Faith & Public Services
Mapping the $39 billion overlap between religious hospitals, federal social service grants, and the lobbying campaigns that protect the arrangement.
Published March 21, 2026
Key Findings
- Religious hospitals receive $39.1B annually in Medicare and Medicaid as the sole emergency provider in 72 counties covering 3,677,117 residents
- In 50 of those 72 counties, the same religious organization (or its affiliate) also receives federal social service funding — creating a 'double capture' of public health infrastructure
- Religious organizations received $4.9B in direct federal grants (2015–2026), led by Catholic Charities' $3.9B for refugee resettlement, housing, and Head Start
- Federal lobbying by major religious health systems: $35.2M with 396 filings (40%) flagging conscience-clause, RFRA, or reproductive policy language
- New York SPARCS billing data confirms restriction: Catholic hospitals document zero tubal ligations in 36 percentage points more cases than secular peers — even at hospitals performing 800+ C-sections annually
- In Erie County, NY: Catholic Health closed two hospitals (Kenmore Mercy 2021, Mercy Buffalo 2022), leaving Sisters of Charity (Catholic) as the only ER option for southtowns residents — while its affiliate Catholic Charities administers WIC for the region
- IRS Form 990 XML confirms: Bishop Fisher is named Chairman of Catholic Charities of Buffalo; Monsignor Zapfel (diocesan representative) sits on the Catholic Health System board — a single episcopal authority governs both the WIC program and the hospital
- CHS executives donated $12,500 to Gov. Hochul in 2022 (the year Mercy Hospital closed); six CHS officers are recurring HANYS PAC donors — HANYS lobbied Albany on hospital CON law during the closure period
Disclosure: Zach Beaudoin, who conducted this analysis, is a candidate for Erie County Legislature, District 11. The Erie County case study below documents patterns in Erie County governance. All findings are derived from public records; methodology is at /methodology/.
Religious hospitals, social service agencies, and family planning grantees receive tens of billions of dollars in annual public funding. In 67 counties, a religious organization operates the only emergency room. In 50 of those counties, the same religious institutional network also receives direct federal grants for WIC, Head Start, refugee resettlement, or other social services — creating circumstances where families in those counties encounter only religiously operated providers across multiple publicly funded service categories.
The Hospital Desert
A “hospital desert” means the county’s only emergency room is operated by a religious organization that follows doctrine-based clinical guidelines, such as the Catholic Church’s Ethical and Religious Directives (ERDs). The ERDs prohibit sterilization, contraception, emergency contraception, and abortion at all facilities that operate under them.
New York state billing data (SPARCS) confirms these restrictions are reflected in actual care: Catholic hospitals document zero tubal ligations at a rate 36 percentage points higher than secular peers — even at facilities performing 800+ C-sections annually.
The Double Capture
In counties where the only hospital is religious, low-income families often also encounter religious organizations when accessing federally funded services. Catholic Charities — the social service arm of the Catholic Church — received $3.9B in federal grants since 2015 for refugee resettlement, Head Start, housing, and nutrition programs (WIC). When the same diocesan authority governs both the hospital and the social service network, families may face no secular alternative within the county across multiple publicly funded service categories.
The Lobbying and Finance Loop
Religious health systems spent $35.2M in reported federal lobbying (2017–2025), with 40% of filings using language related to conscience exemptions, RFRA, or reproductive policy. Their executives and employees contributed $10.1M in documented federal campaign contributions across three election cycles.
In Erie County, New York — where Catholic Health closed two hospitals in 2021–2022 and its affiliate administers the WIC program — the CEO donated $12,500 to Gov. Hochul in 2022 and six CHS executives are recurring donors to HANYS PAC, the hospital industry’s Albany lobbying arm.
Erie County Case Study
Erie County is the clearest documented example of the double-capture pattern:
- Catholic Health (Trinity Health affiliate): closed Kenmore Mercy (2021) and Mercy Hospital of Buffalo (April 2022); Sisters of Charity Hospital (Catholic) is now the nearest ER for multiple southtowns communities
- Catholic Charities of Buffalo: confirmed WIC local agency ($66.2M); Bishop Fisher named Chairman on IRS Form 990
- Single authority chain: IRS XML confirms Bishop Fisher governs Catholic Charities directly and exercises indirect board authority over Catholic Health through his diocesan representative (Monsignor Robert Zapfel)
- Procedure restriction confirmed: Sisters of Charity: 863 C-sections/year, zero tubal ligations (NY SPARCS 2024)
Downloads
- Hospital desert counties (CSV)
- Double-capture counties (CSV)
- NY procedure gap — SPARCS (CSV)
- Federal lobbying filings (CSV)
For newsrooms: contact editor@thepublicledgers.org for the full dataset.
Explore Religious Healthcare Deserts
Counties where the only emergency room is operated by a religious health system.