Response to the Hobby Lobby ruling

Excerpted from “CMA doctors hail Supreme Court mandate ruling, decry ongoing targeting of faith community,” CMDA News Release. June 30, 2014 — The 15,000-member Christian Medical Association, the nation's largest and oldest faith-based doctors' organization, today praised the Supreme Court's ruling in two Health and Human Services (HHS) Obamacare mandate cases but noted "increasing attempts by the government to coerce the faith community." CMA had outlined the medical aspects underlying religious objections to the HHS Obamacare mandate in its friend of the court brief in Burwell v. Hobby Lobby and Conestoga Wood v. Burwell.

CMA CEO Dr. David Stevens said in a statement, "We are very thankful that the Supreme Court acted to protect family businesses from government coercion and fines for simply honoring the tenets of their faith.

"This is a much-needed victory for faith freedoms, because this administration continues its assault on the values of the faith community. We are witnessing increasing attempts by the government to coerce the faith community to adopt the government's viewpoint in matters of conscience," noted Stevens.

CMA also filed a friend-of-the-court brief in another Supreme Court case this term, McCullen v. Coakley, to defend First Amendment free speech and assembly rights of pro-life advocates against a Massachusetts law that prohibited many citizens from entering a public street or sidewalk within 35 feet of an abortion facility.

"There seems to be growing intolerance of the faith community by some government officials who appear to want to extinguish the First Amendment freedoms that allow for a diversity of values," Stevens observed, "We are seeing this antagonism expressed in coercive government mandates enforced with harsh penalties and discriminatory practices that threaten to eliminate the faith community from the public square."

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): “I’m appalled that the ruling was five to four. One vote and we would have lost religious freedom, perhaps forever, in this country. It would have impacted us as healthcare professionals most of all, as Judge Alito noted in his majority opinion. He wrote, ‘Under HHS’s view, RFRA (the Religious Freedom Restoration Act) would permit the Government to require all employers to provide coverage for any medical procedure allowed by law in the jurisdiction in question—for instance, third-trimester abortions or assisted suicide.’

“We are already seeing the co-opting of the unwilling as a result of court rulings in the same-sex marriage issue. The courts are requiring participation by family-owned businesses in wedding ceremonies, despite their religious objections. The government is also forcing recognition of same-sex marriages as a condition for federal grants in this country and abroad.

“CMDA’s amicus brief, representing you, affected the decision. It scientifically established the potentially deadly effect of two ‘morning after pills’ and two types of IUDs on nascent life before implantation. That fact was accepted in the majority opinion.

“We won the battle, but the war is not over. We must continue to fight relentlessly locally and nationally to protect healthcare right of conscience. The stakes are just too great to do otherwise.”

Resources

Learn more about CMDA’s efforts to protect the right of conscience
CMDA’s amicus curiae brief

Supreme Court to announce ruling on conscience v. coercion

Excerpted from commentary by Jennifer Marshall,"HHS Mandate: Only the Beginning of Obamacare’s Conscience Problems," Daily Signal, June 17, 2014 - Any day now the U.S. Supreme Court is expected to rule in the case of Hobby Lobby and Conestoga Wood Specialties—family-owned businesses that have gone to court to challenge a provision under Obamacare that requires them and nearly all other employers to cover abortion-inducing drugs, contraception and sterilization, regardless of their religious beliefs.

The suits, brought by the Green family, evangelicals who own Hobby Lobby, and the Hahn family, Mennonites who run Conestoga Wood, are among 49 filed by family-owned businesses challenging the Obamacare HHS mandate. The Obama administration has been unwilling to compromise. Meanwhile, 51 lawsuits have been joined by hundreds of non-profit religious organizations seeking to preserve their religious independence to set internal policy consistent with their faith. All told, 300 plaintiffs.

But it is important to remember that all this commotion is the result of one small aspect of one set of regulations concerning preventive care under Obamacare. And that means we’ve only just begun to see the potential conscience problems that could come from this massive overhaul of our health care system.

Handing the moral compass to remote bureaucrats to navigate this territory is a bad idea. The centralization of more decision-making about the benefits that health plans must provide means that such determinations are more likely to be made without respect for Americans’ differing beliefs on these issues.

That’s why we need patient-centered health care. Americans should be free to choose the health care plans that meet their needs and reflect their moral convictions. Individuals and families need to be able to direct their health care in accord with their conscience; that includes the benefits, treatments and procedures financed through their health insurance.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: “My friend and colleague Jennifer Marshall realizes what our founders and the ancient philosophers knew--that left unchecked, Government will compete with God for the people's allegiance, replacing His universal standards with State ideology and mandating submission. Consider the following observations:

