Proposals take aim at church health plan inequities that left those in Navajoland uninsured

[Episcopal News Service] The denominational health insurance plans that cover Episcopal clergy and lay employees have a number of structural inequities built into their costs, an unintended consequences of the wide range of benefit options, the age of enrollees and state and regional differences in health care costs that have been found to be particularly burdensome for some Indigenous church employees.

Those are some of the key findings of the Task Force to Advise the Church on Denominational Health Plan, as outlined in the 20-page Blue Book report it submitted for consideration by the 81st General Convention when it convenes June 23-28 in Louisville, Kentucky. The task force proposes three resolutions to improve equity in health coverage. Its report also includes a detailed and independent actuarial review of the health plans, which are managed on behalf of The Episcopal Church by the Church Pension Group.

At the root of the challenges to health equity are policies adopted by past General Conventions that limit the Church Pension Group’s ability to adjust insurance rates based on disparities in local health care costs. As a result, church employees in lower-income regions often pay higher rates than their local peers, while those in higher-income regions often pay less.

“Among the most acute pressures faced by the domestic dioceses, congregations, and faith communities of The Episcopal Church is the precipitously rising cost of securing quality health insurance benefits for lay and clergy employees,” the task force said in its report. It noted that some past actions of General Convention “have unintentionally raised costs.”

The most alarming example cited by the task force involved clergy and lay employees of The Episcopal Church in Navajoland, an area mission serving Navajo communities in parts of Arizona, New Mexico and Utah. Until this year, those church employees had effectively opted out of the denominational health plan because of the cost and were relying instead on the federal Indian Health Service.

“Our failure to provide the same benefits to our Indigenous employees as we do to others is an injustice that violates our church’s commitment to Becoming a Beloved Community and must be corrected,” the task force said in its report.

The situation in Navajoland went unnoticed until leaders testified about their situation last year at the task force’s open hearing, and members of the task force appealed for emergency relief to Executive Council, which approved $150,000 to cover Navajoland’s health insurance premiums for 2024. The task force’s proposals to the 81st General Convention aim to ensure that coverage will continue.

The task force has proposed Resolution A101 to help address this. It would urge CPG “to adopt methods to provide equitable churchwide pricing of plans offered by the Episcopal Church Medical Trust” and to take additional factors into consideration, such as “the relative ability of each covered community to pay for needed benefits” and “the prevailing cost of comparable coverage within the area covered.”

The resolution specifically seeks relief for Navajoland employees and those in the three Episcopal dioceses with significant Indigenous ministries that receive churchwide support: Alaska, North Dakota and South Dakota.

“We want to be sure that those four dioceses, which are supported by the budget of the church, are taken into special account,” San Diego Bishop Susan Brown Snook, vice chair of the task force, told Episcopal News Service. She underscored that Navajoland is a particularly concerning case. “The grant that The Episcopal Church has been providing for years, for decades, has not be adequate to cover health care costs for its employees.”

In its Blue Book report, the task force presented the example of Navajoland within the broader context of what it found to be “unintended subsidization” of some church employees’ health insurance by the payments for other plan members’ insurance.

In addition to the geographical differences, the task force raised concerns that some of the church’s most expensive health insurance plans – the “platinum” and zero-deductible plans – cost CPG more to maintain than it collects in employer- and-employee-paid premiums for those plans. In other words, employees who opt for less coverage are collectively paying more than their coverage is worth, while employees with the best coverage are getting even more than what they and their employers pay for.

The solution proposed by the task force, in Resolution A100, would ask CPG to make the funds “self-sufficient and self-funding at each offered benefit level to the extent possible and appropriate.” It also encourages CPG to offer coverage options that are comparable to those offered by other Protestant denominations. The task force found that The Episcopal Church offers more generous top plans than those other denominations.

The task force took a different approach in considering the third factor behind the “unintended subsidization” – the age of enrollees. The report acknowledges it is not unusual across the health insurance industry for older participants to use insurance more than younger participants.

“Try as we might, there is no action the General Convention can take to reverse the realities of the passage of time, and the reality that older individuals will always have higher claim costs,” the task force wrote, adding that it “expressly does not recommend further adjustments to rating mechanisms to remove functional subsidy … by age.”

Instead, the task force, in Resolution A102, proposes asking CPG to further educate the church about the availability of the Medicare Small Employer Exemption for some congregations. That option, a potential alternative to the denominational health plan, would allow some employees aged 65 and older to enroll in Medicare while working for churches with fewer than 20 employees.

The three resolutions have been assigned to the 81st General Convention’s Agencies & Boards committees, which will hold their first meeting at 3 p.m. Eastern April 12 on Zoom. The parallel bishops’ and deputies’ committees have not yet scheduled a hearing on the resolutions.

– David Paulsen is a senior reporter and editor for Episcopal News Service based in Wisconsin. He can be reached at dpaulsen@episcopalchurch.org.