The United States Supreme court today upheld much of the health care reform act, especially the provision that mandates every American to purchase health care insurance.

The 5-4 ruling of the justices affirms health care coverage for an estimated 30 million Americans, but did not remedy some provisions that the United States Conference of Catholic Bishops (USCCB) finds most troubling.

The mandate for Catholic organizations to provide coverage for contraception and sterilization, with little alternative for conscience exemption, was not specifically resolved in the ruling.

In a statement July 28, the USCCB said that for “nearly a century” Catholic bishops have called for “comprehensive health care reform to ensure access to life-affirming health care for all, especially the poorest and the most vulnerable.”

The bishops’ conference opposed three major provisions of the Affordable Care Act (ACA), as the health care reform law is known.

• The law allows federal funding to pay for abortions and for plans that cover abortions, which the statement said “contradict(s) longstanding federal policy.” It added that the Department of Health and Human Services (HHS) has already approved “”high risk’ insurance pools that would have covered abortion.”

• Language for “essential conscience protection” is not included in the law, the statement said. The lack of conscience protection for the law’s mandates is apparent in HHS’s “preventive services mandate, which forces religious and other employers to cover sterilization and contraception, including abortifacient drugs,” the statement said.

• Immigrant workers and their families are not treated fairly by the law, according to the statement. “ACA leaves them worse off by not allowing them to purchase health coverage in the new exchanges created under the law, even if they use their own money.”

The U.S. bishops have not joins in some efforts to repeal the ACA. But the high court’s decision on President Barack Obama’s signature initiative as president “neither diminishes the moral imperative to ensure decent health care for all, nor eliminates the need to correct the fundamental flaws” that the bishops’ identified, according to their statement.

“We therefore continue to urge Congress to pass, and the Administration to sign, legislation to fix those flaws,” it said.

— Matthew Gambino