Hannah Amaris Roh is Bitch Media’s 2020 Sacred Writes Writing Fellow
Donald Trump’s own brush with coronavirus hasn’t stopped him from continuing to downplay the pandemic in a recent tweet telling Americans not to “be afraid of COVID”—an arrogant, irresponsible dismissal of this public-health crisis that’s especially nauseating because COVID-19 continues to ravage the global community. Reported cases have now topped 7.5 million in the United States, with 42,553 new cases and at least 721 deaths reported in the United States yesterday. Yet the Republican Party continues to rush the confirmation of Amy Coney Barrett to the Supreme Court—not only threatening to unravel women’s right to bodily autonomy but also putting the Affordable Care Act (ACA) in immense peril; the latest challenge to Obamacare is scheduled for a Supreme Court hearing just one week after the election. This administration’s systematic attempts to roll back the ACA already led to a frightening decline in health- insurance coverage in 2018; needless to say, the decline has only intensified. As of July 2020, an estimated 5.4 million Americans have lost their health insurance during the pandemic-led recession.
The increasing precarity of health coverage has led more people to seek out alternatives. This includes my own parents, who did not qualify for Medicaid or Obamacare subsidies when they immigrated to the United States from Korea in 2019, and could not afford private insurance. Their faith-based circles led them to Christian Healthcare Ministries (CHM), a nonprofit religious organization whose members pool monthly “gifts” in order to share the cost of medical bills. CHM, which claims to be compliant with the ACA, offers three different plans or “programs”: gold, silver, and bronze. When my parents explained that the gold program would cost them only $344 per month—compared to an estimated $1,000 for private insurance—I dug a little deeper and quickly heard alarm bells. CHM’s site includes a disclaimer stating that “CHM isn’t insurance,” but that itself links to the organization’s “ministry standards”—which present CHM as a “trusted way to provide medical care.”
Its relationship to the ACA is equally unclear: CHM claims to be “an eligible option under the national healthcare law,” but also states that they are a “federally certified exemption.” In fact, CHM is not legally bound to guarantee coverage of any medical expenses, but you’d have to scour the fine print for that clarification. I warned my parents more than once that CHM is not actual health insurance, but they eventually joined anyway. They had no other affordable options, and as Christians, they figured they could trust a faith-based alternative. In addition to CHM, there are at least four other major organizations operating in the United States: Samaritan Ministries, Liberty Healthshare, Medi-Share, and Trinity HealthShare. (That said, such organizations are unregulated, making it difficult to pin down their numbers.) And though these cost-sharing ministries have been around for more than 30 years, enrollment has steadily increased since the Trump administration began relaxing the rules of the ACA, allowing for these kinds of exemptions to traditional health insurance.
In 2015, total membership for these ministries hovered around 340,000. By 2018, that number had reached 1 million. The ministries can offer affordable prices because what they sell isn’t classified as insurance, and can thus sidestep the ACA’s requirements and state regulations (for instance, guaranteed coverage for pre-existing conditions). But they seem to go to great lengths to obfuscate the difference. Trinity HealthShare is a particularly elusive example: It claims to be a “non-profit health care sharing ministry (HCSM),” and the organization is affiliated with Aliera Companies (also known as “Aliera Healthcare”), a for-profit company that markets, sells, and administers Trinity’s plans. Aliera, via its brokerage service Ensurian, states that its plans are “not insurance,” but touts individual and family coverage options using the language of the industry. The Trinity website emphasizes the “affordability, portability, and customization” of its programs as advantageous “over employer options.” A “consult fee” is basically a co-pay, a “member shared responsibility amount” sounds like a deduction, and a “monthly contribution” might as well be called a premium.
The ideological profile of such organizations, meanwhile, is as much a lure as the comparatively inexpensive prices. Liberty Healthshare’s former CEO, Larry Foster, pitched the ministry at 2019’s Conservative Political Action Conference with familiar Republican talking points: “The simple idea all of us in this room believe is that government doesn’t know best…. Health sharing is a uniquely American idea that’s based on choice, freedom, and access.” His assessment is technically correct: America is the only wealthy democracy in the world that sees health as a commodity and not as a human right. The national obsession with individual freedom—as well as the Republican party’s long game of privatization—is rooted in a doctrine of self-reliance and rugged individualism. As Washington Post columnist Helaine Olen aptly wrote in her coverage of Liberty Healthshare, a promise of “freedom” from the ACA appeals to “the belief that personal charity can substitute for government action.”
As you might expect, there have been some very rude awakenings for now-former members. Some cases are minor but consequential, like one Liberty Healthshare member whose flu-shot bills ended up in collection. Others, however, are catastrophic. In 2019, the Houston Chronicle covered the story of an Aliera member who was denied $195,000 in claims for her cancer treatment; Aliera also refused to pay a Georgia family that was saddled with a $325,000 bill after emergency brain surgery for their 10-year-old child. Aliera and Trinity are now facing class-action lawsuits in at least four states, as well as an FBI investigation into deceptive advertising practices. One California lawsuit states that Aliera and Trinity “sold inherently unfair and deceptive health care plans…and failed to provide them with the coverage the purchasers believed they would receive. Defendants claimed the healthcare plans were not ‘insurance’ in order to avoid both oversight by the state insurance commissioner and minimum requirements mandated by the Patient Protection and Affordable Care Act.”
