Capital Commentary is the weekly current-affairs publication of CPJ, written to encourage the pursuit of public justice.

Principles for Health Care Policy: A Guide for Voters

Leah Anderson


October 12, 2012

By Leah Anderson

Over the next few weeks, Capital Commentary will publish a series of articles that evaluate the 2012 presidential candidates against the principles of the Center.  A more in depth analysis of the health care platforms of both candidates can be found in the 2012 election guide on

The Affordable Care Act is one of President Barack Obama’s signature policy achievements. It has also been the target of unrelenting criticism from Republicans, including Governor Mitt Romney. If this were not enough to bring it center stage for the 2012 election, the escalating costs of healthcare make it a critical issue for government, businesses and family budgets. 

President Obama’s campaign platform on healthcare focuses on defending the law, promoting its benefits and identifying a few areas for future change. Governor Romney’s health care policy position is also articulated in response to the ACA: He pledges to repeal “Obamacare” and to replace it with a set of more effective reforms. 

The Center for Public Justice Guidelines for Government and Welfare offer several principles that guide our evaluation of the candidates’ health care policy platforms. First, the Guidelines affirm healthcare as a legitimate area in which government should be active. Governments are to “legislate, enforce and adjudicate public laws for the safety, welfare and public order of everyone within its jurisdiction. The guiding norm, or principle, for such laws is public justice.” Public health programs like vaccinations promote safety and public order; a network of quality healthcare providers facilitates the well-being of society by meeting people’s physical needs. Concerns for the physical and mental health of its citizenry falls within the bounds of government responsibility. 

Second, public justice in welfare policy demands that governments will work to ensure “access…to good healthcare” as a means of preventing intractable poverty.  This means that governments should ensure that everyone has access to some basic level of “good” healthcare.

Third, a just healthcare system will contribute to reductions in poverty and will not increase poverty.  

Fourth, when Christians approach health policy discussions, it should be with more than their own self-interest in mind. The question is not how will this healthcare reform affect me, but how does it contribute to or detract from “just public order for them and for all their neighbors.” (Emphasis added.)

The Center’s Guideline on Welfare envisions diverse responses of the market, non-governmental organizations (NGOs) and government to societal issues, including healthcare. Although governments are rightly concerned with healthcare, a just response to healthcare problems can, as a fifth principle, include the participation of NGOs, including religious organizations. 

Sixth, the use of market forces may be a legitimate means to allocate resources and make decisions within healthcare, although within boundaries. As the Center’s Guidelines note, “Americans tend to see government as the guarantor of a free market through which every other good can be realized in freedom, not by government mandate. Free markets certainly represent an important economic dimension of a diversified society. Yet government has a responsibility to do justice to individuals, families, churches, and other dimensions of society, none of which is reducible to economic considerations.”

Finally, the Center’s emphasis on religious freedom is also important to mention in regard to healthcare due to the fact that religious institutions are significant healthcare providers in the U.S. The Catholic Church alone operates over 600 hospitals in the U.S., and religious beliefs influence healthcare choices.

The ACA is a complex law, but the central components include 1) a requirement that everyone have health insurance, what’s referred to as the “individual mandate,” 2) a requirement that insurance companies cover anyone who applies for insurance, regardless of their health, 3) federal regulations that describe the basic minimum coverage that all health insurance, public or private, must provide, 4) the expansion of Medicaid to cover more Americans and 5) the introduction of government subsidies to make health insurance more affordable for those who do not qualify for Medicaid or do not receive healthcare through their employer. These key measures emphasize expanding access to healthcare but will not likely address the problem of growing costs. 

The Obama campaign website emphasizes the parts of the law that are popular.  For example, the law ends lifetime caps on coverage, demands that insurance companies spend 80 percent of premiums on healthcare and requires insurance companies to let children remain on their parents insurance until they are 26. It also eliminates co-pays for women’s preventive care and contraception and ends the practice of charging women more than men for insurance policies.

Governor Romney agrees that “No American should ever have to fear being left uncared for in the middle of the world’s most advanced health care system,” but he critiques Obama’s policy solutions as an over-reach of the federal government. He proposes empowering states to address healthcare challenges by changing Medicaid to a block grant program, where the federal government gives a fixed amount of money to the state for Medicaid rather than covering a percentage of costs.  He also suggests lifting federal government standards and requirements on private insurance and Medicaid coverage. As part of his plan to enhance competition and consumer choice, Romney says he will “end tax discrimination against the individual purchase of insurance,” although it’s not clear whether he’s suggesting an end to the current practice of not taxing employer-provided health insurance plans or something else.

One element of the ACA Romney pledges to maintain is the requirement that health insurance companies cover individuals with pre-existing conditions as long as they “maintain continuous coverage.” Romney’s campaign material also mentions helping the uninsured and chronically ill—but without offering specific policies that might achieve these goals. Governor Romney’s healthcare reform agenda emphasizes reducing healthcare costs and cutting the federal government’s health expenditure but has fewer proposals directed specifically at improving access to healthcare.

Health care policy is complicated, with competing demands of justice and many different policy approaches to address problems. Neither candidate completely fulfills the principles outlined here, but elections almost always require choices between imperfect options.  Given the importance of healthcare to public justice and the economy, readers should prayerfully evaluate candidates’ proposals and include an assessment of healthcare in their voting decisions this November.

—Leah Anderson is Associate Professor of Politics & International Relations at Wheaton College in Wheaton, IL.

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Capital Commentary is a weekly current-affairs publication of the Center for Public Justice. Published since 1996, it is written to encourage the pursuit of justice. Commentaries do not necessarily represent an official position of the Center for Public Justice but are intended to help advance discussion. Articles, with attribution, may be republished according to our publishing guidelines.”