A Conversation with Sister Carol, Obama’s Favorite Nun

Before taking a seat onstage opposite Sister Carol Keehan, member of the Daughters of Charity order that launched early hospitals, orphanages and schools, VAHHS CEO Jeff Tieman described  how working for the poor and vulnerable drove Sister Carol every day.
“When I was privileged to work with her personally for 10 years [at the Catholic Health Association from which she just recently retired], she demonstrated perseverance in the face of peril, confidence and courage in the midst of criticism and optimism when the odds were long,” he said.
Sister Carol, who was named one of the 100 most influential people in the world by Time Magazine for her work on the Affordable Care Act (ACA), is a true health care reform hero, Tieman related.
To kick off the conversation, he asked Sister Carol why she and the Catholic Health Association made the ACA such a priority.
“To be frank with you, [health care] has always been a priority,” she answered. “I’ve spent my life in health care. When I was 25, I was sent by the Daughters of Charity to open a children’s hospital. It was a hospital that cared for everybody in the whole area. Every child had a private room; every child had excellent care. That’s not the situation in most of America. That’s not the situation when you look at people who are pregnant or have diabetes,” she explained.
“For me,” she remarked, “it’s a scandal for a nation with all the riches the US has not to give everybody at least basic health care and not to promote good health. It was just something that I couldn’t stand. I’m a nurse first. I worked on the front lines with people who were poor all my life. I knew they were suffering. I had to do something about it,” she said.
In order to prepare the groundwork for health care reform, the Catholic Health Association had to redirect public opinion on several fronts. For one, community hospitals were under fire as Senators challenged their tax-exempt status as not-for-profit organizations.
“In order to have a credible voice in the marketplace, we had to get that off the table and prove yes, we were doing what we said we were going to do. We were more than worthy of our tax-exempt status,” she noted.
She said it was a tough climb. Long before Obama won the presidency on a platform that promised creating a system that worked for everyone, the Catholic Health Association got in the game.
“Board leadership could see that perhaps we were getting to the right time to do this,” Sister Carol relayed. “Because of an earlier misinformation campaign (“Harry and Louise” ads) during Hillary Clinton’s failed effort to create universal health care as First Lady, the subject was just toxic. Nobody wanted to touch health care on Capitol Hill. No one running for president wanted to touch health care because it was just the kiss of death,” she explained.
“We could see that there was enough anxiety and people were hurting enough that it had a chance,” she said. “But we had to do it in a better way than had been done before. So way before President Obama was elected, we looked at how do you start to seed the ground? How do you make people see that this has got to be fixed and that it can be fixed and that everybody will be better off, not just poor people?”
She recounted hiring Tieman. “We wanted to make sure we had somebody full-time to seed things in all the right places, doing focus groups, finding out what people thought,” she noted.
“We developed our vision for health care for the future. We never had a plan, not a bill we were advocating for. Because of this, we were able to look at others' ideas and say ‘What does it do to promote health? What does it do to get all of the people in the country having health care? If it does that, I can get on board.’”
President Obama swept in with the promise of creating a health care system that worked for everybody and the commitment to do it. Sister Carol was behind him throughout the fight to pass the ACA.
“It’s important to not let people drown you out with misinformation,” she stressed. “That can kill you before you get started.”
One misinformation campaign that particularly frustrated her was launched by pro-life groups, who insisted that the ACA would dramatically increase the number of abortions performed in the country.
“Having been in maternal infant care and in the emergency department, to see people using my church to prevent people from using the care they needed was frustraing,” she noted. “I knew bishops who were over and over again trying desperately to get people the care they needed. And people who had these great titles, ‘Focus on the Family,’ 'pro-life this and that' . . .they said this will be the biggest expansion of abortion in the history of this nation. What’s a bishop to do? And their staff believed it. I’ve been pro-life all my life. That’s why I’ve been in health care. That’s why I’ve worked so hard for quality maternity care . . . I know women who say ‘I just can’t afford to have a baby.’ And they can’t. If you can say, ‘Your baby is so important and you are so important that we will find a way to get you maternity care,’ that’s the way to [be pro-life]. People in this country should never have to make a choice because they can’t afford health care for themselves or their child,” she said.
