Politics & Policy

No Mercy

Will Chris Carney and Paul Kanjorski pay the ultimate November price for their health-care votes?

Did Obamacare kill the Catholic hospital Joe Biden was born in?

That’s been a matter of battling press releases, news reports, and even a radio ad in Pennsylvania in recent days, as the vice president went back to Scranton — home of Mercy Hospital, where he was delivered — to campaign for Rep. Chris Carney.

The controversy got fired up when Kevin Cook, the CEO of Mercy Partners — a health-care system run by the Sisters of Mercy, with three hospitals in Pennsylvania — commented about those three locations’ being put up for sale: “Health-care reform is absolutely playing a role. Was it the precipitating factor in this decision? No, but was it a factor in our planning over the next five years? Absolutely.”

Cook’s “absolutely” set off a firestorm.

The hospitals in question serve the congressional districts of two supposed pro-life Democrats — Carney and Paul Kanjorski — who voted for the Obamacare legislation this spring and have been targets of the pro-life Susan B. Anthony List’s “Votes Have Consequences” campaign because of it. (Mercy Tyler Hospital is in Tunkhannock, in Carney’s district; Mercy Hospital is in Scranton and Mercy Special Care Hospital is in Nanticoke, both in Kanjorski’s district.) Both Carney and Kanjorski voted for the Patient Protection and Affordable Care Act even though the legislation does not prohibit abortion funding, as we have seen in a number of states, including Pennsylvania.

The issue has been picked up by Republican Tom Marino, running against Carney. But the most dynamic response has come in a radio ad from CatholicVote.org, a national grassroots lobbying group. The ad declares: “Three Catholic hospitals right here in northeast Pennsylvania are calling it quits and are now up for sale. The reason? Obamacare.”

Joshua Mercer, CatholicVote’s co-founder, tells me: “I think this story really resonates with people for the same reason that the entire health-care debate became so intense. Health care is very personal. There are a lot of pressures in today’s health-care market for Catholic health care. Some Catholic hospitals have to close down. Some are merging with corporations — and that involves a difficult discussion on what exactly Catholic health care is all about.”

But the question remains: Did Obamacare actually put the hospital where Joe Biden was born, along with the other two, in this predicament: an uncertain future, one likely to involve a dramatic change in identity and mission?

In the wake of a firestorm about Kevin Cook’s comments — including adamant denials from Sr. Carol Keehan, president of the Catholic Health Association (CHA), in Washington, D.C. — Cook returned to local media and emphasized that Obamacare was one among many factors leading to the decision to sell. He also emphasized that the hospitals are not closing, as the CatholicVote ad suggests. He added, “I actually find it disappointing that a decision that we made that was in the best interest of the community has been politicized the way it has.”

CatholicVote’s Mercer doesn’t see himself in a battle with Cook. “I think Mr. Cook gave that TV reporter last week an honest assessment of the financial outlook over the next few years, given all the new federal mandates and regulations that are coming. His decision to sell was certainly not done lightly, and I’m sure he would have preferred to keep the hospitals operating as they have been since 1917. He said that national health-care reform wasn’t the only reason, but he did admit it that the president’s health-care law ‘absolutely’ played a role in their decision to sell.”

Mercer stands by the ad: “If Mr. Cook was telling the truth last week, we think the people of Northeastern Pennsylvania deserve to know that the votes cast by Chris Carney and Paul Kanjorski in favor of Obamacare played a role in the decision by Mercy to sell.”

While CatholicVote does not criticize a hospital administrator who is trying to do his best in uncertain times, Mercer feels less than warmly toward the head of the CHA. He accuses Sr. Carol Keehan of going “on the attack against us” — unsurprisingly, he adds. “When the Bishops said the bill was unacceptable because it lacked a prohibition on taxpayer funding and lacked a conscience clause for health-care workers, it was Sister Keehan who came out strongly in favor of the bill. She said the bill wasn’t perfect, but that it would improve health care and would be good for Catholics. And President Obama thanked her by giving her a pen he used to sign the health-care plan into law.”

Mercer adds: “Pro-lifers were upset that Sr. Carol Keehan was ignoring the Catholic bishops and placing the business interests of Catholic hospitals first. But it appears that in supporting Obamacare, Sr. Carol Keehan wasn’t even representing the best interests of Catholic hospitals. And this story in Scranton confirms this.”

The predicament of these three hospitals definitely raises questions about what exactly the CHA was doing when it provided a key endorsement of President Obama’s legislation. “Thank God for the nuns,” Speaker Pelosi has proclaimed, recognizing how Sister Keehan and her trade association, along with other liberal sisters, helped march the legislation to passage. (They weren’t the only religious Catholic women with something to say about the bill, for the record.)

The controversy is about more than three hospitals. It has to do with honest brokering, which was missing in the Democratic push for the legislation and in the lobbying from a major trade association that provided the Obama administration a great deal of unholy cover. Says Mercer: “Catholics are rightly concerned about maintaining the special role of Catholic health care in the United States. And this new development shows that Obamacare is not the boon to Catholic health care that Sr. Carol Keehan would have us believe. In fact, the new federal mandates and regulations found in this health-care law could place the future of Catholic health care in jeopardy.”