Plato: “[T]here exist divine moral laws, not easy to apprehend, but operating upon all mankind. God, not man, is the measure of all things.”ⁱ
Cicero: "True law is right reason in agreement with Nature; it is of universal application and everlasting; it summons to duty by its commands, and averts from wrong-doing by its prohibitions."ⁱⁱ
Augustine: "True justice has no existence save in that republic whose founder and ruler is Christ....ⁱⁱⁱ [T]there can be no people, and therefore no republic, where there is no justice."^iv
Thomas Jefferson: "[O]ur rules can have authority over such natural rights only as we have submitted to them. The rights of conscience we never submitted, we could not submit. We are answerable for them to our God."^v
James Madison: "Religion, or the duty which we owe our Creator, and the manner of discharging it, can be directed only by reason and conviction, not by force and violence; and therefore all men are equally entitled to the free exercise of religion, according to the dictates of conscience."^vi
Charles Colson: "Both church and state assert standards and values in society; both seek authority; both compete for allegiance. As members of both the religious and the political spheres, the Christian is bound to face conflict."^vii

When Government replaces God and His universal standards, the only standard left is the sword of the State, which it wields with coercive power (fining Hobby Lobby $791 million dollars a year^viii) to enforce its own ideology. Take a stand with the Green and Hahn families as they fight in the courts for religious freedom. As Mordecai explained to a hesitant Queen Esther,^ix this edict also has you in its crosshairs.

Resources
CMA Supreme Court brief in Hobby Lobby religious freedom case
CMA’s Freedom2Care website on freedom of faith, conscience and speech
CMA commentaries

Action
Use our easy pre-written customizable message to support H.R. 940 - Healthcare Conscience Rights Act (House bill) and S. 1204 - Health Care Conscience Rights Act (Senate bill)

ⁱ Cited in Russell Kirk, The Roots of American Order (LaSalle, Ill.: Open Court, 1974), 81.
ⁱⁱ Charles Colson and Ellen Santilli, God and Government, Grand Rapids: Zondervan, 1987, updated 2007, Kindle location 4917.
ⁱⁱⁱ Colson, location 1482.
^iv Colson, location 14479.
^v Thomas Jefferson (1743–1826), U.S. president. Notes on the State of Virginia (1787), Query 17, p. 159, ed. William Peden (1954).
^vi James Madison (1751–1836), U.S. president. Virginia Declaration of Rights, 1776. W.T. Hutchinson et al., The Papers of James Madison, vol. 1, p. 175, Chicago and Charlottesville, Virginia (1962-1991).
^vii Colson, Kindle location 2223.
^viii http://townhall.com/columnists/hankadler/2014/03/29/hobby-lobby--when-is-26-million-really-43-million-n1815062/page/full
^ix Esther 4:13.

The misery of healthcare

Excerpted from “How Being a Doctor Became the Most Miserable Profession,” The Daily Beast commentary by Daniela Drake, MD, MBA, April 14, 2014 — By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second-most suicidal occupation—the level of sheer unhappiness amongst physicians is on the rise. Simply put, being a doctor has become a miserable and humiliating undertaking.

Not surprisingly, many doctors want out. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession. It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system.

Unfortunately, things are only getting worse for most doctors, especially those who still accept health insurance. To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes. Neither patients nor doctors are happy about that. What worries many doctors, however, is that the Affordable Care Act has codified this broken system into law. While forcing everyone to buy health insurance, ACA might have mandated a uniform or streamlined claims procedure that would have gone a long way to improving access to care.

Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their jobs. And now that Medicare payments will be tied to patient satisfaction—this problem will get worse. Doctors need to have the ability to say no. If not, when patients go to see the doctor, they won’t actually have a physician—they’ll have a hostage.

Almost comically, the response of medical leadership—their solution— is to call for more physician testing. In fact, the American Board of Internal Medicine (ABIM)—in its own act of hostage-taking—has decided that in addition to being tested every ten years, doctors must comply with new, costly, "two year milestones." In an era when nurse practitioners and physician assistants have shown that they can provide excellent primary care, it’s nonsensical to raise the barriers for physicians to participate. It is tone deaf. It is punitive. It is wrong. No wonder doctors are suicidal. No wonder young doctors want nothing to do with primary care. But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone.

Commentary

CMDA Psychiatry Section Chair John Yarbrough, MD, MBA:“Working as a physician today is different than it was when my father began his practice in internal medicine nearly 40 years ago. Insurances, laws, decreased time with patients, board certifications and electronic medical records are amongst many potential contributors to making life miserable. The demands placed upon us can be overwhelming.

“Recent experiences on a trip to Am_an, Jord_n were unsettling and left me in need of spiritual and emotional refueling. One event in particular while treating Syri_n refugees was when, outside our building, a young 11-year-old girl emerged onto the street with her upper body lit on fire. She had poured kerosene on herself and lit herself on fire after receiving news that her abusive father was coming to pick her up and she would no longer live with her grandmother. This desperate child saw no other way of escaping her situation and is still in a Jord_nian hospital’s ICU with third-degree burns.

“As Christian physicians, the restoring love and grace offered by Jesus Christ dying on the cross for our sins is our path to salvation and an eternity in fellowship with God. While all of us have a wish list of things we would like to see change in our field, our higher calling is our antidote to misery. We are to focus on storing up treasures in heaven and not focus on earthly things."

