Bob Vineyard, owner of the Georgia Insurance Shop, asked that question on InsureBlog, a popular health web log he co-edits.
“Something is causing people to abandon traditional health insurance and seek out a non-insurance solution.”
Vineyard was referring to growing national membership in what are called Health Care Sharing Ministries (HCSMs), a medical coverage option the Affordable Care Act (ACA) exempts from the individual mandate to buy health insurance.
HCSMs are not new, nor are they insurance. Instead of paying premiums, HCSM members send monthly financial contributions to a pool that funds others’ medical bills. Membership totaled about 200,000 when the ACA passed and has doubled since.
While most of the current 104 HCSMs are closed to non-adherents of the Mennonite or Old German Baptist churches, seven offer “open or modified open membership,” according to the Alliance of Health Care Sharing Ministries.
Medi-Share’s CEO Ted Squires says that over the 24 years since its founding, the ministry has paid over $1.4 billion of health costs and negotiated $690 million in provider discounts.
HCSM enrollees pay substantially less than do those carrying traditional insurance plans. According to health policy journalist Lisa Zamosky, Liberty HealthShare membership costs are $199 per month for single members, $299 for couples, and $449 for a family. Medi-Share claims its average member pays about $350 per month.
There are often limitations to the services reimbursed by HCSMs. Many do not cover mental health or substance abuse services. Medical underwriting is permitted, and pre-existing conditions may be excluded.
Members are frequently asked to pledge to religious principles, such as regular prayer or church attendance, and coverage may not be available for conditions caused by tobacco use or alcohol abuse.
HCSMs are also exempt from state and federal regulation and may limit how much expense they cover.
“We’ve seen the members continue to meet the needs every single month for our entire history,” says James Lansberry, vice president of Samaritan Ministries, “but that doesn’t mean that there are any guarantees or obligations that go along with insurance.”
HCSMs “are a leap of faith, both literally and figuratively,” cautions Sabrina Corlette, a research professor at Georgetown University. “You can’t go to a government agency to complain.”
On the other hand, Zamosky notes that physicians are generally enthusiastic about the arrangement, as third-party interference with treatment is removed, access to providers is widened and reimbursement is agreeable. Liberty HealthShare claims that 97 percent of all doctors and hospitals accept the reimbursement the nonprofit negotiates for patients.
One ministry member is 53-year-old Alabama business owner Michelle Ballard, who lost her coverage in late 2013. “My plan didn’t cover pregnancy, which is illegal under ACA,” she explained in a personal communication.
When she enrolled in a low-level ACA plan, Ballard saw her premiums more than double and her annual deductible rise to $6,000. After coverage of a simple lab test was denied, she canceled her policy.
“ACA is catastrophic insurance at Cadillac rates,” she writes. Joining Christian Care Ministry “wasn’t an easy decision, but it was the only affordable legal option.”
Affordability has increasingly been a problem for the 43 percent of individual customers who don’t receive federal subsidies. These individuals are clear losers under the ACA, according to Corlette, and represent “entrepreneurs who run their own businesses, freelancers and consultants, farmers and ranchers, and early retirees.”
Industry expert Robert Laszewski notes that unsubsidized ACA plans are losing customers. 2017 enrollment declined 29 percent for those paying full freight, but only 4 percent among those receiving federal help with their costs.
North Carolinians Teri Goodrich, 59, and her husband, John Kistle, 57, were enrolled in ACA plans for three years before their total premiums and deductibles grew to over $34,000. They opted out of ACA-approved coverage in 2017, but for next year, they hope to earn less income so that they can qualify for subsidies.
Corlette explains that individuals such as these were paying artificially low premiums before the ACA and now “pay more of the true cost of health care.”
The number of people who’ve left traditional insurance for lower-cost ministry assistance isn’t currently known. But ministry membership isn’t just about saving money, says self-employed Iowan Rebecca Welch.
“I feel better about paying a monthly amount to families in need than to helping insurance companies and CEOs who make over $20 million a year.”
Ballard agrees. “You can pay a ministry less than the [IRS] fine and actually help with health care. Who wants to give more money to the government?”
Ballard negotiates cash prices with her health providers, and recently underwent surgery at a 60 percent discount.
“I can’t imagine ever going back. If I go bankrupt, it will be paying for health care, not insurance.”
Dana Beezley-Smith, Ph.D., is in private practice serving children, adults and families in Green, Ohio. Her email is: firstname.lastname@example.org