WASHINGTON — Congressional Republicans’ recent steps to repeal and replace the Affordable Care Act (ACA) has bishops, as well as some Catholic elected leaders and health care officials, concerned about millions of Americans possibly losing access to quality and affordable medical care.

In a May 4 statement, Bishop Frank Dewane of Venice, Florida, chairman of the U.S. Conference of Catholic Bishops’ Committee on Domestic Justice and Human Development, called on the U.S. Senate to remove “harmful” provisions from the American Health Care Act (AHCA) when that chamber takes up the bill for consideration.

Bishop Dewane told the Register that the current version of the bill, while having some positive provisions such as improved life protections and restrictions against abortion funding, would create new barriers for millions of Americans who need health care.

“Overall, it’s just that too many people start to fall out of the plan, and that causes us great concern,” Bishop Dewane said.

But at the same time, pro-life advocates and other Catholic observers are pleased that the legislation the GOP-controlled House of Representatives passed on May 4 redirects tax dollars from Planned Parenthood to community health centers and prohibits taxpayer funding of health care plans that cover abortion.

“As this bill moves to the Senate, we urge our U.S. senators to follow the House’s lead and ensure that pro-life protections and the redirection of Planned Parenthood funding remain, because without it, this bill will fail,” said Jeanne Mancini, the president of March for Life.

Whether the anti-abortion provisions stay in the health care legislation that emerges from the Senate remains to be seen. The GOP has a razor-thin majority with 52 seats, and Sen. Mitch McConnell, the majority leader, is expected to bring a bill to the Senate floor that can appeal to Republican moderates and prevent one or two members of his caucus from joining the 48 Democrats who will surely all vote against a measure that repeals President Barack Obama’s signature health care law.

Joshua Mercer, political director of CatholicVote.org, a conservative nonprofit political advocacy group, told the Register that the GOP Senate leadership probably wants to prevent a scenario where Vice President Mike Pence casts the tie-breaking vote. Such a vote would give Democrats a key talking point for the 2018 midterm elections.

Mercer also said the Senate could either draft its own legislation from scratch, or take the House bill and amend it to include more generous tax credits for low-income and older Americans, as well a modest expansion of Medicaid. “Both those things would make the Senate Republicans, who are more moderate than the House Republicans, a lot happier,” Mercer said.

 

Senate Republicans

Some concerns within the Senate’s GOP caucus over the House health care bill are already showing. Sen. Lindsey Graham of South Carolina panned the bill for having been passed with only three hours of debate and without an analysis from the non-partisan Congressional Budget Office.

Such a bill, Graham said, “needs to be viewed with suspicion.”

Stephen Schneck, former director of the Institute for Policy Research & Catholic Studies at The Catholic University of America, told the Register that the American Health Care Act was rushed through the House with no public hearings.

“The process was problematic in a lot of ways, and the Senate rightfully is concerned about all of that,” said Schneck, who served as a national co-chair of Catholics for Obama. He predicted that Republican budget hawks will also have issues with the possibility that the bill could drive up the national deficit in the form of huge tax breaks to wealthy Americans. “With the level of disagreements among Republicans, this is going to be a very slow process,” Schneck said.

The House measure barely made it through the chamber, as 20 Republicans split with their party to vote against the bill. The legislation passed by a vote of 217 to 213, just one vote over the 216 needed. Not one House Democrat voted for the measure.

 

The Bill’s Contents

Among its provisions, the AHCA eliminates the Affordable Care Act’s individual mandate that Americans buy health insurance or pay fines. The legislation also replaces subsidies to help people purchase insurance on the exchanges with refundable tax credits based on age.

The bill freezes Medicaid expansion, repeals all ACA taxes, creates high-risk insurance pools to cover the most expensive people to insure, and enables states to grant waivers to insurance companies to charge higher premiums for people with pre-existing conditions.

Bishop Dewane expressed concern with the Medicaid freeze, adding that many struggling families rely on Medicaid for health coverage. “There are some positive aspects without a doubt, but we try to stress that all people in every family have to be able to see clearly how they’ll fit within and have access to the health care system in a way that meets their needs, and that isn’t there right now,” Bishop Dewane said.

Robert Destro, the founding director of the Interdisciplinary Program in Law & Religion at The Catholic University of America’s Columbus School of Law, told the Register that he is not surprised that the cost of Medicaid expansion has been a stumbling block in Congress because the costs to insure an expanded Medicaid population could be significantly higher than expected. “The whole goal of Obamacare was to move us closer to a single-payer system, and that’s really what the Medicaid expansion was about,” Destro said. “If you think about what single payer would look like, it would look like either Medicaid or Medicare, but most likely Medicaid.”