Country names censored for security reasons

Resources

Faith and Health Resources
Contentment by Richard A. Swenson, MD

SCOTUS hears case on free speech re: abortion in Obamacare

Excerpted from "Campaign speech case is regulatory overkill," commentary by George F. Will, Washington Post, April 18, 2014 - Former U.S. representative Steve Driehaus, a Cincinnati Democrat who considers himself antiabortion, says he lost his 2010 reelection bid because the antiabortion Susan B. Anthony List violated Ohio’s law with ads saying that when he voted for the Affordable Care Act (ACA), he voted for taxpayer funding of abortion. When he learned that the SBA List planned to erect billboards proclaiming “Shame on Steve Driehaus! Driehaus voted FOR taxpayer-funded abortion,” he filed a complaint with the Ohio Elections Commission, the truth arbiter and speech regulator. So the billboard company refused the SBA List’s business.

Driehaus says the ACA does not specifically appropriate money for abortions. The SBA List counters that the ACA can subsidize abortion-inclusive insurance coverage.

Driehaus says insurance companies must collect a “separate payment” from enrollees and segregate this money from federal funds. The SBA List says money is fungible, so this accounting sleight of hand changes nothing.

Driehaus says an executive order issued after passage of the ACA, which was promised to get him and a few other pro-life Democrats to vote for the act, prohibits ACA funds from being used for abortions. The SBA List says the executive order proved that the ACA itself allowed taxpayer-funded abortions.

Ohio’s law, which obviously is designed to encourage self-censorship, certainly chilled the SBA List’s political speech. The SBA List’s brief to the Supreme Court notes that “a law requiring citizens to pay $1 before they could publicly comment on electoral issues or candidates for office would be immediately justiciable (and promptly invalidated).” Yet Ohio’s law makes it easy for literally millions of Ohioans to subject participants in the political process to much more expensive costs — not to mention the threat of incarceration.

This case, which comes from Cincinnati, where the regional IRS office was especially active in suppressing the political speech of conservative groups, involves the intersection of two ominous developments. One is the inevitable, and inevitably abrasive, government intrusions into sensitive moral issues that come with government’s comprehensive and minute regulation of health care with taxes, mandates and other coercions. The Supreme Court will soon rule on one such controversy, the ACA requirement that employer-provided health-care plans must cover the cost of abortifacients. The other development is government’s growing attempts to regulate political speech, as illustrated by the Obama administration’s unapologetic politicization of the IRS to target conservative groups.

These developments are not coincidental. Government’s increasing reach and pretensions necessarily become increasingly indiscriminate.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: – “Government actions hostile to religious freedom have triggered a raft of cases that now are reaching the Supreme Court. They're worth tracking because (a) they involve our faith-based and pro-life colleagues and (b) the principles impact virtually every believer, and especially those who own or work for businesses--including medical and dental practices. These cases include, but are not limited to:

1. the recently heard religious freedom cases of faith-motivated for-profit employers forced to violate their conscience convictions by participating in providing HHS-mandated contraceptives that the FDA notes can end the life of a human embryo;
2. the free speech case analyzed above, of a pro-life organization censored for political speech that sought to educate voters on abortion-related provisions in the Affordable Care Act (Obamacare);
3. the upcoming religious freedom cases (of a total of nearly 100 cases in all) of non-profit organizations also opposed to participating in the HHS contraceptives mandate.

“With the number of Americans who hold no religious affiliation increasing (read my analysis of that trend here), the faith community is losing natural supporters of religious freedom. That means we have to step up our efforts to protect ourselves in law and also to educate our countrymen.


“Some basic points to emphasize about religious freedom:

1. Faith-based groups help the poor and needy. (Polling shows that even the non-religious still appreciate the charitable services of the faith community.)
2. Religious liberty protects against discrimination and promotes tolerance and diversity. (Why should religious views be censored in the public arena? Religious tolerance is a hallmark of our democratic republic designed to aid the coexistence of disparate groups and viewpoints.)
3. A threat to one group’s First Amendment freedoms is a threat to all. As Protestant Pastor Martin Niemoller lamented after serving in a concentration camp during the Nazi holocaust, ‘First they came for the Jews. I was silent. I was not a Jew. Then they came for the Communists. I was silent. I was not a Communist. Then they came for the trade unionists. I was silent. I was not a trade unionist. Then they came for me. There was no one left to speak for me.’”

Resources

CMA SCOTUS brief in Hobby Lobby religious freedom case

CMA’s Freedom2Care website on freedom of faith, conscience and speech

CMA commentaries

Action

Use our easy pre-written customizable message to support H.R. 940 - Healthcare Conscience Rights Act (House bill) and S. 1204 - Health Care Conscience Rights Act (Senate bill)

CMA religious freedom commentary on Fox News

(Excerpted from "Families fighting Obamacare's assertion of 'pill-level power,'" published by Fox News, March 25, 2014)

By Jonathan Imbody, CMA VP for Govt. Relations

The mandate under Obamacare that prescribes the provision of 20 specific contraceptives exposes the audacity of pill-level government decision-making. While many Americans, including those with religious convictions, approve of and use certain contraceptives, the government-mandated, no-exceptions list includes four especially controversial items (Plan B, ella and two intrauterine devices--IUDs) that the FDA notes can end the life of a developing human being.

