The Supreme Court decision overturning the constitutional right to abortion is revealing the growing influence of Catholic health systems and their restrictions on reproductive services including birth control and abortion — even in the diminishing number of states where the procedure remains legal.
Catholic systems now control about 1 in 7 U.S. hospital beds, requiring religious doctrine to guide treatment, often to the surprise of patients. Their ascendancy has broad implications for the evolving national battle over reproductive rights beyond abortion, as bans against it take hold in more than a dozen Republican-led states.
The Catholic health-care facilities follow directives from the United States Conference of Catholic Bishops that prohibit treatment it deems “immoral”: sterilization including vasectomies, postpartum tubal ligations and contraception, as well as abortion. Those policies can limit treatment options for obstetric care during miscarriages and ectopic pregnancies, particularly in the presence of a fetal heartbeat.
“The directives are not just a collection of dos and don’ts,” said John F. Brehany, executive vice president of the National Catholic Bioethics Center and a longtime consultant to the conference of bishops. “They are a distillation of the moral teachings of the Catholic church as they apply to modern health care.” As such, he said, any facility that identifies as Catholic must abide by them.
The role of Catholic doctrine in U.S. health care has expanded during a years-long push to acquire smaller institutions — a reflection of consolidation in the hospital industry, as financially challenged community hospitals and independent physicians join bigger systems to gain access to electronic health records and other economies of scale. Acquisition by a Catholic health system has, at times, kept a town’s only hospital from closing.
Confusion post-Roe spurs delays, denials for some lifesaving pregnancy care
Four of the nation’s 10 largest health systems are now Catholic, according to a 2020 report by the liberal health advocacy organization Community Catalyst. The 10 largest Catholic health systems control 394 short-term, acute-care hospitals, a 50 percent increase over the past two decades. In Alaska, Iowa, South Dakota, Washington and Wisconsin, 40 percent or more of hospital beds are in Catholic facilities.
What post-Roe America could mean for your birth control
3:48
With Roe v. Wade overturned, the legality of abortion has been left to the states. Some worry that access to certain types of contraception could be next. (Video: Julie Yoon, Hadley Green, Sarah Hashemi/The Washington Post)
“It’s all about market share,” said Lois Uttley, a senior adviser to the hospital equity and accountability project at Community Catalyst. Uttley, who has been tracking hospital mergers and acquisitions since the 1990s, said that with fewer choices, patients today face more difficulty obtaining reproductive services.
In Schenectady, N.Y., Ellis Medicine is in talks with the multistate Catholic giant Trinity Health. Last month, in Quad Cities, Iowa, Genesis Health System signed a letter of intent to enter a partnership with MercyOne, also part of Trinity Health. And this semester, Oberlin College had to find a new provider to prescribe contraceptives after outsourcing student health services to a Catholic system that would not provide them.
In rural northeast Connecticut, residents are protesting the prospect of their 128-year-old hospital becoming part of a Catholic system and the potential impact on reproductive services.
“It would be very troubling to see cutbacks in a state like Connecticut,” said Ian McDonald, a stonemason who opposes the proposed deal between Day Kimball Healthcare in Putnam and Massachusetts-based Covenant Health.
Kyle Kramer, chief executive of Day Kimball Healthcare, said the proposed affiliation with Covenant Health would rescue the financially challenged 104-bed hospital.
“Obviously it has connotations,” Kramer said of the proposed move to faith-based ownership. The Catholic directives would “provide guidance,” he said in an interview, while insisting that “the services that we have provided in the past are the same services that we will continue to provide in the future.”
Kramer did not answer questions in a follow-up email about how contraception and elective sterilizations could continue to be provided under Catholic doctrine if their primary purpose is for birth control. Nor did he specify how emergency obstetric care that could result in terminating a pregnancy might be affected.
