More than one million Americans have turned to faith-based health sharing ministries, which help their members pay for medical expenses, in place of traditional health insurance. But as one ministry recently acknowledged, "[T]here is no coverage, no guarantee of payment"—leaving some patients facing potential financial ruin, Reed Abelson reports for the New York Times.

Background

Health care sharing ministries operate cost-sharing funds that help members pay for medical expenses. Members generally must "adhere to a Christian lifestyle," Abelson reports, and pay a fixed monthly fee that either is pooled into a general account or goes directly toward another individual's medical bill. Members then can submit medical bills to the fund to share the cost among the group.

However, the ministries are not subject to state regulation and are exempt from Affordable Care Act (ACA) requirements, including the law's essential health benefit requirements. As a result, many of the health care ministries do not cover pre-existing conditions, preventive care services, mental health care services, or substance use disorder treatment. They also do not cover abortion services and certain types of birth control. The ministries also are able to set limits on the amount they pay for treatments.

Further, unlike traditional health insurers, health sharing ministries have no legal obligation to cover claims.

Patients raise concerns

Despite these limitations, health care sharing ministries have grown in popularity in recent years, and they currently serve more than one million Americans, Abelson reports.

According to Abelson, the ministries are attracting new members in part because they offer lower monthly prices and are seeing less competition as some insurers have exited the ACA's exchanges. The ministries also have diversified, with new health care sharing ministries entering the market that place less stringent religious requirements on enrollees.

The lower costs for membership are what attracted Dan Plato to Liberty Healthshare. When Plato started working as an independent consultant in 2018, he learned an ACA insurance policy for his family would cost around $1,300 per month. "It was very expensive and beyond our needs," he said. In comparison, coverage through Liberty Healthshare in Ohio was about half that, according to Plato.

But while Liberty seemed like a deal, Plato noted a low bill for a flu shots ended up in collections. In turn, he began to question whether Liberty would cover his family in the case of a serious medical event. "It's not something we could trust in that situation," Plato said. He left Liberty in 2019.

Mark Collie, a freelance photographer in North Carolina, also opted for a health sharing ministry in place of traditional health insurance when his family couldn't afford traditional health insurance. The ministry, Samaritan Ministries, limits payments for members at $250,000.

After Collie's family joined Samaritan, his eight-year-old son Blake had an aneurism and spent two months in the hospital, Abelson reports. Blake's bills have not been tallied, but they will very likely exceed Samaritan's cap, according to Abelson.

Samaritan Ministries in a statement about its coverage said, "Just trust God." It tells members that that "there is no coverage, no guarantee of payment."

Collie said Samaritan is a viable option and pointed out that it covered many bills before his son was hospitalized. "Every single person has prayed for me and my family," he said.

Still, he was relieved when he learned his son was eligible for Medicaid and that the program will cover Blake's medical care in full, Abelson reports.

Now states are taking action

As the ministries increase in popularity, regulators are giving them more scrutiny, Abelson reports.

But because the ministries are not considered health insurance under the ACA, regulators have limited legal grounds to intervene. Katie Keith, a consumer representative to the National Association of Insurance Commissioners, said, "Regulators haven't been willing to assert any control or regulatory authority over these plans." She continued, "They feel their hands are tied. At the end of the day, it's not insurance."

In the meantime, several states—including Colorado, Washington, Texas, and New Hampshire—are trying to prevent certain ministries from operating.

Kate Harris, chief deputy insurance commissioner in Colorado, said, "The nature of what we're hearing from consumers around the state is absolutely heart breaking."

In Texas, the attorney general brought a lawsuit against Aliera Healthcare, which marketed Trinity Healthshare ministry, to block in from offering "unregulated insurance products." Aliera has since stopped offering plans in Texas and said it is communicating with regulators to resolve the uses.

Aliera in a statement said that "it's deeply disappointing to see state regulators working to deny their residents access to more affordable alternatives offered by health care sharing ministries." Trinity said it states clearly on its website that membership under the ministry does not count as health insurance (Abelson, New York Times, 1/2).