Most people, most of the time won’t be too sick. Of the people who do get sick, most people won’t be too sick. But there are a few people who will get very sick and need very expensive treatment.
Health insurance in the post-PPACA world covers these people by removing life time caps. But in a genuflection to the sensitivies of the religious, PPACA exempted several clusters of quasi-insurance from regulation and allowed for not quite insurance to count as insurance for mandate purposes. The New York Times reports on a health sharing ministry in Texas:
members promise to abide by a lifestyle that includes frequent church attendance, little drug or alcohol use, and no premarital or gay sex. Monthly fees at Samaritan range from $180 for an individual to about $400 for a family, with members paying the first $300 of their medical bills out of pocket.
Samaritan members send medical bills to the ministry, which in turn directs other members to mail their monthly payments to the person in need. If there is not enough money available in a given month, members receive a percentage of their request and hope to be reimbursed later when there is more money to go around….
In addition, members are essentially putting their faith, and medical bills, in the hands of the network without assurances that they will be paid. Most members also face a lifetime cap of $250,000 per medical condition — an amount that can be easily spent if a person is seriously injured or faces a long-term illness….
Health policy experts say the ministries rely on the fact that their members are mostly young and healthy, and on some coverage limits. The ministries do not pay for some of the most expensive care, like treatments for pre-existing conditions, that federal law requires of traditional insurers. And if a ministry member contracts a sexually transmitted disease, he or she has to foot the bill….
In insurance terms, the ministry in question is offering a decent size but cherry picked risk pool with significant pre-exisiting condition limits, medium to high deductibles for routine care and fairly low lifetime caps for fairly low premiums. If it was not religious, these plans would have died with PPACA as they would slowly lose their grandfather status.
Yet, for most people, most of the time, this is not that bad of a deal as most people, most of the time are fairly healthy, especially if you can limit your covered population to mostly younger families. But God help someone if they get shot by a formerly responsible gun owner who needed a twenty round magazine for his semi-automatic rifle to get a single deer, get hit by a bus, or have a kid with cystic fibrosis or have a nasty and complicated cancer as this insurance won’t protect them.
Prayer is not a good public policy for tail risks.
And to your last line I’ll say “amen”.
My assumption is that when disaster strikes (at least an on-going disaster like the kid with CF or the cancer) then they’ll be expelled from the “ministry” for lusting in their hearts or failing to discern God’s position on Ukranian trade policy or something. Then, because of this life-changing event, they’ll be eligible for ACA plans and the rest of us will be carrying the free riders… as usual.
In other words, the sick person is totally dependent on the kindness of congregants.
Protestants. Who will form a new church when they don’t like the color of the new choir robes.
Do these “ministries” work with providers similar to traditional insurance companies or are their beneficiaries on their own when it comes to negotiating price and payment terms? I recently had relatively minor surgery and was surprised by how many different entities were involved and billed my insurance company. It would have been a nightmare dealing with it on my own.
Snarki, child of Loki
The REAL question is: “do they cover SNAKEBITE treatments?”
Whenever I hear some rightie say “oh, just go to a church for help with you bills” I wonder just how wealthy their church is? I’m a member of a fairly healthy mainline Presbyterian church and the bills from just one uninsured member with cancer might bankrupt us. It took a year of fundraising and three years of extra pledges to buy a new furnace/AC and to fix the elevator that some elderly members use to get to the chapel. Hell, if we could pay medical bills we wouldn’t need to make sure to provide health insurance to our minister and staff!!
I know that religious belief is so fragile a flower that we must not ask that churches make any sacrifice to continue, thus no taxes. But betweeen this and the exemption from being required to vaccinate their kids this protection of religion is way, way to much. This puts their membership at risk and the vaccination thing puts the rest of us at risk. Sadly, since our elected officials have to get RE-elected, they will continue to cave to the demands of various religions. So many religions would pitch one huge fit if asked to live by the rules that the rest of us do.
(Yes I know the anti-vaxxers can use “we believe that vaccinations are dangerous” as an excuse, but that is ridiculous as well and they too would pitch a fit with every libertarian pitching one alongside them because “Freedom!”. )
ALL YOU HEATHENS JUST DON’T PRAY THE RIGHT WAY, THAT’S WHY YOU ALL GET SICK. OR HIT BY BUSES. OR SHOT BY INNOCENT GUN OWNERS. LEARN TO PRAY THE RIGHT WAY!!!!!
Sister Rail Gun of Warm Humanitarianism
Actually, it’s because the churches are supposed to be doing charitable work with that untaxed money.
I would be all for allowing them to continue to be tax-exempt so long as the money over and above average operating expenses went to, say, feeding and housing the poor instead of building a Crystal Cathedral. But that would require them to keep records and be audited and all that nasty worldly stuff….
@Jado: There are Christian wingers who believe exactly this. That bad things only happen to those of too little or inadequate faith. It’s like the book of Job gets totally ignored by them.
@Sister Rail Gun of Warm Humanitarianism: And unfortunately the IRS division that enforces that is tiny. And the IRS just had a huge budget cut that will most likely continue in the near future. So they’ll continue to get away with it.
