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CMA Comment on HHS Strategic Plan

The Christian Medical Association, representing 18,000 members and Freedom2Care, representing 30,000 constituents, salutes the staff of the U.S. Department of Health and Human Services for their excellent and encouraging work on the draft strategic plan. 

Download file Health & Human Services Draft Strategic Plan

We offer the following comments:

P. 6: We applaud and deeply appreciate the inclusion of the unborn in the HHS mission: "our ultimate goal is to improve healthcare outcomes for all people, including the unborn, across healthcare settings."

P. 7: The strategies outlined in Objective 1.1 (Promote affordable health care, while balancing spending on premiums, deductibles, and out-of-pocket costs) incorporate common-sense (but not always common) strategies for prevention and the prudent use of resources while advancing crucial reforms such as transparency in pricing (p. 8) and "payment models that reward value over volume" (p. 9). 

P. 8: We especially appreciate HHS's concern for the poor, as many of our members have specifically focused on providing healthcare to poor and underserved populations. Such patients stand to significantly benefit from efforts to "streamline eligibility and enrollment processes for Medicare, Medicaid, and other community supports so that all populations, including individuals most in need, have access to the services they need."

P. 9: Importantly, HHS recognizes that medicine is not divorced from its societal context, prompting the goal to "provide information on the prevalence, causes and consequences of high health care financial costs, including social factors that exacerbate costs."

P. 12: We appreciate the strong emphasis on results rather than mere activity: "Promote the development, implementation, and use of experience and outcome measures, including patient-reported data and price transparency data, as appropriate, for use in quality reporting."

P. 12: "[E]xtending needed flexibility to states and partners seeking to implement these solutions" incorporates the principle of subsidiarity, by focusing power and accomplishing goals at the level closest to the patient (which in few cases will be the federal government in Washington, DC).

P. 14: We deeply appreciate the goal of "removing barriers for faith-based and other providers." Our current lawsuit over the HHS transgender mandate provides an unfortunate example of how government policy can wrongly penalize rather than strengthen and encourage the faith-based health professionals, clinics and hospitals that are dedicated to meeting the needs of poor and underserved patients in accordance with ethical convictions. 

The same faith conviction that compels these entities to care for needy patients also compels them to serve according to conscience. Accommodating conscience—a founding American principle—thus advances and protects healthcare access.

PP. 15-18 and throughout: We deeply appreciate the section dealing with not only removing barriers to but actively drawing upon the strengths of faith-based healthcare entities. Doing so will not only enforce key American principles of religious freedom but also enhance practical healthcare goals such as "reducing provider shortages in underserved and rural communities" (p.17). When faith-based health professionals are protected from discrimination for their beliefs, they remain free to ethically care for underserved patients. Without such protections, national polling shows that over nine of ten faith-based health professionals will feel forced to leave medicine altogether.

Past government violations of religious freedom show the need for a concerted and new effort to ensure compliance with the First Amendment principle of free religious exercise, with existing federal law and with Executive Order 13798 of May 4, 2017. 

For example, the Office of Civil Rights (OCR) during the Obama administration decided to allow California to flout federal law regarding abortion participation compulsion over the conscientious objection of faith-based entities. The Obama administration also unfortunately aggressively pursued programs, regulations and court cases that opposed religious freedom, such as forcing nuns to violate religious tenets (the Obamacare contraceptive mandate); coercing health professionals and redefining sex discrimination (the HHS transgender mandate); threatening pro-life doctors and health care access (the gutting of the federal conscience regulation); denying federal human trafficking grants to pro-life programs for victims (the HHS grant scandal); and trying to limit churches' hiring freedom (the Supreme Court Hosanna Tabor case).

Without a concerted and focused program to enforce religious freedom laws and policies, the federal bureaucracy is more likely to exclude, discriminate against and target the faith community for prosecution. Since its inception, the HHS faith-based office has served the interests of the faith community with varying degrees of effectiveness and consistency, depending largely on the ideological slant of the administration in power.

