Each member is responsible for premiums, 'clean living,' many out-of-pocket expenses, and most importantly price shopping, similar to purchasing an automobile, or a mortgage, or even weekly groceries. IE: Hey, Doc, How much is this gonna cost? This effort recently found an ally in Pres. Trump who last month "issued a highly anticipated executive order on health care price and quality transparency. The White House also posted a fact sheet alongside the order. The goal of the executive order is to help consumers know the prices and quality of a good or service and to make informed decisions about their health care."
So, what does an HCSM pay for? Years ago, when self-employed, I had a catastrophic health insurance policy from a private insurance company. It's exactly how it sounds - I paid a low monthly premium (about $80?), plus paid for many routine, out-of-pocket expenses, but if I was run over by a bus, or stricken with cancer, the catastrophic costs were covered. However, in 2010, Obamacare outlawed those types of private market policies (let that sink in).
Health-care sharing ministries is a work-around which resurrects many aspects of the old catastrophic health insurance model, and when astronomical health care expenses arrive at your mailbox, each HCSM draws on its multi-million dollar endowment to cover those expenses.
From Lauren Fink at The federalist:
"For nine years, as Obamacare tore through American households and clinics and hospitals, HCSMs quietly grew—twice, thrice, and now nine times their size. Today there are 1.2 million HCSM members, and their medical expenses covered by sharing ministries exceeds $1 billion annually. Membership is expected to reach 1.68 million by 2020.Personally, I don't find any of that 'too off-the-grid.' Traditional health insurance has the 'tobacco-free' check box in exchange for a lower premium; recent changes in the law require a premium penalty for any spouse on your employer provided plan when that spouse could be covered by their own employer plan; reasonable and customary, reduced or refused payments are health insurance form letters we've all read; and until 2010, with the authoritarian commands of Obamacare, mental health care - like substance abuse treatment - was an option, not a mandate; plus, who hasn't screamed at the clouds when confronted by the brick walls of the 'out-of-network' maze?
Growth has its pains, and some HCSMs are under fire over issues of quality and honesty. Member complaints within Liberty HealthShare and Aliera Healthcare Inc. have raised red flags in several states, especially Washington state, where both were ordered in May to stop operating.
Joining a health-care sharing ministry is not without its risks and downsides. HCSMs are not insurance and cannot guarantee payment; this might be too off-the-grid by itself for many people. Most HCSMs have far less comprehensive “coverage” than traditional health insurance. Some, like Medi-Share, require members to never use any tobacco products and can cancel membership if it’s discovered that a member has smoked even one cigarette.
HCSMs typically aren’t set-it-and-forget-it as health insurance, whether it’s paying up front for prescriptions or medical care, sending in reimbursement forms, or realizing that preventative medicine even for children isn’t always shareable, and finding cheaper options for vaccines, which can cost about $1,000 in each child’s first two years of life. Mental health care is not covered by any HCSM."
Most of us are creatures of habit, resistant to change, yet just like the FICA withholding mirage of 'I didn't pay taxes; I got a refund,' perhaps we've all gotten a bit too soft within our set-it-and-forget-it, 'Insurance will pay for it' comfort zone.
Health-care sharing ministries might be the best free market alternative to driving down astronomical health care costs.
