Facing a Supreme Court decision that could dismantle a substantive chunk of his landmark health care law, whom did President Obama choose to appear with Tuesday to talk about the law? A nun.

Obama’s decision to give one of his biggest recent speeches about the Affordable Care Act at the Catholic Health Association, led by chief executive Sister Carol Keehan, is of course a way of showcasing prominent religious support for a law that has many faith-based critics. Keehan heads the nation’s largest group of nonprofit health care providers.

On Tuesday, Obama said the ACA would not have happened “had it not been” for Keehan. “And it’s true, I just love nuns, generally,” he said, “I’m just saying.”

Obama’s appearance also spotlights the sometimes complicated feelings faith-based activists have expressed about the law. While more politically conservative types have long been opposed on principle to expanding the government’s role in health care, religious Americans – traditional or more liberal – have sometimes been torn. They feel simultaneously that access to health care is a moral, religious issue and that the fight over the law at times had an anti-religious tinge.

The conflict, which continues as the ACA makes its way through the courts, centers on the White House mandate requiring employers to provide contraception at no cost to employees. The way the mandate initially worked set off many faith-based groups, including Keehan’s and other close allies of the White House, who felt it needlessly burdened groups who wanted an exemption to the contraception part.

In response, the White House tweaked the mandate a few times, and Keehan and other allies eventually came out in full support. Considering the U.S. Conference of Catholic Bishops – essentially the voice of the institutional church in the United States – was working strongly against the mandate, Keehan’s public support was no small thing. Other church groups joined her, including NETWORK, a Catholic lobbying group that focuses on social issues like health care and poverty.

On Tuesday, some faith leaders said the bruised feelings about the mandate were in the past, while others disagreed, saying the White House tweaks weren’t sufficient to keep all employers from violating their consciences. Among the many lawsuits the ACA is facing are those from people and groups who say it violates their religious freedom.

Meanwhile the current Supreme Court case, King v Burwell, doesn’t touch on religious issues, and among the large groups who have argued in the administration’s favor are the CHA and Catholic Charities USA.

“There was a bump in the road when the mandate came out, and I don’t know why the White House didn’t get that. It was elementary, my dear Watson,” said Sister Simone Campbell, executive director of NETWORK and a speaker at the 2012 Democratic National Convention. “They messed up, but in my view they fixed it.”

Campbell saw Obama’s appearance at the CHA as “a thank you” to Keehan. The event, she said, was planned before the issue was scheduled to come before the Supreme Court. King v. Burwell was argued in March.

“It’s the holy spirit,” Campbell said Tuesday.

Among the many faith-based groups who filed briefs against the mandate when it came before the Supreme Court last year was the Orthodox Union, one of the biggest Orthodox Jewish groups in the country. The offering of contraception didn’t pose theological issues for Jews, said advocacy director Nathan Diament, but a “trampling on religious liberty” did.

Michael Sean Winters, a fellow at Catholic University’s Institute for Policy Research and Catholic Studies who writes on politics and the church, said Tuesday that he felt the tension over the mandate has mostly faded “except for the hard-core activists.”

Bishops who opposed the law from the start were more vociferous because of the mandate, Winters said, which they see as anti-religious. But many are tired of religion being tangled up in expanded health care – an issue the Catholic Church has long championed, he said.

Speaking Monday to the Catholic Health Association, newly-named Chicago Archbishop Blasé Cupich called on leaders of Catholic health care institutions to keep in dialogue with others.
“Rather than dismissing or ridiculing the other, we should always give the best possible interpretation to our dialogue partners,” he said. Not doing so risks turning sacred theology into “a political and ideological battlefield.”

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