A recent piece at National Review Online by Dorinda Borlee, Nicholas Nikas and Mark Rienzi brings into the light a very alarming new wrinkle associated with the minimum coverage provision of the Patient Protection and Affordable Care Act (PPACA). Apparently, abortion providers may receive funding from federally mandated insurance premiums paid by private citizens so long as it is funneled through separate accounts which are specifically intended for allocating reimbursements for abortion procedures.
This abortion allocation rule has the feel of some back-room conspiracy, but it is simply a natural outgrowth of the original minimum coverage provision of the PPACA. If the Supreme Court decides that NOT purchasing a good or service qualifies as regulable “commerce,” then there really is no concrete limit to what the government can mandate private citizens to do or not do. As long as someone can argue that a particular action or non-action by citizens sufficiently impacts the public weal, that could then serve as pretext for an enforceable federal edict. Two days ago, the Supreme Court was hearing arguments about the constitutionality of the minimum coverage provision, Judge Alito asked whether under this reasoning Congress could mandate that citizens purchase burial insurance, since it’s an eventuality that applies to everyone. Stephen Breyer replied directly that, “yes, of course they could” if it were determined necessary for the public good. The question, though, is what couldn’t be justified under this reasoning?
You may recall that when Bart Stupak and the “Stupak 11” tried to prevent federal abortion funding from being included in the original bill, they were able to hold out until the last minute when they finally relented on account of assurances by Obama that he would prohibit such funding through an executive order in the form of a signing statement. The lesson to take away from this is that Obama is actually adhering to the letter of his agreement. Yet what he is doing to make up for the lost federal funding to abortion providers is even more heinous, in my view. At the very least, it is the same sort of casuistic shell game that the administration is proposing to Catholic institutions with regard to contraception funding.
What supporters of Obama and the Democratic party do not realize is that the abortion industry (and Planned Parenthood in particular) is an enormous corporate interest group, which influences policy in the same way every other corporate entity does. The moral debate surrounding its work obscures the fact that what the abortion industry is ultimately after is profit, to the tune of three-quarters of a billion dollars each year. (Just multiply the estimated number of abortions by the average cost of each abortion procedure.)
The way Belmont Abbey College has handled the issue of the HHS mandate is exemplary, in my view. They have received a good deal of resistance for it, though, even from within their ranks. Several employees have filed suit against them, and the student newspaper even ran a story pointing out that there were two drug stores located on their property which sell contraception. I found the abbot’s reply to the situation very illuminating:
After the student newspaper, The Crusader, published an article in May 2008 pointing out that the Abbey profits from the sale of contraceptives at two stores on its land, the Abbot responded by stating that: ‘[They] are preponderantly good operations, i.e. 99 percent or more of their business is not problematic, and the employment generation and economic stimulation they provide for the community of Belmont are worth tolerating a small amount of evil. The Abbey is not willing to lease to them because they sell contraceptives, but despite it.’
The case is a very intriguing instance of how material cooperation with evil can become illicit. If you recall from Dana’s excellent post on this topic from awhile back, material cooperation with evil does not itself constitute a moral transgression so long as (a) the good whose attainment is bound up with that cooperation is sufficiently great, (b)the attainment of that good increases with an agent’s proximity to the activity in question and (c) the activity in question does not involve grave scandal. The drug store case clearly meets all these requirements, in precisely the ways the abbot described. Cooperation with the PPACA, however, not only involves great scandal, but also violates condition (b) since an employer’s increased engagement in this act (presumably through the gathering of more information as to the destination and distribution of their payments) would in no way increase the good to be obtained in the act, but would only serve to exacerbate the element of scandal and remove any lingering excuplatory ignorance!
The bigger issue, though, is the cooperation with the political evil involved with these mandates. There has to come a point- and it may be coming soon- when paying our taxes can no longer be considered licit cooperation with evil (which is the case now, in my view). There has to come a point when the violation of the inherent autonomy of citizens and the various intermediary associations within society (including the Church) constitutes a level of injustice that can no longer warrant material cooperation of any kind. In this case, I still think there is room for paying monetary penalties for noncompliance, since this would amount merely to submission to the penal function of the State (which is certainly within its rightful authority) and would also be an expression of resistance to unjust laws. But I’m not entirely sure where to draw the line there; it gets very messy.
What I worry most about, though, is the complete loss of any concrete barrier to what the State can require of us under the pretext of “the public weal”. And the issue cuts across ideological lines: this President sees the funding of abortion providers as a national interest, but the next President could see the funding of rapacious conglomerates with borderline-monopolies as a national interest. The scary thing is that once the government is permitted to provide such funding through legal mandates of private transactions, there is no way to hold in check the government’s power to direct citizens’ money to the industries of their choice. If you think corporate lobbying is bloated and corrosive now, then just wait to see what it will look like a couple years from now if the Supreme Court upholds this law.
Firstly, possibly a quibble, but that depends on the math: “The moral debate surrounding its work obscures the fact that what the abortion industry is ultimately after is profit, to the tune of three-quarters of a billion dollars each year. (Just multiply the estimated number of abortions by the average cost of each abortion procedure.)” There is a difference between gross receipts and profit.
Secondly, we are dealing with two aspects of the problem namely a further distinction between insurance purchased by a secularist or protestant, and and insurance purchased by a Catholic entity.
