teaching.”

The attorney who filed the suit was an architect of the Texas abortion law that was the nation’s strictest before the Supreme Court overturned Roe v. Wade in June and allowed states to ban the procedure.

“Defendants do not show a compelling interest in forcing private, religious corporations to cover PrEP drugs with no cost-sharing and no religious exemptions,” O’Connor, who was appointed by President George W. Bush, wrote.

O’Connor also ruled that a federal task force that recommends coverage of preventive treatments, which is made up of volunteer members, violates the appointment clause of the U.S. Constitution.

The impact of the ruling beyond the plaintiffs was not immediately clear. However, patient advocates and Democrats criticized the decision as a threat that reverberates beyond Texas. The Human Rights Campaign called it “an intentional attack on LGBTQ+ people.”

The Biden administration is likely to appeal. The U.S. Department of Health and Human Services did not immediately respond to a request for comment.

Employers’ religious objections have been a sticking point in past challenges to the federal health care law, including over contraception.