Last week, President Obama, along with Department of Health and Human Services Secretary Kathleen Sebelius, unveiled a compromise agreement for implementing the Patient Protection and Affordable Care Act (ACA). The president, of course, had been getting hammered by both his political friends and foes following a decision to not exempt faith-based organizations (other than houses of worship) from a condition in his healthcare reform requiring employers to cover their employees’ contraception costs.
The Obama administration claims that the compromise balances “individual liberty” and “basic fairness.” Individual liberty here refers specifically to religious liberty claims, especially those made by religiously affiliated organizations like Catholic Charities, hospitals, and universities. Basic fairness, by contrast, signifies groups like Planned Parenthood, NARAL Pro-choice America, and other advocates who argue that a woman’s wellbeing hinges upon access to comprehensive reproductive healthcare, including contraception. The latter group further maintains that access to such care reduces health-care costs. Opponents generally concede the cost point, but balk at the idea that religious employers should be legally required to pay for or directly provide contraceptive services, an activity which contradicts papal doctrine within the Catholic Church.
President Obama’s compromise predictably attempts to solidify support from progressive Catholics and blunt the “war on religion” critique of political conservatives. Yet another question remains: how did Obama, who received an honorary degree from the University of Notre Dame, so thoroughly misjudge the objections of his supporters, particularly Catholic ones?
One possible account is that Obama failed to gauge the consequences of implementing ACA based on a narrow definition of religious employers. Justice in healthcare markets is not simply a question of who gets coverage, of what sort, and who pays for it. It’s also about the moral significance and legal scope of religious exemptions from mandates within ACA. Under what circumstances are religious groups exempt from laws which bind other organizations? More pointedly, what exactly constitutes a religious employer?
Does it refer exclusively to houses of worship or are religiously affiliated colleges, universities, and social service agencies included? The Obama administration chose the “house of worship” definition, presumably thinking they arranged an acceptable balance between liberty and fairness. The immediate and intense response to their decision convinced the administration that their restrictive definition was perceived not as an attempt to ensure that all recipients of taxpayer dollars play by the same rules, but as an attempt to force religiously affiliated employers to pay for coverage that violates their religious convictions.
I doubt that the administration intentionally sought to marginalize religious liberty in implementing the new healthcare law. Obama, after all, is a Christian who, as he notes, started working in Chicago as a community organizer, paid by the Catholic Church to mobilize Catholic parishes. It would seem odd to undermine the religious liberty of the organization which helped refine his sense of public service.
Nevertheless, the administration apparently neglected to sufficiently consult the fragile coalition that made his ACA possible in the first place — one thinks of Catholic Health United, columnists like the Washington Post’s E.J. Dionne, and others.
In 2008, President Obama campaigned as an individual change agent who could transform partisan politics and the machinery of public administration. The reality is that, more often than not, politics is a reactive enterprise of elected officials issuing then clarifying public statements; implementing laws, then revising that process in response to organized money, organized people, and organized voices.
Obama initially struck the wrong balance between religious liberty and access to preventive healthcare, giving due attention to the latter principle and insufficient attention to the former. To his credit, he listened and corrected his misjudgment.
When the government upholds an important principle and simultaneously shortchanges the civil right to freely exercise religion, it is the responsibility of religious groups to petition the government for a redress of grievances. That responsibility, after all, is also a civil right.