Catholic health care systems are now able to operate pension funds free of federal funding requirements, according to a rulling handed down December 8 by the U.S. District Court for the District of Colorado.
According to a Bloomberg news report, Judge Robert E. Blackburn wrote that a plan can be a church plan “in one of two ways – by being established and maintained by a church or association of churches, or by being maintained by a qualifying organization that is controlled by or associated with a church.”
The practical implication of the ruling is that Catholic health care ministries now have a distinct competitive advantage over other non-Church health care entities that are required to meet federal pension funding requirements.
What’s more interesting is to consider the written decision in the context of other issues that apply in a health care context.
In the decision, Blackburn said that “the Catholic Church itself (not unlike other established religions) is a huge conglomerate that operates in various forms and formats, including corporate ones.”
Later, he also said that “regardless of the personal convictions of any single employee, both CHI and the DB Plan Subcommittee are animated by and bound by Catholic doctrines in the performance of their duties.”
Furthermore, he says, The “First Amendment creates a protected zone for churches to decide these issues of religious [*11] doctrine free from government intrusion. This protected zone includes: (1) a church’s law and doctrine; (2) a church’s religious mission; and (3) a church’s polity, administration, and community. . . . The First Amendment “plainly forbids” courts from inquiring into this departure-from-doctrine claim.”
Then, in a discussion of whether or not a First Amendment challenge would survive, he cites the three-pronged “Lemon test,” and makes the following points:
- For a law to have forbidden “effects” under Lemon, it must be fair to say that the government itself has advanced religion through its own activities and influence.”
- A principle (of Lemon) is violated “when accommodation of a religious practice or principle imposes burdens on non-adherents they would not otherwise be required to bear.”
- The third and final prong of Lemon inquires whether a statute requires “excessive government involvement in religious affairs, including whether such involvement is a continuing one leading to an impermissible degree of entanglement”.
We need to consider these issues in the context of health care itself and and especially when public funds are being used (sometimes exclusively) to fund services that are then restricted by doctrine.
Is a government contract that turns over 97% of all public funding available for a 50-year period to a Church entity “advancing religion through its own activities and influence”?
Is it a violation of Lemon when a Church entity that receives government funding imposes restrictions on patients and physicians who have no other practical options?
And how do we resolve these issues without entangling government in doctrine, especially when the essence of Catholic doctrine in a health care setting is all about how health care services – which are heavily regulated – will be delivered?
One answer might be that no federal or state funding should be allowed for the delivery of any health service that is governed by religious doctrine.
And for any of these discussions, one needs to consider what will happen when the State is called upon to fund services through religious entities that are small in number now but likely to grow. For example, should a Muslim health system that treats diabetics receive government funding if patients are required to fast during Ramadan? Should they received government funding if women are not allowed to be seen by male physicians or if women physicians are not allowed to see male patients? And who should make the decisions? Physicians? Clerics?
According to Beckers’, seven or the ten largest nonprofit health care systems are Catholic. The long-term implications of encouraging and supporting even more government funded, religiously-based health care institutions are not well understood. But we all need to be paying attention.