‘Obamacare’ Is About Access, Not Excess

MASS REPEAL: Calls for the dismantling of President Obama’s signature healthcare legislation have gone into overdrive since the Supreme Court ruled the law as constitutional last month. (Jonathan Ernst/Newscom)

The federal government has not taken over health care. The federal government has taken over access to health care. There is a difference.

When I was a student at Morehouse College in the early 1970s, activists launched a campaign to address the shortage of African American doctors in the state of Georgia. They produced bumper stickers that asked “Only 100 Black doctors in Georgia?” with a map of the state’s 139 counties in the background. With many of those 100 doctors concentrated in urban areas such as Atlanta, people voiced clear concern over access to health care for thousands of African Americans in rural, poor and remote areas. Morehouse College President Hugh Gloster responded to this concern by founding the Morehouse School of Medicine, which joined Howard University Medical School, Meharry Medical College and the Charles Drew School of Medicine (similarly founded to address access issues in the Los Angeles area) as the nation’s only predominantly Black medical schools.

Were the government to have taken over health care, the government would be proffering medical diagnoses, prescribing medicine, and performing surgery. This is not the case. What the Supreme Court’s ruling upheld on June 28 was not government-controlled health care, but a federal system that expands access to health care for millions of Americans, mostly poor and many people of color. In a country where national strength finds measure on barometers of military might and economic prosperity, Scripture connects a nation’s well being to its care for the poor. In the fifth chapter of the biblical book bearing his name, Jeremiah challenges his nation, saying:

5:26 For among my people are found wicked men: they lay wait, as he that setteth snares; they set a trap, they catch men.

5:27 As a cage is full of birds, so are their houses full of deceit: therefore they are become great, and waxen rich.

5:28 They are waxen fat, they shine: yea, they overpass the deeds of the wicked: they judge not the cause, the cause of the fatherless, yet they prosper; and the right of the needy do they not judge.

5:29 Shall I not visit for these things? saith the Lord: shall not my soul be avenged on such a nation as this?

And among the judgments God speaks through Ezekiel, health care stands prominently:

34:4 The diseased have ye not strengthened, neither have ye healed that which was sick, neither have ye bound up that which was broken, neither have ye brought again that which was driven away, neither have ye sought that which was lost; but with force and with cruelty have ye ruled them.

Interestingly, the arguments against the healthcare reform upheld by the Supreme Court do focus on the problem of systemic access, and the price to be paid for it — whether the price is monetary in the form of the penalty for failure to carry health insurance or individual liberty in the form of governmental coercion. Yet in both cases, the plight of the poor and needy, the sick and infirm, goes unaddressed. How to make health care accessible for those on the margins of society receives little attention from those who would dismantle “Obamacare.” Promises to repeal the legislation without offering a clear alternative for how we as a nation make health care available and accessible to all persons reduces “the least of these” to political pawns, whose lives represent fodder for a political machine designed to appeal to the self-interests of America’s middle class.

UPHOLDING THE LAW: Supporters of President Obama’s healthcare reform rallied outside the Supreme Court chambers prior to the Court’s historic ruling on June 28. (Jonathan Ernst/Newscom)

Such a move must be resisted by President Obama and supporters of the legislation. The president campaigned for much of 2008 by appealing to that same middle class. He has lost some of their support with his championing of this version of reform, but that is precisely because our electoral system makes it difficult to appeal to a moral high ground as a strategy for garnering support (unless the issues revolve around sexuality and/or abortion). Some who have been disappointed by the president but still support him for reelection need to become more vocal in raising this issue above individual self interest to the moral high ground, much as Jim Wallis and Sojourners put forth the notion that poverty is a moral issue in the 2004 presidential campaign.

The question of access to health care ought matter significantly to people of faith. But it is easy to see how a church whose own theology promises personal prosperity apart from systemic issues of justice can miss the mark of its high calling to care for the poor. Indeed, it is as if a central claim of many messages draws directly from the Rev. Frederick J. Eikerenkoetter, better known as Reverend Ike: “The best thing you can do for the poor is not be one of them.”

Our ministry to the sick must move beyond prayer and visitation, and our work amongst the poor requires more than acts of charity. Justice questions continue to loom large in a nation with rampant inequality in quality of life, minimized access to maximal care, and economic stumbling blocks that tie the quality of health to possession of wealth. The spiritual gift of healing is not restricted to those in a specific economic category. If God’s divine, miraculous intervention to bring healing cannot be tied to social status, why should not a national healthcare philosophy be similarly non-discriminatory?

