Providers feeling the heat?
Vatican’s rebuke of nuns may signal reform ahead
The Vatican’s surprising reprimand of a Maryland-based nuns group could signal pressure on Catholic healthcare providers who similarly have broken with the church leadership over healthcare reform.
In April, the church ordered Seattle Archbishop Peter Sartain to oversee changes over the 1,500-member Leadership Conference of Religious Women, which represents most of the 57,000 nuns and sisters in the U.S. The action is a result of a three-year investigation prompted after the group endorsed President Barack Obama’s healthcare reform bill in 2009.
Sartain’s deployment has caused some Catholic health experts to wonder if the Vatican will further rein in Catholic organizations, including the Catholic Health Association of the United States, that have provided dependable support for the Patient Protection and Affordable Care Act.
The Vatican’s eight-page report cited, among other concerns, “a prevalence of certain radical feminist themes incompatible with the Catholic faith in some of the programs and presentations sponsored by the LCWR,” and described the group as “silent on the right to live from conception to natural death, a question that is part of the lively public debate about abortion and euthanasia in the United States.”
“I have to say, it was like being socked in the stomach—it really took my breath away,” said Sister Simone Campbell, a nonvoting member of LCWR and executive director at Network, a Washington, D.C.based Catholic group focused on social justice issues. How Sartain will attempt to reform LCWR was unclear, Campbell said. LCWR’S leaders remain in Rome and are scheduled to convene later this month for a special meeting to discuss the Vatican’s actions, a spokeswoman for the group said.
A CHA spokesman declined to comment. Whatever direction the church may take, Campbell said she doesn’t see the CHA and its CEO, Sister Carol Keehan, reversing their support of the ACA: “I think it’s way too soon to tell, but I do know Sister Carol is a committed, dedicated, vigilant advocate for healthcare for all,” Campbell said.
Paul Danello, a healthcare lawyer specializing in Catholic law, said he doesn’t think the Vatican’s actions are isolated, and said the church will seek sweeping reforms among other groups, including the CHA. Keehan has been a longtime backer of the ACA, but that support came to a test in February after the White House’s announcement that Catholic hospitals and other religiously affiliated workplaces would have to offer contraception coverage to employees in their employer-provided health plans (Feb. 13, p. 8). That mandate came through an HHS preventive services regulation, originally issued in August 2011.
Keehan warned Obama that the contraception mandate “went too far,” leading to White House and CHA staff working together on a change in which health plans would provide contraceptives, but Catholic employers would have to pay for them.
While the CHA praised the Obama administration for addressing the concerns, other groups, including the U.S. Conference of Catholic Bishops, weren’t bashful in their crit- icism and continued to demand that the mandate be rescinded.
The CHA is an independent, separate entity from the church and could not be directly disciplined, but the bishops could publicly criticize the organization and place pressure on the group to make changes. The latter is likely to happen, Danello said. “A line has been drawn in the sand,” he said. “I don’t think at this point the U.S. Conference of Bishops, Rome, the pope, is going to sit there and say it’s simply a political matter that we disagree on.” The reprimand has Campbell concerned that lawmakers and health providers could be distracted in dealing with the Vatican’s actions instead of focusing on the implementation of the healthcare law: “And that would be in, in my view, really wrong if that happens,” she said.
If the church does exert new influence on Catholic providers, that could complicate mergers and acquisitions, said Lawrence Singer, director of the Beazley Institute for Health Law and Policy at Loyola University, the Jesuit school in Chicago.
Non-catholic hospitals would pose more questions to potential Catholic investors, Singer said. These inquiries aren’t new, but concerns over limiting services in places where the affected facilities are the only providers in the area would increase: “I think that will be the first question: ‘Please explain to us exactly what the role of the local bishop and the Vatican has over our partnership,’” Singer said.
Dignity Health in San Francisco this year split its formal ties to the church and changed its name from Catholic Healthcare West (Jan. 30, p. 6). Dignity officials said the change would make it easier for the system to do business with non-catholic institutions while seeking to expand from its footprint in the West into a national system. Earlier in April, the 38-hospital system announced plans to acquire the secular 36bed Ashland Community Hospital in Oregon, which would be its first transaction since the split.
Singer and Danello said they expect other Catholic systems to follow Dignity’s model and sever formal ties with the church if the Vatican’s actions make it difficult for them to consummate deals with secular hospitals. A Dignity spokeswoman declined to comment.
Observers wonder whether the Vatican will seek to rein in the CHA and Keehan, above, for its support of the reform law.