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Phil Harmon was a successful business executive with deep roots in the Quaker community of the Northwest. By the 1990s the Oregon man had several homes in Oregon and Washington State. In his early career, he sold insurance. He gained widespread trust as a businessperson and garnered clients such as George Fox University, a Quaker school in Newberg, Oregon, and the Northwest Yearly Meeting, an organization of 67 Quaker churches in Washington, Oregon and Idaho. But he began to collect premiums without buying the insurance and using the premium payments to cover his clients’ claims.

While a sour economy and rising costs make it harder for small businesses to afford health coverage, one group of employees is especially vulnerable: clergy.

Many denominations provide health care for clergy, but pastors of small and independent churches can be hard-hit by rising health-care costs. Some clergy latch onto their spouses’ health care, or take a second job that offers insurance. But as the job market tightens, even those secondary solutions are hard to come by.

For the clergy, health-care reform has become personal.