These – as far as I can see them from this distance – are the polar positions of the US debate about proposals by their Department of Health and Human Services for implementing an employer-pays private insurance scheme for all employees.
The discussion on an earlier post of this blog has helped me a bit, and I’d like to sum up what I think I’ve learnt.
We can agree, I think, that the issue is not whether or not the US needs or should have a universal healthcare provision. The US Catholic bishops, along with many other advocates for the poor, have been calling for such a provision for a long time. We might argue whether private insurance is the way to go, or whether the HHS proposals will give universal coverage, or whether requiring employers to pay insurance premiums for their employees will have an inflationary, deflationary, or neutral effect, or whether State-level setting of standards will disadvantage some people (particularly children), or whether it will decrease health performance by adding costs to the sector. But this isn’t where the bulk of the debate is taking place, and it isn’t the sticking point for US religious leaders.
Nor is there a problem with covering both corrective and preventative healthcare.
The issue is the HHS decision to include sterilisation procedures and contraceptive medications and devices in the mandated coverage as part of the preventative healthcare category.
The Church teaches that sterilisation and the use of contraceptive medications and devices for contraceptive purposes is damaging to the individuals involved, and to society. To take artificial measures to prevent conception is disordered, or sinful, says the Church. It is also well established in moral theology that procuring the opportunity for someone else to do a sinful act (such as by paying for their contraceptive medications or devices) is, in itself, sinful. (And sometimes illegal, as Kim dot Com is in the process of finding out.)
Is the HHS healthcare plan an attack on religious freedom?
In relation to the HHS healthcare plan, the Church says that it is an offence to religious freedom to require a Church employer (such as a university or a hospital) to pay for contraception for its employees.
On the previous thread, we debated at length whether or not contraception is wrong. And a lot of the US debate has been on this ground. However, for this post, can we put this issue to one side and just accept that the Church believes it to be wrong?
So here’s the question: under what circumstances can the US State require a legal or human person to do something that their religion says is wrong, or to provide money so that someone else can do it? [UPDATE Question edited to meet Jerry’s input]
This post will get too long if I try to bite all of that off at once, so I’ll just address a point that Chris raised.
Is the insurance payment part of the wage packet?
In the recent discussion, Chris raised the argument that insurance premiums paid by the employer are part of the employee’s wage packet, and therefore it is the employee who is paying for the insurance. This is a reasonable point, and needs to be fairly considered. If the employer acts merely as an agent for the employee in collecting the premiums and passing them to the insurer, then that puts a layer of distance between the employer and the payment, part of which is being used for a purpose the employer considers to be evil. The Church has a whole set of principles around co-operation with evil, and when we are able (under duress or for the sake of a greater good) to be part of something that others are using for evil purposes.
We could debate where we’d sit collecting for someone else their premiums for sterilisation and contraceptive cover on such a continuum. But is this in fact the case? Are the insurance premiums part of the wage packet? This is certainly the case for private insurance paid for by the employer in New Zealand. I have four questions to clarify the US situation.
1. Will the employee’s taxable income include the insurance premiums when tax is calculated?
2. For those on the basic wage, will the insurance premiums reduce their take home pay, and for those on the cusp of a tax level, will the premiums change their level?
3. Does the employee have the choice to refuse the health insurance, or to choose their plan?
4. Have the premiums been described by the US government as a cost to the employee matched by a wage rise from the employer.
If the answer to all four is yes, then the premiums are part of the wage packet. So let’s have a look.
1. No, the premium is not counted in the employee’s wage for tax purposes. On the contrary, the employer – if categorised as a small enterprise – will receive a tax credit of up to 50% of the cost of the premium.
2. No, the premium payment does not change the employee’s tax status, nor does it take the take-home pay of a minimum wage worker below the threshhold.
3. No, the employee has no choice about joining the scheme or about the basic package that the scheme covers.
4. No, the US government has made it very clear that this is FREE health insurance.
What do you think? Have I missed some questions? Have I misinterpreted some facts? Or are the healthcare payments a cost on the employer rather than a payment by the employee?