Health care in the United States

"We're going to ask the wealthiest people and the largest corporations to start paying their fair share of taxes. We're going to take on the pharmaceutical industry and have Medicare negotiate prices. We're going to finally deal with child care and pre-K. Can you imagine in this country where you have free pre-K for every working family in America? We're going to have — end the disgrace of the United States being the only major country on Earth not to have paid family and medical leave. We're going to expand Medicare to cover dental, hearing aids and eyeglasses. We are going to got home health care... We're going to have — end the disgrace of the United States being the only major country on Earth not to have paid family and medical leave. We're going to expand Medicare to cover dental, hearing aids and eyeglasses. We are going to got home health care."

"Let Mr. Barrasso go to the folks in Wyoming and ask them whether they think it's a good idea that they should be paying a third of their income in child care. Ask elderly people who don't have any teeth in their mouth whether they should be able to get dentures through Medicare. Ask the scientific community whether the time is now in a big way to deal with climate. Ask the ordinary American consumer whether we should take on the greed of the pharmaceutical industry, which charges us the highest prices in the world for prescription drugs."

"The crisis of public has long been a widespread demand in several countries, particularly in the U.S. Surveys showed that even before this crisis, healthcare was among the main concerns of the U.S. population because of the debt it generates for families and because 27.5 million people do not have any kind of coverage. Bernie Sanders has been attacked, not only by Trump but also by the Democrats and Biden, because he calls for Medicare for All. All healthcare systems are organized around the profits of big corporations."

"Obamacare's going to be repealed and replaced. Obamacare is a disaster if you look at what's going on with premiums where they're up 45, 50, 55 percent... They [the uninsured] are going to be taken care of. I would make a deal with existing hospitals to take care of people."

"Here are the principles that should guide the Congress as we move to create a better healthcare system for all Americans: First, we should ensure that Americans with pre-existing conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the healthcare exchanges. Secondly, we should help Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts –- but it must be the plan they want, not the plan forced on them by the Government. Thirdly, we should give our great State Governors the resources and flexibility they need with Medicaid to make sure no one is left out. Fourthly, we should implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance – and work to bring down the artificially high price of drugs and bring them down immediately. Finally, the time has come to give Americans the freedom to purchase health insurance across State lines –- creating a truly competitive national marketplace that will bring cost way down and provide far better care. Everything that is broken in our country can be fixed. Every problem can be solved. And every hurting family can find healing, and hope."

"For historical purposes remember, I was able to get rid of the INDIVIDUAL MANDATE, the most unpopular and expensive part of ObamaCare. You are no longer forced to pay a fortune for the “privilege” of NOT getting bad healthcare. This ended ObamaCare as we knew it. Thank you!"

"This section provides: No entity which receives a grant, contract, loan, or loan guarantee under the Public Health Service Act [42 U.S.C. 201 et seq.], the Community Mental Health Centers Act [42 U.S.C. 2689 et seq.], or the Developmental Disabilities Services and Facilities Construction Act [42 U.S.C. 6000 et seq.] after June 18, 1973, may— (A) discriminate in the employment, promotion, or termination of employment of any physician or other health care personnel, or (B) discriminate in the extension of staff or other privileges to any physician or other health care personnel, because he performed or assisted in the performance of a lawful sterilization procedure or abortion, because he refused to perform or assist in the performance of such a procedure or abortion on the grounds that his performance or assistance in the performance of the procedure or abortion would be contrary to his religious beliefs or moral convictions, or because of his religious beliefs or moral convictions respecting sterilization procedures or abortions."

"Access to medical care has long bedeviled swaths of rural America — since 2005, 181 rural hospitals have closed. A 2020 KHN analysis found that more than half of U.S. counties, many of them largely rural, don’t have a hospital with intensive care unit beds. Pre-pandemic, rural Americans had 20 percent higher overall death rates than those who live in urban areas, due to their lower rates of insurance, higher rates of poverty and more limited access to health care, according to the Centers for Disease Control and Prevention’s 2019 National Center for Health Statistics."

"In the absence of a statute, a physician is under no obligation to engage in practice or to accept professional employment."

"A body of state and federal law allows persons and institutions in the healthcare industry to assert conscience-based refusals to provide patient services. While early healthcare refusal laws focused on the conscience claims of professionals opposed to performing certain procedures, over time refusal laws expanded through concepts of complicity to cover an increasing number of persons and institutions in healthcare services. The complicity-based conscience claims in Hobby Lobby resemble and perhaps descended from these legislated exemptions, popularly termed healthcare refusal laws or conscience clauses."

