As Americans wait to see what the Supreme Court does with President Barack Obama’s signature health care overhaul, few have a stronger interest in the outcome of this momentous test than the Catholic bishops. Their support for universal health coverage, their duty to defend the Church’s institutional interests, and their fear that the Church’s religious liberty rights are being compromised are all in play. 

In particular, the question that preoccupies the bishops, as well as other Catholics, is what impact, if any, the decision will have on the Obama administration’s controversial mandate requiring Catholic colleges and universities, hospitals, and charities to give their employees health insurance that covers contraception, sterilization, and drugs that induce abortion. Pending the court’s ruling, expected in June, the only possible answer now is that the impact could be anywhere from decisive to nonexistent. It’s up to the court. 

In general terms, the long-awaited test of the Patient Protection and Affordable Care Act — popularly known as Obama-care — could have any one of three outcomes: the law is overturned entirely, it is upheld entirely, or it is partly overturned and partly upheld. 

The cases raise profound questions of constitutional interpretation. The largest of these concerns the extent and the limits of the federal government’s authority to reach into the lives of individuals and command them to do specific things — in this case, purchase health insurance. But the same question — How far may the federal government go? — is indirectly raised by the abortifacient-contraceptive-sterilization mandate. The U.S. Conference of Catholic Bishops denounces it as a violation of the religious liberty guaranteed by the free exercise clause of the First Amendment. 

The model of church-state relations upon which defenders of the mandate appear to operate, consciously or unconsciously as the case may be, is one in which the government can compel Catholic institutions to help implement policies offensive to the Church’s beliefs, while granting or withholding exemptions at its pleasure. This in itself is an unhealthy subordination of religion to the state, founded on secularist principles. 

Clearly, if the Supreme Court overturns Obamacare entirely, the abortifacient-contraceptive-sterilization mandate will go down. If the court upholds the law in its entirety, this provision so obnoxious to the Church will stand. And if the Affordable Care Act is upheld in part and overturned in part, Church lawyers will join a small army of legal analysts picking through the majority opinion — and what may well be a large number of dissenting and concurring opinions — to determine the implications. 

Despite their strong objections to the mandate, history and Catholic social doctrine combine to create an unavoidable ambivalence in the bishops’ attitude toward Obama-care. The American hierarchy for decades has supported universal health coverage as a matter of social justice. When the White House press secretary said the bishops had always opposed health care reform, Cardinal Timothy Dolan of New York, president of the bishops’ conference, protested angrily, calling the remark “scurrilous and insulting, not to mention flat-out wrong” in a March 2 letter to the hierarchy. 

The bishops are not parties to any of the cases presently before the Supreme Court. But Cardinal Dolan said the USCCB was having discussions with “some top-notch law firms” if the bishops decide to go to law. Like many other aspects of this complex situation, whether that does or doesn’t happen may depend on what the Supreme Court does in June. 

Russell Shaw is an OSV contributing editor.