For many pastors, the answer to questions about how health care reform will impact their compensation are depressingly similar—wait and see.
That’s unnerving for ministers as open enrollment under the Affordable Care Act begins Oct. 1, and as spiraling costs of health insurance are reducing benefits many churches can offer their staff.
“Health care reform is a big deal for ministers,” said Bill Wilson, president of the Center for Congregational Health. “The vast majority of clergy are in small settings and not part of a large group. Plus, clergy are high-risk for coverage and premiums are excessively high as a result.”
Cooperative Baptist Fellowship’s Church Benefits Board, the October deadline means it’s time for congregations to exercise “good stewardship choices for our church staffs and congregations.”For Gary Skeen, president of the
As churches prepare for 2014, when the Patient Protection and Affordable Care Act becomes more broadly implemented, questions arise from pastors, business administrators, and personnel and finance committees.
O.S. Hawkins, president of GuideStone Financial Resources, said the Southern Baptist entity is intent on maintaining its role as an advocate for church plans in general and for pastors and others in ministry it serves specifically.
“Since the enactment of ObamaCare in 2010, GuideStone has been focused on addressing the impact of this law upon our pastors and others serving churches and ministry-related organizations,” Hawkins said.
Experts at GuideStone insist pastors and churches must address four main concerns as they look to re-enrollment for 2014:
• Whether they will provide coverage for their employees or put them in a position of having to obtain coverage on secular exchanges.
• How exchange plan benefits and total cost of coverage, including out-of-pocket expenses, exchange taxes and fees, will compare with their existing coverage.
• Whether, if they use a secular health plan provider, they will be subsidizing abortion-causing drugs.
• Whether their health plans meet applicable health care reform limits and rules.
Health care exchanges
Under the health care reform law, health care exchanges—or marketplaces—were to be set up in all 50 states. Many states elected not to do so, meaning the federal government must establish them in those states. To date, 24 states have, or are working to, establish state-run or federal-state partnership exchanges. The remainder will have federally run exchanges.
Despite an Oct. 1 deadline to establish exchanges, much remains unknown. Subsidies available to eligible individuals and families who seek their coverage through a health plan on an exchange may lower out-of-pocket and/or premium costs. However, many exchanges may only offer limited provider networks, including fewer choices of doctors and medical facilities.
While many pastors and their families would otherwise qualify for these subsidies, the way the law was written excludes them from accessing subsidies if they participate in a church health plan.
“GuideStone continues to work diligently with a broad coalition of denominations to help pastors and other ministry workers who want to keep their coverage with church health plans,” Hawkins said.
“The Church Health Plan Act of 2013 , S.B. 1164, would offer the same premium tax credits available to individuals who get their coverage from secular exchanges to those who can get their coverage from church health plans, like GuideStone’s.
“GuideStone has been instrumental in getting this legislation introduced into the Senate. But this effort is moving slower than it should because both Democrats and Republicans are putting politics over the needs of pastors. We continue to urge legislators to stand up for pastors and pass this important legislation, which will help more than 1 million ministry workers across all denominations.”
Costs and coverage
“Our participants can rest assured that the quality GuideStone coverage they depend on will continue well past 2014,” Hawkins said. “Much is still uncertain about commercial market and exchange pricing. Some in the industry have speculated that premiums for exchange plans could jump 40 to 50 percent, which raises understandable concern. In contrast, GuideStone’s average rate increase for 2014 will be in the single digits—and that increase is driven by the burdensome requirements of ObamaCare, as well as conditions in the health care marketplace.”
GuideStone’s Church Health Plans meet—and often exceed—the minimum value coverage requirements set forth by health care reform. GuideStone’s plans already include many provisions mandated by health care reform. For example, GuideStone already was providing coverage with no annual or lifetime limits, and GuideStone never terminated a participant’s coverage for high or frequent claims.
“GuideStone remains committed to actively managing health care costs and providing participants a wide range of cost-effective coverage options in the future,” Hawkins said. “In addition to being competitively priced, they include elements such as capped out-of-pocket maximums that help participants control their overall costs.”
To get a true sense of the cost difference between health plans on the exchanges and their current provider, GuideStone recommends individuals look beyond base premiums and include out-of-pocket costs such as deductibles, co-pays and co-insurance, as well as weigh the importance of provider networks, which can have a dramatic effect on the cost of accessing care from their existing doctors and facilities.
GuideStone’s Church Health Plans offer health care benefits designed to reflect the convictions of Southern Baptists and other evangelicals. GuideStone’s Church Health Plans, for example, cover a wide range of FDA-approved birth control options, but they exclude from coverage those that cause abortions.
“Even before the government issued its contraceptive coverage mandate, GuideStone was preparing to fight any requirement to cover abortifacients,” Hawkins said.
“Through the efforts of GuideStone and others, churches and closely-related denominational organizations were exempted from this objectionable mandate. But we are still fighting the battle to protect other organizations that do not fit in those exempt categories yet share these biblical convictions regarding the sanctity of life, such as colleges and universities and various other ministries. …
“There is simply nothing more important than protecting the most vulnerable among us—the unborn. We are pursuing every possible avenue of advocacy in that regard, including formulating a legal challenge in the courts on behalf of those ministry organizations that have not been exempted and may not have the resources to bring actions of their own.”
The health care reform law, more than 2,000 pages long, already has spawned more than 20,000 pages of regulatory guidance. For the most part, specific needs of churches and other ministry organizations are not addressed. That makes adherence to the law much more difficult.
“We’ve looked for ways to shoulder as much of the burden of ObamaCare for our participants as we can,” Hawkins said. “Those in our plans can know that they’re complying with applicable provisions of the law and that we’re actively advocating on their behalf.
“ObamaCare imposes a number of requirements upon employers with 50 or more employees, and GuideStone has been working closely with those employers to provide assistance and support.
“However, we also provide the same assistance and support to our smaller employers through a variety of channels.”
As re-enrollment materials are mailed out in September and October, GuideStone will continue to update its website with more up-to-date information.
Patterson Coates, assistant manager of the CBF Church Benefits Board, said his agency also is planning a series of blogs in the coming weeks and months on the health care law. The main theme will be what the change means for the local church.
The board also has begun gathering information on a new Web page called Health Insurance Marketplace containing information, documentation, videos and links.
“The marketplace is intended to help individuals and small employers find affordable health coverage and compare plans all in one place based upon level of coverage, quality and price,” Skeen said.
Compiled from reporting by Jennifer Carter and Roy Hayhurst of GuideStone Financial Resources in Baptist Press, Bob Allen in Associated Baptist Press and Robert Dilday in the Virginia Religious Herald