On May 4, Congressional Republicans gathered in the Rose Garden at the White House to celebrate a 217-213 vote to pass H.R. 1628 (the American Health Care Act, or the AHCA) that finally accomplished something they had tried more than 50 times before: to repeal and replace the ACA, also known as “Obamacare” (even though only 17% of Americans supported such legislation according to one poll). President Trump took the podium to boast, “We’ve come up with a really incredible health care plan, this has brought the Republican Party together.”
Republicans have been quick to defend the AHCA. My Congressional Representative, Brad Wenstrup (R-OH-2nd District), praised the bill because it “restores pro-life principles to our nation’s healthcare.” He noted that pro-life organizations like the National Right to Life, Susan B. Anthony List, the Family Research Council, and the Concerned Women for America supported passage of the bill. But this cherry-picked list makes it seem like the AHCA is a slam-dunk for those concerned about defending human life at every stage. On the contrary, a number of Catholic organizations opposed the AHCA, including the Catholic Health Association of the United States and NETWORK, the Lobby for Catholic Social Justice, which coordinated and published concerns from more than 40 Faith Organizations. Widening the scope, Representative Jim Cooper (D-TN-5th District) listed 50 groups opposed to the AHCA, including the AARP, American Medical Association, American Health Care Association, National Partnership for Women and Families, AFL-CIO, and National Council of La Raza, among others. Representative Jim McGovern (D-MA-2nd District) denounced the bill in a most eloquent manner, calling it a “shameful” piece of legislation that was rushed after a “pathetic process.”
Indeed, it seems it was premature to celebrate and defend the bill without an updated Congressional Budget Office report. This nonpartisan review—released earlier this week—makes it difficult to claim this bill “restores pro-life principles to our nation’s healthcare.”
Here are a few highlights from the CBO report on the AHCA:
- 23 million Americans would become uninsured and it would increase costs for the sickest and oldest citizens.
- In 2026, 51 million people under age 65 would be uninsured (compared to 28 million under the ACA).
- Medicaid (federal and state health insurance for low-income and disabled Americans, as well as children and the elderly) spending would be cut by $834 billion and 14 million people would lose Medicaid coverage.
- Low-income senior citizens could see premium increases as high as 800%, whereas the richest Americans would see their premiums drop. (The richest Americans will also enjoy a $346 billion tax cut over ten years.)
- Current funding levels will cover only 110,000 individuals with a pre-existing chronic condition. If states use other funding, they could cover up to 600,000 individuals with pre-existing chronic conditions, which is not even a third of the 2.2 million enrollees who have a preexisting chronic condition at present. Others report that the AHCA would only cover about 5% of those with preexisting conditions.
- The cost of maternity care could also increase by thousands of dollars, which would likely lead to higher rates of abortion. (The ACA provided prenatal and pediatric care to 9.5 million previously uninsured women, an enormous achievement for families.) Some have said the AHCA disproportionately targets women, especially women in poverty while others call the bill anti-life. Surely those who complain about having to pay for prenatal care for others—as Rep. John Shimkus (R-IL-15th District) did in March—miss the point about what it means to be pro-life.
- 1 in 5 Americans struggle with mental illness, but the AHCA would let states drop coverage for mental health and substance abuse (the Surgeon General reported in November that almost 21 million Americans struggle with substance abuse), charge people higher premiums if they have a pre-existing condition (like anxiety or depression), and create high-risk pools, which would be another way to charge people with mental illness more and provide less coverage.
These features of the AHCA make it clear that “Trumpcare” falls well short of the standard set by Catholic Social Teaching, whether that refers to the life and dignity of the human person, the call to participation in social life, the preferential option for the poor and vulnerable, or solidarity.
Before moving to Cincinnati, my family and I lived in Boston for seven years. During that time my wife (who is a nurse) worked at a community health clinic that provided care to anyone in need. (Thanks to then-Governor Mitt Romney, Massachusetts offers universal health care coverage.) Not only does this kind of preventative care improve the health and wellbeing of countless individuals, families, and communities as well as save the state money (that would be spent by higher costs associated with illnesses that would otherwise go untreated and get worse or the expenses related to ER visits where patients cannot be denied care), but it saves lives. In December, the White House Council of Economic Advisors issued a report that stated, “If experience under the ACA matches what was observed under Massachusetts health reform, an estimated 24,000 deaths are already being avoided annually.” In contrast, the AHCA—by taking coverage away from millions of Americans—will mean that more people will die (and other progress made by the ACA will be reversed).