Mercer points to a problem that is much bigger than abortion funding — a broader “culture of death”-related issue that was underplayed in much of the pro-life and religious opposition to Obamacare. “The central problem with Obamacare,” Chuck Donovan, senior research fellow at the Heritage Foundation, points out, “is that it moves us closer to a single-payer system where Catholics and other religious have fewer practical options to find and fund plans that reflect their beliefs. As the central government controls more money in the system, what will Catholic hospitals do if future liberal administrations ask them to choose between existence and fidelity to their belief systems? We should work to avoid the dilemma.”

Donovan continues: “PPACA did one or two things quite well with respect to the conscience issue, but several others it did not do well at all. Most emphatically, it did not strengthen the ability of Catholic families and individuals who wish to associate with one another in the purchase of health care to find insurance that reflects their conscience and to refrain from paying, directly or indirectly, for procedures or omissions that offend that conscience.”

Sister Keehan insists that there is no problem: “Given the recent media coverage, it is also important to note that health reform does not in any way imperil the ability of Catholic hospitals to operate as they always have — in accordance with their values and in full compliance with the religious and ethical directives of Catholic health care.” But in legislation whose details are only now becoming clear, this might be much more of a stretch than saying Obamacare killed Mercy. As Leonard J. Nelson III, author of Diagnosis Critical: The Urgent Threats Confronting Catholic Health Care, underscores: “Sister Carol has a big stake in Obamacare. Only the administrators at Mercy know for sure what role the possible reductions in reimbursement levels had on their decision and they have now circled the wagons. There is some conscience protection in the PPACA, but it may not be as ironclad as she claims.”

Nelson explains: “As part of their dealmaking in support of Obamacare, the Catholic Health Association agreed to cuts in Medicare reimbursement rates for hospitals in exchange for the promise of universal care. Apparently, those in charge of the CHA thought that the reduction in uncompensated care would outweigh the effects of the reduction in reimbursement levels. It is too soon to know whether that is going to hold true. It may also be that the hospitals are concerned about being cut out of the accountable-care organizations that will be formed as a result of Obamacare. It is sad . . . and it comes on top of the closure of St. Vincent’s in New York and the approval by the Massachusetts AG of the sale of Caritas Christi to a for-profit system. I fear there will be more of these types of sales.”

Of Sister Keehan’s decision to buy into the cuts, Nelson says: “I thought it was imprudent and inconsistent with CHA’s mission. They are supposed to be providing care to the indigent as part of their mission as a Catholic hospital. In exchange, Catholic hospitals are afforded their nonprofit status. So in the name of social justice they attempt to avoid that obligation by pushing for a vast expansion of the federal role in health care and a promise of universal health care. This could undermine their claim to tax-exempt status. And at the same time they put on the table future cuts in reimbursement levels under the federal program. It seems like they are giving up whatever autonomy they had left and embracing federal control that will eventually lead to the erosion of their Catholic identity. This is particularly risky in light of the fact that the political figure that they embraced, President Obama, is the most pro-abortion president in history based on his record and statements.”

James Capretta, a fellow at the Ethics and Public Policy Center, agrees that “Obamacare has made it more difficult for mission-oriented hospitals to survive on their own because of Medicare cuts and the emphasis on forming all of these accountable-care organizations in the future.”

The Keystone Mercy controversy is a complicated one, involving issues of moral and religious principle as well as hard-headed, dollars-and-cents accounting. CatholicVote’s Mercer tries to take some of the rancor out of the October-before-an-election news, telling me about the Mercy decision: “With regards to the decision made by Mr. Cook, I do think it’s true that Mercy has been considering this decision to sell for years. But it seems that the new federal mandates, and the investments that they would require, played a role in making that decision. Another factor is the reimbursements that government insurance provides. Cook seemed to indicate that the federal reimbursements would get worse under the new health-care law. I think the underlying lesson for Catholics is that government and health care don’t mix well.”

Obamacare is clearly playing a role in the uncertain future of these Pennsylvania hospitals. We’ll be debating way past the election how much of a role it was, because no one fully knows the reach of a bill with more arms than can fit on a government chart. But right now, two public servants are running for reelection, and their chances will depend in part on how they voted on the law, and what they did and didn’t know about it. Anyone who’s driven through Scranton or listened to Joe Biden on the campaign trail knows Catholicism is as much of a mainstay in northeastern Pennsylvania as its Main Streets. So you can understand why Democrats, and a trade association that walked in lockstep with them, are worried that Cook’s “absolutely” will have electoral legs — as it should for two Democratic congressman who recklessly voted in lockstep with their party’s leaders. This is especially so when it compounds worries Pennsylvanians already had about the future of health care. Obamacare will not be merciful to already struggling mission-based hospitals. And with both Carney and Kanjorski on behind in the polls, voters may not be feeling merciful either.

Kathryn Jean Lopez is editor-at-large of National Review Online.

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