More on the Denominational Health Plan

I mentioned last week that two dioceses had submitted C resolutions to General Convention regarding the Denominational Health Plan under the Church Medical Trust. I was interested that those two dioceses (one of which is my own) agreed that implementation should be delayed, but disagreed about what the end result should be.

Today the Episcopal News Services released this story about the Denominational Health Plan. It turns out that there are more than two dioceses - perhaps many more than two - concerned about the impact of the plan. I won't try to detail the various concerns. I suggest you read the story.

What does seem to be at issue, though, is the recurring questions of what justice might require, and whose ox gets gored. More to the point, one theme among various apparently different comments is this: should I get behind significant cost savings across the board, if I don't see cost savings immediately in my own local circumstances?

We'll have some interesting things to talk about in Indianapolis this summer: the Anglican Communion Covenant; blessings of gay and lesbian couples; possibly reshaping the Episcopal Church; and what kind of budget we need for the Episcopal Church, whatever shape it's in. We'll have many things to talk about, but I won't be surprised if this topic doesn't generate as much discussion as any of these others.

To Help With the Episcopal Endorsement Process

I have noted before that among the most common search strings that lead a person here is "Episcopal endorsement." I have tried to update this site as the link for the application for endorsement has changed. This morning I've also added it to the links on this page. You'll find it in the sidebar under "Professional Chaplain Links."

Do note, also, that you can find it at the Episcopal Church's revised web site. You can find it from the initial page under the menu "Who We Are" (which is, I suppose, interesting in itself: it could also have gone under "What We Do" or "Ministries." Not that I'm complaining; I just find it interesting). One way or another, I hope folks find this helpful.

A Good Discussion on Grief and Depression

Some readers may be aware that the Diagnostic and Statistical Manual of Mental Disorders (known more generally as the DSM, with the next edition to be DSM V) is in the process of revision. One controversy in that process has to do with the diagnosis of major depression, and what is known as “the bereavement exclusion.” That is, symptoms that might indicate clinical depression might, for a person who has suffered a significant loss, might only indicate normal grief.

With that in mind, when I heard that there would be a segment on NPR’s Talk of the Nation discussing this issue, I was wary. However, when I listened I was pleased. Jennifer Ludden interviewed a clinical social worker and a psychiatrist. Both were able to discuss their own experiences of grief. Both were able to speak to the normalcy of grief. Both focused less on specific symptoms, and more on function: how well is the person moving over time past the initial grief and reengaging the world. Moreover, both were respectful of the support of clergy and chaplains for those grieving, both in general and in response to a chaplain who called in to the show.

It was an interesting and informative discussion. You can go here to read the transcript or listen to the recorded conversation. Take the half hour or so to listen. It will be well worth your time. 

General Convention 2012: Reactions to the Denominational Health Plan

Things come full circle. One of the reasons I started blogging six years ago was to comment on legislation and issues at the 2006 General Convention. Now we’re coming to the 2012 Convention.

So, I’ve started watching the legislation being posted for this summer’s Convention. As a reminder (and especially for those for whom details of General Convention are new territory), resolutions to General Convention come in four categories. “A” resolutions come from commissions, committees, agencies, and boards (CCAB’s) of the Episcopal Church. “B” resolutions come from bishops. “D” resolutions come from deputies.

And then there are “C” resolutions. C resolutions come because a diocesan convention or a provincial meeting (in Episcopal parlance a province is a regional gathering of dioceses) have passed a resolution on a subject that included instructions to “memorialize” the General Convention on the subject. That is, a diocesan convention or a provincial meeting passes a resolution to express an opinion and to put that opinion before General Convention as a resolution.

So far, C resolutions are the only ones that have been posted on line. You can already see on line those that have been posted (and I’m sure there will be more).

Right now, the significant majority of C resolutions posted are on the subject of Structural Reform, and most of those have almost identical language. However, there are a few outliers, and two have my attention. That’s because their subject is the Denominational Health Plan, an effort of the Church Medical Trust based on Resolution A177 in 2009. The resolution specified that the plan should be implemented no later than the end of this year. It specified that the Church Medical Trust would offer a plan (or, really a selection of plans), and that within those dioceses had a number of choices. However, one choice it didn’t include (and a choice that is available under canons before this change) was whether or not to participate. That is, dioceses of the Episcopal Church in the United States, their congregations, and any agencies they would designate as “Episcopal” have to participate in the plan. Now, individuals can opt out if they have other provision for health insurance; but institutions can’t opt out. The point of that is to have as many lives as possible covered in the insurance plan; because the more folks you have covered in the plan, the lower the premium (at last in general). (I wrote more about 2009-A177 at the time.)

