health care

Column: Looming Issues for Next Session

1280px-2009-0521-ND-StateCapitolThe next legislative session is, depending on how you look at it, “only” or “still” five months away.  Either way, the session is approaching and now is a good time to recognize some looming issues for the next session.

The Budget 

The state budget is already the dominant issue.  The legislature just had a special session to address declining revenues, but the real work remains for the regular session.

On the one hand, North Dakota is, by some standards, doing well financially.  Unemployment is low and the state is funding some very real needs in infrastructure and education — though still not parental choice.  On the other hand, oil revenues are very low and agriculture commodity prices are taking a hit.  This means that the state is not expected to bring in as much revenue as previous years, which leads to new and difficult challenges with spending and collecting revenue.

Expect heated debates about the budget to dominate the session from Day 1 to sine die.

Human Service Needs

In February Governor ordered a set of across the board cuts for all state agencies.  These cuts hit the provision of human services especially hard.  For one thing, despite the fact that Department of Human Services targeted “new” programs for elimination, the fact remains that these were still needed programs and they were identified as such by the legislature.  Secondly, the truly needy are most impacted and are in less of a position than most of us to adjust the reduction or elimination of services.  Thirdly, some of those reductions, especially in the area of long-term care, resulted in additional losses in federal matching funds.

The Department of Human Services was spared in the second round of reductions that occurred in August, but it will likely have to present a reduced budget for the next biennium.  Just as the Year of Mercy closes, concerned citizens will have to work to make sure that our most vulnerable citizens are not left behind.

Behavioral Health and Substance Abuse

Just about every observer agrees that the state is in a crisis when it comes to behavioral health and substance abuse.  The situation was already bad before the opioid and fentanyl epidemic hit the state.  Nevertheless, while most would agree that something needs to be done, not everyone agrees on what should be done or whether there is enough funding and will to get it done.

The Department of Human Services is already in the process of reforming its delivery system through the Human Service Centers and the State Hospital.  In the meantime, an interim legislative committee has studied the matter and is preparing draft legislation for the next session.   Some of the proposals will require state funding.  There will exist tremendous pressure to not devote new funding to mental health and substance abuse services in light of the state’s budget problems.  Not acting, however, could put even more of our neighbors at risk and cost us more money in the long run through incarceration.

Incarceration Reform

Addressing our incarceration numbers is linked to addressing our behavioral health needs.  North Dakota locks up too many of its non-violent citizens for low-level drug-related crimes.  The situation is financially unsustainable and short-sighted as a policy matter.  Recommendations to lower penalties for non-violent offenses and offer alternatives to incarceration have met with some resistance.  Meanwhile, it is certain that any serious effort to address our skyrocketing incarceration rates must work in tandem with efforts to provide better and more extensive mental health and substance abuse treatment.

Medicaid Expansion

Over 19,000 North Dakotans have medical coverage as a result of Medicaid expansion passed by the legislature in 2013. Passage of the legislation, which the North Dakota Catholic Conference and the state’s Catholic health care facilities supported, was difficult.  To appease some concerns, the legislation was given a “sunset” of July 31, 2017.  This means that the legislature must renew the program during the next legislative session or thousands of North Dakotans will lose or lack health care coverage they otherwise would have.  The families impacted usually earn too much to qualify for traditional Medicaid but don’t earn enough to receive subsidies under the Affordable Care Act.

There is a peek at some of the issues facing the next Legislative Assembly, and space does not allow me to write about the refugee program, revision of the state’s marriage laws, and protecting legislation to help the unborn and their mothers.  Stay tuned to the conference’s Facebook page and be sure to ask your candidates about these issues.

Catholic Conference: Supreme Court Decision Disappointing But No Direct Impact on North Dakota Law

logosharpsmallBismarck, North Dakota -Christopher Dodson, Executive Director of the North Dakota Catholic Conference issued this statement on the Supreme Court’s decision to strike down a Texas law requiring abortion physicians to have admitting privileges at a local hospital.

“Although today’s Supreme Court decision is a setback for women’s health and common sense, it should have no direct impact on North Dakota law.

