She has been photographed with President Barack Obama and Vice President Joe Biden.

She is frequently cited by the mainstream media as the ultimate authority on Catholic health care. She has consistently been in the top tier of “The 100 Most Powerful People in Health Care.” And she is credited with capturing the “Catholic vote” needed to pass the 2010 Patient Protection and Affordable Care Act commonly called Obamacare.

So, who is Sister Carol Keehan? And how did the Daughter of Charity of St. Vincent de Paul come to wield such power?

Sister Carol did not respond to repeated requests for an interview for this article, but, like most powerful people, she leaves a considerable paper trail that allows an accurate portrait to emerge.

Sister Carol entered the Daughters of Charity — founded by Sts. Vincent de Paul and Louise de Marillac in 1633 — in 1965. She started her career as a nurse and rose through the ranks in Catholic health care, obtaining a doctorate along the way.

She became president and CEO of the Catholic Health Association (CHA) in 2005, a position she still holds. Under her leadership, the CHA — a trade association of hospitals, nursing homes, surgical centers and clinics — has been a powerful influence in shaping health-care policy in this country, even though the CHA has no authority to speak for the Church on faith and morals.

The CHA and the nation’s Catholic bishops share a common goal of securing adequate health care for everyone. However, as CEO of CHA, Sister Carol has publicly challenged the bishops’ leadership when addressing prudential matters of grave importance to Church-affiliated institutions, thus undercutting the canonical authority of the bishops and giving ammunition to critics of the Church who try to claim that there is more than one legitimate Catholic position on these moral issues.

Sister Carol began a distinguished career in hospital administration in 1969, eventually becoming president and CEO of Providence Hospital in Washington in 1989.

During her 15 years in that position, she was credited with turning around a floundering hospital, while still keeping its doors open to serve the poor. She became chairwoman of Sacred Heart Health System in Pensacola, Fla., in 2004, and that same year was elected chairwoman of the CHA board of trustees after having served as vice chairwoman.

During her term as chairwoman of the board (June 2004 to June 2005), Chicago priest Father Michael Place, then-CEO and president of CHA, resigned. A national search was launched for his replacement, and Sister Carol was named new president and CEO in October 2005.

Sister Carol made it clear from the beginning of her tenure that she would work unceasingly for the CHA goal of health-care coverage for the uninsured. She played a major role in a national coalition on health-care reform, testified before congressional committees and lectured widely.

By 2007, Sister Carol was named “Most Powerful Person in Health Care” by Modern Healthcare magazine, a leading trade journal (Modern Healthcare, Aug. 27, 2007). Her power extends to the present day, as her $962,467 in salary and benefits in 2010 indicates. Much of that goes to her religious order.

After Barack Obama won the presidency in 2008, Sister Carol and the CHA stood with the bishops in objecting to the administration’s decisions to allow federal funding of embryonic stem-cell research and to roll back the Bush administration’s rule protecting the conscience rights of health-care providers.

Sister Carol represented the CHA at a White House Health Reform Summit on March 5, 2009, where she joined other participants in calling for immediate reform. Initially, the bishops also were supportive of health-reform efforts. However, as details of the proposals emerged, the bishops repeatedly told lawmakers that they could not support a health-reform bill unless it included prohibition of abortion funding and protection of conscience rights.

As the concerns of the bishops increased, so too did Sister Carol’s sense of urgency about passing the health-reform bill.

In a Jan. 28, 2010, letter to the House of Representatives, Sister Carol urged passage of the bill, writing that “political realities and concerns” should not be allowed to “derail what may be the last opportunity of our lifetime to address the continuing shame of allowing so many individuals and families in our nation to go without access to affordable health care.”

She repeated that plea in a statement urging action at the Feb. 25 Health Reform Summit, writing, “The price of inaction is simply too high to pay.”

Sister Carol penned an article in the March 15, 2010, issue of the CHA publication Catholic Health World in which she urged passage of the bill and assured readers any coverage for abortion would have to be paid for by a person’s own dollars.