And in Texas, regulators allege that only 20 percent of Aliera’s membership fees actually go toward payment of medical bills—the opposite of ACA rules, which require at least 80 percent of premium payments to go toward medical costs. Other states, including New York and Washington, have also begun to crack down on Aliera and similar groups. Here’s the irony: These ministries’ belief in personal charity itself exposes “self-reliance” as a myth, because these groups actually acknowledge the concept of healthcare as a shared responsibility. Medi-Share, for example, calls on a sense of “authentic community.” Christian Healthcare Ministries cites the ethical and religious mandate to “bear one another’s burdens” (a reference to Galatians 6:2) and states in its guidelines that “We believe that every person must be afforded compassion, love, kindness, respect, and dignity.”
All ministries include pages for prayer requests, some of which operate like GoFundMe campaigns. Members of Samaritan Ministries, in fact, send payments for medical expenses directly to other members, often with personalized, handwritten notes that mention prayers on their behalf. Members testify about these experiences on the ministries’ blogs, which themselves often feature additional tips on managing personal health—coming full circle to the appeal to self-reliance. Health-share ministries do understand the ethics of healthcare as a fundamentally communal responsibility—it’s their tribal definition of “community” that has both medical and ethical consequences. Their definition of community as something that can be voluntarily formed only by a common set of religious beliefs is exemplified by one statement from a member of Samaritan Ministries: “A community is an organically grown organism, so it can’t succeed if it’s pushed and enforced from the top level down. You have to have a moral foundation, a reason to trust those whose needs you’re sharing.”
“Christian healthcare” is an inevitable result of white American evangelicalism’s strategic alignment with the GOP.
In other words, there is a refusal to trust people unless they live by “biblical principles”—a phrase that’s often evangelical code for a socially conservative outlook based on a strictly literal interpretation of the Protestant Bible. A biblical lifestyle is, in fact, a premise of membership. Samaritan Ministries requires its members to attend church weekly, abstain from alcohol and drugs, and abstain from “any sexual activity outside of traditional Biblical marriage as designed by God between one man and one woman.” CHM not only refuses to cover the medical expenses of pregnant “unwed mothers,” but also directs them to seek a “Christian pregnancy center”—otherwise known as a crisis-pregnancy center, where any assistance has religious, and sometimes punitive, strings attached. The websites of almost all health-share ministries evince a theology of patriarchy that’s accompanied by images of white nuclear families and references to God as “he.”
Equally disturbing is the fact that membership involves waiving the right to sue the ministry. Samaritan Ministries states that Christians “are not to sue each other in the civil courts or other government agencies… A person initiating a legal proceeding against Samaritan Ministries to become a member would disqualify himself from membership.” What such ministries demand is ultimately an agreement to enter an alternative universe on the basis of Christian identity. As evidenced by Liberty Healthshare’s appearance at CPAC, “Christian healthcare” is an inevitable result of white American evangelicalism’s strategic alignment with the GOP: These ministries capitalize on the American obsession with individual freedom, casting it as religious freedom and ultimately redefining the idea of a public good as a tribal good. There are no built-in structures of accountability within their community—and certainly no accountability to or consideration for people outside of it.
One joins as a member asking other members for their thoughts and prayers, and hoping that at least some of their Christian brethren help get the bills covered. What evangelical Christians might call “faith” looks, in practice, much more like nihilism. As one member of Samaritan Ministries says in a 2016 PBS interview, “At the end of the day, I’m not depending on insurance, and I’m not depending ultimately on Samaritan Ministries, I’m depending on God.” But what if God doesn’t come through and you’re stuck with hundreds of thousands in unpaid medical bills? Public health is about community—about honoring our ethical commitments to one another because we acknowledge that the health of the whole is inextricably tied to the health of the individual. Its success depends on both faith and ethics—faith in our shared public institutions, and faith in a plural society.
The COVID pandemic has exposed alarming fractures in those commitments and underscored how one person’s “faith” can be weaponized against others to worsen an already shared precarity. The allure of health-share ministries to increasing numbers of Americans is an indictment not only of our broken healthcare system, but also of evangelical Christian ethics and the tribalism it reinforces. In some ways, Christian healthcare is simply an extreme version of the desire for healthcare privatization and the profit derived from it. Its idea of “community” fosters an ever-deeper distrust of government and an antipathy toward humans with different religious traditions, different practices, and different worldviews—a rejection of the very possibility of pluralism. Their insularity perpetuates an already destructive pattern of theological reasoning that justifies the abdication of civic responsibility.