Why would the government intervene to force the provision of free contraceptives for every woman from the Hamptons to Beverly Hills? Everyone who has easily bought and used contraceptives at the neighborhood drug store can readily see that the administration has no compelling interest to do so beyond raw politics and ideology.

President Obama unwittingly confirmed the lack of a compelling need for government intervention when he asserted in a White House address, "Nearly 99 percent of all women have relied on contraception at some point in their lives--99 percent." Why would the federal government intervene to mandate the provision of what even the President admits is a ubiquitous product? The existing ready access to contraceptives, combined with literally millions of exemptions handed out by the administration to virtually everyone but religious objectors, effectively rules out any government claim to a compelling reason for the mandate.

The Supreme Court in a few days will examine whether the administration violated federal law that requires a "compelling" government justification for trampling Americans' conscience freedoms. The Court will hear two cases of family-owned businesses whose only crime appears to be not sharing the administration's ideology. Two families that own and operate companies--the Conestoga Wood Specialties and the Hobby Lobby--maintain a science- and faith-based objection to providing just the four of the mandated contraceptives that can end a human life.

As a result, these two family-owned businesses face government fines totaling millions of dollars as the cost of exercising what they thought were every American's unalienable First Amendment freedoms. They could also, of course, simply drop their employees' healthcare insurance altogether. But that option likewise incurs draconian Obamacare fines, and the families want to continue providing excellent health coverage to employees as they were able to before Obamacare.

These families now fight in court for the freedoms that other Americans have fought for on the battlefield.

Read rest of commentary.

Resources

CMDA Right of Conscience Resources

Action

Use our easy pre-written customizable message to support H.R. 940 - Healthcare Conscience Rights Act (House bill) and S. 1204 - Health Care Conscience Rights Act (Senate bill)

Supreme Court hears religious freedom, contraceptives cases

Excerpted from "Supreme Court divided as it hears argument on contraceptive coverage," Washington Post, March 26, 2014 - A divided Supreme Court seemed sympathetic Tuesday to the views of business owners who say their religious objections protect them from a requirement in President Obama’s Affordable Care Act that health insurance plans cover all types of contraceptives. The conservative wing of the court seemed to agree that the challengers in the two cases — closely held corporations owned by families whose religious beliefs the government does not question — could be covered by a federal law that provides great protection for the exercise of religion.

So for the contraceptive requirement to apply to the companies, the government would have to show that it has a compelling interest in enforcing the requirement, that this does not impose a substantial burden on religious exercise, and that there is no less-intrusive way to provide coverage to female workers.

Justice Anthony Kennedy may have signaled a deeper concern when he raised the worry that the government’s reasoning would mean there was little that employers could object to funding. Kennedy told Solicitor General Donald B. Verrilli Jr. that under Verrilli’s view, a corporation “could be forced in principle to pay for abortions.” The court will render a decision in the cases — Hobby Lobby Stores vs. Sebelius and Conestoga Wood Specialties v. Sebelius — during its current term, which ends in late June.

Commentary

CMA VP for Government Relations Jonathan Imbody – “These cases hold profound significance for our free exercise of religion, as guaranteed by the First Amendment to the U.S. Constitution and as advanced in a federal law, the Religious Freedom Restoration Act. The Christian Medical Association filed an amicus curiae (friend of the court) brief, available here.

“The cases hinge on several key principles:

• Americans do not sacrifice their First Amendment freedom to exercise religious convictions once they launch a business (including a medical or dental practice). Consider, for example, that the New York Times corporation does not lose its First Amendment free speech rights simply as a result of incorporation; nor do incorporated churches lose their free exercise rights.
• The government may only abridge the free exercise of religion when it can prove a ‘compelling interest.’ The fact that the administration has exempted millions of secular employers (though refusing to exempt many religious employers) undermines any government claim that the mandate is compelling. The lack of studies showing that pills such as ella and Plan B actually reduce unplanned pregnancies also undermines a claim of compelling interest.
• Even when the government can prove a compelling interest to transgress religious liberty, it may only do so by the ‘least restrictive’ means available The least restrictive means of providing contraceptives would be for the government to directly provide them to women who cannot afford them, as it does around the world--not to force conscientious objectors to participate in the distribution.

“Many of my attorney colleagues who attended Tuesday's oral arguments at the Supreme Court felt guardedly encouraged. I attended a briefing at the U.S. Capitol in which similar optimism was voiced, based on the justices' line of questioning.

“If we win this decision, Christians gain a measure of protection against the increasing assaults on our religious freedom. If we lose, we can expect more fines, discrimination, job losses and even jailing as a result of growing animus toward the faith community and the increasingly counter-cultural values for which we stand. Even with a court victory, we still face the huge and more important task of winning an audience with our colleagues and our culture, to present the principles and claims of the kingdom and our King.


