Evangelical Healthcare Sharing Plan Catastrophically Fails — But Why Did So Many Join in the First Place?

Remember the 1990s?

The inexplicable popularity of fluorescent fanny packs?

The innocent thrill of getting AOL and connecting to the world wide web for the first time? 

Everyone talking about how Bill Clinton was probably the Antichrist who would someday, somehow use the United Nations to establish a one-world government and bring about the Battle of Armageddon? (Strangely, no one could ever explain the specifics.)

Okay, okay, maybe the end times mania wasn’t a part of your ‘90s experience. If that’s the case, lucky you.

In addition to the sometimes literally apocalyptic Bill Clinton conspiracy-mongering that was ubiquitous in the right-wing evangelical milieu I inhabited as a middle-schooler and high-schooler, there was also the deliberate fomenting of wildly irrational hatred for Hillary Rodham Clinton, encompassing everything from, “She kept her maiden name in her name, that godless feminist witch!” to “She and Bill are murderers!” to “Don’t tell me it takes a village to raise my kids, you commie!” 

And then there was “Hillarycare.” More properly known as the proposed Health Security Act of 1993, the bill emerged from a task force headed by then-First Lady Hillary Clinton. Her role in the creation of the bill—which was subjected to a failed legal challenge from the “vast right-wing conspiracy” that dogged the Clintons throughout Bill’s terms in office—was one of the reasons Republicans and their right-wing Christian base gave for attacking it. (Never mind that the same people, a little over two decades later, raised no objections to the appointments of Ivanka Trump and Jared Kushner to Trump White House roles riddled with actual conflicts of interest, and for which they were clearly unqualified, whereas Hillary Clinton is nothing if not a qualified policy wonk.)

The intensity of the Hillary hatred in our milieu was such that the association of her name with the 1993 healthcare bill alone was enough to get people’s hackles up. Of course, the bill’s approach to universal healthcare itself was profoundly conservative by global standards. In fact it’s similar in key respects to the Affordable Care Act—a.k.a. “Obamacare”—about which the Christian Right has been throwing massive fits since before the bill even passed.

The Christian Right’s objections to the ACA, the reverberations of which continue to manifest in the present, have a sort of “back to the future” feel for me. I’ve been reflecting on all this as the news broke that Sharity, a “health sharing ministry” previously known as Trinity HealthShare, is being liquidated amid a spate of lawsuits. According to Christianity Today, the conservative Christian “ministry,” which has a history of denying claims, currently holds over $300 million in unpaid claims, the would-be beneficiaries of which are unlikely to ever recoup the money they’re owed.

Who would have thought that a Christian health sharing ministry that insisted on the “right” to provide health coverage with no state oversight would fail so spectacularly? I mean, it’s not like the Alan Greenspan approach to letting the financial industry police itself—an approach wrongheadedly embraced, incidentally, by President Bill Clinton—ever resulted in disastrous consequences that could have served as a lesson or anything… But seriously, folks.

It’s impossible to say at this point whether the Sharity scheme was a conscious grift on the part of at least some of its executives from the outset, but even some supporters of Christian health sharing view it that way. Even before filing for bankruptcy, Sharity had gained a bad reputation among fellow conservative Christians—including among its peers in its own niche conservative Christian industry, in which some longer-term players have admittedly acted more responsibly. 

That fact notwithstanding, I find the whole concept of Christian health sharing outside of broader structures for the financing of healthcare dubious at best, particularly given that exempted ministries are largely left to police themselves and aren’t subject to the ACA’s minimum coverage requirements (let alone that they can decide what treatments are too “sinful” to be covered at all). As healthcare industry expert Reed Abelson noted in the New York Times back in 2020:

These Christian nonprofit groups offer far lower rates because they are not classified as insurance and are under no legal obligation to pay medical claims. They generally decline to cover people with pre-existing illnesses. They can set limits on how much their members will pay, and they can legally refuse to cover treatments for specialties like mental health.

In short, members have no recourse to appeal denied claims. In any case, Sharity’s failure certainly strikes me as predictable, and very likely to have occurred even if a few states hadn’t sued the ministry on evidently well-founded charges that it skirted the law by operating an unregulated for-profit insurance company under the guise of a religious ministry. Given that there’s no mechanism for keeping bad actors out of the Christian health sharing industry, whatever we think of the concept in the abstract, the frequent “bearing of bad fruit,” to borrow a biblical metaphor, seems like an inevitability.

It’s easy to dunk on the victims of Sharity’s failure who are now getting a taste of their own “personal responsibility” medicine. After all, we’re not responsible for their poor life choices, so let them sort it out, right? But we should be better than that. I want everyone to have fully subsidized healthcare, although it’s tempting to indulge these impulses when the population in question is so brazenly hypocritical, is working overtime to deprive transgender people like me of rights, and holds the kind of disproportionate political power that has allowed them to become a major factor in why Americans can’t have nice things, such as Medicare for all.