The Supreme Court ruling on the constitutionality of the Affordable Care Act provides the opportunity for the various agencies: government, hospitals, physicians, pharmaceutical companies, insurance companies, and employers to move with plans for implementation. It is good news for many who currently have little if any access to health care.

While many decry the “intrusion of big government,” an unanswered question for Christians who have opposed healthcare reform is “how has the church mobilized on behalf of the sick and the poor?” In other words, could it be that the intrusion of “big government” in part reflects a gaping hole in our mission to care for the least of these through ministries of mercy, prayer for healing, and advocacy for the oppressed? Are we so busy with “destiny and prosperity” that our attentions have been taken from our responsibilities to fulfill Jesus mission in Luke 4 and Matthew 25?

‘Obamacare’ Prevails: Supreme Court Upholds Healthcare Law

In a 5-4 vote, the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act today, including the controversial individual mandate that requires all Americans to buy health insurance beginning in 2014. However, the ruling limited the federal government’s power to punish states for not expanding Medicaid coverage, as the ACA required.

“The Court did not sustain it as a command for Americans to buy insurance, but as a tax if they don’t. That is the way Chief Justice John G. Roberts, Jr., was willing to vote for it, and his view prevailed. The other Justices split 4-4, with four wanting to uphold it as a mandate, and four opposed to it in any form,” Lyle Denniston, the 81-year-old reporter, wrote on SCOTUS blog today.

The immediate sense is that this is a major victory for President Barack Obama and the signature legislation from his first term in office. “Whatever the politics,” the president said after the ruling, “today’s decision was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court’s decision to uphold it.”

But the decision also was an indication that the Supreme Court perhaps isn’t as predictably partisan as many believed prior to the announcement. Breaking with the court’s other conservative justices, Chief Justice Roberts announced the judgment that allows the law to go forward with its mission of covering more than 30 million uninsured Americans. Many observers speculate that Roberts’s ruling reflected his attempt to avoid going down in history as an activist chief justice on what might be the most important decision of his tenure.

UrbanFaith spoke to a variety of legal and medical experts about what the implications of today’s decision may be.

BERNARD JAMES: “An extraordinarily important substantive issue about the power of Congress under the Commerce Clause.”

Bernard James, professor of law at Pepperdine University in Malibu, California, along with three other sources UrbanFaith talked to earlier this week, expected the individual mandate to be struck down, but said the ruling has the potential to answer “an extraordinarily important substantive issue about the power of Congress under the Commerce Clause.”

The Commerce Clause refers to Article 1, Section 8, Clause 3 of the U.S. Constitution. It gives Congress the power to regulate commerce with foreign nations and among the states.

“Once it’s clear what the Commerce Clause permits and what it requires, not just health care, but all other subjects on the current agenda for this Congress will be more easily pondered and legislated,” said James.

“There were not five votes to uphold [the individual mandate] on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power,” editor Amy Howe wrote on the SCOTUS blog. “Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose,” she wrote in her summary of the ruling.

JAMES A. DAVIDS: “This is like federalism on steroids.”

James A. Davids, former president of the Christian Legal Society and a joint professor at the Robertson School of Government and the School of Law at Regent University in Virginia Beach, Virginia, said that ever since the New Deal was implemented in the 1930s, the Supreme Court has viewed federal power “expansively.” That vision of federal power was “tweaked” under the Renquist court, Davids said, in its rulings on two bills, the Violence Against Women Act of 1994 and the Gun-Free School Zones Act of 1990. As with today’s ruling, the court said then that there may be good reasons to enact these laws, but not under the Commerce Clause. “There were exceptions going into the power of the government under the Renquist court, under federalism issues, and this is like federalism on steroids,” said Davids.

Davids also said the Rehnquist court ruled that it was constitutional for the federal government to withhold highway funding from South Dakota when the state refused to comply with the National Minimum Drinking Age Act. In this case, the Court said current Medicaid funding cannot be revoked, but new funding can be withheld.

“Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding,” Chief Justice Roberts wrote in his opinion. Roberts, who was appointed by President George W. Bush, cast the deciding vote to uphold the ACA.

DR. BEN CARSON:“We got what could be expected” from politicians.

