Will birth-control mandate cost more or less? Yet to be seen

Will requiring insurance companies to provide contraception be cost-neutral, as the Obama administration claims? It is unclear, and so is whether insurance companies will make Catholic institutions pay more. These were the findings of FactCheck.org, a nonpartisan, nonprofit, consumer-advocate project funded by the Annenberg Public Policy Center of the University of Pennsylvania.

In support of its claim, the administration cites data from Hawaii's birth-control mandate, which shows health insurance premiums "did not appear" to increase. The study also found the number of pregnancies increased after contraception coverage was required.

But when Pennsylvania considered imposing a similar mandate, a state agency found "the amount of possible savings relative to the cost of the legislation is unclear." Findings were also unclear in Connecticut when officials there looked at whether or not insurance plans saved enough because there were fewer pregnancies to offset the cost of providing coverage. A Texas study found insurance companies would not save enough because women would buy contraception on their own.

A recent survey of 15 insurance companies found six thought costs would increase and another three felt the move would be neutral in cost. None felt they would save money because of the mandate.

"Until better data are available, we're unable to conclude whether the Obama birth-control mandate is likely to result in a net cost increase or not," FactCheck reports.

Obama changes health-insurance rule to placate religious groups that oppose birth control

In an effort to quell a firestorm of controversy, President Obama announced today that his administration change its new rule that requires employers to offer free birth-control coverage in their health insurance plans. The rule has outraged some Roman Catholic leaders, whose tenets prohibit artificial contraception. (Associated Press photo by Susan Walsh)

Today's change essentially requires insurers, rather than religious employers, to cover the cost of coverage for contraception. "Any employer who has a religious objection to providing contraception will not have to provide that service to employees, but in those cases the insurer will be required to reach out directly to the employee and offer contraceptive care free of charge," report Christi Parsons and Kathleen Hennessey of the Los Angeles Times.

Yesterday at the Conservative Political Action Conference, Senate Republican Leader Mitch McConnell of Kentucky joined several other speakers in lambasting the original version of the rule, calling it "an assault on religious liberty," reports James R. Carroll of The Courier-Journal.

Obama's adjustment did not appear to placate most critics, but Sister Carol Keehan, president of the Catholic Health Association, said, "The framework developed has responded to the issues we identified that needed to be fixed." (Read more)

St. Joseph Health System announces merger with Jewish Hospital & St. Mary's HealthCare

Rebuffed in its bid to take over Louisville's University Hospital, Catholic Health Initatives announced today that its St. Joseph Health System had merged with Jewish Hospital & St. Mary’s HealthCare, effective retroactively to Jan. 1. Gov. Steve Beshear rejected the original merger plan because of University Hospital's public status and the proposed control of CHI, which follows Catholic health directives.

The new organization is called KentuckyOne Health and is headed by Ruth W. Brinkley, as president and chief executive officer. She is a former executive at CHI and Ascension Health. The organization "includes hospitals, clinics, specialty institutes, home health agencies, satellite primary care centers, and physician groups with more than 80 locations, 2,500 staff physicians and more than 13,000 employees across the state of Kentucky and southern Indiana," CHI said in a press release. It said it will invest $320 million into the merger.

"As part of KentuckyOne Health, historically Jewish facilities will remain Jewish," the release said. "Historically Catholic facilities will remain Catholic." Dr. Gerald Temes, chair of Jewish Hospital HealthCare Services, said in the release, “We have had a mutually beneficial relationship with Catholic Health Initiatives for the last six years. We’re confident this is the right direction for the Jewish Hospital organization.” (Read more)

Critics, proponents debate Louisville hospital merger

Questions regarding ectopic pregnancy, end-of-life care and funding for indigent care were addressed Wednesday by proponents and critics of a proposed merger between University Hospital, Jewish Hospital & St. Mary's HealthCare and St. Joseph Health System. The issues were discussed at a meeting of the Louisville Forum.

The merger, which still needs approval by Gov. Steve Beshear, would give St. Joseph majority control over the three systems. Because St. Joseph is owned by Catholic Health Initiatives, University Hospital and Jewish and St. Mary's would have to adhere to Catholic health directives.

