When Sister Carol Keehan took the helm of the Catholic Health Association in 2005, more than 46 million Americans lacked health insurance. From the start of her tenure, she made expanding access to health care for this population a key priority. Fourteen years later, as she nears her retirement on June 30, Sister Keehan said, “being able to play a small role in health care policy” stands out during a career that includes working as a nurse, managing the revitalization of a D.C. hospital and leading one of the church’s most important entities.
Others would say that her influence in health care policy is hardly small. She has been repeatedly named one of the most powerful people in U.S. health care and was even called one of the “most influential people in the world” by Time magazine in 2010. President Barack Obama said that Sister Keehan was vital to the passage of the Affordable Care Act, which has given about 20 million Americans access to health insurance.
The Daughter of Charity received a diploma in nursing in 1964 and was drawn to emergency medicine, a field she liked for its “fast pace” and opportunities “to be helpful to people at really critical times.” She once thought she would spend her entire career in the E.R., but Sister Keehan entered hospital management in 1969. By 1989 she was president and C.E.O. of Providence Hospital in Washington, D.C., and then in 2004, board chair of Ascension Health’s Sacred Heart Health System in Pensacola, Fla. Prior to heading C.H.A., she served on the board for six years, including one as chairwoman. She has won numerous awards and honorary degrees, testified in front of congressional committees and sits on a number of health-related boards.
Sister Keehan has been repeatedly named one of the most powerful people in U.S. health care and was even called one of the “most influential people in the world” by Time magazine in 2010.
In an interview with America on May 24 in Chicago, where she was receiving an honorary doctorate in ministry from the Catholic Theological Union, Sister Keehan said she is ready for a break from her years of fighting to improve health care. Sister Mary Haddad, a Sister of Mercy of the South Central Community, will lead C.H.A. beginning next month.
But Sister Keehan wants others to continue the fight to expand access to health care for the marginalized and to ensure that Catholic health care in the United States remains strong.
“Other people have to take the lead now,” she said.
Fixing U.S. health care
When it comes to the state of U.S. health care, Sister Keehan does not pull any punches.
“Our health delivery policy is a disgrace,” she said. “The health insecurity we have created for people in this country is just overwhelming.”
The numbers are mind-boggling. Americans reported borrowing $88 billion to pay for medical care in 2018, according to a Gallup survey, and a 2016 survey found that 26 percent of U.S. adults have had a “serious financial problem” because of medical debt.
“People should not have to come hat in hand trying to get health care for themselves or their children,” she said. “It is not the way a nation should treat its people.”
“People should not have to come hat in hand trying to get health care for themselves or their children. It is not the way a nation should treat its people.”
It was that concern for the economic pressure created by the U.S. health care system that led Sister Keehan to support the Affordable Care Act, nicknamed “Obamacare,” in 2010. That position put her at odds with the U.S. Conference of Catholic Bishops. And it was more than a nominal signal of support. The Washington Post in 2010 called it “a critical endorsement,” and President Obama said at the C.H.A. annual meeting in 2015, “We would not have gotten the Affordable Care Act done if it weren’t for her."
Following her public support for the bill, Sister Keehan faced attacks from conservatives for not toeing the bishops’ line on health care. She maintains that many U.S. bishops wanted the bill to pass, but she thinks that overzealous staffers at the U.S.C.C.B. convinced some, including then-president Cardinal Francis George, that the law would use federal funds to pay for abortion and force Catholic entities to pay for contraception coverage.
“If I believed that, I wouldn’t have supported it,” she said.
The bill passed and the prohibition against using federal money to pay for abortion remained intact. (It would be a couple of more years before the so-called contraceptive mandate ignited rounds of litigation between Catholic entities and the Obama administration.) Regardless, Sister Keehan said that some of her speaking engagements were postponed or canceled, that she was asked to step down from committees in Rome and that people wrote letters to her superiors saying she should be exiled from her community.
On the day the bill became law, Sister Keehan was in Rome and unable to be at the bill-signing ceremony. But President Obama used 22 pens to sign the bill, and one went to Sister Keehan. Above her desk at the C.H.A. office in Washington, it has hung along with three photos: one of her standing alongside Vice President Joe Biden, one of the bill-signing ceremony and one of her shaking President Obama’s hand.
“I don’t have any regrets,” Sister Keehan said of the controversy, adding that allowing families to have some peace of mind when it comes to health care was worth it. She said that even the strongest supporters of the Affordable Care Act knew it was always going to be a work in progress.
“We knew at the start [the Affordable Care Act] didn’t go far enough,” Sister Keehan said. “But we also knew it was a giant step forward.”
To that end, she says there are still many fixes needed when it comes to ensuring Americans have access to health care, and the debate around health insurance is likely to play a major role in the 2020 election. President Trump has tried many times, unsuccessfully, to dismantle the Affordable Care Act, and many Democrats running for president have said they support universal health insurance.
Sister Keehan said “it is important that we study every option.” Americans tend to like choices, she added. But that desire for choice does not rule out a more robust public option that allows more Americans to buy into government-run health insurance programs. She noted that even Medicare is not a one-size-fits-all program, as people who use Medicare often purchase supplemental plans as well. Decisions must be made with robust data, and the nation “should not do anything based on anecdotal evidence,” she cautioned.