Earlier this month—in direct contrast to the GOP’s emphasis on free-market healthcare choices—Pope Francis declared that healthcare is a human right, not a “consumer good.” This claim has also been made by the United Nations (Article 25 of the Universal Declaration of Human Rights) and other secular organizations. Rights imply duties and these responsibilities are owed to individuals as well as the common good of all. Human life cannot flourish without basic healthcare. Dr. Martin Luther King Jr. lamented that “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” It is unacceptable to tolerate systems and structures that diminish human dignity and subvert the common good—and the AHCA is guilty on both charges. This stands in stark contrast to the biblical vision of the human person—as created in the image and likeness of God in Genesis 1:26—as well as the divine command to love your neighbor as yourself (repeated twice in the Hebrew Scriptures) and especially those in greatest need (the command to love the stranger, widow, and orphan—the most vulnerable in society—is repeated no less than 36 times in the Old Testament alone and a point Jesus emphasizes in Matthew 25:31-40). Cutting Medicaid by billions of dollars and depriving poor people, children, the elderly, and the disabled of healthcare is a failure to live up to the tenets of Catholic Social Teaching and what a pro-life agenda should involve (or a “whole life” commitment, for that matter).
Catholics can’t allow the GOP to define what constitutes a pro-life agenda when it shows such little regard for life in so many forms. President Trump’s 2018 Budget raises even more alarms, as the USCCB recently pointed out. Trump’s policies—whether in cutting foreign aid or wiping away protections for the environment or increasing military spending or securing a $110 billion arms deal with Saudi Arabia—seem to create conditions that make life more fragile and precarious, rather than promoting human flourishing, integral development, and the peace he promised Pope Francis he’d strive to accomplish.
Alternatively, Catholics have to continue to put pressure on Democrats to make room for pro-life folks on the left. More work needs to be done to advance the dignity of life by ending capital punishment and mass incarceration, passing gun control legislation and environmental protections, fighting systemic racism and advocating for racial justice, welcoming the stranger, whether immigrant or refugee, and combating sexual assault, domestic violence, child abuse, homelessness, hunger and famine, mental health, substance abuse, unemployment and poverty. A Whole Life commitment means forging communities that celebrate diversity and inclusion by respecting life in every form. These priorities do not fit neatly in either the Republican or Democratic parties, something we should be reminding the members of Congress, especially since one-third of the House and one-quarter of the Senate are Catholic (and Congress as a whole is 91% Christian, so these teachings create challenges for most of our elected representatives).
This requires that more Catholics (as well as other Christians and people of good will) embrace a critical distance and prophetic voice to condemn the personal and social sin that contribute to policies that dishonor human dignity and diminish the common good. At the same time, Catholics cannot tire of announcing with hope the vision for collective flourishing where all life is recognized as sacred and belonging to the common good marked by freedom, peace, justice, and solidarity. As Pope Francis remarked in his TED Talk last month, to build the future requires a tireless commitment to solidarity, hope, and a revolution of tenderness that reminds us of the goodness in us and around us as well as the fact that we belong to each other.
When Pope Francis addressed Congress in September 2015, he stated, “Politics is an expression of our compelling need to live as one, in order to build as one the greatest common good: that of a community which sacrifices particular interests in order to share, in justice and peace, its goods, its interests, its social life.” Healthcare is a fundamental right and a good that is essential for the harmony and flourishing of human life, both personal and social. Guaranteeing this right is not the work of politicians (or healthcare providers) alone. Discipleship is personal but it is never private and we have to embrace our duties as citizens. We each have an important role to play in politics and in times like these, civic engagement is crucial. Catholics should continue to demand more from our elected officials, especially in holding them accountable to the dignity of all life and the rights and duties that contribute to the universal common good. Indifference and despair ought to be considered intolerable.
It’s easy to think the system is rigged or broken, the players are motivated by self-interest or special interests, and that we cannot make a difference at the local, state, or federal levels. But this kind of thinking is precisely what enables political dysfunction and corruption. We have to find ways to be more effective in raising our voice, explaining our concerns, and holding our elected representatives accountable to the values that promote human dignity, rights, and the common good. As I’ve written elsewhere, “slacktivism” (clicking to sign a petition or send a pre-filled email) isn’t enough. A recent study found that even calling members of Congress isn’t enough. We have to organize, share our stories, and show how my story and your story create a story of “us” that builds common ground in a time of nearly unprecedented division and political polarization.
At a recent conference on cultivating a collective impact, Harvard Kennedy School of Government professor (and long-time community organizer) Marshall Ganz said, “Charity asks what is wrong and how I can help. Justice asks what is wrong and how can I fix it.” Most Christians know that charity is at heart of discipleship, but not enough know—and live out—a similar commitment to justice. We have to change the sinful social, economic, and political beliefs and structures that exclude, marginalize, and oppress.
We can and must do better.