As such, "The other merger partners have agreed not to perform certain services forbidden by those directives: elective abortions; sterilizations; contraceptive dispensing for the purpose of contraception only (except in cases of sexual assault when the victim isn't already pregnant); artificial insemination and in-vitro fertilizations; and euthanasia," reports Laura Ungar of The Courier-Journal.

Altogether, there are 72 Catholic health directives, but David Laird, president and chief executive officer of Jewish and St. Mary's, said his organization and University Hospital have not agreed to abide by all of them. "We are not a Catholic hospital," said Laird, left. "University will not become a Catholic hospital," he said. (Photo by Frankie Steele)

Merger critic Beverly Glascock, a Louisville attorney and former nurse, broached the issue of ectopic pregnancies, which occur in the fallopian tube rather than in the womb. In all cases, the fetus cannot survive and there is danger to the mother if the tube bursts.

But, in a merger document released earlier this week, one of the banned procedures includes "elective (direct) abortions." "In the case of extra-uterine pregnancy, no direct abortion will be performed," the document reads.

Dr. Dan Varga, chief medical officer for St. Joseph Health System, addressed the issue, saying "a direct abortion is the termination of a viable pregnancy, and ectopic pregnancies are, by definition, not viable," Ungar reports.

The issue of indigent care was also discussed. Since CHI has said it will invest $320 million in the deal and commit $200 million to improve University and Jewish hospitals, one audience member asked how much of that would be used for indigent care. Laird said a combined $270 million in indigent care is already being spent. As for whether the CHI funds will increase that sum, Laird said he could not say. "How much will these hundreds of millions of dollars will go to help the indigent?" Glasscock asked. "Not one dollar, not a cent."

As for end-of-life care, merger partners said they have "agreed only not to perform euthanasia, which they do now," Ungar said. Continuing to provide food to someone in a vegetative state and honoring living wills should not be a concern. (Read more) To view a video of part of the hospital merger discussion, click here.

Republican leader and former U of L trustee says university made poor argument that hospital isn't public

The University of Louisville made a “terribly flawed argument” when it claimed that University Hospital was not a public entity, former U of L Trustee Bill Stone told cable channel cn|2's "Pure Politics" program yesterday. "That argument has been central as university leaders try to finalize a merger with two private hospital groups, Jewish Hospital and Catholic Health Initiatives," Ryan Alessi notes.

Stone, a former Jefferson County Republican chairman, said he agreed with Democratic Attorney General Jack Conway's ruling in an open-records case that the hospital is a public entity, and “I don’t know of any lawyer of merit who wouldn’t agree with Jack Conway’s assessment. That has been the weakness in U of L’s selling point. The University of Louisville Hospital is part of the university.”

Alessi reports, "Stone said the university should be highlighting the positives of the merger." Stone told him, “I think this merger can be sold to the public on the basis of how much it will mean to this community economically, what it will mean from a prestige point of view, where it will be an incubator for Nobel Prize-winning scientists.” For the story and video, click here; for the video only, on the image above.

Is University Hospital public? Attorney general will decide; merger proposal raises question of church-state separation

Attorney General Jack Conway has been asked to decide "whether University Hospital is a public institution — an issue in the controversial plan to merge the University of Louisville’s main teaching hospital with two other health-care systems," Patrick Howington of The Courier-Journal reports.

ACLU of Kentucky and The Courier-Journal have appealed denials of of open-records requests they made to University Medical Center Inc., which does business as University Hospital. "UMC turned down both requests on grounds that it is a nonprofit corporation rather than a public agency and therefore isn’t subject to the act," Howington writes. An attorney general’s opinion on open records or open meetings has the force of law unless overturned in court.

