Last week, the U.S. Supreme Court upheld as constitutional the most controversial element of the federal Affordable Care Act (ACA): the mandate that all individuals must purchase private health insurance. The court held that the mandate was essentially a tax that Congress could compel citizens to pay.
The ruling also leaves in place another mandate opposed by a majority of Americans: the HHS mandate that private employers, including religious ones, must include so-called “preventive services”— abortifacient drugs, sterilizations, and contraception — in health insurance plans offered to employees.
For various reasons, including the presence of the two mandates already mentioned, many are calling for the ACA’s repeal. Others are celebrating the court’s ruling as protecting needed health care reform legislation. So, what is next?
The bishops of Minnesota, along with their brethren around the U.S., were not involved in the ACA litigation, nor did they take a position on the legal questions presented to the Supreme Court. They have not advocated for the repeal of the ACA altogether, and they do not do so now.
Rather, the bishops have called and continue to call on Congress to amend the ACA so that it protects the unborn, the rights of conscience, and the health care needs of immigrant families.
Access to basic, affordable health care is a human right
Before unpacking the bishops’ position concerning federal health care reform, it’s worth recalling how they arrived at it.
The Catechism of the Catholic Church and other magisterial documents make clear that access to basic medical care is a human right. Society has a responsibility, as a matter of justice, to ensure that each person has the health care they need for their growth and flourishing (CCC 2288). When society fails to ensure that people have access to basic, affordable care, government has a duty to offer assistance, particularly for families and the elderly (CCC 2211).
Guided by this teaching, a pastoral concern for the lay faithful and the common good of all of society, and the church’s experience as the largest single health care provider in the country, the bishops of the United States have, since 1919, advocated for comprehensive health care reform that provides universal access to basic care for all citizens.
In a 1981 statement, the American bishops said the following: “It is the responsibility of the Federal Government to establish a comprehensive health care system that will insure a basic level of health care for all Americans. . . . The Federal Government should also insure adequate funding for this basic level of care through a national health insurance program.”
Guiding principles for health care reform
When advocating for health care reform at the federal level, the bishops have laid out the following guidelines for sound policy:
- Genuine health care reform must protect human life and dignity, not threaten them, especially for the most voiceless and vulnerable.
- Health care legislation must respect the consciences of providers, taxpayers and others, and not violate them.
- Coverage should be truly universal and should not be denied to those in need because of their condition, age, where they come from or when they arrive here.
- Costs must be restrained and applied equitably across the spectrum of payers.
Providing affordable and accessible health care that clearly reflects these fundamental principles is a public good, a moral imperative, and remains an urgent national priority.
ACA needs to be amended by Congress and the president immediately
Although the ACA is designed to give all Americans access to health care, the U.S. Conference of Catholic Bishops did not support its final passage in Congress. Three serious problems in the law remain in place and require Congress’s immediate attention.
First, the ACA allows use of federal funds to pay for elective abortions and for plans that cover such abortions, contradicting longstanding federal policy.
Second, the ACA fails to include necessary language to provide essential conscience protection, both within and beyond the abortion context. The HHS mandate forcing religious and other employers to cover sterilization and contraception, including abortifacient drugs, illustrates this problem in dramatic fashion.
Third, the ACA fails to treat immigrant workers and their families fairly, leaving them worse off by not allowing them to purchase health coverage in the new exchanges created under the law, even if they use their own money.
These problems are of grave concern and must be fixed immediately. Otherwise, their continued existence could signal the misuse of the ACA as a government bludgeon to impose an ideology inconsistent with the duty to ensure access to life-affirming health care for all.
The ACA represents an important opportunity to advance social justice and ensure that the health care needs of all Americans are met. But health care policy, like health care itself, must be guided by sound principles and moral truth. If it isn’t, health care policy no longer promotes a culture of life and human dignity, but instead endangers the well-being of persons and the health of society.
The Catholic Church will continue to be a staunch advocate — in the community, in the legislative arena, and even in the courts, if necessary — for health care reform that protects the sanctity of human life and the rights of conscience, as well as promotes both healthy citizens and the common good.
Jason Adkins is executive director of the Minnesota Catholic Conference.