Tag Archives: John F. Brehany

Is Catholic health care a thing of the past?

Matthew Rarey: consolidation, regulation, and persecution pose a three-fold challenge . . . 

Health care providers are taking a beating from ObamaCare, and Catholic hospitals and physicians fighting to keep the faith are no exception. Many suspect that the end game is not only a singlepayer system, but a shutdown of faith-based delivery.

“Catholics should be worried,” warns John M. Haas, president of the National Catholic Bioethics Center. “It’s not so much a Catholic identity issue within Catholic health care, but fierce and relentless threats from government and a profound shift in cultural attitudes regarding issues such as contraception.”

Such threats have already forced the Church out of other social ministries — including adoption services — thanks to laws and mores condoning same-sex “marriage.”

Regulatory culture

A statue of the Blessed Mother stands in front of Loretto Hospital in New Ulm, Minn.

A statue of the Blessed Mother stands in front of Loretto Hospital in New Ulm, Minn.

John F. Brehany is executive director and ethicist of the Catholic Medical Association, an association of individuals across the country dedicated to learning, implementing, and sharing their faith in the health care industry. Most of its 2,000 members are physicians.

He cites two factors militating against a robust Catholic identity in health care.

“First, the federal government is actively hostile to the Catholic faith and at best indifferent to the protection of conscience rights in organized medicine,” Brehany says. Of particular concern is the Health and Human Services (HHS) mandate. This employer requirement to provide insurance plans covering contraceptives, abortifacients, and sterilization procedures is “proving a real challenge to the Catholic institutional presence in health care.”

The U.S. Supreme Court heard cases seeking the mandate’s repeal in late March and is expected to give its ruling at the end of June.

Second, says Brehany, is the financial pressure being exerted upon health care providers to stay in business. To “cut more costs out of the delivery structure, many are consolidating,” he notes. Encouraging this trend is the need to comply with ever more burdensome federal regulations — a costly procedure that’s putting many physicians out of private practice.

“Government has so ramped up regulations and penalties for compliance with federal law that private physicians are being driven out of business and joining hospitals,” Brehany explains. “They can’t afford the software systems and lawyers necessary to letting them know whether they’re in continual compliance,” thus avoiding crippling penalties. When Catholic hospitals consolidate with non-Catholic hospitals for similar reasons, these consolidations can pose “a challenge to maintaining a robust Catholic identity.”

Consolidation, not compromise

John Haas

John Haas

In 2012, Catholic Healthcare West relinquished its formal Catholic identity in order to expand its network to include non-Catholic hospitals, thus increasing its marketing power and profitability. Now called Dignity Health, it may be a harbinger of further consolidations by which Catholic health care providers drop their Catholic identity for the sake of the bottom line.Despite that change in name and formal identity, “there’s more than meets the eye with the Catholic Healthcare West issue,” Haas notes. Dignity Health’s transformation was made in consultation with the Church and approved by former San Francisco Archbishop George Niederauer. It has promised to run its Catholic hospitals in accord with the U.S. Conference of Catholic Bishops (USCCB) document Ethical and Religious Directives for Catholic Health Care Services.

“But it now means that the overarching system of Dignity can bring non-Catholic hospitals into the system and have them continue doing things Catholic hospitals can’t,” says Haas, citing sterilization procedures. “Dignity has said none of its hospitals can perform abortions, however. There’s still a strong Catholic moral influence.”

Haas says that consolidation is the trend of the future.

“You can find almost no freestanding hospitals anymore — they’re all entering into collaborative arrangements to survive,” he told Legatus magazine shortly after returning from a meeting in Rome, where he is a member of the Pontifical Academy for Life. “When a non-Catholic hospital or system puts pressure on a Catholic partner to do things not in accord with moral law, that’s where the threats come in.”

The National Catholic Bioethics Center, led by Haas, gives ethical guidance to Catholic health care providers considering collaborative arrangements with non-Catholic entities, helping them stay true to their Catholic identity. A major concern is maintaining the principle of non-material cooperation with evil.

The NCBC worked with one Catholic health care system for over a year to maintain its integrity through the consolidation process, Haas says. The $620 million deal did not happen until the NCBC affirmed that no ethical or religious directives would be broken.

“What came into play were tubal ligations, contraception, and sterilization, which are such a miniscule part of the overall delivery of health care but in our day and age, such a neuralgic issue,” says Haas.

Peter Breen

Peter Breen

For now, vigilant bishops are key to ensuring the Catholic identity of Catholic health care, Haas says. However, a game changer may be in the works: The Obama administration’s repeal of conscience provisions, which had allowed health care providers to receive federal funds despite refusing to perform procedures the Church deems unethical, could threaten the very existence of Catholic health care.

“You often hear people saying with great bravado that a Catholic hospital would close down before it did abortions [to receive the government funding so vital to their operation],” he notes. “If it came to that and a Catholic hospital refused to do abortions, the state could take it over and say this institution exists by our leave as a non-profit. It’s happened before in Church history, but not yet here in America.”

Catholic health care in the catacombs?

Peter Breen, executive director and legal counsel of the Thomas More Society, says the movement in politics to devalue faith-based ministries has turned into active hostility.

Concerning mergers between Catholic and secular health care institutions, Breen says “there’s a real fight over whose ethics will win out.” In a case not yet made public, the Thomas More Society is defending a Catholic doctor that a secular hospital involved in a partnership with a Catholic hospital refused to hire because of his opposition to administering abortifacient birth control.