Meanwhile, Howington also writes that "Some legal advocates and constitutional scholars say," citing court cases, that the hospital's "plan to follow Catholic health-care directives under a pending merger could violate the U.S. Constitution’s provision to keep state and religious matters separate." (Read more)

The Courier-Journal, continuing to explore Louisville hospital merger, says many more questions still need answering

The proposed merger of the University of Louisville hospital with Jewish Hospital & St. Mary’s Healthcare and with St. Joseph Health System of Lexington, which follows the teachings of the Roman Catholic Church, continues to draw heavy attention from The Courier-Journal. Sunday's newspaper had a long column by editorial writer Pam Platt, and an editorial that online was packaged with a video discussion among the editorial board and U of L President James Ramsey, David Laird of Jewish and St. Mary’s, Dr. Daniel Varga of St. Joseph and James Taylor, CEO of University Hospital.

"On many levels, the merger . . . is appealing," the editorial began, saying the new system would be broader and more efficient and secure the three Louisville hospitals as they compete with Baptist Hospital-East and Norton Healthcare, which recently announced an affiliation arrangement with the University of Kentucky" hospital. "Two significant issues continue to make the merger problematic, however." In addition to the issues of reproductive care, the editorial wonders whether advances in medical science that conflict with Catholic teaching could cause the merger to "unwind," as hospital officials put it, and what the ramifications of that would be. (Read more)

In her column, Platt, right, focused on the merger's impact on women, saying it remains unclear. For example, "The partners say transportation will be provided for pregnant women wanting tubal ligations, as well as for their infants. But what will be the process for them accessing that? What are the details? . . . Many of us need more answers to additional questions . . . before we know if this merger is the answer not only for the business end of things, but for all the people who depend on the hospitals for their care." The merger needs state approval to proceed. (Read more)

Baptist Hospital East would allow U of L docs to perform tubal ligations there after merger with Catholic system

Since the merger between Jewish Hospital, University Medical Center and Saint Joseph Health Systems will prevent female patients from getting their tubes tied there — because St. Joseph is owned by a Catholic-based parent company — Baptist Hospital East will provide a facility where University of Louisville doctors can perform the procedure.

"This will ensure our ability to provide reproductive services for our patients after the merger occurs," said Dr. David Dunn, U of L executive vice president for health affairs, addressing perhaps the largest single concern about the merger. University Hospital CEO James Taylor called it a "very small" compromise. "We compromised only a location, not a population."

Through a $15 million fund "that will be set aside from the assets of University Hospital and given to U of L for that purpose once the merger closes," uninsured women will be able to have tubal ligations at Baptist, whether they're being done after giving birth via C-section or vaginally, reports Patrick Howington of The Courier-Journal. They can also be done even if the procedure is unrelated to childbirth. University of Hospital performed 301 tubal ligations last year.

University Hospital has historically provided care for indigent patients who cannot afford to get care elsewhere. Because these patients are not wealthy enough to choose which hospital they go to, they have no choice but to adhere to Catholic directives. Though the issue of female sterilization has been addressed, there is still the issue of how end-of-life care will be handled at University Hospital. That includes how living wills and the removal of a feeding tube will be dealt with.

The merger, which would create Kentucky's largest health-care system, still needs the approval of Gov. Steve Beshear and the Catholic Church. "We have a public institution with a public mission that has been supported by the public dollars and public leadership for many years," said state auditor Crit Luallen. "And we have to look at how a merger with a religious organization changes the public's access and the public's protection." (Read more)

Planned merger of Louisville hospitals grows more controversial; C-J devotes considerable space to it and Beshear steps in

UPDATE, July 27, 3:43 p.m.: Gov. Steve Beshear issued a statement saying "It is clear there are growing concerns within the community about issues related to the hospital’s future level of access to medical services, and those concerns need to be fully vetted before the Commonwealth takes the legal steps required to approve this merger," such as changes in leases of public property and agreements on operation of the hospital. Just as important as the legal issues, Beshear said, is "the public policy of how the University of Louisville Hospital will continue to honor its mission as a public teaching hospital that provides access and care to citizens, especially those who are indigent." The governor said his administration "will hold a series of conversations with the principals in the proposed merger and other interested parties," starting with a meeting among four of his cabinet secretaries, Mayor Greg Fischer, state Auditor Crit Luallen and Attorney General Jack Conway.

