Healthcare at the Precipice: Sr. Mary Haddad on the Looming Coverage Crisis

As 2025 draws to a close, millions of Americans stand at the edge of a healthcare cliff. Sister Mary Haddad, President and CEO of the Catholic Health Association, returns to The Healthy Project to sound the alarm on an urgent policy crisis that threatens to undermine healthcare access for working families nationwide.

Following the passage of major Medicaid cuts in July that will affect 10 million people, enhanced premium tax credits under the Affordable Care Act are set to expire at the end of the year. The result? An estimated 4.2 million more Americans are losing coverage, with millions facing dramatic cost increases. For rural communities already struggling with limited resources, the impact could be devastating.

This episode examines the intersection of healthcare policy, economic justice, and human dignity. Sister Mary draws on Catholic social teaching to frame healthcare access not merely as a policy preference but as a moral imperative rooted in the inherent worth of every person. She offers a clear-eyed assessment of how hospital closures, emergency department overcrowding, and the loss of telehealth flexibilities create a perfect storm threatening the most vulnerable among us.

Beyond diagnosis, this conversation explores solutions. What must Congress do immediately? How can healthcare systems balance mission-driven care with financial sustainability? What role should everyday citizens play in advocacy? And perhaps most importantly: what does hope look like when systems are breaking down?

In This Episode:

The Immediate Crisis

• Understanding the connection between July's Medicaid cuts and expiring tax credits
• Why 4.2 million working Americans face losing coverage
• The "sticker shock" families are experiencing during open enrollment
• Congressional gridlock and the December deadline

Rural Healthcare Under Pressure

• Lower median incomes meeting higher insurance costs
• The competitive disadvantage of rural insurance markets
• Hospital closures and service reductions on the horizon
• The hidden costs: hotel stays and hours-long drives for basic care

Emergency Departments as Safety Net

• Why ERs become primary care when coverage disappears
• The economic burden of treating delayed, acute conditions
• Federal mandates and the impossible position of hospitals
• Triage challenges when systems are overwhelmed

The Telehealth Question

• How COVID revealed telehealth's essential role
• Temporary extensions vs. permanent policy solutions
• Access equity and the digital divide
• Real stories from rural South Dakota

Moral Framework & Advocacy

• Healthcare as inseparable from human dignity
• Operating as a "ministry that functions as a business"
• The responsibility of citizens to engage with the government
• Moving from despair to concrete action

Looking Forward

• Strengthening existing coverage systems
• The critical need for primary care investment
• Acknowledging that U.S. healthcare is "broken"
• Building coalitions across providers, payers, and government

Sister Mary's perspective is particularly vital for those interested in the social determinants of health, healthcare economics, policy advocacy, and faith-based approaches to social justice. Her framing of hope as "concrete actions" rather than abstract aspiration offers a powerful counter-narrative to policy fatalism.

Guest: Sister Mary Haddad, RSM, President & CEO, Catholic Health Association of the United States

Resources: Learn more and take action: www.chausa.org

Show Notes:

• July 2025: "One Big Beautiful Bill" passes with major Medicaid cuts affecting 10M people
• Premium tax credits expiring December 31, 2025
• 4.2 million Americans projected to lose coverage without extension
• Rural areas particularly vulnerable due to limited market competition
• Telehealth flexibilities extended only through January 31, 2026
• Emergency departments face increased burden as primary care access shrinks
• Catholic social teaching emphasizes healthcare access as fundamental human right

Related Episodes: June 2025 - Medicaid at a Crossroads: A Conversation with Sr. Mary Haddad (Part 1)

About The Healthy Project: The Healthy Project explores the systems, policies, and people shaping health and healthcare in America. Host Corey Dion Lewis brings thoughtful conversations about how we can build a healthier, more equitable future.

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Corey Dion Lewis (00:01.016)
Hello, everybody. Thank you for listening to the Healthy Project podcast. I'm your host, Corey Deion Lewis. And today we have someone no stranger to the podcast. just had you on in June. Sister Mary Haddad is here to continue another conversation on some very important topics. So Sister Mary, thank you so much for being here. I really appreciate it.

Sr. Mary Haddad (00:27.679)
Thank you, Corey, for the return invitation.

Corey Dion Lewis (00:30.668)
Yeah, absolutely. Absolutely. It's super important. know, since Sister Mary, since our last conversation in June about Medicaid, the healthcare policy landscape has become even more complex. And can you start by giving us a sense of what's at stake right now as we approach the end of 2025?

