Q&A: How will the new health care law affect members of health care sharing ministries?

Members of health care sharing ministries like Samaritan are exempt from the individual mandate portion of the Patient Protection and Care Act, or the health care reform law. But we don’t live in a vacuum, meaning that many other aspects of the PPACA will have an impact on all of us, even if we don’t have to buy health insurance. But what will those impacts be?

For this Q&A, we went to James Lansberry, vice president of Samaritan Ministries International and president of the Alliance of Health Care Sharing Ministries. Besides helping to lead Samaritan, James also is considered an authority on health care economics.

Q: How will aspects of the new health care law–apart from the individual mandate–affect HCSM members as patients?

Lansberry: The first thing health care sharing members are going to find is that they’re going to be hit with the same kind of health care inflation that everyone’s going to be hit with. The cost drivers in the Patient Protection and Care Act are all pointing up.

For example, all insurance companies are going to be forced to cover all preventive medicine, which is not defined anywhere in the bill, so it can be anything regulators want it to be without a single dollar of co-pay. What happens is if you take away any consumer dollars from a particular procedure, it’s going to drive the price up. If you as a medical provider offer mammograms, which are certain to be under preventative care, and know that the insurance companies are going to have to cover mammograms no matter what you charge, your prices are going up. So it’s going to make it more difficult for uninsured people, like people who are in health care sharing ministries, to find preventative tests that are affordable unless they’re finding providers who don’t take insurance at all, providers like you might find through the Association of American Physicians and Surgeons.

The number of available doctors will also go down. I think you’re going to see a significant number of doctors entering into early retirement because of the increased paperwork that’s going to be coming through both this and the electronic records mandate that was part of the Patient Protection and Care Act as well. We’re really looking at a lot of difficulty for medical providers, especially your simple general practitioner, who’s already making less money than specialists.

I also think you may find an increase in the number of doctors who want to return to a simpler practice, or a direct practice as you might hear it called sometimes, where doctors work directly for the patients and don’t bill a third party. Those direct practices are on the rise. I think that those who are still going to be uninsured, which is going to be significant number of Americans, are going to be looking for those kind of doctors because they’re going to be the only ones who are affordable. And I think that hopefully the success of doctors in direct practice will encourage more doctors toward direct practice. You might see an increase in that, which will be good for Samaritan members, because I think medical providers who are used to taking cash will be an easier fit for someone who’s a part of Samaritan Ministries.

On the other hand, an additional complicating factor we’re going to see in the future is that the providers who don’t go to direct practice are going to be more and more antagonistic toward cash patients, because there are going to be fewer of them available if most of whom they’re seeing are insured patients. It’s really too early to tell whether that’s going to be out there.

The cost of medical services is going to continue to go up, the cost of insurance is going to continue to go up, which is going to make health care sharing even more affordable. We’re going to try to continue to work with providers to get discounts. We’re going to try to work with our members to make sure that they’re taken care of and that we can help them find providers if they’re not finding one that’s amiable. But up to this point we’re still not hearing any stories from members about being turned away from medical providers because they don’t have insurance, which is a good thing for our members.

Q: Is it going to become more difficult then for health care sharing members to be able to negotiate upfront cash discounts?

Lansberry: It could, but there’s nothing in the law that actually affects that, and so I don’t think it’s going to be more difficult in the sense of providers being constrained any more by the law

Q: So, members of health care sharing ministries like Samaritan are going to run into higher costs at some point?

Lansberry: Likely higher costs, unless you find a doctor who deals primarily with cash patients. One other potential unintended consequence of the law, which actually could help health care sharing ministries, is that more people will become uninsured. The more uninsured out there, the more likely there is to be a cash market available.