Kentucky Governor Steve Beshear said January 9, 2012 for the second time in two weeks that he was rejecting a hospital merger of the publicly-funded University Hospital with a Catholic-oriented consortium, Catholic Health Initiatives (CHI).
The rejection of the Kentucky merger marked a welcome success story for people supporting reproductive options and it shows how concerned citizens, working together, can have a real impact in their communities. It also sends a clear message to Washington D.C. policymakers that ordinary Americans do not want their health care options limited by singular religious views.
The Kentucky Religious Coalition for Reproductive Choice and others objected to the restrictions on reproductive health care that would have resulted from the merger. Particularly affected would have been the needy, for whom University Hospital is the main source of care.
The proposed hospital merger – or its rejection – didn’t generate much attention outside Kentucky, but it was big news in the state. The plan, first raised in the early summer of 2011, involved merging two hospitals in Louisville and one in Lexington into a single entity under the majority control of CHI, a Denver-based chain. In addition to University Hospital, which had been built with public funds, the others joining in the merger plans were Jewish Hospital and St. Mary’s HealthCare in Louisville and St. Joseph Hospital in Lexington.
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CHI indicated that it would operate under the Ethical and Religious Directives (ERD) of the Roman Catholic Conference of Bishops, and all of the merging hospitals would be required to conform to the ERDs, even if they or their patients did not subscribe to Catholic beliefs. This created a significant problem for reproductive health care since the ERDs prohibit or restrict a range of medical procedures related to reproductive health, including abortion (even when medically necessary), family planning, contraception, emergency contraception, tubal ligation, vasectomy and stem cell research. Employee health care options at these hospitals would have been similarly curtailed, regardless of employees’ personal religious beliefs.
The Board of the Kentucky Religious Coalition for Reproductive Choice (KRCRC), a state chapter of the Religious Coalition for Reproductive Choice (RCRC), headquartered in Washington D.C., voted unanimously in December to take a stand opposing the merger. In a letter to the editor, KRCRC wrote that the Catholic Ethical and Religious Directives were not compatible with providing the full range of reproductive health care services to the area’s citizens. The letter said:
[W]e cannot condone a hospital merger that will restrict reproductive health care services to those who need it most, at our public hospital, based on the ethical dictates of the Catholic religion.
RCRC has long supported women’s moral right to make decisions about childbearing according to the dictates of their conscience and religion. RCRC reaffirmed this commitment in November 2011 in a statement to a congressional subcommittee on health, noting:
“Institutions operating with public funds and serving the public should not be allowed to impose beliefs about health care on entire communities and all of their patients. This is especially critical in communities where a religiously affiliated institution is the only or main service provider.”
RCRC also said:
It is important to note that many religions support a woman’s right to access reproductive health care, including abortion and contraception, as a matter of free exercise of conscience protected under the law.
Community advocates in Louisville, including The American Civil Liberties Union of Kentucky, Planned Parenthood of Kentucky, the Women’s Political Caucus, Presbyterians Affirming Reproductive Options, and the Presbyterian Church (USA) (whose denominational offices are in Louisville) voiced their opposition to the hospital merger, as well. Local leaders and activists began a community awareness campaign, disseminating information about the ramifications of the merger and holding forums in the city. KRCRC and other groups emailed their members, urging them to contact the governor with their opposition to the merger.
Many of the negotiations for the merger were conducted in private, away from public participation. Publicly, officials of University Hospital and other partners argued that they could not survive financially without the merger. However, more questions began to be raised when it was learned that CHI would have a controlling majority of votes on the board of the new corporation.
As objections grew, CHI promised to make compromises. But many of them simply did not meet the needs of the community. For example, CHI offered that a woman who wanted tubal ligation following delivery could be transferred to a local hospital in another part of town – an area inaccessible to most economically-disadvantaged people. In addition, the mere fact that a woman was being sent to the other hospital would interfere with her right to confidential medical care. The merging group also said that emergency contraception could be not provided to rape survivors in an emergency room unless the victim was tested first to make sure that she had not been pregnant before she was raped.
Attorney General Jack Conway and the State Auditor Crit Luallen expressed concerns in the fall about the merging partners’ secret negotiations and a lack of transparency about future operating plans. Nonetheless, the movement toward the merger marched forward, with the deal likely to be sealed in early January, 2012. The final say-so related to the participation of University Hospital lay in the hands of the governor.
Throughout the fall, letters to the editor of the Louisville Courier-Journal ran heavily against merger in an increasing crescendo. On December 17, 2011, a poll was released showing that 49 percent of 502 respondents opposed the merger and 41 percent favored it after hearing arguments for and against the merger.
But the real turning point came on December 18, 2011 when the Louisville Courier-Journal published an editorial, insisting in no uncertain terms that the governor should reject the merger “for fundamental reasons that go to the heart of the American law and experience.” The editors wrote that the merger of the University Hospital with CHI would undermine the separation of church and state and would harm indigent patients. It opposed turning over a publicly-built facility…
“to a religious group that limits standard medical care based on religious dogma. That is a classic breach of the wall between church and state so eloquently articulated by Thomas Jefferson and so painfully secured by the brave souls who founded this nation….. In a public hospital, decisions about treatment should be made between the patient and her doctor. There is no room for an uninvited clergyman in the room when those determinations are being made.”
On December 30, Governor Beshear announced that he was rejecting the merger to protect taxpayer property. “University Hospital is a public asset with an important public mission,” the governor said. If the merger were to take place, “the public would have only indirect and minority influence,” he said.
Within a week, Jewish Hospital, St. Mary’s Healthcare and Lexington’s St. Joseph Hospital announced they would merge with CHI without University Hospital. But the fight over University Hospital wasn’t yet over. CHI said it would come back to the governor with other adjustments. On January 9, 2012, Gov. Beshear held firm. He said that he would work to find other solutions to shore up University Hospital’s finances, but that the merger discussions were over.
The community coalition that had organized against the merger finally breathed a sigh of relief. The steady and clear articulation of citizens, working together with the reproductive justice and civil rights communities, to oppose this merger secured an important victory.
Elected officials and policymakers in the nation’s capital also should take note: Americans do not want their health care decision making, including about reproductive health, pre-empted by a religious institution.