DIY Health Insurance Pools Don’t Always Keep People Afloat

Photo credit: Luke Jones, CC BY 2.0.

We’ve probably all had this idea at some point. It’s the sort of thing you say to friends over a latte and a plate of avocado toast: “What if a bunch of us didn’t buy health insurance and put all of that money into a shared healthcare account instead?”

With enough people, you could form your own little insurance pool and save money, right? It’s a natural step up from the GoFundMes we’re all doing, and we could ensure everyone gets the benefits they need.

Well, some churches do in fact have their own insurance pools, and today’s must-read longread is about the benefits—and consequences—of this system:

There’s A Christian Alternative To Health Insurance, But It’s Not For Everyone

For Christians looking for a way to opt out of an expensive health insurance market that they see as profit-driven, intruding on their personal freedom, and indifferent (at best) to issues of abortion and the sanctity of life, health care sharing ministries may seem like the perfect, providential solution. These ministries now legally satisfy the individual mandate of the 2010 Affordable Care Act, and have expanded rapidly since its passage. But there are serious drawbacks lurking below the surface. These ministries’ policies replicate some of the most significant problems with insurance that the ACA was intended to address in the first place, and come with their own unique risks for consumers.

This is a very long longread, and it’s difficult to summarize except to say that “the fantasy of the shared insurance pool doesn’t necessarily work out in reality.” Yes, some people get their healthcare needs paid for. Others don’t. There are rules about what health care sharing ministries will cover and what they won’t, and sometimes those rules seem unfair. (One health care sharing ministry profiled in the article does not cover healthcare for adopted children.)

You’ll probably be curious about how health care sharing ministries handle the cost of healthcare “without insurance,” and the answer is… they ask their members to negotiate discounts.

Ministry members often pay their medical bills out of pocket and wait for reimbursement; they are also encouraged to negotiate discounts with their providers. Bet Olson did this when she was with Samaritan: “I remember saying, ‘We don’t have insurance. Do you have a cash rate?’ Sometimes that would drop [the bill] by, like, two-thirds.” The website for Christian Healthcare Ministries recommends a similar strategy: “Insurance companies regularly negotiate prices and you can, too.” If a patient doesn’t get a discount of at least 40%, Christian Healthcare Ministries recommends working with its patient advocates to coach you.

So… yeah. It’s insurance-ish but it’s not insurance. It’s one way to cover the cost of the American healthcare system, but it’s not as effective as it could be and comes with its own problems. If you’ve ever wanted to see how the shared insurance pool idea might work out in reality, and have enough time to make it through an 8,500-word article, it’s a really good read.

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