All Catholic Bishops Must Act on Medicaid Expansion

Bishop Paul Swain of the Diocese of Sioux Falls, SD is out of step with the official stated position of the U.S. Conference of Catholic Bishops, which affirms that “health care is a basic right flowing from the sanctity and dignity of human life.”  In the battle over Medicaid expansion, Bishop Swain chooses to remain steadfastly on the sidelines.

The bishop’s silence betrays the pressing need to act on behalf of the “least among us”—those who will suffer without the promise of accessible and affordable health care.

Where a leadership void exists, millennial Catholics should fill it.

Our faith is grounded in a man who went about healing those with no food, no shelter, and no hope for being healed elsewhere.  Our generation is primed for civic-mindedness and social activism.  We must demand a level of public engagement from the Sioux Falls Diocese and others across the country on crucial life issues like basic healthcare for all, especially the poor.

I am calling on Catholics in South Dakota to make their voices heard, but I also urge fellow millennials to bring focused energy to bear where their dioceses are unresponsive to the cries of the very ones whom Jesus came to help.

Here is the immediate background:  A ruling by the U.S. Supreme Court in June 2012 leaves the choice of expansion of the federal-state Medicaid program under the Affordable Care Act up to each individual state.  So far, about half of the states have announced their intention of participating in expansion, while 19 states have either declared they will not participate or are leaning toward not participating.  Four states are currently pursuing alternative models.  States can choose to opt in or out of Medicaid expansion at any point. Though the federal government covers 100% of the expanded Medicaid benefits from 2014-2016, this gradually drops to 90% in subsequent years.  The smaller administrative costs for expanding Medicaid will be shared equally between federal and state governments.

In late 2012, South Dakota Gov. Dennis Daugaard announced his intention to reject federal funding to increase health coverage for low-income citizens in his own state.  Expansion of the Medicaid program in South Dakota would result in health coverage for as many as 48,000 low-income citizens.  A push for expansion during the 2013 state legislative session was unsuccessful and the issue was not put to a vote.

When questioned by local reporters and Catholic social justice advocates, Bishop Swain has so far refused to endorse the expansion of Medicaid in South Dakota.  And while each bishop and his diocese are free to operate with relative autonomy, Bishop Swain is decidedly at variance with the U.S. Conference of Catholic Bishops, who wrote in a 2009 letter to the U.S. Senate:

The bishops support the expansion of Medicaid eligibility for people living at 133 percent or lower of the federal poverty level. The bill does not burden states with excessive Medicaid matching rates. The affordability credits will help lower-income families purchase insurance coverage through the Health Insurance Exchange.

Furthermore, dozens of Catholic bishops across the country have themselves publicly and vigorously supported Medicaid expansion.  Bishop Swain’s abdication of moral leadership is unacceptable for such a visible Church figure, especially on this urgent life issue.

The U.S. Bishops produced a guide outlining Catholic political responsibility entitled Forming Consciences for Faithful Citizenship: A Call to Political Responsibility from the Catholic Bishops of the United States.  The bishops write, “Some question whether it is appropriate for the Church to play a role in political life. However, the obligation to teach about moral values that should shape our lives, including our public lives, is central to the mission given to the Church by Jesus Christ.”

This is why, for instance, in April 2012, the Bishops strongly condemned the U.S. House budget crafted by Rep. Paul Ryan (R-WI), writing a formal letter to lawmakers urging them to “resist for moral and human reasons unacceptable cuts to hunger and nutrition programs.”  They continued in the letter, “As pastors and teachers, we remind Congress that these are economic, political and moral choices with human consequences.”

And on the issue of care for the poor and the sick, the bishops are unambiguous, calling for “greater assistance for those who are sick and dying, through health care for all…the USCCB supports measures to strengthen Medicare and Medicaid.” Indeed, every Catholic bishop in the states of Texas, Ohio, Florida, Illinois, Arizona and New Mexico, among others, has publicly urged their governors to embrace Medicaid expansion.

