Tag Archives: health insurance

Changing the Conversation on Health Insurance

While politicians in Congress wrangle over how to repeal and replace Obamacare, some Catholics and Evangelical Christians have already found an alternative to health care insurance. Surprisingly, it has been around for 30 years. They call it “health care sharing,” and it’s based on the biblical principle of believers sharing each other’s needs. In this case, the “sharing” applies to medical costs.

New model

Jamie Lagarde, a member of Legatus’ Austin Chapter, was so convinced about the merits of health care sharing that in 2015 he helped found Sedera, a health care sharing organization.

“Sedera is in the business of sharing health care costs,” Lagarde explained. “We have 2,000 members in 30 states, and we have doubled in size in the last six months. What we have found is that there are spiritual and economic benefits to applying biblical principles. Who said that insurance was the only way to deal with medical costs? We want to do what Uber did for transportation and what Airbnb did for hospitality.”

Surprisingly, health care sharing is one of the few types of organizations that is exempt from Obamacare requirements.

In health care sharing, people sign up as “members” and share each other’s medical costs. The monthly cost of membership is lower than insurance rates. Each member is considered a “self-pay” patient, and their bills are negotiated down as such. Sedera members can go to any doctor they want.

“For example, we had one couple who had a premature baby,” said Lagarde. “Their baby had to stay in the NICU. Ordinarily, this would cost $199,000. We were able to negotiate the bill down to $30,000 because the couple was considered ‘self-pay.’ We have advocates especially dedicated to negotiating down all of our members’ bills.”

All medical bills over $500 are subject to negotiation. Everything is done behind the scenes with little involvement from the member.

“Getting fair prices for medical services is critical to keeping rates down for the health care sharing community,” said Lagarde.

Bringing costs down

Another example Lagarde gives, closer to home, was when his wife recently went to a dermatologist. The doctor prescribed a cream which cost $600. Through Sedera, they were able to negotiate the price of the cream down to $50.

“We save our members 40 to 60% off their health care costs,” he said.

Lagarde co-founded Sedera with Dr. Tony Dale, a British evangelical Christian. Dale worked as a family medicine practitioner in Britain before moving Stateside in 1987. After having knee surgery in the U.S. in 1996, Dale became interested in medical economics. The cost of his knee surgery was staggering compared to what it would have cost in Britain. He was determined to find a way for individuals to have access to quality and affordable health care.

Dale and his wife Felicity were also involved in medical missionary work in developing countries. Both had a passion for bringing health care to individuals and groups who could not otherwise afford it.

“I was impressed by Dr. Dale when I met him because he is a man of God,” Lagarde explained. “He takes his faith very seriously and incorporates it into his work. Up until then, for me, Sunday Mass did not directly translate into my work on Monday. But Dr. Dale taught me that faith in the workforce does exist and can be an incredibly powerful thing. At Sedera, we are practicing what we believe.”

After meeting Dale, Lagarde remembers one day waking up and telling his wife that he needed to stop what he was doing and join forces with his new friend.

“I felt called to do this. I loved Dr. Dale’s vision of health care in America,” said Lagarde.

Lagarde and Dale began to work on the Sedera concept in 2014 and officially opened in 2015.

“It’s nice now to work for a company where I can share who I am,” Lagarde said. “This is the best and most fulfilling job I have ever had.”

Because of the cost savings which Sedera is able to achieve, the organization is able to help companies get out of the red and into the black.

“I’ve met CEOs of companies who told me that they had stopped offering group health insurance at one point because it was too expensive. With Sedera, these same companies can now help their employees. They save $1,000 to $3,000 per employee per year,” he said.

Faith-based model

Though Sedera doesn’t ask members questions about their faith — as most health care sharing ministries do — the company is clear about the fact that it won’t share the costs of abortion, sterilizations, in-vitro fertilizations, surrogacy or abortifacients.

“I think this is the next big thing,” said Lagarde. “Insurance is a great thing for cars and homes. You offset a highly unlikely event with insurance. But with health care, all of us need it. We all have health care costs. This is about managing expectations and unexpected costs. With more transparency, you get to become more involved in your health costs. This is the way health care should be done.”

Another person who has become convinced about the merits of health care sharing is Mike O’Dea, co-founder and director of the Christ Medicus Foundation. O’Dea has been working for 20 years on the issue of protecting conscience rights for those in health care. He regularly works hand-in-hand with evangelical Christians in lobbying the federal government.