For this reason, we would encourage a program with a singular focus on religious freedom—the protective legal foundation without which faith-based healthcare cannot long exist. This focus could be accomplished by restructuring or replacing the current faith-based office with a First Freedom Center.  

First Freedom Center staff would focus on religious freedom and would carry out its mission by through education, building networks and overseeing grants:

  1. Educational and communication programs could be employed to inform, persuade and engage both government personnel and the public regarding religious freedoms. 

For example, the First Freedom Center could conduct conferences nationwide to reach members of the faith-based health community and others that have not previously partnered with the federal government. Such entities often do great work on shoestring budgets but lack the knowledge and resources to navigate the federal grants system—a system that has the potential to greatly expand their work and reach more patients. 

These conferences could feature current faith-based grantees explaining their philosophical considerations regarding government partnerships and detailing their experience working with HHS. The conferences could also feature government grants experts and legal experts explaining how to evaluate the appropriateness of federal grant-seeking, legalities and commitments related to federal grants and an overview of the entire process from proposal to evaluation. 

  1. The First Freedom Center could map the reach and value of agency-relevant faith-based entities in the nation, with the goal of building a two-way network for communications and action. A cooperative network can greatly expand the reach and effectiveness of government programs and in some cases replace them. 
  2. The First Freedom Center could function as a type of agency ombudsman to ensure the protection of religious freedom in grantmaking. First Freedom Center expert staff, working in concert with the Office of Civil Rights, could review all relevant agency grant programs to identify and challenge anti-religious freedom stipulations and ensure a level playing field for the faith community to compete. 

The inclusion of faith-based health professionals on grant review panels can help protect against discrimination against faith-based organizations. Their inclusion can also encourage participation by faith-based organizations as more learn how the grantmaking process works.

P. 22: We appreciate the goal to "increase access to … women’s health services that improve the incidence of healthy childbirth, including prenatal/pregnancy care and supports, and encourage and support lactation accommodations." We encourage the inclusion of the thousands of pro-life pregnancy centers, such as those coordinated by Care Net and Heartbeat International, in this effort.

We also applaud the goal to "support patient, consumer, and caregiver involvement in care planning, as appropriate, to ensure that care is person-centered, responding to the needs and wishes of those being served, including their religious or conscience needs and wishes."

P. 26: The faith community should prove an invaluable asset in reaching the vital goal to "educate and empower individuals and communities, including through partnerships with faith-based and community organizations, to recognize the signs of serious mental illness and substance use disorders, to encourage screening and identification of such problems."

P. 30: Regarding the goal to "promote emergency preparedness and improve response capacity" by "providing expertise and tools to state and local governments, health systems and facilities, and other organizations, including faith-based and community organizations," it is imperative that all federal agencies, including the Federal Emergency Management Agency (FEMA), refrain from discriminating against faith-based entities.  Unfortunately, recently flooded churches in Texas have had to resort to suing FEMA, seeking equal access to disaster relief grants available to other non-profits. Harvest Family Church v. FEMA challenges a FEMA policy that bans churches from applying to its relief program simply because they are religious. 

P. 34: We deeply appreciate the commitment expressed in the statement, "A core component of the HHS mission is our dedication to serve all Americans from conception to natural death…." Any abridgment of this clear understanding of the human lifespan reflects not science but ideology. Tragically, human beings are increasingly vulnerable at both ends of this continuum, through abortion and assisted suicide and euthanasia. We support all efforts to protect human life at these vulnerable points as well as advancing care and compassion for all in between.

P. 35: We affirm the goal to "foster coordination and innovation across safety net programs, including faith-based and community organizations, to help individuals and families in need to become self-sufficient." This goal reflects both compassion for those who need a hand up and a recognition that fostering continued dependency apart from true need is not compassion but the undermining of human dignity.

While generally supporting the goal of favoring "evidence-based or evidence-informed healthy marriage and relationship education," it should be taken into account that social science research unfortunately can be slanted according to an ideological rather than scientific consensus. This bias should be watched for especially in controversial areas such as marriage and sex education, where significant peer pressure can be exerted in the social programs communities to force conformity to a particular ideological point of view. 

