Nov. 13-19, 2003
VOL 122 NO. 40
Catholic Health Care
By Dennis Poust/ SUN contributing writer
St.Joseph’s Hospital was established May 6, 1869 in a former dance hall and saloon. Five sisters of the Third Order of St. Francis purchased the land and buildings for $12,00
Photo courtesy St. Joseph’s Hospital Archives
When a group of French Ursuline Sisters traveled to the Louisiana Territory in 1727 and set up a free hospital to care for the sick, they could not possibly have imagined the impact that Catholic health care would one day have in America. But from those humble beginnings, Catholic health care evolved into a vital cog in the nation’s health care delivery system and one of the church’s most significant ministries, caring for untold millions — sick and healthy, poor and rich, preborn to elderly — over the last 275 years.
New York State alone contains 39 Catholic-affiliated hospitals, 61 nursing homes, 19 certified home health agencies, three licensed home health agencies, 15 long-term home health care programs and six hospice programs. Catholic health care provides 15 percent of the health care services delivered in New York State.
The 39 hospitals see 400,000 annual admissions, 1 million emergency room visits and 4.4 million outpatient visits. The nursing homes account for 10,400 beds, and the hospice programs admit 6,500 terminally ill New Yorkers every year. In addition to these health care providers, the Catholic health care system includes a managed care insurance plan, Fidelis Care New York, which covers 160,000 low-income New Yorkers in the government sponsored Medicaid, Child Health Plus and Family Health Plus programs.
Today, however, Catholic health care in America faces challenges — both external and internal — like none other in its 275 year history. Sustaining Our Presence In 1996, while working on a story for a national Catholic newspaper on the challenges facing Catholic health care, I attended the annual meeting of the Catholic Health Association, which was held that year in San Antonio, Texas. Interviewing Auxiliary Bishop Joseph Sullivan of Brooklyn, one of the nation’s leading authorities on Catholic health care, I asked him what the biggest challenge facing Catholic health care is today. His answer was blunt: “Sustaining our presence in the health care field.”
In effect, the challenge was nothing less than survival. “We can be very true to ourselves and lose our presence if we’re not particularly collaborative and willing to take the kind of risks the founders of this ministry took way back when,” Bishop Sullivan warned at the time. He specifically mentioned a national trend toward a market-driven system featuring for-profit health care systems that he feared would put profitability over concerns for human life while running Catholic hospitals out of business. While New York maintains a ban on for-profit hospitals, that is not the case in other parts of the country, where such hospitals have, often very aggressively, competed with Catholic systems.
In the years since Bishop Sullivan’s comments in San Antonio, Catholic hospitals have taken steps to address the threat to their survival, particularly by heeding the bishop’s call for collaboration to counter the market forces. With the cost of medical care ever rising, and the often stingy reimbursements provided by managed care drowning health care institutions in red ink, Catholic institutions have moved boldly to form networks or other types of partnerships to reduce duplication of services, contain administrative costs and generally make the Catholic health care system operate more efficiently and effectively. While this sort of collaboration has been effective, it has not eliminated the financial challenges, and it has not addressed —at least not fully — other challenges that continue to test the ministry.
Some of those challenges are based on demographics — both in terms of who is running the systems and where the systems are operating. As the religious orders that have traditionally run Catholic hospitals and nursing homes see their ranks ever thinning, the institutions are increasingly run by lay women and men. This is not to say that lay leadership results in the loss of Catholic identity, but it presents issues that were just not there before, namely how to keep the spirit of religious mission alive in an environment where more and more laypeople are running the day-to-day operations. The Catholic Health Association has attempted to address that with a stronger focus on leadership training to instill a sense of mission in lay administrators.
While successfully keeping that sense of mission is critical from a religious standpoint, it is equally important from a corporate, bottom-line standpoint because Catholic identity is an important part of how Catholic health care institutions position themselves in the marketplace. As the health care field becomes more corporate and impersonal, Catholic health care institutions stand out as offering a commitment to the individual. This focus on the patient, which is at the heart of the “Catholic identity” of these institutions, resonates with a public weary of being treated like a number. When Catholic health care institutions talk about respect for the innate dignity of the human person, it’s not just a line in a mission statement, but the philosophical underpinning of the entire ministry, as well as its greatest selling point.
A separate demographic challenge involves the question of where Catholic health care institutions are located. Catholic hospitals were among the first on the scene as cities developed across New York, and have subsequently witnessed the flight of residents to suburbia. In some cases, community hospitals have fled with the population, leaving only the Catholic hospitals to serve those who remained, often among the poorest residents in the state. While this reality underscores the ministerial aspect of Catholic health care, it strains hospital budgets as well. Catholic hospitals perform approximately $200 million in charity care every year, only a fraction of which is reimbursed by the state.
