Reexamining the Health Debate: The U.S. bishops respond to 'Cul-de-Sac Catholicism'
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.
(1) The funds appropriated for the Community Health Centers will be co-mingled with existing funds under the HHS and the Hyde amendment - there is no attempt or desire to segregate. This whole argument (which only arose at the last minute, and had a hint of desperation) is based on a "hermeneutic of suspicion" - it plays into the right-wing attempts to label Obama as the "most pro-abortion president ever" who is trying to sneak in abortion wherever he can.
(2) The bulwark against using federal subsidies to fund plans in the exchange that include abortion is watertight, and must satisfy rigorous accounting standards. If you want a plan with abortion, you pay a supplemental premium. In the version the bishops supported, you pay for a supplemental policy - the fungibility of money argument applies equally in both cases.
(3) They ignore a couple of other issues that could restrict abortion: (i) states have the right to ban plans with abortion from joining the exchange (this goes further than the Stupak amendment as it would even restrict those paying their own money); (ii) the requirement to make a separate payment is going to dissauade people from choosing these plans, which in turn will reduce the incidence of them being offered.
I was talking to some Irish priests recently, and they simply could not understand the USCCB position. Why was abortion the defining issue, especially since great attempts had been made to restrict funding for abortion? The CHA and Sr. Keehan had it right, and they are on the front lines of health care provision - they see every day that the current system is appalling and lacking in solidarity.
Prof. Cafardi makes an argument that the bishops need to address - why were they working in lock-step with the partisan NRLC on this issue? The abortion arguments, and the language of those arguments, was practically indistinguishable. The NRLC has opposed universal healthcare for years, and raised a lot of outrageous arguments about death panels and rationing. Is this a credible ally?
But it gets worse. Under the Bush administration, the NRLC endorsed the Medicare Advantage program, a program that sends federal subsidies to private insurance companies in connection with the Medicare program. While the moral issues are exactly the same, the NRLC did not fight for prohibitions against abortion funding. In fact, all that the Medicare Advantage appropriations bill says is that insurance companies who refuse to provide elective abortion cannot be discriminated against. This is incredibly weak. Remember, Medicare covers disability as well as abortion, so the issue is moot. And today, Medicare Advantage is providing elective abortion. Where were the bishops back then, and why are they so silent about this today?
Second, the Bishops are incorrect on federal subsidies. Most private insurance is subsidized through a tax exclusion of funds for the purchase of private insurance. The new law does not go beyond that. While the subsidy in the new law is of a different character than the old tax subsidy, the essential nature of the two is fundamentally identical and no ground is really lost in the transition. Indeed, because the new approach expands health care to families that do not now have it, some families will be more likely to have the first child or additional children because they now have medical coverage - so overall the bill will decrease abortions. I would not have wanted to face my maker if I were one of the opposing bishops had I let health care die, as those who died as a consequence (both because they had no insurance or because they were aborted because the family had no insurance) would be there demanding justice.
3. Many of those who supported the ban original House bill saw the Senate bill as roughly equivalent and voted for it because they saw many of the objections propounded by the Church's allies on this issue to be partisan first and principled second - and with good reason for they likely were. Many of us share the desire to treat immigrants better and look forward to working with the Bishops on immigration reform and hope that as much pressure is applied to its those who aligned themselves with the Bishops on Health Reform. Indeed, we are quite chagrined that pressure was not put on the National Right to Life Committee to support the underlying House bill once the Stupak language was added. The fact that the Bishops seem to focus all of their displeasure on Democratic voters and members of Congress and none on Republican voters and members of Congress is troubling.