Recent headlines have told the story “Catholic Hospitals, Bishops Split on Health Care” and “Catholic Bishops Fight for Authority Over U.S. Flock.”

These volatile headlines refer to the fact that some Catholic individuals and organizations publicly disagree with the U.S. bishops about provisions of the 2010 Patient Protection and Affordable Care Act, commonly known as Obamacare. This opposition from within the Church makes the bishops’ effort to preserve religious freedom much more difficult, for the Obama administration and some Democrat congressmen have been quick to use a “divide and conquer” strategy by invoking these dissident groups as if they are legitimate Catholic authorities.

The most prominent Catholic supporter of Obamacare has been the Catholic Health Association of the United States (CHA), led by its president and CEO, Sister Carol Keehan, a Daughter of Charity. Playing a supporting role for her have been the officers of the Leadership Conference of Women Religious (LCWR) and the conference’s lobbying arm, Network. Sister Carol declined to be interviewed for this story.

Not all sisters have followed the CHA and LCWR lead, however; for entire orders of women religious are beginning to speak out in support of the bishops. As of March 29, the Register had identified 23 orders of women religious who have posted on their websites statements supporting the bishops’ position. (See sidebar.)

Likewise, a statement of support has been issued by the Council of Major Superiors of Women Religious (CMSWR), an alternate superiors’ conference to LCWR that was canonically erected by the Vatican in 1992 after some superiors became disaffected with the LCWR leadership’s agenda to radically change religious life. CMSWR members are superiors who represent about 15% of U.S. women religious.

Nevertheless, Sister Carol and the other high-profile sisters who have publicly opposed the bishops’ position have been hailed by Obamacare supporters as having legitimate moral authority in the Church to counter the bishops. For example, on March 8 — International Women’s Day — Sister Carol was named by the Center for American Progress as one of “13 Religious Women to Watch in 2012 Changing the World for Good” because: “She was instrumental in garnering support for the Affordable Care Act in 2010, when CHA broke with the U.S. Conference of Catholic Bishops to publicly support the act. As a result, Keehan gave moral permission to legislators who were conflicted about supporting the bill.” 

So, what gives these sisters and the CHA authority to grant “moral permission” for disagreement with the nation’s bishops?

Nothing. Neither the sisters nor the CHA hold any authority to speak for the Church on faith and morals: That authority belongs to the bishops alone, as Archbishop Joseph Naumann of Kansas City, Kan., told Catholic News Service during his recent ad limina visit to the Vatican. He said that his group of Midwestern bishops also spoke with Vatican officials about the public support of the CHA and LCWR for the so-called “accommodation” in the HHS mandate. The bishops have rejected the “accommodation” because it still requires religious institutions to provide insurance that covers immoral services.

“Those efforts are really undercutting the Church and trying to divide it again by setting up two teaching authorities when there’s only one within the Church,” Archbishop Naumann said. “It’s a very serious issue, I think, particularly when religious try to insert themselves in the role of trying to be the teachers within the Church. They have important roles to play, but they are not the ones to teach on these matters.”

Furthermore, the CHA and the LCWR are run by executives who often issue statements without polling their full memberships on policy positions, even though they often imply a consensus of their members when that isn’t the case.

For example, the LCWR Feb. 10 statement of support for the HHS “accommodation” was issued in the name of its three officers only. Similarly, the CHA’s Feb. 10 statement was released only under the name of Sister Carol Keehan.

The LCWR and the CHA are closely linked, for the CHA board of trustees is made up chiefly of executives with the health-care systems that are sponsored by religious orders whose leaders belong to the LCWR. The canonical status of the two groups is different, however.

The LCWR is a canonically erected organization of religious superiors. In the 1950s, the Vatican had asked superiors to organize themselves into national conferences for mutual support and to facilitate communication with the Vatican. The LCWR now has about 1,500 members — only about 3% of the 55,000 Catholic sisters in this nation. The religious orders led by LCWR members hold about 85% of the nation’s women religious, but the individual sisters have no voice or vote at LCWR, even though the LCWR often claims to speak for the majority of U.S. sisters.

