How the ACA boosted enrollment in healthcare-sharing ministries

In less than a decade, healthcare-sharing ministries have seen their membership grow by more than a million people, in part due to an exemption provided in the ACA.   

Healthcare-sharing ministries are a form of health coverage where its members, who usually share a religious belief, make monthly payments to cover the expenses of other members. They are not health insurance plans. 

The roots of these ministries date to the early 20th century when Amish and Mennonite communities pooled their money to lighten the burden of debt for individuals, PBS reported in 2018. Many of the largest modern healthcare-sharing ministries were founded in the 1980s and 1990s. Christian Healthcare Ministries, which bills itself as the first healthcare- sharing ministry for Christians, began in 1981. Christian Care Ministries, which said it serves 400,000 members, was founded in 1993. 

Membership in these organizations soared during the 2010s after passage of the ACA. In 2014, there were about 160,000 people involved in healthcare-sharing ministries, according to PBS. By 2018, that figure rose to 1 million. In 2014, the ACA granted ministry enrollees exemption from the law's penalty for not having health insurance. Costs in these organizations are often far lower than in health insurance plans, according to the Wall Street Journal

There are now 1.5 million Americans who belong to healthcare-sharing ministries, according to data from the Alliance of Health Care Sharing Ministries, a trade group representing seven of the nine largest organizations.

But healthcare-sharing ministries have drawn the ire of some state insurance regulators and lawmakers. In 2018, for example, the Nebraska Department of Insurance warned that the organizations aren't insurance, aren’t regulated and can’t be forced to pay members’ medical bills, according to the Wall Street Journal.  

In Colorado, lawmakers passed a bill May 5 that would require healthcare-sharing ministries to submit annual reports on their operations to the state, according to the Colorado Springs Gazette. If enacted, the organizations would be required to report how much money members pay versus how much in medical bills the organizations cover. 

States lack data on healthcare-sharing ministries doing business within their borders, according to the Commonwealth Fund. Currently, only Massachusetts has rules requiring regular data submission. The Commonwealth Fund analyzed that data in a report released March 2.  

About half  the claims submitted by members were deemed eligible for payment, according to the report. The data shows claims paid by the organizations as a percentage of what members pay in monthly contributions  — comparable to a medical loss ratio  — ranged from 16 percent to 70 percent in 2019 and 28 percent to 111 percent in 2019, according to the report. The ACA requires all plans sold to individuals to pay at least 80 percent of  premiums toward healthcare costs.

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