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__ Special Report________________________
Forced to Pay
Without their knowledge or consent, Americans are funding contraception and abortion through government programs and private health-care plans.
By Matt McDonald
“Against Abortion? Then don’t have one,” read a popular bumper sticker. In the view of advocates of legal abortion, that slogan captures the essential privacy of moral decisions. Opponents of abortion dismiss the logic of the bumper sticker, but they may take some comfort from it, too. Abortion, after all, probably does not touch them directly. The same may be true for contraception. Other people may be availing themselves of abortion and contraception, and these services may be both legal and readily available. But anyone who wants to avoid contact with abortion and contraception can do so easily enough—or so it would seem.
But these days it is not easy to avoid paying for abortion and contraception, at least indirectly. In the United States, the federal government has funded contraception programs since the 1960s. The government also funds some abortions in the cases of rape, incest, and when the life of the mother is threatened. Almost all state governments fund birth-control clinics, and some also pay for abortions for poor women. So anybody who pays taxes in the United States is, at least in some small way, subsidizing abortion and contraception.
That reality applies to most people who have health insurance as well. In the early 1990s, two-thirds of all health plans provided coverage for abortion and 86 percent paid for sterilizations, according to a 1993 survey by the Alan Guttmacher Institute, a nonprofit research organization in New York City named for a former president of Planned Parenthood.
In the eyes of those who support access to contraception and abortion, the money spent by governments and health-insurance plans is the necessary cost of helping women do what most want to do: avoid getting pregnant for the vast majority of their childbearing years. “We have a public health problem that is hitting every community, regardless of income level, and regardless of region, and we as a nation have to commit to attacking the epidemic levels of unintended pregnancy,” explains Robert Jaffe, deputy director of the New York affiliate of the National Abortion and Reproductive Rights Action League.
Those who oppose the public and private coverage of contraception and abortion see the subsidies as bad public policy and an assault on their right of conscience. “We’re all being forced to subsidize the culture of death today, both through the private and public sectors,” says Michael J. O’Dea, president of the Christus Medicus Foundation, a nonprofit organization that monitors health care from a Catholic perspective.
The Church’s view
The Roman Catholic Church teaches that a fetus is a human being and that abortion is the unjustified taking of a human life. The Church also condemns artificial contraception, arguing that it divorces sexual intercourse from its purposes, unity and procreation, by meddling in the act God created to bond a married man and woman and to bring forth new life. While these are very old Church teachings—St. Jerome once called contraception “murdering a child before it is conceived”—they have received renewed emphasis during the reign of Pope John Paul II, whose landmark “theology of the body” has sought to redefine the Church’s presentation of sexuality as not just a series of prohibitions but also a guide to happiness. As the Pope teaches, all means of artificial contraception reduce sexual intercourse to material pleasure and drive a wedge between man and woman by making them view each other as mere sex objects. Though the Pope considers abortion murder, and therefore more serious than contraception, he also argues that abortion is a byproduct of what he calls the “contraceptive mentality.”
So the Pope explains that contraception is both a sort of “gateway” sin and a grave evil in itself. The Church considers her teaching on contraception not only binding for Catholics, but a universal moral truth. Surveys, news reports, and casual conversations will confirm that the vast majority of Americans reject this view (to the extent that they even know that such a view exists). Still, anyone who follows the Church’s teaching on these matters believes contraception is gravely wrong. The Church prohibits Catholics from aborting or contracepting. But the Church requires more than that: she also insists that Catholics should not purposely aid others who want to do these things.
As seen by those who disagree with the Church’s teaching, contracepting is a morally permissible act that allows women to have sexual intercourse and avoid pregnancy—a goal that supporters of contraception find perfectly reasonable. Some even argue that contraception is a morally good thing, because it can prevent the arrival of unwanted children and thus perhaps reduce poverty.
