Skip to comments.The Devil in the details of Obama healthcare
Posted on 07/23/2009 8:03:40 AM PDT by bdeaner
Last fall there was great concern among the United States Bishops about the possible passage of the Freedom of Choice Act (FOCA) and its threat to Catholic health care. President Obama had promised to sign FOCA during the campaign. If passed in the form it was most recently proposed, FOCA would have displaced current conscience legislation that protects Catholic hospitals from being forced to provide abortions. Some U.S. bishops indicated that passage of FOCA could result in the closure of Catholic hospitals.
FOCA was not passed, but the Obama administration has moved ahead with the rescission of the conscience regulations adopted in the waning days of the Bush Administration that reinforced current conscience clause protections. President Obama recently indicated to a group of Catholic leaders that he was in favor of robust conscience protection, but it is difficult to determine what this means in light of his actions. He has indicated that passage of FOCA is not a priority for him. And in fact there may be no need for a direct confrontation because he can achieve most of what FOCA would achieve by the passage of federal health care reform legislation.
President Obama is a remarkably adept politician who has skillfully marginalized the U.S. Bishops and pro-life Catholics through his Commencement address at the University of Notre Dame and his appointment of pro-choice Catholics to key health care posts in the administration. Unless there is specific language added to the current proposals to make them abortion neutral, the passage of the federal health care reform legislation backed by the Obama administration will eventually result in mandated coverage of abortion by all public and private health care plans and tax subsidies for abortions. Democratic leaders in the House and Senate have rejected attempts to include specific language in proposed legislation that would rule out an abortion coverage mandate.
In addition, if the current legislation passes without amendment, we are likely to see more situations like the recent Caritas Christi case in Massachusetts. Caritas Christi, a Catholic health care system operating six hospitals in Massachusetts, entered into a for profit joint venture to offer a state-subsidized Commonwealth Care health plan to low income patients. The Ethical and Religious Directives for Catholic Health Care Services (ERDs), a set of norms adopted by all U.S. Bishops prohibits Catholic hospitals from providing direct abortions and from entering into arrangements to facilitate access to abortions. But this for profit health plan would have provided coverage for abortions with $50 co-pays. Indeed, all plans offered through the Commonwealth Care program are required to provide coverage for abortions.
In order to get approval of their plan from the Commonwealth of Massachusetts, the Caritas Christi joint venture agreed to facilitate access to abortion as well as other family planning services through a 24 hour telephone line. Thus although abortions were not to be performed in Catholic hospitals, Caritas Christi apparently agreed to provide referrals for abortion. The President of the Catholic Health Association, Sister Carol Keehan, supported this arrangement arguing that it was justified as a matter of social justice. The Caritas Christi joint venture was to begin offering its health plan on July 1, 2009. Cardinal OMalley sent the planned joint venture to the National Catholic Bioethics Center for its recommendations, but when they couldn't find any way to redo the arrangement to make it consistent with the ERDs he pulled the plug on the joint venture.
The Massachusetts health care system that provides the context for the Caritas Christi case has emerged as a model for federal health care reform. Massachusetts requires coverage of abortion as part of the standard package of health insurance benefits. Similarly, it is likely that abortion will eventually become part of the standard insurance benefit package in all private health plans as a result of federal health care reform. This will make it impossible for Catholic providers to offer a health plan without violating the ERDs. And offering a health plan or being a partner in a health plan is financially beneficial because it increases the flow of patients into your hospitals.
So there will be financial pressures on Catholic hospitals to become involved in providing insurance coverage and services in violation of the ERDs even if there is not a direct mandate in the law that they provide abortions. And undoubtedly some health plans will pressure Catholic hospitals to facilitate access to abortions in order to participate as providers.
As Professor H. Tristram Engelhardt, Jr., of Rice University prophesied, calls by Catholics for social justice in health care have been translated in secular terms as a plea for universal access to abortions. The Catholic Health Association has supported President Obamas health care reform efforts on the basis of social justice. Indeed, appeals to social justice by some leaders in Catholic health care in advocating for a more expansive federal government role in health care have become commonplace despite the potential threat that a unitive system poses to the moral foundations and the mission of Catholic hospitals. Their support for a government run system ignores the traditional emphasis on the principle of subsidiarity in Catholic social teaching. And it is possible to reform health care and achieve universal access without a vast expansion of federal power. Long ago, Friedrich Hayek foresaw the potentially mind-numbing effect of such appeals and their threat to freedom. He stated:
The appeal to social justice has nevertheless by now become the most widely used and most effective argument in political discussion. Almost every claim for government action on behalf of particular groups is advanced in its name, and if it can be made to appear that a certain measure is demanded by social justice, opposition to it will rapidly weaken. [T]he prevailing belief in social justice is at present probably the gravest threat to most other values of a free civilization I believe that social justice will ultimately be recognized as a will-o-the-wisp which has lured men to abandon many of the values which have inspired the development of civilization [L]ike most attempts to pursue an unattainable goal, the striving for it will also produce highly undesirable consequences, and in particular lead to the destruction of the indispensable environment in which traditional moral values can flourish, namely personal freedom.
It is particularly important to those who support the continuation of a distinctive Catholic health care system based on the ERDs, that federal health care reform legislation not lead to mandated abortion coverage. None of the proposed reforms explicitly mentions abortion. But the Senate Health Committee would set up a Medical Advisory Council that will determine standard benefits for private and public health plans. In the Obama administration, the standard benefit package will undoubtedly include abortion. The Senate Health Committee rejected an amendment that would have prevented any governmental plan from paying for abortions. Similarly the House legislation, HR 3200 will require most insurers to provide a package of essential benefits that are to be delineated by a Health Benefits Advisory Committee. In addition, it requires the appointment of a Health Choices Commissioner who is empowered to set the standards for private health plans. Clearly, in the Obama administration these essential benefits will include abortion.
In addition to the coverage mandate in private plans, adopt of the current health care reform proposals will result in taxpayer subsidies for abortions. Recently, on Fox News Sunday, White House budget director Peter Orzag was specifically asked by Chris Wallace: Are you prepared to say that in a government public-funded, taxpayer-funded public health insurance plan that no taxpayer money will go to pay for abortions? Orzag replied: I am not prepared to say explicitly that right now. Its obviously a controversial issue, and its one of the questions that is playing out in this debate. Catholic health care leaders should call upon pro-life Democrats and Republicans in Congress to insist on the specific exclusion of an abortion coverage mandate and taxpayer subsidies in both private and public health plans as a pre-condition for their support of any reform legislation.
About the Author:
Leonard Nelson, III is a professor at the Cumberland School of Law, Samford University. He is the the author of Diagnosis Critical: The Urgent Threats Confronting Catholic Health Care published by OSV Press in June 2009.
“The Devil in the details of Obama healthcare”: literally, not figuratively...
The forgotten clause of the 1st Amendment, “(N)or prohibiting the free exercise thereof.”
OTOH. . .Given that this bill is not about your health; but rather; your life; and the Government wants it; call that literally and figuratively, inherently, demonic. Worse than the devil; actually.
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