Government's Religious Hospitals

69 Pages Posted: 12 Sep 2022 Last revised: 5 Apr 2023

See all articles by Elizabeth Sepper

Elizabeth Sepper

University of Texas at Austin - School of Law

James David Nelson

University of Houston Law Center

Date Written: September 28, 2022


States are not supposed to own or operate religious institutions, but they now do. This Article uncovers that across the country, church and state have merged, joint ventured, and contracted to form public, yet religious, hospitals. It traces the origins of these curious institutions to dramatic transformations over the last forty years in the political economy of healthcare and the constitutional doctrine of church and state. At stake are the foundational commitments of secular government to equal citizenship and religious freedom.

Yet, constitutional litigation offers limited recourse. In an increasingly religious marketplace, only sustained attention to the political economy can reverse the confluence of church and state. This Article proposes strategies to unite religion law and political economy and to move from religious domination to pluralism and from discrimination to equality. As government-religious institutions proliferate beyond healthcare—in schools, prisons, police departments, and child-welfare agencies—reform efforts must take on broader trends toward consolidation, privatization, and religionization of the economy.

Keywords: hospitals, church-state, establishment, religion, privatization, healthcare

Suggested Citation

Sepper, Elizabeth and Nelson, James David, Government's Religious Hospitals (September 28, 2022). 109 Va. L. Rev. 61 (2023), U of Texas Law, Legal Studies Research Paper , Available at SSRN: or

Elizabeth Sepper (Contact Author)

University of Texas at Austin - School of Law ( email )

727 East Dean Keeton Street
Austin, TX 78705
United States

James David Nelson

University of Houston Law Center ( email )

4170 Martin Luther King Blvd.
Houston, TX 77004
United States

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