We write to restate our principled position on health care reform and to respond to critics, including Professor Nicholas P. Cafardi, who have misinterpreted that position and/or misread the facts. As we outlined in numerous letters to Members of Congress during the debate, the U.S. Conference of Catholic Bishops has for decades supported health care reform to protect the life, dignity and health of all. Our goal with regard to the protection of life in health care reform was to maintain the status quo regarding abortion funding, i.e., to apply the Hyde amendment to federal funds flowing into the reformed health care system just as it is now applied to current health care programs where federal funds are involved (e.g., Medicaid, SCHIP, Federal Employees Health Benefits Program).

1. The Hyde language has two essential elements: no direct federal funding of elective abortion and no federal funding of plans which include elective abortion. The funding of the Community Health Centers in the new legislation violates the first provision of Hyde and the mixture of federal subsidies with private funds in the exchanges violates the second. We understand that the Community Health Centers, which currently receive federal funds, do not perform abortions. In some cities and neighborhoods they are the first defense against disease for vulnerable individuals and families including immigrants. The reason they don’t currently fund abortions is that their federal funds are provided by the Health and Human Services Appropriations bills, and therefore are subject to the Hyde amendment ban on federal funds in these bills being used for elective abortion. Unfortunately, in the new legislation new funds for these centers will not flow through the HHS Appropriations but are appropriated through the new legislation itself which does not have the Hyde language. While the President’s Executive Order states that abortions will not be performed, the reality is that those funds must be available for abortion because federal appellate court rulings over 30 years will require them to be used for this purpose. The law that controls Community Health Centers, Sec. 330 of the Public Health Service Act, compels the centers to provide “family planning” and “gynecology” services as “required primary health services”–and now the courts can be expected to interpret these categories as they did in Medicaid before the Hyde amendment was passed. An executive order cannot contradict a statutory mandate interpreted by the courts. 

2. We also understand that there is much confusion about which plans in the exchanges will allow abortions and which will not. Any plan that wants to provide elective abortions can do so and only one plan is required to be free of abortion coverage, according to the legislation. However, federal tax credits will subsidize the plans that choose to cover elective abortions: that violates the second provision of the Hyde amendment and is contrary to how every other federal health program operates, as noted above. Further, if an individual or family feels compelled to choose a plan that includes abortion, because that is the best plan for their needs, the new law requires the insurance carrier to collect a separate premium from each enrollee, solely to pay for abortions. It is true that many plans currently cover abortion, but those plans do not receive direct federal subsidies and they are not actively told by the federal government not to allow any enrollee to opt out of abortion coverage. This is not the status quo on abortion that we had urged. It is instead a significant change for the worse in current abortion policy.

3. When the House passed its bill in November of last year, corrective language that would have fixed these problems was championed by 64 pro-life Democrats, showing that federal funding of abortion is not and never has been a partisan issue. In our response to the final bill we praised the positive features of the bill, particularly the Pregnant Women’s Support Act provisions, which the bishops’ conference has long supported. We also criticized the provisions on immigrants, which we and others believe would leave them worse off than they are now. We are appalled by the ban on purchase of insurance by undocumented immigrants even if they use their own funds, and the continuation of the five-year ban on coverage for legal immigrants. We reaffirm our commitment to work with Democrats and Republicans in Congress and with others, including Catholic organizations, to fix the abortion funding problem and the conscience protections and to remove the obstacles to health insurance for immigrants. We are aware that our principled stand was not always popular with those who wanted to see health care reform enacted regardless of how it impacted longstanding protections for life and conscience, including some in the Catholic community. However, we were compelled to oppose the final bills put forward by Congress because we concluded that despite the good they can do, they posed an expanded threat to human life and that is too big a price to pay.

We are surprised and dismayed that respected Catholic commentators such as Prof. Cafardi would misunderstand  and misinterpret the Conference’s position when it is so well-documented and so readily available (See www. usccb.org/healthcare). As Professor Cafardi knows, standing up for principle is not partisanship and working for health care reform that respects life and dignity is not a dead-end. The bishops’ conference continues to hope that going forward the Catholic community will come together to correct the problems in the health care law that endanger life, undermine conscience protection and hurt immigrants. In our common efforts to protect the life, dignity and health of all, we can unite our church and serve our nation. 

This article appears in April 12 2010.

The Most Rev. John C. Wester is the archbishop of Santa Fe, N.M.