In an appearance that boldly signaled the enduring intertwined interests of a political leader and an industry lobbyist, President Barack Obama was invited to give the keynote address today at the Catholic Health Association's annual conference in Washington, D.C. 

"It has been my privilege to work with the president and his team over the past seven years," said Sister of Charity Carol Keehan, who leads the Catholic Health Association, a lobby that represents Church-affiliated health care institutions, as she introduced Obama to conference attendees.

"With CHA’s deep gratitude for his leadership and concern for the well-being of all Americans, it is my honor and pleasure now to introduce the president of the United States, Barack Obama."

Five years ago, when the president signed the Affordable Care Act (ACA) into law, he gave one pen to Sister Carol, in recognition of her critical role in organizing support for the bill. Since then, through the troubled healthcare.gov rollout, the explosion of litigation arising from the Health and Human Services contraceptive mandate, and a GAO report, which found that plans authorized by the ACA were using federal dollars to fund abortions, Sister Carol has remained a staunch defender of the president and Obamacare.

Her support has helped to provide moral credibility for the administration during tough moments. Specifically, it helped to reassure Catholics, who have been concerned about the HHS mandate and reported violations of the president's promise that the ACA would not circumvent long-standing federal laws that barred the use of tax-payer funds to subsidize direct abortion.  That reassurance was offered even when the U.S.. Conference of Catholic Bishops, many other pro-life organizations, a government watchdog and even secular media offered clear proof that ACA-authorized plans required consumers to pay an abortion surchange, and that in some state exchanges, virtually every plan covered abortions. 

This year, as the U.S. Supreme Court prepared to consider the latest legal challenge to the ACA, the Catholic Health Association filed an amicus brief urging the high court to rule in the administration's favor. She marked the CHA brief with a press-conference video, which echoed the CHA's long-standing reasons for supporting the ACA. The video and brief dismissed constitutional questions about the tax subsidies now at risk in some states as a "technicality."

Sister Carol's public support for the president in this matter, and his appearance at the CHA event suggest that her standing as a  religious sister will, once again, be used to leverage political support for the president. And, in this case, it sent the  message that there will be hell to pay if the high court, specifically the four Catholic justices on the conservative wing, rule against the White House. 

What has the Catholic health care lobby and its members received in return for such support?

The ACA has been a "financial windfall" for much of the hospital industry. Indeed, Catholic hospital networks are outperforming their secular counterparts in some regions of the country, while standalone hospitals in poorer communities have fared less well.  

Meanwhile, critics say, this improved bottom line has come at the cost of fracturing the unity of Catholics and their leaders.  During an era of rising church-state conflict, Sister Carol has broken ranks with the U.S. bishops, and downplayed or dismissed serious ethical and religious-freedom concerns provoked by the administration's health-care policies.

Today, as the White House confirmed the president's appearance at the CHA event, it acknowledged Sister Carol's invaluable role.  

"President Obama will address their annual conference and thank them for their dedication to helping ensure all Americans have access to health care," read the White House post.

The White House used the CHA forum as an opportunity to "release updated data on how the Affordable Care Act is working in every state in the country," and it  announced  the launch of "a new interactive long form web page — 'Health Care in America'."