What the US bishops want to see in health care reform

Washington D.C., Mar 8, 2017 / 15:29 pm

As Congress considers a new health care law, the U.S. bishops are calling for a plan that does not fund abortion, but respects conscience rights, while also ensuring universal access to affordable health care.

"The Bishops of the United States continue to reject the inclusion of abortion as part of a national health care benefit," four committee chairs for the U.S. bishops' conference said in a letter to Congress this week, while adding that "all people need and should have access to comprehensive, quality health care."

The bishops' letter, sent to all members of Congress on Tuesday, was signed by Cardinal Timothy Dolan of New York, chair of the U.S. bishops' pro-life committee; Archbishop William Lori of Baltimore, chair of the bishops' religious liberty committee; Bishop Joe Vasquez of Austin, chair of the bishops' migration committee; and Bishop Frank Dewayne of Venice, chair of the bishops' domestic justice and human development committee.

In the letter, the bishops responded to House Republicans' recently unveiled plan to take the place of the Affordable Care Act.

Entitled the American Health Care Act, the proposed plan would scrap the old individual and employer mandates and expand the available tax credits available to purchase health insurance.

However, those who drop their plans and delay too long in buying a new one could see a penalty of up to 30 percent of their new plan's premiums for having a gap in coverage. Critics charge that this could unfairly penalize those who choose to go without health insurance, or even deter them from buying a new plan when they get sick.

The bill would also double the amount that could be contributed to health savings accounts, or tax-free accounts to save money for out-of-pocket medical expenses.

At a Tuesday press conference introducing the plan, House Speaker Paul Ryan (R-Wisc.) said that the bill is only the first phase of a three-part program that includes deregulation of the health care market and additional reforms, giving consumers the "freedom to buy" the health coverage they want.

Abortion controversy

Pro-life groups have hinged their support of a replacement plan for the Affordable Care Act on whether any taxpayer subsidies or tax credits would fund abortions.

Rep. Kevin Brady (R-Tex.), chair of the House Ways and Means Committee, told EWTN News Nightly's Jason Calvi that he expected Senate staffers to work to ensure no abortion coverage is funded in the law through subsidies or tax credits.

In addition, the proposed bill would defund Planned Parenthood, the nation's largest performer of abortions, for one year, around $400 million.

Abortion funding has long been a controversial subject in health care. The Hyde Amendment – a policy passed yearly by Congress as part of appropriations bills – prohibits federal funding of abortions except in cases of rape, incest, or when the life of the mother is at stake.

This policy "must extend to any relevant health care plan," the bishops insisted on Wednesday. No federal subsidies for health insurance coverage – or even tax credits for coverage – should pay for any "health care plans that cover abortion," they stated.

While President Barack Obama signed an executive order stating that an enforcement mechanism must be found to ensure no abortion funding under the Affordable Care Act, a 2014 report by the Government Accountability Office found that this might not have been the case.

The report found that 15 insurers and one state exchange were not itemizing abortion coverage in health plans offered on the exchanges and did not indicate that such abortion coverage was billed separately. Thus, federal subsidies could very well have paid for abortion coverage.

Also, in five states, all the health plans offered on the exchanges covered abortions, offering no alternative to those conscientiously objecting to paying for abortion coverage in their plans.

The U.S. bishops' conference had originally opposed the Affordable Care Act because they believed the executive order would not be enough to prevent abortion funding. Cardinal Francis George of Chicago, then-president of the U.S. bishops' conference, had stated of the bill that "there is compelling evidence that it would expand the role of the federal government in funding and facilitating abortion and plans that cover abortion."

Changes in coverage

Universal access to health care, including for those immigrants left out of coverage under the Affordable Care Act, must also be part of new legislation, the bishops insisted.

"Any modification of the Medicaid system as part of health care reform should prioritize improvement and access to quality care over cost savings," they added.

Some of the biggest changes under the proposed bill would be to federal subsidies, ending the expansion of federal Medicaid grants to states after several years, and determining Medicaid grants to states based on their numbers of Medicaid patients.

The Affordable Care Act's Medicaid expansion had helped those caring for elderly parents and drug addicts, argued Rep. Richard Neal (D-Mass.), ranking member on the Ways and Means Committee. This would be cut in the new health care bill.

The Medicaid expansions provided many low-income Americans with coverage and these expansions should not be erased, the U.S. bishops said, noting that "those who are essentially the working poor or who find themselves one crisis away from falling into deep poverty" were covered "for the first time" under the Medicaid expansion.

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If the expansion is rolled back, these families should be exempt from premiums "through some other means," they said.

Furthermore, the bishops advocated for health-sharing ministries, saying, "Those who choose to participate in alternative approaches like health sharing ministries should retain the ability to do so and be further supported."

Louis Brown, director of one such Catholic ministry, called CMF Curo, stressed that health-sharing ministries must have "equal access to health savings accounts" so participants can save like everyone else for out-of-pocket medical expenses.

Other concerns in health care

A number of policies in the Affordable Care Act remain in the bill, or will be phased out over the period of several years. Young adults are still allowed to remain on their parents' health insurance plans until age 26, and insurers are still prohibited from denying coverage based on pre-existing medical conditions.

Brown told CNA that the plan "is a first step to restoring an American health care system where the dignity of the person is at the center, not the mandates of the government."

Under the current system, he said, "the federal government was dictating so much of what the market looks like, and it wasn't doing a good job of that," thus driving up health insurance premiums even more in some areas.

The average "benchmark silver" premiums were reportedly set to rise 22 percent in 2017, it was predicted in October. Although federal subsidies would offset cost increases for eligible Americans, others saw their premiums rise but were not eligible for these subsidies.

Also, in more than 1,000 counties, there was only one insurer offering plans on the exchanges, and in some counties all insurers had pulled out of the exchange.

There were also serious religious freedom concerns with the health care system, in part because of government mandates like the birth control mandate.

The Affordable Care Act had mandated preventative coverage in employee health plans, which the Department of Health and Human Services later interpreted to include employer coverage for sterilizations, contraceptives, and drugs that can cause early abortions.

And the recent transgender mandate that doctors perform gender-transition procedures if asked to do so, despite any concerns they might have about the patient's health, was another example of this, said Brown.

"Too much of the Affordable Care Act was used as a vehicle to undermine the right of conscience and religious freedom in health care," he said.

The bishops also pushed for the conscience rights of health care professionals in their letter. The bishops' conference has previously pushed for the passage of the Conscience Protection Act, which would establish federal protections for doctors or hospitals conscientiously objecting to performing abortions.

"Such protections should extend to all stakeholders, including insurers, purchasers, sponsors, and providers and should cover any regulatory mandates," the bishops said in their letter.