Letter to U.S. Senate on Health Care Reform, June 1, 2017

June 1, 2017

United States Senate
Washington, DC 20510

Dear Senator:

When the House of Representatives passed the American Health Care Act (AHCA), the United States Conference of Catholic Bishops noted the positive aspects of the bill, including critical life protections, but urged that the Senate "must act decisively to remove the harmful proposals from the House bill that will affect low-income people—including immigrants—as well as add vital conscience protections, or begin reform efforts anew."

The AHCA contains many serious flaws.  Most troubling are unacceptable changes to Medicaid that reports indicate will leave millions of additional people uninsured in the years ahead. 

Pope Francis has warned, "When a sick person is not placed at the center and considered in their dignity, attitudes arise which can even lead to profiteering on other people's misfortunes.  The growing health poverty among the poorest segments of the population is due precisely to the difficulty of access to care . . ."

You have a grave obligation as Senators, then, when it comes to policy that affects health care.  When health care reform was first being taken up by this Congress, the Bishops offered key moral principles.¹   As you decide how to proceed, these principles remain vital, including:

1. No Affordable Care Act repeal effort should be undertaken without the concurrent passage of a replacement plan that ensures access to adequate health care for all.

2. Respect for life: No health care reform plan should compel us or others to pay for the destruction of human life, whether through government funding or mandatory coverage of abortion.  Long-standing "Hyde Amendment" protections must extend to any relevant health care plan in order to prevent federal funding of abortion and not as a temporary fix or future promise.  Federal resources must not be used to assist consumers in the purchase of health care plans that cover abortion.  

3. Access for all: Reform efforts must begin with the principle that health care is not a privilege, but a right in keeping with the life and dignity of every person.  All people need and should have access to comprehensive, quality health care.  Reform efforts should consider people's differing circumstances and ensure access which is in accord with their means.  Every individual and family must be able to see clearly how they will fit within and access the health care system in a way that truly meets their needs, and immigrants must be included among them.

4. Truly affordable:  Many lower-income families simply lack the resources to meet their health care expenses.  The Bishops have serious concerns about structural changes to Medicaid that would leave large numbers of people without the coverage they now rely upon, including those who gained access to care as part of the Medicaid expansion that came with the ACA.  Reform also ought to address barriers to affordability for those living above the poverty level but who are still working hard to make ends meet.  

5. Comprehensive and high-quality:  Health care is much more than mere insurance.  Other aspects of health care policy require the attention of policy-makers:
   
   Access provided in national health care policy needs to focus on the maintenance and promotion of good health as well as treat disease and disability for all people, regardless of means;
   
   Incentives for preventative care, early intervention and maintaining a reasonable choice of providers—whether they be individual providers, groups, clinics or institutions—are all part of a comprehensive approach that can help ensure high quality;
   
   Our system should encourage individuals to develop a sense of ownership over decisions that affect their health and well-being;
   
   Approaches that encourage people to enter medical professions, and which foster more humane and responsive relationships between doctors and patients should be pursued.

6. Honoring conscience rights:  Congress should expressly provide conscience protections for those who participate in any way in health care.  Such protections should extend to all stakeholders, including patients, insurers, purchasers, sponsors, and providers.

Should the Senate choose to use the AHCA as a starting point, you must retain the positive elements of the bill and remedy its grave deficiencies.  We suggest the following:

• Retain the AHCA's life protections for the unborn;
   
• Ensure affordable, adequate coverage for all stages of life for those who currently receive Medicaid from the recent expansion;
   
• Remove the Medicaid "per capita cap" provisions;
   
• Increase the level of tax assistance, especially for low-income and older people, in the tax credit proposal;
   
• Retain the cap on costs of plans for older Americans at a 3 to 1 ratio;
   
• Reject "health status underwriting" for those with pre-existing conditions, which could seriously impact the affordability of their health care;
   
• Oppose significant penalties, which the poor cannot afford, for gaps in coverage;
   
• Fully restore the "presumptive eligibility determination" authority to states and hospitals.  This authority provides faster access to important health and treatment options, and reduces other costs borne by providers and the community;
   
• Continue the requirement that states afford individuals Medicaid benefits during a reasonable opportunity to establish citizenship or qualified immigration status;
   
• Add conscience protections that meet the requirements outlined above.

The Catholic Church remains committed to ensuring the fundamental right to medical care, a right which is in keeping with the God-given dignity of every person, and the corresponding obligation as a country to provide for this right.  Health care debates must not be reduced to only those elements which appear most politically expedient; those without a strong voice in the process must not bear the brunt of attempts to cut costs.  The Bishops stand ready to work with Congress to address problems with the Affordable Care Act in ways that protect the most vulnerable among us.

Sincerely,


His Eminence Timothy Cardinal Dolan        
Archbishop of New York                
Chairman, Committee on Pro-Life Activities    

Most Rev. William E. Lori
Archbishop of Baltimore
Chairman, Ad Hoc Committee for Religious Liberty

Most Rev. Frank J. Dewane        
Bishop of Venice    
Chairman, Committee on Domestic Justice  and Human Development

Most Rev. Joe S. Vásquez    
Bishop of Austin
Chairman, Committee on Migration

¹ (https://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/joint-letter-to

Senate-Principles-letter-Health-Care-Reform-2017-06-01.pdf