Health share ministries offer alternatives to ACA

Feb. 05--When Jolie and Chris Jenkins' 7-year-old got sick last year with a recurring infection, the medical bills could have flattened the budget for the Walla Walla family of eight.

Their daughter's care for the illness required two doctor visits, three lab tests and an ultrasound -- with the latter procedure alone one that typically rings up at about $1,200, the couple said.

"If you take your kids to the emergency room at 2 a.m. for a cold, it's like a $1,000," Jolie said.

The Jenkins should know -- Chris is an emergency medicine doctor for Walla Walla General Hospital. And despite health insurance available through his job, the Jenkins found their share of such coverage to be prohibitively expensive.

But Chris, 40, and Jolie, 34, chose long before their daughter got sick to opt for an alternative to traditional health insurance. The cost to treat their child: $500, with no copay to worry about.

That doesn't mean they are breaking Affordable Care Act laws that require people to have medical insurance. The Jenkins, like hundreds of thousands of other Americans, have chosen to opt out of the health insurance fray altogether by joining a Christian-based organization focused on covering care costs.

"Health care sharing ministries" or "medical sharing plans," as these alternative plans are coined, are offered by big and small faith-based nonprofits. Users are exempted from buying traditional insurance through a loophole in the present ACA model that allows religious organizations to share health care costs among members.

Thus for the Jenkins, care is not a matter of faith in the U.S. government -- and whether ACA will survive a Republican Congress' vow to repeal it -- but simply a matter of faith.

Shared money, shared beliefs

Relying on a community of Christians to share their medical bills instead of private health insurers appeals to about 800,000 Americans, according to the Alliance of Health Care Sharing Ministries, founded in 2007 as an Illinois-based umbrella group that lobbies for health share organizations.

According to a 2016 Wall Street Journal story, the National Association of Insurance Commissioners estimates there are about 50 health share organizations in the United States overseeing about $60 million annually in health care payments.

They typically work like this: Members agree to live by Christian values-based rules -- don't drink, much; eschew drugs and tobacco; no sex outside of marriage; and otherwise avoid unhealthy lives. Members then agree to share health care expenses among themselves. Each contributes a monthly amount to a pool, or "share box."

When a billable medical event happens, the member pays for it out of pocket -- often with cash for the lower "self-pay" fee many providers offer -- then submits the bills to their health share community.

But don't bother sending along bills for such things as injuries suffered in collision while driving drunk or a pregnancy outside of marriage. Those issues don't fit with Christian values, according to health-sharing guidelines.

Some groups operate more insurance-like, asking members to use an in-network provider. The doctor, hospital or clinic then sends its bill directly to the organization, which will negotiate for a discount.

If an ailment or injury is covered, the money comes back to the provider or individual household via the pool of money members of the sharing plan contribute to monthly. Or, a member's expenses are presented to others in the pool who voluntarily send financial help directly to the submitter.

The monthly cost per household ranges with size of family, but averages out to about $400 a month -- less than most of the ACA plans. And users are exempt from the $2,085 maximum tax penalty for going without health insurance in 2016 and 2017.

For the past many years, there have been four major players in the business: Christian Care Ministry's Medi-Share program, Liberty HealthShare, Samaritan Ministries and Christian Healthcare Ministries.

The Jenkins, with six children ranging in age from 13 to 3, wanted to be sure they signed up with an organization that had already stood the test of time. Jolie, who holds a computer science degree, researched options. Christian Healthcare offers about the same coverage as a top or middle-layer ACA plan, she found.

The bonus for the Jenkins, they said, is that their money is going to other families and medical expenses with every payment, not to plump up a bank account of a corporate insurance company.

All health share groups have various versions of "shared beliefs," the Jenkins found. Signing such a contract at Christian Healthcare a year and half ago was a simple declaration of what the family believes in their Mormon faith.

"I'm a Christian. I'm going to live by certain things, like be moderate in alcohol use, don't smoke, don't have extramarital sex," Jolie said. "The genius of this is, you're not paying for people's stupid lifestyle choices. People out drinking, out doing stupid things? We don't pay for that."

Post-ACA future?

Like federal, state and private health insurers and their customers, families like the Jenkins belonging to Christian-based health share organizations await the fate of the Affordable Care Act. The new Republican administration and majorities in the House and Senate are working toward repealing former President Barack Obama's landmark health care act, but offer few details on how it might be replaced.

