Less than one year after President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), the largest health-care legislation passed in the last 45 years, the House of Representatives has voted to repeal the law (and is pledging to hold hearings into its many provisions), more than half of the states have filed lawsuits to have the PPACA overturned, a key provision of the law was ruled unconstitutional by a federal judge on Jan. 31, and the majority of the public continues to voice opposition.
What should faithful Catholics be thinking and doing at this time?
I think Catholics should welcome this opportunity to review, and perhaps substantially revise, the PPACA as the law raises issues of prudence and principle requiring honest debate and timely action.
For example, there are key economic fault lines in the law that should be matters of serious prudential concern, particularly as the effects of governmental borrowing and spending are coming home to roost. Creative accounting was used during passage to make the apparent cost of the law seem acceptable, such as paying only six years’ worth of benefits with 10 years of revenue.
The “doc fix” in Medicare — which will cost at least $200 billion over a decade — was left off the table and the budgeting. Even apart from these two issues, the chief actuary of Medicare and Medicaid estimates that PPACA will add a minimum of $250 billion to the deficit. Health-insurance premiums are rising, and promise to go higher, and for good reasons. To name only one, PPACA will require health insurers to cover a range of preventive services at no up-front cost. This may seem convenient at the point of service, but the costs of the treatment must be paid at some point, and will result in higher premiums.
Furthermore, the new law will cause upheaval in people’s health-insurance coverage, notwithstanding Obama’s promise that people could keep their insurance if they liked it (and more than 80% of people are satisfied with their health insurance). Last fall, a respected health-insurance analyst estimated that 80 million-100 million people may well be forced to change their health-insurance arrangements between 2014 and 2016.
In a 2010 survey, only 55% of employers say they are likely to continue offering health insurance. The reason is that PPACA will raise the costs to employers of providing coverage, but level only a minimal fine if they decline to do so (and allow their employees to buy insurance in the new exchanges). The chief actuary of Medicare and Medicaid has estimated that at least 14 million employees will lose employer-provided coverage, while 7 million seniors will lose their Medicare Advantage plans. More than 18 million people receiving health-insurance coverage will be put on Medicaid, a system already failing to provide ready access to quality care.
Higher costs and disruptions in coverage will not be the only deleterious effects of the new law. While the government plans to cut costs in health care, most of these revolve around reducing payments to physicians and other health-care providers. Several national surveys of physicians show they understand this dynamic and fear for the future. A national survey conducted by Thomson Reuters recently reported that 65% of physicians think the quality of care will deteriorate in the next five years; 57% think the new system will be worse for patients, and 78% think it will be worse for physicians. Already burdened by regulations and battles over reimbursement with third-party providers (governmental and private), many physicians are contemplating early retirement.
Abortion Funding Beyond Dispute
As serious as these prudential issues are, they pale in comparison to the issues of principle at stake in the new law. For example, it is now beyond dispute that PPACA provides an avenue for federal subsidies of abortion. Whatever doubts existed evaporated when states began using federal funding for high-risk pools to pay for abortions. The nonpartisan Congressional Research Service found that neither PPACA itself nor the executive order precludes federal funds from subsidizing abortions. And former presidential chief of staff Rahm Emanuel admitted in a recent interview that he worked successfully to keep abortion advocates satisfied while convincing former Rep. Bart Stupak, D-Mich., to drop his amendment. Finally, PPACA forces people to subsidize the abortion coverage of others, even if they are opposed to abortion.
The PPACA also contains inexcusably flawed language regarding conscience protections. The law requires state and federal governmental bodies to respect rights of conscience with regard to assisted suicide and euthanasia, but not with regard to abortion and other medical procedures. (Only insurance plans are barred from discrimination based on refusal to participate in abortion.) Finally, language in the PPACA is vague regarding whether state-law protections of conscience will be respected in the new regime.
Vast New Federal Powers
Perhaps the core Catholic teaching least respected in the new legislation is the principle of subsidiarity. Essentially, this teaching holds that a larger (and more remote) entity should not usurp the authority and functions of a smaller, local entity. This principle has been repeatedly taught in encyclicals, most recently by Pope Benedict XVI in Deus Caritas Est (God Is Love): “We do not need a state that regulates and controls everything, but a state which, in accordance with the principles of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need.”