The Church allows that in some cases a married couple might have a valid reason to avoid pregnancy for a time while maintaining a normal sexual relationship. But the Church teaches that it is never justifiable to use evil means to achieve a good (or at least justifiable) end, and it finds artificial contraception to be evil all the time. For those couples with a grave reason for avoiding pregnancy, the Church recommends natural family planning, a system of periodic abstinence based on the woman’s fertility cycle—which researchers report prevents pregnancy more than 99 percent of the time.
Contraception: From Pariah to Pillar
For most of the 20th century, selling contraceptives and spreading information about them was illegal in many states. In 1942, Cardinal William O’Connell, then Archbishop of Boston, successfully led the fight to reject a statewide referendum in Massachusetts that would have legalized birth control. The story of the campaign is told in James M. O’Toole’s 1992 biography of Cardinal O’Connell, Militant and Triumphant.
In 1948, the Democrats won a majority of seats in the Massachusetts House of Representatives for the first time ever, in part because they were able to paint the Republicans as supporters of birth control. Shortly afterward the Democratic leader in the Massachusetts House, Tip O’Neill (who would eventually rise to become the powerful Speaker of the US House of Representatives), was even willing to kill a bill allowing married women to keep their jobs as teachers, because Cardinal O’Connell’s successor, Archbishop Richard Cushing, worried that if a teacher was married and kept her job she would practice birth control. According to John Aloysius Farrell’s new biography of O’Neill, Archbishop Cushing called O’Neill at the Massachusetts State House to lobby against the bill; O’Neill walked up to the Republican leader on the floor and told him, “The archbishop is opposed to this bill and we are going to kill it.” And the Republican minority leader immediately backed off.
Today this sort of unabashed exercise of Catholic political power, and the political and social climate in which they were exercised, are so unfamiliar that an interest in those old campaigns might be seen as merely antiquarian.
In 1965, the US Supreme Court struck down lingering state laws that outlawed contraception for married couples, in a case called Griswold vs. Connecticut. A few years later, the court struck down state laws barring contraception for unmarried couples as well.
By that time, widespread contraception was a fait accompli. The oral contraceptive known as The Pill had become popular starting in the late 1950s, and the sexual revolution that soon followed led to an increased reliance on contraception by unmarried couples engaged in sexual relations. Many married couples opting for smaller families also relied on The Pill. While official Church theologians still applied the Church’s doctrine against contraception through the mid-1960s, many anticipated that the Vatican would change the Church’s teaching, or at least circumscribe it so as to prohibit condoms and other “cruder” methods, but allow The Pill. Pope Paul VI was slow to respond, appointing a commission to study the matter. When he finally reaffirmed the Church’s condemnation of all forms of artificial contraception in 1968 with the encyclical Humanae Vitae, his pronouncement was widely ignored (where it was not rejected outright).
In the early 1970s, some 30 years after Cardinal O’Connell helped keep birth control illegal in Massachusetts, the US bishops’ conference announced it would not oppose the legality of contraception—a stance it still maintains. “We think government should be neutral on that subject, neither prohibiting nor promoting contraception,” says Richard Doerflinger, associate director of the Secretariat for Pro-Life Activities at the National Conference of Catholic Bishops in Washington DC, in an interview with Catholic World Report.
Yet government does promote contraception, with little public discussion of the matter. Abortion, while legal everywhere and subsidized in many places, is bitterly divisive in the United States; politicians generally hate to be asked about it or see it mentioned, because they know there is a high likelihood of stirring up passionate opposition from partisans on either side. There is no such divisiveness about contraception, though: legislators are all for it.
Since at least 1970, when President Richard Nixon signed legislation creating a federal contraception program called Title X of the Public Health Services Act, the federal government has spent hundreds of millions of dollars promoting contraception in all 50 states. And public support for so-called family planning programs remains solid.
The political support is so strong, in fact, that American bishops consider government subsidies for contraception impregnable (so to speak). “We generally do not lobby against federal funding of contraceptives as such,” says Doerflinger. “There’s unfortunately little support for a move like that.”
