31,000 Tennesseans forego health insurance to share medical bills
I read an article from THE TENNESSEAN a few days ago on a subject we get inquiries about here at the agency. Some of our customers, in doing their due diligence to find healthcare for their family, ask about Christian member-funded healthcare programs. We have given them the names of some of the organizations mentioned in this article and some customers have had success in participating in them. This article focuses on this aspect of healthcare coverage. It’s an interesting read!
PLEASANTVILLE, Tenn. — Sixteen years ago, when Larry Ryan quit his government job to become a self-employed electrician, he also left behind his health insurance.
Ryan, a father with a growing family, was tired of the bureaucracy of insurance, so he decided to search for something new. He gravitated toward a Christian health care sharing ministry, a little-known alternative to insurance in which members pool their money to pay each other’s medical bills.
The ministry came with an unsettling caveat — it can’t actually guarantee payment — but Ryan liked the rest of what he heard. First, joining a health sharing ministry was cheaper than just about any insurance on the market. Second, the ministry aligned with Ryan’s beliefs by refusing to cover abortion or birth control. And third, instead of paying premiums to a faceless insurance corporation, each month Ryan would send money and prayers to another family, not unlike his own, that was in need.
“Up to that point, all we knew was health insurance,” Ryan said during an interview on a snowy day at his home in rural Tennessee. “We understood very well how insurance worked, or how it failed to work, I would say.
“And so we wondered — is this really going to work?”
For this family, it has. Since 2004, Ryan, his wife, Gian, and their nine children have paid for most of their medical bills with Samaritan Ministries, a nationwide network of Christian families that replaced traditional health insurance with faith and crowdfunding. Although the Ryan’s have been fortunate enough not to suffer a calamitous ailment or injury, Samaritan has helped the family pay for three births, several surgeries and a handful of trips to the emergency room.
In February, Ryan’s contribution to Samaritan was to mail about $600 to a Montana family with a premature child. He was also in the process of sharing about $1,000 of his own medical bills across the Samaritan network. Since 2006, he said, his family has paid into the ministry about the same amount of money it has received in aid.
“No complaints,” Ryan said. “It has worked exactly as advertised. For us.”
In Tennessee, where general health is poor and the number of uninsured adults and children is on the rise, more than 31,000 people have abandoned traditional health insurance in favor of Christian health care sharing ministries, a cheaper but largely unregulated alternative to insurance. Most ministries say their enrollment is steady, but Samaritan’s Tennessee membership has grown 80% in five years.
In some other states, government officials have discouraged residents from joining these ministries and sued or banned one group they accuse of deceit. Tennessee officials have not taken any such action, but some academics and insurance experts have sounded alarms about what they describe as a poor mimicry of real health insurance.
The crux of their concerns is not in dispute: Christian health ministries are not legally required to pay anyone for any medical care. If you depend on them to cover your medical bills, you could be left with only partial payment or no help at all.
“People are contributing to something on a wing, a prayer and a promise,” said Teena Hewgley, 66, a retired Middle Tennessee insurance agent. “I know that some people of faith want to believe in this, but you have got to realize there is no guarantee.”
This is crowdfunding, not insurance
At first glance, a Christian health care sharing ministry could be mistaken for health insurance. Like insurance, sharing plans are designed to help families pay for medical bills they cannot afford on their own. But the similarities end there.
Legally, health sharing ministries are not insurance, so they are not regulated by state insurance commissioners and aren’t required to meet insurance standards set by federal law. The Affordable Care Act requires insurance companies to cover essential medical needs, but sharing ministries are exempt.
Ministries still cover millions of dollars in medical bills every month, but they do so because they want to, not because they are required to do so, said Anthony Hopp, Samaritan’s vice president of external relations. Hopp described Samaritan as well-organized crowdfunding, similar in spirit to passing a hat to collect donations.
Gian and Larry Ryan eat lunch with their children at
their home Friday, Feb. 7, 2020, in Pleasantville, Tenn. Since becoming
disillusioned with traditional health insurance, the Ryans have relied on a
Christian health sharing ministry to cover themselves and their nine children.
(Photo: Courtney Pedroza / The Tennessean )
“It’s just a community of people who have mutually agreed to voluntarily share in those medical needs as they arise,” Hopp said. “Even though this model is probably lost on most young people today, it’s not that different from what would happen at a barn raising in an Amish community. The barn burns down, and then soon after, everybody shows up and they work together.”
