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Didn’t see this coming – the Republicans’ healthcare “plan”

In a move that caught all Capitol Hill – and me – by surprise, President Trump and key Senators finalized the outline of the GOP’s new healthcare plan over the weekend.

Set to be announced later today, the plan builds off the faith-based “sharing” programs already in place in the ACA, greatly expands their reach, incentivizes employers to adopt faith-based coverage, and enables these programs to compete in the senior market. There are a half-dozen or so ministry/faith-based programs now in operation with total membership around the million mark.

Unlike regular insurance, members “share” the cost of care by paying into a central fund that then reimburses individuals for needed medical services.

Currently faith-based coverage is provided by entities including Liberty HealthshareChristian Medi-ShareSamaritan Ministries, and Altrua Healthshare. As of today, these entities don’t have to provide the same level of benefits, coverage, or financial protection insurers do under the ACA. And, they are pretty much exempt from regulation as they aren’t “insurance” per se.

Faith-based sharing programs will compete with the big healthplans for members in the federal – and perhaps states’ – healthcare exchanges. The plans, which are much less expensive than “regular” health insurance, may well see huge gains in membership.

On ABC’s thisweek Sunday talkshow, Whitehouse Chief of Staff Mick Mulvaney  asserted the plan would deliver on the President’s promise to protect Americans with pre-existing conditions. “We’ve heard it over and over again, Americans trust their churches and ministers to do the right thing [which includes addressing pre-existing condition coverage]. So, we’re going to build off the amazingly successful faith-based programs now in place, expanding their reach and helping them compete in the free market.”

When asked how the new plan would maintain or expand the number of Americans covered by health insurance, Mulvaney didn’t get into any details other than claiming “faith-based programs will have much lower administrative costs as they don’t have all the overhead the big insurers do…this will make insurance much less expensive, which means more people can afford it.”

It appears Vice President Mike Pence has been strongly advocating for the faith-based approach for some months.  Evidently Pence, a self-described evangelical Christian, was prepared when the President publicly called for Republicans to be “the party of great healthcare” last week. The VP met with Trump, Mulvaney, and key Senators over the weekend and finalized the outline of the plan.

Mulvaney, who is one of the members of Trump’s team leading the charge on repealing Obamacare, said Sunday “There’s absolutely zero daylight between the president and vice president on this issue.”

Interviewed on CNN’s State of the Union yesterday, Mulvaney went further, describing the plan as fulfilling Senate Republicans’ request that the Administration provide them with “principles” that they could build a healthcare plan around.

Here’s the issue. Faith-based programs don’t have to keep a certain level of financial reserves, can deny payment for any reason, exclude any condition, and cancel coverage. And, in most states no regulator is watching over the programs.

Sure, this will make “coverage” cheaper, but there’s no guarantee it will be there when the buyers need it.

I’d expect this approach to face tough sledding in the Senate, and likely won’t be considered at all in the Democratic – controlled House. However, it’s likely Trump will try to do much of the heavy lifting via regulatory means and Executive Orders. However, these efforts will undoubtedly be challenged in court, where Trump has had a pretty poor record. I’d also expect the big healthplans will roll out their lobbying big guns.

But…the move further cements Trump’s standing with evangelical. As he’s clearly playing to his base to prep for the next election, it will serve him well.

What does this mean for you?

Just when you think you’ve heard it all…

4 thoughts on “Didn’t see this coming – the Republicans’ healthcare “plan””

  1. Oh come on Joe, tell us how you really feel. It seems like somewhere between your heart and your fingers there is a filter working overtime.

  2. I’m self-employed and just switched to a christian healthcare ministry for my family of 5 this year in 2019. I have been happy with the switch so far (though I have not needed the “coverage” yet).

    It’s very true that these plans are not “insurance.” They make it very clear that they have no obligation to pay your claims. If fact, they appear to go to good lengths to make it clear that “they” (the sharing ministry) does not pay your claims. Other members share in paying your qualified medical expenses. At the same time, I believe these plans do have a strong record of coming through for their members when the members need it.

    A big advantage of these plans for most people is the dramatically lower “premiums.” In my case, I was paying $2600/month on the exchange in Nebraska and now I pay about $600/mo through Christian Healthcare Ministries. What I get for that is a bit complicated, but it essentially boils down to the fact that I present myself as a an uninsured, private pay patient when my family or I go to the doctor. There is no “deductible” that accumulates at all for us, and nothing at all gets sent to the healthcare sharing ministry for a typical doctor visit. There is no hassle of billing, re-pricing and waiting. We just say we are private paying. We ask for a discount and offer to pay the same day if they want us to. Most doctors have fair private pay rates and will even potentially discount further if you offer to pay right away.

    We essentially have a $500 “copay” for any medical incident or visit. Any expenses beyond that are eligible to be submitted to be shared (reimbursed) by other members. In the instance we did have a more expensive medical issue, once we received our shared amount back (everything above our $500 responsibility), we would be responsible for paying the entire amount to the provider. Our plan does not reimburse providers directly. I believe at least one of the other plans does, but I’m not sure.

    These plans do exclude pre-existing conditions to varying degrees, and they may not cover as many services as some insurance plans. These plans may not work for every individual or family, but for me (and a large segment of the US population) they seem to be just what the doctor ordered. Considerably less expensive and uncomplicated to administer.

    Bottom line is this creates a VERY different way to consume healthcare. For my family, it is working great so far. We are happy to take ownership of arranging and negotiating our own healthcare. Through three months, we have seen the doctor a few times (a strep-test for our 1 year-old, some vaccinations, and a doctor visit for my wife). Each time we have paid the entire bill ourselves. No need for the “insurance” side of this yet…and I’m hoping we won’t have a need to submit anything for “sharing.” When that does happen, I hope it works out just the way it’s supposed to!

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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