This view would earn Sister Carol a lot of hate mail and threats. She needed extra security at buildings she frequented to keep her safe. She endured picketing at her appearances. The Vatican kicked her off the stage during an event. People even called for her removal from the Sisters of Charity. During this hard time, Sister Carol chalked the behavior up to lack of understanding of the bill.
“You have a right to what you believe, but you don’t have a right to your own facts. And that was an important thing,” she said.
She wasn’t alone in being targeted for her stance.
“People who voted for [the ACA] got thrown out of pro-life organizations and lost their seats for voting for it. One man from Pennsylvania told me, ‘I only got one term, but it was the most important time to be in Congress and I don’t regret my decision because I had the chance to do the most important vote there was,’” she quoted.
Tieman remembered the night when the bill passed the House. He was in the chamber and Sister Carol was traveling abroad.
“The next day, I was talking to people on my trip, trying to be sociable. I looked down at my phone and saw that I had a call from the White House; I had to let it go to voicemail!” Sister Carol remembered.
The message from Obama, which Tieman recalled staff asking his boss to play over and over, said “Thank you Sister Carol for what you’ve done for the country.”
“He was always very gracious and very grateful,” she noted.
When asked how she thinks health care reform has fared, Sister Carol reported she thinks there’s a positive side and a very concerning negative one.
“Twenty million people got health care that didn’t have it,” she began. "West Virginia—a state that got more people newly covered than every other state except Kentucky—found one of the things it did was actually reduce the suicide rate. [Before the ACA], people just couldn’t afford their medications. They had done all they could to raise funds with churches and family members. They just couldn’t keep going. Now [after the ACA], they could walk into drug stores and get their hypertension meds, their insulin,” she added.
She noted two other huge positives in the ACA—no pre-existing conditions and no lifetime limits. She recalled giving a talk about these two provisions to a group that included a seemingly well-to-do woman.
“You looked at her and thought, ‘This is a gal that has it made. She has a good job, a good education.' Afterward, she came up to me and said, ‘Those two things you talked about will change my life.’ Her husband had muscular dystrophy and her daughter had cystic fibrosis. ‘We try to forego care because of lifetime limits. And I can’t change insurance because I’d have coverage for everything except what I need it for the most,’ the woman said.”
Unfortunately, Sister Carol remarked, the number of uninsured is on the rise again because of efforts of the current administration. That frustrates her, as does the fact that some states refuse to allow the ACA to help them.
“It would save the states so much money if they would just do Medicaid expansion—where they have done it, it’s good for the state, not just the people. And it’s good for the providers,” she stressed.
When asked about Vermont’s delivery system reform, Sister Carol said she thinks it’s courageous work.
“I was CEO of a hospital in Maryland, which is totally all-payer. If you create the right incentives, you drive the system in the right direction. In most states, we have perverse incentives. Our health care financing system is a misery. The incentives are so perverse,” she noted.
“You guys are the size that could make the difference and the size to get everybody in [to the system],” she posited. She stressed putting the insurance company policy holder ahead of the stockholder, studying the effects of Medicaid and Medicare, looking at how we finance medical education and creating the right incentives for nursing.
“The most important goal for the Maryland hospital association—the key policy—is keeping their all-payer system. There, they don’t have perverse incentives to cut staffing or market away from Medicare and Medicaid. Whether you have a high-option Blue Cross plan or Medicaid, it’s the same payment. It’s not a perfect system, but it's a movement in the right direction,” she explained.
She noted that the work we do in delivery reform will be invaluable to Vermont, but also to the rest of the country. Our small size, she said, could also help us with the workforce issues that plague hospitals nationwide—maybe worldwide.
“You’ve got to find ways to capture being part of the healthcare team as an incredibly wonderful experience,” she said. “Hospital people can get things done! But when all day, you don’t have the supplies you need or can’t get the lab results in; when half of the people are from an agency and will be somewhere else tomorrow; you’ve got to be able to have honest conversations about your work. As an industry, with your small size and the spirit that Vermont is known for, you can do that. You can model a lot that the rest of us can learn from.”