Is It Immoral to Purchase Health Insurance with HHS Mandate Coverage?

By Dr. Jeff Mirus ( bio - articles - email ) | Sep 17, 2012

In the wake of my recent commentary (Civil Disobedience and Health Care), some readers have begun to ask: “Is it immoral to purchase health insurance which implements the HHS mandate to provide coverage for contraception, sterilization and abortifacient drugs?” I will attempt to answer that question here.

Some may be surprised when I say at the outset that, if it is not possible to find alternative coverage, then No, it is not immoral to purchase such health insurance, especially given the catastrophic consequences of being without health insurance in our current medical system, and the growing government pressures and penalties for failure to get insurance. Others may laugh triumphantly and declare that I have thus exposed the moral weakness of the position of the Catholic Church on religious liberty with respect to health care. The surprise may be warranted; the laughter is not.

Let us take the surprise first. In the absence of a contrary declaration by the Magisterium of the Church (to which I would submit immediately), it seems clear to me that the purchase of health insurance which includes some elements of immoral coverage is a matter of remote material cooperation with evil in a situation where it is all but impossible to avoid that remote cooperation. Just as we may morally pay taxes even though some tax money is used immorally and we may morally patronize various business which use a portion of their earnings immorally (and in fact this is inescapable in the modern world), so too I believe that if there is no reasonable way to avoid health insurance with some elements of immoral coverage, then it is not immoral to purchase such coverage.

Note that this judgment depends on an evaluation of the remote character of the evil (i.e., only a tiny fraction of the health insurance premium is used to cover immoral procedures, and a direct connection of specific dollars to specific procedures does not exist), the difficulty of avoiding the evil (i.e., the coverage of these immoral procedures is or will be endemic throughout the insurance industry as mandated by the civil government), the impossibility of disentangling ourselves completely from the evils in question, and the responsibility to both ourselves and others, under today’s conditions, to carry health insurance. In my judgment, this situation qualifies as merely remote cooperation with evil which, under typical circumstances, does not involve sin, unless it is desired for its own sake. (God knows that there are some Catholics who will, in fact, desire it for its own sake. This would be formal cooperation in evil in addition to material cooperation. For them, and for others who should know better, the purchase of such health insurance will, in fact, be seriously sinful.)

Nonetheless, it is important to emphasize that this is ultimately a prudential judgment, not about the evil itself, but about its remote material character in the moral analysis.

Now let us take up the laughter. There is nothing in this judgment which in any way invalidates the American bishops’ insistence that the HHS mandate is, in fact, a violation of religious liberty; that the HHS mandate is morally objectionable; and that Catholics and other men of good will ought to take reasonable and prudent steps to resist and reverse it. Nor does this judgment in any way render civil disobedience ridiculous or disingenuous. The purpose of civil disobedience is to enable citizens to resist and hopefully reverse a law which they find morally obnoxious in some way. This seldom means that citizens are actually morally bound to disobey the law (and typically, when they are so obliged, their resulting refusal is not called “civil disobedience”).

In the present case, as I’ve already indicated, the HHS mandate, and the entire edifice of Obamacare, is morally obnoxious on several grounds. First, of course, it mandates insurance coverage for intrinsically immoral procedures, forcing insurance companies into a very substantial cooperation with evil. Second, it requires most persons and employers to purchase this insurance, thereby forcing them into some degree of cooperation with evil. Third, it marks a definite new stage in American Federal governmental insistence that citizens violate (and be permitted to violate) the natural law. And fourth, it marks a new stage in the intrusion of American Federal government into the freedom of citizens to make their own decisions in matters as diverse as medical care and the purchase (or non-purchase) of commercial products.

In other words, the Obamacare/HHS Mandate conglomeration violates the natural law, human liberty in general, and religious liberty in particular. With respect to its violations of the natural law, the law is intrinsically immoral, and with respect to its increasing level of coercion of both businesses (including the insurance companies themselves) and individuals, it can be strongly argued to be immoral based on well-informed prudential judgment—as a case in which, despite the constant bumping of individual rights against the common good, the State has clearly gone too far.

It makes perfect sense to condemn this law, to work hard to see it overturned, modified or repealed, and to engage in civil disobedience whenever that is likely to have a positive result. Moreover, such civil disobedience, in any reasonable and prudent manner, would be perfectly moral. In addition, it is actually morally obligatory at least to oppose the law, and it would be morally commendable for all persons of good will to seek to establish alternative insurance or cost-sharing systems which do not have the same moral drawbacks. But this does not mean that individual persons are morally obliged to refuse health coverage that is compliant with the new law, if they cannot reasonably find alternative coverage, or cannot arrange for alternative coverage without undue duress.

If the law required us to participate personally and directly in assisting others in using contraceptives, obtaining sterilizations or aborting their children, we would be morally obliged to refuse. But I do not think we are morally obliged to refuse health coverage altogether because the government requires some portion of the collected premiums to be used to pay for immoral procedures for others who make evil decisions.