WASHINGTON — As President Obama signed the bitterly contested bill overhauling the U.S. health-care system yesterday, the legislation’s passage prompted regret, recriminations and defiance among Catholic and pro-life leaders.

In the final weeks of negotiations on Capitol Hill, the U.S. Conference of Catholic Bishops found its most dependable support in Rep. Bart Stupak, D-Mich., the author of the Stupak-Pitts amendment, who vowed with other pro-life House Democrats to block passage of the bill if it failed to include adequate conscience provisions and an explicit ban on federal funding of abortions.

Then, without warning, Stupak moved to support the $940-billion Patient Protection and Affordable Care Act. The congressman justified his reversal by pointing to a presidential executive order that resolved his anti-abortion concerns.

The 11th-hour executive order was just the final twist in a complex, often unpredictable legislative battle.

In an extended process that both transfixed and frustrated Capitol Hill and much of the nation, the U.S. bishops’ conference exerted its moral sway and promised the full weight of its institutional support — if and only if the bishops’ concerns were fully addressed in the bill’s final language.

The bishops had lobbied for years to make universal health care a reality. The final version of the legislation, however, violates fundamental precepts of Catholic moral doctrine and social justice.

Shortly after the president signed the bill into law yesterday, the USCCB’s president, Cardinal Francis George of Chicago, joined by members of the conference’s administrative committee, issued a statement that expressed skepticism regarding the impact of the presidential executive order.

“We share fully the admirable intention of President Obama expressed in his pending executive order, where he states, ‘It is necessary to establish an adequate enforcement mechanism to ensure that federal funds are not used for abortion services,’” said the statement, which was approved unanimously by the 32-member Administrative Committee of the USCCB. “We do not understand how an executive order, no matter how well intentioned, can substitute for statutory provisions.”

The bishops’ statement also restated the Church’s concerns regarding the absence of adequate conscience protections, “both within and beyond the abortion context.”

“As well, many immigrant workers and their families could be left worse off since they will not be allowed to purchase health coverage in the new exchanges to be created, even if they use their own money,” the statement pointed out.

Catholic Misrepresentation?

Stupak’s public embrace of the executive order baffled and angered many of his onetime pro-life allies, who contend that it cannot secure their legislative objectives.

Richard Doerflinger, associate director of the bishops’ secretariat for pro-life activities, and the conference’s foremost pro-life lobbyist, noted in a published interview that in the wake of Roe v. Wade a series of court decisions confirm that “health legislation creates a statutory requirement for abortion funding, unless Congress clearly forbids such funding.” In contrast, presidential executive orders can easily be rescinded.

Given the Democrats’ dominance on Capitol Hill, the struggle to include anti-abortion provisions in the health-care overhaul was always a high-wire endeavor.

As they ponder their defeat, anti-abortion activists applaud the USCCB and reserve their recriminations for Stupak, liberal activists who misrepresented abortion provisions in the bill — and then spread confusion through the media — and the damaging impact of dissident Catholic groups that undercut the bishops’ moral authority.

“In my lifetime, I’ve never seen the bishops do a better job of addressing an issue of major importance. For over a year, they have worked on the Hill to get their point of view heard,” said Bill Donohue of the Catholic League for Religious and Civil Rights.

Like many activists, Donohue was deeply angered by the divisive role of various “Catholic” groups that contested the bishops’ stance.

Indeed, if Stupak’s change of heart signaled ultimate defeat, his decision was preceded by an equally troubling action taken by the Catholic Health Association: Sister Carol Keehan, the Catholic Health Association president and CEO, issued a widely publicized endorsement of the bill during the final week of negotiations.

The health bill’s supporters on the Hill and in the media used the Catholic Health Association endorsement to attack the bishops’ credibility as moral and religious leaders.

“The divisions in the Church greatly harm our ability to give a clear witness,” said Bishop R. Walker Nickless of Sioux City, Iowa. “As bishops, we don’t want power or influence, but we want to speak as clearly as possible on moral issues. The political position of Catholics in public office has to be held to a higher standard.”

Archbishop Charles Chaput of Denver, in a column published Monday in his archdiocesan paper, adopted a sharper tone.

“In the crucial final days of debate on health-care legislation, CHA lobbyists worked directly against the efforts of the American bishops in their approach to members of Congress. The bad law we now likely face, we owe in part to the efforts of the Catholic Health Association and similar ‘Catholic’ organizations.”

“The CHA statements were tremendously damaging,” said Charmaine Yoest, president and CEO of Americans United for Life, who noted that they were used in media campaigns attacking Stupak in his home district.

Constantly Shifting Process

Pro-life leaders acknowledge that voter confusion regarding both the legislative process and the substance of the proposed legislation further complicated their legislative strategy.

“The challenge for the bishops, and for all of us, was the way this legislation evolved,” observed Father Frank Pavone of Priests for Life. “News stories talked about reconciliation, but few people knew exactly what that covered. The constantly shifting legislative process made it difficult to activate the parishes to back the USCCB.”

The spectacle of Stupak’s last-ditch negotiations with his party leadership created the impression that reconciliation could actually address his concerns. But reconciliation was limited to budgetary issues.

To accommodate Stupak’s concerns, the Senate would have to go back and redraft its own bill, and then vote on it again. However, Senate Democrats had chosen reconciliation precisely because Scott Brown’s surprise victory in the Massachusetts Senate race eliminated their filibuster-proof majority. Reconciliation was the only way to get the bill passed — unless pro-life House Democrats like Stupak refused to go along with their party leadership.

“Maybe the USCCB could have addressed this impasse sooner and explained that the Senate Democrats couldn’t risk a legislative defeat,” noted James Capretta, a fellow in the Economics and Ethics Program at the Ethics and Public Policy Center, a Washington, D.C., think tank. “But it’s not the bishops’ problem that Scott Brown won the election.”

Some Catholics have questioned whether what is widely characterized as a “top-down government takeover of health care” truly qualifies as fulfillment of the Church’s requirement to care for the sick.

“When I suggested that the Catholic principle of subsidiarity should also guide our evaluation of health-care plans, I received a lot of comments,” acknowledged Bishop Nickless. “Abortion is the primary issue, but the principle of subsidiarity also should be included in our criteria for better health-care solutions.”

Catholic Hospitals

Like most Catholic and pro-life leaders, Bishop Nickless wants the struggle for a morally sound health-care overhaul to continue.

“It’s a sad time in the Church, and we are going through this Lenten penance, but we are not giving up hope,” he said.

“Among the issues we must still consider is how the health-care bill will affect the operations of our hospitals.  Individual bishops will have to look at their hospitals to make sure they are going to respect life at all costs.”

In the days that have followed Stupak’s change of heart, pro-life activists have proposed a number of responses, including constitutional challenges in the courts. Moments after Obama signed the bill into law yesterday, the Thomas More Law Center filed a challenge to the health bill’s constitutionality in federal court on behalf of four plaintiffs who object both to being compelled to purchase health insurance and to being forced to contribute to the funding of abortion.

The suit, which invokes the Constitution’s commerce clause and its First, Fifth and 10th Amendments, argues that “there is no enumerated power in the Constitution that permits the federal government to mandate that every American citizen purchase or obtain health-care coverage or face a penalty.”

But Father Pavone also wants anti-abortion activists to swallow their sense of betrayal and stay engaged with House Democrats. “We need Democrats and Republicans in the ranks of the pro-life movement. We’re not a one-party movement,” he said. “Meanwhile, the health-care debate has raised public awareness about abortion funding. This will fuel concerns at the state level and federal level.”

Joan Frawley Desmond writes from Chevy Chase, Maryland.