The I-Hate-Obamacare Chronicles has its predictable chapters, written by entrepreneurs who don’t want Uncle Sam telling them they must either insure their employees or pay subsidies. The citizens forced to drop substandard policies in favor of more expensive, yet more inclusive, policies, have penned their objections. (These healthy people don’t yet recognize the worthlessness of the policies they are mourning.) And the well-insured, wealthy solons who blather against Obamacare in Congressional tirades have added their harangues – part of their life-work to block whatever this President has done.
Religious people, members of conservative sects that deplore extramarital sex, drugs, alcohol, and tobacco (the two-fer vices that are both immoral and unhealthy), have also spoken up. They see immoral people as unhealthy people, and the moral ones are loathe to pay for the diseases of the larger pool of immoral Americans.
The good news for the moral ones: This Act allowed them an exit: they can join faith-based collectives that pool premiums to pay medical bills – a different variation of risk-based insurance, called “health-sharing ministries”. (They can join only those that have been in operation since 1999, to preclude the scams that might otherwise surface.) Enrollees will not face a tax penalty for being uninsured. The catch: the enrollees pledge to live faith-based lives, eschewing the litany of unhealthy sins. As a reward, the right-living pool will not need to pay for sexually transmitted diseases (HIV, AIDS, Chlamydia), abortion, or diseases linked to alcoholism, drug abuse, or smoking. Presumably, their costs will be lower than for the larger pool.
More good news: 26 states have exempted these ministries from state regulation. The government is off their backs.
Enrollees pay a hefty price for getting government off their backs. The backbone of a risk-based pool is numbers: the higher the numbers, the greater the spread of major catastrophes — and the smaller the premiums. (That is probably why enrollees in faith-based ministries may well gravitate to Medicare once they turn 65 – reluctantly accepting the protection of government). These ministry pools are small, compared to national pools. An enrollee, even one with a low income, can face a deductible as high as $10,000. And where the Affordable Care Act subsidizes enrollees with low incomes, the participants in these ministries get no subsidies. Nor do they get the protections considered basic to public health: free immunizations and preventive care visits, a cap on expenditures, and general oversight of the policy’s management.
An article in the Charlotte Observer describes one pastor, a member of one such ministry. With a $10,000 deductible, he faced a bill for over $1,000 for immunizing his children (later negotiated down to $400). Under the Affordable Care Act, the visits would have cost him nothing. The ministries suggest that enrollees willingly pay whatever the plan may cost – though the publicity hints that since the pool will not be subsidizing abortion, drug treatment, etc, the overall costs may be lower than among the profligate general population. This pastor did not complain about the higher cost, but did lament the lack of government subsidy for his children’s immunizations. (The government would have subsidized the visits of uninsured low-income children.)
Faith is laudable. And sins are sins. Yet these members have selectively chosen their sins to avoid. The ministries’ publicity omits gluttony and sloth, yet obesity springs in large measure from these two sins. And obesity ups the risk for diabetes, heart disease, arthritis, and certain kinds of cancer, which up the total costs. Members have also overlooked the sin of pride. They do not accept the possibility that they will ever lapse. No recognition of original sin there.
They assume that because they live upright lives, they will escape the diseases, accidents, and disasters that beset everybody, not just the debauched: e.g., cystic fibrosis, multiple sclerosis, cancer (non-smokers can still get lung cancer), scleroderma, Alzheimer’s disease, glaucoma, Crohn’s disease, pneumonia, meningitis … As for injuries, regular church-goers break their legs, arms, pelvises, necks. Accidents happen to all of us.
Beyond the sins, there are virtues, like love and charity. We may not feel like our brother’s keeper, but under the Affordable Care Act we are. We all to some extent accept responsibility for the population’s health, sharing the burden. Government mandation (yes, the mandation word) expresses a commitment to the whole of us. In a nation that fragments by race, ethnicity, and political vantage, the faith-sharing ministries represent yet another schism, delineating “us” from “them.” How sad.
Joan Retsinas writes about health care in Providence, R.I. Email retsinas@verizon.net.
From The Progressive Populist, January 1-15, 2015
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