So far, two dioceses have submitted C resolutions on the Denominational Health Plan, both asking that it’s implementation be delayed. However, they really say two very different things. One is resolution C22 from the Diocese of West Missouri. It calls on General Convention suspend implementation of the Denominational Health Plan “pending consideration of a more equitable and unified Denominational Health Plan that eliminates unfair regional differences and dramatic cost disparities between dioceses…” The point of this is

That the 77th General Convention instruct the Church Medical Trust to formulate a plan that creates a single, unified national plan for the entire Episcopal Church with no variance in premium costs from diocese to diocese, thereby eliminating dramatic cost differences for similar health insurance coverage between dioceses and regions of The Episcopal Church; and be it further

Resolved, That the suspension of implementation of the Denominational Health

Plan is lifted only when the Church Medical Trust presents a revised, unified

national plan consistent with the intent of this resolution to the Executive Council….

The result of this would be, if you will, truly a single plan for the Episcopal Church in which all would still be required to participate. It would be, essentially, an ecclesial form of a single payer plan covering a single, all encompassing risk pool. The suspension is in place until this is done which could take a while; and this resolution calls for things to stay as they are until that can be offered.

This is different from resolution C27 from the Diocese of Central New York. That resolution calls for the Denominational Health Plan to be delayed another three years. It also maintains that all Episcopal diocese, parishes, and institutions would be required to offer health insurance to clergy and lay employees. However, “each diocese or other ecclesiastical organization or body subject to the authority of the church has the right to make decisions as to whether the Episcopal Church Medical Trust or another plan sponsor shall provide health insurance;…”

This is a different result. While it does require all dioceses, congregations, and institutions to provide health care, and requires it within a limited period of time, it specifically rejects a single denominational plan, or having a choice of plans but only from those offered through the Church Medical Trust. This might improve things for some clergy and for many lay professionals, but it resists a church-wide mandate in favor of a multiplicity of health plans – essentially, an incremental change within the same health insurance market that we already have. It would not result in a single risk pool.

Now, full disclosure: for those who didn’t already know, West Missouri is my diocese. Although I voted on the resolution that resulted in C22, I did not participate in preparing it (and I’m not saying how I voted). My only point in this post is to note how different would be the results of these two resolutions. It could raise the question of what problem proposers of each wish to address. C22 is about equity for institutions across the Church accomplished by universal participation. C27 is about freedom of choice for institutions within the Church, albeit with a requirement that all provide something – essentially an individual mandate.

It does seem to reflect the same sort of arguments about providing health care that we’re hearing in the wider American society. Granted, both proposals are progressive enough to require some coverage (after all, we are Episcopalians); but the means, the choices, and (presumably) the costs would be very different.

Even with delay and suspension both of these plans will be overtaken by events if the Affordable Care Act is fully implemented. In that case, passing C27 could result in some dioceses, congregations, and/or institutions could find their coverage through state insurance exchanges. In addition, I will be surprised if there are not additional resolutions from bishops and/or deputies, which may offer other, different models.

Which brings us to this question: what sort of employer do we want the Episcopal Church to be. That’s not simply a matter of whether we think it important to offer health insurance. Not only do both these resolutions require it, but existing canons require it (albeit for a more limited collection of employees). Rather, this might be seen as another expression of the question whether the Episcopal Church is a single body made up of its dependent dioceses; or whether we are an association made up of dioceses which are themselves  associations of congregations and institutions. Both these opinions are being expressed within the Episcopal Church today, and perhaps we shouldn’t be surprised that they might be expressed in a variety ways, including this.

And perhaps that ought to be an aspect of any General Convention, and of any resolution to General Convention. Every day we have the opportunity to ask the question of what kind of church the Episcopal Church wants to be. Moreover, I can’t think of a better forum in which to ask the question than General Convention. It is, really, the same vocational question each of us faces, writ large: what is God calling us to do now? These resolutions raise the specific issue of health insurance for Church professionals. Other resolutions will raise other issues. However, the larger context remains the same: in each issue, to what is God calling the Episcopal Church now? Or, to put it more personally, as it were: before God what sort of institution do we want the Episcopal Church to be?