Mary Haddad, R.S.M., does not want to join the blame game over the government shutdown, which entered day seven on Oct. 8. The gridlock in Washington is “reflective of a government that is not responding to the needs of the people,” Sister Haddad, the president and chief executive of the Catholic Health Association, said. “Both sides need to take responsibility here; it’s indicative of a government that is not working for us today.”

And from her perspective, the entire dispute seems a little beside the point. U.S. Catholics and C.H.A. membership, she said, “believe that health care is a basic human right and everyone needs access in order to flourish.” C.H.A. represents more than 650 hospitals and 1,600 long-term care and other health facilities in all 50 states.

Democrats say they are holding out for the restoration of health care eligibility to Medicaid and Medicare recipients that had been tightened by congressional Republicans over the summer in an effort to achieve a historic $1.2 trillion cut in health spending. They are also pressing for the extension of federal subsidies for health insurance plans. Republicans accuse Democrats of shutting down the government because they want to provide taxpayer-funded health services to “illegal aliens.”

Vice President JD Vance led the charge on cable news and social media. “If you’re an American citizen and you’ve been to the hospital in the last few years,” he told reporters, “you’ve probably noticed that wait times are especially large and very often somebody who’s there in the E.R. is an illegal alien. Why do those people get health care benefits at hospitals paid for by American citizens?”

One of the Democrats’ primary asks before adding their votes to a continuing resolution that would reopen government is that Congress extend tax credits that were boosted during the Covid-19 pandemic for health care plans offered under marketplaces created by the Affordable Care Act. Those programs in 2025 reached a record enrollment of more than 24 million Americans—three out of four of those A.C.A. enrollees live in states won by President Trump in the 2024 election.

“Everyone is about to experience dramatically increased premiums, co-pays and deductibles because of the Republican health care crisis. Everyone,” House Democratic leader Hakeem Jeffries of New York warned during a news conference on Oct. 3.

Calculated misinformation?

As the political bickering continues, what Sister Haddad wants to keep at the forefront is the precarious overall state of U.S. health care and its potential to end up as another piece of collateral damage during this latest legislative showdown. Sister Haddad describes insinuations that health care is being provided to “illegals” as misinformation that diverts attention from the true risk to health care delivery looming ahead.

“There’s a lot of misinformation that’s being said that is really just trying to shape the minds and hearts of people in this country in a very negative way, and it’s disturbing, quite honestly.”

“It’s not about undocumented [people],” she said. Last July’s Big Beautiful Bill, the Republican budget reconciliation package crafted by the Trump administration and congressional Republicans, “repealed services and Medicaid for those who are here legally. That’s the heart of the issue,” Sister Haddad said. And that spending is partly what Democrats say they want to see restored before they will cooperate in reopening the federal government.

But it is surely true that Catholic hospitals, like all other hospitals across the United States, take care of anyone who crosses their thresholds seeking care—including those without legal status. Sister Haddad describes that as a response to the church’s mission and the minimum requirements of medical ethics. Beyond the moral call, though, treating all people who come to emergency rooms seeking help has been the law of the land since the Reagan administration.

The Emergency Medical Treatment and Labor Act requires hospitals that receive federal funding to evaluate and stabilize every person who arrives at their doors, regardless of insurance coverage, income or immigration status. Times have apparently changed, but when the law was passed in 1986, that obligation was viewed as a modest and sensible minimum care proposal meant to discourage the “dumping” of sometimes critically ill patients at a competing health care provider.

Hospitals may pick up the tab for that care over the short term, but if the federal government declines to pay for indigent care, hospitals have to raise other fees and charges that are eventually passed on to the general public, Sister Haddad said. Facilities that are unable to find another way to pay for those care obligations, she warns, may be forced to close their doors.

She worries that could mean the loss of health care facilities, particularly in America’s rural counties that face significant costs associated with the treatment of undocumented workers in the nation’s agricultural communities. She does not believe a $50 billion reserve fund for rural health care included in the Big Beautiful Bill will make up the difference. “It’s a drop in the bucket,” she said.

The budget package, signed by Mr. Trump on July 4, does not represent the president’s first attempt to legislatively euthanize the A.C.A. In 2017 during the first Trump administration, White House allies in Congress tried to directly repeal the act.

“Thank God for John McCain, it did not happen,” Sister Haddad said.

Obamacare under threat

Passed in March 2010, the Affordable Care Act, the signature achievement of the Obama presidency, has created access to health care for more than 40 million Americans. The A.C.A. expanded Medicaid in 40 states to cover 21 million low-income adults under 65 and protected as many as 133 million with pre-existing conditions from losing their health insurance.

