A recent article in the New York Times expressed concern that the wave of consolidation in the health-care sector initiated by the enactment of Obamacare has resulted in Catholic hospitals affiliating with secular systems thereby restricting access to abortion, sterilization, and contraception. The article mentions the recent affiliation between Providence Health and Services (one of the largest Catholic systems) and Swedish Health Services (a secular non-profit) in Seattle and the promise by Swedish to refrain from performing elective abortions. Criticism of this affiliation persists notwithstanding the announcement by Swedish that it will “help underwrite” with Planned Parenthood a clinic in a neighboring building to provide a full range of “reproductive services including elective abortions.” Indeed, it is unlikely that the promise is enforceable: Swedish made a similar promise to refrain from performing elective abortions when it took control of the former Providence hospital several years ago, but nonetheless continued to perform elective abortions in the hospital.
The Times article also accurately notes that “the restrictions at any given [Catholic] hospital may not be clear.” And further that ‘the confusion is likely to increase.” Until recently, it could be assumed that Catholic hospitals adhered to Catholic teaching in providing health-care services. Their Catholic identity was preserved by the presence of the members of the sponsoring order, maintenance of a close link with the Diocesan bishop, and adherence to the Ethical and Religious Directives for Catholic Health Care Services (ERDs). But now the Catholic identity of these hospitals is eroding. The membership of these religious orders has declined precipitously and these same hospitals are now managed by lay people many of whom are not Catholic. The connection with the bishop is more remote. And adherence to the ERDs is problematic particularly when it comes to direct sterilizations.
In 2008, after a story by Ann Carey identified Catholic hospitals in Texas that were performing direct sterilizations, Bishop Corrada of Tyler, Texas, insisted that those hospitals stop performing direct sterilizations, and one hospital challenged his interpretation of the ERDs. In 2010, Bishop Robert Vasa revoked his recognition of St. Charles Hospital in Bend, Ore., as a Catholic hospital, after he determined the hospital was providing direct sterilizations. In 2010, Bishop Olmsted revoked his recognition of St. Joseph’s Hospital in Phoenix, Ariz., as a Catholic hospital because of its continuing non-compliance with the ERDs’ prohibitions on direct abortions and direct sterilizations. Subsequently, Catholic Healthcare West, the owner of St. Joseph’s Hospital, a 40-hospital Catholic system, decided to drop its Catholic affiliation to facilitate mergers with non-Catholic entities. And a recent dissertation by Sandra Hapenney, a Doctoral candidate at Baylor University, found that based on her analysis of data from the National Center for Health Statistics, 48 percent of the 176 Catholic hospitals that she studied with obstetrical services were performing direct sterilizations.
There is also a growing rift between the United States Conference of Catholic Bishops and the Catholic Health Association (CHA). Sister Carol Keehan, CEO of the CHA, defied the bishops and backed Obamacare despite its lack of adequate conscience protection, even receiving a signing pen from the president. And although she initially supported the bishops’ objection to the preventive-services mandate requiring Catholic institutions to provide insurance coverage for contraceptives, sterilizations, and abortifacient drugs, she later split with them by endorsing the accommodation offered by the Obama administration despite the fact that it is meaningless. The Times article notes that when questioned about the difficulty of remaining true to Catholic doctrine and serving the broader community, Sister Carol referred to it is “a constant challenge.” While acknowledging that the hospitals should adhere to the ERDs, she emphasized that the hospital viewed “their mission much more broadly, including caring for those who are less fortunate and treating patients with respect.”
Obviously, Sister Carol has her own agenda and is not coordinating her activities with the bishops. Taking her at her word, Sister Carol is an enthusiastic supporter of Obamacare because she is a “social justice” Catholic who believes that the primary role of Catholic hospitals is to provide access to health care for the poor. She knows that, in order to survive and prosper, Catholic hospitals need additional resources to compete with other hospitals so they can’t afford to provide significant amounts of free care. And she believes the best way to provide health care for the poor is through a federal entitlement program. The difficulty with this approach is that once the federal government has in effect turned the health-insurance industry into an arm of the federal government it has total control over the future of Catholic hospitals. These hospitals cannot afford to say no to the government. Not only will they have to provide insurance coverage for their employees for contraceptives, sterilizations, and abortifacient drugs, but eventually they could be forced to provide a full range of “reproductive services” to their patients.
Ironically, however, as the gulf between the bishops and Catholic hospitals continues to grow, and despite the fact that it is increasingly clear that some Catholic hospitals are providing sterilizations and maybe even abortions in violation of the ERDs, the Left will continue oppose acquisitions of non-Catholic facilities by Catholic systems because of the potential impact on access to sterilization and abortion services. And while Catholic hospitals have been willing to enter into complicated arrangements to accommodate the demands of those seeking to preserve access to abortions and sterilizations, it appears that the only accommodation that will be acceptable to the New York Times, Planned Parenthood, and the ACLU is total capitulation. Left-wing advocacy groups will continue to oppose the expansion of Catholic health systems as long as these systems continue to promise adherence to the ERDs notwithstanding the actual impact of these affiliations on the availability of sterilization and abortion services. Even Catholic hospitals with a diluted Catholic identity are still too Catholic for the New York Times and its allies.
— Leonard J. Nelson, III, is a Professor at Cumberland School of Law, Samford University and the author of Diagnosis Critical: the Urgent Threats Confronting Catholic Healthcare (OSV 2009).