ObamaCare: What you need to know (Part 4): Christian health sharing ministries...

With all the uncertainty surrounding healthcare plans made available under Obama's Patient Protection and Affordable Care Act (PPACA), many Americans are wondering if there are any alternatives out there. Or, more to the point, is there any way to opt out of ObamaCare and not pay the penalty for not having medical insurance?

The short answer is "yes". According to this page on HealthCare.gov, you can avoid paying the penalty if:

  • You’re uninsured for less than 3 months of the year;
  • The lowest-priced coverage available to you would cost more than 8% of your household income;
  • You don’t have to file a tax return because your income is too low;
  • You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider;
  • You’re a member of a recognized health care sharing ministry;
  • You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare;
  • You’re incarcerated, and not awaiting the disposition of charges against you; or
  • You’re not lawfully present in the U.S.

(That same page also lists hardship exemptions.)

This post lists three different ways to "opt out" of ObamaCare, but I'm going to focus on just one: Christian sharing ministries. I am aware of three Christian sharing ministries:

  1. Samaritan Ministries
  2. Medi-Share
  3. Christian Healthcare Ministries

According to the websites of these healthcare sharing ministries (Samaritan, Medi-Share, Christian Healthcare), each will exempt its members from the penalty for not purchasing health insurance.

When I spoke to a representative at Samaritan Ministries about this exemption, he told me that they are actively lobbying to have "safe-harbor" laws for Christian sharing ministries added to the laws of every state. While a number of states already have positive, explicit legal protection for Christian sharing ministries, a number of them do not. It's still legal for these ministries to operate in states that do not have that explicit protection, but it certainly gives members peace of mind if the necessary laws are in place. For information on whether or not your state has safe-harbor laws for Christian health sharing ministries, click here.

I was also informed by the Samaritan representative about a bill in Congress being sponsored by Aaron Schock, a congressman from Illinois. HR3728 (PDF) makes members of health care sharing ministries eligible to establish health savings accounts. This would be a boon to anyone enrolled in such a ministry, since it would allow them to save money tax-free to help cover the cost of their medical needs.

Of the three ministries, I am most familiar with Samaritan. In a future post, I will provide an overview of Samaritan Ministries. I hope we can follow that up with more information about the other two ministries.

Before we move to the specific health sharing ministries, however, one important question needs to be answered:

Why should you join a Christian sharing ministry, and not simply sign up for ObamaCare like everyone else?

(Please understand that my answer to this question represents my views alone, and not necessarily the views of any other contributors to this blog.)

I think there are a number of compelling reasons to skip out on ObamaCare and join a Christian sharing ministry:

  • Cost. Depending on your family situation, it is entirely possible that it will be much cheaper than ObamaCare. Bear in mind that for many people there are two prices for an ObamaCare plan—the actual price, and then the subsidized rate they will pay. In my case, the sticker price for using a Christian sharing ministry will be much higher than the subsidized cost of the cheapest ObamaCare plan. However, many Americans will find that even their subsidized ObamaCare plans will cost them more than their previous health insurance plans, and much more than a Christian healthcare sharing ministry.
  • Freedom to choose your medical providers. Depending on the ministry, this is more or less true. Some Christian sharing ministries essentially make you a "self-pay" patient, meaning you can choose to get your medical care wherever you want. The bonus here is more cost savings for you. All hospitals and doctors are willing to negotiate on prices. Although this might sound scary, self-pay patients pay far, far less than the "listed price" for healthcare, and at least one ministry assists a great deal with any negotiations. Also, many healthcare providers are eager to work with responsible self-pay patients, as it means that they are able to collect their money without hassling with insurance companies and government paperwork. Another of the ministries has partnered with a large PPO, again providing a lot of freedom as to where you get your care, and presumably removing the need to negotiate the price. On the other hand, in many places ObamaCare has resulted in few or no choices about where you get your care. 
  • Quality of care. Speaking of choosing where you get your medical care, this affects quality of care. Numerous top hospitals are opting out of ObamaCare. If you're on an ObamaCare plan, and you want access to a quality hospital that has opted out, you'll simply have to pay out of pocket. (This same principle is at work in the story I told in this post.) And if you don't know, please understand: quality of care as well as outcome can vary enormously from doctor to doctor and from hospital to hospital. 
  • Opposition to the socialization of healthcare. The success of the PPACA depends on young, healthy, middle and upper class people joining and paying more for their healthcare plans. I don't know what kind of an impact health sharing ministries will have on the success of the whole endeavor, and I suspect it may be small. Still, it's a way to "vote with your wallet."
  • Personal responsibility. This may seem high-handed, but that's not my intention. I understand that those who purchase an insurance plan are taking personal responsibility for healthcare for themselves and their family. However, being a self-pay patient forces you to be much better educated about healthcare costs, to shop around, and to negotiate prices. In general, I think self-pay patients will be better informed and more proactive than others. If it's going to impact your wallet, you're going to pay attention.