Yet the PPACA vests vast and unprecedented powers in the federal government, and within the government, in unelected bureaucrats and advisors. According to the Center for Health Transformation, the secretary of Health and Human Services was given 1,968 new or expanded powers, including the power to determine the type of insurance Americans must purchase, which hospitals can participate in certain programs, what health-care services are considered “essential,” etc. And a new Independent Payment Advisory Board (IPAB) will have the power to set the level of reimbursements in health care. Since it will take a supermajority vote in Congress to overturn its recommendations, the IPAB will largely determine which services will be provided and which will not. Taken together, the federal government will dictate to an unprecedented degree how much people must spend on health-care services, what services can be offered and what services will be denied, either explicitly or implicitly.
What is the proper response to the significant principled and policy flaws in the PPACA?
Given the issues at stake, Catholics should welcome the chance to review and revise the new law. While some problems — even those related to abortion funding and conscience rights — may be correctable by amending the current law, others, particularly those provisions violating the principle of subsidiarity, may well require substantial change.
There are a variety of political tools and options at hand. Catholics should make use of these judiciously. What Catholics should not do is either rest content with the status quo or become intimidated by the sheer scale of the challenge at hand. Catholics can bring many resources — from venerable teachings to hands-on experience in providing health care. Catholics should draw on the full spectrum of the Church’s teaching and provide a united witness on the principles of authentic health-care reform.
John F. Brehany, Ph.D., S.T.L., is executive director and ethicist at the Catholic Medical Association. More information about the CMA can be found at CathMed.org.
Edward Pentin: Images of Rome's 2013 March for Life
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The thing that this ignores is that the pre-health care bill system was not created by smaller entities. That system (health care tied to employment) was created by Federal Policy during WWII that capped salaries. So health benefits was another way to pay an employee.
So if the system before was created by government policy, why can’t the government change the policy?
The previous (very expensive) system was not created by free markets, but policy. Why do you ignore this in your post?
And health insurance is going up no matter what, this is just a good excuse for the insurance companies to do it.
And if 80 per cent of the people who have insurance are happy with it—what about all of the people who do not have access or cannot afford it?
Private insurance also forces people to subsidize abortion.
If you want folks to take your jornalism seriously, you need to find authors who are credible. The Catholic Medical Association? Give me a break.
Repeal and replace with a plan that celebrates life NOT death!
Great analysis outlining flaws in the health care bill. Republicans are not going to be able to repeal the law. Their repeal efforts are a means to put Democrats and Obama on record defending a bad bill. The Obama administration has already given almost 2,000 exemptions from the bill until after the 2012 elections so that people don’t see the effects of the bill before voting in 2012.
The real push will come in eliminating the most onerous provisions and correcting major defects. Congress has already approved in a bipartisan vote to eliminate the requirement that all businesses report to the IRS all expenditures over $600. What a outrageous job killing, growth restraining provision!
Raymond A.
Why don’t you think Dr. Brehany is credible?
What was different in the PPACA from existing Hyde admendment protections against Fed funding? What about Executive Order—Patient Protection and Affordable Care Act’s Consistency with Longstanding Restrictions on the Use of Federal Funds for Abortion?
I still maintain that until these questions are answered, the support of the healthcare law by many Catholics in healthcare was and is justified given the enormous social benefit.
I would appreciate serious answers to the above questions.
Thank you
@Frank Earnest
Those are really good questions. It seems that even the Hyde amendment had a number of loopholes. I think many Catholics were hoping that PPACA would do better.
You may be interested in this document:
http://www.usccb.org/prolife/HR3-testimony-2011-02-08.pdf
Let us know what you think.
Martin, Many thanks for this reference. I have not fully digested it, but my take is that the PPACA did not address the implementation issues that are addressed in the USCCB testimony. The testimony also preceded the Executive Order. As a Catholic and a physician, I must say that implementation is never perfect, and that there are tax cheats, and benefit cheats, and folks who will mis-direct or pervert the intent of legislation. However, I personally feel that the enormous benefit intended by the PPACA is an extra-ordinary moment in support of our Christian calling to heal and comfort the sick, and I am supportive of the stand taken by the CHA and other Catholics in support of the measure. I am opposed to abortion, but weary of its use as a trump card to opt out of dialogue about how society provides for those already born.
Thank you again for providing the reference for me.
Peace
@Frank Earnest. “However, I personally feel that the enormous benefit intended by the PPACA is an extra-ordinary moment in support of our Christian calling to heal and comfort the sick, and I am supportive of the stand taken by the CHA and other Catholics in support of the measure.”
I am glad for you that you “feel” the Democrat, pro-abortion party dictated so-called healthcare reform legislation “is an extra-ordinary moment in support of our Christian calling to heal and comfort the sick….” Since you identify yourself as a “physician,” and a Catholic, you have responded to the Christian calling to “heal and comfort the sick,” and that is good. But tell me, where did Jesus say in the Gospels He came to get you to get government to do the good works he taught his disciples and followers to do themselves?
