Blessed Insurance

(with Joe Maxwell) - The digital clock reads 3:45 a.m. as the alarm rings in Joel Smith's bedroom. Mr Smith and his wife live a comfortable life in a spacious, modern log-cabin home situated on a hill overlooking a fish-stocked lake in the northern Mississippi countryside. As a ceiling fan whirls somewhere in the darkness overhead, the Smiths nudge each other out of bed and onto their knees. On the nightstand next to their king-size bed sits an Amplified Bible, a pair of reading glasses, and a telephone.

Joel picks up the latter and dials 1-800-PSALM 33 to check a recorded list of urgent prayer requests. Soon, the couple is deep in prayer for people they've never met, but with whom they share a common bond and commitment. And they're not alone: The members of Christian Care Medi-Share conduct a 24-hour, seven-day-a-week prayer chain for fellow members who have suffered sickness or injury serious enough to require filing a claim. At least, they would have filed claims with traditional insurers. At Christian Care Medi-Share they file "needs," which bring not only the traditional reimbursement check, but also a card or letter from another member who has prayed for them.

A log cabin in rural Mississippi seems worlds away from the marble halls of Congress, yet health care is a burning issue in both locales. Like the Smiths, many in Congress are willing to try some radical measures to stop the spiraling cost of health care, which has soared from $387 per person in 1972 to $3,294 in 1993; by the turn of the century, the U.S. Department of Health and Human Services estimates that number will be $5,712. With numbers like those, it's safe to say that, like the Smiths, some in Washington are losing sleep over the issue-though few, most likely, are turning to prayer in their sleepless hours.

What happens in Washington is important to believers and unbelievers alike for the simple reason that the vast majority of Americans continue to get their health coverage through their employer. That means that like it or not, they're at the mercy of an increasingly costly and cumbersome system that doesn't seem to satisfy anyone-employees, employers, even insurance companies.

One major problem with the system is "job lock," the perception by some 25 million workers that they can't leave dead-end jobs without losing their health insurance. Both houses of Congress have now passed legislation guaranteeing portability of insurance, which means, basically, that when it comes to health coverage, you can take it with you.

Until late last week, portability was about the only thing the House and the Senate could agree on. With one eye on the history books, Bob Dole, in one of his last actions as senator, brokered a compromise between Republicans in the two chambers. House leaders agreed to delete a cap on medical malpractice awards, a provision which they had earlier insisted was necessary to make health care not only legally accessible in theory but affordable in practice. For their part, Senate negotiators agreed-to the consternation of two top Senate Republicans-to give up guaranteed mental health coverage, a provision that businesses and economists thought would be disastrous. "The cost is horrendous," says Robert Moffit, deputy director for domestic policy studies at the Heritage Foundation. "The bottom line is a 4 to 5 percent increase in premiums for workers and their families. And if the language applied to federal programs, it would add $80 billion to Medicare and $35 billion to Medicaid."

The problem with mandating mental health coverage is that "mental health" is such a broad category that it practically invites abuse. If workers sought therapy every time they got the blues, corporate health care budgets could quickly end up in the red. Christian cost-sharing programs, however, think they've got a simple answer to such abuse: conscience and clean living.

Every Christian care ministry stipulates that membership is based on living a healthy lifestyle, which means not smoking, not doing illegal drugs, and not participating in sex outside of marriage. Several groups, including the largest-Christian Brotherhood Newsletter-also prohibit drinking entirely, while a few, including the Christian Care Medi-Share Program, permit alcohol in moderation. (Generalizations can be tricky because there are already some half-dozen such groups in existence: Christian Care Medi-Share; Samaritan Ministries in Greenfield, Ind.; the Christian Brotherhood Newsletter in Barberton, Ohio; All Saints in Tyler, Texas; and Helping Hands in Oklahoma City, Okla.)

