"I hope they don't take anything away from us."
Those were the words of a Baptist minister from Georgia named Daniel, uttered in my living room about five years ago as the Affordable Care Act (ACA) was wending its way through Congress. His daughter and mine had encountered one another while dining at a nearby restaurant, hit it off and we set up a play date.
We had an interesting conversation--intellectually, it was at a far higher level than most of the other parents I've spoken to during play dates. But it was also clear by dint of his background that Daniel considered pending healthcare reform with gimlet-eyed suspicion.
Anyone who hasn't been comatose the past several years knows by now that the ACA has been resolutely resisted by a wide swath of the Christian evangelical community. It's led by large corporations with nationwide operations such as Hobby Lobby, and thousands of ministers such as Daniel who convey the message at a local level. And as Hobby Lobby has been able to opt out of the contraception provision of the ACA, it turns out large numbers of Americans have been able to opt out of the ACA on religious grounds altogether.
The San Jose Mercury News recently reported that some 300,000 Christians nationwide are officially opting out of the ACA--including the tax penalties--by participating in healthcare "sharing ministries." Since the ACA has been rolled out, there's been huge growth in such ministries: enrollment is up by about 50 percent over the past year.
These ministries essentially offer to cover the medical bills of any individual who officially abides by a Christian lifestyle and attends church on an ongoing basis.
The anti-ACA come-on begins the second you land on their websites. "Sick of insurance? Come join us," says the home page of Samaritan Ministries, the largest of such payers with more than 120,000 members nationwide. Click on a link entitled, "what about the new federal healthcare law?" and the first sentence declares: "If you are a committed Christian, you do not have to violate your faith by purchasing health insurance from a company that pays for abortions and other unbiblical medical practices."
On the website of Medi-Share, the second-largest of these ministries with about 95,000 members nationwide, the home page pronounces: "learn how Christians are EXEMPT from the mandate to purchase health insurance in the healthcare reform law."
In other words, a blanket condemnation of perhaps the most significant acts of U.S. legislation in the past 50 years, but repurposed as a marketing tool.
That's not to say there aren't some facets of the ministries that appear attractive. The premiums for coverage appear competitive with plans available on the health insurance exchange. Medishare charges $320 a month and a $7,500 deductible for a family whose household head is in their late 40s. For Samaritan Ministries, it's $405 a month. And there is a genuine spirit of the members of these groups wanting to help one another.
But that spirit tends to dissipate the deeper you delve into the fine print of the coverage they offer (which, they stress, is not insurance). It's more instructive to list what is excluded from coverage by these ministries than what is covered. Cancer and cardiac care is not covered if you had a previous diagnosis in the past seven years. Diabetes care is not covered if you've had the condition within the past year. Colonoscopies and most forms of preventive care are excluded. And in many instances there are hard coverage caps of $250,000 to $500,000 for the care provided.
Medi-Share offers a 20 percent discount on coverage if you're not overweight or diabetic, but it specifically excludes coverage for weight loss counseling. And if you're even the passenger in an auto accident where the driver was drinking, coverage to treat your injuries is excluded.
Medi-Share also does not cover maternity care for any pregnancies that occur out of wedlock, unless the member was the victim of a "verifiable" rape. That's so close to former Republican Rep. Todd Akin's "legitimate rape" comment that sunk his 2012 U.S. Senate campaign in Missouri that any woman who would not find this clause disturbing is in some form of denial.
A look at Medi-Share's provider network is also instructive. On my home turf of Los Angeles County, it includes just a handful of hospitals serving a region of nearly 11 million souls. Few are well-known institutions, and it is entirely possible to live 60 miles or more from the nearest participating facility.
By contrast, the ACA has no lifetime limits on coverage, no pre-existing condition exclusions, pretty generous preventive care and income-based subsidies. And while there have been complaints about the narrow networks offered by some of the health plans, they are positively brimming with choices when compared to those of a sharing ministry.
It will be interesting to see if these ministries are able to get more hospitals into their networks down the line, but given their relatively paltry enrollment numbers, I do not see that happening any time soon. It may be time for some hospitals to provide the actual rundown of ministry coverage versus actual health insurance.
In the meantime, I see a lot of potential members facing an entirely avoidable bankruptcy because of the many coverage exclusions imposed by these ministries, or seeing a loved one traumatized a second time as they endure a potentially arbitrary and picayune rape "verification."
In short, these sharing ministries do offer an alternative to participating in the ACA. But the tradeoffs are so immense that the rationale of doing so should be questioned, even when factoring in the religious component. Instead, it appears the people who object to healthcare reform on religious grounds or fears of a confiscatory government should know that if anything is being taken from them, their own hand may play a leading role. - Ron(@FierceHealth)