As a physcian you know that no one in need of medical attention goes un cared for whether they have the money to pay for it or not. There is all kinds of help for such people. So why are you allowing your distortion of “our Christian calling” to interfer with my right to medical care where the decision for that care is made by me and my doctor without government bureaucrats making that decision for us?
@Laura. “So health benefits was another way to pay an employee.
So if the system before was created by government policy, why can’t the government change the policy?”
The federal government allowing employers to add a benefit of health care to employment as a substitue for increased pay, when wage and price controls were enacted during WWII, is not a government program of health care. Government didn’t mandate that employers do that, either. It was a voluntary act the employer was allowed to do without violating the law at that time. Health care legislation is controled by the individual states, as is health insurance, not the federal government.
As a Catholic RN I oppose PPACA..Obamacare. I want it repealed and replaced! First of all why did the USCCB endorse this government takeover of healthcare when they are supposed to endorse subsidiarity? This is just a first step to more Socialism, which I thought the Catholic Church was against (according to many encyclicals from the Pope’s). I think every Catholic wants more affordable healthcare and help for the poor, but it does not require this over reaching bill. We all know the consequences when government runs everything (ask patients in Canada and Europe).....long waiting for appointments and surgery and rationed care. Look at the mess Social Security, Medicare and Medicaid is in run by the government!
Then we have President Obama the MOST pro-abortion president we’ve had, who the first thing he told Planned Parenthood was: “The first thing I’d do as President is sign the Freedom of Choice Act. That’s the first thing I’d do.” The FOCA would do away with all pro-life legislation passed so far. He couldn’t do it all at once so he’s trying little by little to get it done and his presidential pro-abortion record is appalling. I’m sorry for being blunt but any Catholic who voted for him was directly supporting abortion.
Then there is the conscience rights issue. President Bush made these stronger before he left office, but Obama is cutting them. As a nurse I do not want to be forced to participate in medical treatments that go against Catholic teachings. The way this bill was passed should be red flags for everyone….., shutting out any Republican ideas and NOBODY knew what was in it before it was signed and they still don’t know!
I have a lot of questions for the USCCB and their continued endorsement of the Democratic Party and looking the other way on issues that directly go against non-negotiable teachings of the Catholic Church.
Insurance costs will continue to go up until we address the root causes of most disease in the US, Poor diet. With the average persons over consumtion of sugar, processed wheat products, overconsumption of meat, Alcohol, stimulants etc. The nations health will continue declining.
If you factor in the poisons most people consume everday in higher and higher amounts it is only by God’s grace that many, many more are not ill.
The few mega-companies that supply most of the junk food have no reason to change as long as their major motivation is whatever provides the highest profit to their share holders. Until they see their moral responibility to provide higher quality life sustaining food and the evil of profiting from life destroying foods.
Why is the cost of a meal of fresh fruits and vegetables more than the cost of a Big Mac Fries and a coke? Because the meat, wheat and sugar (high fructose corn sugar)industries are all heavily subsidised by the government. i.e., The true cost of a pound of beef would be close to $25 if you took away all the subsidies. Wheat about $18 and corn sugar about $12.
agree with GHU!
@Steve R. “Insurance costs will continue to go up until we address the root causes of most disease in the US, Poor diet.”
Insurance cost go up because of lawsuits which now amount to 40% of the cost of health insurance. Lawsuits were not allowed to be addressed in the pro-abortion party so-called reform of health care legislation drafted behind locked doors by the pro-lawyer Democrat Party elected officials.
As far as diet is concerned, nobody makes people buy and eat the things they do. The responsibility is not the governments, or the manufactures, but the people themselves. Just like God will judge each and very one of us, each of us are solely responsible for what we do - not governments or businesses. Our bodies are supposed to be temples of God. If they aren’t is - that the Church’s fault? Come to think of it, it just might be. I don’t remember ever hearing a sermon about gluteny, or how we are supposed to take care of the body God gave us, not just for appearance but for our own health as well.
You need to reduce health cost drivers:
1. Keep gov (fed, state, local) out of health care.
2. Ask health care people to lower their pay, benefits and perks.
3. Tell patients that they will need to pay for health care.
You can add to the list.
Raymond A.: I think you are confusing the Catholic Medical Association with the Catholic Health Association. The CMA has been consistently critical of Obamacare (as far as I can remember).