"Refusal laws exempt medical providers from duties of patient care that are imposed by various bodies of state and federal law governing institutions and professionals. Licensing boards enforce professional standards against healthcare institutions, doctors, nurses, and pharmacists. Tort law, and specifically medical malpractice, provides redress to patients injured by breaches of professional duties. Institutional actors and individual providers are also subject to common law and statutory obligations, including those imposed on public accommodations and healthcare facilities. And patients have constitutional rights, including reproductive and medical decision-making rights, in the healthcare context. Against this backdrop, refusal laws allow individuals and institutions in the healthcare industry to express conscience objections to interacting with persons who seek certain medical services—most commonly abortion, sterilization, and contraception. The laws provide religious exemptions for those who assert that abortion, sterilization, and contraception are sinful, and who object to acting in ways that, the claimants assert, would make them complicit in the sinful conduct of others. The laws appear to exempt healthcare providers from duties to patients. And they generally do not provide mechanisms to mediate their impact on patients."

"We can trace the emergence of healthcare refusals legislation to Congress’s passage of the Church Amendment in 1973. That legislation followed on the heels of two significant judicial decisions: the Supreme Court’s 1973 Roe v. Wade decision invalidating criminal prohibitions on abortion; and a 1972 federal district court decision enjoining a Catholic affiliated hospital, which was deemed to engage in state action because of its receipt of federal funding, from prohibiting sterilization at its facilities. The Church Amendment, which passed with near unanimous support, provided that receipt of federal funds would not provide a basis for requiring a physician or nurse “to perform or assist in the performance of any sterilization procedure or abortion if his performance or assistance in the performance of such procedure or abortion would be contrary to his religious beliefs or moral convictions.” It also provided that no “entity” could be compelled to “make its facilities available for the performance of any sterilization procedure or abortion if [such] performance . . . is prohibited by the entity on the basis of religious beliefs or moral convictions.”"

"The separate normative order authorized by healthcare refusal laws may take a highly institutionalized form. For example, Catholic healthcare delivery is governed by the Ethical and Religious Directives for Catholic Health Care Services (Directives), promulgated by the U.S. Conference of Catholic Bishops (USCCB). Implementation of the Directives, which ensure that healthcare is delivered in conformance with Catholic theological principles regarding cooperation and scandal, is enabled by healthcare refusal laws. According to the Catholic Health Association, one in six patients in the United States is treated by a Catholic hospital. (In Washington State, approximately half of the state’s healthcare system is now Catholic-run.) It is clear, then, that healthcare refusal laws empower a substantial segment of the healthcare industry to operate in conformity with religious principles that dictate limitations on services relating to abortion and contraception. But the Catholic hospital system is not the only organization coordinating claims on refusal laws. Religious hospitals represent nearly a fifth of the healthcare delivery system in the United States, and eight of the twenty-five largest healthcare systems are religiously owned. Even secular hospitals may act on a traditional norm widely shared in the community. And other loosely affiliated providers may act on the basis of shared convictions. For example, resistance to emergency contraception may be widespread and include both hospitals and pharmacies. In states and regions where abortion and certain forms of contraception are stigmatized, healthcare refusal laws, along with other restrictions, may create a system in which the disestablished sexual norms continue to be enforced. With widespread, cross-denominational assertion of claims for exemption, accommodation of complicity-based conscience objections can have far-reaching effects."

"On the federal level, a 1996 omnibus appropriations bill provided that neither the federal government nor any state or local government could “subject any health care entity to discrimination” based on the entity’s refusal to provide abortion services, abortion training, arrangements for abortion services, or referrals to other entities that provide abortion services. Some states, particularly when covering contraception, explicitly included the provision of information among the list of covered acts. Colorado law, for instance, provides: “No private institution or physician, nor any agent or employee of such institution or physician, shall be prohibited from refusing to provide contraceptive procedures, supplies, and information when such refusal is based upon religious or conscientious objection . . . .”"

"Mississippi, which in 2004 passed the nation’s broadest healthcare refusal law, 94 provides an illustration of a provision drafted with the evident aim of making as many persons eligible for exemption as possible. The law defines “health care service” to include: any phase of patient medical care, treatment or procedure, including, but not limited to, the following: patient referral, counseling, therapy, testing, diagnosis or prognosis, research, instruction, prescribing, dispensing or administering any device, drug, or medication, surgery, or any other care or treatment rendered by health care providers or health care institutions. Mississippi’s law defines “health care provider” with similar breadth: “Health care provider” means any individual who may be asked to participate in any way in a health care service, including, but not limited to: a physician, physician’s assistant, nurse, nurses’ aide, medical assistant, hospital employee, clinic employee, nursing home employee, pharmacist, pharmacy employee, researcher, medical or nursing school faculty, student or employee, counselor, social worker or any professional, paraprofessional, or any other person who furnishes, or assists in the furnishing of, a health care procedure."