The merger that would put a Catholic health group in charge of the University of Louisville's hospital is growing ever more controversial, as demonstrated by today's edition of The Courier-Journal. The top story was about U of L President Jim Ramsey's uncertain response to a request by state legislators to answer questions of a legislative committee, accompanied online by a photograph of a somewhat sheepish-looking Ramsey, left. UPDATE, July 28: Ramsey says he will appear before the panel Aug. 17.

The paper's editorial page was mainly about the issue. The top editorial was headlined "Ramsey's silence," and it referred to the second 'editorial' on the page, actually a recitation of email correspondence between Ramsey and one of his Fern Creek High School classmates and her husband, who oppose the merger and questioned Ramsey's charcterization of an earlier C-J editorial as "not based on complete and factual information."

Next to that piece was a letter from the lawmakers: Rep. Tom Burch, chairman of the House Health and Welfare Committee and a Catholic who opposes the merger because of its implications for reproductive and end-of-life procedures; and Reps. Mary Lou Marzian and Joni Jenkins of Louisville. It was illustrated by a photo of Ramsey looking thoughtful. Above it was a letter, illustrated by a photo of Pope Benedict XVI, from Eugenia K. Potter, former executive director of the Kentucky Commission on Women, headined "Is it dogma or discrimination?" Conservative commentator Martin Cothran has a contrary view on his blog.

UPDATE, July 27, 8 a.m.: The C-J editorial page is again mainly about the issue, with an editorial urging the state auditor, governor and attorney general "to thoroughly scour and bring transparency to the negotiations with Catholic Health Initiatives;" an article by former University Hospital nurse Beverly Glasscock saying that the hospital wouldn't be able to perform emergcy abortions needed to save a woman's life; and a letter from former university trustee Bill Stone defending Ramsey from what he calls an "over the top" attack by the paper's editorial board.

Louisville hospital merger could thwart some patients' final wishes

More concerns are being raised about the merger that would put a Catholic hospital group in charge of the University of Louisville's hospital. First, it was the prospect that women getting Caesarean sections would not be able to get their tubes tied at the same time. Now, "A growing chorus of protest from local residents, doctors and others has erupted over the fact that Catholic doctrine could override patients' end-of-life wishes," Laura Ungar and Patrick Howington report for The Courier-Journal.

"While many wealthier patients could simply choose a different hospital, indigent patients have little choice but University Hospital for treatment, including end-of-life care," the reporters note. "That has left some worried about how end-of-life decisions will be affected if living wills and decisions to remove a feeding tube, for example, will not be honored if they are 'contrary to Catholic teaching'."

Denver-based Catholic Health Initiatives told the newspaper that advance directives such as living wills would be honored “in the vast majority of cases” but “There may be the rare situation, such as a patient in a persistent vegetative state who is not in the dying process, when what the patient is requesting through his or her advance directive is not consistent with the moral teaching of the Church. In those few cases, a Catholic health care facility would not be able to comply, and with the family's guidance, the patient would be transferred to another facility, or to their home under hospice and family care.” (Read more)

Louisville hospital merger probably means poor women won't get their tubes tied at University Hospital any more

Women who deliver through Caesarean sections at the University of Louisville Hospital may no longer be able to get their fallopian tubes tied at the same time, Patrick Howington of the The Courier-Journal reports. This rule may be one of many the hospital plans to adopt if the proposed merger with Catholic Health Initiatives, parent company of Lexington-based St. Joseph Health System, goes through.

The hospital has agreed to honor the Roman Catholic Church's rules against sterilization as a part of the merger agreement. University "President James Ramsey said reproductive procedures that can't be done at University Hospital will be performed at U of L's outpatient center on Chestnut Street, which isn't part of the merger," Howington writes. This would require an additional surgery for women seeking tubal ligations since the outpatient center does not deliver babies. "That's really inappropriate," said Dr. Marcello Pietrantoni, a Louisville obstetrician who specializes in high-risk pregnancies. "You're going through a second procedure, and the risks of complications . . . are doubled." (Read more)

Medical risks and additional costs are not the only concerns Louisville residents and neighbors have about the proposed merger. An editorial in today's Courier-Journal reminds readers of the hospital's missions to provide care for indigents in the city and train doctors, and questions the level of care from a public hospital guided by a religious organization. To read the editorial, click here.