One cannot read the gospels without being struck at how much of Jesus’ earthly ministry was devoted to healing. The Gospel of Matthew, for example, reports that “Jesus went throughout Galilee…preaching the good news of the Kingdom and healing every disease and sickness” (4:21). In sending out his disciples he charged them also to “heal the sick” (10:7). Jesus’ concern for the poor is also inescapable. He repeatedly instructs us to attend to their needs. In the parable of the sheep and the goats (Matthew 25), Jesus proclaims that those who wish to enter the Kingdom of Heaven must care for the hungry, naked, and sick—the “least of these.”
Pope Francis has embraced this message. In May 2016 speech to the Doctors with Africa mission group, he stated, “Health is not a consumer good but a universal right, so access to health care cannot be a privilege.” He emphasized in particular the responsibility of Christians to care for the most vulnerable, a theme he again took up in February of this year, warning that the growing lack of health care “among the poorest segments of the population, due to lack of access to care, must leave no one indifferent.”
The American Health Care Act (AHCA), which was pulled from consideration before the House of Representatives on March 24, 2017, does not pass the test proclaimed in the Gospel and endorsed by the pope. It fails to help the “least of these” and reflects just the kind of indifference Francis has denounced. According to a nonpartisan Congressional Budget Office analysis, it would have removed $880 million in federal funding over a decade from the Medicaid program, which pays for health care for the elderly, disabled, children, pregnant women, and the low-income adults. Not coincidentally, it would have cut taxes by almost exactly the same amount for wealthy people, insurers, and providers. The legislation would have cut taxes for each of the four hundred highest income taxpayers in the United States by an average of $7 million annually—enough to cover premium subsidies for over eight hundred thousand lower-income Americans.
The legislation also would have eliminated by 2020 the Affordable Care Act’s income-based premium tax credits, which make health insurance affordable for lower-income Americans, as well as its cost-sharing reduction payments that reduce deductibles and coinsurance for consumers with incomes below 250 percent of the federal poverty level. In their place it would have established fixed-dollar tax credits that would have provided more federal assistance for younger and higher-income consumers even as it reduced the assistance now offered to older and poorer consumers.
The legislation was pulled at the last minute, in large part because of opposition from Republican House members who thought it was still too generous to the poor.
The debate over AHCA offers a striking contrast to the final hours of the debate over the Affordable Care Act (ACA). As some readers may remember, different versions of the ACA were passed by the House and Senate in 2009. There was an expectation that the two versions would be combined into a final bill in a conference committee between the House and Senate, but the sudden loss of the Democrat’s filibuster-proof Senate majority left only one option for moving forward: House enactment of the Senate bill.
This caused a crisis of conscience for a number of “Blue Dog” Democrats, led by Congressmen Bart Stupak and Joseph Pitts, who had included a provision in the original House bill that they believed would ensure that no federal funding would be used to pay for abortions. The Senate bill contained similar provisions, inserted at the request of Sen. Ben Nelson of Nebraska, but Stupak, Pitts, and others questioned whether it went far enough.
This issue almost brought an end to the Affordable Care Act after more than a year of Congressional hearings and floor debate. At the last minute, however, President Obama, issued an executive order—the only ACA-related executive order of his presidency—directing the federal agencies to ensure that ACA funding for insurance-premium tax credits and community health centers not be used to pay for abortions. With this issue addressed, Stupak and other prolife Democrats voted for the bill and it became law.
The Affordable Care Act is in fact profoundly prolife. Since enactment, it has saved thousands of lives. But the prolife Democrats who voted for it paid a heavy price. Many were defeated in the 2010 congressional elections, including at least one who was falsely accused of having voted “for taxpayer-funded abortions.”
Where are lawmakers of faith now? The AHCA would increase the number of uninsured by 24 million within a decade, including 14 million who would lose Medicaid. Losses of coverage would fall disproportionately on older and poorer consumers. Many would die prematurely because of lack of access to health care. Who is speaking up for them?
On March 9, 2017, the United States Conference of Catholic Bishops sent a letter to Congress laying out principles for health-care reform. This letter states forthrightly that “a repeal of key provisions of the Affordable Care Act ought not be undertaken without the concurrent passage of a replacement plan that ensures access to adequate health care for the millions of people who now rely upon it for their wellbeing…. Any modification of the Medicaid system as part of health care reform should prioritize improvement and access to quality care over cost savings.” The bishops joined many other faith leaders in urging Congress not to repeal the ACA without making adequate provision for health care for the poor.
One prominent Republican politician has spoken to the importance of faith in health reform. In 2013, Ohio Governor John Kasich stated: “Now, when you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor. You better have a good answer.” Since then, he has continued to advocate for support for Medicaid, and to testify to his faith as a motivation for doing so. Other moderate Republicans have also expressed concern that the AHCA went too far in cutting Medicaid and reducing the poor’s access to health care. But for the most part, issues of faith have been missing from the repeal-and-replace debate.
For now, repeal of the ACA is on hold. But legislation to repeal parts of it could come back at any time. The Children’s Health Insurance Program (CHIP), which provides access to health care for over 8 million children, must be renewed this year if it is to continue. Funding for Medicaid and Medicare is at risk as Congress considers further tax and entitlement program cuts. Moreover, prompt and decisive action must be taken now by the administration, and possibly by Congress, to ensure the continued availability of coverage through the ACA marketplaces to moderate-income Americans. Congress has put the funding for marketplace insurers at risk and the erratic actions of the Trump administration have undermined the confidence of insurers.
Now is the time for courageous action by people of faith, including members of Congress. Jesus calls us to a prolife agenda of caring for the sick and the poor. We as Christians must call on the government to embrace this agenda. Legislation or administrative actions in health care that undermine care for the most vulnerable are morally unacceptable.
