An anti-abortion activist prays outside a Planned Parenthood clinic on February 22, in Austin, Texas. But lobbying efforts earned them protected status under the Affordable Care Act, allowing their members to remain exempt from the individual insurance mandate the ACA established — provided that the ministries existed prior to , underwent annual financial audits, and retained members even after they developed medical conditions.
Patient Profiling: Are You a Victim?
And membership of health care sharing ministries has seen explosive growth since the passage of the ACA in Joel Noble, Samaritan Ministries' director of public policy and the vice president of the Alliance of Health Care Sharing Ministries, told me that its three member ministries Samaritan Ministries, Medi-Share, and Christian Healthcare Ministries have a total membership of just under , individuals, up from about , in February Medi-Share, the Florida-based ministry, has grown from 35, members in to more than , members in April The ACA requires insurers to fully cover some forms of birth control , for example; Christian sharing ministries have no such obligation.
But there are significant differences between what insurance companies and sharing ministries are legally required to offer consumers. They typically don't always cover pre-existing conditions and often have gaps in critical services, such as coverage for mental health services. A pre-existing condition was a problem for Tara Owens. A spiritual director in Colorado, Owens suffered a heart attack in April The next month, her husband lost his job and they were soon left without insurance. Health care sharing ministries try to keep costs low for their clients, and, according to Solidarity founder Faddis, sharing the costs of pre-existing conditions would be prohibitive.
Ministry members often pay their medical bills out of pocket and wait for reimbursement; they are also encouraged to negotiate discounts with their providers. Do you have a cash rate? There is little to no cost sharing for chronic conditions or preventive care. If you are diabetic, for example, you will most likely have to cover the cost of insulin on your own. Jones, the South Dakota pastor, was reluctant to join Samaritan at first. Health care sharing ministries, however, make their own rules. As Zain got older, Bet and Erik Olson decided to begin the process of adopting again. In November , almost two years after they went to Ethiopia to meet Zain, they were matched with their daughter, Tess, a vibrant young girl with boundless energy.
They met her in April , she turned 2 in May, and they brought her home in June. This time, they knew there would be some challenges: Tess had received conflicting test results in Ethiopia, indicating the possibility of a blood disorder. Bet and Erik called Samaritan. Bet and Erik decided to appeal. They wrote an email to the leadership of Samaritan Ministries, asking the organization to reconsider its stance. A health care company cannot deny coverage to an adopted child that it would have otherwise provided for a biological child.
The Olsons also asked Samaritan to consider that to be anti-abortion means to be pro-adoption. It is not an option in the Kingdom of God, but rather a command. Bet and Erik are aware of these criticisms and have worked to understand them. The number of international adoptions in the United States is declining overall from 19, in to just 5, in as other countries increase regulations, but the Christian interest in adoption is going strong.
Tess, with her special needs, would require some care that Zain had not, and Bet and Erik felt it was incumbent on them to encourage Samaritan to raise its standards. Health care sharing ministries remained in business after the implementation of the Affordable Care Act only because of extensive lobbying by two groups that work on their behalf: the Alliance of Health Care Sharing Ministries and the National Coalition of Health Care Sharing Ministries.
Ted Kennedy, who worked on the development of the ACA. Aware of their unique position in the health care landscape, these ministries continue to think about how to protect themselves from meddling regulations, and that involves a robust public relations effort.
With the ongoing GOP effort to repeal and replace the Affordable Care Act, these ministries are once again concerned for their futures. Sharing ministries might seem like an appealingly stable alternative to traditional insurance coverage, as legislation is up in the air, but what the AHCA or other changes to health care policy would mean for them remains uncertain — and it might not be good. Still, ministry leaders have confidence in their continued survival. Which does happen.
Some ministries have had solvency issues because of clear-cut financial mismanagement.
Scandals like this are rare, but some state regulators consider the basic premise of health care sharing ministries misleading, and have tried and mostly failed to exercise oversight. The state passed a bill in that allowed Medi-Share to resume operations, but a number of Medi-Share members faced trouble nonetheless. The Oklahoma Insurance Department said there was nothing stopping Medi-Share from facilitating payments in the state.
The Nileses and Medi-Share underwent a binding arbitration process, which ruled in favor of Medi-Share. Karen Niles died in Every state in the US has a department that regulates insurance, but state policies on health care sharing ministries vary widely, if they exist at all. Insurance commissioners in Washington and Kentucky , as well as in Oklahoma , have all tried at different times to stop certain ministries from operating within their state borders, on the grounds that they are actually insurance companies and should be regulated as such.
But in each case, the ministries were given exemptions by state legislatures that saw the issue as one of religious freedom. In recent years, health care sharing ministries have worked with the conservative legislative forum the American Legislative Exchange Council to prevent the same back-and-forth from playing out in other states.
