Exempted from the Affordable Care Act’s individual mandate penalty, they’ve grown from 150,000 to 1.1 million enrollees.
These ministries have limited government oversight and have far more freedom to reject applicants with pre-existing conditions or claims that don’t meet moral standards. Experts warn that the growth of these programs can further weaken the ACA’s marketplaces.
Health care sharing ministries have become a more entrenched part of the health care system than anyone could have possibly imagined eight years ago, when they were quietly exempted from the ACA’s individual mandate penalty. The plans were an afterthought at the time, with only about 150,000 individuals enrolled in the faith-based plans. The exemption was included by Senate Democrats as a seemingly innocuous way to insulate the bill from attacks by Christian conservatives.
In the next eight years, however, enrollment in health care sharing ministries has skyrocketed, particularly in states in which the individual insurance market has had spiraling premiums and dwindling competition. As more people look for cheaper alternatives to health insurance, they are stumbling on ministry plans to escape Obamacare’s requirements and state oversight, but still satisfy the law’s individual mandate which, despite its repeal in the recent tax overhaul, remains in effect until 2019. Independent figures aren’t available, but according to the nonprofit groups that offer the faith-based plans—most of which are explicitly Christian—they now have more than 1.1 million members. What was once a fringe idea, limited to devout Evangelicals and small Mennonite churches in more rural parts of the country, has found acceptance with a segment of the population for whom the government safety net is unavailable and the free market options are unaffordable.
The idea behind the health care sharing ministries dates back at least a century. For decades, in Mennonite and Amish communities across the country, people pooled their money to lighten the burden of debt for individuals during hard times. And since the 1990s, larger ministries have fanned out to other Christian communities, offering services on the same principles.
These ministries are not required to be solvent, keep reserve funds or accept anyone who applies. People can be rejected if they have a pre-existing condition — diabetes, cancer or Alzheimer’s disease — but also if their behavior is deemed unhealthy, such as smoking or using illicit drugs. Applications often ask where people attend church. In certain ministries, applicants can be denied membership if they do not sign a statement of faith pledging to live a Christian lifestyle.
Once accepted, members pay a monthly membership cost. When a medical need arises, members submit a medical claim for approval. If the cost is approved, it’s paid for by the ministry, which draws from the pool of money paid by members each month. It’s also common practice for members to pray with patients for their healing over the phone, individually or through call centers. Some ministries will assign members to a health coach. Treatment that is seen as a violation of faith — an abortion, contraception or treatment for opioid use disorder, for instance — may not be covered. Read more from PBS
Dale Bellis, executive directory of the ministry Liberty HealthShare, told Politico:
We are an unabashedly Christian ministry. We don’t monitor an individual’s faith commitment—how many times they attend church or what they’re doctrinal beliefs are.
The growth in health-sharing ministries comes amid growing interest in association health plans. The Trump administration is betting big on the latter as a way to reduce insurance costs, proposing a rule that would expand who could form those associations. But experts warn that, similar to the ministries, these plans aren’t required to meet the consumer protections outlined in the ACA. Read more in Fierce Healthcare