In 2010, after months of debate, Congress passed health care reform legislation, the Affordable Care Act (ACA).

The late Cardinal Francis George, then President of the U. S. Bishops’ conference, opposed the ACA as passed. Along with other problems, the law “would expand the role of the federal government in funding and facilitating abortion and plans that cover abortion” and failed to include “essential conscience protections (both within and beyond the abortion context).” 

Broad language in the ACA became the basis on which the Obama Administration in 2011 issued a rule—commonly called the Contraceptive Mandate—requiring coverage in most private health plans of sterilization and abortion-inducing drugs and devices as well as contraception, along with “counseling and education” to promote the coverage. 

In succeeding years, efforts to correct the abortion funding and conscience protection defects in the ACA were not successful. 

Early in 2017 the House again passed the No Taxpayer Funding for Abortion Act (H.R. 7). Also, the latest version of conscience legislation, the Conscience Protection Act of 2017, was introduced in both House and Senate (H.R. 644, S. 301).

On March 20, 2017, the House Committee on the Budget reported the American Health Care Act of 2017 (AHCA) (H.R. 1628). The bill was placed on the House calendar but was not voted on. 

On review, the U.S. bishops found some provisions in the AHCA commendable, for example, those restricting or prohibiting abortion funding, while other provisions presented “grave challenges that must be addressed before passage.” The latter included the lack of conscience protection against health care mandates. The bishops expressed concern that efforts to improve deficiencies in the ACA should not create other problems, “particularly for those who struggle on the margins of our society.”