ANALYSIS/OPINION:

When it comes to the intense (and intensifying) debate over health care in America, the conversation begins at the top of the alphabet. “A” is for “Access.”

One of the key lessons we’ve learned from the Obamacare experience is that “having health insurance” isn’t the same thing as having access to quality health care.

Millions of Americans are learning the hard way about the tradeoffs between health insurance policies that have no premiums (so-called “free health care”) or those with low premiums but high out-of-pocket costs. The dual promises of “free health care” and the ability to “keep your existing insurance if you want to” were quickly proven to be mere political slogans with no basis in reality.

“The truth,” as Oscar Wilde quipped, “is rarely pure and never simple.” Nowhere is this truer than when it comes to insurance design. Americans are understandably “B” (baffled) about their lack of “C” (choice).

Broader access comes via expanded choice. Some believe average citizens can’t be allowed to choose their health coverage. These are the same voices who initially decried the Medicare Part D drug benefit because seniors couldn’t possibly choose the plan that was best for them. Today Part D has a 90 percent approval rating among those 65 and older.

In August 2018, the Trump administration finalized rules that expand access to so-called “skinny” short-term health insurance plans. These are low-cost, low-coverage options designed for healthy young people — among others — who chose to opt out of Obamacare. They instead prefer to pay the mandated fine, which is generally lower than the price of even a low-cost Obamacare “bronze” level policy.

Another option that is gaining momentum among wide demographic swaths is health-sharing ministries — organizations that facilitate the sharing of health care costs among individual members who have common ethical or religious beliefs.

A health care sharing ministry does not use actuaries, does not accept risk or make guarantees, and does not purchase reinsurance policies on behalf of its members. The monthly cost of membership in a health care sharing ministry is generally lower than the cost of insurance rates for a similar policyholder or family.

According to an estimate from the Alliance for Health Care Sharing Ministries, when the Affordable Care Act — which recognized health care sharing ministries as an alternative form of insurance — fully went into effect in 2014, an estimated 160,000 people were enrolled in these programs nationwide. Today, as many as 1 million people have joined, says the alliance.

Health Sharing eliminates traditional insurance marketing expenses. The Affordable Care Act mandated that health insurance companies use a maximum of 40 percent of health insurance premiums for marketing and administrative costs. Health sharing plans are, by definition, benevolent organizations structured for the benefit of their members, with administrative costs generally in the 10 percent range.

Members of a health share pay a predetermined monthly amount, which goes to pay other members’ eligible medical costs. At its core, health sharing is simple and encompasses the basic belief of caring for one another, as well as the time-honored ideals of strength in numbers and sharing burdens together.

Thirty states have safe harbor laws that distinguish health care ministries from health insurance organizations. Some of the larger health care sharing ministries include Christian Healthcare Ministries, Medi-Share, a program of Christian Care Ministry, Samaritan Ministries, Liberty HealthShare, MCS Medical Cost Sharing and Altrua HealthShare.

Most health sharing ministries tend to have restrictions, such as abstaining from excessive drinking and use of tobacco or illegal drugs. They usually require members to be in good health and make a statement of belief, as well. Liberty HealthShare is more inclusive, accepting members with a wide variety of beliefs.

According to Larry Foster, CEO at Liberty HealthShare, “Health Sharing is an ingenious answer to the high cost of today’s healthcare.”

“Ingenious” is in the eye of the beholder, but health sharing is an option that needs to be more widely understood and considered by millions of Americans seeking alternative access to health coverage. More options are better and Americans (yes — even religious ones) have the smarts to make their own choices.

“Liberty is the right to choose. Freedom is the result of the right choice,” said Jules Renard.

• Peter J. Pitts, a former FDA associate commissioner, is president of the Center for Medicine in the Public Interest.

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