American governments are not supposed to own or operate religious institutions. But they do. Across the country, states run hospitals that enforce religious doctrine. The origins of these hospitals lie at the intersection of dramatic transformations in healthcare’s political economy and in Religion Clause doctrine.
They argue that the time is ripe for the field of Religion Law and Political Economy (RLPE). Not only can RLPE illuminate the sociolegal mechanisms by which institutions like government-religious hospitals develop, it can also point the way toward a set of concrete reform measures—from state “insourcing” of social services to embracing competition policy to transacting for church-state separation. The paper uncovers and catalogues the organizational structures underlying government religious hospitals—from public ownership of formerly religious hospitals that continue to operate in accordance with religious doctrine to joint ventures in which the public actor is subordinate to a religious partner in matters of faith and mission. Neoliberalism’s ascendance created fertile soil on which government religious hospitals took root. Policies favoring austerity starved the public sector—including the local governments that typically ran public hospitals—leaving powerful religious entities as attractive state partners. A revolution in Religion Clause doctrine escalated government-religious involvement and today makes it more difficult to unwind such arrangements than in the past.