“What has come out of all this work was that we saw a need in the Catholic world for health care sharing,” said O’Dea. “We didn’t have the exemption that evangelical Christian organizations had.”

O’Dea and his team looked into health care sharing plans for Christ Medicus employees and realized that it was a great opportunity. They chose Samaritan Ministries, one of the oldest health care sharing ministries in the country.

“The best part is that people of faith can share each other’s burdens and pray for each other,” he explained. “This goes back to biblical times. We have many testimonies of people and how good they feel to be supported by this network, and the design of the plans is right in line with Catholic teaching.”

SABRINA ARENA FERRISI is Legatus magazine’s senior staff writer.

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ObamaCare five years later

JOHN BREHANY writes that Catholic business leaders are still burdened by ObamaCare . . .

John F. Brehany

John Brehany

by John Brehany

The Patient Protection and Affordable Care Act (aka ObamaCare) is five years old. Legatus members should continue to learn about and respond to this flawed legislation.

Where do we stand at this point? It’s hard to say. The Administration has not provided regular and reliable data about implementation. And the Galen Institute has identified 49 significant changes in ObamaCare (30 by unilateral executive action) since 2010. Most have involved delays or waivers of mandates, deadlines and fees. Another significant change — providing federal subsidies in states without insurance exchanges — is under review by the Supreme Court.

After these caveats, it’s clear that there has been some progress in providing access to health insurance. In 2014, a total of 14 million people obtained new access to health insurance (5.8 million bought health insurance and 8.7 million were added to Medicaid). The net increase, however, was closer to 10 million due to millions losing their employment or private insurance. Significantly, only half of those buying insurance at Healthcare.gov were uninsured, and only one-third of those eligible for subsidies signed up. This lack of participation should be concerning. In 2014, health insurance premiums increased an average of 49% despite President Obama’s pledge that families would see an average $2,500 reduction in annual health insurance premiums. For now these increases are being masked by subsidies.

What will we be facing? The real impact of ObamaCare will be felt in the next few years. First, the employer mandate is set to be enforced in 2016. Employers have already cut employee hours and reduced benefits, and this trend is likely to continue. The disruption in employment-based health insurance could be greater than that in the individual market in 2013. Second, the full costs of ObamaCare will become more apparent in 2017. The Administration has been tapping a $25 billion reinsurance fund to backstop health insurance companies’ losses, allowing them to keep premiums artificially low. After this fund expires at the end of 2016 and insurance companies gain claims experience with the newly insured — who are older, sicker, and poorer than originally projected — on Healthcare.gov, costs almost certainly will be much higher.

What should we do? Catholics and Catholic business leaders in particular should play a key role in proposing and enacting substantive changes to the current law as soon as the window for action opens — after a new president takes office. The Catechism teaches: “It’s not the role of the pastors of the Church to intervene directly in the political structuring and organization of social life. This task is part of the vocation of the lay faithful, acting on their own initiative with their fellow citizens” (#2442).

While being cognizant of key data and of the rules for effective political discourse, Catholic business leaders should make a compelling and comprehensive moral case for substantial changes in ObamaCare that will achieve authentic health care reform and protect essential human goods. I suggest there are at least three indispensable components of this moral case.

First, a moral case should be built on the foundation of Catholic social teachings, especially the principles of social justice and subsidiarity. We respect social justice (CCC #1928) when we ensure that the vulnerable and marginalized have access to adequate health insurance and health care. We respect the principle of subsidiarity (CCC #1883) when we ensure that decisions about health insurance and health care are made at the lowest, most local level.

Second, a moral case should be built on the dignity of the human person and on respect for fundamental human goods — above all, respect for the right to life, of conscience, and of religious freedom. ObamaCare’s sloppily written legislative language undermines longstanding protections for these rights in federal and state law. And the HHS mandate has been imposed with disregard for the religious beliefs of millions.

Third, a moral case can and should build on the strengths of the American social tradition. These strengths go beyond broad human freedom and decentralized governance to include high levels of generosity across the population. America is the most generous nation on earth. Philanthropy has been essential to building the finest and most advanced health care institutions. Legislation and taxes are necessary to protect human rights and the common good. Yet, where the welfare state is strongest, generosity of philanthropy dedicated to serving those in need is the weakest. Sound political and economic measures for health care reform should be supplemented by encouraging philanthropy.

JOHN BREHANY is the director of institutional relations at the National Catholic Bioethics Center.