Even abortion opponents almost never fight contraception subsidies. Some believe that contraception reduces the number of abortions by preventing unwilling mothers from conceiving. (Contraception opponents dispute that claim, countering with statistics showing that the rate of unwanted pregnancy has increased when contraception has been more widely available.) Others simply see no use in expending political capital when it is unlikely to bring a return on the investment.
“It’s very difficult to find pro-life folks who would carry the argument,” says Father Michael Place, executive director of the Catholic Health Association, headquartered in St. Louis, Missouri. “It’s very difficult to find allies.” He adds: “I think the majority of legislators sees access to contraception as just another dimension of health care.”
Forcing insurers to comply
Rather than fighting contraception outright, Catholic authorities are focusing on a new effort by advocates of contraception to force private health insurers to provide birth control as part of their health-care plans.
According to Michael O’Dea, while the vast majority of health plans have made the policy decision to cover sterilization surgery and abortion on their own, fewer have voluntarily offered coverage for oral contraceptives. So advocates of access to contraception have turned to government to try to force insurers to include The Pill, which otherwise costs about $30 a month. Thirteen states already require most employers to cover contraceptives in their health insurance packages.
Supporters of these legislative efforts contend that contraception is a basic part of any health and wellness program for most women, and that women have a right to affordable birth control. “Basically, women should have access as part of their insurance coverage to birth control,” says Jaffe, who is lobbying for a similar law in New York. “It’s discrimination for contraception to not be covered.” He argues, moreover, that the individual woman should have the power to decide whether contraception is required to maintain her health: “The decision whether or not to use birth control should rest with the employee, not with her boss.”
As Catholic World Report went to press in mid April, the New York legislature was split between two versions of the contraception mandate: a state senate bill that would provide a fairly wide exemption for religious organizations, and a state assembly bill that would not exempt Catholic affiliates. The latter proposal particularly worries Church authorities, who claim their right to conscience is in jeopardy.
“It’s the height of unfairness . . . to require a Catholic organization to pay for items or services that run directly counter to Catholic doctrine,” says Cathy Cleaver, director of information and planning for the US bishops for pro-life activities. “This is just flat-out discrimination. It’s un-American. It’s unfair.”
The concerns of the Catholic Church are not limited exclusively to Church-affiliated institutions, Cleaver maintains. “We are in solidarity with those non-Church employers who also have a moral objection to this kind of heavy-handed government control,” she says. But she notes that the US bishops see protecting the Church structure as their first duty. She continues:
And that’s really what our involvement is designed to do, to see that there’s an exemption for religious organizations. The issue where we really have a voice is when our churches and church-related organizations are forced to violate the dictates of Church doctrine.
Jaffe says contraception supporters might be willing to compromise with the Church over smaller health-care plans, such as those that might cover only parish priests or other small groups. But he said the Church is being unreasonable when it comes to large corporations that happen to carry the Catholic label. “The woman who works at Fordham University in the law library, or the woman who works in the cafeteria at a Catholic hospital, should have the same access to health care as the woman who works in a secular university or hospital,” Jaffe says.
Already here
Church authorities on the East Coast know what they are fighting against in New York, because their counterparts are already dealing with it in the country’s largest state, California.
In 1999, California passed a law requiring all health insurance plans to cover oral contraceptives if they covered any prescription drugs. Although the legislators exempted churches, the legislators tailored the definition of a religious organization so narrowly that it does not include many Catholic institutions, including hospitals, universities, and social service organizations. The law took effect January 1, 2000.
Catholic Charities of California, one of the organizations affected, sued in July 2000 to have the law overturned on the grounds that it violates the First Amendment right to freedom of religion. That case is now being considered by a state appeals court, which has taken legal briefs and was expected to hear oral arguments in late April or early May (after the deadline for this issue of Catholic World Report). Yet even if Catholic Charities wins the lawsuit, the decision would probably only allow organizations in California with strong ties to the Catholic Church to offer prescription drugs to their employees without covering contraceptives. The owner of a secular business who objects to providing contraception would probably not benefit from such a ruling, because courts would usually construe his First Amendment freedom-of-religion rights more narrowly.