As of last year, 30 do. At the heart of the debate is the question of how health care sharing ministries differ from traditional insurance, and, ultimately, what the consequences of those differences are. Health care sharing ministries are legally required to disclose the fact that they are not insurance. Which is fine, but to hear them tell it, theirs is still the superior product.
In fact, everything is written in such a way that there is no assurance at the bottom line. We just wish that we had trusted in His provisions sooner. Samaritan Ministries and its members assume no responsibility for your medical bills. Whether you receive any share money to help you with your medical needs will depend on the voluntary giving of your fellow members as an expression of Christian love, but no matter how mu ch money you receive, you always remain solely responsible for payment of your own medical bills. The Affordable Care Act was written in part to ban certain discriminatory practices that led to people being denied insurance coverage.
But health care sharing ministries have retained the right to discriminate, either by not sharing certain costs or by requiring more of certain members they deem unfit. For example, health care sharing ministries uniformly refuse to share costs related to self-inflicted injuries or suicide attempts — an issue that has also plagued traditional insurance companies, despite a health care privacy law requiring them to do so.
Nor will they share needs related to fertility treatments, contraception, or, in some cases, injuries related to acts of war. Even if health care sharing ministries are very good for most of their members, ultimately they make it more difficult for traditional insurance plans under the ACA to flourish. A cancer diagnosis or complications with the delivery of a child can result in bills well over that standard lifetime limit, leaving members on the hook and in search of an insurance program that will help them out.
And since insurance companies can no longer discriminate against sick people, they must accept whatever patients come back to them from these ministries — now with more serious and more expensive conditions. This question of seepage is also, in a way, a question about the fundamental nature of health care sharing ministries. Insurance is far from perfect — unwieldy, expensive, and often byzantine in its structure.
Disputes are common and there is no guarantee of fairness. Yet the contract involved with insurance exists to protect consumers. A popular saying in evangelical churches is that everyone — even atheists — has faith. Left, protestors in New York, Jan. Right, protestors demonstrate at a health care rally in Philadelphia, Feb. Insurance companies deal in a strange collision of the ethics of capitalism, compassion, and cronyism, in a manner that often makes it difficult for the sickest people to get the money they need for care.
Customers who take out more money than they put in — to pay for surgery, chemo, radiation, or hospice care, perhaps — are a drain on their system. Health care sharing ministries also enact values, and they exist in large part because one or two Christian individuals were moved to put their faith into action in new ways. Most ministries cite the same Bible verses as foundational to their existence: Acts 2 and Galatians 6. They sold property and possessions to give to anyone who had need.
The Catholic Church is currently one of the largest, if not the largest, private providers of health care in the US, with nearly hospitals across the country. But truly universal health care is often lost in translation, with each sect offering care to those it deems worthy due to practical considerations, and by its own subjective standards. Are we holding sharing ministries to the standards of a Christian organization, or are we holding them to the standards of other health insurers? And when they incorporate parts of both, how should this new space be regulated?
Radical inclusivity is a noble and biblical ideal for Christian organizations to work toward. Jesus, after all, never asked about pre-existing conditions. That may be enough. However, there are Christian values that can seem at odds with one another. When they collide, the results can be messy, denying care for people who have violated some tenet of Christianity — real or perceived. All five of the big ministries require their members to sign a statement of faith; some, like Samaritan and Medi-Share, require that members agree to reserve sex for lifelong marriage between a man and a woman.
Solidarity and Liberty HealthShares both share costs for unwed mothers. Instead, Christian Healthcare Ministries recognizes that in such circumstances the assistance needed goes far beyond financial aid. Therefore, we encourage you to seek help from a compassionate, Christian pregnancy center if you find yourself in this situation…You are in our prayers. While much of the work on care involves care work and caregivers within settings, such as hospitals, shelters, nursing homes, and asylums Conradson a , care is given and received in a multitude of ways and in a variety of places.
This is to frame care as an ethics of encounter Gordon , as a set of practices which shape human geographies beyond these familiar sites of care provision. Analytical perspectives on landscapes of care range from the macrolevel to the microlevel. At the regional or even international scale, policies and place characteristics impact on the distribution, availability, migratory flows, and composition of health and social care workforces. We observe that care also occurs in many settings that expand the traditional notion of care—for instance, in extralegal spaces of care.
Our work builds upon this expanded notion of care, which takes into account where care takes place and how caregiving is provided, expanding care and responsibility beyond those whom we know. For Conradson a , b , this space of care is about the relations and practices of care—observed interactions between individuals—that constitute particular spaces. Here, we think about responsibility that involves care of and for others at a distance, taking into account, for example, who is responsible for caring and who should be cared for. By framing conceptions of care from this perspective, one can better examine individual and collective levels of care and their impact on society Massey Another way to think about caring for others is to think of it as a way of bridging temporal, spatial, and social distances for meaningful human connection.
