By David Gushee
From a Christian perspective aiming to advance human dignity at every stage of life, the version of the health-care bill that passed in the House Nov. 7 was a remarkable public-policy victory. It is stronger than the version that passed the Senate Finance Committee, and dwarfs in impact the Republican alternative offered in the House by Minority Leader John Boehner (R-Ohio).
It is time for evangelicals, Baptists, Catholics and other Christians to get off the sidelines and push hard for health-care reform along the lines of the House bill. This is a historic opportunity that may not come along again, and is fully in keeping with our faith. What are we waiting for?
The bill (H.R. 3962, the “Affordable Health Care for America Act”) extends health coverage to 96 percent of all legal residents of the United States by 2013, covering 36 million people who would otherwise be uninsured. This is not quite universal health coverage. But it is far closer than our nation has ever come toward achieving this very basic aspect of the common good. We are talking here about saving thousands of lives and improving the quality of life for millions.
Meanwhile, the bill also would ban insurance companies from denying coverage for pre-existing conditions or charging people higher rates because they are sick — morally grotesque practices that have ruined the health and finances of millions of Americans.
To help people afford health coverage that they would now be required to buy, the House bill provides partial subsidies to families earning up to 400 percent of the federal poverty level. Premiums and out-of-pocket health-cost limits are set low enough that they will not eat up a disproportionate percentage of the income of the poorest Americans.
Republican critics worry that health-care reform will bust the budget. But the nonpartisan Congressional Budget Office estimates that the House bill will actually save $104 billion to the federal budget over 10 years. That’s quite an accomplishment. Undoubtedly the critics’ real worry at this point is that the House bill funds H.R. 3962 through a 5.4 percent tax on individuals making more than $500,000 and families making more than $1,000,000 per year. Also, employers with payrolls above $500,000 would be required to provide coverage for employees or pay a penalty for failing to do so. And the House bill tries to control costs by providing health-insurance exchanges and, within such an exchange, a public-insurance option. All of these cut against Republican laissez-faire economic ideology, but this cannot outweigh the benefits of the legislation from a perspective that is more committed to Christian values than libertarian ideology.
A fascinating and unexpected development related to abortion occurred during House debate on the measure. An amendment sponsored primarily by anti-abortion Democrats and pressed hard by groups such as the United States Conference of Catholic Bishops altered H.R. 3962 to ban abortion coverage in the public option and block the use of federal subsidies to go toward the purchase of insurance plans that include abortion coverage. In the days leading up to the vote various amendments were considered in furious private negotiations among Democrats, and incredibly it was the most anti-abortion of all of them that passed.
I have sought to follow the nuances of the debate over the role of abortion in health-care reform, and the level of complexity has been mind numbing. It has been critically important to me to see delivery on the stated intent of the president to achieve abortion neutrality — not to use health-care reform as an occasion for pushing federal policy on abortion one way or the other. This amendment is believed to be just such an abortion-neutral provision by the pro-life side, but I understand that the pro-choice side believes the amendment went much too far. Undoubtedly this issue will vex the legislation until it either passes the Senate or dies. For now, it ought to clear the way for conservative Christians to support the legislation.
There are still things that could be done to make health-care legislation more humane. For example, the House bill discriminates against legal, documented immigrants in terms of their access to Medicaid coverage; other immigrants, of course, are openly blocked from full access to coverage — as if the body of an “undocumented” little girl is not also in need of basic health care when ill. Christians should not be among those who consider residency status to be more important than basic human needs.
Sadly, these provisions are unlikely to change. But all told, the version of health-care reform that passed Saturday in the House is far better than one might have expected even a few weeks ago. Speaking from an evangelical Christian ethical perspective, I strongly support it and hope that very soon something like it will be the law of the land. I call on all Christians to join the fight.