Sharing and caring

President Obama says he's looking for creative, "outside-the-box" thinking on health care. But the reform plans that have the greatest likelihood of passing put at risk a Christian alternative to insurance that is now being used by more than 100,000 people in the United States.

James Lansberry is vice president of Samaritan Ministries, the largest of the "health care sharing ministries" whose members pay for each other's health care costs. His organization's members pay for about $3 million in expenses a month. Payments vary, but a three- (or more) member family pays $285 per month directly to another family with a current need. Samaritan Ministries keeps track of who's paying and who needs to be paid, and the ministry receives $170 per year from each family for serving as the clearinghouse.

Christian Care Medi-Share, the other major player in this market, has members set up a credit union account. Monthly payments go into that account. When needs arise, the ministry is authorized to transfer money in-or out to the accounts of others. (Disclosure: Samaritan Ministries and Christian Care Medi-Share have advertised in WORLD.)

"We're already saving our members dramatic amounts of money," Lansberry said. "But the current reform schemes threaten our survival. They mandate traditional insurance. We're working hard to make sure that our members are seen as filling the intent of individual insurance mandates."

That's why Lansberry is also the president of the Alliance of Health Care Sharing Ministries, a group that also represents Christian Care Medi-Share. The goal of the alliance is simple, Lansberry said: "We're trying not to get shut down."

Even though the 100,000 people participating in such plans are less than 1 percent of the total U.S. population, they represent a critical "skunk works" for health care innovation. "Our members ask what things cost, and they pay at the time of service, or they get a bill that is paid quickly," Lansberry said. "Some Medicare and Medicaid reimbursements take a year. Even conventional insurance often takes 90 days." That simple innovation-allowing the customer to pay for services directly-takes significant costs out of the system.

But most people in health care sharing ministries are participating because of Christian principles. "Galatians tells us to 'bear one another's burdens,'" Lansberry said. "You can save a lot of money by participating in health care sharing communities, but it is not the money, but the community, that most of us find valuable. Our members pray for each other. They have a different relationship with their doctors. They go to doctors they choose for their families, not doctors chosen for them."

Robert Baldwin, president of Christian Care Medi-Share, said the biggest problem government regulators have with health care cost sharing is the notion that "people would trade a contractual obligation to pay for a situation where they put their trust in fellow Christians." The fact that payments are made, and faster than with traditional insurance, is a powerful Christian testimony.

Another criticism is that these nonprofit ministries have no reserves to pay for catastrophic costs. Christian Care Medi-Share has a $1 million limit on what it will pay; Samaritan Ministries has no limit, but Lansberry said that the most his organization has paid to a single member is less than $500,000.

Ken Walker, who has been a member of a health care sharing ministry since 1996, has had heart surgery, and his wife has had cancer. "Without health cost sharing, I would be staring up at a huge mountain of debt," he said. Conventional insurance would have required thousands of dollars in deductibles and co-payments-and that after paying around $1,000 a month for insurance.

One of the ironies of the situation is that any reform might stop ongoing financing improvements in their tracks. According to Lansberry: "We're seeing innovation. Clinics are springing up that allow payment at time of service. Health care reimbursement accounts and higher deductibles are being used by major corporations such as Johnson & Johnson and Safeway, reducing costs and improving care. About 20 percent of Americans under age 65 now have health care savings accounts. The truth is that we're moving in the right direction. We just need to keep Washington out of the way."