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Lobbying for prayer insurance

By Ruth Morris
11/17/2009 © Health News Florida

MIAMI-- Little noticed in the noisy healthcare debate, Robert Clark of Belleair has been criss-crossing the state, meeting with lawmakers and other government officials, as part of a growing campaign by the Christian Science Church seeking coverage for prayer treatments.

The nudge at the federal level and in every state seeks to put prayer on the roster of treatments that private insurance companies will pay for, exempting them only if they find they are not cost-effective.
The church's lobbying has awakened opposition from those concerned that it elevates prayer to the level of evidence-based methods.
"The goal is to help the patient spiritualize their concept of themselves and the whole situation," said Clark, who lives in Pinellas but has an office in Sarasota. "This relieves fear and anxiety; healing is the natural result."
At the heart of the controversy, the church is asking lawmakers to write a "non-discrimination" clause into healthcare legislation that would require private insurance companies to consider funding prayer treatments by its practitioners, or healers. The provision would also include physical care by Christian Science nurses.

Christian Science practitioners are not paid by the church, but by patients. The church says practitioners typically charge $20 to $40 to pray with ailing church members, suggest scripture passages and discuss spirituality.

Clark said the Christian Science Church has a representative like him in every state, working "to secure a place at the table as health care legislation is being discussed."

While the prayer proposal represents pennies compared to the nation's overall healthcare bill, critics say there's more than money at stake. For one, the provision would allow payments to unlicensed providers.

"It doesn't matter that the costs are low, the principle is: Should I have to pay for stuff which is essentially... faith-based?" said healthcare consultant Brian Klepper of Fernandina Beach. "As far as I'm concerned we should only pay for evidence-based care."

Church officials say they consulted legal experts before floating their healthcare provision, purposefully avoiding challenges to the separation of church and state. For example, the proposal focuses on private plans on a health insurance exchange, where clients can shop for coverage tailored to their needs.

Supporters also note the provision  refers only to types of care that the IRS accepts as legitimate medical expenses.

If earlier efforts are any indication, the church may get its way. In 2006, when Massachusetts mandated all residents carry health insurance, the state allowed private insurer Tufts Health Plan to cover Christian Science spiritual care. The church is headquartered in Boston and offers the Tufts plan to its employees there.

The church's spiritual healing provision was dropped from the House bill on health care reform, but enjoys support from several prominent Senators, including Orrin Hatch (R-Utah) and Democrat John F. Kerry of Massachusetts.

Senior church official Phil Davis said the Medicare program, for those over 65 and the disabled, already covers treatment by Christian Science nurses. They aren't reimbursed for spiritual care, he said, but for physical assistance like bathing, cooking and helping patients get around. The church has about 25 nursing facilities in the United States, he said, including two in Florida, in Apopka and Fort Lauderdale. Of the 25 nationwide, 17 receive Medicare funding. 

"We don't see this as a government mandate. We see it as a requirement not to discriminate," said Davis. "If they (health insurance providers) come back to us and say, 'We did a study and we don't think it's cost effective, they can deny or restrict coverage based on those criteria."

Davis also said the church receives regular calls from members disgruntled by the prospect of having to pay health insurance at all. Mandated coverage is a key issue as lawmakers hammer out a final reform proposal.

"One of the things we hear from members is: 'We're going to be forced to pay for something we don't use,'" said Davis.

Davis said the Christian Science Church does not pressure members to abstain from seeing a doctor. Instead, he said, Christian Scientists decide for themselves if and when to seek medical treatment, but they consider prayer their primary healing tool.

"We don't keep tabs on this, but most Christian Scientists tend to choose prayer.. to lean in that direction," he said.

Ken Loukinen, President of Florida Atheists and Secular Humanists, said it was fine with him if private plans choose to reimburse prayer treatments.

"But it's wrong for Congress to write laws sanctioning it," he said. "It gives the appearance of elevating the view of religion versus a scientific method."

He added: "I don't want one penny of my healthcare dollar to pay for somebody's religious care if it could pay for even 30 seconds of cancer treatment for somebody's child."

Others question whether a spiritual healing provision would apply to other churches, or to alternative therapies. If prayer is covered, why not massage, or reiki, or cleansing ceremonies?

With or without spiritual care, Klepper argued the healthcare system is rife with non-evidence-based treatment. He used the example of a doctor who buys an advanced imaging machine, and then ramps up his orders for tests on that machine, even when evidence shows there's no improvement in outcomes as a result. Klepper sees such practices as a huge factor in skyrocketing costs.

"But even though we have lousy rules now, it doesn't make it a good idea to extend those rules (to covering prayer treatments)," Klepper said. "Things are out of control enough."

--Ruth Morris is an independent journalist in Miami.