"[A]s the Mississippi law demonstrates, as healthcare refusal laws grew to include contraception, some states specifically covered pharmacists and pharmacies with objections to selling contraception. As changes occurred in the economic organization of the healthcare field, conscience legislation began to apply the logic of complicity to insurance plans’ and HMOs’ financial relationships. In 1997, Congress passed a Balanced Budget Act that provided conscience provisions for Medicaid and Medicare managed care providers that objected to providing, reimbursing for, or covering abortion counseling or referral. A 2004 appropriations bill broadened the de finition of a healthcare entity to include HMOs and insurance plans, and withheld federal funding from any federal agencies or state governments that discriminated against healthcare entities on the basis of their refusal to cover, pay for, or refer for abortion. In 2008, the Bush Administration adopted regulations that expanded the coverage of the Church Amendment itself, defining “Health Care Entity” to include HMOs and health insurance plans and assistance to include “counseling, referral, training, and other arrangements for the procedure."

"Overall, the claims upon which recent healthcare refusal laws are based contrast sharply with the claims featured in the cases that Congress referenced in RFRA. Rather than invoking unfamiliar religious beliefs, the claimants object to laws departing from traditional social norms. The claims for accommodation are generally not asserted in courts; instead, they are primarily asserted in politics, and redressed through legislation. The accommodations provided by healthcare refusal laws are not designed for particular religious claimants, such as the Amish or members of the Native American Church; instead, they authorize exemptions for persons asserting conscience objections based on any religion or, with the inclusion of “moral” objections, no religion at all. Accommodation of these claims does not entail costs borne by society as a whole; instead, accommodation has consequences for the third parties whose conduct is at issue. Crucially, healthcare refusal laws make little or no effort to offset their impact on third parties."

"[A]s we have seen, healthcare refusal laws that accommodate claims of complicity are not limited to Catholics, and these laws have become a major focal point of a cross-denominational coalition that includes evangelical Protestants. In some areas, the accommodations furnished by healthcare refusal laws may align the actual provision of hospital services with majority religious and moral beliefs in the locality. Widely shared norms may result in the systematic denial of goods or services, even without formal organization around a governance instrument like the Directives. Healthcare providers may subscribe to those norms or may feel pressure to conform to them in order to avoid controversy and maintain community standing. Indeed, some healthcare refusal laws do not even specify that the refusal be based on the provider’s religious or moral objection, thereby seemingly authorizing refusals for any reason."

"At common law, physicians actually had no duty to treat any patient at all, even in an emergency."

"Even before Roe was decided, states that permitted abortion were taking action to protect those physicians or hospitals that objected to participation in abortions. In 1971, New York enacted a criminal law prohibiting discrimination against any person for his or her refusal to participate in abortions. Many other states—including Arkansas, Alaska, Colorado, Delaware, Florida, Georgia, Hawaii, and Maryland—included explicit conscience protections for individuals and institutions in the same statutes that liberalized their abortion laws. That trend of protecting conscientious objectors to abortions continued and dramatically expanded in the aftermath of Roe. Today, virtually every state in the country has some sort of statute protecting individuals and, in many cases, entities who refuse to provide abortions. Most of these statutes arose in the decade following Roe. Some states expressly limit this protection to the practice of abortion, which is treated specially. Other states protect conscience for other procedures as well."

"At the federal level, Congress likewise took almost immediate action after Roe to protect physicians and hospitals from being forced to perform abortions. In particular, as part of legislation known as the “Church Amendment,” Congress clarified that recipients of certain federal funds were not required to provide abortions, and that those facilities were prohibited from discriminating against employees who refused to participate in abortions. When inserting the particular language in the Church Amendment that protects individual conscience, Representative Heinz said the following: Mr. Chairman, freedom of conscience is one of the most sacred, inviolable rights that all men hold dear. With the Supreme Court decision legalizing abortion under certain circumstances, the House must now assure people who work in hospitals, clinics, and other such health institutions that they will never be forced to engage in any procedure that they regard as morally abhorrent. . . . [In addition to protecting institutions from being forced to perform abortions,] we must also guarantee that no hospital will discharge, or suspend the staff privileges of, any person because he or she either cooperates or refuses to cooperate in the performance of a lawful abortion or sterilization because of moral convictions. . . . . Congress must clearly state that it will not tolerate discrimination of any kind against health personnel because of their beliefs or actions with regard to abortions or sterilizations. I ask, therefore, that the House approve my amendment . . . . Without further discussion, the House promptly passed the Amendment and the bill by an overwhelming margin: 372–1. The Church Amendment was ultimately enacted and signed into law in 1973."

"In the years prior to Roe, at least fourteen states had already liberalized their abortion laws. These pre-Roe liberalization laws frequently came with the creation of express statutory protection for physicians and other healthcare personnel and institutions that refused to participate in abortions. Likewise, when it decided in 1970 to support greater access to abortion, the American Medical Association also resolved that “[n]either physician, hospital, nor hospital personnel shall be required to perform any act violative of personally-held moral principles.” Once the Court’s decision in Roe established a constitutional right to abortion, state and federal legislatures acted quickly and decisively to confirm that no physician could be forced to provide an abortion. At both the state and federal levels, legislators quickly enacted conscience statutes to protect individuals and institutional healthcare providers from being forced to participate in abortions. These laws were not limited solely to the direct performance of abortion. Instead, they protected against compulsion to participate even indirectly, including by referral or providing space."