The Cathoholic

Obamacare and Abortion Funding, Part II

This was a busy week for the pro-life movement and the USCCB. On Tuesday, the National Right to Life Committee released a report charging that the high-risk insurance pools in Pennsylvania that would receive $160 million in federal funds--courtesy of the new health bill--would include abortion services. The Department of Health and Human Services and Rep.Bart Stupak denied the charge, and insisted that the Executive Order already prohibited federal funding for abortion. The next day, without precisely saying so, the HHS spokeswoman said that the new state high-risk insurance pools "will not" fund abortion services. By Thursday, the USCCB was able to release a statement that confirmed an HHS policy shift had occurred. Here's the story. I've Googled this issue, and most major media organizations don't appear to be interested in the matter.  ABC and Fox pulled together stories.

UPDATE: NPR covered this issue yesterday, mostly from the perspective of abortion-rights groups who contend that preventing coverage of abortion services in the state high-risk insurance pools is going beyond the boundaries of the Executive Order.

Here's some of the documentation organized by the National Right to Life Committee:

Following NRLC's release on the Pennsylvania plan on July 13, the initial statement from DHHS, issued late July 13, was as follows:

 

< STATEMENT FROM JENNY BACKUS - HHS SPOKESWOMAN

Under the Affordable Care Act and the President’s related Executive Order, federal funds made available to states for the Pre-Existing Condition Insurance Plan may not be used to fund abortion.  We will reiterate this policy in guidance to those running the Pre-existing Condition Insurance Plan at both the state and federal levels. >

 

In a second statement, issued late July 14:

FOR IMMEDIATE RELEASE                                            Contact:   HHS Press Office

Wednesday, July 14, 2010                                                                         (202) 690-6343      

STATEMENT OF HHS SPOKESWOMAN JENNY BACKUS ON THE PRE-EXISTING CONDITION INSURANCE PLAN POLICY

 

As is the case with FEHB plans currently, and with the Affordable Care Act and the President's related Executive Order more generally, in Pennsylvania and in all other states abortions will not be covered in the Pre-existing Condition Insurance Plan (PCIP) except in the cases of rape or incest, or where the life of the woman would be endangered.

 

Our policy is the same for both state and federally-run PCIP programs. We will reiterate this policy in guidance to those running the Pre-existing Condition Insurance Plan at both the state and federal levels. The contracts to operate the Pre-existing Condition Insurance Plan include a requirement to follow all federal laws and guidance.

 

****

http://www.whitehouse.gov/the-press-office/executive-order-patient-protection-and-affordable-care-acts-consistency-with-longst

 

The White House

Office of the Press Secretary

For Immediate Release

March 24, 2010

Executive Order -- Patient Protection and Affordable Care Act's Consistency with Longstanding Restrictions on the Use of Federal Funds for Abortion

EXECUTIVE ORDER

ENSURING ENFORCEMENT AND IMPLEMENTATION OF ABORTION RESTRICTIONS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT

By the authority vested in me as President by the Constitution and the laws of the United States of America, including the "Patient Protection and Affordable Care Act" (Public Law 111-148), I hereby order as follows:

Section. 1. Policy. Following the recent enactment of the Patient Protection and Affordable Care Act (the "Act"), it is necessary to establish an adequate enforcement mechanism to ensure that Federal funds are not used for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered), consistent with a longstanding Federal statutory restriction that is commonly known as the Hyde Amendment. The purpose of this order is to establish a comprehensive, Government-wide set of policies and procedures to achieve this goal and to make certain that all relevant actors -- Federal officials, State officials (including insurance regulators) and health care providers -- are aware of their responsibilities, new and old.

The Act maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly created health insurance exchanges. Under the Act, longstanding Federal laws to protect conscience (such as the Church Amendment, 42 U.S.C. 300a-7, and the Weldon Amendment, section 508(d)(1) of Public Law 111-8) remain intact and new protections prohibit discrimination against health care facilities and health care providers because of an unwillingness to provide, pay for, provide coverage of, or refer for abortions.

Numerous executive agencies have a role in ensuring that these restrictions are enforced, including the Department of Health and Human Services (HHS), the Office of Management and Budget (OMB), and the Office of Personnel Management.

