Paying for Something Bigger: The Sentiment of Sociality and Health Care Sharing Ministries in the United States/Pagando por Algo Maior: O Sentimento de Soclalidade e os Sacerdocios de Partilha de Cuidados de Saude nos Estados Unidos da America

This article considers the ways that sociality is constructed and articulated in health care sharing ministries (HCSMs), which are faith-based, non-profit organizations that share in the payment of medical bills but are not insurance. When the Affordable Care Act (ACA) was passed in 2010, it included HCSMs in its list of religious exemptions to the individual mandate, and yet because HCSMs are not insurance, the law did not require them to follow any of its own reforms, such as the ban on pre-existing condition exclusions. What this has meant is that HCSMs are effectively operating as a stand-in for pre-ACA low cost, low coverage insurance in the post-ACA era and yet come with certain social benefits. Based mainly on ethnographic interviewing, I suggest that within the world of HCSMs, the loss of some coverage value has been replaced by the social value that these organizations offer to their members. I develop the concept of "socially-transacted health care" to explain how the payment side of health care comes to be experienced in HCSMs as a general feeling of knowing and being in relation with. I argue that this particular expression of sociality--or what I describe as "sociality as sentiment"--is achieved through a particular set of prescribed social practices, and together these do the work of constructing and binding persons as moral persons and lead people to think that they have good health care. The article therefore contributes to the renewed effort in anthropology to think sociality and adds to the emergent anthropology of insurance by showing that "good health care" is not necessarily or always measured by the yardstick of coverage and maybe defined in other ways. [Keywords: Health care, insurance, sociality, personhood, gift-giving]