The Spokesman-Review, Spokane, Wash., Shawn Vestal column

Jan. 25--More than 70,000 people have signed up for health insurance in Washington state under the Affordable Care Act.

Sue Lani Madsen is not one of them. In fact, Madsen and her family -- facing big increases in premiums and deductible under Obamacare -- are part of a class of the uninsured-by-choice: They are joining a Christian health care sharing ministry, an exemption explicitly allowed under the new law.

The co-operative is not contractual insurance, but it will operate in ways that are not entirely dissimilar to an insurance pool: participants pay to share risk and cover large medical expenses. Beyond that, Madsen says, the ministry helps restore a personal, biblical component to her family's health care coverage.

It "feels like finding a stable lifeboat in a choppy sea," she wrote in a December blog post.

There are several reasons that Madsen -- an architect, rancher and blogger from Lincoln County -- and her family have made this change. Most of them trace back to the Affordable Care Act, which she opposes.

In the first place, the ACA has not proven affordable for Madsen's family, she said. In the past, they have bought individual policies on the private market; similar plans under Obamacare included sharp increases in premiums and deductibles, and they did not want to accept a subsidy. Because they live in Lincoln County, their options through the health exchange are even more limited, and it's unclear how well services will be covered at all.

Like other evangelical Christians, Madsen does not want to support, or be coerced into, a system that provides abortions; like other small-government conservatives, she objects to the sheer size and reach of Obamacare, and she's convinced that a central, federal approach to a system that is so large and expensive is bound to fail.

"All it did was take a system of health care that was already too complex ... and add another layer of complexity," she said.

A former Republican legislative candidate, Madsen blogs regularly at the Seattle PI website under the title Forthright with Sue Lani Madsen. She and I have mixed it up a few times online, and it's safe to say that we agree on around zero percent of political issues.

But Madsen brings a wealth of knowledge and experience regarding health care to the discussion. Her personal experience as a health care consumer is diverse: she decided to forgo insurance as a college student; she was covered by an excellent employer-provided plan for 16 years as an employee of an architectural firm; she helped provide insurance for employees as a part-owner of a firm of her own; and she's been self-insured while working as a consultant. Her husband runs a business using goats to graze away weeds. She's also been involved in rural health care policy and is an EMT.

Until recently, her family was covered through a private plan that they purchased through the Washington Farm Bureau. Their annual premium was $6,864. As Obamacare took effect, Madsen began researching her family's options. To buy a similar plan on the private market or through Washington Health Plan Finder would cost 50 percent to 60 percent more, she said, with a joint deductible of $10,000 for her and her husband -- nearly twice their old deductible.

However, her family could qualify for a significant subsidy that would make the insurance affordable -- something she did not want to do. Here is what she wrote about that option on her blog:

"We could let the federal government borrow or print money to pay $9,156 in subsidies directly to the insurance company on our behalf. And if we happened to earn more in 2014 than our average over the last three years, we'd only have to return $2,500. We'd be over $6,000 ahead on the deal -- but it's not the right thing to do."

Joining Christian Healthcare Ministries, Madsen said, is. Like levels of insurance plans, there are different levels of cost and coverage through CHM, which insures around 30,000 households and 100,000 individuals across the nation. Madsen's family will pay $300 a month and another $140 annually; they will be responsible for each individual health care "incident" up to $500 and routine preventive coverage. CHM covers approved expenses beyond that up to certain limits -- $125,000 per diagnosis in some cases, though members can raise the level of catastrophic coverage as high as a million dollars.

Crucially, the sharing ministry is not contractual. Members pledge to share each other's costs, but it is voluntary, and there are no guarantees. In addition to helping cover health care costs, the plan offers Christians a way to put their beliefs into practice, she said. They can help each other individually, and they circulate a newsletter that encourages members to pray for those in need and reach out to those who need help.

"We should, as Christians, be sharing each other's burdens," she said.

That strikes me as an apt way to describe the underlying impetus of Obamacare, as well as other government social programs: shouldering each other's burdens. To Madsen, there is a big difference. In her view, a centralized, bureaucratic system built upon rules -- not upon relationships -- is unsustainable.

"All of the social systems have broken down as we have shifted these responsibilities to the state," she said. "We lost a lot when that happened."

It's a new world out there, in more ways than one. Lots of people in Madsen's shoes -- the self-insured -- have been hit with disruptions. Many others are being covered with insurance for the first time.

Meanwhile, Madsen is less than a month into her family's experiment.

"It really is a leap of faith," she said. "You're trusting your community will come in behind you."

Shawn Vestal can be reached at (509) 459-5431 or shawnv@ spokesman.com. Follow him on Twitter at @vestal13.

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