Resources

CMDA Right of Conscience Resources

Action

Use our easy pre-written customizable message to support H.R. 940 - Healthcare Conscience Rights Act (House bill) and S. 1204 - Health Care Conscience Rights Act (Senate bill)

Therapists Explore Dropping Solo Practices to Join Groups

Excerpted from “Therapists Explore Dropping Solo Practices to Join Groups,” Shots: Health News from NPR. October 24, 2013 -- In the corporate world of American healthcare, psychologists and other mental health therapists are still mostly mom-and-pop shops. But the business model for therapists is shifting away from solo practices and toward large medical groups, say mental health experts. That change is propelled by the Affordable Care Act, which mandates mental health benefits in insurance coverage, and by the Mental Health Parity Law, which requires private and public insurers to cover mental health needs at the same level as medical conditions — by charging similar copays, for example.

Organizations that advocate for mental and behavioral health — groups that long complained that they were treated as second-class providers — have applauded the federal laws. But inclusion has come with some unhappy caveats, including less pay and more paperwork. Patients used to paying $150 in cash for a therapy session will, with some limitations, have sessions covered by their health plan. That means many therapists will have to figure out innumerable insurance plans and byzantine billing codes for the first time.

In many ways, therapists are encountering what medical doctors have complained about for years: the confusing, confounding and, some might say, hostile insurance bureaucracy that providers must tangle with in order to get paid. The increasing complexity of running a practice has meant more therapists are taking down their shingles or forming groups with other therapists to share the burden, executives at national mental health groups say. Others have joined large medical groups that offer mental health services as part of comprehensive care.

Commentary

CMDA Member and Psychiatrist Robert Rogan, DO, JD: “This article touches on several current issues in mental health affecting our society. One, the loss of autonomy, may be far more serious than we realize. The freedom to serve as we in conscience believe best is something we need as believing practitioners. Conscience issues are already prominent in current medical practice in general. If we can’t ‘choose our clients,’ we may find ourselves being asked to provide therapy in an area we find morally uncomfortable.

“People do seek mental health services and pay ‘out of pocket’ not just for insurance reasons but also for privacy. The HIPAA regulations with compliance that began on September 23, 2013 seem to reflect this possibility.

“Paperwork issues are not just documentation chores but very concerning potential legal traps. Billing is serious business for more than just reimbursement reasons. We need to be truthful but careful in what we write. Also, we need to be ultra-careful what we sign. We need to know every pitfall in contracts we sign. If there is legal terminology you don’t know, look it up or get legal counsel. A subtle term like ‘hold harmless,’ now in very common use, can be the entrance to a professional minefield.

“On the other side, solo practice can have physical dangers with our changing patient demographics. Group practice can provide more collegiality as ‘iron sharpens iron.’ We can be of great use in practices where mental health service is needed by other non-mental health practitioners.”

Resources
Healthcare Right of Conscience Ethic Statement
Augustine College at CMDA CD Set

Court upholds religious freedom in contraceptives mandate case

Excerpted from "Court strikes down birth control mandate," published in The Hill, November 01, 2013 - A federal appeals court on Friday struck down the birth control mandate in ObamaCare, concluding the requirement trammels religious freedom.

The D.C. Circuit Court of Appeals — the second most influential bench in the land behind the Supreme Court — ruled 2-1 in favor of business owners who are fighting the requirement that they provide their employees with health insurance that covers birth control.

Requiring companies to cover their employees’ contraception, the court ruled, is unduly burdensome for business owners who oppose birth control on religious grounds, even if they are not purchasing the contraception directly.

Legal analysts expect the Supreme Court to ultimately pick up an appeal on the birth-control requirement and make a final decision on its constitutionality. In the meantime, Republicans in Congress have pushed for a conscience clause that would allow employers to opt out of providing contraception coverage for moral or religious reasons.

The split ruling against the government on Friday was the latest in a string of court cases challenging the healthcare law’s mandate. Friday’s ruling centered on two Catholic brothers, Francis and Philip Gilardi, who own a 400-person produce company based in Ohio.

"They can either abide by the sacred tenets of their faith, pay a penalty of over $14 million, and cripple the companies they have spent a lifetime building, or they become complicit in a grave moral wrong," Brown wrote.

The Obama administration said that the requirement is necessary to protect women’s right to decide whether and when to have children.

Commentary

Matt Bowman, Senior Legal Counsel, Alliance Defending Freedom– “Two new cases have vindicated religious freedom for people in their everyday professions, and have upped the ante for another Supreme Court showdown, in 2014, with the Obama administration over religious liberty and Obamacare. The U.S. Courts of Appeals for the Seventh and D.C. Circuits, in Chicago and Washington, respectively, both ruled in the last few days that when people of faith engage in a business they do in fact possess the freedom to exercise their religious beliefs when the government commands them to violate those beliefs. The Gilardi family out of Ohio, the Korte family of Illinois and the Grote family in Indiana all run businesses and seek to do so consistent with their Christian faith. They object to the Obamacare mandate to provide abortifacient drugs, contraception and sterilization in their employee health plans.

“On November 9, the Seventh Circuit declared that the Korte and Grote families and their businesses can assert rights against the federal government under the Religious Freedom Restoration Act of 1993 (RFRA), which ‘operates as a kind of utility remedy for the inevitable clashes between religious freedom and the realities of the modern welfare state, which regulates pervasively and touches nearly every aspect of social and economic life.’