The secularist believes that abortion is perfectly OK, some moving on to say that abortion would nearly vanish if society did a good job of providing for the needs of the pregnant lady and of her child in gestation and afterwards. Some protestants agree with the secularist, and this Catholic joins in the sentiment that abortion would nearly vanish if society acted toward full social justice.
Whether we like it or not, to the extent there is a government benefit offered to the public, it is possibly a denial of equal protection of the law to say that female contraception services are not covered, particularly where female contraception medications, e.g. ‘the pill’, can be prescribed for medical reasons other than contraception, invariably are prescription medications, and cannot be obtained without a doctor’s appointment or several. The argument could be made that penal, testicular, and prostate treatments are covered, so why not ob/gyn?
Finally, the entire cost of abortion and contraception services in the United States, is likely minuscular as a percentage of the federal budget, or as a percentage of all medical insurance paid; and if there is no insurance applicable to those services, the cost will wind up being imposed upon the cities, counties, and states that reimburse hospitals for services not paid by the patient. In short, there’s a public expense for such things no matter how you slice it.
De minimis for sure. Meanwhile let’s fight to get the skinflints out of Congress, and enact sweeping legislation for the benefit of the pregnant and of the young once born. Let’s advertise these programs and hire counselors to implement the program and then see abortion become scarce and rather universally frowned upon. That may be way faster then waiting for Roe v Wade to be overturned, if ever.
Mr. Clark,
No shoe has dropped at all. And the heinous plot you are attributing to President Obama is actually the result of the compromise in late December 2009 with pro-life Democratic Senator Ben Nelson. It received a great deal of attention at the time and has been a well known feature of ACA. It is utterly mistaken to refer to it as a “new wrinkle” or, as your source (NRO) describes it, “the dirty little secret of this unconstitutional scheme.”
A great deal of the misinformation about this issue, including misinformation in the NRO article you link to, is cleared up on Politifact. I urge you and anyone else interested to read it carefully.
To put it very briefly, what the compromise insisted on by Senator Nelson results in is that those who (1) purchase insurance from a state health care exchange, and (2) choose to have abortion coverage in their policy, will have to pay for the abortion coverage with a separate check. Those who are covered by employer-provided insurance (the majority) are unaffected. Also, states have the right to prohibit abortion coverage in insurance policies, and currently 15 do so. No one will be surprised if that number increases.
So it all boils down to the simple proposition that those who choose abortion coverage in policies they purchase from a state exchange will have to pay for that coverage out of their own pockets. Exactly how can this be seen as government forcing people to do something that violates their consciences?
You say:
First, this strikes me as a partisan political statement, inappropriate on Catholic Moral Theology. But at least you only accuse “supporters of Obama and the Democratic party” of ignorance, not malevolence. First, I would say that one can be a supporter of Obama and the Democratic party without supporting abortion. One can also be a supporter of Obama and the Democratic party and realize there are pro-abortion forces who have their own interests at heart and lobby for them aggressively. Since Planned Parenthood is a non-profit organization, I find it a little odd to accuse them of being after profit, but certainly they have self-interests and lobby on their own behalf. One can also be a supporter of Obama and the Democratic party and, like myself, believe that in spite of the pro-abortion lobby and the pro-choice position of Obama himself, the ACA does not have any “dirty little secrets” that benefit Planned Parenthood or other abortion providers.
You say, in boldface and italics:
In reality, the government is not providing funding through legal mandates of private transactions. Anyone who does not want to purchase abortion coverage through a state exchange can buy a policy without it. Anyone who doesn’t want to write two checks—one of them for abortion coverage—can simply choose a policy without abortion coverage. And it is difficult for me to imagine why anyone who does choose abortion coverage is being coerced into doing something against his or her conscience by writing a separate check for it.
Now, let’s look at how things worked before Obamacare was even conceived. Most people received their insurance coverage through their employer. If their employer chose to provide coverage of contraception and abortion, and employees were expected to pay something toward the cost of their insurance, then employees were paying directly toward coverage of contraception and abortion, no matter whether they intended to take advantage of that coverage or whether they considered contraception and abortion immoral. What choice did they have? If they did not want to pay anything toward coverage of contraception and abortion, they could decline to accept the insurance coverage provided by their employer. Were they ever urged to do so, so as not to “cooperate with evil”? Have the bishops ever urged, or will they ever urge, Catholic employees of companies who provide insurance coverage that includes abortion and contraception to do without employer-provided insurance? If so I have never heard of it. And for those who obtain insurance through their employers, nothing will change.
If Omamacare survives the Supreme Court, I would say very little regarding who pays for abortion will change. Those who are covered through their employers will still be paying part of the cost of abortion coverage. Those who buy insurance from a state exchange, and choose abortion coverage, will pay for it out of their own pockets just the way any other individual does now who buys an insurance policy that covers abortion. Whether or not exchanges permit abortion coverage at all in insurance is up to the states, just as abortion itself would be if Roe v Wade were overturned. Those who buy insurance through state exchanges will actually have more freedom to choose policies that don’t cover abortion than those who are fortunate enough to have employer-provided insurance, since buying from an exchange will allow people to choose their own policies rather than have little choice other than to accept what their employers offer.