Before the Cross | Catholics must work to protect the conscience rights of health care providers

Before the Cross - Archbishop Robert J. Carlson's Column

Days before final votes in Congress on the Affordable Care Act, Cardinal Francis George, then president of the U.S. Conference of Catholic Bishops, reaffirmed what we bishops had said many times over the previous year: "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."

The final legislation passed by Congress was flawed in several respects. It fell short of universal access, most notably with respect to immigrants. For the first time in decades, it allowed for federal funding of elective abortions and of health benefits plans that cover such abortions. It excluded longstanding protections for conscience rights on abortion by failing to apply the annual Hyde-Weldon amendment to the billions of dollars newly appropriated by the act. And it created new open-ended mandates for "essential health benefits" and "preventive services" to be included in almost all private health plans, without any provision for individuals or institutions that may have a moral or religious objection to particular items or procedures.

This last deficiency in the statute has now been exploited by the Department of Health and Human Services to impose a nationwide mandate for coverage of all FDA-approved contraceptive drugs -- including at least one abortion drug -- sterilization procedures and education and counseling to promote these to "all women with reproductive capacity." The HHS rule includes an exemption for "religious employers" so narrowly crafted that many religious organizations cannot fulfill any of its four requirements, let alone all four. Catholic health care providers, educational institutions and social services agencies would have to be listed in the tax code as a church or similar narrowly defined entity, make the inculcation of religious doctrine their organizational purpose, and largely refuse to hire or serve non-Catholics to be fully eligible. It has been said that Jesus and the apostles would not be "religious enough" under such a test, as they served and healed people of different religions.

Here we see immediately how a failure to respect conscience rights poses a serious threat to the goal we share of expanding access to health care. For under the new HHS mandate, Catholic organizations committed to their moral and religious teaching will have no choice but to stop providing health care and other services to the needy who are not Catholic, or stop providing health coverage to their own employees. This is an intolerable dilemma, and either choice will mean reduced access to health care.

In this new rule, we have moved very far from the longstanding consensus on respect for rights of conscience that has prevailed in the federal government for decades. To cite just one instance, when Congress decided to require contraceptive coverage in the Federal Employees Health Benefits Program in 1999, there was also a strong bipartisan consensus that any health plan would be exempt if its carrier simply objected on the basis of religious beliefs -- and that individual health care providers in all plans would be protected from being required to violate their religious beliefs or moral convictions.

This policy remains in place to this day. So for the past 12 years, a Catholic health system could offer a health plan without contraceptive coverage to anyone who wanted it, including federal employees -- yet now it will be prohibited from offering such a plan to anyone, even its own employees.

Write to your representatives and senators. Insist that respect for the rights of conscience be an integral part of all health care legislation and policy. Such accommodations have been the norm in federal law for many years, and it is long overdue that they be permitted by the health care reform law as well.

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