Also, newer programs may demonstrate great promise but may not have been in existence long enough to allow for long-term research. Just as the FDA can fast-track certain drugs that show great promise in treating difficult diseases not have not yet been fully tested, promising new social programs lacking long-term research may still merit serious consideration.

P. 37: Regarding the goal of "safeguarding the public against preventable injuries and violence," we encourage further development of HHS's efforts to combat human trafficking. Building upon its considerable past efforts in this area, HHS can advance a strategic initiative that:

  1. Develop a national trafficking victims' center for treatment, education and advocacy;
  2. Provide grants to expand the body of research on victims' health needs and the public health threat of trafficking; 
  3. Increase efforts to train healthcare professionals to identify, report and treat victims. This can be done without massive government expenditures. The Christian Medical Association, for example, has provided (without government funding) a training module for healthcare professionals (see www.cmda.org/TIP) that carries Category One Continuing Medical Education credit. HHS could coordinate a White House summit on health and human trafficking, challenging key medical specialty groups and public health leaders to similarly educate their constituents and thus engage an army of healthcare professionals to recognize, report and rehabilitate victims.

P. 40: Regarding the objective to "support faith-based and community organizations to promote strong, healthy family formation and maintenance through programs that combine marriage and relationship education services," it should be remembered that historically, faith-based organizations have faced the prospect of government discrimination when their views on marriage and sexuality have not matched the views of the administration. For example, many faith-based organizations hold to the conviction that marriage is the union of one man and one woman, that sex is to be reserved for marriage, and that adopted children have the best outcomes when they have both a mother and a father. If faith-based groups are to partner with the federal government in social programs, it is imperative to protect the right of these organizations, as far as possible, to maintain fealty to their faith tenets. 

P. 50: Regarding the objective to "promote ethical and responsible research" and "especially with respect to research involving human embryos or embryonic stem cells/tissue, fetal tissue, genetic engineering and manipulation of the germ cell, and the creation of chimeras," HHS may consider creating a faith-based council on bioethics. The goal of of the council would be creating a document, publicly accessible, featuring ethical perspectives drawn from major faiths in the USA on these issues as well as assisted suicide and euthanasia, reproductive technologies, organ donation and human genetic engineering. The council thus could provide the American public and the scientific community with a deeper understanding of the religious principles held to by many Americans that impact bioethical issues. 

P. 52 To help with the objective to "support basic science and applied prevention and treatment research on approaches to reduce the global burden of HIV, viral hepatitis, enteric and respiratory diseases, tuberculosis, malaria, and neglected tropical diseases," Christian Medical Association members include hundreds of doctors serving overseas who have practical experience with neglected tropical diseases and also with faith-based HIV programs. Many work in remote areas and have had to come up with innovative approaches in the face of scant resources. We would be glad to provide HHS with access to these experts for consultation.

PP. 56-64: We welcome "HHS efforts to develop the systems, workforce, and infrastructure to address the health, public health, and human services challenges of today and the future" and the "responsible allocation and expenditure of public funds." Especially helpful will be the "use [of] public-private partnerships to prevent and detect fraud and other inappropriate payments across the healthcare industry by sharing fraud-related information and data, promoting best practices, and educating partners." It should be noted that the accommodation of conscience convictions can have a side benefit of encouraging whistleblowing, as ethically concerned individuals realize they will enjoy protection if they decline to "toe the line" and speak up when corruption needs to be exposed.

Conclusion

The leadership of HHS has produced a commendable and comprehensive plan that, if effectively implemented, promises to significantly advance the goal of enhancing the health and well-being of Americans. 

We especially welcome the emphasis on partnering with the faith-based health community in achieving this goal. 
We also laud the recognition that the mission of HHS and our government extends the full spectrum of human life, from conception to natural death.

The Christian Medical Association and Freedom2Care commit to working diligently with HHS to achieve this goal. Thank you for your labors on this plan and for advancing these key principles.