Sr. Mary Haddad (00:54.111)
Yes, thank you, Corey. And if you don't mind, I want to do a brief recap of what we talked about in June, because I think it's important to connect the two realities. And if we recall on July 4th, the one big beautiful bill was passed. And this was really a tax bill that was signed into law and included major cuts to the Medicaid program.

Corey Dion Lewis (01:01.379)
Yeah.

Sr. Mary Haddad (01:20.283)
an estimated 10 million individuals will lose coverage because of that law. And so now, moving through the past couple of months, we've been really trying to ensure that Congress extends the health premium tax credits. We recognize the facts. If those credits are not extended,

An additional 4.2 million working Americans will lose coverage and millions more will see their healthcare costs dramatically increase. And right now in November, we started the enrollment program and already we're hearing reports that families are feeling the pressure because they're seeing sticker shock on what their coverage rates will be.

Corey Dion Lewis (01:54.584)
Mm.

Sr. Mary Haddad (02:15.26)
So that is the important priority for CHA right now.

Corey Dion Lewis (02:20.654)
Wow, that is just, I can only imagine what that feels like, you know, going into the new year, knowing the potential of the prices coming up. And also Sister Mary, not only things are getting more, everything is getting more expensive. there's just so much more, I believe that people are just going to go into survival mode more than anything.

during this time. Your September op-ed in real clear health, I wanna make sure I have that correct, warned that time is running out for millions of Americans as you've been talking about. And now we're seeing these very issues at the center of what's going on. How does it feel to see your concerns kinda playing out in real time?

Sr. Mary Haddad (03:16.286)
Wow, you know, at the time of the real push around the Medicaid cuts, we also knew that this was on the horizon with the inability to extend these tax credits. And I would say it's both unfortunate and disheartening that Congress could not come together in a bipartisan manner to prevent the shutdown and to address the rise in cost of premiums for working Americans.

We recognize the fact that the shutdown has jeopardized the health and stability of millions of family. Those families, most of them are living paycheck to paycheck. And our communities depend on those essential services. The government's reopened and we're really happy about that. But they have yet to reach an agreement.

on how they will address the extension of these tax credits under the ACA. state leadership, excuse me, Senate leadership agreed to bring up a separate bill on extending the tax credits in December, but didn't provide any details on what that would be. And we know currently that the House hasn't committed to a vote.

on this extension. So everything is still pretty much up in the air and what's going to happen. And these expire at the end of the year.

Corey Dion Lewis (04:45.836)
Right, right. And you mentioned that five million people could lose coverage entirely. And with rural Americans being disproportionately affected, why are rural communities particularly vulnerable here?

Sr. Mary Haddad (05:04.095)
Well, Corey, rural communities certainly are challenged just simply because there's less competition in those markets. the median income for people who live in rural areas are generally less than what we see for people and families that live in urban areas. So they're already starting way behind the finish line.

And it's a challenge for our members who serve in those rural communities to experience the impact that these cuts will have on healthcare. It threatens their ability to ensure the stability of those ministries. There could be potential cuts of service, potential closing of hospitals because of this.

So we're very focused on our rural hospitals and our rural communities because of this.

Corey Dion Lewis (06:01.57)
Yeah, and you know, your perspective, you know, leading the Catholic Health Association, you know, what are you hearing from hospitals and healthcare providers right now about how they're preparing or struggling to prepare for a potential lapse in these tax credits?

Sr. Mary Haddad (06:20.011)
Many of our hospitals and as I said particularly in rural communities already are operating on thin margins and they're always looking for ways to be more efficient and to better utilize what limited resources they have. But the reality we know those resources are finite. We don't have a bottomless pit of funds that will continue to manage this throughout the crisis.

And, you know, especially as I said, after the cuts with the Medicaid program were passed this summer, that just exacerbates the pain that is experienced by these hospitals. And as I said that, you know, these cuts will reduce services and perhaps even layoff staff are closed entirely. And then we have situations where

our most vulnerable areas, particularly in rural areas, communities are being left without access to healthcare and being forced to drive great distances in order to access both primary care and acute care services.

Corey Dion Lewis (07:33.314)
Yeah, and I kind of want to touch on that what you just said. One of the things you talked about was, you know, some of the health, these clinics already operating on very thin margins and the, you know, how people are going to use healthcare if things don't change. And you wrote powerfully about how the expiration of the tax credits would force more people to use emergency departments as their primary care option.

Can you walk us through what this means for hospitals that are already operating on very thin margins?