“The opinion upholds facts found by a trial court in Texas concerning a Texas law’s impact in Texas.  The facts are very different in North Dakota.

“To name just two of the differences: the Texas law purportedly caused many abortion clinics to close.  No abortion centers have closed in North Dakota due to this state’s law.  In Texas, some abortion providers could not obtain admitting privileges.  All of North Dakota’s abortionists have admitting privileges at a local hospital.

“North Dakota’s law has not placed an “undue burden” on women seeking abortion and has, if anything, furthered women’s health in cases of emergencies.

“For further information, we concur with the statement of the United States Conference of Catholic Bishops on the Supreme Court decision:”

# # #

Keywords: North Dakota Catholic Conference, abortion, health care, pro-life, Texas abortion law, Whole Woman’s Health v. Hellerstedt, U.S. Supreme Court

Cardinal Dolan and Archbishop Lori to Congress: Support the Conscience Protection Act

handsCardinal Timothy M. Dolan and Archbishop William E. Lori – as chairmen of the U.S. Conference of Catholic Bishops’ Committee on Pro-Life Activities and Ad Hoc Committee for Religious Liberty, respectively – wrote to the U.S. House of Representatives, March 31, urging support for the Conscience Protection Act of 2016 (HR 4828).
The Conscience Protection Act, they wrote, is “essential legislation protecting the fundamental rights of health care providers…to ensure that those providing much-needed health care and health coverage can continue to do so without being forced by government to help destroy innocent unborn children.”
HR 4828 has a “modest scope,” they noted. “While existing federal laws already protect conscientious objection to abortion in theory, this protection has not proved effective in practice… The Conscience Protection Act will address the deficiencies that block effective enforcement of existing laws, most notably by establishing a private right of action allowing victims of discrimination to defend their own rights in court.”
Cardinal Dolan and Archbishop Lori recalled the Hippocratic oath’s rejection of abortion in the profession of medicine, indicating that the Act will benefit not only Catholic medical professionals but “the great majority of ob/gyns [who] remain unwilling to perform abortions.”
Finally, they explained that conscience protection facilitates access to life-affirming health care: “When government…mandates involvement in abortion as a condition for being allowed to provide life-affirming health care services, it not only undermines the widely acknowledged civil rights of health care providers but also limits access to good health care for American women and men.”
The full text of their letter is posted at:
For more on the bishops’ promotion of conscience rights, including a recent video about a nurse who was coerced to take part in a late-term abortion, visit:

Year of Mercy: The Dying and the Dead – New Column

If there is one theme that runs through all manifestations of mercy it is the call to never abandon.  Mercy calls us not to abandon those in prison, the hungry, the poor, the homeless, the women who have had abortions, the unborn, refugees, or those with disabilities.

True mercy also means not abandoning the dying or the dead.hands

Under the guise of “mercy” and “compassion” assisted suicide and euthanasia are becoming increasingly acceptable.  Five states – Washington, California, Oregon, Vermont, and Montana – allow assisted suicide and at least five states are considering legislation to legalize it.

Proponents portray assisted suicide as a merciful act necessary to relieve a terminally-ill person’s pain and suffering, despite the fact that most of the laws do not require a person to actually be in pain or truly be terminally ill.  They go to great lengths to avoid the fact that assisted suicide is assisted killing.

Like abortion, assisted suicide and euthanasia are not examples of society rising up to meet the needs of the suffering, but are instead examples of society giving up and abandoning those in need.

As one of the official documents for the Year of Mercy reminds us:

The word for mercy in Latin is misericordia. The etymology of the word derives from the Latin misere (misery, necessity) and cor/ cordis (heart) and is identified with having a heart full of solidarity with those in need. So in everyday language mercy is identified with compassion and forgiveness.

Mercy, therefore, is linked to compassion.  Compassion means to “suffer with.”  As Jason Adkins, my counterpart in Minnesota, puts it: “Sending someone home with a vial of pills to die, and perhaps even die alone, is not compassion, it’s not humane.”