We will then turn to an analysis of the historical context, which will be an important item of consideration when we later examine Freedom University as a contemporary manifestation of an extralegal space of care. As a reminder, our research questions are 1 how has the broader context of institutional power structures and the responses to such structures informed the emergence of Freedom University, and 2 how has Freedom University emerged as an example of an extralegal space of care that functions as a counternarrative to established policy?
To answer the first question, we examine the historical context of the broader freedom movement and relevant examples. We consider the genealogy of Freedom University's institutional ancestors, presenting it as a response to established power structures of education and tracing the history of extralegal spaces of care in the American South, from Freedom Schools of the past to contemporary manifestations like Freedom University.
To answer the second question, we examine the emergence of Freedom University as a counternarrative to Board of Regents Policy through the theoretical lens of spaces of care within the framework of geographies of care. To do this, we conducted a content analysis Hay of primary documents and relevant media discourse to explore the ways in which Freedom University exemplifies a geography and space of care.
First, primary documents collected from Freedom University's website were analyzed in order to determine how the organization has positioned itself within the broader historical and contemporary context that led to its formation. These documents include web pages and documents posted to the website. Second, a database was constructed of media content about Freedom University published since , when Freedom University was founded. The content analysis was also mindful of any organic themes that emerged beyond the specific a priori themes. Of the a priori themes, there were three that stood out the most as an outcome of the content analysis.
Spaces, landscapes, and geographies of care have manifested in different ways in different times. In order to better understand Freedom University in its contemporary context, we first consider a genealogy of Freedom University's institutional ancestors, including the Freedom Schools, which functioned as extralegal spaces of care in the southeastern US and emerged as a response to established power structures. Furthermore, current developments in sociolegal spaces, such as the results of the policies of the University System of Georgia's Board of Regents, forces one to examine policies that were enacted to help or hurt those on the margins.
Because we are focused on the liminal state of public higher education for immigrant youth, as part of our consideration of Freedom University's institutional genealogy, we specifically examine the Jim Crow era, the creation of Freedom Schools, and the Supreme Court decision in Plyler v. This is followed by a discussion of the policy decisions in Georgia that led to the creation of Freedom University.
Ferguson , Cummings v. The architects of the Jim Crow laws believed that education was the key to economic success, and one goal of Jim Crow laws and policies was to make education for black children inferior to that available to whites, ensuring that southern blacks remained marginalized.
Consequently, southern schools remained segregated and black schools received little to no public funds. In fact, if there was only enough public funding for one school in the area, the school would serve only white children. This was often the case in rural communities, which is where the majority of blacks lived during this time. If there was enough money for two schools to coexist, black children were enrolled in school at lower rates than their white counterparts, often because they were pulled out of school to work on farms or labor with their parents as sharecroppers.
These factors, combined with poor infrastructure for learning, little to no books for instruction, overcrowded classrooms, and few educators, resulted in multigrade classrooms and limited instruction. However, the focus was on adults, and so black children did not benefit from these educational activities. However, as more young people became a part of the Freedom Movement, this unmet need became apparent. As a result, the education received at a Freedom School was not derived from a traditional curriculum.
The lessons were based on two sets of questions. This model of education was implemented in at least forty Freedom Schools run by volunteers and supporters throughout the summer months. This culminated in the Mississippi Freedom School Convention in August , which promoted the adoption of resolutions to enforce the Civil Rights Act, including resolutions pertaining to public accommodations, housing, education, health, foreign affairs, federal aid, employment discrimination, the plantation system, civil liberties, law enforcement, city maintenance, voting, and direct action Ritterhouse ; Marshall ; Hale Although these advances often came at great personal cost—due to deadly violence, beatings, arrests, bombings, and arson, along with economic terrorism—the emotional toll experienced by those involved eventually yielded significant gains for the black community.
Doe Ritterhouse ; Marshall ; Hale Board of Education occurred in , it took roughly another decade for secondary and postsecondary institutions in the South to become desegregated. The most prominent post—Civil Rights era case concerning this form of discrimination took place in Texas where, in , the state legislature passed a law allowing school districts to reject the enrollment of children who had not been admitted to the United States legally. Seven years later, in Plyler v.
In Plyler v. This has been particularly true in the state of Georgia, where access to higher education for undocumented youth has been neutralized due to policies passed by the University System of Georgia's Board of Regents. In October , the Board of Regents passed Policy 4. Furthermore, in December the Board passed Policy 4. It is evident that formal state structures have differentiated the manner in which immigrant youth are served in the public higher education system. This has resulted in different social and political actors applying pressure to challenge the status quo.
It is at the nexus of immigration status and identity politics that one can see the many challenges and opportunities individuals and communities must contend with.
