Yes, Healthcare Is a Right

They’re still at it. Another court challenge to the Affordable Care Act (ACA) is taking place in the Northern District Court of Texas in a suit brought by Texas and nine other states. [1] To understand the basis of the challenge, we must call to mind the Supreme Court ruling that upheld the “individual mandate” portion of the ACA in 2012. In that case, National Federation of Independent Business v. Sebelius [2], the Court held that, while Congress has no power to command the citizenry to buy health insurance, the “penalty” for not buying health insurance was actually to be understood as a tax, and was, therefore, constitutional.

But last year this tax was eliminated by Congress. There is no longer a tax for failure to buy health insurance. The ACA still has a mandate to purchase health insurance, but the mandate is now toothless.

Now since the imposition of a tax for failure to buy health insurance was designed to incentivize its purchase, and since the purpose of that incentive was to spread costs and keep premiums down, Texas and the other plaintiff states are saying that the purpose of the ACA has been defeated. Somehow, that makes it unconstitutional they say.

Of course, two features that will disappear along with the ACA if the plaintiffs are successful are the subsidies that help people afford insurance, as well as the rule against excluding pre-existing conditions—indeed, there will be no requirement that health insurers accept people with pre-existing conditions at all.

Ordinarily it would be the task of the Justice Department to come to the defense of this federal legislation. In this case, however, the Trump administration has declined to do so. [3] But if the plaintiffs prevail, that will be bad news for people with pre-existing conditions, and those who can’t afford health insurance without the subsidies provided by the ACA.

There are voices to be heard, even among Catholics, that health insurance or healthcare shouldn’t be the business of government. These would certainly applaud a victory on the part of Texas and the other states. But should healthcare be a concern of government? Does Catholic social teaching call for government’s involvement?

The answer is yes, quite unambiguously so.

The Catechism tells us that it “is the role of the state to defend and promote the common good of civil society, its citizens, and intermediate bodies.” (Catechism of the Catholic Church (CCC), §1910) [4] The “common good requires the social well-being and development of the group itself. Development is the epitome of all social duties. Certainly, it is the proper function of authority to arbitrate, in the name of the common good, between various particular interests; but it should make accessible to each what is needed to lead a truly human life: food, clothing, health, work, education and culture, suitable information, the right to establish a family, and so on.” (CCC, §1908)

“Concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment, and social assistance.” (CCC, §2288) [5] “The political community has a duty to honor the family, to assist it, and to ensure especially…in keeping with the country’s institutions, the right to medical care, assistance for the aged, and family benefits….” (CCC, §2211) [6] [7] And Pope Francis reminded us not too long ago in the apostolic exhortation Evangelii Gaudium that it “is vital that government leaders and financial leaders take heed and broaden their horizons, working to ensure that all citizens have dignified work, education and healthcare.” (§205) [8]

So, according to Catholic social teaching, it is a governmental and societal responsibility that every citizen have access to necessary healthcare. We can dispute about what the best way of accomplishing that would be. But, if we are to claim adherence to Catholic teaching, we may not ignore the requirement. And that means that we must be sincere about coming up with solutions that will actually work. It is, therefore, inconsistent with Catholic social teaching to get rid of the ACA and replace it with nothing or something worse.

The icon of St. Joseph the Worker is by Daniel Nichols.

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