“We can tell all the horror stories we want about Europe and Canada,” she said, “but we have got more horror stories about people in this country” related to medical bills.
Access to medical care for L.G.B.T. people
Last month, the U.S. House passed the Equality Act, a bill designed to enhance existing civil rights protections by including sexual orientation and gender identity. Hours before the vote, the Catholic Health Association released a statement signed by Sister Keehan explaining why it could not support the bill in its current state.
“We actually didn’t come out against it, we said we didn’t support it” as it is written, Sister Keehan said. She said that the C.H.A. has consistently supported policies and rules that improve care for L.G.B.T. patients, such as when it supported visitation rights for same-sex partners in 2010, and now it supports ensuring staff use the preferred pronouns of trans patients. The issue with the Equality Act, she said, is that it does not respect the religious beliefs of Catholic health care workers.
The issue with the Equality Act, says Sister Keehan, is that it does not respect the religious beliefs of Catholic health care workers.
“It needs to be recrafted so that it achieves what it wants to achieve without unnecessarily going after other rights,” she said.
Some critics say Catholic hospitals can violate the rights of transgender patients by refusing to perform surgeries related to gender identity. Earlier this year, Oliver Knight sued a Catholic hospital in California, claiming that it canceled a planned hysterectomy minutes before it was to be carried out. Mr. Knight identifies as transgender. According to the lawsuit, the patient was told the surgery could not be completed because of the church’s prohibition on elective sterilization.
Sister Keehan said that L.G.B.T. people should feel comfortable in Catholic hospitals. But some procedures, including ones related to gender, are not performed on a routine basis in Catholic hospitals.
“If we do a procedure—say open heart surgery, cancer treatment, gallbladder disease—[L.G.B.T. people] are as welcome as anybody else,” she said. “What we have said is we don’t do transgender surgery. But in many of our hospitals, we [also] don’t do brain surgery. We don’t do this procedure or that procedure.”
Reproductive health care
Other critics, such as MergerWatch, have said that Catholic hospitals refuse to offer appropriate medical care to women, especially to pregnant women who may experience complications during pregnancy.
But Sister Keehan said that is simply not true.
She said that Catholic hospitals routinely treat women whose lives are in jeopardy because of complications with pregnancy. Sometimes that means delivering a fetus that is not viable in order to ensure the life of the mother is protected. She said these cases are rarely as simple as they are sometimes presented in the media.
“Most of the time, [parents] want that baby and it will always be the baby they lost,” Sister Keehan said.
Sister Keehan: the issue of specific services being unavailable in some Catholic hospitals “gets overblown.”
Sister Keehan weighed in publicly on a controversy involving a pregnant woman’s life being in jeopardy in 2010, when a bishop in Arizona stripped a Phoenix hospital of its Catholic affiliation after a procedure to save the life of a pregnant woman resulted in the death of the fetus she was carrying. The bishop classified the procedure as an abortion, but the hospital administrator who signed off on the case, Sister Margaret McBride, said that the hospital adhered to Catholic ethical and religious directives, emphasizing that the death of the fetus was not the intended result. Sister Keehan supported Sister McBride’s decision, calling it at the time a “heartbreaking situation.”
Sister Keehan said that women today should feel confident they will receive appropriate care in Catholic hospitals, pointing out that they are regulated and accredited just like other hospitals.
MergerWatch argues that Catholic hospitals are sometimes the only options in some places and that as a result, women may not have access to some medical services or medical counseling if it goes against church teaching. For instance, Catholic hospitals often will not perform tubal ligations, which some women seek immediately following delivery. Sister Keehan called that “a legitimate concern,” but she said that the issue of specific services being unavailable in some Catholic hospitals “gets overblown.”
As to the mergers, a trend that cuts across every sector of health care, Sister Carol pointed out that Catholic hospitals frequently operate in areas where other health care networks refuse to set up shop, often because of concerns over cost.
“The fact of the matter is many places where we’re the only hospital is because other people don’t want to be there,” she said.
“That’s often why we’re the only hospital—because it’s not profitable,” she added.
The future of Catholic health care
The C.H.A. estimates that one in seven hospital patients in the United States is cared for in a Catholic hospital. But with the number of priests and women religious falling each year, what will make a hospital “Catholic” in coming years? Sister Keehan said it all comes down to the quality of care.
“It means treating the whole person. It means being attentive to the most vulnerable among us. It means fair treatment to your employees,” she said.
She said laypeople will be granted more responsibility, but they are guided by the same vows as women religious, those made at baptism. Sisters could have decided to sell off the health care system they helped to create and used the money in other ways—perhaps buying villas in Hawaii, she joked—but their commitment to mission meant they had no choice but to partner with laypeople. And there is no resting on the success of the past.
“If you were a really good Catholic hospital yesterday, that’s wonderful,” she said. “But today’s a new day. You have to be a really good Catholic hospital today.”
Correction: In an earlier version of this story, Mary Haddad, the incoming president of the C.H.A., was erroneously called a Sister of Charity. She is a Sister of Mercy of the South Central Community.