Sr. Mary Haddad (08:08.021)
Sure. Emergency departments are the most expensive part of a hospital system. So we have to recognize that. We have just very high technology, staffing. The cost of emergency care is very expensive relative to the whole of acute care services. So if we see people who don't have health care

who don't have access to primary care begin to utilize emergency room services as their means of accessing care, it's gonna put a dramatic increase on cost on these hospitals. Because we're taking the entree into healthcare in the most expensive way possible instead of looking at access through preventative and primary care services.

We also recognize that ER services are already overcrowded and overburdened. And with the increase that we're anticipating of uninsured utilizing emergency room as their source of care, we're going to have even a more challenging situation in these emergency rooms because of, you know, people coming there who really don't need emergency care.

So our hospitals are going to have to figure out how do we triage this in a way because everyone who presents themselves at an emergency room must be provided care. They have to be assessed, they have to be triaged, and they have to be either admitted or sent elsewhere for follow-up services. They have to be treated in the emergency room. That's federal law.

Corey Dion Lewis (09:56.494)
Mm-hmm

Sr. Mary Haddad (10:01.554)
So we can't get around that, but the challenge is when people start using ER for primary care, that puts added burden and added cost on the hospitals.

Corey Dion Lewis (10:12.64)
Yeah, and I can only imagine the fear of someone, know, you know, when people are going to do what they have to do to get the care they need, you know, especially during this time, but also thinking of, you know, that person who probably on paper really does need to go to the emergency room. What does that do for that time and their care too, because of everything that's going on?

Sr. Mary Haddad (10:20.021)
course.

Sr. Mary Haddad (10:37.897)
Right, and Cory, I also would like to share that I think it's important to recognize when people use emergency room services as the last resort, they've already delayed care. So when they do come, they're probably sicker than they would have been had they gone to primary care first or had the care that they needed. So when families lose coverage and they're trying to balance out

Corey Dion Lewis (10:52.558)
Mm-hmm.

Sr. Mary Haddad (11:08.802)
delaying access to health care so they could pay their rent, pay their utilities, get the healthy food that's needed for them to survive. By the time they come, they're really sick. And so we recognize the fact that not only is it going to be more costly, the acuity of those individuals in need will be higher than it would have been had it been through primary care.

Corey Dion Lewis (11:22.478)
Mm.

Corey Dion Lewis (11:37.322)
Right, wow. And I understand telehealth flexibilities are also at risk of lapsing. Though this has received less public attention, what would a lapse in these flexibilities mean for the patients and the communities you serve?

Sr. Mary Haddad (11:53.907)
Right. Well, thankfully, the compromise to reopen the government included a provision that reinstated the waivers and allowed for telehealth to continue to operate at least until January 31st, 26. So we have a little bit of time. but what's frustrating with that, these temporary extensions really aren't helpful. We have to make them permanent.

Corey Dion Lewis (12:10.869)
nice.

Sr. Mary Haddad (12:23.423)
because we're constantly adjusting to such an unstable system of care. We don't know if it's gonna be funded, gets pulled back. So we're continuing playing this back and forth with the government that's very frustrating. I wanna remind the listeners that telehealth actually has been core to healthcare delivery for years. It was really COVID that brought it into the

the spotlight because it was a means of being able to provide care to communities at a time when they were not able to come into the hospitals, when everyone was on shutdown. We had to recognize how would we continue to get the primary care to individuals who needed it. So telehealth was a tremendous resource during the time of COVID and the recognition that

it needs to be core to the delivery system. And so we see today that, you know, telehealth services really is a lifeline to millions of people across this country. Again, particularly those in rural areas who have an inability to drive, you know, miles, I would say one hour to two hour to provide to get the care they need. They're able to get it through telehealth services. You know, I would also say

Corey Dion Lewis (13:42.755)
Yeah.

Sr. Mary Haddad (13:48.971)
Cory, I think it was interesting. A couple of years ago, I was at one of our member systems in South Dakota and their hospital was surrounded by hotels. And I was taken aback by this because again, this is a very much a rural community, but all these hotels were surrounding the hospital. And I learned that people who come in for care, they often have to spend one or two nights in a hotel.

Corey Dion Lewis (14:18.808)
Mmm.

Sr. Mary Haddad (14:19.177)
because it takes them so long to get to the hospital or get to the care that's needed. And so think about the added cost of having to pay two or three nights at a hotel stay on top of what you're paying for your healthcare services. This is the challenge in rural communities.

