Caring for the sick and vulnerable is a core value in all major religions. That is one reason why faith-based organizations have played such a crucial role in providing health care in this country. From community clinics to large hospitals, they have long been on the front lines when it comes to caring for those in need. And in addition to providing direct services, faith leaders have advocated for health care reform, providing a moral vision that undergirds economic arguments for repairing a broken health care system.
With the passage of the Affordable Care Act, we saw the challenges of transforming religious values and beliefs into legislation. The process was difficult at times, as faith communities had to reconcile their theological beliefs with the different views and beliefs of those with whom they work and serve. They also had to contend with hard-edged politics, clashing constituencies, vested interests, and political power.
The process of discerning how to be faithful and also serve the common good led to fierce debates within faith communities and the larger society. Some of those debates are still playing out more than two years after passage of the Affordable Care Act. Faith communities continue to champion health care reform, however, and are key actors in the public education and implementation of this law in the states.
Faith-based groups have long provided health care, especially to those who are poor, uninsured, and disenfranchised. Catholic hospitals today account for more than one-fifth of all admissions in the country. Muslim-run clinics in Chicago, Houston, and Los Angeles serve all who come, regardless of ability to pay. In Washington, D.C., faith-based Columbia Road Health Services provides care to the area’s most vulnerable residents, regardless of their ability to pay. Likewise, Christ House, also in D.C., serves as a holistic infirmary that ministers to the needs of homeless men and women.
Faith communities have also spoken out for reforming our health care system, urging that it reflect the values of human dignity, shared responsibility, compassion, stewardship of resources, and concern for those who are vulnerable. Advocates for reform include the U.S. Conference of Catholic Bishops, the United Methodist Church, the Evangelical Lutheran Church in America, the Episcopal Church, the Union for Reform Judaism, the Central Conference of American Rabbis, and others.
Such support is also reflected in the values of people in the pews. A 2009 survey by the Pew Forum on Religion and Public Life showed 6 in 10 Americans—including 48 percent of white evangelicals, 55 percent of Catholics, 56 percent of white mainline Protestants, and 72 percent of the religiously unaffiliated—favoring a government guarantee of health insurance for all citizens, even if it would mean raising taxes.
Faith-based advocacy for the Affordable Care Act
Faith groups were obvious allies when health care reform legislation was proposed in 2009. Faith for Health, a coalition of more than 30 mainline and evangelical Protestants, Catholics, Muslims, Buddhists, and Jews, came together to back legislation and mobilize the grassroots.
In August 2009 the coalition sponsored a conference call with President Barack Obama that included 140,000 people of faith. The president thanked them for their work and stressed the moral imperative of health care reform. The coalition also sponsored “40 Days for Health Reform” where advocates made 20,000 calls to Congress and visited 100 members of Congress while attending an “Affordable Health Care is A Family Value” rally in Washington, D.C.
There were other faith-based campaigns. Faithful Reform in Health Care, an interfaith group based in Ohio, provided congregational resources and study guides. Catholic bishops and Jewish leaders wrote sermons and op-eds, and the United Church of Christ launched a campaign that sent 100,000 messages to Congress. One of the most powerful advocates for health care reform was the Catholic Health Association, which provided professional expertise and a strong moral voice in favor of the individual mandate and the Medicaid expansion.
While these broad coalitions were united in their support for health care, member organizations emphasized different objectives. Some groups called for a single-payer system while others championed a “public option” alongside reforms to the private insurance market. The Catholic Bishops stressed the importance of including coverage for undocumented immigrants in health care legislation. In addition, they petitioned the White House to exclude federal funding for abortion. The Religious Coalition for Reproductive Choice and others, however, called for including the full spectrum of reproductive health services, including family planning and abortion.
Case study: Values bump up against politics
One of the provisions of the Affordable Care Act requires employer health insurance plans to cover a range of preventive services for women with no co-pays. The services include annual well-woman visits, screenings for gestational diabetes and HIV, testing for HPV, and breastfeeding support. The services also include access to FDA-approved contraceptive methods and family planning counseling.
The Obama administration included a religious exemption to the contraceptive requirement for houses of worship and other nonprofits that primarily employ and serve people of the same faith. After being criticized for not including religiously affiliated institutions such as hospitals and universities, the administration put forth a broader accommodation that protected the religious liberty of these institutions along with women’s health, by requiring the insurance companies to provide contraceptive coverage directly to female employees.
Despite the accommodation, the U.S. Conference of Catholic Bishops and other conservative faith leaders accused the administration of waging an “attack” on religious liberty. The bishops organized a Fortnight for Freedom campaign; distributed tracts, pastoral letters, and sermons to dioceses around the country; and helped spearhead lawsuits opposing the rule.
In contrast, many religious groups and people of faith support the contraceptive coverage requirement. For them, the ability to plan one’s family is a deeply moral decision informed by conscience. In July more than 200 religious leaders signed a public statement affirming birth control as morally good for women, their families, and society. A Public Religion Research Institute survey found that 57 percent of Catholics believe religiously affiliated employers should include contraceptive coverage in their health plans. In addition, majorities of white mainline Protestant, religiously unaffiliated Americans, religious black Americans, and Catholic and Protestant Hispanic Americans agree that religious employers should be required to provide health care plans that cover contraception.
Voting values once again
When the Supreme Court upheld the Affordable Care Act in June, faith leaders gathered near the building to applaud the decision. James Winkler, general secretary of the General Board of the Church and Society of the United Methodist Church, called the decision “a reflection of the moral and ethical character of our people,” and Sister Simone Campbell of NETWORK described the law as “pro-life” and “the right thing to do.”
As the Affordable Care Act is implemented across the country, faith groups will continue to educate communities on broadened options for care, help establish new policies in their clinics and hospitals to implement the law, and press for expanded health care coverage for the most vulnerable. Last month more than 100 national and state faith leaders called on governors in key states to expand their Medicaid programs to cover millions of low-income Americans.
The passage of health care reform provides a glimpse at how faith groups are working with others to turn their vision into reality. It also shows the complexities of engaging one’s values in the public square.
This November Americans will vote on which candidates best reflect their moral views and have an effective plan for governing. For many people of faith, the fight for health care reform reflects deeply held values that were tested in the political arena and still remain strong.