Cardinal Francis George of Chicago, then-president of the U.S. Conference of Catholic Bishops, issued a statement in which he cited the differences between the bishops and the CHA. The CHA, he said, believed that the moral objections could be corrected after passage of the final bill, while the bishops said the bills’ flaws were fundamental: “Assurances that the moral objections to the legislation can be met only after the bill is passed seem a little like asking us, in Midwestern parlance, to buy a pig in a poke.”

Then Network, a lobbying group of Catholic sisters, wrote a letter to all members of Congress citing the CHA support and urging passage of the health-care bill. That letter was signed by more than 50 religious sisters, most of whom were leaders of their orders.

On March 21, 2010, CHA released a statement by Sister Carol applauding passage of Obamacare in the House of Representatives and urging passage in the Senate. She contradicted the bishops’ position, saying: “We are confident that the reform law does not allow federal funding of abortion and that it keeps in place important conscience protections for caregivers and institutions alike.” 

When Obama signed the bill into law March 23, 2010, Sister Carol was photographed at his side, given one of the pens the president used to sign the bill, and praised by some lawmakers for having secured the necessary votes to win the day.

In a statement dated May 21, 2010, the three bishops who were most involved in the health-reform topic at that time — Cardinal Daniel DiNardo of Galveston-Houston, Texas, Bishop William Murphy of Rockville Centre, N.Y., and Bishop John Wester of Salt Lake City — reaffirmed the U.S. bishops’ position and made it clear that it is the role of bishops to make moral judgments and provide guidance to Catholics, not the task of individuals or groups. They specifically named the CHA and concluded that the organization’s “fundamental” disagreement with the bishops had “resulted in confusion and a wound to Catholic unity.”

Sister Carol nevertheless continued to pronounce on moral matters when she issued a statement through CHA on Dec. 22, 2010, supporting St. Joseph Hospital and Medical Center in Phoenix for a decision to allow an abortion.

She openly disagreed with Bishop Thomas Olmsted of Phoenix, who had judged the hospital to be in violation of the USCCB’s “Ethical and Religious Directives for Catholic Health Care Services.” She wrote: “They carefully evaluated the patient’s situation and correctly applied the ‘Ethical and Religious Directives for Catholic Health Care Services’ to it, saving the only life that was possible to save.”

Mercy Sister Margaret McBride, the hospital’s director, was excommunicated for her role in the abortion. She later repented and was restored to full communion with the Church.

Sister Carol subsequently was honored as one of Time magazine’s “100 Most Influential People” in the world for 2010 and embraced by groups that have been at odds with the Catholic hierarchy themselves.

The National Catholic Reporter named her “Person of the Year” for 2010, and the Leadership Conference of Women Religious (LCWR) gave her its 2011 “Leadership Award.” (Since 2009, that organization of sisters, who lead about 85% of the women’s religious orders in the U.S., has itself been under a doctrinal assessment by the Congregation for the Doctrine of the Faith.)

When the “pig in a poke” that Cardinal George had warned about materialized on Jan. 20 of this year, with the Obama administration’s mandate requiring most religious institutions to provide insurance that covers contraception, sterilization and abortion-inducing drugs, Sister Carol briefly joined the bishops and countless other Americans to protest this assault on religious liberty.

After weeks of stormy reaction by even Obama’s staunchest Catholic supporters, the president announced on Feb. 10 a so-called “accommodation,” which — as the bishops explained — really changed nothing.

Nevertheless, Sister Carol supported Obama’s initiative, saying: “The Catholic Health Association is very pleased with the White House announcement that a resolution has been reached that protects the religious liberty and conscience rights of Catholic institutions.”

The LCWR sisters followed suit with a statement of their own in support of the “compromise.”

Even though Sister Carol and the women religious who publicly supported her do not represent all the sisters in the country and have no moral authority in the Church, some writers observed that a “magisterium of nuns” had asserted itself against the bishops and Sister Carol had emerged as their champion.

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