Pope Leo XIV chose his recent visit to Uruguay to issue a call for universal health care in “every society.” As he explained to his audience on Nov. 6, the issue has been on his mind of late. There was some doubt that Leo would be able to make this first visit as pope to South America after lung-cancer surgery just weeks ago.
He told the crowd in Montevideo that during his surgery and recovery, “I experienced firsthand the limitations imposed by illness, and I received care for which I am deeply grateful.”
The experience, he said, “makes me think of the many men and women who lack the means to obtain a timely diagnosis or receive the treatments they need.”
“Ensuring that health care is accessible to everyone, regardless of their resources, is a duty that confronts every society,” Leo said, adding, “caring for those who suffer is a responsibility incumbent upon the entire human family.”
A spokesperson for a human right
“It’s fantastic to have the pope talking about universal access,” Lucas Swanepoel, vice president of advocacy and public policy for the Catholic Health Association of the United States, says. Leo has helped propel the issue to the cultural forefront, and the American press is paying attention.
The matter is particularly timely in the United States. The Trump administration has significantly turned back progress made by previous administrations on health care access, and substantial new barriers created by the president’s signature legislation, the One Big Beautiful Bill Act, are scheduled to go into effect in January 2027.
At the same time, the 120th Congress convenes on Jan. 3. The “blue tsunami” midterm wipeout of the Republican majority could mean that legislative proposals like Vermont’s Senator Bernie Sanders’s “Medicare for All” may receive a hearing in Washington.
The Catholic Health Association, alongside the U.S. Conference of Catholic Bishops, has long supported universal access to health services. How the nation reaches that objective is still up for discussion, Mr. Swanepoel says, noting that most other nations have managed comprehensive health access through different versions of mixed public and private systems. “What does that mixed system look like in application in the United States? That’s the goal.”
The pope’s consistent advocacy will surely help get the message across. People may be more willing to listen, Mr. Swanepoel says, to “a pope who was born in a Catholic hospital, born in the American health care system, has had American insurance products…and understands how our system works.” The pope has also lived in other nations and traveled broadly, seeing firsthand how other nations achieved a social good that has consistently eluded policymakers in the United States.
Universal health care access is an issue that the pope has already brought up a number of times in his still-young papacy. Speaking to a conference convened among European bishops and officials from the World Health Organization last March in Rome, he said: “Universal health coverage is not merely a technical goal to be achieved; it is primarily a moral imperative for societies that wish to call themselves just.”
Beyond the demands of justice and mercy, inequities in health delivery, he warned, can be a driver of conflict. “Health cannot be a luxury for the few,” Leo said, calling it “an essential condition for social peace.”
Health care for all has long been urged by the church as a natural right, articulated directly since at least “Pacem in Terris” in 1963, when Pope John XXIII wrote that humankind “has the right to live…the right to bodily integrity and to the means necessary for the proper development of life, particularly food, clothing, shelter, medical care, rest, and, finally, the necessary social services.”
Leo might be gratified to learn that Uruguay, a deeply secular state, indeed sponsors a health care system that includes all, a system highly rated by the U.S. Department of Commerce, no less. Perhaps Uruguay offers a model worth considering by its much more affluent neighbor, the United States.
The United States made substantial progress on health access between 2010 and 2025, when the percentage of America’s uninsured fell from 16 percent to 8 percent because of the mandates and new insurance marketplaces created by the Affordable Care Act, known colloquially as Obamacare. But this year, the percentage of uninsured people among working-age adults, ages 19 to 64, crept back up to 11.2 percent from the 8.9 percent recorded in 2024, according to a biennial review published by the Commonwealth Fund in October. That trend coincided with a decline in A.C.A. marketplace and individual market coverage, from 8.5 percent in 2024 to 6.4 percent in 2026.
The fund reports that policy changes in 2025 advanced by the Trump administration—and accepted by a compliant Republican Congress—“led to the biggest cuts to Medicaid and the [A.C.A.] marketplaces since the [Obamacare’s] passage.” According to the report, “the combined effects of these changes are expected to drive the number of uninsured people to 37 million by 2036. That would be about the same number of uninsured as in 2014, when most of the A.C.A.’s changes took effect.”
The administration has alleged that the hundreds of thousands removed from Medicaid or A.C.A. marketplaces represented ineligible applicants, people fraudulently receiving assistance or duplications in services. Advocates say those claims are a “smokescreen” for a blunt effort to reduce federal spending on health care.
Sharp increases in the cost of health insurance plans offered through the federal insurance marketplace and heightened eligibility and paperwork barriers in 2027 promise to push the number of uninsured even higher if the incoming Congress does not intervene. Many of the people who will lose their Medicaid coverage next year, Mr. Swanepoel worries, will be eligible people who simply did not fill out a form correctly or failed to file one on time.
But the number of the uninsured is only a part of the problem. More than 12 percent of Americans experienced a gap in coverage during 2026, and 23 percent were underinsured, meaning, according to the Commonwealth Fund, “they had coverage, but their plan didn’t provide affordable access to care.”
In fact, according to the Commonwealth Fund, nearly half of working-age adults, 46 percent, were inadequately insured in 2026. Mr. Swanepoel explains that higher percentages of insured mean little if co-pays and deductibles are so high that families choose to forgo treatment, therapy or prescription medicines.
