Regardless of who you believe about that controversy, there's no mystery around the core facts:
The bishops, who officially speak for the church and decide whether a hospital is certified as Catholic, opposed the reform law because they said it provides federal funding for abortion, among other reasons. But the national professional association of Catholic hospital executives said the law was flawed but overall a positive step and the CHA endorsed it, giving lawmakers like Sen. Bob Casey (D-Pa.) the cover to vote for it.
On June 14 in Denver, after watching the video in which both Obama and Casey thanked CHA and Keehan for their support, Keehan took the stage to hold aloft the black executive pen she received from the president—one of the several pens Obama used to sign the actual legislation into law.
If ever there was a time for anonymous public catcalls from disaffected skeptics that was it.
Keehan received a standing ovation. No boos, no rotten tomatoes.
Denver resident and Catholic T.R. Reid, who has been on the guest-speaker circuit for a year promoting his new book on how other countries provide universal access to healthcare, said he was happy to have gotten he chance to address the CHA as an invited speaker.
“It gives me a chance to say thank you,” Reid told his audience on the closing day of the conference. “I know you got rapped by the bishops. … Look, that's the bishops. I can tell you, most American Catholics believe that you got it right.”
But did the hospital association have a right to publicly and pointedly disagree with their bishops? The Rev. J. Bryan Hehir, a professor of religion at Harvard University and the former CEO of Catholic Charities USA, said the question of what exactly the reform law would do was narrow enough to allow differing interpretations.
“One of the things we need in the church is a tolerance of differences of opinions,” Hehir said. “As we debate issues, the important thing is not to forget why we are all here.”
There are reasons to think the differences between American hospitals and their bishops will become more pronounced, not less, in coming years.
Take the widespread conversion of Catholic hospitals to lay leadership. In 1968, only 26 of the 796 Catholic hospitals had CEOs or administrators who were drawn from laity. Today, 611 of the 694 Catholic hospitals have lay corporate leaders.
Or consider the mandatory retirement age of bishops of 75, which will cause about a third of 265 active U.S. bishops to submit letters of resignation within about four years to the Vatican, offering Pope Benedict XVI the chance to appoint a large slate of new leaders.
So while fewer Catholic hospitals than ever are governed by leaders who have never attended seminary or lived in a convent, a pope widely seen as more conservative than his predecessor will get the chance to shape a large number of the leaders who interpret the rules governing those hospitals.
And despite the vigor with which the proponents of healthcare reform in Washington patted themselves on the back after the bills were signed, everyone recognizes that the battles over reform are far from over. The law only describes general ideas and goals, but it will be up to the regulators and bureaucrats to decide exactly how healthcare reform is implemented.
“When the bill is signed by the president, that's only half of it. There's always the regulations,” said Princeton economics and politics professor Uwe Reinhardt during a June 14 panel discussion in Denver. “That can change substantially what you think is in there.”
I'm sure even the CHA and the bishops can agree on that.