Last fall, about a month before her Medicaid coverage was scheduled to expire, Darolyn Lee realized that she needed to get her contraceptive implant replaced. Lee, a 37-year-old in Chicago, called the managed care organization in charge of her plan to find out where she should go to get the new implant. She was told that the closest in-network provider was Mercy Hospital and Medical Center, a Catholic hospital about 30 minutes away by bus.
When she got to the hospital for her appointment, the doctor said she couldn’t replace Lee’s birth control, but wouldn’t say why. Instead, she gave Lee a referral card for the hospital’s obstetrics and gynecology department. Lee, assuming that hospital bureaucracy was to blame, made another appointment and returned to the hospital a few weeks later. But when the second doctor walked into the room, she explained that she, too, could not replace the implant. She offered Lee a pap smear instead.
Lee was stunned and angry. Through tears, she asked where she could get her implant replaced. The gynecologist gave her a referral for the county hospital. “I couldn’t say nothing else — I was just upset,” Lee said. “They had wasted my time going to all of these appointments, only to not do anything that I had requested.”
In a statement, Mercy said it provides high-quality care that is in line with national standards, but declined to comment on Lee’s case.
When Lee left Mercy for the second time, she still didn’t know why both doctors had refused to change her implant. She learned later that it was because of the hospital’s Catholic affiliation. Mercy and other Catholic hospitals are committed to a set of religious guidelines, the Ethical and Religious Directives, which interpret Catholic moral teachings to determine what kinds of medical care hospitals can offer. They include a blanket ban on abortion and restrictions on contraception, both of which are opposed by the Catholic Church.
For Catholic health care institutions, the directives offer essential guidance to ensure that hospitals are offering care aligned with their religious identity. But as Lee’s case shows, insurance can propel patients into those institutions without informing them about the limitations on the services they can receive.
Thanks to a wave of mergers and consolidations that has been reshaping the U.S. health care system, Catholic hospitals are playing a bigger role in patient care. According to a 2016 report by the American Civil Liberties Union and MergerWatch, an organization that tracks the ownership of medical facilities and advocates against religious restrictions on health care, one-sixth of hospital beds nationwide are in Catholic facilities. But those beds aren’t distributed equally — Catholic health care systems are especially heavily concentrated in the Midwest, for example. Nearly 30 percent of hospitals in Illinois were Catholic in 2016, according to the report.
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