Yee of little faith! If you find yourself in the tail, that’s because deus lo vult as you were a naughty boy/girl.
Wow. I didn’t realize that PPACA allowed such exceptions. I’m surprised that more organizations haven’t driven a truck through that opening. Sounds more encompassing than what Hobby Lobby was doing.
One of our new-hired employees a few years back declined coverage, as he and his wife were “already covered” by one of these scam outfits. She was four months pregnant at the time.
I thought he was insane and told him so directly. He didn’t like that, and I probably shouldn’t have said it, but damn.
Thankfully, he left two months later. I really didn’t want to know how that story ended.
These operations ought to be banned and prosecuted.
@CONGRATULATIONS!: I disagree, those operations should continue, but people who are in them should also be required to buy top-off coverage to cover the $250,000 claim every now and then.
Speaking of faith based medical decisions, I just found out that the reason my son hasn’t been able to play with one of his friends over the holiday break is because his friend has whooping cough. I was really shocked to learn that they are anti-vaxxers.
@Richard Mayhew: They won’t do it. One of this person’s specific issues with health insurance was that it was, well, insurance. Apparently the most hardcore of the hardcore look upon insurance as gambling and “refuse to participate in such a mocking of the will of God”. Those words are verbatim, by the way. Kinda hard to forget that level of crazy.
So yeah, I’d be fine to let them participate in their make-believe system if they had something to cover the inevitable car accident or cancer, but apparently to them such is anathema. Therefore my sentiments about banning and prosecution. I’d also be fine with their crazy cost-sharing ideas if hospitals could simply refuse to treat people who can’t pay, but they can’t (and shouldn’t) and we end up eating the bill in the end. Which I am not OK with. You can pay for your religious beliefs, but don’t ask me to.
@CONGRATULATIONS!: Some parts of this country are so rightwing religiously that the ACA probably had no choice but to allow these makeshift health insurance plans to continue. I agree with you that in most other developed countries, such plans would be laughed out of existence.
My reaction to this was to think about how vulnerable to fraud it is. How hard would it be for someone to gin up a fake or exaggerated health incident and then get reimbursed? It doesn’t sound like these ministries have an extensive fraud investigation unit. The second you have a bunch of people getting together to do something based on “faith” — particularly when money is involved — it’s almost guaranteed to collapse in a shitstorm of corruption, fraud, and abuse.
Mike in NC
@Patricia Kayden: Only in effing Texas would some loon seek health care from their church.
This approach is modeled after how the Amish operate. As the Amish get exceptions for this (they are even exempt from Social Security), I am sure there would be a lawsuit if we prohibited this for other religious organizations.
These are the same people who talk about being able to barter a couple of chickens & apples for a doctor’s visit. And they also think that a $2 tip is very generous.
Do these religion-based “health plans” bargain for discounted rates the way regular insurance companies do? When I was hit by a truck while riding my bike, the undiscounted bill for the initial two week hospital stay was $250,000, but I think my insurance ended up paying about $65,000. And that quarter mill doesn’t count the doctors’ fees, the expensive antibiotic when the rod in my leg became infected, the surgery to remove the rod, or the stay on rehab. I thought right-wingers were supposed to be fiscally conservative?!
One of the best parts of the ACA is the abolition of lifetime caps. The cap at my company was $1.5 million. I’m in the midst of a 2nd go around with thyroid cancer. If the cap was still in place, I would be about halfway to that amount.
The ban on denials for preexisting conditions is also huge IMO. I have no plans to change jobs, but I now feel like I at least have the option to consider a change if the right opportunity came along.
Have a safe and happy new year everyone!
You don’t need a very complicated cancer to blow through 250 grand. My wife’s breast cancer, diagnosed early and with straight-forward, successful treatment, ended up costing that much.
I’m at about $500k for my first diagnosis in 2009 and the recurrence in 2014.
Also had an ACL reconstruction in 2012 that totaled close to $50k with the physical therapy included.
Still not finished with the latest bout of thyroid cancer. I just went ahead and signed up for the max of $2500 in my 2015 flexible spending account.
I’m lucky that I have good insurance through my job. I sometimes think about looking elsewhere. I have enough time in to have maxed out with PTO. It’s hard to think about giving that up.
Hope your wife stays in remission!
Fixed that for you. If Gawd-bothering is good at one thing, it’s filtering the general population into a never-ending stream of hopelessly-gullible fuckwits who’ll believe anything.
They accept members all across the US, not just Texas. The limit is $250,000 per “need” which is one illness or accident. Members pay list price to doctors/hospitals and must administer all the bills themselves. As for the possibility of fraud, members
And pastors are always reliable, of course.
Here’s an example of the difference between what is billed and what is paid. For one unlucky patient:
Medical bills last year: $1,239,968.72
Total payable* last year: $382,969.32
Unpaid difference was $856,999.40, most of it due to rates negotiated by the insurance company but also some 10s of thousands in hospital double billings.
Most of the expenses were for one major illness with continuing expensive care expected this year so WAY beyond any $250k cap.
* By both the patient and the insurance company