In February, the Boston Globe revealed that Caritas Christi, the health care arm of the Boston archdiocese, was a leading contender to win a lucrative contract from the Massachusetts state government. Under the terms of the contract, Caritas Christi and a secular partner in the bid, the Centene Corporation, would provide medical coverage for low-income Massachusetts residents. The terms of the contract explicitly stipulated that coverage must include provisions for abortion, contraception, and sterilization.
The involvement of Caritas Christi in the bidding for this government contract drew careful scrutiny from both the pro-life movement and the abortion industry. Pro-lifers in Massachusetts asked for assurances from Church leaders that the Catholic health care system, which operates six hospitals and enlists the services of 2,000 physicians in the Boston area, would not perform abortions or make abortion referrals. Abortion advocates, on the other hand, demanded assurances from state regulators that the Catholic agency would not interfere with women’s unrestricted access to abortion. The abortion advocates soon received the guarantees they wanted. Pro-lifers did not.
Caritas Christi and Centene Corporation won the government contract, and barring some sudden change in plans, on July 1 their joint venture—called the Commonwealth Family Health Plan (CFHP)—will begin administering state health care benefits. Although the exact workings of the plan have not yet been revealed, women covered by CFHP may receive taxpayer-subsidized abortions, contraceptive services, and voluntary sterilizations on request. Concerned Catholics in Boston are nervously hoping for some sign that the program is not what it appears to be: a deliberate surrender of moral principle for the sake of financial gain.
A TROUBLED HISTORY
That Caritas Christi needs a financial boost is beyond dispute. Years of rising costs and questionable management have taken their toll, forcing the Catholic health care agency to sacrifice its independence and pushing it to the brink of bankruptcy. Dr. Ralph de la Torre, the president of Caritas Christi, has told hospital employees that without an infusion of cash—of the sort that the partnership with Centene and the Massachusetts state government would provide—the organization could quickly go out of business.
Until recently Caritas Christi was unambiguously owned and operated by the Archdiocese of Boston, with the archbishop serving as chairman and the chancellor and vicar general also sitting on the board. But in the early years of the 21st century the agency’s troubles drew unwanted attention from a paternalistic state government.
In April 2004, Archbishop Sean O’Malley dismissed the president of Caritas Christi, Dr. Michael Collins. Although no explicit reason was given for the ouster, it was generally understood that the new archbishop was dissatisfied with the doctor’s management style. But the first replacement for Dr. Collins, Emmett Murphy, brought no relief; he stepped down hastily after reporters questioned the accuracy of his resume. Next came Dr. Robert Haddad, who was forced out in 2006 amid accusations of sexual harassment of female employees.
Meanwhile, the financial losses were mounting and Caritas Christi was actively seeking a buyer. By 2007, the agency was involved in serious talks with Ascension Health, the nation’s largest Catholic health care system. But those talks trailed off, in part because accountants discovered that Caritas Christi had overstated its revenues by $10 million.
At this point the attorney general of Massachusetts, Martha Coakley, announced that she could no longer watch the archdiocesan health care system flounder. Citing her duty to supervise the affairs of non-profit groups, she announced an investigation of Caritas Christi. In March 2008 the attorney general released a highly critical report, and recommended major changes in the agency’s governance. She strongly recommended that the Boston archdiocese “relinquish direct and indirect control over strategic, operational, and financial matters, and focus only on moral and ethical issues.”
The archdiocese quietly acceded to the proposed reforms. In a sweeping reorganization announced a few weeks later, the archbishop of Boston lost his traditional place as chairman, and the archdiocese was allotted only three seats on the 16-member board. The archdiocese announced that its control over the affairs of Caritas Christi would henceforth be “limited to matters pertaining to Catholic identity, mission, and the implementation of the religious and ethical directives of the United States Conference of Catholic Bishops, and any transaction that would involve the sale or transfer of the system.”
In a highly unusual policy for a nonprofit organization, the reconstituted Caritas Christi has declined to identify the members of its board of directors. The latest official papers filed with state regulators do not reflect the organizational changes of May 2008. So when Caritas Christi became involved in the controversial bid for the state health care contract, Catholics hoping to influence the agency’s policies—or to express their concerns about the moral dimensions of the government contract bid—did not know where to address their concerns.