Navigating murky waters

John F. Brehany: Catholic business owners and the challenge of ObamaCare  . . . .

John F. Brehany

John F. Brehany

The looming implementation of the Patient Protection and Affordable Care Act (aka ObamaCare) is posing critical short-term and long-term challenges to Catholic business owners. How they respond will go a long way toward determining whether the Catholic faith will remain a viable and vibrant presence in American society.

Since ObamaCare’s passage in 2010, employers have waited to learn how the new law would affect their employees and their bottom lines. After missing multiple deadlines, the Obama administration was forced to delay the employer mandate until 2015. In the meantime, however, businesses have experienced significant uncertainty and rising costs, which have negatively impacted employers and employees alike.

A recent U.S. Chamber of Commerce survey showed that only 3 in 10 small business owners say they are ready to comply with ObamaCare, and 25% of business owners are still not sure of what the new law means for them. The average cost of health insurance for families increased by almost $2,500 during President Obama’s first term — almost the exact amount he promised that premiums would decrease as a result of his signature legislation — and a growing number of employers expect costs to rise even higher when ObamaCare is fully implemented. Businesses are responding in a variety of ways — like dropping “extra” benefits such as coverage of spouses, passing on more costs to employees, buying cut-rate health insurance, and by cutting employee hours.

Under ObamaCare, a person who works 30 hours per week is considered a “full-time employee” qualifying for health insurance. Many businesses have reduced employees’ hours below this threshold, causing labor leaders to publicly complain that ObamaCare is undermining the 40-hour work week and the economic benefits provided by full-time employment. Catholic business owners must exercise creativity and prudence in order to protect their businesses and their employees. But these choices pale in complexity to the ethical challenge posed by the HHS mandate.

The most radical change for Catholic business owners under ObamaCare in the short-term is the imposition of the HHS mandate, which requires all health insurance plans (not only those of businesses with more than 50 employees) to provide FDA approved contraceptives (including abortifacients), sterilization, and reproductive counseling to all girls and women without copays or deductibles. While faith-based institutions fought the Obama administration’s radically new definition of “religious employer,” the HHS mandate took effect months ago (in new health insurance plan years starting after Aug. 1, 2012) for practically all businesses in the United States.

Catholic business owners now face a significant ethical dilemma — to either comply with the HHS mandate and cooperate with the evils it entails or to refuse and accept the consequences. To comply with the mandate means to directly subsidize drugs, devices and operations which are objectively evil. Moreover, these “reproductive benefits” will be available not only to employees, but to their daughters, who will be able to access these “services” without the knowledge of their parents. Such a direct and confidential subsidy has long been a goal of Planned Parenthood.

However, refusing to comply with the HHS mandate can entail, at a minimum, either crippling fines of at least $100 per employee per day or dropping all health insurance coverage. Given the manifest evils being subsidized and the direct attack on religious freedom, Catholic businesses can justify providing health insurance in compliance with the HHS mandate (as remote mediate material cooperation) only on a temporary basis while seeking a long-term change in the law or an adequate exemption.

In the long term, it’s possible that the Obama administration and its supporters are hoping to eliminate employer-sponsored health  insurance and impose a single-payer system, in which the federal government is the ultimate arbiter of health-care services, pricing and payments. Sen. Tom Coburn (R-Okla.) and Jeffrey Flier, M.D., dean of Harvard Medical School, both argued in the past that ObamaCare, by intent or by its very nature, is practically guaranteed to fail in a few years. Sen. Harry Reid (D-Nev.) admitted as much in an interview in August. What does this mean for Catholic business owners?

Radical changes in health-care financing may be unavoidable. Employer-provided health insurance is not mandated by Church teaching; a just wage and workplace are. In these challenging times, Catholic businesses can play a key role in promoting a whole range of goods identified by Catholic moral and social teachings, including religious freedom, human dignity, responsibility in the workplace, and subsidiarity, to name only a few. We are now facing a powerful federal government that is increasingly hostile to religious freedom and promoting a culture of death. Only if Catholics work together in new ways and establish new networks of support, can the Church sustain an authentic public witness to the faith.

In the coming months and years, Catholic business owners should view the challenges posed by ObamaCare as an opportunity to renew their Catholic faith and witness to it more explicitly — in their businesses and in the public square.

JOHN F. BREHANY, PH.D., STL, is the executive director and ethicist of the Catholic Medical Association.