Christian health plan launches in Texas

A Christian anti-abortion health insurance plan is hoping its faith-based coverage shakes up the market in Texas.

Presidio Healthcare last month launched the FortressPlan, which adheres to ethical and religious directives that guide Catholic hospitals and health care providers. The directives prohibit abortion, contraception, gender-affirming care, in vitro fertilization and medically assisted suicide.

The plan is built on Christian principles, but members do not need to subscribe to the faith to enroll, said Daniel Cruz, co-founder and CEO of Presidio.

The plan is aimed at individuals and families with incomes that are too high to qualify for subsidies that lower the cost of Affordable Care Act health insurance plans, Cruz said. It does not cover pre-existing conditions or offer certain benefits, such as mental health coverage, which Cruz said is intended to keep the plan affordable while the company is growing.

"We've got to make sure that we're on a firm financial footing," said Cruz. "That's going to serve our families and members well at the end of the day."

Presidio has been licensed in Texas since August, according to a filing with the Texas Department of Insurance. Cruz, an actuary, co-founded the company with its chief legal officer, Bob Hogan.

Large companies dominate the U.S. health insurance market, as smaller companies often struggle to enroll enough members to keep premiums stable, said Ken Janda, a former health insurance executive and professor of practice at the University of Houston Fertitta College of Medicine.

A core principle of commercial health insurance is risk pooling, where members combine their health "risks" and share medical expenses. Smaller health plans are more susceptible to volatility, because a single high medical bill is shared by fewer members.

"You need a lot of people in your risk pool -- tens of thousands of people -- to have a stable risk pool, so your rates are very stable," Janda said.

Cruz declined to say how many people have enrolled in the plan, but he said interest has been "great" and that Presidio reached its projections for the rollout. He believes the plan is in a solid financial position to succeed in Texas.

"I think we can hit sustainability pretty quickly," Cruz said. "That's not a concern of mine."

Christian health plan

The plan does not cover health care services that are prohibited by the ethical and religious directives, a set of guidelines developed by the U.S. Conference of Catholic Bishops. Catholic hospitals and health care providers such as CommonSpirit Health, the owner of Baylor St. Luke's Medical Center in Houston, also follow those guidelines.

Texas law bans nearly all abortions but includes exceptions for life-threatening medical emergencies. Cruz said Presidio's plan will pay for medical expenses associated with life-saving care, but he views those circumstances as "morally complex" and different from an abortion.

"That is not the same thing as an abortion. That is a realization that there's a tragedy involved," he said. "You're not intending to end that life. You're just intending to save the mother's life."

Presidio will consult with the National Catholic Bioethics Center to determine if a service should be covered by the plan.

The center offers a hotline that Presidio staff can call if there's a need for a quick decision in an emergency, Cruz said.

The ethical and religious directives prohibit IVF, but Presidio will help to connect members to fertility consultations and other services intended to help people with infertility, Cruz said.

The plan does not cover contraception. It also excludes gender-affirming care, which Texas law prohibits for minors, and medically-assisted suicide, which is illegal in the state.

While the plan is guided by Catholic principles, enrollees will not be required to sign a statement of faith, Cruz said.

"We're not here to be the arbiters of other people's values," he said. "We just want to spread what we believe."

'Unique' insurance

Presidio chose Texas for its launch because the state consistently ranks worst in the nation for rates of uninsured adults and children, and because Texas has strong religious freedom laws that allow businesses to operate in alignment with their beliefs, Cruz said.

"We're entirely unique, and this is probably the best state to really kind of set that precedent," Cruz said.

Presidio's network includes more than 993,000 providers and 5,700 hospitals across the U.S., according to its website, though it does not specify how many of those providers and hospitals are in Texas.

While the enrollment is open to all religious backgrounds, Cruz said he hopes that through effectively serving a non-Christian family well, it would create an opportunity to share more about their faith.

Presidio plans to expand to Florida, Indiana, Georgia, North Carolina, Ohio and other states in the future, according to the company's website.

The plan is not available through the ACA marketplace because it does not meet certain requirements, such as covering preexisting conditions. Presidio's founders have been critical of the ACA in the past, but Cruz said the company could look to meet the requirements to join the marketplace in the future.

Presidio says the plan is the first Catholic health insurance plan in the U.S. It is different from a health care sharing ministry, a type of coverage where members contribute to a shared fund to pay for future medical bills. Those contributions are typically lower than the cost of major health insurance plans.

'Trusting the system'

But health care sharing ministries are not regulated, so they are not legally required to pay members' claims. Attorney General Ken Paxton's office sued a Georgia company in 2019 after receiving numerous complaints about unpaid medical bills.

Presidio is registered with the Texas Department of Insurance, so the company must follow Texas law and maintain enough funding to pay its members' medical bills, Cruz said.

"We want families to know that it's not that they're just trusting us because we're saying, 'trust us,'" Cruz said. "They're also trusting the system and the regulatory environment that protects them as well."