All these ministries point to widely published statistics indicating that up to 80 percent of all diseases are the result of lifestyle choices. The American Medical Association estimates that up to 40 percent of all hospital patients are treated for problems resulting from alcoholism, while the U.S. Department of Heath and Human Services in 1993 reported that $188 billion in annual health care spending results from unhealthy lifestyles that lead to higher incidence of cancer, accidents, AIDS, and heart disease.

Proponents of Christian cost-sharing ministries say they shouldn't have to support with their premium dollars the destructive conduct of others. Says John Reinhold, president of Christian Care Medi-Share: "Our members believe in sharing and caring, but they do not wish to subsidize those Christians or non-Christians who choose to live in a way which inevitably leads to a premature breakdown in mind and body, i.e., using tobacco, taking drugs, gluttony."

If the Dole-brokered compromise survives, conscientious believers won't have to worry about subsidizing mental health care in the near future. But that issue was always relatively minor compared to the feelings generated over medical savings accounts. The House version of health care reform included tax exemptions that would entice more companies to establish MSA plans, which allow employees to "bank" health care dollars in an account which they personally control. By living healthy lifestyles and becoming smarter health care consumers, employees may end up with a surplus in their accounts. That surplus can then be applied to future medical expenses, rolled over into a retirement account, or even withdrawn to buy Christmas gifts.

The very idea of giving consumers that kind of control over their health care decisions was enough to send liberals into cardiac arrest. The Associated Press recently published a reckoning of organizations that had gone on record for or against MSAs. While 13 groups, from the Family Research Council to Eagle Forum, supported the MSA concept, 43 others had come out in opposition, including such heavyweights as the United Auto Workers, the American Nurses' Association, and the American College of Physicians.

With that kind of opposition, it's no surprise that the more status-quo-oriented Senate pointedly refused to include any MSA provision in the Kennedy-Kassebaum health reform bill. Though the disagreement between House and Senate threatened for a time to scrap reform efforts all together, Dole managed to work out a compromise on MSAs as well. According to Kris Fortner, legislative aide to Rep. Bob Inglis (R-S.C.), a key House sponsor, Republicans in both chambers have agreed to allow tax-exempt MSAs for the self-employed and for companies with fewer than 51 employees. After three years and a federal study, MSAs would be extended to employers and individuals, unless Congress voted against it.

Though House Republicans wanted MSAs available immediately to all Americans, Mr. Fortner acknowledges that the compromise is "a big agreement. We've overcome the major obstacle in the health reform bill." With even Nancy Kassebaum, co-author of the Senate version, signed on to the compromise, Republicans appeared last week to have the votes to send a reconciled bill to the president within days.

At that point, the prognosis becomes more iffy. President Clinton has threatened to veto any health care bill that includes MSAs, and prominent Democrats such as Edward Kennedy, Sen. Kassebaum's erstwhile ally on health reform, want him to do just that. But several political developments make Republican supporters hopeful that health reform will not be pronounced DOA. First, as Mr. Moffit points out, both Richard Gephardt and Tom Daschle have strongly -and publicly-supported MSAs in the past. That could make it hard for them to lead effectively any fight to maintain their president's veto.

Then there is Mr. Clinton's own political savvy. With an election just around the corner, he's been running hard to the right on value-laden issues such as welfare reform, adoption, violence on television, even school uniforms. If MSAs can be cast in the same mold, the president may have trouble carrying through with his veto threat. "To the extent that this issue can be explained to the American people, it's going to sound pretty good," Mr. Moffit says. "That means a veto would be tough to explain. Given his verbal capacity, the president might be able to do it, but it will be a tough sell."

The underlying value in much of the current debate is one of control. Who should make decisions about health care: the individuals involved, or some faraway corporate or government bureaucrat? MSAs seem perfectly suited to the present mood in the country, which is once again stressing the age-old American value of self-reliance. Even Prudential, after 25 years of urging insurance buyers to "Get a piece of the rock," has changed its slogan. These days the company's advice is, "Be your own rock."