Led by House Speaker Paul Ryan and President Donald Trump, Republican leaders worked hard to gather enough GOP votes in the House about two months after Ryan had to cancel a vote on an earlier version of the bill that lacked support from the Freedom Caucus, which is composed of conservative and libertarian Republican House members.

Mercer credited Trump with helping to marshal enough support to get the bill through the House.

“You have to give some credit to President Trump knowing how much of his legacy was tied into this,” Mercer said. “He worked the phones a lot, and he put pressure on the Freedom Caucus from the left and right.”

But getting the support of the Freedom Caucus — whose members came around on a far more conservative version of the AHCA — alienated several House Republicans, including Chris Smith of New Jersey. Smith, the co-chairman of the Bipartisan Congressional Pro-Life Caucus, said he voted against the AHCA largely because the bill cuts Medicaid funding by $839 billion. He said the bill’s provisions would hurt disabled persons, “especially and including” children and adults with autism, as well as the elderly and the working poor.

“Over the past several years, we have seen the flaws of Obamacare, including increased premiums and deductibles, diminishing health care options and patients losing plans they were assured they could keep,” Smith said. “These very real problems underscore the need for meaningful bipartisan reform.”

Bishop Dewane said the bill’s measures to provide flexibility and additional health care options require appropriate safeguards so that the effectiveness and reach of the nation’s health care system is not curtailed. The bishop also expressed concerns about the bill’s tax-credit system. He said it could make it more difficult for people to afford health insurance, especially low-income families and elderly Americans on fixed incomes.

“A lot of people may have access, but if they don’t have the funds to buy it, it becomes almost a moot point,” said Bishop Dewane, who added that he would like to see conscience rights for all stakeholders, including insurers, purchasers, sponsors and providers.

“These conscience rights need to be honored, but that’s presently not there,” the bishop said.

Sister Carol Keehan, president and chief executive officer of the Catholic Health Association of the United States, also expressed deep concerns with the House bill, which she said “threatens the health coverage of millions of Americans” who have gained coverage through the Affordable Care Act.

Analyzing health care reform through a Catholic social teaching perspective, Destro said a tension exists between the right of people to control their own health care decisions and the need to help Americans who do not receive health insurance from an employer and earn too much money to qualify for Medicaid.

Said Destro, “The question that Catholics have to answer is: How do we balance the principle of subsidiarity and the principle of solidarity?”

 

Support

Some Catholic medical observers praised House Republicans for passing the bill. Louis Brown, director of the Christ Medicus Foundation CURO, a Catholic faith-based health care cost-sharing ministry, described the AHCA as an important first step to improving health care for all Americans, especially the vulnerable.

“The American Health Care Act promises to deliver relief from the Affordable Care Act and to empower truly affordable, patient-centered health care. The bill also would provide significant funding for those with pre-existing conditions through high-risk insurance pools,” Brown said in prepared remarks.

Some key pro-life leaders are also on board with the health care-reform effort. Marjorie Dannenfelser, president of the Susan B. Anthony List, congratulated House Republicans and called on the Senate to keep the measure’s “non-negotiable” pro-life provisions and “quickly advance” the bill to the president’s desk.”

Lila Rose, founder and president of Live Action, called the House vote on the AHCA a “huge step” toward ending taxpayer support of Planned Parenthood.

“We have a president who is prepared to sign this long-awaited bill into law, so I urge the Senate to move quickly to pass it,” Rose said in prepared remarks.

Schneck said he expects the Senate, where McConnell has assembled a working group to draft the chamber’s version of health care reform, to take its time before bringing a bill to the floor, which he said might not happen until the fall because of recent turmoil in Washington over Trump firing FBI Director James Comey on May 9.

However, Mercer said he does not expect the Comey controversy to impact health care reform.

“House Republicans like their bill, but they know the chance of the final bill being 99% of what they passed is rare,” Mercer said. “That almost never happens.”

Destro said he believes the Senate’s working group will seek to tackle tough problems in the medical industry, such as the high price of prescription drugs. He said the senators have shown themselves to be concerned especially with people in the middle who would not qualify to be covered under Medicaid expansion.

“I think you will see a lot of innovative things coming from them,” Destro said. “They recognize that one of the problems with being poor or being under-employed is that you don’t have the same flexibility that everybody else has.”

Brian Fraga writes from

Fall River, Massachusetts.

This story was updated at 5:30pm Eastern May 19.