If a pastor gets sick, given a choice between "a wing and a prayer" or "a wing and a prayer and health insurance," he or she would probably choose the second option—if it's available.

A recent survey by the National Association of Evangelicals found that the churches and related evangelical organizations are having the same challenges as other Americans, and jerry-rigging some of the same partial solutions. But significant numbers of pastors—the format of the NAE's survey wasn't designed to produce a precise estimate—go uninsured. Others get their coverage through their spouse's job, or by holding down a second job outside their church that gives them access to coverage. Those over 65 can get Medicare. Some are poor enough to qualify for Medicaid. Young pastors who are relatively healthy sometimes opt to get a private policy instead of buying into a church or denomination-sponsored plan, meaning the bills go up for the older and sicker.

"Only a few of our churches are adequately addressing this problem," one denominational leader was quoted as saying in an NAE report. "We tried two or three items to provide health insurance, but we have not been able to make it work," lamented another.

"This is a large and growing problem for American pastors and churches,' said Leith Anderson, NAE president, "So many churches are small and too many pastors are uninsured. There is no room in limited budgets for premiums or no way to get adequate insurance at any price. As clergy age with the rest of America's population, we may see a growing list of pastors entering retirement with bankrupting medical bills."

The NAE has been instrumental in cultivating support within the Christian community for addressing global warming and issues of environmental sustainability more generally. We have hope they might someday come to play a similar role in broadening support for a more sustainable health care system that works for all. I was in West Virginia last week for a series of meetings coordinated by the West Virginia Council of Churches. Evangelical churches are not part of the Council there, but representatives from their community did come and participate in two of the meetings in Charleston. Let's just say we all learned a lot, and hope and expect to continue dialogue about what Scripture has taught us ought to be and what health policy analysis has taught us can be.