Perhaps Barack Obama assumed that religious leaders would simply offer a token protest to his new mandate for religious organizations to provide free birth control, even when contraception, abortifacients, and sterilization violate the core doctrines of their faith. The president might have had reason to expect that Catholic bishops wouldn’t put up much of a fight, considering their support for the Patient Protection and Affordable Care Act (PPACA), commonly known as ObamaCare, from which Health and Human Services derives the authority to dictate their coverage requirements to employers.

Obama has enjoyed significant support from Catholics, the largest religious group in the country, winning the Catholic vote by nine points in 2008 and relying on their support to pass the PPACA. However, the Catholic bishops have united against the Obama administration after the imposition of the mandate, along with leaders of other religious denominations. Richard Land, who leads the largest Southern Baptist organization in the U.S., proclaimed solidarity with Catholics and pledged to go to jail before submitting to the HHS mandate.

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Evangelical leaders Chuck Colson and Timothy George declared this the moment when Christian organizations would have to choose between Caesar and God. Jewish theologian and scholar Meir Soloveichik signed a joint statement of opposition in The Wall Street Journal, along with Colson and Bishop Donald Wuerl – a statement noting that stories "involving a Catholic, a Protestant and a Jew typically end with a punch line,” but that they consider this to be no laughing matter.

The strongest statement of opposition came this week from President Obama’s home town of Chicago. Francis Cardinal George sent a message to parishioners in the archdiocese that the Catholic Church would shut down its various institutions in the community before violating the core doctrine of Humanae Vitae by providing contraception, sterilization, and abortifacients to its employees, free or otherwise. In a lengthy missive, George remarked that Catholic bishops are fighting for a separation of church and state, and that the mandate represents an unprecedented arrogance in Obama’s attempt to have government define the boundaries between faith and works.

“Liberty of religion is more than freedom of worship,” George wrote, noting that even the Soviet Union allowed people to go to church, “if you could find one.” The HHS mandate emulates the Soviet experience, George argued, in declaring that only places of worship demonstrate the free exercise of religion protected by the Constitution, and not “schools, religious publications, health care institutions, organized charity, ministry for justice and the works of mercy that flow naturally from a living faith.” If the Obama administration insisted on enforcing its mandate on Catholic organizations, George concluded, then "two Lents from now” their listing of Catholic hospitals and health-care institutions would be empty.

What would that mean to the U.S., and to Obama's health care reform mandate? Put simply, it would create a disaster for the delivery of health care in the country, and rapidly escalate the public costs of health care.

The Catholic Church has perhaps the most extensive private health-care delivery system in the nation. It operates 12.6 percent of hospitals in the U.S., according to the Catholic Health Association of the U.S., accounting for 15.6 percent of all admissions and 14.5 percent of all hospital expenses, a total for Catholic hospitals in 2010 of $98.6 billion. Whom do these hospitals serve? Catholic hospitals handle more than their share of Medicare (16.6 percent) and Medicaid (13.65) discharges, meaning that more than one in six seniors and disabled patients get attention from these hospitals, and more than one in every eight low-income patients as well. Almost a third (32 percent) of these hospitals are located in rural areas, where patients usually have few other options for care.

Compared to their competition, Catholic hospitals take a leading role in providing less-profitable services to patients. They lead the sector in breast cancer screenings, nutrition programs, trauma, geriatric services, and social work. In most of these areas, other non-profits come close, but hospitals run by state and local governments fall significantly off the pace. Where patients have trouble paying for care, Catholic hospitals cover more of the costs. For instance, Catholic Health Services in Florida provides free care to families below 200 percent of federal poverty line, accepting Medicaid reimbursements as payment in full, and caps costs at 20 percent of household income for families that fall between 200 percent and 400 percent of the federal poverty line.

Imagine the impact if these hospitals shut down, discounting the other 400-plus health centers and 1,500 specialized homes that the Catholic Church operates as part of its mission that would also disappear. Thanks to the economic models of these hospitals, no one will rush to buy them. One in six patients in the current system would have to vie for service in the remaining system, which would have to absorb almost $100 billion in costs each year to treat them. Over 120,000 beds would disappear from an already-stressed system. 

The poor and working class families that get assistance from Catholic benefactors would end up having to pay more for their care than they do under the current system. Rural patients would have to travel farther for medical care, and services like social work and breast-cancer screenings would fall to the less-efficient government-run institutions. That would not only impact the poor and working class patients, but would create much longer wait times for everyone else in the system. Finally, over a half-million people employed by Catholic hospitals now would lose their jobs almost overnight, which would have a big impact on the economy as well as on health care.

Some may doubt that the bishops would create this kind of havoc and disruption, and perhaps President Obama believes Cardinal George and the U.S. Conference of Catholic Bishops to be bluffing. However, Obama may want to read St. Ignatius of Loyola, the founder of the Jesuits, and his Principle and Foundation of faith, which informs Catholics on the priority of salvation. The first task of mankind, according to St. Ignatius, is to serve God and “save his soul,” and “other things on the face of the earth” should be used only as long as they serve that purpose. When they become a hindrance to salvation, St. Ignatius warns to “rid himself of them.”

If Obama insists on forcing the Catholic Church to fund and facilitate access to products and services they believe imperil their own souls and those of others, the bishops will simply stop employing people in these religious organizations – and once those doors close, they may never reopen.