"Who is this Barack Obama who mocks the armies of the living God?" demanded James Lansberry, Christian crusader against government-regulated health care, last summer in the heat of the battle over reform.
Since the health-care reform bill passed last month, Lansberry has become a hot commodity on the conservative talk-radio circuit where he sings the praises of health-care-sharing ministries (HCSMs), Christian nonprofit organizations through which members agree to cover each others? health-care costs. As president of the Alliance of Health Care Sharing Ministries, Lansberry, and his team of lobbyists, had persuaded Senate lawmakers to exempt alliance members from the individual mandate. That exemption, Lansberry said, made those ministries "an island of freedom amidst this terrible piece of reform legislation" and "the last pro-life option for Christians of faith."
The exemption raises an array of concerns, including constitutional questions about the limits of such religious exemptions as well as about adequately protecting consumers without the type of regulatory oversight required of insurance companies. It is also emblematic of how elected officials cater to religious objections without fully examining their origins or consequences.
The exclusion from the individual mandate is "just another example of an exemption granted by a legislature that doesn?t bother to look under the rock," says Marci Hamilton, a professor at Cardozo Law School and author of God Versus The Gavel: Religion and the Rule of Law. "It happens all the time. A religious group asks for an exemption, and busy legislators think, well, it?s religion, at least I?m doing some good for someone today. But they don?t ask the hard questions."
Lansberry is also vice president of Samaritan Ministries International, the largest of a handful of HCSMs with 46,000 members (HCSMs have a nationwide membership of roughly 100,000 ). For Samaritan's members, there are no premiums, co-pays, or claims forms. To join the HCSM, applicants must agree to a statement of faith that they are a "professing Christian, according to biblical principles" set out in Romans 10:9-10 and John 3:3. They must agree to adhere to guidelines that include no sex outside of "traditional Biblical marriage," no smoking or drugs, and mandatory church attendance. They must agree to pay their membership fee and monthly share, and they must also agree not to sue Samaritan in the event of any dispute because "Christians are not to sue each other in the civil courts or other government agency."
Members pay for their medical costs out of pocket, and submit their receipts to the ministry, which then "publishes" members? "needs" in a monthly newsletter. There is a $100,000 cap on reimbursements, and certain medical conditions, including some pre-existing conditions, pregnancies of single mothers, abortions, drug and alcohol rehabilitation, and sexually transmitted diseases, are excluded. Each member then sends their monthly "share" to a member who has a published "need." In an interview, Lansberry maintained that no Samaritan member has had a "need" go unfunded, because "God is the ultimate provider."
Due to HCSMs' lobbying, most states do not regulate them as insurance companies. But the National Association of Insurance Commissioners has consumer-protection concerns about HCSMs, noting, "Such arrangements are not insurance and the participants do not have the protections available to purchasers of licensed insurance plans." Michael McRaith, director of the Illinois Department of Insurance, says, "This is not an issue of whether faith-based communities are appropriate vehicles to share health-care costs. The issue is: Are consumers in fact receiving what they?ve been told they?re paying for?" Unlike conventional insurance companies, McRaith says, sharing arrangements are not required to maintain reserves to pay out claims; the contracts are not subject to the same conventions and interpretations as insurance contracts; and consumers do not have recourse to state regulators or private litigation if their claims are denied.
While the mission of insurance companies is simply to pool health risk, Samaritan, which has 501(c)(3) status under the Internal Revenue Code, states in its most recent tax return that its primary purpose is "to carry out the Biblical Great Commission of Matt[hew] 28:19 & 20, currently focusing on developing a Christian worldview among its members and the broader Christian community." This, according to the tax return, is "opposite the ?entitlement? mindset that is endemic in our culture."
Samaritan argues that a community of believers should be exempt from government requirements for insurance so they can care for each other in accordance with their religious beliefs. But according to Hamilton, HCSMs are not constitutionally entitled to the exemption from the individual mandate. "I don?t know of any group that has a set of religious beliefs that require religiously orchestrated insurance," she said. "Under the Equal Protection Clause, under the Free Exercise Clause, and under the Establishment Clause, the government cannot give someone a benefit just because they?re religious" but only exempt them if there is a burden on their religious practices, such as the exemption certain Native American tribes have for use of peyote in religious ceremonies. Health care, she added, is "the arena where it?s my view that the Supreme Court needs to start explaining what are the boundaries for exemptions."
Last summer, Lansberry discussed HCSMs at the annual conference sponsored by American Vision, a group with ties to the Christian Reconstructionist movement, which aims to remold society to conform to biblical law, replacing regulation by the state. Lansberry downplayed the health-care crisis, claiming that it is "important that we see health-care reform is not urgent, and the reasons for it not honest." Lansberry complained, "We?ve allowed government to provide charity" rather than the church. "Every time we let the government help someone we should be helping," he maintained, "we rob Jesus of glory, and we are thieves just as much as the government who's stolen that money from us to provide that care."
Doug Phillips, president of the Christian Reconstructionist group Vision Forum and son of conservative movement icon Howard Phillips, touted Samaritan after the passage of health-care reform, calling it a "biblical alternative to socialized health care." American Vision also began offering Samaritan membership rather than insurance to its employees. "We believe that the Bible mandates Christians to exercise servanthood dominion in every area of life," American Vision Vice President Brandon Vallorani said in a press release announcing the affiliation. "SMI is doing just that in the area of health care and God is clearly blessing it."