Since the LCWR is canonically erected, it must answer to the Vatican. The LCWR has had ongoing disagreements with Church authorities for years, and, in 2001, the Congregation for the Doctrine of the Faith warned the LCWR about several doctrinal errors it had made regarding homosexuality, ordination of women priests and acceptance of the doctrine reiterated in Dominus Iesus (On the Unicity and Salvific Universality of Jesus Christ and the Church).

In 2009, the CDF ordered a doctrinal assessment of the LCWR because the errors persisted. The LCWR also led highly publicized resistance to the recent apostolic visitation of women religious by the Congregation for Institutes of Consecrated Life and Societies of Apostolic Life. Results of those two Vatican initiatives have not yet been announced.

The CHA, on the other hand, is not an entity of the Catholic Church. It is not canonically erected, but is merely a trade organization that engages in political lobbying and professional development. It was started in 1915 by priests and sisters involved in health care, and now has a diverse membership that includes the religious orders that sponsor health-care facilities, as well as the facilities themselves, including health systems, hospitals, long-term-care facilities and related organizations. Most members are Catholic, but non-Catholic entities also may join if they meet certain requirements. CHA of the United States should not be confused with state CHAs, which are separate entities and usually associated with a state Catholic conference.

The CHA bylaws state: “The association shall maintain liaison and confer with the USCCB in those matters pertaining to religious and moral practice.” However, glaringly absent from the bylaws is any reflection of a commitment to the teachings of the Catholic Church or the authority of the U.S. bishops.

Canon law allows for these voluntary associations, but their oversight by Church officials is more nebulous than with a canonically erected entity. Canon lawyers consulted by the Register said that bishops have control over the use of “Catholic” in an association’s title (Canon 300 and 312:1:2), and a voluntary association needs the written consent of a diocesan bishop to establish itself in his diocese (Canon 312:2). Also, Canon 678 states that bishops maintain authority over the works of religious orders pertaining to “the care of souls, public exercise of divine worship and other works of the apostolate.”

The canonists said the bishops’ authority to shut down the CHA or a bishop’s ability to order a Catholic hospital in his diocese to leave the CHA were complex issues. However, in 2010, Bishop Thomas Tobin of Providence, R.I., did withdraw St. Joseph Health Services from CHA.

“I am very disappointed in the position that the CHA has taken under the leadership of Sister Carol Keehan on these last two issues — when Obamacare was passed and now with the debate over the HHS mandate,” Bishop Tobin said. “The whole debate over health care, and especially now the attack on the freedom of religion that will certainly affect the Catholic Church — this has been a moment of crisis and great anxiety for the Catholic Church — and it’s disappointing that one of the members of our family has abandoned us during this time.

“As I said in my letter to Sister Carol, I think it’s very divisive and causes confusion and scandal for people, and it does give a great deal of political cover to politicians who want to go off and do something that’s unacceptable.”

Bishop Tobin said that he was in a strong position to take this action since St. Joseph Health Services is sponsored by the diocese and not by a religious order. He said this was the only Catholic health system in his diocese, and he did not have all the canonical details about a bishop’s authority regarding membership in the CHA by a Catholic hospital or system not sponsored by the diocese.

“I think the bishops could certainly exert some moral influence and powers of persuasion even if they don’t have absolute canonical authority to do that,” Bishop Tobin said. “I’m sure they would have a great deal of weight doing that, because it is related to the Catholic mission and identity of the Catholic hospital or medical center.”

An active sister who did not want her name revealed because of possible repercussions in her order told the Register that some sisters have gotten so involved in doing the good work of taking care of the poor that “they have forgotten what being good — following the Gospel — really means.” Sister said that not all sisters whose religious orders sponsor hospitals in the CHA — as hers does — are happy with the stand of the CHA and the LCWR against the bishops. Individual sisters often have no power in their orders to change anything, she explained, and many are afraid to speak out because of retribution by their superiors.