This generosity has limits, however.
Generally, health sharing ministries offer low to no coverage of preexisting conditions, prescription drugs, addiction treatment, dental procedures or mental health care. Some ministries cap their coverage at a few hundred thousand dollars.
Ministry members are also encouraged, and sometimes required, to haggle. Because no insurance company is negotiating with hospitals to reduce prices, ministries expect their members to push hospitals and clinics for self-pay discounts before sharing their medical bills across the crowdfunding network. To get maximum discounts, families sometimes must pay upfront and then wait to be reimbursed by their ministry.
Finally, participants must adhere to a Christian code of conduct, including attending church and daily prayer. They can lose coverage if they abuse alcohol, smoke cigarettes or marijuana or have sex outside of a heterosexual marriage. In nearly all cases, if a child is born to unmarried parents, maternity costs are not covered.
“I might tell someone to beware because these sharing plans don’t offer protections for preexisting conditions, and their eyes glaze over.”
CAROLE MYERS, UNIVERSITY OF TENNESSEE HEALTH POLICY EXPERT
Carole Myers, a University of Tennessee expert on health policy, worried that people who join health sharing ministries might not truly know the rules and limitations of their coverage.
Even if ministries are explicit about how they differ from insurance, some families likely join without realizing there is no guarantee their bills will be paid, Myers said.
“I might tell someone to beware because these sharing plans don’t offer protections for preexisting conditions, and their eyes glaze over,” Myers said. “Health insurance is so complicated that people rarely get past the first paragraph. They are not discriminate shoppers.”
Nationwide, as many as 1 million Americans are estimated to be enrolled in Christian health sharing ministries. Medi-Share, believed to be the largest ministry in Tennessee, says it has 12,000 members in the state. Two similar groups, Christian Healthcare Ministries and Samaritan, said they have 9,700 and 7,200 Tennessee members, respectively. Liberty HealthShare said it has 1,500 members, and Trinity HealthShare said it has about 750.
Some states warn against ‘sham’ ministry
Of all the Christian health sharing ministries in the nation, none have raised more alarms than Trinity.
Over the past year, government insurance regulators in Colorado, New Hampshire, Texas and Washington have taken legal steps to bar Trinity from their states, insisting the company doesn’t meet the legal requirements of a health sharing ministry and is therefore misleading customers and selling what amounts to unregulated insurance.
Washington officials called the coverage peddled by Trinity and its parent company, Aliera Healthcare, a “sham.” Trinity has denied all wrongdoing but agreed to stop operations in Washington and Colorado.
Concerns about sharing ministries don’t stop with Trinity. In December, the Nevada Department of Insurance warned residents not to be “fooled” by ministries that are “mimicking health insurance” but don’t guarantee any coverage. And Peter V. Lee, the head of California’s Affordable Care Act marketplace, has called for increased transparency and oversight of ministries, according to The New York Times.
Tennessee officials have not been so bold. In a recent interview with The Tennessean, state Insurance Commissioner Hodgen Mainda declined to comment extensively on health sharing ministries because they are outside of his jurisdiction, but stressed it was important for residents to know the difference between ministries and health insurance.
“I’m happy that our consumers have choice,” Mainda said, “but we want them to do their due diligence whenever they are evaluating benefits to cover them or their families.”
Some health care experts have been far more pointed in their advice. Brian Haile, a former TennCare official who now leads Neighborhood Health, said he worried about the incomplete and undependable coverage provided by health sharing ministries.
Haile specifically recommended that Tennesseans invest in an accidental death and dismemberment policy, which is a cheap form of life insurance, if they otherwise relied on a Christian health care sharing ministry.
“I’m sure a majority of them are trying to work in good faith and do good stuff,” Haile said. “But because there are so little legal constraints and regulatory oversight, somebody could make a lot of money at someone else’s expense, and that should be a real concern.”
The Tennessee Department of Insurance and Commerce declined to say if had investigated or was investigating any Christian health care sharing ministries. Mainda said that, of about 3,000 consumer complaints received by the department over the past year, only five were about these ministries.
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This is a reprint of a story released on February 24, 2020 from THE TENNESSEAN written by Brett Kelman who is the health care reporter for The Tennessean.