For Dr. Ben Carson, the world-famous neurosurgeon and director of pediatric neurosurgery at Johns Hopkins Children’s Center in Baltimore, Maryland, the outcome of today’s decision doesn’t change much. “The impetus behind the bill was the fact that we had these escalating costs and people who weren’t adequately covered … even though we spend twice as much per capita on healthcare as anybody else in the world,” said Carson.

He supports the concept of health-care reform, but doesn’t think the ACA was done right and compared the effort to hiring pundits to rebuild a bridge instead of hiring structural engineers. “It was done by politicians and special interest groups as opposed to by people who actually know what the problem is and know how to deal with it,” said Carson. “We got what could be expected in that situation.”

Escalating beaurocracy and a lack of comprehensive electronic medical records make the practice of medicine more difficult than it once was, Carson said. In his new book, America the Beautiful: Rediscovering What Made This Nation Great, he includes a chapter on health-care reform. He suggests using “health stamps” to incentivize the uninsured to use  clinics rather than emergency rooms for their primary care. This would lead not only to cost savings, but to better care for patients with chronic illnesses, Carson said.

He also advocates Tort reform to rein in the costs of medical malpractice suits. “We’re the country in the world that has the biggest problem with that. Is it because we have the worst doctors? Of course not. It’s because of special interest groups. The Trial Lawyers Association. We will not deal with them. Every time it has come up before Congress, the House has passed it, but the Senate will not vote on it, because there are some filibustering senators who are in the hip pocket of the Trial Lawyers Association,” said Carson.

Finally, Carson said we have to come to grips with the fact that insurers make money by denying people care. “That’s a basic inherent conflict of interest. We have to find a way to deal with that,” he said.

TONY MEGGS: “We’re grateful that congress, both left and right, saw healthcare sharing ministries like ours … as being part of the solution.”

Some Christians, especially the self-employed and small business workers, are participating in medical cost sharing ministries like Medi-Share because they can’t afford the high cost of individual health insurance plans. Today’s ruling won’t have a direct impact on them, said Tony Meggs, the president and CEO of Medi-Share’s parent organization, Christian Care Ministry.

As part of an alliance of three cost sharing organizations, Medi-Share lobbied for and won an exemption from the individual mandate for its members. “We’re grateful that Congress, both left and right, saw healthcare sharing ministries like ours and the other two ministries as being part of the solution,” said Meggs.

His organization’s 19-year history of paying every eligible bill (approaching $700 million to date) and its focus on wellness and preventative care helped convince legislators that cost-sharing ministry members deserved an exemption, he said.

“They understand that they need to bend the cost curve in some way in getting people to make better choices in terms of how they live their lives. From a diet and exercise perspective, those are things that Congress was interested in, and so I think it was a combination of [that and] the fact that we’ve been here for a long time. This is how we help people. It’s credible. We’re not scamming people,” said Meggs.

Medi-Share’s steady growth “accelerated” after the ACA was enacted, Meggs said, and he expects that growth to continue because he says there is about a 40 percent cost difference between an individual health insurance plan and a monthly Medi-Share contribution.

There are differences, however. Medi-Share participants must sign a statement of faith and agree not to abuse drugs or alcohol or engage in extra-marital sex, Meggs said. Medical problems resulting from violations of these agreements are not generally “shared,” nor are mental health problems or some pre-existing conditions. Additionally, insurance companies are contractually obligated to pay for eligible services, but “sharing” medical expenses is voluntary for Medi-Share members. “There’s no guarantee. There’s no contract. Our program is strictly voluntary, but what I can tell you is that over a 19 year history, a 100 percent of every eligible bill that we’ve ever published has been shared,” said Meggs

What about you?

How will today’s ruling impact your family’s health decisions?

Obama’s Healthcare Mandate: Redefining Religious Freedom?

RELIGIOUS LIBERTY UNDER FIRE?: Supporters of religious freedom and against President Obama's HHS mandates on faith institutions rallied in front of the HHS building on March 23. New protest rallies led by Catholic and conservative groups are taking place around the nation. (Photo: Olivier Douliery/Newscom)

Last Friday at noon, hundreds of demonstrators gathered on Capitol Hill and at rallies across the nation to protest President Barack Obama’s health-care law and, specifically, the law’s mandate requiring employers to provide insurance coverage for contraceptives.