The very study of legal geography speaks to the important role of determining how laws and legal processes cultivate sociospatial settings to address these intersectionalities in different ways Forest ; Mitchell The physical space allowed for community building and a space of solidarity. Students who attend Freedom University do not receive academic credit, and faculty members receive no financial compensation for their activities.
In an attempt to provide a counternarrative to the exclusionary practices that affect these youth, students have applied their learning to organize events or demonstrations to change these policies as well as others that adversely impact the immigrant community. Freedom University may be viewed, through the lens of geographies of care, as a contemporary manifestation of an extralegal space of care emerging as a counternarrative to established power structures that marginalize a particular segment of the population.
Viewing spaces of care and concern Conradson a as part of a holistic view of human care that encompasses physical, social, and emotional domains Kearns and Gesler ; Johnsen, Cloke, and May , Freedom University is an example of a space of care and concern for undocumented youth who have been marginalized from accessing higher education in Georgia. As such, Freedom University is an example of an extralegal space of care manifesting in response to entrenched power structures that marginalize, and make increasingly more vulnerable, a particular segment of the population.
Enter Freedom University, an underground Georgia institution providing undocumented young people with college courses. By consensus, the group chose the name Freedom University. The landscapes of care concept notes that care is given, received, experienced, and understood within a broader context that is shaped by social, political, and economic factors operating from the local to the international level Milligan and Wiles As a space of care, Freedom University has also emerged as one component of the landscapes of care for a particular vulnerable, marginalized population—in this case, undocumented immigrant youth in Georgia.
Media discourse has noted the connection between Freedom University and the Freedom Schools that emerged during the Civil Rights Movement era. The above examples suggest that Freedom University operates within a landscape of care for undocumented youth in Georgia. Some of the discourse also describes the experiences that students gained by participating in Freedom University, including creating a sense of community around their common experience as undocumented students.
In light of the preceding content analysis of Freedom University through the lens of geographies of care, it has become increasingly apparent that more needs to be done to unpack the liminal legality of immigrants. Although our focus has been on Freedom University, future research should examine varying manifestations of extralegal spaces of care.
These counternarratives to established power structures should advance how spaces of care and concern, landscapes of care, and care for the nearby other are framed and promoted across different, and often conflicting, stakeholder groups in society across different legal geographies. Such research, coupled with a specific analytical lens— from a feminist perspective, for example—may elucidate the complexities that revolve around who cares, what we care about, when we exercise care, where care is demonstrated, why we care, and how we care.
Geographies of care is a framework for understanding different types of spaces and landscapes of care. Such spaces and landscapes have emerged as ways through which groups can organize against and resist systemic barriers. As such, a geography of care framework is an important perspective with regard to understanding agency and resistance as well as the ways in which people navigate liminal legality across uneven legal geographies.
A geography of care framework is also an important lens through which to examine the challenges faced by other vulnerable and disenfranchised communities. Future research can help identify opportunities for overcoming barriers and challenges in addition to simply examining manifestations of extralegal spaces of care as responses to established power structures.
In the case of Freedom University, these spaces of care are crucial, especially in a geographic area like Atlanta and Georgia more broadly. While Atlanta may position itself as a welcoming place, some of its practices and policies are hostile to immigrant populations, both statewide and in the counties where most immigrants, including undocumented immigrants, live. Institutions like Freedom University are key spaces for resistance, and one way in which immigrants affected by these policies are enacting this resistance is by taking care of one another, creating spaces of care, and centering care for the nearby other.
In our research, we observe a bridging of individuals who live in close proximity but are not necessarily in the same social spaces.click
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By bridging social distance, we are connecting with, and even caring for and about, those at a distance. This connection is forged between those who have immigrated in a variety of ways, who connect via their personal histories, their countries of origin, or even those countries that they passed through on their migration journey. Indeed, Freedom University's expression of care observed in interactions in highly localized places is connected to the concept of care for and about distant others—bringing people together so that they connect with each other before going about solving problems.
Freedom University is a contemporary example of a geography of care and concern within a major emerging immigrant gateway metropolitan area, navigating a variety of multiscalar policy contexts within an immigration federalism framework. This example of a space of care, within a landscape of care, has emerged from the broader landscape of confusion and disenfranchisement created by policy changes at the state and national level. It is an example of the many ways in which receptivity toward newcomer populations, which ranges along a spectrum between positive and negative receptivity, manifests in a particular place from a variety of sectors of a community—public, private, nonprofit, and education, among others McDaniel and Smith Thus, Freedom University operates in its current form with the hope that one day it will no longer need to exist—once the students it serves are embraced by the larger, more legitimized, geography of care.
Her research and practice revolves around the nonprofit sector's role in facilitating immigrant integration. His research interests focus on the processes and impacts of immigrant settlement, adjustment, integration, and receptivity in cities and metropolitan areas. Volume 41 , Issue 1. The full text of this article hosted at iucr.
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