Federal appeals panel upholds exemptions for religious-based health care providers

Tuesday, May 2, 2000

A federal appeals court panel has upheld federal exemptions for religious-based health care providers against a First Amendment challenge.

In 1997, Congress created exceptions to the Medicare and Medicaid Acts for people who have religious objections to receiving medical care and allowing their children to receive it. Section 4454 of the 1997 Balanced Budget Act creates the exceptions for “religious nonmedical health care institutions,” such as Christian Science sanatoria. The exceptions allow individuals who hold religious objections to medical care to receive government assistance from religious-based health care providers. Section 4454 also exempts religious-based groups from congressional oversight requirements.

Shortly after Section 4454′s passage, a nonprofit group called Children’s Healthcare Is a Legal Duty sued federal officials, claiming the exemptions advance religion in violation of the First Amendment’s establishment clause. A U.S. District Court in Minnesota dismissed the group’s lawsuit, saying it had not presented a viable claim against the government.

A three-judge panel of the 8th U.S. Circuit Court of Appeals voted 2-1 yesterday in favor of the Medicare and Medicaid exceptions, saying they did not advance religion. The majority panel concluded that the statutory exemptions for religious-based health care providers were a permissible government accommodation of religion.

According to the majority, without the exceptions provided in Section 4454, individuals holding religious objections to modern medical health care “are forced to choose between adhering to their religious beliefs and foregoing all government health care benefits, or violating their religious convictions and receiving the medical care provided by Medicare and Medicaid.”

“By extending nonmedical health care benefits to individuals who object for reasons of religion to medical treatment, section 4454 spares such individuals from being forced to choose between adhering to the tenets of their faith and receiving government aid, and in doing so removes a burden that the law would otherwise impose,” wrote Judge Roger L. Wollman for the majority in Children’s Healthcare Is a Legal Duty v. Health Care Finance Administration.

Children’s Healthcare Is A Legal Duty — or CHILD — was founded in 1993 “to protect children from abusive religious and cultural practices, especially religion-based medical neglect.” The group also “opposes religious exemptions from duties of care for children.” Before the 8th Circuit, the group argued that the federal medical exemptions for religious health care providers advanced or promoted the religious cause of such providers and specifically preferred Christian Scientists over other religions.

The 8th Circuit, however, said the exemptions do “not create any more of an incentive for persons to engage in religion than other religious accommodations that have been upheld by the Supreme Court.”

As an example, the court noted that religious institutions are allowed to hire based on religion in contravention of the Civil Rights Act of 1964.

In his dissent, Judge Donald P. Lay accused the majority of creating an opinion that “upholds the constitutionality of a statute which provides a government benefit solely to religious institutions and their adherents.”

Lay said that while the Medicare and Medicaid provisions appear to be neutral, the “legislative history in this case reveals a specific intent to solely benefit Christian Scientists.”

Before Section 4454′s adoption in 1997, the Medicare and Medicaid exemptions were only for “Christian Science sanatorium.” A federal court in Minnesota found those exemptions unconstitutional in 1996. Lay said Section 4454 was adopted only to pass constitutional muster.

Lay said the “form and effect of the Medicare and Medicaid provisions,” after examination are merely to restore the unconstitutional exemptions invalidated in 1996. As evidence, Lay cited the comments of Sen. Ted Kennedy, D-Mass., given during floor debate on Section 4454. Kennedy, during the debate, claimed that: “For 30 years, the Christian Science Church relied on Medicare and Medicaid benefits and built a health care system that assists thousands of men and women.”

The First Church of Christ, Scientist intervened in the case to defend the federal exemptions.

A call to Rita Swan, president of Children’s Healthcare Is a Legal Duty, was not returned. The group could ask the three-judge panel or the full circuit to rehear the case, or it could ask the Supreme Court to hear its appeal.