Conservative politicians and activists led the charge, with leaders such as Minnesota congresswoman Michele Bachmann declaring, “This is about, at its heart and soul, religious liberty. … We will fight this and we will win.” Bachmann’s battle cry represents a growing movement of religious conservatives who contend that the president’s plan violates their freedom and beliefs.

Growing up, I had the opportunity to attend a Catholic school until my senior year. As a result, I know first-hand the strong commitment to pro-life causes that many Catholics hold. For instance, as a choir member, it was an annual tradition for us to sing at the youth mass that occurred before the Right to Life March, a protest against Roe v. Wade. Abortion, euthanasia, and the death penalty were topics that came up regularly in religion class. So it came as no surprise when I heard that 34 Catholic organizations have filed 12 federal lawsuits challenging the U.S. Department of Health and Human Services’ birth control mandate under the Affordable Care Act (also known as “Obamacare”).

Under the mandate, employers are required to provide access to contraceptive services as part of their health plans at no cost. However, as President Obama stated during a February 10 press conference, “[W]e’ve been mindful that there’s another principle at stake here — and that’s the principle of religious liberty, an inalienable right that is enshrined in our Constitution. As a citizen and a Christian, I cherish that right.” Knowing that many religious institutions oppose the use of contraceptives, originally all churches were exempted from the requirement. Now, that exemption is extended to any religious organization that has an objection to providing contraceptives; in those cases, the insurance company is responsible, not the organization.

To many people, including Christians, this sounds reasonable. So, why are Catholic organizations complaining?

The problem, they argue, is in the definition of “religious organizations.” In a lawsuit filed by Catholic organizations in Washington, D.C., the plaintiffs state that the mandate requires religious organizations to satisfy four criteria.

• First, the organization’s purpose must involve teaching and sharing religious values.

• Second, employees must subscribe to the same faith.

• Third, the organization must primarily serve those that subscribe to the same faith.

• Finally, the organization must be a non-profit.

“Thus, in order to safeguard their religious freedoms,” the lawsuit continues, “religious employers must plead with the Government for a determination that they are sufficiently ‘religious.’ ” Failure to adhere to the mandate could lead to penalties and fines. Since many Catholic organizations, such as hospitals, charities, and schools, employ and extend services to people of different faiths (and many people who claim no faith at all), it would be difficult to prove they are exempt from the mandate based on religion.

“If a group isn’t perceived as ‘religious,’ then they will be forced to provide drugs that violate their doctrine,” says Chieko Noguchi, the Director of Communications for the Archdiocese of Washington, one of the plaintiffs. “If the government can order us to violate our conscience, then what comes next?”

But don’t think that this is just a Catholic issue. According to the mandate’s opponents, it affects all Americans who profess to believe in God.

“One of the central missions of any church is supporting the less fortunate in our communities,” writes Lutheran pastor Joe Watkins in a June 3 editorial for the Philadelphia Inquirer. “With this mandate’s redefinition of a religious institution, many charitable operations will effectively be driven out of business. Under the new law if you are a Lutheran charity and you provide help to or hire non-Lutherans, you cease to be a religious institution. The same goes for Catholics, other Protestant denominations, and all other faith-based organizations.” He also argues that this will not only impact all religious groups, but also those who are either influenced or helped by these groups, since more time would be dedicated to religious background checks for potential employees and clients.

“It is distressing that our government would opt for a coercive and unfair regulation that requires us to make such an impossible choice,” Watkins wrote. “As a church, we have always opposed the use of drugs and procedures that are abortion-inducing. … Under this new governmental regulation, though, just by simply following our beliefs, we will face penalties under law.”

Watkins isn’t alone in his critique of the mandate. Back in February, some 2,500 Catholic, evangelical, Protestant, Jewish, and other religious leaders signed a letter asking the President to “reverse this decision and protest the conscience rights of those who have biblically based opposition to funding or providing contraceptives and abortifacients.” Also, the Catholic Church is planning to invite evangelicals for their upcoming event “Fortnight for Freedom,” which will take place the two weeks between June 21 and July 4 in order to bring attention to religious freedom issues.

In his speech announcing changes to the mandate, President Obama reflected on his first job in Chicago working with Catholic parishes in poor neighborhood. “I saw that local churches often did more good for a community than a government program ever could, so I know how important the work that faith-based organizations do and how much impact they can have in their communities.”

