A controversial move to transfer operation control of three secular Denver area hospitals to a Catholic health care system expected to take place on Dec. 31 appears to be on hold pending federal approval.

The unexpected delay by the Federal Trade Commission to bless the transaction may provide local critics with a last gasp effort to continue fighting the deal. Community members and medical professionals contend the transfer would unfairly subject comprehensive reproductive health and end-of-life care to church doctrine over patients’ needs. The Catholic church considers abortion, contraception, elective sterilization and termination of invasive life support as “intrinsically evil” and refuses to provide these medical services or respect patients’ advance directives.

The disputed takeover in Denver exemplifies the very serious implications for the 127 non-denominational hospitals that succumbed to merger fever with cash-flush Catholic health care systems in the 1990s. According to a study by Catholics for a Free Choice, half of merged secular-Catholic hospitals suspended most or all of their reproductive health care services. Eighty-two percent denied emergency contraception to rape victims — and more than a third refused to provide a referral.

But for some tax-exempt, nonprofit hospitals co-owned by secular and church interests, there was little more than a wink and a nod to church mandates on care. Comprehensive reproductive health care services quietly remained available.

That care came later under close scrutiny in 2001 when the U.S. Conference of Catholic Bishops revised its Ethical and Religious Directives for medical care to address “misinterpretation and misapplication of the principle of cooperation with other-than-Catholic organizations.” In other words, the church would no longer turn a blind eye to reproductive health and end-of-life care at its secular partner facilities that did not meet strict Catholic orthodoxy.

MergerWatch.org notes several examples of broken promises by Catholic health care systems to preserve reproductive health services at non-religious hospitals it acquired through mergers. Typical reasons included newly installed diocesan bishops with more dogmatic views on medical directives or the Vatican overturning decisions made by previously autonomous bishops.

More importantly, the local hospital policymaking was a little noticed precursor to the bare knuckles strategy on recent display with the church’s relentless lobbying for the 2009 Stupak and Nelson amendments to further restrict access to abortion care via publicly-subsidized health insurance plans. At the same time, the Catholic Archdiocese of Washington, D.C., threatened to end social service programs for tens of thousands of poor residents if the city council approved a same-sex marriage ordinance.

Now, the Denver hospital takeover is offering a glimpse of the intense pressure being brought to bear by the church on its health care partners. The Vatican’s renewed insistence on complete doctrinal influence on patient care is bolstered by very real threats to hold desperately needed institutional capital funds hostage until its theological demands are met.

And that once delicate balance between serving patient needs and adhering to strict Catholic medical directives is unraveling in plain sight.

Source: Pew Research Center.

The news domination about the Stupak-Pitts amendment to the U.S. House’s health reform bill that prohibits federal funding of abortion services in both public and private insurance plans belies the more important reasons some members of the public oppose the plan.

According to a Nov. 19 study by the Pew Research Center:

When asked to choose the single most important issue from a list of possible reasons, 8% of opponents selected abortion funding. This translates into just 3% of all Americans who both oppose the legislation and say abortion funding is the main reason for their position. Among opponents, concern about too much government involvement topped the list, with 38% saying it was the most important reason, followed by 27% who cited the expense of reform. Fewer cited the risk to their own health care (14%) or the possibility that illegal immigrants might be covered (7%). [Emphasis mine]

The Pew findings raise a critical issue: With so few Americans opposed to health care reform because of the potential for abortion funding, why did the political aim of the U.S. Conference of Catholic Bishops and conservative religious groups have such a disproportional impact on the final House bill?

Outrage over the Stupak-Pitts amendment to the House health reform bill ignores a bigger problem: it kills competitive advantage.

By inserting theological beliefs about reproductive health care into the private health insurance market, conservative House members have breached a no-mans land in the One Holy Apostolic Free Market they claim to worship.

With heavy lobbying by the U.S. Conference of Catholic Bishops, the Stupak-Pitts amendment creates a favorable competitive situation for the 624 Catholic hospitals across the nation — a lucrative business that spent $85 billion dollars in 2007 and encompasses 13 percent of the health care sector.

The Denver-based Catholic Health Initiatives is now the largest of the church’s hospital systems in the country with 78 hospitals and 40 long-term care facilities in 20 states and operating revenues exceeding $9.6 billion ranking it sixth among all for-profit and charity health care networks.

It goes without saying that the church opposes abortion, contraception and sterilization on theological grounds which is they’re right as a private business.

But those medical directives also drive away patients that secular and other religiously-affiliated hospitals use to their advantage by emphasizing that they respect patient-physician decision-making on difficult medical decisions. Plus, from a cold, calculating green eyeshade perspective, sepsis from botched back alley abortions and multiple child births is a lot more expensive to cover than contraception.

With good odds that some sort of health care reform bill will pass Congress and be signed by the president, the potential for profit-making is unprecedented.

Congressional health insurance reforms promise the prospect of 36 million uninsured Americans — who are currently self-rationing care, paying on sliding fee scales, or not paying at all — flowing into hospitals, clinics and outpatient facilities via subsidized insurance, mandated policies and more affordable options in the proposed insurance exchange. Of the total uninsured, an estimated 15 million women of reproductive age could be eligible for coverage.

But this is where things get tricky.

One of the many factors patients use in choosing an insurance network physician is one with in-patient admitting privileges to a local hospital with the best reputation. And with these young, newly insured patients hospital loyalty could result in lots of billable revenue over their lifetimes.

Except the religious directives that restrict reproductive care creates a huge dilemma for Catholic hospitals trying to penetrate the billion dollar women’s market share in a brutally competitive health care sector. And that’s setting aside the fact that women make most medical decisions for their entire family. The power of their purse is great.

So the bishops used Stupak-Pitts to erase that competitive disadvantage. Make no mistake, health care — be it private, for-profit or public charity — is a business not for the faint of heart. And no less so for a Capitol Hill lobbyist with a clerical collar.

The $2.5 trillion health care industry now represents 18 percent of the nation’s gross domestic product and is expected to double in less than 10 years. And those projections were made well before “health care reform” ever passed Barack Obama’s presidential campaign lips.

And now as the Senate enters the arena, we are faced with a critical question: Is the role of Congress to surreptitiously do the stealthy bidding of private business — even those who have the power of absolution, political or religious — against its secular industry rivals?

A version of this commentary appeared at RH Reality Check.