Significant changes in the ACA could include eliminating legal consequences for not having health insurance, as mandated by ACA rules, and that is a game changer for everyone, said Dr. Dave Weldon, president of the Alliance of Healthcare Sharing Ministries.

The same people who didn't buy insurance before the ACA may return to avoiding enrollment or "gaming the system" by waiting until they are sick to obtain coverage, he said.

"That's like being allowed to wait until your back bedroom is in flames before buying fire insurance," added Weldon, who practices internal medicine in Florida and served as a Republican in the U.S. House of Representatives for 14 years.

Buyer beware

Critics of health care sharing organizations, however, say not every medical expense is reimbursed under the model. Also, unlike the ACA mandate, many pre-existing health conditions exclude people from joining a health share -- for a period of years, or forever.

Mainstream media and health industry information websites attest to reimbursement problems, a lack of external regulation and unpredictability of coverage for unexpected and major medical events.

According to a 2016 article in Becker's Hospital Review, which provides business and legal information for health care industry leaders, critics say some people only join health shares to avoid ACA rates or because they are ideologically opposed to the government insurance model.

"Others are worried about how these plans could affect the ACA exchanges. Because members of health sharing ministry plans are often healthier, the sicker people flock to the exchanges or Medicaid," according to Becker's.

As well, share ministries in general won't cover pre-existing or chronic diseases, with some exceptions. Sexually transmitted infections are not covered unless those are contracted "innocently," according to Samaritan ministries in a 2015 New York Times op-ed piece.

The Washington Post in a 2014 article also reported treatment for mental illness, abortion and contraception are also off the coverage list of health shares.

Mike Kreidler, Washington state's insurance commissioner, attempted to halt health share groups from operating in the state in 2011.

"Our issue was that someone should be overseeing them -- and that they were technically acting as a health insurer," said Kriedler spokeswoman Stephanie Marquis. "The legislature disagreed and passed a law in 2011 exempting them from our regulation."

But health sharing is not intended to look like the government's way of covering medical costs. Instead, the rules of conduct and guidelines for reimbursement are meant to encourage personal responsibility, Weldon said.

He recalls a patient who came to him with lung cancer who has smoked heavily for decades and had been coughing for months. It wasn't until the man finally ponied up for health insurance that he sought medical care.

"It used to be a common practice ... and if you allow that, who's paying for that?" Weldon said. "Everyone else is paying those premiums. And that's why the Obamacare premiums went through the roof."

Medi-Share spokesman Michael Gardner said personal conduct of members is important, but medical bills that fall within Medi-Share's rules will be paid, he added.

"There's a misconception about this, that a medical bill is open to whim, and that is not at all the case;" he said. "We have guidelines and we clearly tell people what is and isn't covered."

Medi-Share members, Gardners added, have helped each other pay more than $1 billion in health care costs since the organization was founded in 1993 and now 220,000 people on its rolls.

Social connections

Dale Bellis, chief executive of Liberty HealthShare, said the implementation of ACA boosted his organization's enrollments. Today the company covers 52,000 households totaling about 126,000 people. Before ACA, Liberty had just 100 families in Virginia on its rolls.

Liberty was a melding of Bellis' own organization and one began by the Mennonite Church, where sharing health costs among members is a long tradition.

Bellis compares Liberty to what he calls social community. Not only is each member's money going to help another member, but people pray for and message each other as a way to connect, he said.

That communal atmosphere helps remind members they are accountable to others for staying as healthy as possible. However, should someone submit a bill for an excluded service -- such as addiction treatment -- Liberty works to set people up with other resources, Bellis said.

"And we pray for them and wish them well -- but we're not going to share that cost," he said.

One of the biggest differences Bellis says in health share members and those paying insurance companies is attitude.

"It's such a different paradigm," he said. "It's really relational, it's our money going every month to another person who needs it."

Because of those relationships, an air of entitlement between insurer and insured dissipates with health sharing.

"It's the difference in saying 'I am not only looking out for own interests, but of others as well. I will evaluate costs, review my treatment plan, and shop around to find this service at the best price. I'm not consuming health care dollars I don't have to,'" Bellis said.

Sheila Hagar can be reached at sheilahagar@wwub.com or 526-8322.

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