Sec. 2. Strict Compliance with Prohibitions on Abortion Funding in Health Insurance Exchanges. The Act specifically prohibits the use of tax credits and cost-sharing reduction payments to pay for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered) in the health insurance exchanges that will be operational in 2014. The Act also imposes strict payment and accounting requirements to ensure that Federal funds are not used for abortion services in exchange plans (except in cases of rape or incest, or when the life of the woman would be endangered) and requires State health insurance commissioners to ensure that exchange plan funds are segregated by insurance companies in accordance with generally accepted accounting principles, OMB funds management circulars, and accounting guidance provided by the Government Accountability Office.

I hereby direct the Director of the OMB and the Secretary of HHS to develop, within 180 days of the date of this order, a model set of segregation guidelines for State health insurance commissioners to use when determining whether exchange plans are complying with the Act's segregation requirements, established in section 1303 of the Act, for enrollees receiving Federal financial assistance. The guidelines shall also offer technical information that States should follow to conduct independent regular audits of insurance companies that participate in the health insurance exchanges. In developing these model guidelines, the Director of the OMB and the Secretary of HHS shall consult with executive agencies and offices that have relevant expertise in accounting principles, including, but not limited to, the Department of the Treasury, and with the Government Accountability Office. Upon completion of those model guidelines, the Secretary of HHS should promptly initiate a rulemaking to issue regulations, which will have the force of law, to interpret the Act's segregation requirements, and shall provide guidance to State health insurance commissioners on how to comply with the model guidelines.

Sec. 3. Community Health Center Program. The Act establishes a new Community Health Center (CHC) Fund within HHS, which provides additional Federal funds for the community health center program. Existing law prohibits these centers from using Federal funds to provide abortion services (except in cases of rape or incest, or when the life of the woman would be endangered), as a result of both the Hyde Amendment and longstanding regulations containing the Hyde language. Under the Act, the Hyde language shall apply to the authorization and appropriations of funds for Community Health Centers under section 10503 and all other relevant provisions. I hereby direct the Secretary of HHS to ensure that program administrators and recipients of Federal funds are aware of and comply with the limitations on abortion services imposed on CHCs by existing law. Such actions should include, but are not limited to, updating Grant Policy Statements that accompany CHC grants and issuing new interpretive rules.

Sec. 4. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect: (i) authority granted by law or Presidential directive to an agency, or the head thereof; or (ii) functions of the Director of the OMB relating to budgetary, administrative, or legislative proposals.

(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees or agents, or any other person.

BARACK OBAMA

THE WHITE HOUSE,
March 24, 2010.

Network, Social Justice and the Defense of the Unborn

Here's my article in the National Catholic Register on Network, the self-described "Catholic social justice lobby," that backed the Catholic Health Association during the final week of the health bill negotiations on Capital Hill.

Obama-USCCB: Skirmish on Advance Directives

Last night, while driving to downtown Washington, D.C. to attend the annual dinner of the John Carroll Society, one of the great Catholic institutions in the nation's capital, I heard this NPR story about an April 15th memorandum issued by President Obama.

The memo made headlines because it directed hospitals to allow designated non-family members to visit patients and participate in health care decisions (a long-time concern for gay and lesbian couples). But the memo also addressed another issue of potential concern to Catholic hospitals: all health care facilities that receive Medicare and Medicaid reimbursements  must honor patients' advance directives. Here is the relevant part of the  White House post on the president's memo:

"2. Ensure that all hospitals participating in Medicare or Medicaid are in full compliance with regulations,codified at 42 CFR 482.13 and 42 CFR 489.102(a), promulgated to guarantee that all patients' advance directives, such as durable powers of attorney and health care proxies, are respected, and that patients' representatives otherwise have the right to make informed decisions regarding patients' care. Additionally, I request that you issue new guidelines, pursuant to your authority under 42 U.S.C. 1395cc and other relevant provisions of law, and provide technical assistance on how hospitals participating in Medicare or Medicaid can best comply with the regulations and take any additional appropriate measures to fully enforce the regulations."

The NPR story predicted a possible collision between the president's stance on advance directives and the USCCB's Ethical and Religious Directives, which guide the operations of Catholic hospitals. Last fall, the U.S.bishops tightened their guidelines on tube feeding for patients, arguing that medically-assisted nutrition and hydration be generally included in ordinary care for patients.  In the wake of the  Terri Schiavo, case, the treatment of patients in a so-called "persistent vegetative state" has become increasingly divisive. The USCCB's revised directives sought to secure the rights of patients, who require medical assistance to receive nutrition and hydration and cannot speak for themselves.

