What does Catholic social teaching say about the GOP health care plan?

U.S. House Speaker Paul Ryan, R-Wis. talks about the American Health Care Act during a March 8 news conference in Washington. (CNS photo/Joshua Roberts, Reuters) U.S. House Speaker Paul Ryan, R-Wis. talks about the American Health Care Act during a March 8 news conference in Washington. (CNS photo/Joshua Roberts, Reuters) 

The proposed Republican replacement for the Affordable Care Act (“Obamacare”), unveiled by Speaker Paul D. Ryan in early March and now making its way through the House with the support of President Donald J. Trump, has few fervent supporters but countless critics, from the AARP to the conservative Freedom Caucus. The U.S. Catholic bishops have also been wary of the proposal, and the Catholic Health Association has opposed it outright.

One Catholic member of Congress, Rep. Joe Kennedy III of Massachusetts, called the proposal “an act of malice,” ridiculing Mr. Ryan’s characterization of the bill as an “act of mercy.”


“With all due respect to our speaker, he and I must have read different Scripture,” Mr. Kennedy said at a meeting of one of the House committees considering the bill. “The one that I read calls on us to feed the hungry, to clothe the naked, to shelter the homeless and to comfort the sick. It reminds us that we are judged not by how we treat the powerful but by how we care for the least among us.”

The A.C.A. is flawed in many ways, especially the way it was rolled out without due regard for questions of religious liberty, but the Republican replacement, called the American Health Care Act, seriously tests many principles of Catholic social teaching.

The Compendium of the Social Doctrine of the Church mentions health care as a human right alongside food, housing, work, education and transportation (No. 166). Pope Francis has also been vocal about access to health care, especially with regard to how the poor are treated. “Health is not a consumer good but a universal right, so access to health services cannot be a privilege,” the pope said during a meeting with members, volunteers and supporters of Doctors with Africa in May.

The proposed changes to the health care system exacerbate rather than ease social inequities. 

The plan is still under review by the Congressional Budget Office, which provides official nonpartisan numbers for Congress, but other organizations have begun to cast their own predictions. The Brookings Institute predicts that the C.B.O. “will likely estimate that at least 15 million people will lose coverage under the American Health Care Act (AHCA) by the end of the ten-year scoring window.” An analysis by the rating agency Standard & Poor predicted that “about 6 million to 10 million people will lose health insurance if the bill passes, including 2 million to 4 million currently enrolled in the individual health insurance market, and 4 million to 6 million currently enrolled in Medicaid.” The Compendium identifies “those without health care” among the poor who must be given preferential treatment when making decisions, on a structural or personal level (No. 182).

Further, the proposed changes to the health care system exacerbate rather than ease social inequities. The new tax credits for buying insurance, which would replace the A.C.A.’s subsidies and tax credits, range from $2,000 to $4,000 per year, depending on age. But they are “flat”—that is, not tied to need—and so lower-income households would lose financial support. The Kaiser Family Foundation estimates, for example, that a 40-year-old making $20,000 per year would be eligible for $4,143 in premium tax credits under the current system (in addition to A.C.A. subsidies he may receive to lower the cost of his monthly premiums) but only $3,000 under the Republican plan. He would also lose the A.C.A.’s current tax credits to help with out-of-pocket costs, such as deductibles and co-payments.

Similarly, the new tax credits do not take into account the costs of policies in individual markets, so they would be less valuable in places (predominantly rural areas) where there is little competition in the insurance market and where premiums are higher.


The plan would also freeze Medicaid enrollment in 2020 and cap federal funding per enrollee, based on how much each state was spending in 2016. Vox estimates that the changes amount to ”a $370 billion cut to federal funding to Medicaid over 10 years,” with states unlikely to pick up much of the reduction. And the law would allow states to drop Medicaid coverage of mental health treatment, including drug addiction—another case of reducing care for the most vulnerable in society.

While the Republican plan keeps the requirement that insurance companies cover people with pre-existing conditions, it allows companies to levy a 30 percent surcharge on premiums for one year for anyone who has a 63-day “break” in coverage. Given that many such gaps occur because someone has lost a job or has faced an unexpected expense—such as repairing a car needed to get to work—it is cruel to penalize families who try to do the responsible thing and resume paying for insurance.

Just as disturbing as the details of the plan is the rhetoric used to justify cutting health care for the most needy. Mr. Ryan calls his bill “an act of mercy,” even though the most comfortable will benefit the most, in the form of both tax cuts and tax credits. He seems scandalized by the notion that "The people who are healthy pay for the people who are sick,” though that is not only the whole point of insurance but also a bedrock of a compassionate society. One congressman, arguing for the elimination of requirements that all health insurance cover certain treatment, complains about having to help pay for prenatal care—a far cry from a truly pro-life position.

