Ferenstein: My Experiment with a Cheaper, Legal Obamacare Alternative that Rewards Healthy Lifestyles

Physician Assitant Marina Sarwary (L) takes a shopper's blood pressure as part of the "Shop with a Doc" program, November 28, 2016 at a Ralph's Supermarket in Irvine, California. "Shop with a Doc" is a community health program from St. Joseph Hoag Health hospital group which brings medical professionals and …

Technological advancements should be an unquestionable gift to American healthcare.

We can live longer, more vibrant lives than in any time in human history. Instead, sedentary lifestyles hunched over computers and calorie-packed franken-foods have left us chronically sick and addicted to prescription drugs. This twisted devolution in our health is wrecking the nation’s families, communities, and economy.

In search of an answer, for the past year, I have been experimenting with an obscure Obamacare alternative that I believe holds an answer to declining health and, more importantly, is something that Congress should protect as it considers overhauling the nation’s healthcare law.

I am legally exempt from the Obamacare mandate and only pay about $200 a month for health coverage. The fascinating legal loophole that allows me to save so much money is the existence of unregulated religious “health sharing ministries,” which are allowed to charge consumers higher premiums if they engage in voluntarily unhealthy behavior.

Under this arrangement, if I visit the doctor and he finds that I’m overweight, he’ll prescribe a protocol for healthy eating and exercise, based on what he knows about my unique access to nutritious food and genetics. If I refuse his advice and maintain a dangerously unhealthy lifestyle, my insurance costs can jump over $400 extra a month, reflecting what I am costing others in my healthshare pool.

Healthshares have been around for decades and are a financially sustainable for-profit healthcare insurance alternative.

So, how is my coverage so cheap?

Healthshares are legally allowed to reward consumers for their use of the so-called “miracle drug,” which is what the Academy of Medical Royal College’s clever term for diet and exercise. Healthy behavior is a powerful known treatment for many major illnesses, including cancer, heart disease, depression, and Parkinson’s.

Recently, Republicans have faced a string of attacks in the media for proposing reforms similar to the healthshare model, such as Rep. Mo Brooks (R-AL), who said it’s wise for “insurance companies to require people who have higher healthcare costs to contribute more to the insurance pool.”

He continued, “that helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they have done the things to keep their bodies healthy, and right now those are the people who have done things the right way and are seeing their costs skyrocket.”

Fortunately, businesses for this approach already exist, are growing in popularity, and provide a working model from which to develop sound policy.

Here’s my explainer for why I chose the healthshare model and what I think Congress can learn from it:

What are healthshares?

Healthshares are a kind of co-opt insurance alternative, where members collectively pool their monthly payments and withdraw from the fund in the event of a medical expense. Healthshares have been around for decades and have seen their ranks reportedly surge after the introduction of the Affordable Care Act.

Healthshares keep cost down in a variety of ways, including the benefit of having a self-selected population that is conscious about their health.

They have also had some success negotiating down medical fees on their members’ behalf — like this example noted in the New York Times about Theresa Bixby, a 63-year-old patient who had joined a healthshare shortly before receiving a cancer diagnosis. The Times explains:

Christian Healthcare Ministries assigned her case to a “member advocate,” who negotiated discounts on her fees. These counted toward Ms. Bixby’s $5,000 deductible, so she paid out of pocket only for office visits. In the end, the ministry persuaded the hospital to lop $220,900 off a bill of $301,540 and reimbursed or paid directly the remaining $80,640.

Healthshares began as religious-based organizations that often required consumers to declare their faith to a particular belief, but new entrants into the market have since broadened their admissions to almost any kind of faith.

Between a healthier clientele, discriminating prices, and strategic cost negotiations, healthshares allow members to enjoy (much) cheaper insurance.

What is your insurance and how does it charge you more for an unhealthy lifestyle?

My particular healthshare company, Liberty, flags unhealthy behavior during doctor visits.

For instance, a member who became obese by eating unhealthy foods and refused to exercise would be flagged by Liberty if they saw a doctor who noticed that their patient was dangerously overweight. Liberty would place the member on a higher risk “Healthtrac” plan and work with them to adopt a healthier lifestyle (being on Healthtrac is roughly three times more expensive).

“We have a program called HealthTrac that helps people who have certain pre-existing health problems in their life that may be responsive to lifestyle changes (ex. smoking, obesity, type 2 diabetes, heart disease, blood pressure, etc.),” a Liberty spokesman tells me.

“We do this because of our shared belief that we are to treat our bodies as temples. We welcome anyone who wishes to take responsibility for the care of their health. We try to be as inclusive as possible. We are finding ways to take on people who have higher medical needs so that they too can contribute to others within our ministry.”

Do these programs make people healthier and make healthcare more financially sustainable?

According to an Emory University study, preventable diseases cost America somewhere north of $150 billion a year and cost individual consumers over $1,200 a year. America’s uniquely poor lifestyle is one of the major reasons it cannot afford European-style, single-payer coverage, which would could cost an estimated $15 trillion (!) over a decade.

“We have plenty of money to provide that safety net so that if you get cancer you don’t end up broke,” said Office and Management Budget Director Mick Mulvaney, regarding the so-called “Jimmy Kimmel” test that healthcare should be affordable to every American. However, Mulvaney noted, this guarantee does not extend to folks who have made poor choices.

Mulvaney’s math on national healthcare costs already seems to be playing out for Liberty Healthshare. According to a spokesman, their premium track for overweight individuals does work to keep costs down.

“We have about 12,000 people enrolled in our HealthTrac program and we graduate about 300 people a month,” the spokesman says. “Our HealthTrac members average slightly more than six months within the program. The members in HealthTrac agree to the health goals that are set and they are graduated once they have met those goals.”

