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The shift toward managed care in the mid-to-late 1990s and passage of the Affordable Care Act in 2010 pressured health systems to contain costs, fueling mergers between Catholic and non-Catholic hospitals.
In some cases, changes in ownership broadened access to reproductive services in Wisconsin. Marshfield Clinic’s acquisition of Ministry St. Joseph’s Hospital in Marshfield in 2017, for example, ended adherence to the Ethical and Religious Directives, which Catholic hospitals use in guiding their provision of health care.
But in several instances, previously secular hospitals have become subject to Catholic rules. For example, Victory Medical Center in Stanley discontinued contraceptive sterilization services after Ministry Healthcare System acquired it in 1995.
More recently, Community Memorial Hospital in Oconto Falls became subject to the Catholic directives after being acquired by the Hospital Sisters Health System in 2014. The closest nonsectarian facilities with labor and delivery units are now at least 35 minutes’ drive away.
Even when one Catholic system is acquired by another, access to reproductive services can change.
Dr. Jessika Ralph, an obstetrician/gynecologist, worked as a resident at Milwaukee’s Catholic St. Joseph Hospital when it was acquired by Ascension Health in 2016. Tubal ligations, which were sometimes approved prior to the acquisition, virtually ceased, she says.
“They can’t provide them at St. Joe’s now because they’re owned by Ascension,” says Ralph, referring to the St. Louis, Missouri-based Catholic health system that now operates more hospitals than any other system in Wisconsin.
Some states have taken regulatory action to ensure patients can make more informed choices.
In 2016, Illinois passed a law requiring that health care facilities inform patients of all legal treatment options and refer or transfer them for treatment if a desired service cannot be provided for conscience reasons. A law in Washington State requires that hospitals publicly post their reproductive health policies, although implementation has been uneven.
Unlike Wisconsin, Illinois has a Certificate of Need process in which hospital transactions that cause a potential loss of health care services are subject to government scrutiny and approval.
“I think policymakers should be interested in getting advice from consumers and communities about how to make sure that, when a merger happens or a hospital is going to close or downsize, patients can still get the care they need in a timely manner,” says Lois Uttley, director of MergerWatch, an organization that tracks religious hospital mergers.