Here's what the revised ERDs, approved at the fall 2009 USCCB meeting, say about tube feeding:

“While medically assisted nutrition and hydration are not morally obligatory in certain cases, these forms of basic care should in principle be provided to all patients who need them, including patients diagnosed as being in a ‘persistent vegetative state,’ because even the most severely debilitated and helpless patient retains the full dignity of a human person and must receive ordinary and proportionate care.”

At present, Catholic bioethicists and hospital administrators say that an unresolved conflict between a patient that opposed tube feeding and a hospital that insisted upon it would be very unlikely. The issue, of course, could turn on a matter of principle rather than practice. Down the road, church-affiliated hospitals may seek to legally defend their right to adhere to Catholic ethics on the treatment of patients, irrespective of whether that institution receives government funds.

Health Care Reform & Catholic Hospitals

Here's my story for the National Catholic Register that addresses the new health care bill's impact on Catholic hospitals. The story was published following  news that Caritas Christi--the hospital network affiliated with the Archdiocese of Boston--would be sold to one of the nation's largest private equity firms. 

Despite the Catholic Health Association's endorsement of the bill, it's difficult to predict whether this legislation is likely to help or harm the bottom line of most Catholic hospitals. And that's putting aside any consideration of the critical issues of conscience protections and federal funding of abortion.

When the Catholic Health Association ultimately endorsed the bill, the CHA applauded the expected expansion of health insurance coverage for an additional  30 million Americans. But, weeks after the vote, when I contacted the CHA for this story--and asked whether their members expected the legislation to stem the rising tide of red ink that has forced the closure of stand-alone charity hospitals like St.Vincents in New York--the CHA refused to comment.

The fact is: some hospitals are likely to grow stronger under the new regime and others may lose ground.  Big networks like Ascension Health,  flush with cash, may do better than ever, or they could get hit with the expected decline in reimbursements.

Despite headlines marking public concern regarding the Caritas sale and the St. Vincents closure, Fred Caesar, a CHA spokesman, argued in an email message that a story about the health bill's impact on Catholic hospitals “would not be of interest to the general reader. People want to know more about the benefits from the health insurance legislation in regards to new access, elimination of pre-existing conditions, etc.”

Why the effort to deflect public attention regarding this issue? Despite mainstream media stories that frequently depicted the CHA endorsement as a  prophetic, religiously inspired position,  some politicians and commentators have suggested that the CHA members will directly benefit from a bill that expands the number of patients able to pay their bills. If so, the CHA's uneasiness is more understandable. At the same time, strengthening Catholic hospitals seems like a good thing, so why not just acknowledge the hope that hospitals will  benefit?

Catholic and Pro-life Leaders: Health Bill Postmortem

Here's my article on reactions to the bill's passage by Catholic and pro-life leaders.

They give high marks to the USCCB and vent frustration regarding the Catholic Health Association's endorsement.

Catholic Church's Healthcare Debate/War

Capital Hill has endured months of wrangling over health care reform. Now the debate has moved to the Catholic Church, as we face the cathartic moment of an extended, deeply frustrating political drama. As this battle within the Church plays out in real time, a friend of mine who works at the highest levels of "Catholic health care" wrote this message:

"The Church and shadow-Church and the Magisterium and parallel-magisterium are finally, after 45 years, on public display with a clarity that no Catholic can ignore.  If the health bill passes, with "Catholic health care" support, we will have moral crisis the likes of which we have not seen since slavery since every Catholic will be paying to provide abortion."

From the beginning, the U.S. bishops wanted to make universal health insurance a reality. That was clear. They offered just a handful of preconditions: no federal funding of abortion and robust conscience protections. President Obama said he would honor those concerns. The hierarchy was heartened by the Stupak amendment, which imposed an outright ban on federal funding of abortions. The Senate chose a different path. More wrangling, more closed door meetings. By last Friday, the Democratic party leadership walked away from negotiations with Stupak, and the USCCB had to walk away from a tempting, if flawed solution to the mounting red ink that has forced the closing of many Catholic hospitals throughout the country.