Even in jurisdictions that stop short of legalizing assisted suicide, we can be tempted to abandon the frail and the dying.  North Dakotans needing long-term care, for example, are among those hardest hit by the recent state budget cuts.

The Basic Care Assistance Program funds services that provide care, service, and supervision to those unable to live alone. According to the North Dakota Long Term Care Association the recent cuts will result in a loss of 40% of service providers in the program.  Meanwhile, nursing facilities are taking a $25.1 million hit.

The lack of services can contribute to subtle pressures to relieve perceived — but not actual — burdens. Without realizing it, we can be tempted to make health care decisions, especially for those at the end of life, for reasons of convenience disguised as compassion.

God never abandons and nor should we.  True mercy, true compassion, does not mean aiding in killing or taking actions that intentionally and directly cause death by act or omission.  We must provide ordinary care, including artificial food and water, so long as it provides a benefit. We can provide pain relief and comfort care, even if the method or treatment indirectly and unintentionally shortens life.  The overarching principle is to “be with,” not abandon.

To help guide decisions, whether they are made by you or by someone speaking on your behalf, get the Catholic Healthcare Directive from the North Dakota Catholic Conference at: or call 701-223-2519.


Earthly death inevitably comes.

The traditional seven corporeal works of mercy are: feed the hungry, give drink to the thirsty, clothe the naked, welcome the stranger, visit the sick, visit the imprisoned, and bury the dead.

Bury the dead stands out in this list for a few reasons. To begin with, it is the only work not mentioned in Matthew 25.  Its scriptural basis come from the Book of Tobit, specifically verses 1:17 and 12:12.  It was not until the 12th century that bury the dead was included with the six from Matthew 25.  Thomas Aquinas in the next century firmly established it as one of the seven corporeal works of mercy.

It also stands out because it does not address an immediate need of a living person.  One way of understanding its inclusion is to remember the call to not abandon.  Treating deceased bodies with disrespect and disposing them like trash is a form of abandonment, not only of the body, but also of person who was living.  Aquinas saw a connection between how we treat the dead body and how we treat the memory of the dead and Christ himself, who was also a body and was also buried precursor to the resurrection.

As with caring for the dying, there are sometimes public policy issues that affect our call to bury the dead with dignity.  Many laws affect cemeteries, cremation, and related services.  In addition, Catholic cemeteries are increasingly seeing threats to their ability to operate in accordance with Catholic beliefs.

Thus, with death, as with dying, we need to be vigilant and never abandon.

Catholic Bishops: Despite Budget Cuts, Attend to the Poor

logosharpsmallBismarck, North Dakota – North Dakota’s Roman Catholic bishops, David D. Kagan of Bismarck and John T. Folda of Fargo, have released the following statement on Governor Jack Dalrymple’s order that all state agencies cut their budgets by over four percent:

North Dakota must take its time and remember those on the peripheries when cutting the state’s budget.

In response to declining state revenue Governor Jack Dalrymple has ordered all state agencies to cut 4.05% from their current budgets. We recognize the need for the governor and lawmakers to be good stewards of the state’s resources and fulfill their obligations to the people of North Dakota.  Difficult decisions will have to be made.

At the same time, we remind all involved that the state’s budget is a moral document and will ultimately be judged on how it affects the least of us.  The poor, the marginalized, the addicted, and the ill will disproportionately feel the pain of budget cuts.

We ask the governor and state agencies to resist quick simplistic solutions such as “across the board” cuts.   A compassionate and thoughtful response requires giving due priority to needs of those who will be most hurt by a reduction of services.  This will require time and serious consideration.  It may also mean that some agencies will need to make greater sacrifices than others so that we can give priority to those most in need.

We are confident that all involved will heed the words of Pope Francis when he said: “put the needs of the poor ahead of our own. Our needs, even if legitimate, will never be so urgent as those of the poor . . .”