Since Mr. Trump’s return to office, Sister Haddad perceives a renewed, “calculated plan to dismantle the A.C.A.,” through misinformation and “storylines” that characterize immigrants as violent criminals or “people on Medicaid as being lazy and not motivated to get work.”

C.H.A.’s multiyear strategy, she said, heads in the opposite direction, aiming for “access to affordable, quality health care” for all.

“We will continue to fight for that, but we recognize the fact that this system is broken,” Sister Haddad said.

Despite the expansion of health coverage created by Obamacare, as the A.C.A. eventually became known to critics and proponents alike, the United States remains far from the universal health coverage taken for granted in most Western peer states. It is a dismal possibility that with the passage of the Big Beautiful Bill, progress made under Obamacare is about to be significantly reversed.

“We have finite resources,” Sister Haddad acknowledged. That means “we have to change the system of care. We have to transform health care in this country.”

“We’ve gotten to a point in this country where we’re comfortable with the status quo because we’re making it work and we’re inching by.” But she wishes more people were asking if the nation’s mix of for-profit, private and public health provision is “really a just way of delivering care.”

Health care costs in the United States remain twice as high as in peer states—$14,570 per capita to $6,850 per capita—yet health outcomes are far worse. Health care is a significant driver of both personal and public debt. More than 100 million Americans carry more than $220 billion in medical debt, and medical debt is a contributing factor in more than two-thirds of U.S. bankruptcies.

Americans die younger and suffer from an array of chronic illnesses at rates far higher than peer nations. The United States endures levels of gun deaths and injuries that are essentially unknown in any other advanced Western economy.

“I’m not satisfied with [the] status quo,” Sister Haddad said. “That’s not good enough. I hope we don’t get to that sense of complacency because when we’re complacent, we’re complicit. And things need to change.”

The damage that is being done now will affect the nation for years to come, Sister Haddad warns. Congress is not listening, and members seem immune to appeals from constituents; decisions seem to be emanating from the White House alone.

Care for all is not just the moral call of Catholic health care institutions; it is also smarter social policy, according to Sister Haddad. She points out that U.S. residents who put off seeing a primary care physician because of their status or ability to pay will only become sicker. If they wait until a health crisis occurs, they will end up at an emergency room where their treatment will be far more costly, or worse, they may become debilitated by an illness or injury that could have been readily treatable—an individual tragedy that also represents a significant civic and social cost to all.

The cost of providing health services to some of the most marginalized people in U.S. society barely factors in that losing formula. According to an analysis of 2016 Medicaid data conducted in 2022, the federal government spent $974 million on emergency and lifesaving services for undocumented immigrants, representing 0.2 percent of Medicaid expenditures and 0.03 percent of total national health expenditures that year.

At prayer that morning, Sister Haddad found it ironic that the Parable of the Good Samaritan was the day’s Gospel reading: “That is what’s at the heart of it: Who is my neighbor?”

“As Jesus tells the story, we see that the Samaritan is the one that cared for the [robbed and wounded] man, independent of who he was. He didn’t go to check his ID when he was on the side of the road,” Sister Haddad said.

“Our call is to go and do likewise.”

A repeal of Obamacare?

Since the Affordable Care Act’s major provisions were implemented in 2013, the number of people with health insurance has grown by more than 38 million, and the nation’s uninsured rate has nearly halved, falling from 14.4 percent in 2013 to 7.9 percent in 2023.

Under provisions of the One Big Beautiful Bill Act, described by health care analysts as essentially repealing the A.C.A., the Congressional Budget Office projects the number of uninsured will increase by 16 million to 17 million people, contributing to an increase of three percentage points in the number of uninsured to 11 percent or higher by 2034.

7.5%: The increase in U.S. health spending in 2023.

$4.9 trillion: U.S. spending on health care in 2023—17.6% of G.D.P. In 2022, average spending for health care as a share of G.D.P. among member states of the Organization for Economic Co-operation and Development was 9.2%.

$14,885: U.S. per-capita spending on health care—more than double the $7,371 average cost in other O.E.C.D. member states.

$1,000: U.S. per-capita health care administrative costs—approximately five times more than the average among other high-income nations.

More from America

A deeper dive

The Weekly Dispatch takes a deep dive into breaking events and issues of significance around our world and our nation today, providing the background readers need to make better sense of the headlines speeding past us each week.

For more news and analysis from around the world, visit Dispatches. This week, O’Hare Media Fellow Edward Desciak visits Little Sisters of the Assumption Family Health Service in East Harlem to learn how its team members are helping Manhattan neighbors prepare for an encounter with Immigration and Customs Enforcement agents. L.S.A. wants immigrant parents to protect themselves and their children from unwarranted detention or family separation.

This article appears in December 2025.

Kevin Clarke is America’s chief correspondent and the author of Oscar Romero: Love Must Win Out (Liturgical Press).