“The court went on to declare that the abortifacient/contraception mandate is not justified against religious objectors, because the government merely asserts that free contraception promotes ‘health’ and ‘equality.’ Rebutting the government’s assertion of a so-called ‘right’ to such things as abortion and contraception, the court declared that ‘the government has failed to demonstrate how such a right...can extend to the compelled subsidization of a woman’s procreative practices’ by private citizens.

“On November 26, the Supreme Court will look at three petitions from businesses that have filed similar challenges to the abortifacient/contraception mandate, and it could decide that afternoon to set one or more of those cases for argument in the spring of 2014.”

Resources
Court Cases summary

HHS contraception mandate vs. the Religious Freedom Restoration Act

Action

Urge your senators to support conscience rights - S.1204

Urge your Rep. to protect conscience rights - HR 940

Obamacare rollout highlights views of government

Excerpted from "An opening for the right," The Washington Post, commentary by Jennifer Rubin, October 27 - The Obamacare debacle challenges a number of liberal mantras that undergird a whole set of policies and campaign appeals. Here are the top 10 liberal tenets threatened by Obamacare:

1. If there is a problem, the federal government should attack it.
2. Government can compel people to act against economic self-interest by passing laws.
3. There is no downside to big government.
4. The welfare state is the best mechanism to help the poor.
5. Those opposed to big government hate the poor.
6. Government is capable of running highly complex systems effectively.
7. When addressing big problems it is best to centralize and standardize.
8. Unintended consequences of government programs are a small price to pay.
9. People will trust the government with private decisions and personal information.
10. Spending more and taxing more are evidence of concern for the poor.

All of these precepts have been challenged by conservatives, but there is nothing like a real example and personal experience to drive home a message. We don’t have just a few “glitches” or even a time crunch for putting up the exchanges, we have in Obamacare a fundamental misunderstanding of the limits of the government and citizens’ aversion to big, complicated entities. The effort to construct one big system with a highly regulated product (Obamacare-standard insurance) may in fact be the entire effort’s undoing.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics):
“Our healthcare system is broken and badly in need of a fix. The root problem is that healthcare costs too much, so individuals and businesses can’t afford insurance. The Affordable Care Act, unfortunately, is built on the premise that most people’s health insurance programs are not adequate and all perceived inequities must be solved. So the law says preventative services and contraceptives must be free. It doesn’t allow surcharges for age or preexisting conditions. Children can stay on their parents’ plans until age 26. There are no lifetime cost ceilings. Plans must contain psychiatric, eye and other coverages that most insurance plans have not provided.

“I like all those things, just like I like all the bells and whistles on a Mercedes Benz 500 with its great ride and exquisite comfort. But I’ve never owned a Mercedes because I can’t afford one, just like most people in our country. I drive a Honda Civic and, you know what, it gets me there. We can’t afford the Affordable Care Act either. It will add a whopping $2.8 trillion to our healthcare costs over the next 10 years. Already, self-insured individuals are experiencing the reality of that sticker shock but they are no longer in a market-driven healthcare economy. They can’t buy a well-used insurance vehicle at an economical price. Only a Mercedes is adequate.

“We very well may be headed for a debacle. The ‘cure’ may be worse than the disease. If so, everyone may be so traumatized that they refuse to even give a hearing to a real solution.”

Physicians prepare to deal with increased demand, strain on practices under ObamaCare

Excerpted from “Physicians prepare to deal with increased demand, strain on practices under ObamaCare,” Fox News. October 1, 2013 -- As enrollment in ObamaCare begins, physicians throughout the country are preparing to deal with an influx of newly insured patients – as well as the increased financial demands this will place on their practices. While it will take a few years for doctors to fully determine how they will be affected by ObamaCare, some physicians are already anticipating the need to make major changes to the way they run their practices.

One of the most immediate changes that physicians in these areas expect to see is an increase in patients seeking preventive health care – something many avoided when uninsured. However, scheduling more routine check-ups and screenings may place a strain on already short-staffed practices in rural areas. As a result, some doctors are considering handing over some basic aspects of patient care and education to nurses, nurse practitioners, or physicians assistants in order to treat patients more efficiently. Dr. Jason Marker, of Wyatt, Indiana, is already looking to hire additional staff members in order to meet the increased needs in his community.

Rural areas throughout the country already face a shortage of primary care physicians and doctors like Marker fear that this problem might become exacerbated in coming years, as more patients have the means to seek regular care.

“We know definitively that health insurance coverage and access to a physician are what improve health care outcomes.” Marker said. “We’re about to get changes in coverage, but we don’t have a ready way to say, ‘Here’s another million family doctors.’ So there’s a pipeline problem where it will be another five to 10 years where we are able to get the volume of doctors to take all these patients.”

Marker said Congress will need to step up in order to help fix this problem. “The big weak link is whether or not Congress is willing to put additional dollars into family medicine residential training,” Marker said. “That’s the current bottleneck in the training pipeline, is having residency slots. It doesn’t do good to have residents interested if there aren’t slots to do training.”