In a letter to Gov. Rick Perry, for instance, the Texas bishops write:

Failing to care for the poor and vulnerable unnecessarily increases sickness, premature death, and needless suffering.  It would result in the unnecessary, untimely deaths of an estimated 8,400 low-income Texans every year.

The reality of health care funding is that when people are uninsured and cannot pay their bills, we all pay the price in higher private insurance premiums, overwhelming pressures on the local hospital districts and county government, and hikes in local taxes to cover the cost of uncompensated care.

We need to draw back for the benefit of Texans the tax dollars that Texans send to Washington.  Otherwise, other states will use our nation’s tax dollars to expand their Medicaid programs, while we continue to pay higher local taxes and insurance premiums to provide for uncompensated care.

The USCCB stresses in Forming Consciences, “In the Catholic Tradition, responsible citizenship is a virtue, and participation in political life is a moral obligation.” The Catechism of the Catholic Church itself makes clear, “It is necessary that all participate, each according to his position and role, in promoting the common good.”  Since all Catholic bishops trace their origins to the apostles of Christ, bishops have a special role and responsibility in promoting the common good: to teach and to lead on critical moral issues in dire need of action.  Access to affordable health care is one of those urgent issues.

In Forming Consciences, the Bishops quote Pope Benedict XVI in Deus Caritas Est:

The Church cannot and must not take upon herself the political battle to bring about the most just society possible.  She cannot and must not replace the State.  Yet at the same time she cannot and must not remain on the sidelines in the fight for justice.

When criticized for remaining neutral on Medicaid expansion, Bishop Swain offered flimsy and inconsistent excuses.  The bishop has asserted, for example, that it is not his role to be involved in the political process.  Swain, who prior to converting to Catholicism served as Legal Counsel and Director of Policy for Governor Lee Sherman Dreyfus (R-WI), said on a Sioux Falls radio program in February, 2013:

Part of it is a difference of opinion in what the role of the Church is, of a bishop is.  And part of it is based on my past experience as a lawyer and working in government and having an understanding of the legislative process.  The teaching of the Church is that affordable health care ought to be provided for all.  And how that’s done is a challenge that people of goodwill can disagree on.  Medicaid is a fine way to do it.  But the details of it are beyond my personal understanding.  And so I’ll defer to those who are experts in the field, and particularly to our elected officials to figure out how to do it.

Speaking on special interests in the political process, he acknowledged that the Church has a role to play, but said, “We’re not a political part of that power in that sense.  So the Church sets principles based on the teachings of Christ.”

But the U.S. Bishops make clear in Forming Consciences that this is not enough.  They write:

…the failure to respond to those who are suffering from hunger or a lack of health care, or an unjust immigration policy are all serious moral issues that challenge our consciences and require us to act.  These are not optional concerns which can be dismissed.

Moreover, Bishop Swain’s claims of political abstinence are inconsistent with his own past behavior.  In 2006, he told cheering congregants that he would proudly vote for an abortion ban on that year’s ballot, along with a constitutional amendment banning same-sex marriage.  “…We must take stands on issues in the public sphere,” he told the gathered crowd, “when they touch the core of what we know by reason to be true and affect the salvation of souls.”

Leading up to the following election in 2008, Bishop Swain penned a public letter on that year’s abortion ballot issue—Initiated Measure 11—and distributed it to all the parishes within the diocese.  He wrote, “It is not for me to make judgments about political realities.  We must, however, respond to what is before us.”  And in a comment that seems uncannily analogous to his admittedly ambivalent views on recent health care legislation and regulations, Bishop Swain offered, “Sometimes morally flawed laws already exist.  In this situation, the process of framing legislation to protect life is subject to prudential judgment and ‘the art of the possible.'”

As for the salvation of souls, scripture tells the story of the Last Judgment (Mt 25:31-46), reminding us that we will be judged by our response to the “least among us.”  The Catechism of the Catholic Church teaches, “Those who are oppressed by poverty are the object of a preferential love on the part of the Church…”

So how does Bishop Swain explain his refusal to take a position on expanding Medicaid—a crucial life issue—when he has taken such firm stances on other political issues?