Washington Misses Opportunity to Protect the Freedom to Serve

A statement by Archbishop Joseph E. Kurtz of Louisville President of the United States Conference of Catholic Bishops
The bishops of the United States are gravely disappointed that the 2016 omnibus funding bill did not include the Abortion Non-Discrimination Act (ANDA).  While the omnibus bill certainly addresses other critical issues, the modest reform that ANDA represents — to make federal conscience laws on abortion workable and enforceable — was an urgent legislative priority in these final months of the year.
Many Catholic and other institutions, including those that provide health care and other human services to the poor and vulnerable, have joined in our support of ANDA.  Without ANDA, these caring organizations face legal threats to their very existence, as they lack clear and enforceable protection for their freedom to serve the needy in accord with their deepest moral convictions on respect for human life.  Such threats to conscience also pose a threat to the most marginalized and vulnerable in our society–the poor and the sick, as well as the unborn.
 I am deeply concerned that a foundational principle that has received long-standing, bipartisan support in the past has suddenly become partisan.  No one should be forced by the government to actively participate in what they believe to be the taking of an innocent life. This is not about “access” to abortion. The principle at stake is whether people of faith and others who oppose abortion and abortion coverage should be compelled to participate in them. Federal law has long supported the rights of conscientious objection, and even in recent years, President Obama and many members of Congress have publicly declared their support for these existing laws. ANDA merely sought to give them a more consistent means of enforcement.
Despite this, ANDA was caught in the partisan polarization gripping Washington. To those who supported ANDA, we offer our gratitude and applaud your commitment to maintaining our national consensus in support of conscience protection.  To those who opposed ANDA, we urge you, in the strongest possible terms, to reconsider your position, which stands in opposition to even the modest enforcement of a venerable principle that is rooted in the constitution and has long enjoyed broad, bipartisan support.
We join Pope Francis in “call[ing] for a renewal of that spirit of cooperation, which has accomplished so much good throughout the history of the United States,” a cooperation that must be undertaken “with respect for our differences and our convictions of conscience.”  [Address to Congress, Sept. 24, 2015]  We call upon our elected officials to rise above partisan divisions and to renew their support for this most basic right. ANDA should be enacted as soon as possible. Without it, current federal conscience laws are, now for the first time, being enforced erratically or not at all in places such as California.
The mission of the Church in the public square is to witness to the dignity of every human life and advocate for the freedom to act in accord with one’s moral and religious convictions in defense of those lives, no matter how young or vulnerable. We will continue to reach out to the White House and Congressional leaders untiringly until proper protections are guaranteed.

Action Alert: Protect the Rights of Pro-Life Health Care Providers!

physicianNow is the time to urge Congress to protect the right of conscientious objection to abortion. Please urge your elected representatives to support the Abortion Non-Discrimination Act (ANDA). This proposal is part of the Health Care Conscience Rights Act (HR 940), and is now included in the House’s Labor/Health and Human Services appropriations bill for Fiscal Year 2016 (HR 3020, secs. 530 (d) and (e)). Ask members to include this language in final must-pass funding legislation this year. Please take action today through the link below.

The need for this legislation has grown more urgent since last year, when the state of California started forcing almost all health plans in the state to pay for elective abortions, even late-term abortions. There is no exemption for religious or moral objections. A mandate for hospitals, even religious hospitals, to perform abortions could be next.

California’s coercive policy clearly violates a federal law known as the Weldon amendment, which forbids governments receiving federal health care funds to discriminate against those who decline to take part in abortion. Unfortunately, this and other existing laws have loopholes and legal weaknesses that make them ineffective against such challenges. For example, nurses threatened with loss of their jobs unless they assist in abortions have found they have no right to go to court to see the law enforced. Congress should reaffirm a principle that has long enjoyed broad bipartisan support: Government should not force hospitals, doctors, nurses and other providers to stop offering much-needed health care because they cannot in conscience participate in destroying a developing human life.

Recommended Actions to take immediately:

  • Send e-mails through NCHLA’s Grassroots Action Center: Click Here.
  • Contact your Representative and Senators by phone. Call the U.S. Capitol switchboard at 202-224-3121, or call their local offices. Members’ mailing addresses may be found at or
  • Follow us on Twitter @nchla and retweet our posts. Repost this alert to Facebook or other social media platforms.