Even more ominous, Breen cites a recent suit that the American Civil Liberties Union filed against the USCCB because its Ethical and Religious Directives bars abortion.

“I don’t mean to be apocalyptic,” says Breen, “but if Catholic bishops are unable to set ethical guidelines for institutions calling themselves Catholic, we’re going to have a hard time maintaining an official relation between the Church and not-for-profit Catholic health facilities. If the ACLU is successful, we’ll be put in a tough spot as a Church.”

Joseph Piccione, senior vice president for mission and ethics at Peoria, Ill.-based OSF HealthCare System, says he’s hopeful yet realistic about the continuance of that fundamental part of Catholic discipleship and identity: caring for the sick.

“When we see how Catholic ministries have struggled to remain active even in oppressive communist regimes, we know that we have a learned flexibility from their example,” says Piccione, who holds a licentiate in theology as well as a civil law degree. “We need to be quick on our feet and find ways to continue to serve. Why? Because that’s what the Lord wants of us.”

MATTHEW A. RAREY is Legatus magazine’s editorial assistant.

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Navigating murky waters

John F. Brehany: Catholic business owners and the challenge of ObamaCare  . . . .

John F. Brehany

John F. Brehany

The looming implementation of the Patient Protection and Affordable Care Act (aka ObamaCare) is posing critical short-term and long-term challenges to Catholic business owners. How they respond will go a long way toward determining whether the Catholic faith will remain a viable and vibrant presence in American society.

Since ObamaCare’s passage in 2010, employers have waited to learn how the new law would affect their employees and their bottom lines. After missing multiple deadlines, the Obama administration was forced to delay the employer mandate until 2015. In the meantime, however, businesses have experienced significant uncertainty and rising costs, which have negatively impacted employers and employees alike.

A recent U.S. Chamber of Commerce survey showed that only 3 in 10 small business owners say they are ready to comply with ObamaCare, and 25% of business owners are still not sure of what the new law means for them. The average cost of health insurance for families increased by almost $2,500 during President Obama’s first term — almost the exact amount he promised that premiums would decrease as a result of his signature legislation — and a growing number of employers expect costs to rise even higher when ObamaCare is fully implemented. Businesses are responding in a variety of ways — like dropping “extra” benefits such as coverage of spouses, passing on more costs to employees, buying cut-rate health insurance, and by cutting employee hours.

Under ObamaCare, a person who works 30 hours per week is considered a “full-time employee” qualifying for health insurance. Many businesses have reduced employees’ hours below this threshold, causing labor leaders to publicly complain that ObamaCare is undermining the 40-hour work week and the economic benefits provided by full-time employment. Catholic business owners must exercise creativity and prudence in order to protect their businesses and their employees. But these choices pale in complexity to the ethical challenge posed by the HHS mandate.

The most radical change for Catholic business owners under ObamaCare in the short-term is the imposition of the HHS mandate, which requires all health insurance plans (not only those of businesses with more than 50 employees) to provide FDA approved contraceptives (including abortifacients), sterilization, and reproductive counseling to all girls and women without copays or deductibles. While faith-based institutions fought the Obama administration’s radically new definition of “religious employer,” the HHS mandate took effect months ago (in new health insurance plan years starting after Aug. 1, 2012) for practically all businesses in the United States.

Catholic business owners now face a significant ethical dilemma — to either comply with the HHS mandate and cooperate with the evils it entails or to refuse and accept the consequences. To comply with the mandate means to directly subsidize drugs, devices and operations which are objectively evil. Moreover, these “reproductive benefits” will be available not only to employees, but to their daughters, who will be able to access these “services” without the knowledge of their parents. Such a direct and confidential subsidy has long been a goal of Planned Parenthood.

However, refusing to comply with the HHS mandate can entail, at a minimum, either crippling fines of at least $100 per employee per day or dropping all health insurance coverage. Given the manifest evils being subsidized and the direct attack on religious freedom, Catholic businesses can justify providing health insurance in compliance with the HHS mandate (as remote mediate material cooperation) only on a temporary basis while seeking a long-term change in the law or an adequate exemption.

In the long term, it’s possible that the Obama administration and its supporters are hoping to eliminate employer-sponsored health  insurance and impose a single-payer system, in which the federal government is the ultimate arbiter of health-care services, pricing and payments. Sen. Tom Coburn (R-Okla.) and Jeffrey Flier, M.D., dean of Harvard Medical School, both argued in the past that ObamaCare, by intent or by its very nature, is practically guaranteed to fail in a few years. Sen. Harry Reid (D-Nev.) admitted as much in an interview in August. What does this mean for Catholic business owners?

Radical changes in health-care financing may be unavoidable. Employer-provided health insurance is not mandated by Church teaching; a just wage and workplace are. In these challenging times, Catholic businesses can play a key role in promoting a whole range of goods identified by Catholic moral and social teachings, including religious freedom, human dignity, responsibility in the workplace, and subsidiarity, to name only a few. We are now facing a powerful federal government that is increasingly hostile to religious freedom and promoting a culture of death. Only if Catholics work together in new ways and establish new networks of support, can the Church sustain an authentic public witness to the faith.

In the coming months and years, Catholic business owners should view the challenges posed by ObamaCare as an opportunity to renew their Catholic faith and witness to it more explicitly — in their businesses and in the public square.

JOHN F. BREHANY, PH.D., STL, is the executive director and ethicist of the Catholic Medical Association.