One approach was to claim that there was no bill to review.  He said in the February radio interview, “This particular issue there’s actually no bill written, and the lawyer in me and the old government official in me says I wanna read something before I endorse it.”

This is a red herring. With the exception of the four states seeking waivers to expand Medicaid using federal funds as premium assistance to purchase coverage for newly eligible beneficiaries, each state must simply decide—Yes or No—whether to opt in for Medicaid expansion under federal law.  The mechanism for how this is done is spelled out in great detail in the Affordable Care Act, which is easily available to the public via the internet as a downloadable PDF.  Bishop Swain should know this.

Next, the bishop alleges that health care policy may be used to restrict “freedom of conscience.” This issue, which numerous Catholics dispute now that various exemptions have been granted, is distracting him from the central issue at hand. First, adequate life-saving health care for thousands of low-income South Dakotans should not be held at the mercy of a culture war battle over contraceptives.    Second, let’s remember that broader access to health care reduces abortions, a clear concern of the bishop and all faithful Catholics.  Countless studies, such as this one from the Brookings Institution, make clear that expansion in states’ Medicaid programs will reduce rates of abortion, teen pregnancy, and out-of-wedlock childbearing. Whether one is focused on the primary task at hand of ensuring universal health coverage or the most important social issue, minimizing the number of abortions, the need to support Medicaid expansion is clear.

Every year, an estimated 26,000 to 45,000 Americans die because they lack health insurance. Surely, Bishop Swain’s commitment to life extends to caring for those whom Jesus loved most—the poor and the sick.

I understand Bishop Swain is a religious leader. One could argue that expanding Medicaid is merely a political issue. It is a political issue, but for Catholics, providing care to those in desperate need is fundamental to our faith.  This is not a time for our religious leaders to guard their political capital; it is a time to stand firmly on the right side of a moral issue.  A life issue.

While the Church labors to hold on to the devotion of members of all ages in America, it finds itself in an urgent struggle for relevance in the lives of an entire generation in particular. Such rigidity and aloofness on the pressing social justice issues of our time is a recipe for losing the millennial Generation.

The election of Pope Francis and his immediate change in tone and priorities for the Church are encouraging signs.  Francis has signaled a shift in focus toward social justice, a greater role for Catholic women, and even encouraged young Catholics to make a “mess” in their dioceses in the name of shaking up the old guard and spreading their faith.  Meanwhile, he has conspicuously chosen to deemphasize hardline rhetoric on Church doctrine related to social issues.  These are long strides in the right direction, but will enough American bishops and other clergy get the message?  That will depend, in large part, on how young Catholics respond.

We came of age in this new millennium.  We are the change we were waiting for.  And all around us we see what change looks like. We are defined by our diversity and tolerance, not by the moralistic culture wars that have characterized American politics for the past three decades.  We are focused and determined to lead America into a new civic era of pragmatic problem-solving.

That is why we call Bishop Swain and other Church leaders, silent in the face of losing crucial Medicaid funding, to expand their understanding of preserving life, to see that rejecting these funds amounts to a rejection of real life-and-death assistance for those who need it most.

Please join me in my insistence that Bishop Swain and other reluctant advocates add their voices to the dozens of Catholic bishops who do urge their state leaders to support Medicaid expansion.

Join me also in my hope that our Catholic clergy lead their flocks by embodying the social gospel that lies at the very heart of the life and ministry of Jesus Christ, who did not just talk about compassion, but showed it; did not just teach us about love, but was it; and did not just preach about taking care of the least among us, but did it.  Will we as Catholics follow in the footsteps of Christ our Lord through our actions?

Ryan Casey is a 2010 graduate of the Georgetown Public Policy Institute at Georgetown University.  He lives in Sioux Falls, SD.  You can follow him on Twitter @RyanCaseySD.