Livin’ On a Prayer: Health Care Sharing Ministries

Today we look at the somehow-legal world of healthcare sharing ministries, a form of health coverage where like-minded religious folks share health care costs. After a series of lawsuits and scandals, these companies are in the news again recently. We’ll look at what HCSMs are, how they have flourished as insurance costs rise, and the potential risks they pose to the unsuspecting consumer. Then we’ll turn the page to talk about how communities of faith are playing a key role in winning a just and equitable healthcare system.

Today we look at the somehow-legal world of healthcare sharing ministries, a form of health coverage where like-minded religious folks share health care costs. After a series of lawsuits and scandals, these companies are in the news again recently. We’ll look at what HCSMs are, how they have flourished as insurance costs rise, and the potential risks they pose to the unsuspecting consumer. Then we’ll turn the page to talk about how communities of faith are playing a key role in winning a just and equitable healthcare system.

Our guest today is the Reverend Jim Rigby. Rev. Rigby has been the pastor at St. Andrew’s Presbyterian Church in Austin Texas for over 25 years. He has a love of world religions and a passion for social justice. Healthcare justice has been a part of his ministry because he believes that healthcare is the most basic right to life, along with a living wage and decent housing.


Show Notes

What are Health Care Sharing Ministries?

Ben explains that healthcare sharing ministries (HCSMs) are a form of health coverage in which members, who share religious beliefs, make monthly payments to cover the healthcare costs of other members.

BUT they are not insurance. Insurance is supposed to cover most of your healthcare services, with cost-sharing by the patient. HCSM are much cheaper than insurance, which is why they’re so alluring. But they cover much less, and only pay for a fixed amount of a service, regardless of the total cost. HCSMs, unlike insurance companies, don’t take on any risk.

The ministries are typically Christian. Members generally must declare their religious faith and promise not to smoke, drink alcohol excessively, or engage in extramarital sexual activity. Generally, they also do not cover abortion, mental health services, or birth control. Unlike insurance, HCSMs can deny coverage for people with pre-existing conditions.

The ACA used to fine people for not having insurnace, but HCSMs were exempted from that fine even though they do not meet the federal definition of insurance. (That fine was eliminated under the Trump administration, and the Biden administration hasn’t reinstated it.)

HCSMs have been around since the 80s, but grew in popularity during the 90s and again after the passage of Obamacare – basically whenever we see concerted efforts to make the government responsible for more healthcare costs.

“About 1.5 million Americans are members of these kinds of ministries, according to the Alliance of Health Care Sharing. Some $2 billion in medical expenses were shared through this type of ministry in 2020.  There are over 100 health sharing organizations certified by the U.S. Department of Health and Human Services for meeting the federal law’s definition of a health sharing ministry.” – Reported in Catholic World Report in May 2022.

Unregulated HCSMs leave people behind and contradict the religious values they claim to be based on

Health insurance companies aren’t well-regulated in the United States, but they still have to operate under some basic regulations. Gillian explains that there are virtually no regulations on HCSMs. As a result their practices can be exploitative.

Thirty states actually have “safe harbor” rules that exempt HCSMs from the restrictions on insurance companies. In “safe harbor” states, as long as members receive a written disclaimer from the HCSM and a monthly statement of member requests and contributions, the ministry is not considered to be engaged in the “business of insurance.”

Rev. Rigby discusses the contradiction between capitalism and democracy in the US. Democracy has to be based on basic human rights, while capitalism measures value based on property rights and wealth. The nature of HCSMs is to reward people who can afford it with healthcare, while leaving others behind.

HCSMs are marketed using language based on Christian theology around supporting and sharing with each other, but doesn’t actually live up to those values in reality, leaving people without access to care if they can’t afford it. They are also marketed as a way to avoid funding other people’s birth control and other services you may not agree with.

Consequences of HCSMs on patients

Because they’re not regulated, there isn’t much data or reporting on HCSMs, so it’s hard to get our hands around exactly what people experience. There are lots of anecdotal stories of people being denied coverage for treatment based on a perception they strayed from Christian values (for example an April 2022 tweet by a woman named Tina Nelson said “Friend’s mother died needing a liver transplant.  Had “Christian Health Plan”…was denied the transplant because her liver failed due to Hep C, which was a very “unchristian” thing to acquire.  She was 60.”

Other horror stories include that of Sharity (Formerly known as Trinity Health Share), which went bankrupt last year. A 2022 lawsuit from the state of California alleges Sharity denied the majority of claims and spent as little as 16 cents per dollar on premiums. At its highest point, Sharity had about 40,000 member households nationwide

In April 2021, when the Sharity board learned that the extent of unfulfilled requests was twice what they had expected, they voted unanimously to pursue a reorganization bankruptcy and started the process in July.

Court liquidation documents filed in October 2021 state that the ministry held over $300 million in unpaid member claims. A liquidation trust for Sharity has been set up to distribute the remaining money to members with outstanding bills; however, according to a New Hampshire Department of Insurance statement, “the money recovered will likely be a fraction of the total.”

Jim shares his vision for the role of people of faith and compassion in the movement for healthcare justice. He describes a future where people are more important than property, and Christians have an obligation to be part of the fight to get us there.

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Resources 

More Iowans opting for ‘health sharing ministries’ as alternative to increasingly pricey insurance – Des Moines Register

Column: Trump promotes shoddy faith-based health plans in new attack on Obamacare – Los Angeles Times

Response to Deceptive Marketing of Limited Plans Shows States Can Take Proactive Steps to Protect Consumers – Center on Health Insurance Reforms

Health Care Sharing Ministries: What Are the Risks to Consumers and Insurance Markets? – Commonwealth Fund  

1 million Americans pool money in religious ministries to pay for health care – PBS NewsHour

More People Turn to Faith-Based Groups for Health Coverage – Wall Street Journal

Alaskans opt out of insurance, turn to health care sharing ministries – Alaska Public Media 

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