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Bruce Hawthorn, a pastor from Barberton, Ohio, was involved in a tragic auto accident in 1982 that killed his wife and daughter and left him with $54,000 in unpaid medical bills. Financially weakened, Hawthorn turned to his church for help. The generous responses did more than meet his needs. They also gave him an idea: Why couldn't Christians share payments for each other's medical expenses on an ongoing, organized basis?From that question has grown the Christian Brotherhood, a ministry with an estimated 80,000 members nationwide that processes $4 million worth of member medical bills every month.Others aim to follow Christian Brotherhood's lead, including the Blessed Assurance Bulletin of Lubbock, Texas (currently serving 40 families), and the Medi-Share Program of the Christian Care Ministry, based in Melbourne, Florida (35,000 members).The programs generally have been a success. But one of the programs has experienced financial difficulty, and several declined to release financial reports or audits to Christianity Today. And one academic ethicist challenges the programs' single focus on serving fellow Christians, saying this sidesteps the New Testament charge to care for the needy, regardless of what caused their afflictions.

Christians are drawn to cost-sharing programs for two primary reasons: They are otherwise unable to get insurance or they join from a sense of Christian commitment.In most programs, members pay a fee to join, then contribute a specified monthly financial "share" or "gift" used to pay the medical bills of other members. Shares are generally lower than premiums for conventional health coverage.Many state insurance regulators have asked whether the sharing programs are illegally exploiting a loophole. But ministry leaders say they are not functioning as insurance companies; thus they claim exemption from the restrictions and costs of state and federal regulation."It's more properly called Christian direct-share healthcare," says J. Michael Sharman, an attorney in Culpeper, Virginia, who has worked extensively with some of the ministries.The sharing plans do not guarantee benefits because everything depends on free-will offerings. The ministries say they are for active Christians who follow "biblical lifestyles," meaning the plans exclude smokers, drinkers, the very obese, active homosexuals, or drug addicts, even if they are active churchgoers. They will not pay for abortions.State-regulated health-insurance plans follow a much different set of rules. Allaying the concerns of state regulators has been an arduous struggle for Hawthorn's Christian Brotherhood. Sharman's legal defense of the cost-sharing program was straightforward and faith-focused: "This is simply the body of Christ acting on [God's] commands."Sharman adds: "Many regulators would look at the Brotherhood's membership requirements and say, 'Why do you insist that your members attend church? That's not a valid insurance underwriting criterion.' And our answer was, 'You're absolutely right, but we're not insurance. We're Christians who are bearing one another's burdens.' "It took years, but in state after state, officials and legislators accepted the argument.One exception is Texas. In April 1995, the state insurance department issued an emergency cease-and-desist order against Beracah Ministries of Tyler, Texas, and its All Saints Program. The state ruled that Beracah was engaged in the "unauthorized business of insurance."L. Jack Prater and his wife, Patsy, started Beracah in 1991. By 1995 it had almost 2,000 members, including 800 Texas residents."They didn't actually find anything wrong, or we'd have been in the clink," says Patsy Prater, who has been Beracah's administrator since her husband died in 1997. "But they wouldn't let us contact any of our members in Texas. We had boxes of mail and medical bills that we couldn't even open."Beracah's business address was then just across the border in Texarkana, Arkansas. Insurance regulators in Arkansas soon issued their own cease-and-desist order, as did Alabama. Beracah survived, but today it operates from Shreveport, Louisiana, with only 400 members.Beracah's experience is unusual. Several other programs operate openly across the country, without state licenses or insurance regulation. This freedom from regulation leaves consumers with the responsibility to understand program rules and limitations.

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October 2 2000, Vol. 44, No. 11