Others have waved away the need for adequate health care by misrepresenting Jesus’ observation that “the poor will always be with us” or by saying that people could afford health care on their own if only they gave up supposed luxuries like smart phones. As Stephen Pimpare wrote in The Washington Post, echoing Pope Francis’ comments on donating money to the homeless: “Why do we begrudge people struggling to get by the occasional indulgence? Why do we so little value pleasure and joy? Why do we insist that if you are poor, you should also be miserable? Why do we require penitence?”

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Chuck Kotlarz
3 years 3 months ago

Stuart, the world has many countries. Some do well, others not so well. Countries that fall behind lack either capitalism or democracy or both. With 10,000 corporate lobbyists, it’s no surprise US corporate profits reached an all-time high in 2014. But at what cost? Twenty percent of US children live in families with incomes below the federal poverty threshold.

Trumpcare is not a health insurance plan. It’s a tax cut for the 400 highest income households. Healthcare for millions gets thrown under the bus.

Vincent Gaglione
3 years 3 months ago

Stuart, you wrote "What I am obligated to consider and do as an individual does not translate into a government obligation."
I don't agree with your proposition that Christ's teachings only apply to individuals. You give the Nazis outright justification for all their immoralities since they made their prejudices into governmental programs.
But even taking your position, I live in a democracy. I will endeavor, as I have done most of my life as a union activist, to persuade and cajole my fellow citizens to act collectively to enable Christ's teachings for the social justice of all people in the nation. That's what the debate is right now. Is healthcare just for the comfortable who can afford it or is it the obligation of the comfortable to help all citizens to afford it, even if it costs me more in my taxes. I subscribe to the latter. Apparently you subscribe to the former, which makes for the current political debates.

Stuart Meisenzahl
3 years 3 months ago

You state that relying on individual rather than governmental response to Christs teachings gives justification for Nazi immorality. I find this argument to be a total non sequitor. I believe that Nazi Germany represents exactly the kind of Government sponsorship of a group point of view and an abdication of individual responsibility to respond to that point of view.
Further your united union activity is not the equivalent of government activity. Of course an individual should be able to accept or reject engaging in any number of activities , with or without moral content. Of course an individual should be able to form groups whether or not to promote moral activities in response to Christ teachings . But that is far, very far different than insisting that a government respond to Christ teachings.

So let me pose the following question in response to your Nazi analogy : If your union endorses and supports Pro Choice are you as an individual required to resign from that union? And if you don't ...aren't you "giving outright justification for this resulting immorality since they (the pro choice members) have made their prejudices into a union program"?

Robert Lewis
3 years 3 months ago

When will you supposedly devout Catholics face the fact that THIS is what is preventing greater access to health care for the less affluent in our society; without THIS we could be providing free health care to all the poor children in America, with precisely the kind of "universal," "single-payer" health insurance that the so-called "socialistic" European countries are providing their citizens: http://www.bbc.co.uk/programmes/p04xd4pq?ocid=socialflow_facebook
We choose to spend our nation's resources on the instruments of death, and they choose those of life. It's really as simple as that, and I think that Christ would have you know it.

Stuart Meisenzahl
3 years 3 months ago

I can understand your wanting the benefits of a universal Single Payer System as in "the European countries" but find your reasoning implodes with your professed basis:
"We choose to spend our nation's resources on instruments of death and they choose those of life. It's as simple as that, and Christ would have you know it"
Just who do you think has enabled these wondrous European countries to provide all those social benefits and still remain free independent nations? Have you missed the 50 years of the Cold War and our Church's thundering condemnation of "Godless Communism" as threatening the West? Have you forgotten the required three Hail Marys at the end of Mass for the conversion of Russia? Do you just ignore the enormous cost of US troops stationed in Germany along with tanks and equipment and who provided the European missile defense and nuclear shield?.....those "instruments of death"
Further It was the vicar of Christ in the person of some 7 Popes who found our defeat of Godless Communism and the defense of Europe a moral necessity. It was the Saint Pope John Paul II who threw his lot in with Thatcher and Regan who designed a program to spend the Soviet Union into its final dissolution!
Give me a break ---our implementation of President Kennedy's exhortation "to pay any price in defense of liberty" is exactly how the European nations you admire have been able to divert the sums needed to maintain their own borders to the very social welfare benefits you admire. Our defeat of "Godless Communism" was an exhortation of the Church in the very person of the Vicar Of Christ.


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