The National Catholic Bioethics Center Cautions Catholic Agencies
Considering Assuming Position of ACA Navigator and Other Roles
September 27, 2013
There has been an increasing amount of coverage regarding the role that local people (and in many cases, sponsoring corporations) can or will play in the orchestration of the Patient Protection and Affordable Care Act (ACA) and enrollment of persons in the insurance program at the individual level. Referred to generally as Navigators, these individuals and corporations will be assistants and are claimed to be available to act as unbiased aides who can help individuals as they make decisions about enrolling in the healthcare program.
The National Catholic Bioethics Center has taken ample time to review the status and the roles of these so-called Navigators and the NCBC is urging Catholic agencies not to participate in these enrollment programs lest they cooperate with evil in the role of a Navigator:
The National Catholic Bioethics Center (NCBC) has reviewed the various enrollee registration roles developed to implement the Patient Protection and Affordable Care Act (ACA) and is advising Catholic agencies to exercise caution in assuming such roles.
There are three specific roles to assist consumers in enrolling for health coverage under the ACA:
Navigator: All exchanges (also known as marketplaces)—whether state-based, partnership, or federally facilitated—are required to establish a navigator program. Each exchange will designate entities as navigators and provide them with grants for helping individuals and small employers with the application and enrollment process. Navigators will also conduct public education activities to raise awareness about the exchange and provide referrals to other consumer assistance resources.
In-Person Assisters (IPAs): In the final exchange blueprint, the Center for Consumer Information and Insurance Oversight (CCIIO) outlined in-person assisters (IPAs) as a second type of assister that is distinct from navigators and other application assistance programs.
Certified Application Counselors (CACs): Being certified as CACs enables organizations that would likely be engaged in application assistance anyway to help consumers in a more formal capacity. For example, although not all community health centers and community-based organizations will be chosen to serve as navigators or IPAs, they are well-positioned to provide application assistance because they are trusted messengers.
The CAC designation will help expand the network of trained assistance that is available to consumers.
[Excerpted from Enroll America Fact Sheet: http://files.www.enrollamerica.org/best-practices-institute/enroll-america-publications/Enrollment_Assisters_Fact_Sheet.pdf.]
There is a significant possibility of scandal, which is to be judged by the diocesan bishop, when a Catholic agency participates not only as a Navigator but also in providing In-Person Assisters or Certified Application Counselors for enrollment in coverage by the Exchanges. This is not just because of the morally illicit drugs and procedures which will be facilitated by implementing the ACA, but also because of the violation of religious liberty occurring pursuant to the U.S. Department of Health and Human Services contraceptive and abortifacient mandate in the implementation of the ACA.
There are also additional concerns, especially for states that have not banned abortion coverage in the Exchanges. Pursuant to the ACA, only one plan per Exchange must omit such coverage. Therefore, those enrolling persons that select a plan that includes abortion coverage are cooperating in a manner that would be hard to justify, even if it was mediate material cooperation with evil (which at times can be justified, as addressed, below). This becomes especially problematic when the enrollee specifically requests abortion coverage (speaking to intent, which constitutes what is always morally illicit formal cooperation). Explicit formal cooperation in evil occurs when the cooperator (e.g., enroller) has the same evil intent as the principal agent (enrollee who desires insurance coverage of abortion for its potential use). Even if the enroller of an enrollee would prefer that the coverage not include abortion coverage, but acts to assure that the enrollee has such coverage as an In-Person Assister, Certified Application Counselor, or contracted Navigator), this could constitute implicit formal cooperation. Even in the absence of direct abortion coverage, the enrollee may be a person who intends to use the abortifacient drugs and contraceptive coverage, facilitated by the enroller, presenting a similar moral dilemma as outlined above.
This is unlike a person accepting a health care insurance plan for his/her family that does include the morally illicit coverage, which cannot be refused, but at the same time knowing that coverage will not be used. This represents remote mediate material cooperation by which material assistance (payment of premiums) is given, which neither causes another person to commit an evil, nor intends evil. It may make the evil possible by contributing to the overall financing of the plan, not dissimilar to paying taxes. For such an enrollee, for the proportionate good of the family’s health care coverage, the remote mediate material cooperation could be justified, with the understanding that the family makes known its objections to such public policy and works in a prudentially appropriate manner to effectuate change.
This is the NCBC opinion on the matter, in which we urge that Catholic agencies not sponsor or assume the roles of Navigator, In-Person Assister, or Certified Application Counselors for the Exchanges because of the implications of these actions for cooperation with evil. Of course, the final decision rests with the diocesan bishop.