Just three members of the 16-member board of Caritas Christi have been publicly identified, and none of them has a background that would reassure prolife activists. Dr. Ralph de la Torre, who as president is an ex officio board member, has been a forceful advocate for an independent hospital system, and the primary force behind the contract bid. James Karam, the chairman of the board, is a businessman whose political sympathies are evident in his generous contributions to liberal Democratic candidates such as Barack Obama. And the only identified cleric on the board, Father J. Bryan Hehir, has been the bête noire of conservative Catholics nationwide since the 1980s, when he emerged as a major architect of the US bishops’ pastoral letter on nuclear weaponry and an apologist for the “seamless garment” approach that saw abortion as only one among many critical issues in political campaigns. Father Hehir, Caritas Christi told inquiring Catholics, served on the board as Cardinal O’Malley’s representative, to ensure that the health care system protected its Catholic identity. If that message was intended to ease the concerns of prolife activists, it failed badly.
In answer to questions from inquiring Catholics, Caritas Christi officials said that the Catholic hospitals would not perform abortions, even if the Commonwealth Family Health Plan (CFHP) won the government contract. Nevertheless, in response to similar questions from the secular press, the joint venture issued a terse statement that the CFHP “will contract with providers, both in and out of the Caritas network, to ensure access to all services required by the authority, including confidential family planning services.” How could these two claims be reconciled? No explanation was forthcoming.
Caritas Christi, Centene Corporation, and the Archdiocese of Boston have all refused to disclose exactly how CFHP would respond to patients’ requests for abortions. Caritas Christi has assured the public that Catholic hospitals would not perform abortions. Nevertheless the abortions would be performed under the terms of the contract the Catholic agency sought to win.
Centene Corporation was identified as the majority partner in the CFHP contract bid. But Centene is a Missouribased corporation, which owned no hospitals or clinics in Massachusetts, and employed no physicians in the state, at the time the bid was filed. Thus it was evident that abortions could not be performed at Centene facilities, unless Caritas Christi offered space to its secular partner for that purpose.
How, then, could Caritas Christi maintain that it would not be involved in the abortion business? Again, the Catholic health care agency refused to answer that question. In fact, when the Boston Globe followed up with a series of inquiries about how the Catholic identity of the Caritas Christi hospitals affected their current medical practices, officials declined to answer those questions as well.
”A GREAT DISSERVICE ”
When the CFHP proposal first came to light, informed sources at the Boston archdiocesan chancery offices reported that Cardinal O’Malley had been caught off guard by the Caritas Christi bid for the state insurance contract. In the first confused hours after the controversy arose, as Caritas Christi refused to answer questions about its policies, the archdiocese declined to make any public comment.
Eventually the cardinal broke his silence, with a statement that offered very little encouragement to those who were appalled by the CFHP bid. “Caritas Christi Health Care has assured me that it will not be engaged in any procedures, nor draw any benefits from any relationship, which violate the Church’s moral teaching as found in the Ethical and Religious Directives,” the cardinal said. He did not explain how the CFHP effort could comply with both the Church directives and the requirements of the state contract. Instead Cardinal O’Malley chose to emphasize that the CFHP would be providing health care services for needy families. “If it can happen without compromising the Catholic identity of the system it would benefit both civil society and especially the poor in our community,” he said.
Local Catholic activists were not convinced. C.J. Doyle of the Catholic Action League observed: “The cardinal refuses to acknowledge in his statement what Caritas has already admitted—that it will contract with other providers in making referrals for abortions.”
As the days passed, and the deadline approached for a decision on the state government contract, many loyal Catholics clung to the hope that Cardinal O’Malley would derail the CFHP proposal if convinced that the contract could not be fulfilled without violating Catholic moral principles. A week before state officials were to announce their final decision, the cardinal slammed that door closed with a clear statement of support for the contract bid:
Caritas Christi will never do anything to promote abortions, to direct any patients to providers of abortion, or in any way to participate in actions that are contrary to Catholic moral teaching and anyone who suggests otherwise is doing a great disservice to the Catholic Church.
While that statement seemed definitive, Cardinal O’Malley issued it along with a curious additional note. He revealed that he was asking the National Catholic Bioethics Center to study the proposed arrangement, to assure him that the CFHP plan was compatible with Catholic moral teachings. If the moral purity of the proposal was so evident that anyone who questioned it was doing a “great disservice to the Catholic Church,” why was any such assurance necessary?
