For a century and a half the Catholic Church in the United States has served the American people with health care, education and social services. Even a few months ago it would have seemed preposterous to suggest that the U.S. government would place the future of those good works at risk. That seems to be what has happened, however, with a decision by the Department of Health and Human Services to allow only a narrow conscientious exemption to the employer health care insurance mandate of the Affordable Care Act, the administration’s signature health care reform law.
For U.S. Catholics as citizens, the administration’s failure to offer a broader exemption presents a grave test of the “free exercise” of religion protected by the Bill of Rights. For the narrow definition of religion in the new H.H.S. guideline is at odds with the millennia-old Catholic understanding of the church as a community of believers in service to the world. The H.H.S. definition would force the church to function as a sect, restricted to celebrating its own devotions on the margins of society. The ruling is a threat to our living as a church in the Catholic manner.
The controversial guidelines, announced on Jan. 20 by Kathleen Sibelius, secretary of H.H.S., restricts religious exemptions to those persons and institutions the administration defines as religious—namely, those that serve clear religious functions, employing primarily co-religionists and serving a largely denominational clientele. The administration rejected appeals from the U.S. Conference of Catholic Bishops and the Catholic Health Association for a broader conscience clause. Religiously sponsored institutions, like all other employers, will be explicitly required to provide coverage for contraception, sterilization and two potential abortifacients, services that are in violation of Catholic teaching. The administration has thus pushed the U.S. bishops into a destructive showdown over the future of Catholic health care, social services and higher educational institutions. It is a confrontation both sides should seek to avert.
The exemption devised by H.H.S. places Catholic institutional employers in an untenable position. The guidelines force them to cooperate, though indirectly, in grave wrongs by facilitating acts the church considers sinful. They also place dissenting institutions in the position of withdrawing health insurance benefits from their employees and from students at their colleges and universities. Employees of such institutions will have to seek out inferior and more expensive health plans on the open market, and their employers will face annual fines from the federal government for refusing to comply with the employers’ mandate.
A misunderstanding of the Catholic mission in the United States lies at the heart of this unexpected conflict. The Obama administration’s religious exemption covers only entities that serve patently religious functions, including parishes and parochial schools. But serving the broader community through hospitals, clinics, service agencies and institutions of higher learning is not an extraneous activity for the Catholic Church. It is a civic manifestation of the church’s deep beliefs in human dignity, solidarity with the suffering and forgotten, the importance of learning and commitment to the common good. Even as the church remains true to its moral teaching, it is called to remain open and engaged with the wider society. The administration must be led to understand that defining away the church’s service to the world infringes upon Catholics’ free exercise of religion.
Less, but equally real, is the threat to Catholic ecclesial identity created by exasperated responses from some church leaders, who unwittingly would acquiesce to the sectarian temptation presented by the state, jettisoning the church’s public institutions in the name of conscience, apparently without sober attention to the church’s historic teaching on remote material cooperation. By complying with similar state-level regulations, however, the practice of Catholic employers in a number of states without conscience exemptions (a full list is at americamagazine.org) suggests many have until now held a different reading of that tradition. In any case, the Catholic conscience needs to remain engaged in the public forum out of our faith in the church as a “sacrament” for the world.
Catholics have resisted authoritarian governments that attempted to confine religion to the altar and sacristy. What has distinguished Western democracies from authoritarian regimes has been not just the freedom of individual believers but especially the institutional freedom of the church. While Catholics should be prepared, if necessary, to resist such a policy in our own country, both sides should leave no stone unturned to find a workable solution without unnecessary confrontation. Practically, in an election year, a solution needs to be found as early as possible. Miscalculations from either side could prove devastating.