By Ann Neumann

Like most family stories, the one told to explain why my Mennonite grandparents chose to switch churches in the 1950s has a few variations. As one version goes, the pastor of Byerland Church, where many of our relatives were active members (and where several generations are buried), asked that my grandmother reconsider the length of the strings on her covering. They were a little too short for the pastor’s modesty. She declined; my grandparents found a new congregation, Willow Street Mennonite Church.

The second version of the story involves my grandfather who, they say, was inclined to purchase health insurance for his young family, a violation of Byerland’s ordinances. While health insurance was popularized in the 1950s (see here for more on the history of health insurance in the US) Mennonites traditionally did not participate in the growing program. Many Anabaptists—a category of Christians that includes both the Amish and Mennonites—have, because of their history of persecution in Switzerland and subsequent countries after the Reformation, refrained from participating in corporate, legal, and government practices or institutions such as: health insurance, lawsuits, military conscription, or public schools. Even today, very few Amish vote.^[1]

While churches like Byerland and Willow Street no longer require that members dress plainly or go without health insurance, many Anabaptists continue to cover medical costs without insurance.^[2] The Amish, for instance, pool their congregation’s money to meet the medical needs that members accrue.^[3] The practices of Mennonite churches are hard to generalize. Their worldly engagement has both drastically changed and not changed at all in the past several decades, depending on the congregation and the conference. Still, the Anabaptist population remains relatively small: about 1.4 million global church members.

Health insurance has changed radically in the past half century because of the increasing rate of self-employment (and unemployment), the decline of affordable job benefits (and salaries against cost of living), the increasing age of the population, the radical rise of medical costs, and the greater availability of medical treatments. When the Obama administration broached health care reform, it was not a minute too soon and about 30 years too late. But ideological and political differences warped the conversation about quality national health care provision into the spectacle of a national World Wrestling Entertainment, Inc., match.

In January 2010, when the policies and provisions of the Affordable Care Act were just taking shape, I wrote a piece for the web publication, Killing the Buddha, about right-wing commenters who got wind that Anabaptists would be exempt from the law’s mandate. “We’re all Amish now,” the likes of Michelle Malkin and Don Surber claimed. “I’d say the Amish have about 16 million people who might want to become Amish and be conscientious objectors to being drafted into Obamacare,” Surber wrote at the time, callously managing to demean both the religious convictions of an entire Christian denomination and to mock the desperate need for equitable care coverage for the rest of the country. (Why 16 million? Perhaps that was Surber’s sad reach for a critical mass?) Malkin’s point that “some faiths are more exempt from government intrusion than others,” I wrote at the time, “is further explained by Raymond Arroyo, [a blogger on Laura Ingram’s website]:

So get this straight: the Amish, Old Order Mennonites and possibly Christian Scientists can opt out of the health care plan, with no penalty, while Catholics and other Christians are bound to pay premiums that fund abortion. How is that fair? Hundreds of Christian, pro-life hospitals, doctors and nurses may soon be forced to violate their consciences and offer or perform procedures they consider morally objectionable.

The conflation of health care providers (hospitals) who serve a pluralistic society with individuals (doctors, nurses, and folks like Surber) who might oppose certain constitutional medical treatments, is not an error. Conservatives have been successful at claiming that institutions and businesses have consciences just like individuals.^[4]

As it turns out, right-wing, anti-Obamacare conservatives were onto something. First came a wave of “religious exemption” haggles between the Obama administration and the Catholic Church. Then evangelical Christian corporations won the right to flout the law.^[5]

Catholic and evangelical families have also found a way around the Affordable Care Act (ACA) mandate in increasing numbers through health sharing ministries, which look a lot like mutual aid societies, a relic of the pre-insurance days. Health sharing ministries have had a revival in the wake of Obamacare’s passage. Last month, Buzzfeed’s Laura Turner wrote a long exposé of Samaritan Ministries, “one of a number of Christian health care sharing ministries in the US that take the place of traditional health insurance by pooling and redistributing members’ money each month.” Samaritan is a nonprofit based in Peoria, Illinois with revenue of more than $34 million in 2015 (up from $6.6 million in 2013). Its members are asked to send their prayers and monthly checks (enrollment costs are based on family size) to those in need and can then submit copies of their medical receipts to the organization for reimbursement.

How many are enrolled in such cost sharing “ministries”? Turner writes that the three largest ministries, Samaritan, Medi-Share, and Christian Healthcare have just under 900,000 individuals. That includes nearly 400,000 new enrollees since February, 2016. Even smaller ministries are experiencing incredible growth, some at the rate of 200% since last year.

Many other health share ministries exist in the country, but they are much smaller, like the Mennonite organization Liberty HealthShare, based in Florida. Another, according to Turner, is Solidarity HealthShare, which is Catholic but partnered with a Mennonite organization to meet Obamacare’s stipulation that qualifying health sharing ministries existed before 1999.