Suggested Message: “Please help ensure that the Abortion Non-Discrimination Act (ANDA), now included in the House’s Labor/HHS appropriations bill (Secs. 530 (d) and (e) of HR 3020), is enacted as part of end-of-year must-pass legislation. Government must not force Americans to violate their religious and moral beliefs about respect for life when they provide health services”.


For a letter, fact sheet, and video on this legislation, and other information on conscience rights, see

USCCB Comments on Medicare’s Proposed Rule on Advance Care Planning

health_care-255x255The U.S. Conference of Catholic Bishops (USCCB) submitted comments on September 4 to the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services. The comments relate to a Proposed Rule to incorporate end-of-life decision making or “Advance Care Planning” into the Medicare program.

The comments filed today by Anthony Picarello, USCCB general counsel, and Michael Moses, associate general counsel, note that while the Catholic Church does not object to encouraging patients to consider future treatment decisions in case they may become unable to communicate their wishes, “the current open-ended proposal has several deficiencies that merit attention before a final rule is considered.”

Picarello and Moses note that “the Church has a long and rich tradition on the parameters for such decision making, providing concepts and distinctions that have long played an important role in secular medical ethics as well.”   They add that “Catholic dioceses and other organizations have actively participated in the nationwide debate on end-of-life decision making and on the pros and cons of various ‘advance directives’.”  They explain that while such directives constitute one approach to advance care planning, they are not the only way, and some documents ignore important ethical distinctions and may be biased toward withdrawal of life-sustaining treatment.

The comment letter also reviews “important statutory guidance on this issue” found in the Patient Self-Determination Act, the Assisted Suicide Funding Restriction Act, and the Affordable Care Act, stating that the safeguards in these laws are not currently reflected in the proposed rule or its preamble.

The USCCB provides the following recommendations for any final rule or published guidance that encourage “advance care planning”:

  • Acknowledge the full range of advance care planning options, including those which rely on discussion and collaboration among family members instead of on pre-packaged documents that may be biased toward withdrawal of treatment;
  • Caution patients about the need to read any document carefully before signing it, to ensure that it fully protects the individual patient’s well-being and values, and inform them that additional resources may be available from their religious denomination or other sources of moral guidance;
  • Completely exclude counseling and documents that present lethal actions such as assisted suicide or euthanasia as treatment options;
  • Treat the counseling session as an opportunity for suicide prevention;
  • Reflect current law’s commitment to an “equality of life” standard that upholds life with a disability or permanent impairment as having inherent worth.

The Most Important Bill You Never Hear About

1280px-2009-0521-ND-StateCapitolThe appropriation bill for the Department of Human Services may be the most important bill you never hear about.

The Department of Human Services is large.  Its budget for the 2013-2015 biennium was over $3 Billion. This session’s bill requests $3.6 Billion, but expect the final bill to be less after adjustments in light of falling oil revenues. The department has over 2,200 full-time employees. (Full disclosure, my wife is one of them.)

While it may be tempting to some to see the department’s budget as proof of an overgrown bureaucracy, the truth is that the department’s services include a wide range of programs that, if looked at individually, are not particularly large or expensive. About 33% of the budget consists of Medicaid and children’s health insurance payments, but the rest covers many other services. These include:

  • Long-term care, which includes nursing homes
  • Special needs adoption
  • Foster care
  • Care for individuals with developmental disabilities, including guardianship services
  • Autism services
  • Abortion alternatives services
  • Guardianship establishment and Vulnerable Adult Protective Services
  • Supplemental Nutrition Assistance Program
  • Temporary Assistance for Needy Families
  • The human service centers
  • The state hospital
  • Child support services
  • Various substance abuse programs
  • The Life Skills and Transition Center (formerly known as the Developmental Center)
  • Child care assistance
  • Low Income Home Energy Assistance
  • Senior Meals Programs
  • Vocational Rehabilitation

And there are many more.  In fact, the budget request had 55 separate line items, most of which are for unique services.  Chances are, if you or a family member has ever been sick, struggling financially, in a nursing home, disabled, facing a mental illness or behavioral health problem, divorced with a child, or unexpectedly pregnant, you have had contact with the Department of Human Services.