A costly, complicated health care system
The United States maintains a complicated health care delivery system that is administered through both the public and the private sector at a cost of $5.2 trillion each year. Some 54 percent of health coverage is provided by the private sector through employer-sponsored health insurance that is deeply subsidized by employee contributions and co-pays. About 36 percent of the population is covered by the government directly through Medicare, Medicaid, the military’s Tricare, the Department of Veterans Affairs and a number of smaller programs. About 30 million people were left out completely in 2026.
Critics of the “Medicare for All” or single-payer approaches to health provision argue that they would prove far too costly and result in poor health outcomes as America’s profit-driven health technology sector loses incentives to excel. But proponents of single-payer point out that under the current regime, the United States has the highest per capita health spending in the world but achieves outcomes far below those in peer states, many of which spend far less on health care.
While he is no doubt gratified by the pope’s interest in health care equity, Johnathon Ross, M.D., notes that the instruction comes “from Jesus, so that’s even a slightly higher step up than the pope.”
A spokesperson for Physicians for a National Health Program, Dr. Ross recalls how Jesus chased the moneychangers out of the temple and then “goes out to the multitudes, and he heals the sick. That’s what we’ve got; we’ve got the moneychangers in the temple of medicine.”
The Parable of the Good Samaritan, he adds, is another instructive text to consider when contemplating the current state of American health care. “This is a Jew who’s lying beside the road and a Samaritan, who’s supposed to be [his] enemy, comes along and helps. So who is your neighbor? Who are you to love?”
Parallel passages and instruction can be found in sacred texts from many other traditions, he points out.
“I think health care should follow the golden rule,” Dr. Ross says. “Treat everybody as you want to be treated yourself…. Who would you say ‘no’ to?”
Medical teams treat everyone who comes in the door, he explains. They should not be put in the position of asking who is legal and who is illegal; who can afford treatment and who cannot. “Don’t ask doctors to be the judge of whether [someone is] worthy of care…. We just want to use our best knowledge and our best abilities to take care of whoever’s in front of us.”
Beyond escaping that moral quagmire, a single-payer approach delivers effective care far more efficiently, he argues, than the current overcomplicated system, subject to perverse incentives and costly rent-seeking. At about $15,800 per capita, U.S. costs are more than twice the average health spending among peer states.
Market-based health delivery has failed to contain costs and distribute health care equitably, according to Dr. Ross. The government has to step in to unravel a market failure of this scale.
The United States, he says, has “the best doctors, the best nurses, the best hospitals, the best drugs, the best equipment, the best research in the world and the worst possible system for giving everybody the care we need.”
A number of studies bear that assessment out. A recent Yale analysis (not yet peer-reviewed) projects that a conversion to a “Medicare for All” style system could save more than 114,000 lives and cut overall costs 20 percent—more than $1 trillion—each year.
But while he remains confident the single-payer model makes the most economic and moral sense, Dr. Ross is not confident it has any chance of making it through the next Congress, even with the midterm success of the Democrats. That level of transformation would require committed presidential leadership he deems unlikely in the final two years of the Trump administration. (Or not: Michigan Senator-elect Abdul El-Sayed has proposed “TrumpCare,” a golden insurance card providing universal health care, dangling the president’s name on the ambitious Democratic plan.)
Far more likely may be incremental changes like MediKids, a universal coverage proposal for all children, or lowering the Medicare eligibility age to include more adults. He also holds out hope that individual states may seize on the moment to begin single-payer experiments.
A plan to replace New York’s hodgepodge of commercial health insurance plans with a single-payer system without deductibles or co-pays for all residents and workers is gathering steam. While an attempt in Vermont in 2014 never got off the ground, Dr. Ross believes deeper-pocketed New York could act as a vanguard for other states in the absence of federal action.
Broader reform will require building a public movement demanding change. And that is where the U.S. church and Pope Leo’s insistence on a more humane and just system can make an important contribution, Dr. Ross says.
Whatever changes may come as the health care access and affordability problem deepens, Mr. Swanepoel is confident Catholic health institutions will continue to have a role to play, as they have since the nation’s founding.
He recalls how European sisters came to America’s shores and got to work building houses and communities of care that would eventually form the backbone of the nation’s health care network. “This is an actual true mission and a true ministry that goes much longer than just one election cycle,” Mr. Swanepoel says. “It is who we are as Catholics.”
Seeking stronger public support that may finally push the United States over the line to universal care will remain a C.H.A. goal. In the meantime, Mr. Swanepoel is preparing for a tough fight soon in Washington to claw back coverage that has been lost over the last two years.
More from America
- The good Samaritan’s lessons for Catholic health care on World Day of the Sick
- After the government shutdown ends, will the U.S. be heading back to the future on health care?
- The ethics of Catholic hospitals—beyond abortion and contraception
A deeper dive
- U.S.C.C.B. on health care policy
- Catholic Health Association: Accessible And Affordable Health Care For Everyone
- Universal Health Coverage Could Save $1 Trillion and 114,000 Lives Every Year, Yale Study Projects
- Lobbying Expenditures in the US Health Care Sector, 2000-2020
- Catholic Social Thought Concerning the Right to Health and to Health Care
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 each week. Some recent reports: “After an Islamist terror attack on a church in Jordan, are Christians still safe?” and “Interview: Archbishop Broglio warns U.S. soldiers are increasingly at risk of ‘moral injury.’”
For more news and analysis from around the world, visit Dispatches. This week: “Voters chose four new Catholic governors on Election Day. Does their faith matter?” and “How Latino Catholics helped flip the Texas border for Democrats.”
Politics
Faith
Culture
Vatican
Scripture
Podcasts