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): -- “When we went as missionaries to Africa, Jody knew we would be far from the grocery store yet entertaining many guests, so she bought a cookbook called More With Less. That phrase succinctly describes the focus that every healthcare professional will need as we move forward. There are going to be more patients to see than ever before but not enough physicians to see them. Though more medical schools are opening, including two Christian ones, there are not enough residencies being funded. Physician assistant and nurse practitioner schools are expanding to help fill in the gap, but the problem is bigger than that.

According to leading economic John Maudlin, reimbursement rates are going to plunge by 25 percent in the next five years. (I encourage you to read the eye-opening article.) The Cleveland Clinic now collects $6 billion a year and expends $5.5 billion. They are projecting their income to plunge to $4.4 billion by 2018, despite a significant increase in their patient load, as commercial insurance companies on average go from paying $.38 on the dollar billed to $.26. (Medicare now pays $.23 and Medicaid $.18.) Since 60 to 80 percent of their cost is for personnel, that is where cost savings will have to be realized. That is why you are already hearing of hospitals and practice groups laying off staff and if those staff are rehired elsewhere, they probably will be paid less.

CMDA’s Executive Vice President Gene Rudd, MD, told those attending the CMDA Midwest Regional Conference a few weeks ago that they would all need to become missionary doctors…but not necessarily by going overseas. They will have to have a missionary's mentality of working very hard and not getting paid as much, but doing it because God has called them to minister through medicine.

Though we will all being doing "more with less" I believe that the opportunities to minister through healthcare are going to be greater than ever! God does His best work in the midst of crisis and change if we simply rest and trust in Him!

Resources
From My Viewpoint: Healthcare Reform by David Stevens, MD, MA (Ethics)
Why HR 3200 is No Healthcare “Reform” by Gene Rudd, MD
Affordable Care Act Impact on Doctors and Patients

Obamacare May Trigger Exodus of Christian Doctors

Excerpted from “Obamacare May Trigger Exodus of Christian Doctors,” CBN News. October 1, 2013 -- Thousands of Christian doctors across the nation are considering quitting medicine or working overseas because of concerns over the new healthcare law.

Dr. Gene Rudd, senior vice president of the Christian Medical Association, says they're worried they could be forced to facilitate abortions or prescribe drugs that violate their convictions.

Rudd says many of them have avoided hiring and taking on new patients due to uncertainty over Obamacare.

Thousands of the doctors provide care for the poorest areas of the United States and feel called by God to help the sick, but say they need to be able to do so with a clear conscience.

Commentary

CMDA Senior Vice President Gene Rudd, MD: “I rarely view or read media reports after I have been interviewed. (In part, this is because someone else at CMDA does that.) But being asked to comment on this article that was based on what I said to a reporter reminded me of how the media uses their perspectives and agendas to create the news. Too frequently I find a failure to report ‘the truth, the whole truth and nothing but the truth.’

“Timed to coincide with the beginning of the enrollment for Obamacare, my interview with this AP reporter covered many perspectives on healthcare reform, perspectives I classified as ‘the good, the bad and the ugly.’ My limited comments about Christian doctors were almost an afterthought. But only those comments made the news.

“Among the many perspectives I cited, one ‘good’ aspect of reform is that some of our neighbors who previously couldn't obtain health insurance coverage would now have some basic level of protection. A ‘bad’ aspect is that now healthy individuals and families who did not have coverage and had little healthcare costs will now have to pay either a penalty for failure to participate or pay premiums. Even with subsidies, one estimate placed the average family premium at more than $5,000. That will be a substantial burden to most family budgets.

“One of the ‘ugly’ aspects of the current reform bill is the permission assumed by the Administration to usurp individual rights and undermine the First Amendment. Already we have seen HHS interpret and implement legislation in a way that attempts to force employers to provide coverage that includes provisions they find morally objectionable. And under the guise of providing required services, we will be required to fund abortions. Only with the use of smoke and mirrors do they attempt to claim otherwise.

“Will reporters continue to filter the news to suit their agendas? Of course. But we will continue to speak the truth in love. Will Obamacare survive? I don’t know. But we will continue to contest provisions that are morally unacceptable and dangerous to our foundation of freedom."

Resources
Voice of Christian Doctors Media Training
From My Viewpoint: Healthcare Reform by David Stevens, MD, MA (Ethics)
Nationalized Healthcare – Prescription or Problem?

Kindergarten lessons on health care

COMMENTARY

Excerpted from July 5, 2012 commentary published in The Washington Examiner

by CMA VP for Government Relations Jonathan Imbody:

Reforming health care is unquestionably challenging, but it's not brain surgery and works best when following basic principles most kindergartners learn. Help others up when they've fallen, keep your hands off other people's stuff and save your lunch money for when it's needed.

[For example]:

• Provide a targeted and sustainable safety net to assist the poor and patients with catastrophic health care costs.
• Preserve patient access to health care professionals through conscience rights and malpractice reform.
• Cut government bureaucracy and paper work and return decision making to patients and their physicians.
• Empower consumers with insurance competition between states and portability between jobs.
• Encourage health savings accounts that protect against unaffordable expenses and let consumers choose care and medicines through transparent pricing.

