A man waves a flag as he joins others opposed to the administration’s health care reform law in front of the U.S. Supreme Court building in Washington June 28. The nation’s high court upheld the Patient Protection and Affordable Care Act as constitutiona l but placed some limits on the federal government’s ability to terminate states’ Medicaid funding. (CNS photo/Bob Roller)

Catholic leaders pledged to continue their defense of religious liberty in the wake of a recent U.S. Supreme Court decision on health care reform.

The June 28 ruling upheld a controversial provision of the Affordable Care Act, often called “Obamacare.”

The U.S. Conference of Catholic Bishops, while consistently advocating comprehensive health care reform to benefit the poor and vulnerable, nonetheless opposed passage of the act for several reasons. The USCCB laid out the reasoning in a June 28 press release and called the legislation “fundamentally flawed.”

Dr. William Chavira, a Phoenix-based obstetrician-gynecologist, was troubled by the Supreme Court decision, for some of the same reasons cited by the U.S. bishops.

“We have a lot of confusion and fear and some of it is the reality of what could happen,” Chavira said. “I think the two biggest issues that are not addressed are protection of conscience for health care companies and institutions and especially for people like myself, OB-GYN Catholic physicians who wish to practice according to the teachings of the Magisterium. I think it really threatens our livelihood.”

Chavira said he’s discussed the uncertainty of what will happen to his practice with his family.

“I don’t know where we will be especially if the current administration is re-elected, what that will do to the reality of my practice and putting what I do at risk,” Chavira said.

About 40 percent of Chavira’s practice consists of care for the indigent, many of whom rely on state-sponsored health insurance plans.

If certain health care plans dictate prescribing contraceptives, sterilizations and abortions, Chavira said he “couldn’t take care of the poor and indigent” that participate in such plans. He will not violate his conscience, he said, and cash payment isn’t an option for these patients.

“They rely on Medicaid and AHCCCS systems and if these things are required, if you have to offer these services, I could not be a provider in that system,” Chavira said. “Do I quit? No, but those of us who practice in this manner, we will have to join together and pray for conversion of heart not only for our president, but of Congress.”

Beyond that, he said, the health reform act “does nothing to address care of immigrants,” a concern also noted by the U.S. bishops.

Chavira said that while he hasn’t filed a lawsuit yet, he is considering his options.

“We should have a protection of who we are, of what our conscience is,” Chavira said. “I don’t think that we should just sit around and take it.”

End of round one

Nikolas Nikas, president and general counsel for the Bioethics Defense Fund, a public-interest law firm that advocates on behalf of human life, emphasized what the Supreme Court ruling meant — and more importantly, what it did not mean.

“We call it a tax on pro-life conscience,” Nikas said. “The effect of this is that there’s still a tax. The only issue that was decided was whether you can force people to buy insurance whether they want it or not.”

The religious freedom issues, Nikas said, were not touched upon by the June 28 decision.

“Had the whole thing been struck down, all the bad mandates threatening religious liberty would have gone down,” Nikas said. “Because this was upheld, and because none of the issues decided by the court affected the question of… conscience, it all remains to be seen. This is going to end up back at the Supreme Court.”

The 20 lawsuits filed against the Affordable Care Act are moving forward, he said.

“While we’re disappointed that the threats to religious liberty did not evaporate with the whole law going down, the religious liberties issues will now have a full day in court,” he said. “This is round one in a long fight.”

Mike Phelan, director of the Office of Marriage and Respect Life Issues for the Diocese of Phoenix, offered a similar take.

“The HHS mandate is still in place and it has to be resisted,” Phelan said. “We actually have a good shot through the courts at that one.”

The health care reform act, Phelan said, was riddled with multiple other problems, among them, a provision for a one-dollar contribution to pay for abortions in most insurance plans.

That little-known fact was discovered by Dorinda Bordlee, vice president and senior counsel for the Bioethics Defense Fund. A thorough reading of the 2,800 page health care bill led to her discovery of the compulsory contribution to elective abortions.

“There is a strong culture-of-death understanding of medicine in the legislation itself, the HHS mandate, which defines pregnancy as a disease, contraception as a cure, including abortifacient contraception,” Phelan said. “It’s just one indicator — a major one the bishops are most concerned about — of the mentality behind much of the legislation itself.”

Phelan said he was concerned about the general lack of understanding among Catholics about the Affordable Care Act.

“We’ve allowed health care to be defined this way, in many cases by not speaking up, by some health care professionals being quiet when they need to speak up, and by a lack of sanctity among Catholics,” Phelan said.

The Supreme Court’s ruling, Phelan noted, was a “tremendous wake-up call.” The health care issue, while complicated, he said, clearly needs to be addressed.

“Whatever the solution is, it can’t undermine our ability to participate in health care as Catholics and it can’t undermine the definition of health care which is first, do no harm,” Phelan said. “[That includes] providing for the dignity of the person, including the unborn person, the elderly, and persons who can provide no measurable production for society, including the handicapped person or unborn person.”

The recent Supreme Court 5-4 decision held that while the health care act exceeded Congress’s authority under the commerce clause, the individual mandate in the 2010 health care act was an exercise of Congress’ power to tax.

The Eternal Word Television Network (EWTN) and Ave Maria University are among many that filed more than 20 lawsuits against the Affordable Care Act, which they see as a threat to religious liberty.