Covenant Health spokeswoman Karen Sullivan said in an email that as part of the regulatory process, the Catholic health system is drafting a public response to questions by the state’s Oct. 23 deadline. The system, she said, is committed to “ensuring that the Ethical and Religious Directives are applied thoughtfully and with empathy, compassion and respect for every person we serve.”
Catholic hospitals and providers are accredited and held to the same standards as their secular equivalents, according to the Catholic Health Association of the United States, which lobbies on behalf of Catholic hospitals.
But reproductive rights advocates say there has been a steady erosion of services in both Republican- and Democratic-led states because of the growing dominance of Catholic hospitals.
Physicians face confusion and fear in post-Roe world
Many patients are unaware of the restrictions because hospital administrators typically don’t outline the services they do not offer, said Sister Simone Campbell, a lawyer who until recently led the liberal-leaning NETWORK Lobby for Catholic Social Justice.
“Many hospitals have dealt with this by being pretty quiet. Dobbs has made it more of a question,” Campbell said, referring to the case that led to the Supreme Court’s overturning of Roe v. Wade.
Catholic facilities may not “promote or condone” contraception, according to the directives — a stance that is not widely shared by the public. Just 4 percent of U.S. adults think contraception is immoral, according to a 2016 Pew Research Center poll. Among Catholics who attend weekly Mass, only 13 percent say contraception is morally wrong, and 45 percent find it acceptable.
The directives, developed in the late 1940s by the U.S. Conference of Catholic Bishops, were updated in 2018, largely to ensure that Catholic doctrine prevails after mergers and acquisitions, according to Amy Chen, a lawyer with the National Health Law Program. They limit options for referring patients to secular facilities, saying employees must not “manage, carry out, assist in carrying out, make its facilities available for, make referrals for, or benefit from the revenue generated by immoral procedures.”
Interpretation of the directives varies among hospital ethics committees. But decisions ultimately rest with the local bishop, who is to be kept informed, the directives say, if “a Catholic health care institution might be wrongly cooperating with immoral procedures.”
“Bishops have a great deal of authority in their dioceses,” Brehany said. “A bishop should ensure that a Catholic organization is abiding by the directives.”
Abortion is now banned in these states. See where laws have changed.
Catholic systems now control about 1 in 7 U.S. hospital beds, requiring religious doctrine to guide treatment, often to the surprise of patients. Their ascendancy has broad implications for the evolving national battle over reproductive rights beyond abortion, as bans against it take hold in more than a dozen Republican-led states.
The Catholic health-care facilities follow directives from the United States Conference of Catholic Bishops that prohibit treatment it deems “immoral”: sterilization including vasectomies, postpartum tubal ligations and contraception, as well as abortion. Those policies can limit treatment options for obstetric care during miscarriages and ectopic pregnancies, particularly in the presence of a fetal heartbeat.
“The directives are not just a collection of dos and don’ts,” said John F. Brehany, executive vice president of the National Catholic Bioethics Center and a longtime consultant to the conference of bishops. “They are a distillation of the moral teachings of the Catholic church as they apply to modern health care.” As such, he said, any facility that identifies as Catholic must abide by them.
The role of Catholic doctrine in U.S. health care has expanded during a years-long push to acquire smaller institutions — a reflection of consolidation in the hospital industry, as financially challenged community hospitals and independent physicians join bigger systems to gain access to electronic health records and other economies of scale. Acquisition by a Catholic health system has, at times, kept a town’s only hospital from closing.
Confusion post-Roe spurs delays, denials for some lifesaving pregnancy care
Four of the nation’s 10 largest health systems are now Catholic, according to a 2020 report by the liberal health advocacy organization Community Catalyst. The 10 largest Catholic health systems control 394 short-term, acute-care hospitals, a 50 percent increase over the past two decades. In Alaska, Iowa, South Dakota, Washington and Wisconsin, 40 percent or more of hospital beds are in Catholic facilities.
