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HEALTHCARE ACCESS FOR CHURCH WORKERS

Introduction

“Improve access to healthcare for pastors and church workers” was one of the top three healthcare access issues identified by delegates at Charlotte 2005. We have tackled this issue by working with representatives of the six major insurance pools currently providing health insurance for the employees of congregations

and the various institutions of Mennonite Church USA. Over the course of two meetings held in October 2006 and March 2007, 20 to 30 participants grappled with understanding the current challenges and recommending a future direction. They identified pastors as the most important segment of “church workers” to address first. Low paid employees of church-related institutions were also identified as a group with special healthcare needs. Additional counsel was received from other leaders and groups familiar with the issues involved with providing health insurance for pastors.

The Current Situation

• Half of the 935 congregations of Mennonite Church USA have 60 or fewer members. These small congregations have limited financial resources to provide health insurance for their pastors, even though they may be employed at least half time by the congregations.
• Across the church about one-third of all pastors rely on employed spouses or another source for health insurance coverage. When this occurs, a congregation currently “escapes” the actual cost of providing health insurance for their pastor(s).
• Based on the recent Church Member Profile survey, at least 5.1 percent of all pastors do not have health insurance. This is based on a sample of 500 pastors surveyed, with 65 percent responding. With nearly 1,300 pastors within Mennonite Church USA, we would expect to find 70 to 100 pastors who do not have any health insurance coverage. Lack of health insurance for pastors is especially apparent among Racial/Ethnic congregations.
• Less than 30 percent of congregations currently participate in the denomination’s health insurance program–Covenant Mutual Benefit Plan (COMB). This plan is available in only 10 of the 21 area conferences. It was established to guarantee insurability and provide coverage portability from one congregation to another. While the plan is financially stable, it lacks the critical mass and spread of risk to be viewed as “competitive” by the majority of Mennonite Church USA congregations. Congregational decision-makers with young, healthy employees often opt for cheaper coverage in the commercial market.

• There is a perceived disparity in quality between the health insurance provided for pastors and the health insurance provided for employees of church institutions. This disparity works as a disincentive against the stated denominational goal of recruiting and training congregational leaders for the future.

Proposed Response

Since the early 1990s, our denominational healthcare statements have called for access to basic healthcare for everyone. Our most recent statement approved by Charlotte 2005 delegates includes the following:

“Because our life together in Christian community is a foretaste of the kingdom of God (John 13:34-35; Acts 2:37-47; 4:32-35; James 1:18-27) we commit ourselves to work toward adequate access to healthcare for all our brothers and sisters, including our pastors, in Mennonite Church USA.”

It is now time to begin this practice by providing a basic level of health insurance for pastors. We must find a way for all congregations of Mennonite Church USA to work together in an arrangement that provides all our pastors and congregational employees with basic health insurance coverage. In order to discuss the implications of moving forward, a proposed plan concept has been created. While this plan could easily be made to work and while a number of pastors and church leaders were consulted in its development, we are using this only as a description for our mutual discernment. The key issue is as follows:

Our tendency toward decision-making in local congregations is in conflict with our ability to practice churchwide mutual aid. Can we bring these two issues together (congregational autonomy and our beliefs about mutual aid) so that all congregations will participate in providing access to basic health insurance for all pastors?

A basic health insurance plan

We believe that if all congregations participate, a basic health insurance plan is feasible that would:

• reflect our beliefs;
• meet pastors’ healthcare needs;
• be affordable for all to join;
• reflect a favorable risk profile.

A favorable risk profile is needed for a health insurance plan to succeed. The graph shows the U.S. population ordered by the amount of healthcare costs consumed in 2003.

The horizontal axis reflects lining up the whole population from the least costly to the most costly. Half of the people (the least costly) incur only 3 percent of the healthcare costs. This picture is an example of a favorable risk profile. Any large insured population with a favorable risk profile would show a similar graph.

The graph illustrates a group of 100 people (reflective of this population) with the 50 healthiest having almost no cost. Twenty people would consume 80 percent of the cost. The five sickest would account for about half the cost. It would be impossible to operate a health insurance plan for just sick people. If the group makeup does not include the large portion of people with no cost, the plan is doomed to fail. That is often what happens when a plan accepts too many sick people. The healthy people in the plan see higher insurance prices due to the costs of the sicker people and opt out of the plan for cheaper coverage. We understand this has been a common practice among our congregations as they consider participation in the current COMB plan. Congregations opt out to save money in their local church budget.

We must build the plan for all pastors around stewardship of health principles so that it provides not only pastors, but their congregations, with incentives to be healthy. Through a specially designed health risk assessment, plan members will know their health-related issues that require attention, and assistance can be provided to work proactively with these challenges. An example of a basic health insurance plan design is shown in the diagram.

A decision made at the denominational level would provide a basic plan for all pastors. A basic plan design must incorporate limits in order to be affordable for all.

Congregations may purchase additional benefits to supplement basic coverage.

Funding for the plan could be structured in several ways. Two options are described:

1. Membership. Since we’re all in this together, funding for the plan would come from congregational assessments based on the number of members in each congregation. Adjustments to the per-member cost would take into account:

• the relative wealth of the congregation as reflected by per-member giving;
• the number of congregational employees who need coverage and their FTE status.

2. Market. For this option, the health insurance is priced competitively with market rates. Congregations would be charged rates recognizing the characteristics of each pastor (age, sex, geographic location). In addition, congregations would be asked to make “mission” contributions to subsidize the purchase of health insurance for pastors serving in lower-income congregations. Congregations whose pastors have coverage provided from another source would be assessed half the cost of the basic plan to assist with this subsidy.

Ongoing relationships between giving and receiving congregations would be encouraged. Annual goals for the subsidy fund would be established and met by both congregational assessments and general fundraising.

Rationale

This proposal is crucial to the long-term viability of Mennonite Church USA for the following reasons:

• Mutual aid. Providing health insurance for pastors and congregational employees is an opportunity to practice churchwide mutual aid. With the participation of all congregations, we can cover the uninsured, support congregations with limited financial resources and deploy a stronger witness beyond ourselves.
• Leadership and the missional church. Pastoral leadership should be considered part of mission rather than infrastructure. Healthy, non-anxious leaders are essential for healthy congregations. Healthy congregations reach out and grow. Providing health insurance will have a positive impact on attracting and retaining leadership talent for the church.
• Stewardship of health. This plan should reflect evidence of a congregation’s commitment to its own health. This plan is an essential part of a congregational wellness plan. In this context, the purchase of health insurance is more than the purchase of a commodity; it secures membership in a faith community committed to healthy living.
• Public policy. Our witness to government is strengthened if we can demonstrate that we are willing to practice what we preach. The plan for pastors is designed to be compatible with our current and former denominational statements on healthcare.

What should delegates do prior to San José to prepare for this issue?

• Learn about the process your congregation or area conference uses for providing health insurance for pastors.
• Share this proposal with the leadership group of your congregation and the committee or persons who make decisions regarding health insurance benefits and costs for the employees of your congregation and seek their counsel.
• In the plan described above, decide which funding option (membership or market) your congregation or area conference favors.
• Based on the above, determine whether you will be able to support the delegate resolution at the beginning of this report.