LOPEZ: What is the truth about abortion, death panels, and how pending bills would affect Catholic hospitals?
NELSON: Although abortion was not mentioned in the initial drafts of either the House tri-committee bill, H.R. 3200, or the Senate Health, Education, Labor, and Pension Committee (HELP) bill, it seems likely that, in light of the pro-choice positions of President Obama and Secretary Sebelius, abortion would be included in the mandated standard benefit package for the public and private plans available through the health-insurance exchange. Under H.R. 3200, after a five-year period, all employer-provided health plans would also be required to provide the standard benefit package.
The House Energy Committee adopted an amendment to H.R. 3200 proposed by Rep. Lois Capps (D., Calif.). Under the Capps Amendment, the public plan and at least one private plan in each region would be required to cover abortion. The remaining private health-insurance plans would not be required to provide abortion coverage, and there would be at least one private plan available in each region without abortion coverage. There is an accounting gimmick included whereby affordability credits (premium subsidies) for low-income persons could not be used to pay for abortion coverage.
Inclusion of abortion-coverage mandates in the health-care reform legislation would change the environment for Catholic health-care providers. Most health plans would expect providers in their networks to provide access to abortions. This would pressure Catholic providers to provide either abortions or abortion referrals, as well as sterilizations, in order to be included in health-care networks.
The “death panel” claim apparently refers to section 1233 in H.R. 3200. This section requires Medicare to reimburse physicians for providing advance-care planning consultations to patients that includes discussion of advance directives, appointment of a health-care proxy, and end-of-life care. This consultation is not mandatory. While the “death panel” claim may be overblown, it is reasonable to be concerned about the prospect of age-based rationing. As pointed out in an article by Betsy McCaughey in the Wall Street Journal, Ezekiel Emanuel, the brother of Rahm Emanuel and health-policy adviser to President Obama, recently published an article in the Lancet calling for age-based rationing. Here is the “Reaper Curve” from that article:
“Age-based priority for receiving scarce medical interventions under the complete lives system.” From Persad, Wertheimer & Emanuel, Principles for Allocation of Scarce Medical Interventions, 373 Lancet 423, Jan. 31, 2009
LOPEZ: Would Catholic hospitals really shut down if the government mandated certain procedures?
NELSON: That would be up to the bishop in the diocese where the hospital is located. At the very least, no bishop would allow abortions to be performed in a Catholic hospital. It is also probable that bishops would not permit Catholic hospitals to provide abortion referrals. If hospitals were required to do this, they could be shut down, continue operation as non-Catholic facilities, or be sold to a non-Catholic system.