I am living proof of the positive effects of the faith-based organizations that President Obama described. I’m a proud, non-Catholic alumna of a Catholic school who understands why Catholics and their supporters are upset and concerned by the Affordable Care Act’s implications for religious freedom. By defining what a religious organization is, the HHS mandate could potentially hinder Christians from living out their faith with integrity. We, as Christians, are called to serve others no matter what. As a self-professed believer, President Obama should’ve recognized this.

What do you think?

Are Catholics and their conservative allies overreacting to the mandate or do they have a point?

The Wisdom of the Health Care Mandate

As the U.S. Supreme Court wrestles with the constitutionality of President Obama’s Affordable Care Act, and especially the “individual mandate” provision requiring every capable American citizen to buy health insurance, many people continue to frame the debate as one of individual rights versus socialized medicine. They view a law requiring all citizens to buy insurance as a violation of fundamental American freedoms. I’d suggest the opposite: requiring all Americans to own health insurance is actually a demonstration of American patriotism and solidarity.

Allow me to explain.

Guess how many states today have laws that REQUIRE citizens TO BUY insurance? FIFTY. That’s right, folks. Every single one of them. Red states as well as Blue states require citizens to buy insurance. To be more specific, every single state requires citizens who drive motor vehicles to buy liability insurance to cover any damage they might inflict.

Now of course this law doesn’t apply to everyone. There are two primary classes of people who do not have to buy automobile liability insurance. Those who don’t drive. And those who can prove financial responsibility to cover any damage they might cause up to a certain limit.

The rationale behind these laws requiring citizens to buy liability insurance is simple. There is a significant risk that anyone who drives a motor vehicle may, over the course of their lifetime, cause an accident which causes damage to the property or bodies of others. There is a strong societal interest in making sure that those so injured can be compensated for their losses. You cannot buy insurance to cover an injury after you cause it. You have to have the insurance ahead of time. The insurance covers the damages caused by negligent drivers. Of course, this cost is paid for by all of the non-negligent drivers who pay their premiums every month without causing any damage. Hence, the requirement that ALL drivers, negligent as well as careful, carry liability insurance.

Those of us who live on planet Earth are also at significant risk of needing medical treatment at some point in our lives. We may contract a disease, be injured as the result of an accident, or develop some other illness or chronic condition — sometimes as the result of our own choices, sometimes not. There is a strong societal interest in making sure that those who need medical treatment can afford treatment for those illnesses. There is also a strong societal interest in making sure that those who provide medical treatment are compensated for having done so.

Health insurance, like any other form of insurance, only works if there is a shared assumption of the risk. Insurance companies rely on actuarial tables to assess the risk and base their rates accordingly (after factoring in a healthy profit, of course). Healthy people have to pay into the program so that sick people are covered. Previously, insurance companies could refuse coverage or charge significantly higher rates for people with pre-existing medical conditions. The current legislation seeks to prevent that by spreading the risk around to all citizens.

Now some may argue that health insurance is different than auto insurance because only people who drive motor vehicles have to purchase insurance. Granted that is true, mandatory health insurance should only be required of citizens who might be expected to contract, carry, pass on, or suffer from a medical condition, or sustain an injury requiring medical treatment. Of course, since I’ve yet to meet another human being who doesn’t fit that profile, I think it’s safe to say it applies to everyone. All of us are vulnerable to physical injury and ailments. Only corpses are not at risk of needing health care.

For those who still think the individual mandate is a violation of one’s individual freedom, another option would be an opt-out provision. To be effective, this kind of provision would need to come with the understanding that those who opt out are not entitled to receive any medical-care treatment that they haven’t paid for prior to the administration of the treatment. Kind of like buying broccoli at the grocery store — you can’t take it home and eat it until you’ve paid for it. If you opt out and don’t have the money when a health issue hits, you’ll get no EMT care, no ambulance ride, no appendectomy, no CPR, no emergency room care, no cancer treatment, no life-saving procedures.

Nada. Zip. Nothing.

If you think this is a cruel approach to health care — leaving people to suffer or die who can’t afford treatment — I agree with you. But what justification for entitlement to treatment can people give who, given the chance to share the risk with the rest of us, REFUSE to do so?

