The debate over health care reform frequently focuses on government policy and programs, often to the exclusion of nongovernment solutions. In this article, part of an occasional series, Sean Parnell reports on how individual citizens, associations, and companies are solving health care problems using markets and voluntary action rather than government programs.
The rising cost of health insurance, particularly in states that impose burdensome regulations and mandates on insurers, has priced many people out of the market. Estimates vary, but research has shown between 14 percent and 25 percent of the uninsured lack coverage because government mandates have driven up the cost of insurance beyond their ability to pay.
Insurance mandates tend to hit especially hard those individuals and families who don’t receive health benefits from an employer. Insurance mandates don’t affect large employers who self-insure, and even employees at smaller firms enjoy a substantial tax preference over those who buy insurance in the individual market.
Sharing Societies
As an alternative to traditional health insurance, some Americans are turning to Christian medical sharing societies. Such organizations offer benefits similar to insurance, but they rely on voluntary giving and association along with a commitment to live according to “Biblical principles.”
There are several different programs, with names such as Christian Care Medi-Share, Samaritan Ministries, and Blessed Assurance Bulletin. Although each is structured somewhat differently, they are generally organized along similar lines.
Rather than charging a premium like health insurance, medical sharing societies ask members to commit to regular monthly contributions to meet the needs of other members with medical expenses. Monthly contributions, often called “shares” or “units,” range from $33.75 for a single person who joins Christian Brotherhood, to $420 for a family of three or more joining Blessed Assurance Bulletin.
Christian Brotherhood’s executive director, Howard Russell, explained medical sharing in this way: “Every Sunday, every church in the country collects an offering for its needs. We work the same way every month, we take an offering for our members’ needs.”
Government Mandates
There are approximately 1,800 mandates on health insurance in the 50 states. For example, 11 states require that acupuncture be covered. Connecticut requires that insurance policies cover wigs for chemotherapy patients, and Massachusetts is one of several states that require insurers to cover infertility treatment.
Because insurance companies are mandated to cover such services in all their policies, some individual buyers of insurance are forced to pay for services that conflict with their own values or subsidize what they may view as destructive or unhealthy lifestyles. For example, some states require that insurance cover contraception, which may conflict with some people’s religious views. Other people simply don’t see the need for insurance to cover the expense of relatively low-cost items like contraception or wigs.
Medical sharing plans typically require that members pay a certain amount before they submit their needs to the organization, similar to insurance deductibles. Medi-Share, for example, has a “member responsibility” of $250 or $911 depending on the plan selected, while Christian Brotherhood offers “personal responsibility” levels ranging from $500 to $5,000.
Christian medical sharing societies require that their members adhere to certain standards of behavior. Typically, members must agree to abstain from tobacco and illicit drugs, limit alcohol consumption, and not engage in sex outside of traditional marriage. In addition, they are required to have their pastor attest to the fact that they regularly attend church (if health permits) and are “living by Biblical principles.”
Programs Cost-Effective
The contributions paid by members of Christian medical sharing societies can be much less than the premiums others pay for health insurance.
In Illinois, for example, a Blue Cross/Blue Shield insurance policy offering 100 percent coverage after a $250 deductible with a maximum lifetime benefit of $5 million has an estimated monthly premium of $235 for a 35-year old male, according to online health insurance broker ehealthinsurance.com. Medi-Share’s “250 Program,” offering essentially the same benefits, has a “monthly share amount” of $145.
The difference is even more stark when comparing medical sharing to insurance in states with guaranteed issue and community rating, two of the most costly mandates enacted by some states.
In a February 2004 Health Care News article, “The New Jersey Car Wreck,” the late Conrad Meier reported the lowest monthly premium available in that state’s individual market for a family policy was $1,208, for a PPO plan with a $1,000 deductible offered by Oxford Health Plans. A medical sharing plan through Christian Brotherhood offering similar benefits would cost $202.50 a month.
Pitfalls Typically Overcome
One potential drawback to medical sharing plans is that they do not have large networks of doctors and hospitals with negotiated discounts, which can mean higher prices for medical care. Medical sharing societies have managed to successfully address that issue.
According to Russell, members first ask medical providers for discounts for cash payment, and they often receive them. In addition, Christian Brotherhood has a Reductions Department that will work with members and providers to lower health care bills, averaging about a 50 percent reduction in bills. They also have been able to build relationships over the years with many providers so discounts are given to Christian Brotherhood members without being asked.
The other potential pitfall is that these associations are voluntary, meaning there is no legal obligation between members to provide funds for medical expenses. Members rely on the “good faith” of their fellow Christians to help them in their time of need. Many of the organizations point to Galatians 6:2 in the Bible, “Carry each other’s burdens, and in this way you will fulfill the law of Christ,” as their guide.
To date, however, this potential problem apparently has not materialized. Medi-Share says every eligible need has been met since its founding in 1993, more than $150 million in medical expenses shared among more than 50,000 members. Christian Brothers has paid out more than $400 million in the past 10 years, according to Russell.
Medical sharing societies offer an option for persons priced out of health insurance markets as well as for those who simply don’t want to pay premiums to subsidize unnecessary care or destructive lifestyles.
May Work for Others
Russell, for one, believes a medical sharing society model could be used successfully with other groups, such as fraternal organizations, other religious groups, or labor unions. “Some states even treat us as fraternal associations,” he notes. “It ought to work for other groups too.”
There is little doubt medical sharing works for those who are members, offering protection against large medical expenses at affordable rates. These societies benefit from some selection by excluding people who engage in high-risk lifestyles such as drug abusers and adulterers. Since most Americans are not drug abusers or adulterers, the medical sharing model would seem to be one that would work for millions of Americans.
Policymakers seeking to expand health care coverage should consider the model Christian medical sharing societies have adopted: a voluntary association of people with a shared bond and commitment to helping meet one another’s needs.
Sean Parnell ([email protected]) is vice president-external affairs for The Heartland Institute.
For more information …
Visit the following online resources:
Christian Care Ministry http://www.tccm.org/
Christian Brotherhood Newsletter http://www.christianbrotherhood.org/index2.html
Samaritan Ministries International http://www.samaritanministries.org/
Blessed Assurance Bulletin http://www.christianet.com/blessed/
Sean Parnell ([email protected]) is a research fellow for health policy at The Heartland Institute.
