Am not sure whether anyone’s seen John Oliver’s latest, a report on Health Care Sharing Ministries on this week’s episode of “Last Week Tonight on HBO.” It seems worth sharing.
Oliver goes into detail about Health Care Sharing Ministries, including how they fulfill the Obamacare requisite to have health insurance. People are considered to be “covered” under the law by participating in a Health Care Sharing Ministry, known by the acronym HCSM (although SCAM might be a much more appropriate acronym for some). These types of “policies” are also known as “Medi-Share.”
Essentially, an HCSM is (supposedly) a religious-based organization (my definition of religion is dramatically different than 99 percent of “religious-based” organizations) that seeks to “share” or pay for people’s medical care by others in the HCSM.
The concept sounds Utopian. Become a member of an HCSM and have your medical bills covered by other people of faith out of the kindness of their hearts. Sounds good, right?
Unfortunately, as Oliver explains, the devil is in the details (pun intended) regarding both how HCSM’s are set up and operated.
Legally, HCSM’s are not required to actually have to pay for any medical bills due to the fact that they are not health insurance companies. Many states, like Florida (of course) actually exempt them through safe harbor laws specifically stating that these organizations can operate outside of health insurance laws in those states since they are not health insurance companies.
Some of those operating HCSM’s claim to pay “100 percent of people’s eligible medical bills,” which is true although what they deem to be “eligible” and what others think should be offers them a loophole as big as the Grand Canyon. For instance, it’s up to the HCSM to determine whether patients have adhered to the same faith-based beliefs and lifestyle which the HCSM deems appropriate. And here’s where this Utopian ideal starts to unravel. Those faith-based beliefs and lifestyle practices require that participants adhere to what the HCSM says is “faith-based” use of alcohol (although they don’t specify what that might be). Another example would be whether you’ve lived a faith-based life in terms of sex outside of marriage or with someone of the same sex. Those are disqualifiers for coverage.
In case you haven’t already gathered it, covering your bills itself...100 percent or otherwise...takes on new meaning under HCSM’s own terms. They might be moved to cover your bills...if you meet their criteria which, basically, constitutes whatever they say at any point in time due to extremely loose wording. And even when an HCSM determines your medical claim is eligible, they will reimburse you only AFTER you have already paid for your medical bill out of your own pocket, according to Oliver’s report. You then, apparently, “submit” your request for your fellow brethren, through the HCSM, to reimburse you for the bill or bills you’ve already paid. Am not sure if it’s required, but apparently, if all else fails,you might be able to count on their “thoughts and prayers” to help you out in cases where they determine that your bill or bills are not eligible. (It’s unclear whether even that’s guaranteed.)
If you now use (or have ever used?) alcohol in accordance with the way people of faith are supposed to (whatever that might be, according to the HCSM) or if you have now (or ever had?) sex outside of marriage or with someone of the same sex or ever had an abortion or any number of things that don’t comport with the way that people of faith are allegedly supposed to conduct themselves...well...all bets are off, in terms of money to reimburse you for the medical bills you’ve already paid.
The Oliver report piqued my curiosity, so after doing a little more research, it appears that these “ministries” require monthly payments to belong, ranging from more minimal plans costing as low as $64 a month to five or six hundred dollars a month, depending on the plan. Those rates and even the names of some (gold, silver, bronze) sound susupiciously similar to actual real health insurance plans offered by real health insurance companies, including those through the Affordable Care Act. And, since HCSM’s are not health insurance companies they are not actually required by law to reimburse you for your medical expenses at all if you don’t meet their “faith-based” standards of belief and lifestyle.
What could possibly go wrong with all that?
Well, rather than go into all the details here, you may want to take the approximately 22 minutes to watch John Oliver’s report on HCSM’s. You’ll even find out how easy it is to set one up, which Oliver himself did, just to see what kind of stringent oversight there might be in doing so (little to none).
One of the key distinctions between bona fide health insurance companies and HCSM’s is that, under the Affordable Care Act, health insurers cannot spend more than 20 percent on administration costs, so must spend 80 percent on health care. HCSM’s, since they are outside of health insurance regulations, especially in states like Florida that have given them “safe harbor,” can, on the other hand, spend much more on so-called “administrative costs.” And, according to Oliver, they do. He cited one example where an HCSM spent only 16.03 percent on actual health care for its members and the rest in “administrative costs” for it and its partner company.
It’s estimated that up to a million people currently participate in HCSM’s.
https://www.yahoo.com/lifestyle/john-oliver-sets-church-unmask-100400412.html
(PS: Others may have already written articles about these so-called “Health Care Sharing Ministries,” but the fact that they even exist and all other details about them were news to me.)
(PPS: Am wondering how the Medi-Share exemption for HCSM’s ended up in the Affordable Care Act to begin with. It sounds like a suspiciously Republican idea, though only one Republican ever voted in support of the ACA (Former Rep. Joseph Cao of Louisiana, who only voted for it after it already had received the 218 votes needed to pass.))
www.yahoo.com/…