Stillbeleive, “As far as diet is concerned, nobody makes people buy and eat the things they do. The responsibility is not the governments, or the manufactures, but the people themselves.” That is exactly my point the goverment through the subsidies on these foods are forcing the people who have very little to have to choose between a cheaper unhealthy meal or paying the rent. On a recent trip to the grocery store I saw a head of organic romaine lettuce was $4.00, tomatoes were $3.99 lb (2 medium tomatoes are about a lb). accross the street a happy meal with fries and a coke was $2.99. If the meat, wheat and sugar in the happy meal were not subsidised by our government the true cost of the happy meal would have been over $10, thereby encouraging the overconsuption of other than life sustaining food. This leads to sicker people and higher insurance costs for all of us.
Steve R. “On a recent trip to the grocery store I saw a head of organic romaine lettuce was $4.00, tomatoes were $3.99 lb (2 medium tomatoes are about a lb”
I’ve been buying groceries for my family for over 25 years. Anyone paying outrages high prices for so called organic foods is throwing their money away. As far as government “subsidies” on foods, I don’t get it. I do know the government mandating ethanol in gasoline is running the price up for corn products. That plus the government shutting down waterways for farming to protect some minute species of animal has also run up the price of food due to the millions of acres of farmland that can’t be used to grow crops. I drove up to San Francisco recently from the LA area and when I got to the Central Valley area, I was shocked and saddened by the wasteland it has become because of the federal EPA cutting off water to the farmers to “save” some useless tiny fish. Also, there is the long delay by the government to approve for the overwhelming majority of farmers to use hybrid agriculture crops that are immune to pesticides through genetic engineering because of concern for the 1% or less of “organic farmers” that fear their crops would become contaminated with the non-organic crops next door. I’ve heard that 40%-50% of the nations fruits and vegetables are grown in the Central Valley of CA. And then, of course, there are the subsidies to farmers to not grow crops.
Steve R,
I would offer that “organic” is going to be overpriced. The same head of romaine lettuce would be less than half the price of the “organic.”
Take potatoes for example. You can buy a 10 lb bag of potatoes (to feed your family for a week,) for the same price as a bag of potatoe chips (an evenings snack.)
Stilbelieve
You are obviously living in some dream world of your own libertarian creation.
First of all, do us the favor of actually posting your name to this nonsense.
Than reveal the source of your information for any of the following outrageous, unsubstantiated comments. Tell us where you are learning this stuff.
1) As a physcian you know that no one in need of medical attention goes un cared for whether they have the money to pay for it or not.
2) Insurance cost go up because of lawsuits which now amount to 40% of the cost of health insurance.
3) If the meat, wheat and sugar in the happy meal were not subsidised by our government the true cost of the happy meal would have been over $10, thereby encouraging the overconsuption of other than life sustaining food. This leads to sicker people and higher insurance costs for all of us.
Frank Earnest. “3) If the meat, wheat and sugar in the happy meal were not subsidised by our government the true cost of the happy meal would have been over $10, thereby encouraging the overconsuption of other than life sustaining food. This leads to sicker people and higher insurance costs for all of us.”
The above quote is not mine. It’s Steve R’s.
I’ll provide my source for numbers 1 and 2 tomorrow.
The points made by the authors are correct. I also agree with GHU. In my opinion no Catholic should support this bill. It is a badly written bill with thousands of pages, some referencing other documents, that is full of non health care related issues and leaves a lot of the detail to the many agencies/commisions/boards etc that are given to HHS to develop and enforce. It is predicated on a cost savings that is a fabrication and lie (only by using disengenuous assumptions that the CBO was required to use did it show a savings). If you look at the projected budget for HHS, it doubles. People scof at the “death panels”, yet what will happen when a gov’t panel determines whether the cost of a procedure is worthwhile when it also is looking at a budget deficit. Putting the gov’t in the healthcare business will only make our health a matter of politics. We are depending upon an unethical, pro abortion, socialist admin to take care of our health - no thanks. I’d be better off buying healthcare insurance like I buy car or house insurance. By the way, noone has no access to healthcare - you go to the emergency room (or many clinics around)- not that I encourage that.
C’mon Frank Earnest, if you were really a physician you’d know that no one who need medical attention goes uncared for, I personally know 2 people who were admitted to a hospital, within the last 3 years (with no ins.) recieved their care and never paid a cent, also if you were truly a physician you’d be aware that ins. cost are up 40 to 50% because of frivolous lawsuits….
. . .and Subsidiary is the poor redheaded half step-child of Catholicism yet again.
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