Pope Francis pleaded Thursday for aid to “all those people around us who are trapped in a cycle of poverty.” Catholic healthcare leaders heard the words as a call for them to do more.
“It is always good to have someone say, 'Is it possible for you to try a little harder?' ” said Sister Carol Keehan, president and CEO of the Catholic Health Association. Keehan sat in the Capitol balcony during the pope's address to a joint session of Congress, at the invitation of California Rep. Nancy Pelosi. “It was utterly breathtaking,” Keehan said.
The pope's visit comes as the Affordable Care Act has expanded insurance coverage and is changing Catholic hospitals' role as part of the nation's safety net. It also comes as the U.S. announces plans to increase the number of refugees admitted into the country by 30,000 a year, including 10,000 next year from war-torn Syria.
Catholic organizations operate 1 in 10 U.S. hospitals and represent some of the nation's largest health systems, with annual revenues in the billions of dollars and broad geographic reach. Hospitals sponsored by the Roman Catholic Church follow the church's ethical and religious directives. They also operate as charities, which requires that they provide community benefits and use their income solely for operations, investment and charity.
Pope Francis emphasized the basic needs of immigrants and refugees. Keehan said those needs present Catholic healthcare providers with an opportunity to supply aid and advocacy.
Immigrants living in the U.S. without authorization, who are not eligible for coverage under the Affordable Care Act, make up a significant portion of the nation's uninsured.
Keehan also noted that Catholic health systems have an important role to play in persuading lawmakers to expand Medicaid in the states that so far have declined, including Florida and Texas.
“Think of what it would do for their health, for their dignity, for their peace of mind,” Keehan said of the uninsured who would gain coverage. Medicaid expansion also would allow hospitals to redirect funds previously used to offset losses from uncompensated care toward other community health needs, she said.
The amount of free medical care provided by Catholic and other not-for-profit hospitals has been scrutinized by patient advocates, state attorneys general and members of Congress. Critics say that many not-for-profit hospitals do not provide enough charity care to justify the tax exemptions they receive. The ACA included new rules for the reporting of charity care and community benefit but stopped short of compelling those hospitals to meet a certain threshold.
A review of Modern Healthcare's database of health system financial results shows wide variation in the amounts Catholic health systems spend on charity care and other activities tallied as community benefits in their financial disclosures. Among Catholic systems with at least $200 million in revenue, community benefit in 2014 ranged from less than 2% of operating expenses to nearly 19%. The average was about 8%.
Meanwhile, the ACA's coverage expansions are significantly reducing the number of people who need charity care, particularly in states that have expanded Medicaid, leading Catholic health systems to consider different ways of carrying out their mission.
“The pope is challenging us to change how we think about health and wellness,” Anthony Tersigni, president and CEO of Ascension, which operates the nation's largest not-for-profit health system, said in a blog commentary for the Hill ahead of the pope's address. “He is calling on us to provide all people with access to healthcare, whether they are sick or well, old or young—whether or not they can afford to pay.”
Tersigni, who was not available for an interview Thursday, told USA Today he will travel to Rome in November to discuss the role of Catholic hospitals with Pope Francis.
In line with Tersigni's comments, this year, SCL Health System, an 11-hospital, Denver-based Catholic system, overhauled its process of getting information to senior leadership from marginalized and vulnerable communities, said David Pringle, the system's senior vice president of mission integration.
“We have a pretty strong sick care system in this country,” Sister Jennifer Gordon, SCL Health's system director of mission services, said. “We don't particularly have a great healthcare system.”
Keehan was a key ally to the Obama administration during the drafting, passage and implementation of the Affordable Care Act, and received a pen used by the president to sign the 2010 bill into law. Her organization's support created a rift with the U.S. Conference of Catholic Bishops, which opposed the law stating that healthcare reform would “expand the role of the federal government in funding and facilitating abortion and plans that cover abortion.”
Pope Francis on Thursday tacitly endorsed a legal challenge to an Obama administration effort to make contraception available at no out-of-pocket cost under the ACA. The pope paid a visit to the Little Sisters of the Poor, an order of nuns that operates about 30 nursing homes and is suing the Obama administration over the effort.
“The Golden Rule also reminds us of our responsibility to protect and defend human life at every stage of its development,” the pope said during his remarks to Congress.