Well, we did it. We opted out of the ACA (Affordable Care Act aka Obamacare) and it feels great! By joining a voluntarist healthshare our medical choices are back in our own hands and the costs have dropped precipitously. And we are shielded from any tax penalties from the ACA.
What is a healthshare?A healthshare is group of people who join together to share their medical expenses among themselves. Unlike insurance which is either run by a large corporation or the government it is a member controlled and operated group. The group comes together and they structure a set of rules (called 'guidelines') for how medical costs are shared among them. Each member contributes an amount monthly (called 'a share') which then gets distributed among the members to pay for their current medical care (called 'needs'). Some healthshares are manually operated where the 'shares' are matched with the 'needs' and members directly send and receive the funds from each other via check. But many are now completely automated where the money is distributed electronically.
Because the members control the organization, it is not geared towards creating a profit for shareholders like corporate insurance. This drastically reduces costs. The cost savings just aren't from eliminating profits. They come from greatly reduced charges by medical practitioners. Medical practitioners build into their costs all the negative aspects of working with insurance; delays in payments, filling in bunches of forms, a staff to 'dance' with the insurance companies on getting them to approve services, etc. This typically leads to a doubling of the cost of health care. In contrast, medical practitioners extend their "cash" price to members of healthshares.
At the same time since it is a member organization, the members can choose what types of proceedures are 'shared' which is typically much more expansive than that of private insurance. For example, when Oregon passed its euthanasia laws many insurers started to refuse to continue paying for life extension medical care in favor of the cheaper euthanasia option (thus maximizing shareholder profits). The healthshares in contrast chose to continue this coverage. Another example is that most healthshares will cover alternative medical providers e.g. midwives for child birth and chiropractors. In fact most healthshares are set up so you can use any medical practitioner you desire!
Because this is a voluntary organization it is also free from most government mandates. Of course they have to adhere to some laws for example medical marijuana bans. But the members can choose to ignore others, for example being forced to pay for abortifacients and 'rock star style' prescription drug habits. To many this morally conscious approach is valued as highly as the cost savings. That is one of the cited reason why the ACA bans new healthshares from forming, only the grandfathered ones are able to continue to operate.
How much can a family save vs. ACA? That, of course, depends on each individual circumstances. But generally,
a lot. Here is the example for my family.
For 2018 we were facing a monopolistic situation as there was only one provider for our area on the government exchange. The HSA compatible plan we were using was eliminated. So here is what we were facing:
ACAProviders: We would need to change doctor and hospital since our provider was not in-network for the new plan.
Deductible: $7340 for each adult, $14,700 for family. We would need to pay this before receiving any medical benefits outside of a yearly 'wellness visit' and drug discount.
Co-pays: $40 for doctor visits, $20 Generic Drugs (of two prescriptions for wife, only one covered).
Dental/Vision: None.
Prescriptions: : Our prescriptions would cost $137 a month under this plan.
Monthly: $882 per month.
Instead we went with the premium healthshare program which included prescription/dental/vision discounts, $10,000 loss-of-life coverage (e.g. burial), as well as diet and exercise coaches to customize a weight loss program for us:
HealthshareProviders: We can use whatever doctors, hospitals, and other providers we choose.
Yearly Unshared Amount: Healthshares don't have deductibles. Rather, they have unshared amounts. We chose one with an annual unshare of $1,000 for our family. That is, once $1,000 is met in a calendar year everything is shared up to $1,000,000
per event.
Co-pays: None.
Dental/Vision: Discounted. We will save about $180 a year.
Prescriptions: Our prescriptions will cost $63 per month.
Monthly Share: $508 per month.
Net: We will be saving ~$448 dollars a month which equates to $5,376 a year with the Healthshare vs. the ACA. And if a serious incident occurs (e.g. heart attack, stroke) we will have saved the difference between the deductible and unshared amount (i.e. $6,340 if one of us, $13,700 if both of us).
It should be noted that we signed up for the most premium healthshare option. There are many less expensive programs. For example, a single person under 30 can get coverage within our healthshare for as little as $107 a month!
What are we giving up?Because participants in our healthshare are pledging to live a Catholic lifestyle there are a small number of items that are not sharable. They include:
Abortions and Abortifacient drugs
Contraceptives
Sex changes
Euthanasia (but on flip side you gain life extension procedures if you choose to use them)
Elective plastic surgery (e.g. face lifts, body tucks...reconstructive surgeries are included)
Recreational prescription drugs
In addition we pledge to avoid smoking, eat healthy foods, get regular exercise, drink only in moderation, avoid extremely risky hobbies like skydiving, and attend mass regularly. For us, these things are not an issue, in fact they are encouraging us to live more healthily.
Does this work?You bet. I have talked to over a dozen people using them and all give it a big thumbs up. The ratings on social media are also very high. Here is an example testimonial:
www.youtube.com/watch?v=ZPIdDplj7dgAnd here is a discussion explaining more on why this approach reduces costs:
www.youtube.com/watch?v=zUmX3u8-TvwFor us this seems the best healthcare solution to, as Jack would say, "live a better life, if times get tough or even if they don't". If nothing else, it is worth benchmarking other options against.