After years of having their health care choices dictated by distant bureaucracies, it's no wonder if many Americans are ready to be more self-reliant. But it also makes the success of Christian cost-sharing groups all the more amazing. While specifics vary from group to group, all share a basic Bible-based philosophy summarized in Galatians 6:2: "Carry each other's burdens, and in this way you will fulfill the law of Christ."

"In our nation's past, our forefathers were quite familiar with bearing one another's burdens," states a brochure published by Samaritan Ministries. "We still have the mandate to bear one another's burdens, but we hardly know what that means anymore. If our barn burns down or an emergency medical problem arises, the insurance company takes care of it and our friends, relatives, and neighbors have little participation in restoring us to our former state. We don't need each other in the way we used to. We're not knocking insurance companies-we're merely saying there is a better way for Christians who desire to minister to the body of Christ while providing for their own medical needs and being thrifty with their money."

Because MSAs are based on self-sufficiency while Christian medical groups are based on shared risk, the MSA tax exemption probably won't have much impact on sharing ministries in their present form. Still, the groups have enjoyed phenomenal growth in recent years, thanks to several provisions that traditional insurers-and even MSA providers-cannot or will not enforce.

Potential members are screened to validate a sincere Christian commitment. Some of the groups accomplish this by requiring membership in a local church and attendance at least three out of every four Sundays; others simply interview an applicant's pastor to verify the person's expressed faith in Christ.

Once accepted, a member usually enjoys coverage equal to or exceeding that offered by most conventional employer group plans. This is possible due to the large number of monthly dues-paying members, which creates a massive pool for meeting claims; some groups also cooperatively purchase major medical policies for catastrophic claims exceeding $50,000.

In the case of the Smiths, their Christian Care Medi-Share benefits are as follows: After a $250 deductible, 100 percent coverage is provided up to $1 million at a rate of $85 per member, $150 per two persons, and $195 per family of three people or more. Eighty-five percent of a monthly family membership fee of $195 goes to pay the medical bills of another member that month, 6 percent is used for processing needs/claims, and 9 percent is used for administrative costs and disease prevention education.

When members incur a need/claim, they report it to their group's national office. From there, different groups go about meeting the needs in different ways. Some, like the Christian Brotherhood Newsletter, "publish" the needs of their members in a monthly newsletter, assigning each member a specific person to pray for and send their monthly support check to. Each member then mails his or her monthly membership fee directly to the person assigned, along with a card or letter of encouragement. Other groups, including CCMS, ask members to send their monthly dues to the main office, which then redistributes the resources to those who have needs that month. Members then receive a notification from the main office informing them of the specific person whose need they helped to meet, and they are encouraged to write and pray for that member as well.

All of which sounds good on paper, but does it really work? After all, the bottom line for most health-insurance consumers-Christian and non-Christian-is, Will the policy pay? That's exactly what ran through Charles and Connie Jackson's minds as they drove their little girl, Jessica, to the hospital for repair of a broken elbow. When a clerk asked for proof of health coverage, Charles, a seminary student, nervously pulled out the membership card provided by Christian Care Medi-Share Association.

Charles thought for a moment that he might have to offer an explanation of his group's novel approach, but he realized the clerk was processing his claim just as she would for any other insurance company. "She didn't ask, so I didn't offer," he says.

In fact, CCMS boasts that, "to date, no member has ever been refused treatment by any medical entity." In some instances, members have routed questions from their medical provider to the group's home office via a toll-free number. In every case, the medical provider's bottom-line concern was addressed: Will this coverage pay? Numerous state insurance regulators have challenged the concept of Christian cost-sharing ministries, but always without avail; eight states have actually passed laws exempting cost-sharing groups from insurance regulation.

In the case of Jessica Jackson, her parents paid the first $250 of her medical bill as a deductible, and then CCMS picked up about another $700 in expenses. The couple says they are now confident not only in the biblical nature of cost-sharing, but in its practical feasibility, too.

Or as CCMS membership chairman Robert Dixon puts it, "Those who join are grateful that behind us is a multi-billion dollar 'safety-net' entity and beneath us are the everlasting arms."