Then Sister Carol Keehan, the president and CEO of the Catholic Health Association backed the Senate bill, a move that prompted Archbishop Charles Chaput, O.F.M.Cap. of Denver, the USCCB President, Cardinal Francis George of Chicago, and Archbishop Dolan of New York to reaffirm the USCCB position--and Cardinal George explicitly  took  aim at Sister Keehan's stance. A few days pass, and two House Democrat holdouts signal their willingness to climb on board the Obamacare train.

Yesterday, the Leadership Conference of Women Religious, already smarting from Rome's decision to launch an apostolic visitation that will review the practices of progressive-minded U.S.women's congregations, issued a statement of support for the Senate bill. Will the statement provide cover for a few more Democrats to back the Senate bill? We'll know the answer to that question very shortly.

Today, the orthodox Council of Major Superiors of Women Religious  jumped into the fray with a statement backing the U.S. bishops as the authoritative voice for the Catholic Church.  Meanwhile,  the USCCB has issued yet another statement that provides further ammunition for pro-life opponents of Obamacare.

I've posted the USCCB response in full below:

U.S. BISHOPS PROVIDE RESOURCES EXPLAINING FLAWS IN SENATE HEALTH CARE BILL  WASHINGTON—The United States Conference of Catholic Bishops (USCCB) has made available several new resources explaining its calls for essential changes to the Senate health care reform bill. In a March 15 statement, Cardinal Francis George of Chicago, President of the USCCB, said that the U.S. bishops would, regretfully, have to oppose the final bill if these changes were not made.             The resources are available at: www.usccb.org/healthcare             Among them is an analysis of the abortion funding provisions of the Senate health care bill that highlights the bishops’ objections (www.usccb.org/healthcare/030410facts.pdf). Two pieces respond to recent criticisms of the bishops’ position on the health care bill, namely criticisms from Timothy Stoltzfus Jost of Washington and Lee University Law School (www.usccb.org/healthcare/jost-response.pdf) and the other regarding the funding of abortion at community health centers (www.usccb.org/healthcare/communityhealthcenters.pdf).             With so much of the health care debate focusing on the nature of the legal “status quo” of federal abortion funding, the page also features a backgrounder on current federal policy on abortion funding (www.usccb.org/prolife/issues/healthcare/abortion_funding_102309.pdf) and an analysis of the House health care bill’s Stupak Amendment (www.usccb.org/healthcare/StupakAmendmentFactsheet.pdf). Update: The USCCB just issued a sharply worded  "clarification," responding to a statement issued by the religious lobbing group, NETWORK, which sent a letter to every member of the U.S. Congress endorsing the Senate bill and purported to represent  tens of thousands of women religious. The USCCB clarification is offered in full here: "Washington—A recent letter from Network, a social justice lobby of sisters, grossly overstated whom they represent in a letter to Congress that was also released to media.  Network’s letter, about health care reform, was signed by a few dozen people, and despite what Network said, they do not come anywhere near representing 59,000 American sisters. The letter had 55 signatories, some individuals, some groups of three to five persons.  One endorser signed twice.  There are 793 religious communities in the United States.  The math is clear. Network is far off the mark." Most unusual! Hard to know where this debate/war is headed. Will it be papered over, once the dust settles? Or will the fissures revealed in these statements erupt into something more definitive--that much discussed, long anticipated schism?     Sister Mary Ann Walsh Director of Media Relations United States Conference of Catholic Bishops

Cardinal George, USCCB President, Rejects Senate Health Bill

Today, hours after Archbishop Chaput issued his broadside against the Senate health care bill, and expressed his frustration with "Catholic" groups that appeared to undercut the Catholic church's united effort to defend the unborn, Cardinal George issued his own compelling statement, printed in full below:

PRESIDENT OF U.S. BISHOPS SAYS COST IS TOO HIGH, LOSS IS TOO GREAT FOR HEALTH CARE BILL NOT TO BE REVISED

The Catholic Bishops of the United States have long and consistently advocated for the reform of the American health care system. Their experience in health care and in Catholic parishes has acquainted them with the anguish of mothers who are unable to afford prenatal care, of families unable to ensure quality care for their children, and of those who cannot obtain insurance because of preexisting conditions.