Corey Dion Lewis (14:37.964)
Yeah, I hear things like that, Sister Mary, and it is so, even, my mind can't wrap, I can't wrap my mind around the fact that telehealth services, though we've seen it, like you've pointed out since COVID, that there is a huge benefit in this. It's almost necessary, the fact that it's not being seen like that.

is just strange to me. And to understand that not only is it serving the provider, but also serving the community in a way where the people are still seeing care and all the benefits from it, it makes you wonder what would happen if those flexibilities disappeared to the communities that we're trying to serve.

Sr. Mary Haddad (15:30.121)
And we also have to recognize the fact that we don't want to see inequities because people don't have the technology they need. We saw that during COVID when students had to remain at home and attend their coursework through internet. And for families that couldn't afford monthly fees on internet services, these children were left without access.

Corey Dion Lewis (15:49.484)
Mm-hmm.

Sr. Mary Haddad (15:58.067)
So as we look at telehealth and subsidizing that form of delivery, we have to ensure that everyone has equal access to those services.

Corey Dion Lewis (16:11.241)
No, 100%. It's kind of a great segue to my next question. You've framed healthcare as a fundamental human right grounded in the inherent dignity of every person. I really love that. How does that moral framework inform CHA's advocacy on these policy issues?

Sr. Mary Haddad (16:36.075)
Corey, I often say to people that our work is driven by our values and what we believe. So for us, these challenges are not financial solely. We know from a business perspective that it will impact financial services, but these challenges are fundamentally moral challenges, moral issues.

because we believe that every person is made in the image of God and therefore has inherent dignity. And our tradition teaches us that access to healthcare is inseparable from human dignity and the common good. So we believe that in very simple terms, good health is essential if one is to thrive and flourish.

And so our belief in the dignity of all people motivates us. So it is a moral issue for us when people do not have access to affordable quality health care.

Corey Dion Lewis (17:47.542)
No, that's understandable. As a mission-driven, faith-based healthcare providers, I would love to you tell me more about that balance. How do you balance the compassionate care mandate with the financial realities of an unsustainable policy environment?

Sr. Mary Haddad (18:11.669)
I have said to people that challenge that and say, do we do this balance? I say, by and large, we're a ministry that operates as a business. so we, not-for-profit healthcare in this country, in addition to Catholic healthcare, can say this, that our mission is really about ensuring care for the most vulnerable.

And so in order to continue to do this, day in and day out, our members are doing incredible work to keep the facilities open and operating even at these very thin margins. They rely on providers to help continue to fill the gap, but it's not realistic for us to think this can be sustained for the long term. We have many, many committed people working

in not-for-profit healthcare and Catholic healthcare throughout this country. And they're committed to ensure that the fulfillment of this mission. But realistically, they too have to pay their bills, right? So we can't assume that we can do this with no adequate reimbursement for the services that we're providing.

Corey Dion Lewis (19:32.717)
Right.

Sr. Mary Haddad (19:33.097)
Or I will also say that Catholic healthcare has been in existence in this country for years. And we've weathered very challenging times in the past. And I believe we will weather these challenging times. But we have to ensure that we have a government that will work with us in addressing the needs of the people of this country. So, you know, we have to push on.

Just policies just health care policies

Corey Dion Lewis (20:05.134)
No, understandable. And you know, what do you feel, you know, Sister Mary, know, what do you feel like, what specifically needs to happen in Congress right now to prevent any more damage? You know, is it a matter of weeks, days, hours? Like, what do you feel like needs to happen?

Sr. Mary Haddad (20:16.907)
I don't know.

Sr. Mary Haddad (20:21.547)
Well, it's a very critical time right now between, you know, what are we, mid-November and the end of the year. So we have, what, about six weeks left here and the tax credits will expire. So we have to really push Congress on acting. That's the bottom line. I read something yesterday that the administration is talking, Dr. Oz had come out there talking about

Corey Dion Lewis (20:28.14)
Yeah.

Sr. Mary Haddad (20:49.675)
the tax credits and what may or may not happen. So we're starting to get a little bit of a buzz that I think people are recognizing that there's a short turnaround time. Something needs to happen because we are really at the precipice of a looming healthcare crisis in this country. And it must be addressed and it must be addressed now.

Corey Dion Lewis (21:12.96)
Man, if you could speak directly to those lawmakers who are negotiating right now, what would you want them to understand about what's at stake?

Sr. Mary Haddad (21:25.387)
I think it's important to remind lawmakers that people are at stake. And oftentimes, you know, we get caught up in the financials and the numbers and the percentages and forget behind those numbers are lives. And so we need to paint a picture of those who are being impacted and what their stories are.