If members refuse a doctor’s recommendations, they must pay $600 a month or more.

What about people who get cancer and yet still live a healthy lifestyle?

Many citizens do everything right and still succumb to terrible diseases. But, with a healthy lifestyle, the frequency and severity of these tragedies are dramatically reduced.

Whenever I think about what human health can be like, I think of Jacinto Bonilla, a 77-year old prostate cancer survivor that regularly competes in the grueling Crossfit games.

I watched in awe as he posted a video of himself shoveling snow in the depths of last year’s New York blizzard to do a set of Olympic ring dips.

“I have been in great shape most of my life.Whatever came up in my life and knocked me down, I always got up and kept on with my training. Yes, I give a lot of credit to Crossfit and my diet. Most of all ,it’s what’s inside of you.The infinite divine mind of God,” he tells me.

The data overwhelmingly supports Bonilla’s experience that lifestyle changes can improve cancer prevention and survival rates.

“Twenty percent to 40 percent of cancer cases and about half of cancer deaths could potentially be prevented through modifications to adopt the healthy lifestyle,” concluded ScienceDaily, describing a 2016 large-scale study published in the prestigious journal, JAMA Oncology.

We shouldn’t look at Jacinto Bonilla as some bizarre exception. Humans are naturally athletic until death. Many of us can live happier, more vibrant lives, even in the face of old age and severe disease.

What about people with genetic-prone obesity or who live in food deserts?

Poverty and poor genetics are serious impediments to good health, but it’s good to remember that obesity is a relatively new epidemic–we’ve had the same genetics for millions of years and managed to keep relatively slim. America is one of the most unhealthy countries on earth, and it’s not because we’re the poorest nation or have some fluke genetic mutation.

Obesity plagues even relatively affluent populations. I saw this first-hand as a chubby middle-class kid growing up in Omaha, Nebraska. A (very) large percent of Americans have all the money and time they need to make better choices.

Moreover, while nutritious foods can be more expensive and inaccessible for some, exercise is not some elite luxury. The latest health science suggests that less than 10 minutes of body weight exercise 3 times a week can have profound effects on our bodies. I often do my short exercises while watching TV.

Yes, some people have physical limitations, but access to bodyweight exercise is nearly universal and time is rarely a barrier.

A licensed physician can understand each person’s unique challenges in being healthy and develop a fair prescription.

Is it ethical to legally monitor people’s health and incentivize behavior?

It was President Barack Obama, together with the larger medical community, that expanded the use of wellness rewards under the Affordable Care Act, which employers can use for small incentives to join a gym or walking program.

Obamacare also included provisions allowing higher premiums on smokers. Thus, the leaders of both parties and the medical establishment has already come to a conclusion that it is both ethical and possible. However, Speaker Paul Ryan has criticized the law for being too restrictive on the size of incentives.

For instance, one recent workplace study found that giving people upwards of $500 a year for more exercise did very little to improve healthy choices. The program failed to improve outcomes. The researchers concluded that $20 extra per bi-monthly paycheck is simply insufficient, which is roughly what Obamacare allows many insurers to provide as financial incentives.

My healthshare provider will charge me an order of magnitude more for unhealthy behavior. Incentives work and are legal–they’re just too small right now.

Isn’t affordable healthcare a right?

I absolutely think healthcare is a right, but it is a deep American tradition to pair all rights with responsibilities. If we give people discounted access to doctors, it is their responsibility to honor the medical recommendations they get at a visit paid for by taxpayers.

No one is taking away choices. But unhealthy people cost me money because I am legally forced to pay to treat diseases they shouldn’t have in the first place.

There is a long precedent in America of promoting the responsibility of health, from taxes on cigarettes to building playgrounds for children.

This doesn’t mean we can’t recognize the difficulty some people have in losing weight or how privilege plays into obesity.

Exercise programs and nutritious foods could be subsidized by the government. Our government could promote the responsibility of health with additional support for disadvantaged populations.

Are healthshares the best model for the nation?

It’s debatable. They have their limitations. BuzzFeed has a pretty great investigative story on how some healthshares systematically preclude people with pre-existing conditions. The stories are heartbreaking.

There are currently too many unhealthy people in America to keep costs down for those unlucky enough to have pre-existing conditions, even if they eat well and exercise regularly.

“We would love [for] health care sharing ministries to get big enough that pre-existing conditions are no longer an issue,” admitted Chris Faddis, founder of the healthshare Solidarity. Until more people are healthier, there need to be more traditional insurance options.

Perhaps even more disturbing, healthshares are not required by law to have enough money to pay for their members’ expenses and are not backed by the government. “This is a recipe for disaster,” says Washington and Lee School of Law Professor, Timothy Jost.

Jost tells me that healthshares have never encountered the type of scale they’re currently enjoying, and it could backfire as less healthy populations join.

Some government regulation may be necessary to protect patients, but we don’t know. Healthshares are in uncharted territory.

What can I or my representative do?

The fate of healthshares hangs in the balance as Congress crafts another healthcare law. Congress should be encouraged to, at the very least, protect essential parts of the healthshare industry, if not continue to leave them unregulated. Congress should also dramatically increase the amount insurance companies can reward healthy behavior.

As for me, I opted out of Obamacare because I will not participate in a system that does not put preventative health as its top priority. America can dramatically reduce sickness and unnecessary death.

Readers are free to join me by joining a healthshare, if one works best for them and their family.

If America is to prosper from technological change, our sense of personal responsibility and standards of health must change as well.


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