It should be pointed out that about 60% of the department’s budget comes from federal, not state dollars.  Nevertheless, the breadth of the department’s actions and size of the total budget can make it seem overwhelming and an easy target when it comes to “trimming” government spending.  After all, the poor, sick, and struggling don’t have strong lobbying organizations.

Another challenge is that some people believe that these services should be provided entirely through private charities, especially the churches.  Certainly churches have a role to play.  Charity is a Christian obligation.  There is, however, a difference between charity, which is freely given in response to an immediate need, and justice, which is due to a person because of their dignity as a human person.  The Church teaches that we should not leave to charity that which is already due as a matter of justice.

We also need to recognize that, mostly out of a desire to protect citizens, the provision of human services has become professionalized and regulated.  As a consequence, the cost of covering all these services would be beyond the capability of the charitable sector.  If you are already tired of the diocese’s capital campaigns, imagine what it would be like if churches had to raise another $1.5 Billion annually.

The Department of Human Services bill is not like an abortion or school choice bill, where you can email your legislator with a simple “yes” or “no” request.  The bill will be passed.  The question is what in it will be funded and at what level.  How, as Catholics citizens, do we engage in the development of such a bill?

Something the Wisconsin Catholic Conference recently wrote about budget bills in general applies to the Department of Human Services bill.  It wrote:

While they contain numerous facts, data, and projections, state budgets are documents through which our state makes choices and sets priorities.  They are about how needs are met and which are deferred or denied.  As such, they are moral documents that define the values of those who enact them.

While the WCC does not take a position for or against the state budget as a whole, it does address aspects of the budget that advance or hinder important priorities.  For Catholics, a vital priority is always that of meeting the needs of the poor, disadvantaged, and marginalized.

Ultimately, the budget bill is a moral document that reflects who we are as a state.  The least we can do is pray for the legislators that will review the department’s bill.

Heavenly Father, grant wisdom and open hearts to our elected officials as they decide how best to help our neighbors, especially the least among us. Amen.

Christopher Dodson, Executive Director, North Dakota Catholic Conference

Cardinal O’Malley, Archbishop Lori Urge Support for the Health Care Conscience Rights Act

—Congress should reaffirm the principle that government “should not force anyone to stop offering or covering much-needed legitimate health care” because of a conscientious objection to abortion or other procedures, said Cardinal Seán P. O’Malley of Boston and Archbishop William E. Lori of Baltimore. In a February 13 letter to the House of Representatives, the bishops, who chair the Committee on Pro-Life Activities and the Ad Hoc Committee for Religious Liberty of the U.S. Conference of Catholic Bishops (USCCB), urged legislators to support and co-sponsor the Health Care Conscience Rights Act (H.R. 940).

It is increasingly obvious that Congress needs to act to protect conscientious objection to the taking of innocent human life,” wrote Cardinal O’Malley and Archbishop Lori. “Recently California’s Department of Managed Health Care began demanding that all health plans under its jurisdiction include elective abortions, including late-term abortions. This mandate has no exemption for religious or moral objections, and is being enforced against religious universities, schools and even churches. Similar proposals have emerged in Washington and other states.”

The bishops noted that the Abortion Non-Discrimination Act (ANDA) section of the bill would give firmer legal basis to the Weldon amendment, part of every Labor/HHS appropriations bill since 2004, which forbids governmental bodies receiving federal funds to discriminate against those who decline to take part in abortion or abortion coverage. They noted that President Obama has expressed support for the Weldon amendment.

In addition, the bishops said that H.R. 940 would incorporate respect for rights of conscience into the Affordable Care Act, allowing those who purchase, provide and sponsor health coverage under the Act to opt out of abortion or other specific items that violate their moral and religious convictions. Finally the bill would recognize a private right of action for victims of discrimination under either provision, so they can go to court to defend their rights.

“We strongly urge you to support and co-sponsor the Health Care Conscience Rights Act,” the bishops concluded.

The full text of the letter is available online: