A Christian family's cost-sharing alternative to federal health care

OMAHA, Neb. — “If you are a committed Christian,” the contract begins, “you do not have to violate your faith by purchasing government-approved health insurance.”

Every year, Gary Duff signs an updated version of these 40-page terms, which detail one way Americans can avoid buying private insurance or paying into the Affordable Care Act (ACA).

The deal is made possible by a little-known provision in the health care law and the contract has one particularly important requirement: The Duff household of nine must abstain from general debauchery.

Samaritan Ministries, a health care sharing group, will charge its national network to cover the family's medical bills, but only if they agree to forsake binge-drinking, extramarital sex, illegal drugs and tobacco (with the exception of celebratory, post-birth cigars). The organization describes itself as a “biblical approach” to health care, guided by Galatians 6:2: Bear one another's burdens.

This appeals to Duff, a 60-year-old former missionary and international business instructor. He and his wife, Sheryl, have home-schooled all seven of their children and taught them to avoid MTV-approved anything.

Samaritan's rules, however, extend beyond the religious realm to the practical one of saving money. Sinful behavior threatens more than a soul's entrance to heaven, Duff and his cohorts believe: It damages the earthly body — and amplifies the price of health care.

“Christians are just healthier people,” he says. “Think of all the physical problems we can attribute to a sinful lifestyle.”

The ACA, the Samaritan contract states, is undesirable because it covers costs that “result from immoral practices,” such as STD treatments or out-of-wedlock births. The law creates a moral dilemma for Duff, who now works as an assistant pastor in downtown Omaha.

“Simply put,” he says, “I don't want to pay for that or encourage it in any way.”

Neither do the estimated 100,000 other Samaritan users. The health care sharing ministry, recognized in ACA as a viable insurance alternative, covers up to $250,000 per “need.” About 37,000 households are in the network.

Samaritan bills itself as non-insurance — and has therefore avoided regulation.

To Duff, it's a way to preserve some personal liberties while giving up the ones he won't miss.

It works like this: When illness strikes, Samaritan members can file a request for aid. The ministry fields each request and alerts other members, who are then morally — if not legally — bound to mail checks directly to the sick. Each member commits to a monthly “share” amount, rather than a premium.

The Duff family pays $400. There's no guarantee their medical bills will actually get covered. They have to front medical costs.

Eleven years ago, Duff maxed out more than one credit card to cover his son's leg surgery after he broke his femur. The $20,000 need was the most they've filed to Samaritan. (But, Duff said, he negotiated a discount for paying that day.)

The repayment system is built on faith.

“I trust that God will provide,” Duff said. “So far, He has delivered every time, and before the bills are due.”

Samaritan, based in Illinois, is among a handful of health care sharing ministries in the United States. There's Medi-Share in Florida, Christian Healthcare Ministries in Ohio. An estimated 300,000 Americans use this insurance alternative, according to advocacy groups.

About $9 million is available to pay medical bills each month, Executive Vice President James Lansberry said. “Obamacare,” he said, has made it more popular.

“When the law passed, and when open enrollment started, the number of people applying to be part of Samaritan doubled,” he said. “They thought, I don't want to support something that goes against my religious beliefs. They actively sought other forms of coverage.”

The ministry relies on grass-roots lobbying. As Washington polished the ACA, Samaritan urged members to push for an exemption from the law's individual mandate, or a penalty-tax uninsured Americans must pay.

The Duffs wrote letters to local politicians. They protested outside a Nebraska senator's office. They won; a health-share ministry form will be available for 2014 tax returns.

The next battle: winning immunity from the ACA employer mandate, which requires businesses with at least 50 employees to offer affordable, comprehensive health insurance to full-time workers. (It kicks in next year.)

Firms that don't comply face fines of up to $2,000 per employee. Samaritan, which employs about 130 people, has already budgeted for the blow.

“We will fight it,” Lansberry says. “It goes against our very DNA. The first step is raising awareness: We're out here; we take care of each other.”

Duff, who retired three years ago from teaching business skills to international students at the University of Nebraska Omaha, didn't join Samaritan just to circumvent the government. He believes in holistic medicine, the kind that conventional insurance typically doesn't cover.

Four decades ago, he and his wife taught English in Japan as Christian missionaries. They felt the universal health care there was impersonal. The American system, no better.

“It didn't work for us,” he said. “One size didn't fit all.”

The Duffs returned to Nebraska uninsured despite their growing brood. Sheryl preferred home births. She disliked the rigid structure of public schools and, to avoid both pathogens and social germs, educated their kids at home on Tea Party Lane in Omaha's farmland outskirts. (The youngest three are now learning middle and high school curricula.)

The couple paid for every medical bill in cash before joining Samaritan, which they call a tight community, in 2000. Members send each other get-well cards, teddy bears and balloons.

When possible, the Duffs avoid doctor's visits. Colds, flus and earaches are treated with herbal remedies.

Together, the family studies the relationship between religion and health — a favorite dinner conversation topic. They own several books about it. One claim that Duff swears by: Worship reduces stress, boosts social support and discourages risky activities.

“Our bodies are temples,” he says. “That's how we treat them.”

In health care and in life, Duff and his wife tell their children to have faith. Make the right choices for their souls, and for their immune systems. The family painted a permanent reminder on their living room wall: “Trust in the Lord with all your heart.”