On the campaign trail, Donald Trump vowed to repeal and replace the Affordable Care Act (ACA), also known as Obamacare. The promise helped him win, and Congressional Republicans, led by House Speaker Paul Ryan, are now gearing up for the massive undertaking. As Mr. Trump takes office and health care policy changes unfold, citizens with pro-life commitments should keep an eye on the developments, because in the new policy our government will be seeking to refine and implement a set of anthropological views.
The practice of medicine involves the whole human body, so policies about it inevitably express a specific anthropology or philosophical understanding of the human person. National legislation that includes every citizen will have the consequence of enacting one anthropology as opposed to others. Accordingly, health care law has become a test of America’s ability to balance an authentic pluralism, one that is capable of respecting both individual freedom and the moral commitments of other individuals who become funders of it.
The Affordable Care Act in particular brought a higher level of politicization to medicine with the individual mandate, the requirement that every citizen purchase an insurance plan. This action makes us all stakeholders, participants in the system regardless of our convictions or opinions about certain procedures. Now every taxpayer’s conscience comes to the table of healthcare policy.
Even setting aside questions of finance and practicality, healthcare has come to symbolize the cultural divide in the population. The dollars and lines of the bills speak volumes and currently lean toward support for abortion, sexual license, sex-reassignment, and physician-assisted suicide. But reform has the option to enshrine a different ethic: one of individual responsibility with emphases on healthy fertility and costly, but ethical, end-of-life care. However, since America lacks cultural agreement on these anthropologies, it will be worth watching as Congress strives to balance the often-opposed ends of individual freedom and social virtue.
The stakes are high both functionally and culturally. Here are six points that pro-life citizens and those mindful of conscience concerns should be on alert for:
- A clear distinction between insurance and medical care – A glaring, but oft-unacknowledged error of the Affordable Care Act is the difference between having health insurance and receiving needed medical care. The former is no guarantee of the latter. The working poor with incomes that set them above the Medicaid threshold have been saddled with low-premium plans that have exorbitant deductibles of up to $13,000, that leave them de facto uninsured and priced-out of healthcare. This problem reveals a gap in concern for certain social groups; it’s part of an anthropology that gives lip service to covering all people, but actually disregards some. Pro-life means pro-life for everyone, so a pro-life policy should seek to increase access for all.
- A repeal of the contraception mandate – As the separate Hobby Lobby and Little Sisters of the Poor cases demonstrated through the court system, there is a problem with forcing employers to pay for procedures and medications they find gravely immoral.
This is not a miniscule minority who objects to something otherwise ordinary, though it is often painted that way. Religious people of all stripes and some secular pro-life Americans oppose the requirement. It’s not that conservatives wish to take issue with others’ private decisions and actions, but that we not be asked to finance behavioral decisions with which we disagree. Privacy and pluralism could be balanced far better on this question.
Fortunately, if the ACA is repealed, the contraception mandate will go with it. The new Secretary of Health and Human Services, Tom Price, could also dispense with it.
- An end to the individual mandate – Requiring all citizens to purchase health insurance was meant to help finance the law by adding the premiums of the young and healthy to the pool of cash for medical expenses, used more by the aged and ill. While this makes sense from a monetary standpoint, it has not stopped prices of premiums and procedures from rising, nor has it provided all with adequate coverage, as mentioned in #1.
Worse, however, is that it prevents a moral opt-out for citizens who would object to any or all portions of the health care system. Although the Supreme Court let it stand, the individual mandate, for many Americans, still represents a violation of freedom of conscience. Ending the individual mandate would be a victory for pluralism, of letting citizens disagree and for preventing the government from legislating on the bodily lives of every single American.
- Adequate funding for the severely ill and dying – Euthanasia is a development that pro-life people need to fight. As physician-assisted suicide gains legal traction, insurance companies have incentives to deny expensive care for cancer patients, such as Stephanie Packer, a mother of four diagnosed with late stage cancer.
Legalized suicide inverts the practice of medicine, turning patients into dollar amounts instead of lives worth saving, regardless of long is left. The cultural message about the value and purposes of life that is sent by legal suicide is tragic and irreversible. If lives are only valuable when they are pain-free and productive, most of us will soon be in the crosshairs. As the government sets policy, we must demand that it take care of its citizens rather than killing them, and that it tells Americans that life is worth living. This should be an anthropological no-brainer.
- A continuation of Hyde restriction on abortion – Presently, the Hyde Amendment, a rider attached annually to the Congressional budget, prohibits federal funding for abortion. It affects Medicaid primarily, but is also present in the ACA. Insurers are not required to cover abortions. States, by contrast, may add abortion coverage or limit it.The principles of the Hyde Amendment permit a level of personal removal for taxpayers who would be funding the procedure that, for many, amounts to murder. Hyde is one of the key compromises that followed the 1973 legalization of abortion. However, it came under fire this campaign season from the Democratic party platform and nominee, Hillary Clinton. In the first week of his presidency, Mr. Trump passed the Hyde rider into a permanent law. For valuing life, it’s a small but important victory. Abortion is a clear-cut case of difference on what it means to be human and who counts as one. Hyde represents one stab at pluralism, a starting point. A committed pro-life healthcare policy will further demonstrate support for women, babies and families through—
- Support for prenatal and neonatal care – Pro-life groups are often criticized for caring more about the baby than the mother. If conservatives have a chance to help shape public health policy, we need to make abortion obsolete. Support for pregnant mothers, new moms, and infants, as well as adoption placement need to be readily available so that women in difficult situations aren’t left alone and without options. Raising a child is difficult and demanding work. If we claim to welcome unplanned children, we need to welcome unplanned children, viewing them and their mothers as essential to the social fabric of our country. That’s an anthropology of life that values people and responsibility rather than seeking to abolish the natural consequences of behavior.
As reform comes to the American healthcare system, pro-lifers have a great opportunity, a chance to demand that our representatives contribute to a culture that truly cares for all its citizens at all stages of life. This is a tall order, certainly, but only by the good fruit of a moral anthropology driven by love rather than self-gain, nihilism or hedonism, will the tree of pro-life views be revealed as a good tree.