Likewise, Leonard Nelson III, author of Diagnosis Critical: Urgent Threats Confronting Health Care, told the Register that the CHA supported Obamacare as a matter of social justice, but the CHA also was motivated by financial concerns. 

“The CHA was willing to accept reductions in future Medicare payments and compromise their independence from government control with the hope of being relieved of the burden of providing uncompensated care” said Nelson, who is a law professor at Samford University specializing in health-care law.

“For these purposes, CHA was willing to part with the bishops on the questions of whether there were adequate conscience protections and restrictions on federal abortion financing in Obamacare,” Nelson said.

Signs of discontent within CHA over its Obamacare positions also have surfaced, and at least one sister-sponsored system has voted with its feet: The board of trustees of the Franciscan Alliance, which runs 14 hospitals in Indiana and Illinois, withdrew its system from the CHA in 2010 and demanded a refund of its membership fee. The Franciscan Alliance is sponsored by the Sisters of St. Francis of Perpetual Adoration, Immaculate Heart of Mary Province.

Gene Diamond, CEO of the northern region of the four-region Franciscan Alliance, told the Register that “The bishops had taken a position on the passage of the Patient Protection and Affordable Care Act, and the Catholic Health Association, particularly Sister Carol Keehan, was attempting to lead Catholic hospitals in a different direction. We felt that it was important to support the bishops, particularly because we strongly agreed with them.”

Diamond said that he had concerns for years about the “woeful” ethical perspective of the CHA in its programs, seminars, speakers and publications. Thus, withdrawing from CHA membership has been “liberating” rather than detrimental, Diamond said. The principal “ostensible benefit” of membership in the CHA was to have a Catholic organization representing the members’ interests before Congress, the executive branch and various federal agencies, he explained.

“The problem is that they have been lobbying against our interests, not for our interests,” Diamond said.

Whether Catholic hospitals and health systems will stick with the CHA in opposition to the bishops is no doubt a big question now simmering in board rooms. An even bigger question is what the bishops will do about self-identified “Catholic” organizations that challenge the bishops’ moral authority, and how this outbreak of public dissent is likely to affect the bishops’ conference’s ability to secure religious freedom so that Church-affiliated institutions can continue their good works.

Religious Sisters Speak Out

As of March 29, 23 orders of women religious who have posted on their websites statements supporting the bishops’ position against the HHS mandate:

Dominican Sisters of St. Cecilia

Little Sisters of the Poor

Dominican Sisters of Mary, Mother of the Eucharist

Sisters of St. Francis of Perpetual Adoration, IHM Province

Sisters of Life

Carmelite Sisters of the Aged and Infirm

Carmelite Sisters of the Most Sacred Heart of Los Angeles

Religious Sisters of Mercy of Alma, Mich.

Daughters of the Immaculata

Dominican Sisters of the Immaculate Conception

Carmelite Sisters of the Divine Heart of Jesus, Central Province

Congregation of the Divine Spirit

The Dominican Sisters of Hawthorne, N.Y.

Franciscan Daughters of Mary, Covington, Ky.

School Sisters of St. Francis, Panhandle, Texas

Servants of Mary, Ministers to the Sick, Kansas City, Kan.

Sisters of St. Francis of the Holy Eucharist, Independence, Mo.

Sisters of the Resurrection, Castleton, N.Y.

School Sisters of Christ the King, Lincoln, Neb.

Franciscan Sisters of Dillingen, Immaculate Heart of Mary Province, Hankinson, N.D.

Sisters of Charity of Our Lady, Mother of the Church, Baltic, Conn.

Sisters of Our Mother of Divine Grace, Port Sanilac, Mich.

Daughters of St. Francis of Assisi, Lacon, Ill.

Register correspondent Ann Carey is the author of Sisters in Crisis: The Tragic Unraveling of Women’s Religious Communities.