Religious Communities Develop around…Health Insurance?

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March 10, 2016; New York Times

Healthcare sharing ministries (HCSMs) are a growing alternative approach to health, confronting the often-catastrophic costs of medical care while at the same time building a religious community. They also allow their members to meet the requirements of having healthcare coverage that is part of the Affordable Care Act while not having to submit to government regulation.

Based on what are described as biblically rooted principles of community and the shared responsibility of Christians for the needs of others, HCSMs are not insurance policies and do not guarantee that they will be able to pay all of their members’ bill. As a group, each ministry’s members takes a “leap of faith,” as described by a ministry member in a recent New York Times article: “There’s a little bit of fear going into it. What if people don’t pay their share and what if the money doesn’t come in? But that’s where the faith-based part comes in—I’m really going to rely on God.”

Since the ACA was enacted, membership in health ministries has grown to over half a million people willing to accept this risk. They are currently able to share responsibility for over $500 million in medical bills annually. The ministries match the needs of their members with contributions their members are asked to make. According to the Alliance of Health Care Sharing Ministries:

A group of committed Christian participants…have offered to give a certain amount each month. This money is shared among the participants to assist those with medical bills. […] This brings Christians together to share medical bills with one another. The key is that medical needs are shared among participants. The personal approach of HCSMs facilitates Christians to bear one another’s burdens in a very tangible way. Biblical principles are foundational to HCSMs and the participants treat each other with respect, prayer, and genuine care.

In addition to helping to pay members’ bills, HCSMs provide a network of others who can provide human connection in time of need and pray for those struggling with illness. Many find this sense of community missing from insurance and government programs and a very attractive feature of HCSMs.

Daniel Alders, an HCSM member, told the New York Times that, “This is a solution for those of us who see the ACA as a problem. […] A community is an organically grown organism, so it can’t succeed if it’s pushed and enforced from the top level down. You have to have a moral foundation, a reason to trust those whose needs you’re sharing.”

Beyond lack of guaranteed coverage, there are tradeoffs. HCSMs may require their members to pay their bills directly to the service provider, forcing them to wait several months before receiving any reimbursement. Furthermore, some services covered by ACA insurance policies are not eligible for what appear to be moral or spiritual reasons:

Pre-existing medical conditions are often not covered, nor are preventive care, mental health and injuries resulting from behavior the ministry considers immoral or reckless. Members who acquire a sexually transmitted disease from an extramarital affair are out of luck, for instance, as are those injured while driving drunk or during a melee. Members are required to live a Christian life that meets the high standards of their HCSM.

HCSM members seem happy to assume these limitations and the greater in exchange for their coverage being in line with their religious principles. One member told the Times that “joining…allowed them to live by their religious beliefs rather than follow a government mandate to buy insurance that may cover things they do not want to pay for, like abortion or birth control.” Another said, “There’s something different about writing my check to someone who needs it. I feel like I’m loving on somebody instead of just paying my premiums.”

As long as the ability of members to offset the costs they face stays positive, there is much to say for this approach. But the lack of guaranteed coverage in the face of an aging population and the high cost of new, innovative treatments means this approach is not a viable alternative for most Americans.—Martin Levine

  • Jim Cross

    Your conclusion that health sharing ministries are “not a viable alternative for most Americans” may be partly correct, but for altogether different reasons.

    “Guarantees” of coverage are dubious, and dependent on viable risk pools and sound actuarial assessments. For example, the failure of health co-ops in the face of irresponsible funding projections coupled with the federal government’s failure to fulfill promises to subsidize them left many co-op members stranded with unpaid bills.

    The macro pressures of an aging population are affecting all health plans. Insurance companies manage this by rationing care. There’s no silver bullet for this problem. We all need to moderate our expectations regarding end of life care. Doctors for example, often do not follow their own advice for cancer treatment, preferring a shorter, more fulfilling and meaningful end of life, as opposed to buying a few more months with radiation, chemo, and the illness and financial ruin that it brings.

    New, innovative treatments need not be costly. The best new treatments reduce the length of hospital stays, are less invasive and as a result, less costly.

    Costs in health care have risen dramatically for several reasons. One, it’s a third party payer system, where no one is responsible for watching the bottom line, and nobody knows what the true cost is. Second, a code driven fee-for-service model rewards activity based on volume. Third, the insurance industry with all of its’ administration and red tape adds a huge burden of overhead to health care, and adds no actual direct patient care. Note that the ACA legislation was all about insurance, not about actual health care.

    Health care sharing ministries are actually at the cutting edge of consumer driven health care, which puts responsibility back in the hands of the patient and their providers, with no intermediary. Many practitioners are beginning to appreciate the freedom and simplicity of not dealing with insurance companies.

    Networks and insurance companies often require additional testing before access to a procedure is granted. In a bid to ration access to expensive procedures, insurance actually adds volume and cost. Networks will tout savings of 30-40%, but the hospitals chargemasters are already inflated beyond reason. This cozy arrangement between hospitals and insurance companies helps the hospitals pay for their facilities and keep everyone well fed.

    By taking the insurance companies and networks out of the middle, patients can become their own best advocates, shopping for their care based on price, pressuring providers to be transparent in their pricing, and making decisions with their providers without regard to the protocols of network gatekeepers.

    So, health care sharing ministries are not for everyone. Too many Americans are conditioned to passively consume health care, blindly accepting the pronouncements of the gods in the white coats, and focusing on their co-pay and deductible, not realizing the true costs. Yet, as ACA plans increase deductibles and pass more cost to the patients, everyone will start asking questions and requiring more transparency from their providers. There are only two groups that I can think of who might not be benefit from health care sharing ministries – public employees and union members. Those are the two groups of people who are often insulated from economic reality.