The proposed Republican replacement for the Affordable Care Act (“Obamacare”), unveiled by Speaker Paul D. Ryan in early March and now making its way through the House with the support of President Donald J. Trump, has few fervent supporters but countless critics, from the AARP to the conservative Freedom Caucus. The U.S. Catholic bishops have also been wary of the proposal, and the Catholic Health Association has opposed it outright.

One Catholic member of Congress, Rep. Joe Kennedy III of Massachusetts, called the proposal “an act of malice,” ridiculing Mr. Ryan’s characterization of the bill as an “act of mercy.”


“With all due respect to our speaker, he and I must have read different Scripture,” Mr. Kennedy said at a meeting of one of the House committees considering the bill. “The one that I read calls on us to feed the hungry, to clothe the naked, to shelter the homeless and to comfort the sick. It reminds us that we are judged not by how we treat the powerful but by how we care for the least among us.”

The A.C.A. is flawed in many ways, especially the way it was rolled out without due regard for questions of religious liberty, but the Republican replacement, called the American Health Care Act, seriously tests many principles of Catholic social teaching.

The Compendium of the Social Doctrine of the Church mentions health care as a human right alongside food, housing, work, education and transportation (No. 166). Pope Francis has also been vocal about access to health care, especially with regard to how the poor are treated. “Health is not a consumer good but a universal right, so access to health services cannot be a privilege,” the pope said during a meeting with members, volunteers and supporters of Doctors with Africa in May.

The proposed changes to the health care system exacerbate rather than ease social inequities.

The plan is still under review by the Congressional Budget Office, which provides official nonpartisan numbers for Congress, but other organizations have begun to cast their own predictions. The Brookings Institute predicts that the C.B.O. “will likely estimate that at least 15 million people will lose coverage under the American Health Care Act (AHCA) by the end of the ten-year scoring window.” An analysis by the rating agency Standard & Poor predicted that “about 6 million to 10 million people will lose health insurance if the bill passes, including 2 million to 4 million currently enrolled in the individual health insurance market, and 4 million to 6 million currently enrolled in Medicaid.” The Compendium identifies “those without health care” among the poor who must be given preferential treatment when making decisions, on a structural or personal level (No. 182).

Further, the proposed changes to the health care system exacerbate rather than ease social inequities. The new tax credits for buying insurance, which would replace the A.C.A.’s subsidies and tax credits, range from $2,000 to $4,000 per year, depending on age. But they are “flat”—that is, not tied to need—and so lower-income households would lose financial support. The Kaiser Family Foundation estimates, for example, that a 40-year-old making $20,000 per year would be eligible for $4,143 in premium tax credits under the current system (in addition to A.C.A. subsidies he may receive to lower the cost of his monthly premiums) but only $3,000 under the Republican plan. He would also lose the A.C.A.’s current tax credits to help with out-of-pocket costs, such as deductibles and co-payments.

Similarly, the new tax credits do not take into account the costs of policies in individual markets, so they would be less valuable in places (predominantly rural areas) where there is little competition in the insurance market and where premiums are higher.

The plan would also freeze Medicaid enrollment in 2020 and cap federal funding per enrollee, based on how much each state was spending in 2016. Vox estimates that the changes amount to ”a $370 billion cut to federal funding to Medicaid over 10 years,” with states unlikely to pick up much of the reduction. And the law would allow states to drop Medicaid coverage of mental health treatment, including drug addiction—another case of reducing care for the most vulnerable in society.

While the Republican plan keeps the requirement that insurance companies cover people with pre-existing conditions, it allows companies to levy a 30 percent surcharge on premiums for one year for anyone who has a 63-day “break” in coverage. Given that many such gaps occur because someone has lost a job or has faced an unexpected expense—such as repairing a car needed to get to work—it is cruel to penalize families who try to do the responsible thing and resume paying for insurance.

Just as disturbing as the details of the plan is the rhetoric used to justify cutting health care for the most needy. Mr. Ryan calls his bill “an act of mercy,” even though the most comfortable will benefit the most, in the form of both tax cuts and tax credits. He seems scandalized by the notion that "The people who are healthy pay for the people who are sick,” though that is not only the whole point of insurance but also a bedrock of a compassionate society. One congressman, arguing for the elimination of requirements that all health insurance cover certain treatment, complains about having to help pay for prenatal care—a far cry from a truly pro-life position.

Others have waved away the need for adequate health care by misrepresenting Jesus’ observation that “the poor will always be with us” or by saying that people could afford health care on their own if only they gave up supposed luxuries like smart phones. As Stephen Pimpare wrote in The Washington Post, echoing Pope Francis’ comments on donating money to the homeless: “Why do we begrudge people struggling to get by the occasional indulgence? Why do we so little value pleasure and joy? Why do we insist that if you are poor, you should also be miserable? Why do we require penitence?”