October 6, 2020

 CONTACT: Kathy Melley, 617-791-0708

Expansive reach, religious restrictions have enormous implications for access to reproductive, LGTBQ+, and end-of-life care

(BOSTON, MA) — Community Catalyst today released a new report documenting the rapid growth of large Catholic health systems over the last 20 years. The report, Bigger and Bigger: The Growth of Large Catholic Health Systems, details the implications for community access to reproductive health, LGBTQ+-inclusive care and end-of-life options because of religious restrictions on such services at hundreds of Catholic hospitals and affiliated urgent care centers, ambulatory surgery centers and physician practices.

Catholic hospitals operate under Ethical and Religious Directives (ERDs) that are issued and enforced by the U.S. Conference of Catholic Bishops. The directives prohibit the provision of key reproductive health services, including contraception, sterilization, abortion and infertility services. The ERDs have also curtailed the provision of LGBTQ+-inclusive care, such as gender-affirming care, and can prohibit patients from exercising death with dignity options in states where that choice is legal. The impact of such restrictions falls heavily on low-income women, LGBTQ+ people and communities of color who have the least access to alternative sources of care.

“The rapid growth and expanding reach of Catholic health systems has enormous consequences for people’s access to the health care they need,” said report coauthor Lois Uttley, director of the Woman’s Health Program at Community Catalyst. “There are parts of the country where people have no choice but Catholic hospitals, and they may be unaware of the restrictions placed on the care they are seeking at those facilities.”

The report explains that Catholic health care has a growing presence across the United States. Through mergers, acquisitions, business partnerships and expansion into new types of care, Catholic health systems are extending the reach of Catholic health restrictions across the country. Key findings include:

  • The 10 largest Catholic health systems have grown and strengthened through mergers and acquisitions, and now own or control 394 short-term acute care hospitals, a 50 percent increase since 2001. The reach of these 10 systems extends beyond traditional acute care hospitals, with over 1,100 total inpatient health care facilities, 864 urgent care centers, 385 ambulatory surgery centers and 274 physician groups.
  • Four of the 10 largest health systems in the country are Catholic: #2 Common Spirit Health, #4 Ascension Health, #6 Trinity Health and #7 Providence St. Joseph Health. These four systems have a presence in all but nine states.
  • The number of short-term acute care hospitals operating under Catholic health restrictions grew by more than 28 percent over the last two decades, even as the number of non-Catholic short-term acute care hospitals dropped by nearly 14 percent. 
  • The number of communities reliant solely on a Catholic short-term acute care hospital has grown from 30 in 2013 and 46 in 2016 to 52 hospitals in 2020. Moreover, in 10 states, 30 percent or more of all short-term acute care beds are in Catholic hospitals and 30 percent or more of all births happen in a Catholic hospital.

The report also explains that Catholic health systems are entering a broad range of alliances with non-Catholic entities – such as public health systems, non-Catholic Medicaid managed care plans and even for-profit drug store chains, which make the spread of Catholic health restrictions more difficult to trace and more challenging for consumers to recognize.

Because of these trends, the report urges health advocacy groups, public officials, insurers and employers offering employee health plans to consider explicit strategies to address the following three priority areas:

  1. Ensure greater transparency surrounding hospital and health system policies that prohibit the delivery of specific health care services, or the provision of information and counseling about prohibited services.

  2. Strengthen public oversight of proposed hospital mergers, affiliations and acquisitions in order to identify and address any potential loss of reproductive health care and other vital health services, or creation of unfair negotiating power.

  3. Restore the balance of public policy by creating greater protection for individual patients’ rights.

“The ever-expanding use of religious doctrine to restrict and deny access to health care threatens people’s ability to obtain timely, affordable access to a range of vital health services in or near their own communities,” Uttley added. “Therefore, it is critical that state and federal anti-discrimination policies be strengthened and enforced in the health care industry, and regulators act to protect consumers’ access to the services they need in their home communities.”

The report notes that Catholic hospitals and health systems receive nearly $48 billion of taxpayer dollars each year, in the form of Medicare and Medicaid reimbursements, while seeking expansion of government permission to use religious doctrine to restrict care.


About Community Catalyst 

Community Catalyst is a national, non-profit consumer advocacy organization founded in 1998 with the belief that affordable quality health care should be accessible to everyone. We work to ensure consumer interests are represented wherever important decisions about health and the health system are made: in communities, courtrooms, statehouses and on Capitol Hill. For more information, visit Follow us on Twitter@healthpolicyhub