It’s been almost 10 years since the Affordable Care Act passed, more than 25 since Bill Clinton tried and failed to bring universal health care and more than 50 since Medicare was formed to at least guarantee health coverage for seniors.
But after a lifetime of debating it, our health system remains maddeningly broken. Just consider the case of Kirkland’s Brad Fuller, and the other Washington residents who found themselves in his position.
Fuller, 63, is a retired electrician with a pension, so these are “supposed to be the golden years.” But like a lot of middle-class folks in the 55-to-64 age bracket, he found himself in a jam: He felt he couldn’t afford the insanely pricey health policies offered for his age, but he’s too well off to qualify for any subsidies.
He ended up falling for what the state insurance commissioner calls “a sham.”
“I got sold a bill of goods,” Fuller says.
He signed up for a faith-based health care-sharing ministry, which have been surging in popularity. These are co-ops of people who ostensibly agree to pay one another’s medical bills. Due to the sway of religion in American politics, the setups were given a special exemption in the Affordable Care Act to operate off the grid of most health-insurance regulation.
Fuller says he thought it was just another insurance plan, but it most definitely is not. The difference is right there in the fine print: “This is not a legally binding agreement to reimburse any member for medical expenses,” says the current material for Trinity HealthShare, which is marketed by another company called Aliera. “Instead, (it’s) an opportunity for members to care for one another in a time of need, to present their medical expenses to other members as outlined in the membership guidelines.”
It comes with a “Statement of Beliefs” about how members are obligated by God to live healthy lifestyles and to “assist our fellow man when he/she is in need according to our available resources and opportunity.”
“It looks like health insurance but it’s not. ‘Just trust God,’ buyers are told,” was the headline on a recent New York Times story about the practice.
Some of these health care-sharing ministries have a good track record of paying medical bills, but the state contends Trinity and Aliera were essentially religious scams. This past week Insurance Commissioner Mike Kreidler banned Trinity from the state and fined it $150,000. He’s continuing to try to ban Aliera as well.
What happened to Fuller is he started paying just $350 a month for his premium, but then got a cancerous tumor on his tongue. When he started spitting up blood he went to the emergency room at EvergreenHealth hospital in Kirkland, but was alarmed to find they had never heard of Aliera. The hospital treated him anyway.
The bill for the hospital stay and a month of radiation and chemo topped $100,000. Despite all the God talk, Aliera wouldn’t cover any of it.
“I haven’t seen a damn dime,” Fuller told me. “My retirement is shot.”
That Aliera’s contract-partner company Trinity got off with just a $150,000 fine suggests to Fuller that the companies are making out like bandits.
“That’s about the total medical debt I have right now, and I’m only one patient,” he said.
There’s a class-action lawsuit against Aliera and Trinity that seeks to recover more. In all, the companies signed up 3,058 Washington state customers, Kreidler’s office says.
In a statement Friday, Trinity said it agreed to stop doing business in the state only grudgingly, insisting that the “vast majority of Trinity members, both in Washington and around the country, are very satisfied with our health care sharing ministry.”
That may be. But a review of the lawsuit shows that some of the other patients were like Fuller — not eligible for government programs such as Medicare or subsidized Obamacare, but crippled by high premiums and deductibles in the individual insurance market. Prime targets, in other words, for the lure of too-good-to-be-true.
This story shows yet again that basic health care for all remains the American unicorn. Obamacare helped the working poor as well as patients with preexisting conditions, but largely left unaided people in the middle, like Fuller. There are still 27 million uninsured Americans — a number that despite near full employment has again begun to rise.
It’s easy to forget, what with impeachment and rising tensions in the Middle East, that health care remains the No. 1 concern for voters in the upcoming election. Fifty years on, at least now we know God isn’t going to solve this one for us.