In addition, the location of Catholic hospitals, combined with their mission, has resulted in many being on the forefront of providing specialty services such as AIDS care and drug and alcohol rehabilitation. Unfortunately, such programs are frequently underfunded by government budgets, leaving the hospitals to underwrite the expensive specialized care. External Attacks But of all the challenges facing Catholic health care, the most insidious of all are the attacks from the outside, mostly by abortion rights groups, who have a clear, if usually unstated, goal of driving the Catholic Church from the health and human services ministries. These groups, such as Planned Parenthood, Naral Pro-Choice America (formerly the National Abortion Rights Action League) and Catholics for a Free Choice, have relentlessly pursued public policies aimed at forcing Catholic institutions to directly violate the tenets of the Catholic faith and, eventually, make it impossible for them to continue to operate.
Results have been mixed. Last year, the New York State Legislature passed and Gov. Pataki signed a bill mandating that Catholic institutions — including health care institutions — include contraception coverage in employee health insurance programs. That law is now being challenged in the courts. This year, the groups turned their attention to legislation that would have forced Catholic hospitals to dispense so-called “emergency contraception” drugs to rape victims even if it would result in the destruction of an already growing embryo. In that case, the New York State Catholic Conference successfully convinced the bill’s sponsors to amend the bill to allow Catholic hospitals to follow church teaching in such cases.
Family Planning Advocates of New York State, the lobbying arm of Planned Parenthood, has even injected itself into the business aspects of Catholic hospitals. A few years ago, the group founded a sister organization called MergerWatch, whose sole purpose is to monitor affiliations between Catholic hospitals and secularly run hospitals in an attempt to dictate what services will be offered. When St. Mary’s Hospital in Amsterdam, N.Y. formed an affiliation earlier this decade with Nathan Littauer Hospital in Gloversville, N.Y., abortion rights groups loudly objected. The reason? As part of the agreement Littauer would no longer perform abortions. New York attorney general Eliot Spitzer then attempted to gain jurisdiction over the affiliation. Spitzer claimed, in part, that because Littauer was no longer performing abortions, it represented a “change of purpose” for the not-for-profit hospital, which would make the agreement subject to the Attorney General’s approval. The two hospitals sued and emerged victorious, delivering a setback to abortion rights groups.
These examples make clear that the Catholic health care system faces continuing challenges to its ministry from the outside. In many cases, the reason is obvious — Catholic health care, which operates in the secular world, caring for patients of every faith, socio-economic background and regardless of ability to pay, is society’s most visible counter-image to the culture of death. Some radical abortion rights groups will stop at nothing to drive these institutions from the state — even at the expense of the health, well-being and employment of many of the poorest members of society. Promoting a Culture of Life The Bishops of New York State have long recognized that Catholic health care is a target of pro-abortion forces. Just as obvious is the urgent need for the continuation of these institutions in the state, particularly among poor and vulnerable populations. As a result, the health care legislative agenda of the New York State Catholic Conference, which represents the bishops in public policy matters, focuses on ensuring continued and improved access to health care for all New Yorkers, as well as protection for the church’s health care mission from this unrelenting attack. Recognizing what Bishop Sullivan called “the intrusion of the marketplace into an arena which is totally inappropriate,” the Conference has consistently urged the state to continue to maintain a strictly not-for-profit health care delivery system in New York.
The Bishops’ legislative agenda calls for simplified enrollment and recertification for Medicaid and other subsidized health plans, increased Medicaid rates for dental and behavioral health services, collaborative efforts to address health staffing shortages, and an expansion of home health care to allow, when possible, infirm and frail individuals to remain at home among family and friends. All such changes will increase access to care. In terms of protecting the church’s health care mission, the bishops urge support for the principle of religious freedom in the provision of health care services and opposition to measures which threaten the Catholic health care mission.
In addition, the Bishops seek adequate funding for and access to services for persons with HIV/AIDS and their families and parity for mental health and substance abuse health insurance benefits. Catholics concerned about these and other legislative issues can stay informed by joining the New York State Catholic Conference’s Catholic Advocacy Network. Just go to www.nyscatholic.org and click “Join the Network.” Or write to the Conference at 465 State St., Albany, N.Y. 12203. Be sure to provide your name, address, phone, email, diocese and parish. There is no cost to join and your name will not be shared beyond the Syracuse Diocese and the Catholic Conference.
Dennis Poust is the director of communications for the New York State Catholic Conference, the official public policy voice of the Catholic Church in the Empire State.