But what draws right-wing, mostly evangelical Christians to these programs in the first place? I think it’s important to understand that draw, as well as the context that’s allowed the ministries to balloon in size since 2010 to the point that they collectively have about 1.5 million members, according to CT’s reporting. 2010, of course, is the year the ACA passed. 

The bill garnered no Republican support despite Democrats severely watering it down in an ill-fated attempt to win at least a few Republicans over, and it passed with an exemption allowing members of health sharing ministries to forgo purchasing health insurance. Thus, even if we find the victims in this case largely unsympathetic, they are in the situation they’re in partly because of a failure of American society and policy. 

Christian health sharing ministries have been around since the 1980s, although before “Hillarycare” became a Christian Right (and more broadly, Republican) flashpoint, I don’t recall hearing or thinking much about health insurance at all. In my early childhood, we evangelicals tended to focus on abortion and stopping “those liberal baby killers”; putting a stop to the advancement of LGBTQ rights; and prayer in school. 

I was in sixth grade when the Clinton administration began working toward universal healthcare, but it was during my seventh-grade year, the first of two years I spent at Colorado Springs Christian School, that I first recall observing significant outrage over the possibility of implementing universal healthcare in the United States. Conservative communities began to be inundated with messaging that “universal healthcare doesn’t work” (a brazen lie).

However, as good Christians, we evangelicals also needed a biblical justification for our opposition to the state’s effort to ensure that everyone was covered, since guaranteeing that people have access to healthcare might, on the face of it, seem like something Jesus would do. And that could have been a problem, since practically every kid in Christian youth groups in the ‘90s would never be seen in public without sporting one or more of those “WWJD” bracelets—in our circle, they were even more common than fanny packs! 

The general line thus became that the state providing healthcare to citizens would constitute “idolatry,” since we Christians were supposed to rely only on God, not the state, dagnabbit. Also something about “choice” and something about “personal responsibility” and “Sure, Jesus healed people, but as an individual, not the government, and as a way to point them to God’s power.”

You see, if people could just depend on the state to make sure their healthcare is affordable, they wouldn’t have to rely on God at all! Jesus would definitely be against that, right? Not to mention how certain policies set by the state might make you complicit in supporting other people’s “sin,” whether through subsidizing birth control or abortion, or the health consequences of someone else’s smoking habit—all of which have been used as selling points in the recent surge in health sharing ministry membership.

I recently discussed this with a friend who attended an evangelical college in the 2010s. She recalls a number of her college acquaintances signing up for Christian health sharing ministries in order to avoid having to fund birth control, which is, not coincidentally, the same reason the Little Sisters of the Poor infamously sued over the ACA’s insurance mandate. 

Beyond that, the same old general Republican (and thinly-veiled racist) rhetoric about “freeloading” and “personal responsibility” and being “forced” to subsidize people who “don’t deserve it” informs the conservative Christian ideological opposition to universal health insurance and thus helps to drive the popularity of alternative health sharing ministries.

A major subtext too is distrust of “big government” and the wider society, which lies beneath the Christian Right’s drive to create alternative institutions in every sphere possible, from contemporary Christian music, to Christian bookstores and publishers, to Christian homeschooling, private schools, and colleges. In other words, if right-wing Christians can’t exert total control over policy in a particular area, they will try to create their own alternative in which they can exert total control, if that’s at all possible (all while repeating ad nauseam, of course, that “God is in control”). 

To be sure, it has proven possible to carve out these enclaves while simultaneously attempting to exert control over society and policy outside them, as we see today in the Christian Right’s attacks on public education focusing on “CRT” along with sexuality and gender, as well as in their dominionist drive to roll back women’s and LGBTQ rights.

At the moment, however, one can imagine the many victims of Sharity’s financial malfeasance feeling quite unmoored. Now that their ideology has come back to bite them in the proverbial butt, will they learn anything about what makes for a functional, fair, pluralist society? I’d like to be optimistic on this point, but knowing evangelicals like I do, I simply can’t. 

Back in the 1990s, I knew someone who, after switching jobs and facing a serious medical issue, ended up deep in debt due to the new insurer’s refusal to cover the kind of “pre-existing condition” that the Health Security Act of 1993 would have required insurers to cover. I know this person suffered and found the situation unfair. Being a Christian woman, however, she went right on voting for Republicans, the party of white Jesus, of “unborn babies,” of “family values”—and of opposition to the bill that would have required insurers to treat people with dignity and care.