What post-Roe America could mean for your birth control
3:48
With Roe v. Wade overturned, the legality of abortion has been left to the states. Some worry that access to certain types of contraception could be next. (Video: Julie Yoon, Hadley Green, Sarah Hashemi/The Washington Post)
“It’s all about market share,” said Lois Uttley, a senior adviser to the hospital equity and accountability project at Community Catalyst. Uttley, who has been tracking hospital mergers and acquisitions since the 1990s, said that with fewer choices, patients today face more difficulty obtaining reproductive services.
In Schenectady, N.Y., Ellis Medicine is in talks with the multistate Catholic giant Trinity Health. Last month, in Quad Cities, Iowa, Genesis Health System signed a letter of intent to enter a partnership with MercyOne, also part of Trinity Health. And this semester, Oberlin College had to find a new provider to prescribe contraceptives after outsourcing student health services to a Catholic system that would not provide them.
In rural northeast Connecticut, residents are protesting the prospect of their 128-year-old hospital becoming part of a Catholic system and the potential impact on reproductive services.
“It would be very troubling to see cutbacks in a state like Connecticut,” said Ian McDonald, a stonemason who opposes the proposed deal between Day Kimball Healthcare in Putnam and Massachusetts-based Covenant Health.
Kyle Kramer, chief executive of Day Kimball Healthcare, said the proposed affiliation with Covenant Health would rescue the financially challenged 104-bed hospital.
“Obviously it has connotations,” Kramer said of the proposed move to faith-based ownership. The Catholic directives would “provide guidance,” he said in an interview, while insisting that “the services that we have provided in the past are the same services that we will continue to provide in the future.”
Kramer did not answer questions in a follow-up email about how contraception and elective sterilizations could continue to be provided under Catholic doctrine if their primary purpose is for birth control. Nor did he specify how emergency obstetric care that could result in terminating a pregnancy might be affected.
Covenant Health spokeswoman Karen Sullivan said in an email that as part of the regulatory process, the Catholic health system is drafting a public response to questions by the state’s Oct. 23 deadline. The system, she said, is committed to “ensuring that the Ethical and Religious Directives are applied thoughtfully and with empathy, compassion and respect for every person we serve.”
Catholic hospitals and providers are accredited and held to the same standards as their secular equivalents, according to the Catholic Health Association of the United States, which lobbies on behalf of Catholic hospitals.
But reproductive rights advocates say there has been a steady erosion of services in both Republican- and Democratic-led states because of the growing dominance of Catholic hospitals.
Physicians face confusion and fear in post-Roe world
Many patients are unaware of the restrictions because hospital administrators typically don’t outline the services they do not offer, said Sister Simone Campbell, a lawyer who until recently led the liberal-leaning NETWORK Lobby for Catholic Social Justice.
“Many hospitals have dealt with this by being pretty quiet. Dobbs has made it more of a question,” Campbell said, referring to the case that led to the Supreme Court’s overturning of Roe v. Wade.
Catholic facilities may not “promote or condone” contraception, according to the directives — a stance that is not widely shared by the public. Just 4 percent of U.S. adults think contraception is immoral, according to a 2016 Pew Research Center poll. Among Catholics who attend weekly Mass, only 13 percent say contraception is morally wrong, and 45 percent find it acceptable.
The directives, developed in the late 1940s by the U.S. Conference of Catholic Bishops, were updated in 2018, largely to ensure that Catholic doctrine prevails after mergers and acquisitions, according to Amy Chen, a lawyer with the National Health Law Program. They limit options for referring patients to secular facilities, saying employees must not “manage, carry out, assist in carrying out, make its facilities available for, make referrals for, or benefit from the revenue generated by immoral procedures.”
Interpretation of the directives varies among hospital ethics committees. But decisions ultimately rest with the local bishop, who is to be kept informed, the directives say, if “a Catholic health care institution might be wrongly cooperating with immoral procedures.”
“Bishops have a great deal of authority in their dioceses,” Brehany said. “A bishop should ensure that a Catholic organization is abiding by the directives.”
Abortion is now banned in these states. See where laws have changed.