Republican governors v. hospitals in the Medicaid expansion fight

by Tom Gallagher

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The constitutionally legitimate Affordable Care Act provides for an expansion of Medicaid in which the federal government will pay 100 percent of the costs of the expansion for the first three years, then 90 percent after that. As part of the anti-Obama campaign by Republicans, a number of governors have vowed not to expand Medicaid in their states, like Gov. Rick Scott of Florida. In Florida, more than 20 percent of its 19 million people have no health insurance.

Yet Republican governors will face the powerful hospital lobby, whose members desperately need the Medicaid expansion funds. Today's New York Times covers this story.

But what should Catholic hospitals do with respect to the Medicaid expansion issue?

Clearly, Catholic hospitals need the Medicaid expansion dollars as much as non-Catholic hospitals. This creates an interesting and serious tension point with Republican bishops and their Republican staff members at the U.S. bishops conference.

So far, the U.S. bishops have repeatedly presented blistering personal attacks on the first African-American president and his administration over the contraception mandate and have created a Cassandra-like call that the religious-liberty sky is falling. This unprecedented, over-the-top partisan attack, coupled with practically no equally aggressive, positive speeches or press releases or tweets about the Affordable Care Act and President Barack Obama's leadership, has had the impact of tainting the entire Affordable Care Act from the Catholic perspective. How could it not?

Meanwhile, in the last 20 years, New York Cardinals John O'Connor, Edward Egan and Timothy Dolan, along with bishops of Brooklyn, have successfully participated in and overseen the demise of Catholic acute care hospitals in New York City. In 2009, I wrote an NCR story about the flagship Catholic hospital in New York City, St. Vincent's, founded in 1849, as it was attempting to survive. A year later, St. Vincent's closed.

So what are Catholic hospitals, their executives and members of their boards of directors, who have civil law fiduciary responsibilities for the mission of their hospitals, including their financial viability, to do with respect to the Medicaid expansion?

It's obvious and clear -- they have no option: It would be immoral and a breach of their fiduciary responsibilities for Catholic hospitals and their leadership not to fight aggressively for Medicaid expansion in their states.

Time will tell whether the U.S. bishops get on board or whether they stand by and watch more Catholic hospitals close.

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