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President Bush Seeks Cap On Malpractice Suits.” “GE Workers Call Two-Day Strike Against Plan Over Co-Payment Insurance Plan.” “Forty-One Million Americans Without Health Care Coverage.”

“North American Missionary Force Dwindles Because of High Cost Health Insurance.”

The last headline hasn’t appeared in any major publication, but it could become a reality nevertheless. Health insurance for some missionaries is now more than $700 a month. Before missionary families can even begin working on raising money for ministry support, many must raise well over $1,000 a month for health coverage, social security, retirement and life insurance.

One missionary leader told me that they have people on their field who have enough money to live, but they don’t have enough money to do ministry. A mission agency recently reported that of the 115 missionaries they have on the field, 62 of them are under-funded. The high cost of insurance is a likely contributor to their being under-funded.

Why is the cost of insurance so high for missionaries? Insurance companies have learned that Americans overseas come home for their medical needs, not just catastrophic care. Missionaries come home to have their babies, have corrective surgery, as well as extensive check-ups. Hospitals in some countries in Eastern Europe, Asia and Africa are places people go to die, not to get well. Our first year in Kenya we were stunned by the death of a colleague who went in the hospital for minor surgery but who developed a blood clot that went to his heart. Americans are afraid that health care in a foreign country will result in death due to the cure. With horror stories like that, is it any wonder that missionaries come home to be treated?

As we all know, insurance is a gamble. Insurance companies are betting you’ll need it and probably that is true sometime in the life of a missionary. While we cannot reduce the odds, we can at least reduce the wager. There are no easy answers to the crisis of missions and health care. However, if North American missions are to have a role in world evangelism, the cost of missions must be addressed. The need is for some creative and bold decisions on how to make it possible for people to see a future in serving Christ cross-culturally for the long term.

First, the church could take more ownership in covering their missionary’s health insurance. I am not suggesting that churches take on full responsibility, but they could help in providing a safety net for those they support. One church, in cooperation with their missionary appointees, found health coverage with a high deductible. With a deductible of $5,000, the missionary’s monthly premiums are lowered considerably. The church has pledged to underwrite that deductible if there is a health crisis. This is not a perfect solution and won’t meet the needs of everyone, but it could be an option for some as they think about a career in missions.

Second, missionaries need to go to the field recognizing that one cost of missionary life means they cannot come home for every health need. I am not advocating irresponsibility or suggesting that missionaries go to the field without some medical coverage. I am suggesting that we are coming to a financial point where we can no longer have our cake and eat it too.

Missionaries cannot equate their situation with pastors in the US who have full medical/dental insurance and a good retirement plan. If we are looking for equity, we’re on the wrong side of the ministry. We must ask ourselves, is it more important to have full medical coverage with a low deductible and an option to come home for every medical claim than it is to be serving on the field? Is it unreasonable to suffer without a safety net for the sake of serving God?

Third, there should be options for missionary health insurance. I have advocated for years that missionaries should be able to choose their insurance coverage and not be lumped into one high cost plan.

A missionary should be able to choose between high safety net coverage or catastrophic/low safety net coverage. I have no condemnation for those who are willing to raise the money they believe is necessary to protect their families. However, requiring young couples who have no children or second-career missionaries to pay for insurance they do not need and probably will never use is not only a waste of money, but keeps good people from entering into missions longterm.

We cannot control all of the high cost of doing missions today. For those who want to be in it for the long haul, both supporting churches as well as field people must think of ways to reduce the risks. But at the same time we need to be willing to take the risks necessary to be engaged in this thing called world evangelism.

Richard Lewis is the international training director for the United World Mission and president of The Next Step.