Are Liberals Under-Estimating the Chances that the Catholic Hospitals Will Win Against the Health Care Act?
posted by Peter Swire
(Disclaimer — I decided soon after law school not to focus most of my efforts on the Supreme Court or con law. There are brilliant people who work on it all the time, and I don’t. But I am a law prof who can’t help noticing some things …)
Last week, liberals went through the near-death experience for the Affordable Care Act — far, far, far closer than the confident predictions of most liberals when the law was passed.
This week, I had the chance to speak in depth with an experienced liberal lawyer about the Next Big Constitutional Thing — the Catholic hospital challenges to the ACA’s requirements that contraception and other coverage must be included for the employees of hospitals, universities, and other Catholic institutions that are not themselves part of the Church.
The lawyer confidently predicted that the Catholic hospitals would lose. After all, everyone knows the peyote case — Employment Division v. Smith, where a neutral state anti-drug law trumped a Free Exercise of religion argument that would have allowed an adherent to use peyote. The lawyer said there was no precedent for the Catholic hospitals to win, such a holding would disrupt innumerable neutral state laws, and even Justice Scalia would be bound by his prior writings to find against the Catholic hospitals.
My reaction — “here we go again.” It felt just like the over-confident predictions that the individual mandate inevitably would be upheld. And my friend sounded like other liberals who have scoffed at the claims of the Catholic hospitals.
My instinct — as a realist prediction of the outcome, and not as a statement of my policy choice — is that the Catholic hospitals very possibly will win if the case goes to final judgment in the courts.
First, I don’t think Justice Scalia will find that a law prohibiting peyote (a “good” and long-standing law) is remotely similar to a law requiring the Catholic Church, for the first time in history, to buy an insurance package that pays for contraceptives. He’ll think that the latter is a “bad” law.
Second, the Catholic Church has tens of millions of members in the U.S., and is not the splinter group at issue in the earlier case. In a realist analysis, the views of a tiny church are not the same as those of the largest organized Church in western history.
Third, the views of the Church on contraception are sincere, widely publicized, and long-standing. Although many individual Catholics don’t follow the doctrine on this issue, the institution of the Church is firmly on record on the issue. This is not a pretext to take mind-altering drugs; it is a major doctrinal tenet.
Fourth, many Catholic hospitals are deeply religious institutions. They often have a cross and a Bible in each room. Many nuns and priests work in the hospitals. Providing health care is deeply rooted in the mission of the Church, and has been for many years. In other words, this is not the equivalent of “unrelated business income.” Instead, religion and healing of the sick are thoroughly intertwined.
Fifth, and my apologies for mentioning it, six of the nine Supreme Court justices are Catholic. I am not saying that a Catholic judge will hold for the Church any more than a white judge holds for whites and a black judge holds for blacks. However, the justices will have deep personal knowledge of the healing tradition of Catholic hospitals. They will read the briefs in the context of their personal knowledge. I don’t think they will lightly assume that they are bound by cases with facts that seem to them quite different.
After we went through this list, my liberal friend said that he had adjusted his prediction. He now thought that some of the district court cases, at least, would go for the Church. He then added an extra idea — the case may arise under the Administrative Procedure Act, on whether the HHS rule was properly promulgated and consistent with the statute. His point was that a court may have a “procedural” way to block the rule from mandating that the Catholic hospitals pay for insurance that covered contraceptives. That might be an easier path for a judge to take than overturning Free Exercise case law, if the judge were inclined to stop the rule from taking effect.
Currently, there are over 20 challenges by Catholic hospitals to this provision. Smart lawyers in each case will be trying to define distinctions that will retain the peyote precedent while letting the hospitals win this case. Randy Barnett and others had a huge success with the “action/inaction” distinction about the individual mandate. My realist instincts are that we will see the emergence of clever, new distinctions for the hospital cases.
I think that many liberal con law experts were complacent when the individual mandate was challenged. If they are complacent again about the Catholic hospital cases, then I, for one, will not be surprised to see the current HHS approach struck down.