In my previous column here at RD, I used historical retrospective and my personal memories of the 1990s era Christian opposition to “Hillarycare” to contextualize the colossal failure of Sharity, a major Christian health sharing ministry (CHSM) that’s currently in the process of being liquidated, leaving some 10,000 families in the lurch with some $300 million of unpaid medical claims. My primary goal was to explore the cultural reasons that many conservative, mostly white evangelicals are drawn to ill-advised schemes like Christian alternatives to insurance. But, while I addressed this point briefly, some readers may have been left wondering whether the problem is with Christian health sharing ministries themselves or whether it was just this particular organization which is clearly either corrupt or poorly run.
In short: there is a problem. A big problem.
In this piece, I’ll look more into the legal and policy nuts and bolts of the matter in an attempt to demonstrate why it is not just bad for individual citizens and consumers, but also harmful to our overall society, to allow the proponents of a twisted concept of “religious freedom” to carve out such massive private, unregulated spaces in areas that could be broadly categorized as public goods.
Here in the United States, of course, the social safety net is already grossly inadequate, and private health insurance still costs too much and covers too little. Why would people want to leave themselves even less protected? The answer is, in a word, ideology. To be more specific, the problem is a right-wing authoritarian ideology in which it’s considered ideal to force people to depend on their families, churches, “God,” and themselves to survive—and if they can’t hack it, tough. Paternalism of this sort leaves those who already have money firmly in charge of how society is run.
Many exponents of this ideology consider themselves libertarians, since they don’t want state actors to do anything to level the economic playing field or help ordinary citizens get through times of crisis. Their sense of fairness is very much the same as that of Heath Ledger’s Joker, only couched in God talk, at least in the case of the mostly white American Christians, evangelicals above all, who’ve established their own parallel institutional universe, separate from the one available to the rest of society. The construction of such isolationist enclaves is a hallmark of fundamentalism, and, on a large scale, they are undoubtedly deleterious to society since they foster anti-pluralist, exclusionary attitudes and the radicalization of those who inhabit them.
In the case of CHSMs, which were explicitly exempted from the Affordable Care Act’s health insurance mandate, they “are legally organized charities, not insurance,” explains constitutional attorney Andrew Seidel, the vice president of strategic communications at Americans United for the Separation of Church and State.
He also told RD that these organizations are “not regulated like insurance companies or bound by the same laws. But they often operate like insurance and market themselves as alternatives to insurance.” Seidel called their ACA exemption a “loophole,” noting that under the law, explicitly, “taxpayers with no health insurance have to pay a penalty unless they are ‘a member of a health care sharing ministry.’”
And yet CHSMs are under no legal obligation to make any payouts, let alone to cover even a fraction of what standard insurers must cover as mandated by the ACA. In other words, our government policy was written to make room for parallel institutional alternatives to insurance, some of which are bound to fail catastrophically—and those failures will undoubtedly have ripple effects.
We’re stuck with a terrible policy simply because the Christian Right has enough political influence to have convinced many to uphold its concept of religious freedom at the expense of the common good. “Just think of how frustrating it is to deal with an insurance company that is heavily regulated in an effort to make it easier for us to deal with them,” muses Seidel. “Now remove those regulations because of misguided notions of religious freedom. That’s what we’re talking about.”
It’s very possible that many people who buy into the programs, which are much cheaper than insurance, think they’re getting essentially the same guarantees when they very much are not. Others, however, likely go in clear-eyed; and for all parties, the exclusive availability of the coverage to “good Christians” is surely a draw. They don’t expect to come down with the kinds of health conditions that only “godless” people supposedly get.
There’s often a “covenant” aspect to these programs—prospective members are told they will be entering a “sacred” agreement with other Christians to share in one another’s burdens, rather than a cold-hearted contract. What this means in practice, however, is that the programs deprive their members not only of guaranteed coverage, but also of privacy. Since they’re not actually health insurance, the privacy provisions of HIPAA are irrelevant, and conservative Christian communities are already used to surveilling and policing one another.
My parents had our family enrolled in one of these plans. Everyone in the plan knew what you were getting treatment for so they could pray for you. Extremely uncomfortable.
— BBminis (@Stephanienase5) April 22, 2022
As an employee of a national Christian ministry in the 90s, I remember the seedy looking dudes who showed up shilling their new “covenant” based health cost-sharing company. Even when I was a believer I felt they were big-teeth fake smiling con men.
— alaine edmondson (@mamabirdalaine) April 22, 2022
For ideologically driven conservative Christians, of course, the exclusion is the point, and the element of community surveillance is perfectly acceptable, as the very same ethos pervades evangelical church communities.
Friend's mother died needing a liver transplant. Had "Christian Health Plan"…was denied the transplant because her liver failed due to Hep C, which was a very "unchristian" thing to acquire. She was 60.
— Tina (@TinaNelson5280) April 26, 2022
From a policy point of view, so long as these programs involve only a small percentage of the population, the economic ripple effects may not seem so worrisome. However, the tendency to withdraw from our country’s healthcare scheme is of a piece with the Christian Right’s attempts to evade sensible oversight in education by opting for homeschooling and Christian schools, both of which are largely unregulated thanks to the Christian Right’s effective lobbying.
In this case, parents who choose these options can now usually also siphon public money away from the public school system through voucher programs, even as they work to force public schools to be remade in the image of their private schools, in which the indoctrination is intense. As someone who attended Christian schools for all but one-and-a-half years of my elementary and secondary education, I should know.
Privatizing public goods is not good policy, and the Reaganite “starve the beast” approach to governance is bad enough on its own. But privatizing public goods so that they can be manipulated by adherents of an extremist ideology is even worse policy, and if those who assure us that they are very concerned with American polarization really want to get at its source, they should stop placing the blame on American secularization—a position for which there is no evidence—and look instead to the huge parallel institutional world right-wing Christians have been able to carve out for themselves due to a misguided policy approach to “religious freedom.”
While CHSMs may not have the same impact on our society overall as homeschooling and Christian schools, they nevertheless provide a preview of the kind of society the Christian Right seeks to remake America into if given the chance: one nation, under God, where white supremacist patriarchy reigns, public schools are gone or Christianized, and the “blessed” decide who is worthy of health care. No privacy, no guarantees, no protections.