You know, these are families, these are children, these are elderly, vulnerable populations. These are people who are working, who are contributing to the communities and trying to raise families. And so I think that it would be very important to really stress that the impact this has happened is not on our budgets, it's on people.

Corey Dion Lewis (22:15.608)
I'm so glad you said that because you know, in this world, especially right now, we see the numbers a lot. You know, who is going, how many is going to affect, know, what the number is, what the data says. And some stuff I think it is easy to forget that these numbers are people. And with feelings, with things that are going on and it's going to change the trajectory of their family. And I think that's...

something that we need to keep in mind as we're looking forward because that six weeks with with the holidays coming up in between that it's going to come fast.

Sr. Mary Haddad (22:52.262)
That's right, absolutely.

Corey Dion Lewis (22:55.404)
You know, and I know it's kind of hard to think in the future right now with everything going on, but looking beyond the immediate crisis, what kind of longer term solutions do you think are needed to create a more stable and sustainable healthcare financing system?

Sr. Mary Haddad (23:16.843)
Corey, in the here and now, I will say that we need to continue to strengthen Medicaid, Medicare, the marketplace insurance, and our employer-sponsored insurance. Those are critical to the current system right now. So we have to ensure that as many people as possible can be covered through those means. We have to also, as I talked about earlier,

ensure that there's access to primary care. So we have the physicians, the primary care physicians who are paid appropriately, who are really the backbone of the healthcare delivery system. We have to ensure that we have sufficient primary care physicians throughout this country. Focus on prevention, focus on wellbeing. That being said, healthcare in this country is broken.

We have a very fragmented system of care, a very fragmented system of financing healthcare, and we have to recognize the fact that we have to come together, providers, payers, government, and figure out a plan how to do this and to do it well, how to create a just healthcare system in the United States.

We have kicked the can down the road for years. This system has been broken. And as I said, we're on the precipice, I think, of a looming crisis because I think we're at a point of saying the external pressures are such with dwindling resources that what we currently have cannot sustain us for the long haul. We have to change the system of care. And we have a responsibility to do that.

Corey Dion Lewis (25:07.25)
Man, % Dr. Sister, sorry, Dick, Dr. Sister. Sister Mary Haddad, thank you so much for being on the show today. For those listeners who want to understand or even take action on this issue, what should they know and what can they do?

Sr. Mary Haddad (25:11.071)
I'll take it.

Sr. Mary Haddad (25:28.179)
I would encourage the listeners to visit our website, chiusa.org, and learn more. I think the best thing you can do is get educated, know the facts, know the situation, to be able to speak to this, and then also to reach out to the member of Congress. I think it's important for people to speak up for your neighbors, your family members, the dignity of all people.

And we have a responsibility to do that. Government is just not a one-way street. Our government is only as good as our engagement with the populace. So I think it's very important that people speak out. So yes, I want to really emphasize the importance of learn the facts and become educated.

Corey Dion Lewis (26:20.558)
100%. Thank you so much. And I want to say, I asked you a similar question in June, but the answer was so good. had to ask you again, you know, despite the challenging landscape we've discussed, you know, what gives you hope as you continue this work?

Sr. Mary Haddad (26:40.139)
Corey, thank you for that question again, because it's interesting. I've been speaking a lot about hope recently, and I read a book, and there was an excerpt in this book. The book was on Pope Francis, actually. And I think I said to the listeners last time that this, church has declared a year of jubilee. We're coming to a close, but this year of jubilee has been on hope.

And the reflection that I read, and I hope I can do it, I hope, listen to me, I hope I can do it justice, that hope is not just, you know, something that's nebulous or, you know, something that we tuck away as invisible to us. It's not concrete. You know, we think of hope as,

something that's out there that we strive for. But this book said hope is actually concrete actions. Hope is something we do. And we do it because we believe in life and we believe in life for everyone. And we're committed to acts to ensure the common good. So hope is not something, you know, we aspire to.

Hope is something we do day in and day out through our actions because of what we believe and how we strive, I would say, for the common good. Excuse me.

Corey Dion Lewis (28:18.84)
No, that's great. Sister Mary Haddad, thank you so much for another powerful word. I don't want to say too much after that because that was also, again, it was great. Thank you so much for being on the show today. I really appreciate it. I will make sure that I have a link to the website in the description of this episode so people can get directly to it. And again, everybody, thank you so much for listening.

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