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Tuesday, January 25, 2011

Catholic Bishops and Health Care Repeal

As Howard Friedman notes over at Religion Clause, the national conference of Catholic Bishops has issued a press release summarizing the Church’s public policy goals for the new legislature.  The release reasserts the Church’s commitment to both “the life and dignity of all” and to the support of “vulnerable and poor persons” during the economic crisis.  Perhaps the most interesting legislative place where these goals intersect (or perhaps conflict?) is in the debate over health care reform.  As the newly Republican House took up a repeal bill last week (which passed on last Thursday), the Bishops faced a seemingly difficult question: Though they actively opposed the health care bill (on abortion grounds) when it came up for a final Senate vote last Christmas, it is clear that the bill, as passed, goes a long way to help poor people.  So which interest would win out when it came time to take a position on repeal?

 Well, perhaps not surprisingly, the Church split the difference and pressed for amendment, but not repeal:  “Rather than joining efforts to support or oppose the repeal of the recently enacted health care law,” wrote Cardinal Daniel DiNardo, “we will continue to devote our efforts to correcting serious moral problems in the current law, so health care reform can truly be life-affirming for all.”    The enduring issue for Catholics is whether or not insurance providers that receive federal funding can cover abortion procedures.  Apparently, the compromise brokered by Senator Ben Nelson of Nebraska—which (1) requires people who want abortion coverage from a private insurer to pay for it themselves separately, and (2) prohibits the use of any federal subsidy to pay for abortions—isn’t enough.    The problem, as best I can discern it, is that separately purchased abortion coverage will still be part of a comprehensive insurance package, which does get federal subsidy.   The Bishops want any abortion coverage to be part of separate rider, so that there is no unholy commingling of funds.

 At the time, Senator Nelson trivialized this disagreement as being “about a staple”—ie, whether the abortion coverage was in the original policy or stapled to the back—but, in actuality, it is a quarrel that goes back to our earliest debates about disestablishment and religious freedom.  Here I’m thinking of the various schemes to exempt Baptists and others from taxation to support established Congregationalist churches and schools, and also of Madison’s arguments about the tyranny of forcing an individual to support (through taxation) an alien faith.  With that said, one wonders whether such formalist minutiae (principled though it may be) should stand in the way of the Church giving its full support to a bill that seems to further other very important missions.   It is at least somewhat refreshing, though, to see the Bishops add a reasoned and principled voice to the repeal movement, rather than the reactionary “socialist operatives did it, repeal it before it destroys our way of life” that seems so prevalent.   They are to be applauded, too, for identifying a specific problem with the law, and offering an alternative—the kind of authentic political discourse that also seems lacking at present.  I can’t help but wonder, though, if this is really the appropriate place to fight the abortion battle; especially given the pressing need for health care among our most vulnerable communities.

 

Posted by Ian Bartrum on January 25, 2011 at 02:33 AM | Permalink

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Comments

Seems to me that the real issue is not the "separate accounting" details, and if the bishops have gotten sucked into viewing it that way, they've lost sight of the underlying point. To me, the broader Hyde Amendment principle was not that "taxpayer money should not be used for abortion," but that "no one should be forced, by government mandate, to pay for abortion." Hyde was simply a manifestation of the principle against mandated subsidy.

Thus, suppose, before the full health-care reform bill, someone had proposed a federal law mandating that all employer-provided insurance, or all insurance, must include abortion. (Such laws have been passed regarding various procedures, or days in hospital, etc.) That would not violate the Hyde "law," because it's not tax money. But it would mean that I, as an employee, would now be forced -- not just by employer choice, but by global federal mandate -- to pay into the pool for my co-workers' or co-policyholders' abortions.

True, that type of subsidy already occurs for all whose insurance does cover that, but at least that result comes from the choices of the insurers and the employers and whatever competing pressures. I can, as a business owner, choose not to provide abortion-inclusive insurance, and I as an employee can try to avoid the employers who choose otherwise, etc.

So let me ask you all -- would such a law have been opposed by the bishops, and would they and like-minded congressmembers have a fair claim that they are simply seeking to implement the underlying Hyde principle in another context, as opposed to "expanding Hyde" by going beyond "tax money" to "private money" ?

Separately, the battle is also -- for both sides -- about law as a teaching and culture-shaping tool regarding "normalizing" versus "marginalizing" abortion. It's not about the dollars or even the subsidy. Is abortion flagged as something "outside" "normal health care," or just one more item along with everything else? Whatever side you take on this HCR-abortion issue, or on the broader abortion issue, it seems to me hard to deny that there is a normalization/stigmatization effect, and so it only makes sense for each side to want the result to go their way.

On top of all that, there are also, for the Catholics or others, the conscience-protection issues re health-care workers, and that is both about the individuals and also about the normalization/stigmatization. If you make all the Catholic nurses assist, etc., they eventually will accept it as OK, or get out of the business.

Frankly, it's a sign of just how MUCH the bishops like the rest of the law that they're trying to still find some middle ground. If they were as single-mindedly devoted to blocking the abortion aspects as their critics say, they could have gone into total opposition earlier, and the bill might never have passed.

Posted by: opposing abortion mandate | Jan 28, 2011 2:25:22 PM

The overall law will provide health care that protects pregnant women. This is a case of the perfect being the enemy of the good. How in the heck is this supposed to work? If a penny of my tax dollars go to some health provider that performs abortions (including for the health of the woman, the Church defining that ultra narrowly), it in some way means a penny is going to "support" abortion. Meanwhile, the Church supports voucher programs that require less artificial support of doctrine people oppose. Indirectly, to be sure, but that is enough here, apparently.

I hate to argue religion here but this is the sort of hairsplitting that led Jesus to note that giving the poor food is not a violation of the Sabbath.

Posted by: Joe | Jan 26, 2011 11:46:34 AM

Thanks, Rick. That's a great point, and one I hadn't really considered (and for the record I paused over that "formalist minutiae" phrase for quite a while). So I take it that, in addition to the deontological sort of claim about autonomy over how my money is spent, etc... there is a second, consequentalist, claim to make about the likelihood that the law as written will bring about more abortions. I guess the thought would be that people are less likely to go out of their way to get an actual "abortion rider" than they would be simply designate part of their insurance contribution to abortion coverage. That may be true, but it strikes me as requiring an empirical kind of answer, which may be hard to get in this case....

Posted by: Ian Bartrum | Jan 25, 2011 3:42:26 PM

Ian, I appreciate this post. My (friendly?) amendment, for what it's worth, would be that the Catholic bishops have repeatedly made it clear that their concerns about public-funding-for-abortion (in the new law, and in other contexts) goes beyond questions of "formalist minutiae"; it's not just about wanting to avoid culpable cooperation with evil, etc. They believe (correctly, in my view) that, wholly and apart from Madisonian worries one might have about burdening pro-life citizens' consciences by spending public funds on abortion, public funding for abortions, as a general matter, results in, well, more abortions, which they see as a bad outcome.

Posted by: Rick Garnett | Jan 25, 2011 2:14:35 PM

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