John Haas, the president of the National Catholic Bioethics Center, told CWR that any opinion his group submitted to the cardinal would be confidential. He refused to offer any hint about his own thinking on the CFHP proposal, explaining that his recommendations could be made public if and only if the archdiocese chose to take that step. Two months later, Catholics in Boston still had no indication of how the proposal could be reconciled with Church teachings—if indeed it could be reconciled at all.
A FIG LEAF?
The facts available on the public record offer no hint of a justification for the Caritas Christi involvement. Abortions will be performed, and the Catholic health care agency is a key partner in the venture that will—through some undisclosed mechanisms—ensure that they are performed. The people of Boston are being led inexorably to the conclusion that the Catholic agency will become a willing partner in the slaughter of the unborn. If there is something wrong with the logical sequence leading to the conclusion, one would expect the archdiocese to correct the public record, in order to avert scandal. Yet the public record is uncorrected.
C.J. Doyle of the Catholic Action League did not flinch from what seemed to be an obvious inference: “It appears that the Caritas Christi/Centene Corporation partnership was established as a fig leaf to give Caritas Christi plausible deniability while seeking a state contract which would require them to violate Catholic moral teaching.”
On March 13, the state government formally awarded the health care contract to CFHP. Before making their final decision, the officials responsible for the selection extracted further assurances that women would have “ready access” to all family-planning services—including contraception, sterilization, and abortion—under the terms of the proposal. The CFHP applicants explained that if particular medical facilities (such as, perhaps, the Caritas Christi hospitals) did not offer those services, the subscribers would be given a toll-free number to call for a referral to another provider, and transportation would be arranged to an alternative facility.
But who would provide the pregnant woman with that toll-free number? Who would make the abortion referral, and arrange the transportation to the clinic? By providing any of those services, CFHP would become involved in the abortion business.
POWER TO THE PEOPLE
In his public statement of support for the CFHP venture, Cardinal O’Malley emphasized that the new health care system would be serving the poor of Massachusetts. When the Boston Globe conducted a survey of Catholic theologians, and found several liberal professors willing to justify the venture, they too concentrated their arguments on service to the needy. Lisa Sowle Cahill of Boston College remarked that it would be “an appalling scandal if the Archdiocese of Boston refuses to participate in Massachusetts’ cutting-edge health care reform program.”
But the CFHP proposal is not a venture in Christian charity; it is a government program. With or without the involvement of the Boston archdiocese, the poor people of Massachusetts would receive government-subsidized health care; that much was already established by state law. The only question at issue, when CFHP submitted its bid, was whether or not an archdiocesan agency would reap the benefits of this lucrative government contract.
Moreover, any attempt to justify this venture in terms of Christian service to the poor runs directly into the moral problems associated with abortion, sterilization, and contraception. If CFHP is a Catholic apostolate, then any involvement in these procedures is unacceptable. If CFHP is not a Catholic venture, and the involvement of Caritas Christi is purely coincidental, then the venture cannot be described as an effort by the Church to serve needy families.
After the CFHP proposal was submitted to the state, Caritas Christi embarked on a publicity campaign. A new logo and letterhead for the agency emphasized “Caritas” while putting “Christi” in smaller type. Public advertisements began to appear, advancing the slogan: “Quality to the people.” Posters in Caritas Christi hospital wards featured a clenched fist—of the sort made popular in 1960s radical imagery—holding a stethoscope against a rainbow background. The publicity seemed deliberately calculated to emphasize the organization’s claim to serve a needy public— and at the same time to downplay its Catholic identity.
The government contract will undoubtedly bring a critical infusion of revenue for the Caritas Christi system. The alliance with Centene Corporation in the CFHP may even lead to a successful sale of the troubled Caritas Christi system. But the apparent involvement of Catholic hospitals in a system that provides subsidized abortions—and the steadfast refusal of the Boston archdioceseto explain how that involvement could possibly be justified—is an astonishing setback for the culture of life. And it bears emphasis that this situation did not arise because the state government forced Caritas Christi into a morally untenable position; the Catholic agency deliberately sought to be involved. The Catholic Action League called the development “a significant defeat for the pro-life movement, inflicted not by secular society, but by the Catholic Church in Boston.”
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