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CCAR Resolution on Health Care
March 23, 2017
Our Jewish Textual Warrant to Provide Health Care
Judaism imposes an obligation on each and every one of us to care for the others among whom we live. If they are poor, we are obligated to provide them with food, clothing, and shelter. This requirement extends to medical care as well.
This obligation is found in multiple places in our holy writings. Leviticus 19:16 commands not to “stand idly by the blood of your neighbor.” Therefore, upon encountering a person in a life-threatening situation, we are required to help. Deuteronomy 22:1-3 speaks of our requirement to return lost property. We are told that we are obligated to return not only a person’s donkey or garment, but “anything” belonging to your fellow human being which he has lost and you have found.” That word “anything” is interpreted to obligate us to restore even a person’s health.[i] Furthermore, Exodus 21:19 introduces the requirement of rapoh yirapeh, “you shall certainly pursue full medical healing.” This verse originally required someone who had injured another to pay for medical costs, but has been extended to obligate everyone to pursue medical assistance in situations of injury or sickness. In addition, the Shulkhan Aruch records the view that, while contributions to erect a synagogue take precedence over ordinary forms of tzedakah, even the synagogue’s needs take a backseat to the requirement to provide for the indigent sick. Furthermore, the sick may not refuse such assistance if they require it to regain health (Yoreh De’ah 249:16).
The poor for whom we are obligated to provide care are not limited to the Jewish poor. A medieval rabbinic authority, Rabbi Nissim of Gerona (Barcelona, 1320-1380) noted that health care funds are specifically designated for the “poor of the world,” not only the “poor of the city.” Thus, when it comes to providing health care, a community must offer help to all who are in need, regardless of their ethnicity, religion, or nationality.
In summary, Judaism establishes a moral imperative to provide access to health care to all.
Health Care in the United States Today
Since 1966, at the initiative of President Lyndon B. Johnson and by act of Congress, the United States has provided a single-payer health insurance program for all Americans age 65 and over, as well as for Americans with disabilities, with some 55.3 million total beneficiaries in 2015. Medicare is not free, but requires payment of income-based premiums. Beneficiaries typically are required to pay 20% of all covered expenses. Beneficiaries may choose between a number of plans and parts of Medicare, but all eligible Americans are guaranteed Medicare’s benefits.[ii] At the initiative of President George W. Bush, Congress initiated a Medicare prescription drug benefit.[iii]
The same law that established Medicare also established Medicaid, a health insurance program that today benefits low-income families, pregnant women, people of all ages with disabilities, and people who need long-term care.[iv] Together with CHIP, the Children’s Health Insurance Program, Medicaid covered 70 million Americans, “or 1 in 5 people in the country” by early 2015. That number included “10.8 million low-income adults and children [who] enrolled in public health insurance since 2013, when the [relevant] portion of [the Affordable Care Act] took effect.”[v]
The Affordable Care Act (ACA), initiated by President Obama, was enacted by Congress and signed into law in 2010. ACA “include[s] the creation of new Health Insurance Marketplaces where low and moderate income families can receive premium tax credits to purchase coverage and, in states that opted to expand their Medicaid programs, the expansion of Medicaid eligibility to almost all adults with incomes at or below 138% of the federal poverty level.”[vi]
“Prior to implementation of the ACA, over 47 million Americans – nearly 18% of the population – were without health insurance coverage.”[vii] Too many Americans remain uninsured today; but that number has been dramatically reduced since 2010, with some 20 million Americans gaining coverage. Cost remains a factor for many Americans who have not obtained health insurance under ACA. Significantly impeding coverage for low-income Americans are the nineteen states – including populous states such as Texas, Florida, Georgia, Missouri, Virginia, North Carolina, Wisconsin, and Tennessee – that have elected not to expand Medicaid under ACA.[viii]
ACA includes several provisions that have improved Americans’ access to health care. “[H]ealth insurance companies can’t refuse [coverage] or charge . . . more just because [of] a ‘pre-existing condition.’”[ix] Health insurance plans that cover dependents must typically now offer dependent coverage to young adults up to age 26.[x] All public and private plans must now cover a wide array of preventative services without charging any copayment.[xi] Notably, these preventative services include no-cost coverage for women’s health and well-being, including contraceptive care.[xii] ACA also requires “that most individual and small employer health insurance plans including all plans offered through the Health Insurance Marketplace cover mental health and substance use disorder services.”[xiii]
CCAR’s Historical Support for Health Care
In both 1976 and 1991, the CCAR adopted resolutions favoring a national health care system with universal, affordable coverage, with an emphasis on preventative care.[xiv] In 1993, we adopted a resolution supporting the then-proposed Women’s Health Equity Act.[xv] The CCAR has supported Planned Parenthood going as far back as 1947.[xvi] The CCAR forcefully called for mental health equity in a 2001 Resolution on Establishing a Complete System of Care for Persons with Mental Illnesses.[xvii]
Therefore, Be It Resolved, that the Central Conference of American Rabbis calls upon the President, Congress, and the States to preserve and expand access to health care, including:
- Reaffirmation of Medicare as a public, universal, single-payer health insurance program for all Americans age 65 and over, with low-cost premiums and co-insurance obligations particularly for low-income beneficiaries.
- Continuation of Medicaid as a public, single-payer health insurance program, with significant standards delineated by the Federal Government, for low-income Americans as well as those with disabilities or requiring long term care.
- Retention of the Children’s Health Insurance Program.
- Expansion of Medicaid to cover all Americans living at or below 138% of the Federal Poverty Level in all 50 states.
- Assuring that no American can be denied coverage nor charged extra for coverage on the basis of pre-existing conditions.
- Retaining the requirement that all health insurance programs that cover dependents must include coverage of dependent children to age 26.
- Requiring that all health insurance programs cover preventative services at no cost to the individual.
- Mandating parity for women’s health care services, including contraceptive coverage.
- Guaranteeing equity in coverage for mental health care and treatment of substance abuse disorders.
- Maintaining laws that require CMS to include all qualified providers, including Planned Parenthood, as authorized providers under Medicare and Medicaid.
- Prohibiting discrimination on the basis of sex, race, religion, national origin, age, sexual orientation, gender identity, disability status, or marital status.
[i] BT Sanhedrin 73a
[ii] National Committee to Preserve Social Security & Medicare.
[v] Kimberly Leonard “Medicaid enrollment Surges Across the U.S.,” U.S. News & World Report, February 24, 2015.
[vi] Rachel Garfield, Rachel Licata, and Katherine Young, “The Uninsured at the Starting Line: Finding from the 2013 Kaiser Survey of Low-Income Americans and the ACA,” The Henry J. Kaiser Family Foundation, February 6, 2014.
[viii] Lara Cooper, “Even With Obamacare, 29 Million People Are Uninsured: Here’s Why,” The Financial Times, May 10, 2016.
[ix] HHS.gov. (HHS>Health Care Home>About the Law>Pre-Existing Conditions.)
[xiv] CCAR Resolution on Health Care, 1976; CCAR Resolution on National Health Care, June, 1991.
[xv] CCAR Resolution on Women’s Health, June, 1993.
[xvi] ccarnet.org>Rabbis Speak>Resolutions, “Birth Control, Digests of Resolutions adopted by the Central Conference of American Rabbis between 1889 and 1974.”
[xvii] CCAR Resolution on Establishing a Complete System of Care for Persons with Mental Illnesses, June, 2001.