The situation disturbs Catholic leaders like Father Place, whose Catholic Health Association has contributed $50,000 to assist the legal case of Catholic Charities of California. He reasons:
We and the [bishops’] conference have a strong position that Catholic providers and others who have conscientious concerns ought not be obliged to provide services that are inimical to their faith and their values. At a minimum we’d like to see it replaced with legislation to allow an adequate conscience clause.
But the law mandating coverage of contraception is technically in effect at this writing, because a lower-court judge refused to issue a temporary injunction barring its enforcement. As a result, some Catholic organizations in California may be opting under duress to provide contraceptives as part of their health-care packages, at least until the outcome of the case is concluded.
Still this is not exactly a new development, as supporters of the law noted before its passage. Many Catholic hospitals already offer contraception as part of their regular health plans, either because they took over a hospital with an existing union contract that could not be changed, or because they simply made their own decision to offer that coverage directly, without any duress.
“It is a fact,” acknowledges Carol Hogan, associate director for pastoral projects and communications for Catholic Charities of California, “and it is one that was used quite effectively by the opposition. … This is a matter of great concern to the bishops, and it is being dealt with.”
To Jaffe and other advocates for contraception access, the availability of contraception coverage for employees of at least some (and probably many) Catholic organizations suggests that the Church is not all that horrified about being associated with contraception. If the Church can come up with third-party entities to keep an arm’s-length distance from practices it finds objectionable—as many Catholic hospital systems do when they wish to operate a hospital that provides sterilizations—then why can’t the Church come up with some sort of indirect way to provide contraception for its employees? “Our argument is ‘you figured it out in that circumstance,’” Jaffe says, referring to the Church.
But Doerflinger, of the pro-life office of the US bishops’ conference, maintains that the bishops are taking seriously the health plans of Catholic organizations. He attributes contraception coverage to an oversight by many Catholic administrators. “They never looked at their employee health insurance as something that needed moral scrutiny, and just bought a package,” Doerflinger says. “That’s extremely unfortunate, and it is being corrected now in many instances.”
Children’s programs
While the California and New York cases center on what private employers may do, most state governments have in recent years implemented (with the help of federal funding) a new generation of state programs designed to serve poor children, and these programs also provide the young people with contraceptives. The reason has to do with political jockeying on health care.
The United States is the only major industrialized Western country that does not have universal medical coverage paid for by the government. Instead, the country has a mixed system, with some people covered by government, some covered by private health insurance companies that are regulated, and some not covered at all.
Since the mid-1960s, the very poor have qualified for Medicaid, a federal program administered through the states that provides health insurance. The elderly have qualified for Medicare, a similar program for retirees. Government employees, such as members of the military, have qualified for government health plans. (Many military veterans can also use the federal government’s health care system, including Veterans Administration hospitals.) Most of the Americans who do not fall into the above categories obtain health-insurance coverage from a private insurer, usually paid for entirely or in part by their employers. But an estimated 44 million do not qualify for a government health program, do not receive health insurance from their employer, and cannot or do not want to pay for health insurance on their own.
In 1993 the Clinton Administration, led by the former First Lady and current Senator from New York, Hillary Rodham Clinton, proposed a universal health coverage scheme. Dubbed HillaryCare, the plan was roundly panned for what critics called an overbearing system of government controls. It failed without ever coming up for a vote.
Since then, though, Congress has sought to extend health-care coverage on a piecemeal basis. Most Democrats are enthusiastic about expanding government services, especially in the context of a tailor-made Democratic issue like the US health-care system, which many Americans find unsatisfactory. Republicans, though somewhat more skeptical about government programs, feel vulnerable on Democratic turf and are often willing to go along with incremental expansions of government.
The results are not always easily predictable, because in health care, an economic issue can quickly be transposed into a moral issue.
Such is the case with the State Children’s Health Insurance Program, an act passed by Congress in 1997 to try to extend health-care coverage to minors whose parents are not poor enough to qualify for Medicaid but probably cannot afford to provide health insurance for their families on their own. As part of the Balanced Budget Act of 1997, the new CHIP program (an English-friendly acronym many observers prefer) appropriated $48 billion in federal matching funds to the states for a 10-year period starting in 1998, according to a report by the Family Research Council, a conservative lobbying group in Washington, DC. The money was supposed to go for some 5,000,000 children whose parents were believed to earn somewhere between the federal poverty level and twice that much.
In designing the CHIP program Congress said nothing about abortion and contraception, but left it to the states to decide how to use the money. Some states simply expanded their existing Medicaid programs. Some developed a hybrid of their existing Medicaid program and a new program for children in slightly better economic circumstances. Some created a separate child-health plan aimed only at the new target audience. But whatever new program they created, almost all the states included coverage for contraception. Medicaid in its basic and expanded forms requires coverage for contraceptives, sterilization, and abortion in the so-called “hardship cases” of rape, incest, and life of the mother. Most stand-alone Children’s Health Insurance Programs also included coverage for contraception. In effect the State Children’s Health Insurance Program expanded the pool of youngsters for whom the federal government could help obtain contraceptives.
State by state
The only exception in the early days of the children’s health program was Pennsylvania, where a local Catholic official began lobbying state administrators and legislators early in the program’s planning stages.
In December 1998, Sister Clare Christi Schiefer, president of the Pennsylvania Catholic Health Association in Harrisburg, wrote the executive director of the state Children’s Health Insurance Program, offering support for the new program but warning that the new benefits “should not cover abortion or other morally objectionable services.”
“Children need a benefits package tailored to children,” Sister Clare wrote. She added:
The ideal for the plan is to protect life and health when it is most vulnerable and in need of care – children in the womb, disabled children, children with chronic diseases. . . . The plan should not become a means to assure that abortion services are covered, nor should it be used as a means to increase the availability of and payment for contraceptives and abortion counseling.
Sister Clare’s association was one of many in a coalition that advocated implementing the Children’s Health Insurance Program, and several of those coalition partners supported contraception, but she managed to persuade them not to take a position on the issue of contraception. She then won key support from the chairman of the insurance committee in the Pennsylvania House of Representatives. Still, it wasn’t until about a year after she started that she felt confident the new program would not cover services she finds morally objectionable. “Now, that doesn’t mean we don’t constantly have to be on top of it,” she tells Catholic World Report.“ . . . I think we always have to be vigilant.”
Contraception supporters contend that government subsidies are essential to providing contraception, especially for poor women who may not be able or willing to pay for pills at the market rate of $30 a month. That logic applies especially for younger women, who may have little access to cash.
While adult women tend to take more control of their sex lives, teenagers who seek assistance usually do so a full year after they first become sexually active, according to Peg Stauffer, president and chief executive officer of Planned Parenthood of Central Pennsylvania. The largest percentage of clients seeking contraception from her office is between 19 and 27, she says. “So we’re not seeing as many teens as need to be seen,” Stauffer says.
Michigan has cut out coverage of abortion from its version of the CHIP, but retained support for contraception and sterilization, according to O’Dea. Texas has moved to cut abortion and contraception from its children’s plan for those whose families earn between 100 and 200 percent of the federal poverty level, O’Dea adds. Observers report that all the other states include contraception, and perhaps the so-called “hardship cases” of abortion, in their new children’s health programs.
In fact, in the US Congress today, the key battle is not over whether the federal government will fund contraceptives, but over whether parents have a right to know that their children are obtaining birth-control devices. Current federal regulations, put in place by the Clinton Administration, require strict confidentiality on medical records for children over the age of 12. The current Bush Administration’s Secretary of Health and Human Services, former Wisconsin governor Tommy Thompson, is considering whether to change those regulations. The time for public comment ended in March, and his decision was expected sometime in April or May.
Critics of medical confidentiality for teenagers, like O’Dea, see it as an insidious attack by government on the rights of parents. Poor parents who do not believe in contraception or abortion may be taken by surprise, he says, when government offers these things to their children, at little or no cost, behind the parents’ back.
Supporters of confidentiality for minors insist they aren’t trying to drive a wedge between parents and their kids, but rather that they are being realistic about teenagers’ sex drives and the likelihood that they will not discuss their sex-related problems with their parents. Jaffe makes the case:
We encourage teens to talk to their parents about sexual health issues. However, for all of history and throughout the world teenagers have been engaging in sexual activity. When that occurs, we need to ensure that teenagers are using birth control. Parental involvement laws aren’t successful in improving communications between parents and teens. . . . We think these laws would make it virtually impossible for teenagers to access birth control in a very sensitive area.
“If you want to make sure that birth control is being used, the last thing you want to do is pass laws saying that a teenager has to come to a parent,” Jaffe says. “It will fail, and the unintended effect will be to decrease use of birth control.”
The Pill for priests?
While Catholic Church authorities are focusing on political battles, some are now also taking a closer look at the Church’s private business arrangements. Catholic hospitals are not the only Catholic organizations that provide contraception coverage in their health plans. So, apparently, do some dioceses.
That was the situation in the Diocese of Lincoln, in central Nebraska, when Msgr. Robert F. Vasa became vicar general in 1996. As he began to look into the diocese’s health plan for priests and a few diocesan employees, he was alarmed to find that the rates were higher than they should have been and that the plan did not cover parish employees. Then he found out that the plan covered tubal ligations, vasectomies, and abortions. However unlikely the scenario might be, a priest of the diocese could have procured a vasectomy, paid for by the health plan the Church was providing. Lay employees could have been sterilized or even had an abortion—again, paid for by the Church’s own health plan.
“We were placed in the position of being adamantly pro-life and opposed to all abortion at all times but our health insurance would pay for one should a group member make that unfortunate and destructive choice,” Msgr. Vasa later wrote. “Perhaps anger can sometimes be a good thing; at that point I was livid!”
The health plans for Catholic school employees in the diocese generally excluded abortion, but the school administrators had given no thought to sterilization, so the plans covered that procedure. And even the alleged abortion exclusion was not always as iron-clad as it appeared. Many health plans exclude what they call “voluntary abortion” or “elective abortion,” but define it in such a way that a physician’s recommendation for abortion on the grounds of a woman’s emotional welfare is considered medically necessary. Thus, abortion is often covered even when the language of a health plan implies that it is not.
The diocese had never requested these services as part of their health-care plan. They were simply part of the boilerplate language of the typical plan their insurer offered. As Msgr. Vasa inquired about changing the plan, he found that some insurers were flat-out unwilling to make any changes to their prepackaged plans to accommodate the moral requirements of the diocese. Other insurers indicated that they would be happy to exclude contraception and abortion from the plan, but not to reduce the premiums. In other words, they were willing to carve out the services the diocese objected to, while still collecting the same amount of money for the insurance pool. And that pool of funds paid for services for other people insured by the same company—including services such as sterilization and abortion.
“I realized that under each of these proposals we were still paying for morally objectionable procedures such as . . . tubal ligations and vasectomies; we were simply not making these things available for the people in ‘our group.’ This made no sense to me,” Msgr. Vasa wrote in an article which is available on the Christus Medicus web site.
Moreover, the health-insurance providers to whom Msgr. Vasa spoke were not only unresponsive but seemed perplexed by his questions. Several times he received responses that amounted to a complaint that the priest simply did not understand the complexities of the insurance process. Other answers were downright hostile.
(Getting information on health insurance coverage can be very difficult, according to several sources, as insurance company employees and agents often tell questioners what they think they want to hear, or lapse into evasive language. One source consulted for this story recalled that he had once received a large packet from an employer detailing a big insurance company’s health plan that never mentioned abortion. Several telephone calls and transfers later, he found out that the plan did in fact cover abortion.
To ferret out information about what is and is not covered, one source recommended calling an insurance company and pretending to want the service the caller actually opposes. A man, for instance, could ask if he can obtain a vasectomy or if his wife can have an abortion that her therapist recommends. A woman could ask if a tubal ligation would be covered.)
After talking to many health care experts, and dismissing their proposals, Msgr. Vasa met Michael O’Dea, then a health-care consultant. In 1997 O’Dea and Tracy Williams, a health-care administrator, designed a fully self-insured plan for the diocese that paid no money for contraception, abortion, or sterilization. They also tailored the plan to include services Msgr. Vasa did want to cover, including marriage counseling and sterilization-reversal operations.
O’Dea recently left his business to form Christus Medicus—Latin for “Christ the Doctor”—a non-profit organization which he describes as a watchdog trying to craft “Christ-centered” health care. Through lobbying government officials and providing information on his web site (www.christus medicus.com), O’Dea is trying to create a conscience clause that would allow employers to omit contraception (and abortion) from their health plans, and to eliminate coverage of contraception and abortion from state health programs aimed at children. The work has been slow going to date, however, and he reports his fledgling foundation is nearly broke.
Meanwhile, in late 1999 Msgr. Vasa was named bishop of the Diocese of Baker, Oregon. Drawing on their experiences in Nebraska, Bishop Vasa and O’Dea are both interested in creating a national Catholic health plan that would allow Catholics faithful to the Church’s teaching to contribute to a pool of funds untainted by association with activities they consider immoral. O’Dea sees the day when a large Catholic organization will form its own health insurance plan that covers only operations and medicines that the Church finds morally acceptable, and offer the plan to anyone who wants it.
“If you are a committed and devoted follower of Catholic theology, you don’t want your dollars going to pay for someone else’s abortion and contraception,” Bishop Vasa tells Catholic World Report. But he acknowledges that many Catholics are stuck with little or no choice about the health plan they provide their families, and that many now feel an obligation to enroll in a health plan even if it contributes to activities they don’t believe in. “It requires an ongoing moral oversight,” Bishop Vasa says, “and it seems to me the Catholic Church as a whole may have a moral obligation to step into the breach.”
Jaffe sees health insurance as one blanket that should cover all of what he considers “baseline” services, including contraception, for everyone. Individuals should not be able to opt out of contributing to contraception, he says, because the very purpose of health insurance is to share risks and the attendant costs. Individuals who may never suffer a broken leg or a bout with pneumonia share the expenses of those who do. Jaffe sees the issue of contraceptive coverage as representing the same sort of shared insurance risk. “The whole idea is that we’re all cross-subsidizing each other, and that’s the fundamental thing about insurance,” he reasons. “You can’t pick and choose the coverage.”
Father Place says that he finds the proposal for a national Catholic health insurance plan an attractive idea, but he doubts it is feasible. He said the Catholic Health Association looked at a similar idea about five years ago, but experts decided it could not be done. “That was seriously pursued, and it was felt that market alignments and local and state regulations made it impossible,” Father Place says. “If you look at the insurance industry, it’s not expanding, it’s consolidating.”
O’Dea acknowledges that such a Catholic health plan would not fly in 13 states that have already mandated that health plans cover contraception. In the other states, however, O’Dea contends that if supporters build enough interest, a Catholic health plan could easily emerge.
“I mean, if the will were there, we could have a Catholic health insurance program, or call it a health insurance program consistent with Catholic teaching, in a matter of months,” O’Dea says.
“All you need is 50,000 employees to have a real strong Catholic health-care program. If you grew into the millions, then you have leverage with the policy makers.”
Matt McDonald is a free-lance writer who lives outside Boston, Massachusetts.