Several factors are attracting evangelicals and Catholics to health care ministries like Samaritan: members appreciate the low overhead costs, aided by the fact that CEOs tend to earn a fraction of what corporate insurance companies do (Samaritan’s CEO took home $184,000 in 2014; in 2015 Aetna and Cigna’s CEOs earned $17.3 million each).^[6] “I haven’t felt like I’ve been throwing my money away to grease some CEO’s pocket,” a ministry member named Jennifer told US News’s Kimberly Leonard last year.

Members also like the sense of community created by sharing financial needs and prayers. But the big draw for many of the Catholics and evangelicals who have rushed to enroll since the passage of the ACA is the ministries’ anti-government and “pro-life” practices, an ideological mix that is as political as it is religious.

At reason.org, Jim Epstein wrote last year that Samaritan protected members from paying for others’ bad behavior. He quotes: “Do you support abortion, sexual immorality, drug & alcohol abuse with your health insurance?” from the cover of one Samaritan pamphlet which, he writes, later warns that “Joining with ‘unbelievers’ to cover the ‘health consequences of sinful living is not a way of showing the love of Jesus Christ.’”

However one might wish to interpret and institutionalize Jesus’s prejudices (on Epstein’s claims of what Jesus would do, I beg to differ), the new iteration of health care ministries pose serious problems for patients. While they satisfy the Obamacare mandate, they bypass most of the consumer protections that Obamacare made law, like inclusion of those with preexisting conditions. As Turner finds, “there are serious drawbacks lurking below the surface” for many members. Samaritan, for instance, has a lifetime cap “between $125,000 and $250,000.” Chronic illness, addiction, mental illness? You’re on your own.

Other restrictions, as noted by health care blogger Sean Parnell, involve members’ demonstrated religious conviction. Parnell writes about Solidarity, which launched last year:

The requirements for membership in the ministry are fairly consistent with those of other ministries, for example no drug or alcohol abuse. Regular church attendance is also expected. Not surprisingly for a Catholic entity, there are also prohibitions on contraceptive use (Protestants tend not to have objections to married couples using contraception) and an expectation that members “[r]eceive the Sacraments regularly” and “[c]onsult with our priests over matters of moral conscience.”

The questions that the current ministry boom raises are many. While the pre-ACA methods and size of health care sharing ministries were apportioned to a small minority religious group (Anabaptists), the increasing inclusion of Catholics and evangelicals signifies something new, primarily because this group’s newfound use of ministries appears to be significantly politically motivated. Where once these ministries sheltered unique religious convictions, centuries old—Anabaptists largely live sequestered from general public life—the new and growing membership of Catholics and evangelicals has begun to transform ministries from havens of protection into organizations that enforce exclusion and even jeopardize member’s health and financial well being.

The articles I’ve linked to above often chronicle cases of ministry members whose health care bills were denied or whose membership was terminated because of coverage restrictions. Turner’s article is framed around a couple whose adopted child was ultimately not covered. Lifetime cost caps, denial of those with existing conditions, and lifestyle requirements further embed discriminating practices.

Ministries like Samaritan have raised concern across the country. As Kimberly Leonard writes at US News (linked above):

Commissioners or judges in Washington, Kentucky and Oklahoma tried to shut health sharing ministries down in recent years, but state lawmakers stepped in, allowing them to run without the same regulations insurance companies face. According to the Alliance of Health Care Sharing Ministries, 30 states have such exemptions.

As the status of health care hangs in Trump’s balance, many leaders in the Catholic Church have come around to the health care provision, urging congress to not repeal the law. Many of the ACA’s protections have proven beneficial to millions.

While the ACA is deeply flawed (a recent article by Helaine Olen at The Atlantic goes a long way in reminding us that our current system is not even close to meeting our health needs), Republican’s opaque and diabolical plan to un-insure 20 to 24 million Americans—while simultaneously relegating elders, the disabled, the chronically and terminally ill, the mentally ill and pretty much anyone who doesn’t have a full time, salaried job to the not very metaphorical curb outside the emergency room door—the politicization of affordable and comprehensive care in the country is likely only to increase.

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^[1] Although that hasn’t stopped Republican’s from focusing efforts on this “often forgotten block of voters”: http://www.aljazeera.com/indepth/features/2016/09/elections-america-amish-voters-160915122802283.html

^[2] You can learn more about plain dress here: https://en.wikipedia.org/wiki/Plain_dress

^[3] The Amish do not have physical churches, they meet in families’ homes; the bishop, deacon and ministers work together to define the level of worldly engagement the group will have, from clothing styles to telephone use.

^[4] For more on the history and evolution of institutional conscience (for instance, hospitals) see here: http://scholarship.law.nd.edu/cgi/viewcontent.cgi?article=1086&context=ndlr

^[5] http://www.npr.org/2012/02/07/146511839/weekly-standard-obamacare-vs-the-catholics; see also Little Sister’s of the Poor, https://www.theatlantic.com/politics/archive/2015/07/obama-beats-the-nuns-on-contraception/398519/

^[6] Although the cost savings for families enrolled in health ministries is disputed: http://www.healthline.com/health-news/christian-health-cost-sharing-programs-growing-in-wake-of-obamacare

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