ARTICLE

CMA submits Congressional testimony on health care law

Excerpted from written testimony by the Christian Medical Association submitted to the United States House of Representatives, House Oversight and Government Reform Committee, Subcommittee on Health Care, District of Columbia, Census and the National Archives. The Subcommittee held a hearing July 10, 2012, "The Affordable Care Act (ACA): Impact on Doctors and Patients."
The ACA's weakening of conscience rights threatens to accelerate looming physician shortages and result in loss of access for millions of patients:

• Currently, 65 million people lack adequate access to primary care physicians.ⁱ
• Fifty medical studies have projected critical shortages of physicians.ⁱⁱ
• The American Association of Medical Colleges concludes, “If physician supply and use patterns stay the same, the United States will experience a shortage of 124,000 full-time physicians by 2025.” ⁱⁱⁱ
• Millions of patients, notably the poor and those in medically underserved regions, depend for care on religious health care institutions and professionals whose faith and conscience compel their service. Faith-based health care depends on protections against discrimination for upholding life-affirming ethical standards. Absent conscience protection, nine of ten faith-based physicians say they would be forced to leave medicine.^iv Yet the Obama administration eviscerated the only federal regulation that protected the exercise of conscience in health care, and partisans in the last Congress shot down amendments to protect conscience in the ACA.
• The HHS contraceptive mandate illustrates how an administration can use the ACA to weaken conscience rights and ignore First Amendment freedoms. Besides mandating a massive expenditure without a cost analysis, the mandate also tramples the conscience rights of virtually every patient, physician, employer and insurer who ethically objects to any of the contraceptives included in the mandate, including those which the FDA notes can end the life of a human embryo.
• Funding for abortion training is not excluded from the Teaching Health Graduate Medical Education (THCGME) program. Without strong conscience protections, such training can become essentially mandatory in practice and can effectively exclude life-affirming OB/Gyn residents from medicine.

REFERENCES:
ⁱ“Shortage Designation: HPSAs, MUAs & MUPs,” HRSA web site http://bhpr.hrsa.gov/shortage/
ⁱⁱ“Recent Studies and Reports on Physician Shortages in the U.S.,” Association of American Medical Colleges, April 2009. http://www.aamc.org/workforce/stateandspecialty/recentworkforcestudies.pdf
ⁱⁱⁱ“The Complexities of Physician Supply and Demand: Projections Through 2025,” AAMC report, October 2008.https://services.aamc.org/publications/index.cfm?fuseaction=Product.displayForm&prd_id=244
^ivhttp://www.freedom2care.org/docLib/200905011_Pollingsummaryhandout.pdf

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COMMENTARY

CMDA CEO David Stevens, MD, MA (Ethics):
"This past week I did a Christian Doctor's Digest STAT interview with Stewart Harris, who teaches constitutional law at a nearby law school. The interview will be released next month. He is Princeton-trained, articulate and media savvy, since he does a regular regional NPR program on constitutional law. Since the contraceptive mandate has generated more than 20 lawsuits that will likely end up at the Supreme Court, I asked him how he thought the Court might rule.

"He thought since the contraceptive mandate is "generally applicable" in that it applies to everyone except churches that this will likely be the argument made by the government, and it could succeed.
"I commented that the religious exemption clause in the contraceptive mandate is the narrowest one ever written into federal law. If it is not overturned, this could have a profound effect on religious freedom, essentially narrowing our right of freedom of religion to simply a freedom of worship. In other words, we could worship whatever and however we desired but would no longer have the right to exercise our religious beliefs in the public square.

"I then stated as an example, 'So if the government required all doctors in OB/Gyn or family practice to have abortion training or to provide abortions in their practice and thus the law was generally applicable to all physicians in those specialties, that would be constitutional?' He responded, 'I hadn’t thought of it in that way, but the answer could be, 'Yes.'

I’m not a constitutional lawyer, but I know there are other factors to consider. CMDA partners with a number of legal organizations that are involved in these suits. These attorneys will also argue that the government does not have a compelling interest to force religious groups to effectively subsidize, against their convictions, all contraceptives. They will also argue that the mandate is not the least religiously restrictive way to pursue its goals. There are also laws on the books prohibiting requiring abortion training or other participation in abortion.

"Stewart went on to comment that the interpretation of the Constitution is unfortunately often based on the 'rule of five' – whatever you can get five Justices of the court to agree on is considered constitutional. He then commented that this is why it is so important to elect people to office who represent your views on important issues. Not only will they pass laws that don’t abuse religious liberty; they are also some of the ones who will decide who the next Supreme Court Justices will be--and whether those justices will follow the original intent of the Constitution or bend it to suit their own preferences. He expects three Justices to be replaced in the next four years.

"It may seem obvious to us that the First Amendment free exercise of religion clause makes the contraceptive mandate unconstitutional, but others see it in a totally different light. We dare not let ourselves think we are too busy to be involved in this crucial time in the history of our country. This fall we must vote and urge as many others as possible to register to do the same."