Mandatory health insurance is PATRIOTIC. It exemplifies the highest ideals of the American public — a willingness to stand up with our fellow citizens against threats against any of us. That means patriotic citizens who are willing to fight and die in the military against threats to the rights and freedoms from our enemies. And it means patriotic citizens being willing to pay for our fair share to spread the risk around, standing together against threats to our health. We don’t want our fellow citizens to be denied health insurance by insurance companies because they have pre-existing medical conditions, or to be charged so much they can’t afford it. We don’t want our fellow citizens losing their homes because of catastrophic illness. We don’t want our fellow citizens buried in debt which they can never repay because of some medical misfortune. We’ve got each other’s backs. That’s how we roll.

May God bless America, and may every American citizen be willing to shoulder his or her fair share of the risk to provide medical care for all, even if it means the government requiring us to buy it.

Obama’s Contraceptive Correction

COURSE CORRECTION: President Obama and Secretary of Health and Human Services Secretary Kathleen Sebelius during their Feb. 10 announcement of a compromise on the contraception mandate. The compromise was a response to the concerns of religious organizations that believe contraceptives violate their religious faith. (Photo: Joshua Roberts/Newscom)

Last week, President Obama, along with Department of Health and Human Services Secretary Kathleen Sebelius, unveiled a compromise agreement for implementing the Patient Protection and Affordable Care Act (ACA). The president, of course, had been getting hammered by both his political friends and foes following a decision to not exempt faith-based organizations (other than houses of worship) from a condition in his healthcare reform requiring employers to cover their employees’ contraception costs.

The Obama administration claims that the compromise balances “individual liberty” and “basic fairness.” Individual liberty here refers specifically to religious liberty claims, especially those made by religiously affiliated organizations like Catholic Charities, hospitals, and universities. Basic fairness, by contrast, signifies groups like Planned Parenthood, NARAL Pro-choice America, and other advocates who argue that a woman’s wellbeing hinges upon access to comprehensive reproductive healthcare, including contraception. The latter group further maintains that access to such care reduces health-care costs. Opponents generally concede the cost point, but balk at the idea that religious employers should be legally required to pay for or directly provide contraceptive services, an activity which contradicts papal doctrine within the Catholic Church.

President Obama’s compromise predictably attempts to solidify support from progressive Catholics and blunt the “war on religion” critique of political conservatives. Yet another question remains: how did Obama, who received an honorary degree from the University of Notre Dame, so thoroughly misjudge the objections of his supporters, particularly Catholic ones?

One possible account is that Obama failed to gauge the consequences of implementing ACA based on a narrow definition of religious employers. Justice in healthcare markets is not simply a question of who gets coverage, of what sort, and who pays for it. It’s also about the moral significance and legal scope of religious exemptions from mandates within ACA. Under what circumstances are religious groups exempt from laws which bind other organizations? More pointedly, what exactly constitutes a religious employer?

Does it refer exclusively to houses of worship or are religiously affiliated colleges, universities, and social service agencies included? The Obama administration chose the “house of worship” definition, presumably thinking they arranged an acceptable balance between liberty and fairness. The immediate and intense response to their decision convinced the administration that their restrictive definition was perceived not as an attempt to ensure that all recipients of taxpayer dollars play by the same rules, but as an attempt to force religiously affiliated employers to pay for coverage that violates their religious convictions.

I doubt that the administration intentionally sought to marginalize religious liberty in implementing the new healthcare law. Obama, after all, is a Christian who, as he notes, started working in Chicago as a community organizer, paid by the Catholic Church to mobilize Catholic parishes. It would seem odd to undermine the religious liberty of the organization which helped refine his sense of public service.

Nevertheless, the administration apparently neglected to sufficiently consult the fragile coalition that made his ACA possible in the first place — one thinks of Catholic Health United, columnists like the Washington Post’s E.J. Dionne, and others.

In 2008, President Obama campaigned as an individual change agent who could transform partisan politics and the machinery of public administration. The reality is that, more often than not, politics is a reactive enterprise of elected officials issuing then clarifying public statements; implementing laws, then revising that process in response to organized money, organized people, and organized voices.

Obama initially struck the wrong balance between religious liberty and access to preventive healthcare, giving due attention to the latter principle and insufficient attention to the former. To his credit, he listened and corrected his misjudgment.

When the government upholds an important principle and simultaneously shortchanges the civil right to freely exercise religion, it is the responsibility of religious groups to petition the government for a redress of grievances. That responsibility, after all, is also a civil right.