In a trend that could challenge the stability of the Affordable Care Act, a growing number of people are turning to health-care ministries to cover their medical expenses instead of buying traditional insurance according to a Wall Street Journal article published last week on their wsj.com website.
The ministries, which operate outside the insurance system and aren’t regulated by states, provide a health-care cost-sharing arrangement among people with similarly held beliefs. Their membership growth has been spurred by an Affordable Care Act provision allowing participants in eligible ministries to avoid fines for not buying insurance.
But now, some insurance commissioners are concerned that the ministries could put consumers at risk if bills aren’t paid. The ministries aren’t overseen by state commissioners, which generally guard against unfair practices and ensure solvency.
- Ministry officials say they aren’t offering insurance, don’t guarantee claims will be paid, and don’t need to be regulated. The nonprofits are well managed, according to ministry officials, with third-party audits and a sterling history of sharing members’ claims.
- Ministries generally don’t allow members to sue and require disagreements to be settled by arbitration and mediation.
- Most ministries don’t always share bills for certain pre-existing conditions, whereas the ACA requires insurers to cover anyone regardless of their past or current medical history.
State regulators also say health ministries disrupt the insurance market because they tend to attract healthier consumers, siphoning them from commercial plans that can be left with sicker or older customers. Insurance commissioners in some states have moved to shut down the ministries’ state operations.
Many of the estimated 50 health-care ministries in the U.S. are small operations, and some churches have their own programs limited to parishioners. There are several large Christian ministries, and at least two other ministries open to people regardless of specific religious faith.
Members typically must abide by Biblical principles such as not having sex outside of marriage, and may have to sign a statement of religious faith.
Some consumers say they joined ministries to avoid rising deductibles and premiums on the health law’s exchanges, and to be free from the law’s penalty, which starts at $695 for 2016.
Consumers generally pay a set monthly amount that goes into a general account or directly to others who have eligible medical bill. They can also submit their own eligible bills to be shared by other members. In some ministries, members make contributions directly to others—and tuck gifts, personal cards and get-well wishes into the envelopes. Preventive care in some cases isn’t covered.
There have been lawsuits by ministry members against a cost-sharing ministry, claiming particular medical bills that should have been shared were not. The cases were ultimately settled or resolved through arbitration.
*Modified from a wsj.com article and other online sources.