Are their drawbacks? The answer, of course, is "yes", and I'll try to list those in the reviews of each ministry. Stay tuned.

Lucas Weeks

Lucas serves as an assistant pastor at Clearnote Church in Bloomington, Indiana. Although he pines for the warm, tropical weather that was familiar to him growing up in west and central Africa, he has since made peace with the harsher climates of North America.

Want to get in touch? Send Lucas an email!

Comments

Brother Lucas,

I can't tell you how helpful your work has been to me. For years I intentionally avoided studying the business of medicine in an effort to focus first and foremost on learning how to best take care of patients, medically speaking. Those days are over, and you've produced an amazing and helpful summary that's helpful both for patients and for those of us trying to take care of them.Love,

Lucas and Adam,

This is helpful. It's something I'm investigating this month. 

I had lunch with local missionary friends a couple of months ago to talk about tip his. They are with Samaritan. She negotiated pricing with the hospital and docs before surgery and now that the hospital has some experience with Samaritan patients, the hospital actually likes them. 

I started looking into this back in 1994 when "HillaryCare" was before Congress. I believe both MediShare and Samaritan have been around at least that long. 

Adam, I've already lost my primary care doc. I did find a new one, but am frustrated that I lost the only one I'd had in more than ten years that didn't either push drugs on me or lie to me about treatments. 

Your point about personal responsibility reminds me of an excellent article from the Atlantic Monthly from a few years ago: http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-...

Its a long article, but worth the read.  His main point is that because the cost of health care is obscured by insurance, patients fail to do due diligence in researching the cost and outcomes of health care providers.  This is one of the reasons that health care costs keep going up; people are not motivated to find the best deal (with the best outcome) for health care.

I'm a PCA pastor and have been a member of Samaritan Ministries for about 10 years and love it!  Feel free to email me if you have specific questions about my various experiences.

In the spirit of keeping with the house rules, I should say that the third comment in this post was posted by my wife, and not me. Our laptop filled in my name before she caught it.

Oh, well in that case, I guess I won’t bother to read the article, Alex. ;)

Anyone who is interested in a Christian health cost sharing should note the maximum benefit is in the $250,000 range (preemie babies, for instance, generally cost much more than this) and read carefully the per incident language--it's not like a regular deductible. 

Dear David,

Thanks for your comment. We intend to put up posts on the ministries in the coming days. Your advice to read carefully is absolutely a must, regardless of whether you are buying insurance, or signing up for a cost-sharing ministry. However, your statement about the maximum benefit is not true of all the ministries, and that’s worth noting.

-Joseph

>>> a number of compelling reasons to skip out on ObamaCare

Lucas,

These reasons don't seem to apply to private employer-sponsored plans. Is the decision you're addressing primarily that of those who are currently uninsured?

Daniel

Hi Daniel,

Employer-sponsored plans are in a completely different category. Remember, Obamacare was primarily meant to increase the number of people with insurance. All those companies that already had their employees insured weren't the problem. The problem was everybody else.

Right now the biggest problems with Obamacare primarily apply to those who cannot get insurance through their employer. Unfortunately, one of the consequences of Obamacare is that the number of people who are in that category is rising.

On top of that, some of the same rules apply to employee coverage, but some don't. Some will, but don't yet. In other words, look for major implications for employer-sponsored plans to hit next year or the year after.

-Joseph

The point I would stress here is that there seems to be a strange exception to the normal vetting process that occurs in dealing with these "ministries".

If a member of your church came to you for advice, and said they had been watching a televangelist with big hair at 2 a.m. on cable TV  asking for money, and they had decided to send him $300 per month, you would raise an eyebrow, and politely start asking vetting questions about how the oversight board is appointed, actuarial audits, who is being paid how much, etc. These "health-sharing ministries" tend to get a free pass. Try getting real data, not summary un-audited financials--good luck. They shouldn't get less scrutiny than the company that insures your house, for pete's sake. The new law gives a break--finally!--to large families. Go to healthsherpa.org or kaiser subsidy calculator.org, and see for yourself. 

>>there seems to be a strange exception to the normal vetting process that occurs in dealing with these "ministries".

Good point, Mr. Miltenberger.

Love,

@Richard,

I agree with your main point: these ministries should get more scrutiny, not less. And they should be happy for the scrutiny. It helps them remain faithful to their primary mission.

Samaritan's regular membership covers incidents to $250,000, but Samaritan has an inexpensive add-on program which covers everything above $250k, into the millions. The highest need shared to date was $1.5 million, negotiated down to $700k, all paid for. That add-on program is called Save to Share, and is setup really well and it's not expensive. Since those really high bills aren't very common, Save to Share participants keep their set aside portion in their own savings accounts until its needed. I wrote about it here: http://samaritanministries.info/save-to-share/

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