Throughout the discussion on health care over the last year, the bishops have advocated a bipartisan approach to solving our national health care needs. They have urged that all who are sick, injured or in need receive necessary and appropriate medical assistance, and that no one be deliberately killed through an expansion of federal funding of abortion itself or of insurance plans that cover abortion. These are the provisions of the long standing Hyde amendment, passed annually in every federal bill appropriating funds for health care; and surveys show that this legislation reflects the will of the majority of our fellow citizens. The American people and the Catholic bishops have been promised that, in any final bill, no federal funds would be used for abortion and that the legal status quo would be respected.

However, the bishops were left disappointed and puzzled to learn that the basis for any vote on health care will be the Senate bill passed on Christmas Eve. Notwithstanding the denials and explanations of its supporters, and unlike the bill approved by the House of Representatives in November, the Senate bill deliberately excludes the language of the Hyde amendment. It expands federal funding and the role of the federal government in the provision of abortion procedures. In so doing, it forces all of us to become involved in an act that profoundly violates the conscience of many, the deliberate destruction of unwanted members of the human family still waiting to be born.

What do the bishops find so deeply disturbing about the Senate bill? The points at issue can be summarized briefly.  The status quo in federal abortion policy, as reflected in the Hyde Amendment, excludes abortion from all health insurance plans receiving federal subsidies. In the Senate bill, there is the provision that only one of the proposed multi-state plans will not cover elective abortions – all other plans (including other multi-state plans) can do so, and receive federal tax credits. This means that individuals or families in complex medical circumstances will likely be forced to choose and contribute to an insurance plan that funds abortions in order to meet their particular health needs.

Further, the Senate bill authorizes and appropriates billions of dollars in new funding outside the scope of the appropriations bills covered by the Hyde amendment and similar provisions. As the bill is written, the new funds it appropriates over the next five years, for Community Health Centers for example (Sec. 10503), will be available by statute for elective abortions, even though the present regulations do conform to the Hyde amendment. Regulations, however, can be changed at will, unless they are governed by statute.

Additionally, no provision in the Senate bill incorporates the longstanding and widely supported protection for conscience regarding abortion as found in the Hyde/Weldon amendment. Moreover, neither the House nor Senate bill contains meaningful conscience protection outside the abortion context. Any final bill, to be fair to all, must retain the accommodation of the full range of religious and moral objections in the provision of health insurance and services that are contained in current law, for both individuals and institutions.

This analysis of the flaws in the legislation is not completely shared by the leaders of the Catholic Health Association. They believe, moreover, that the defects that they do recognize can be corrected after the passage of the final bill. The bishops, however, judge that the flaws are so fundamental that they vitiate the good that the bill intends to promote. Assurances that the moral objections to the legislation can be met only after the bill is passed seem a little like asking us, in Midwestern parlance, to buy a pig in a poke.

What is tragic about this turn of events is that it needn’t have happened. The status quo that has served our national consensus and respected the consciences of all with regard to abortion is the Hyde amendment. The House courageously included an amendment applying the Hyde policy to its Health Care bill passed in November. Its absence in the Senate bill and the resulting impasse are not an accident. Those in the Senate who wanted to purge the Hyde amendment from this national legislation are obstructing the reform of health care.

This is not quibbling over technicalities. The deliberate omission in the Senate Bill of the necessary language that could have taken this moral question off the table and out of play leaves us still looking for a way to meet the President’s and our concern to provide health care for those millions whose primary care physician is now an emergency room doctor. As Pope Benedict told Ambassador to the Holy See Miguel H. Diaz when he presented his credentials as the United States government’s representative to the Holy See, there is “an indissoluble bond between an ethic of life and every other aspect of social ethics.”

Two basic principles, therefore, continue to shape the concerns of the Catholic bishops: health care means taking care of the health needs of all, across the human life span; and the expansion of health care should not involve the expansion of abortion funding and of polices forcing everyone to pay for abortions. Because these principles have not been respected, despite the good that the bill under consideration intends or might achieve, the Catholic bishops regretfully hold that it must be opposed unless and until these serious moral problems are addressed.

update; The Vatican newspaper published an article identifying the U.S.bishops as the authoritative voice for the Church on the health care reform debate--an implicit repudiation of any attempt to provide moral equivalence between the USCCB and the Catholic Health Association.