When Ron Drummond had routine hernia surgery last year, he didn’t bill any insurance company. Instead, he got 25 to 30 personal checks from people he barely knows, many accompanied by a note saying the sender was praying for him.
Drummond, who lives in Basehor, Kansas and works in Johnson County, Kansas is a member of a Christian “health care sharing ministry” — a charity in which members pledge monthly dues to help each other cover unexpected medical expenses.
It sounds like health insurance, in that it’s a group of people pooling medical risk. But the charities say they’re different because they’re based on faith, not regulations. “This is not insurance,” Drummond said. “There is no guarantee everyone is going to pay in.”
As premiums and deductibles for individual health plans have increased under the Affordable Care Act — commonly called Obamacare — more people are turning to such ministries rather than buying traditional health insurance.
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The health sharing ministries are explicitly exempt from ACA requirements, so they can offer monthly dues that are lower than typical insurance premiums, especially for people who accept less coverage and more personal risk.
Dr. Dave Weldon, a physician and former Republican congressman from Florida, is president of the Alliance of Health Care Sharing Ministries. The alliance represents the three largest such groups in the United States: Samaritan Ministries, Christian Care Ministries and Christian Health Care Ministries.
Weldon said the Obamacare carve-out only applies to ministries founded before Jan. 1, 2000. It was meant to accommodate groups like the Amish and Mennonites, who were already exempt from other federal programs on religious grounds.
“The Democrats put the exemption in because they didn’t want these people subject to the (tax) penalty (for not carrying insurance) and they’ve grown astronomically ever since,” Weldon said. “I think the growth is mainly because of the collapse of the individual market.”
More than 100 health care sharing ministries are now registered with the U.S. Department of Health and Human Services. The startups partner with older ministries to use their grandfathered status. Weldon said that since the ACA passed, the number of health care sharing members nationwide has more than doubled from less than 500,000 to about 1 million.
He said all of the health sharing ministries are a little different in terms of their religious requirements, but as a group they’re overwhelmingly Christian. “There’s a guy down in Florida who’s interested in opening a Jewish one but I don’t think he’s made much progress so far,” Weldon said.
Drummond said about 500 families within 50 miles of Kansas City now belong to his health-sharing group, Samaritan Ministries. Drummond and his wife joined Samaritan in 2012, a couple years before the ACA went into effect. They were both in their mid-50s at the time and Drummond had just left Cerner – and its employee health insurance plan – to start his own business.
Drummond attends Antioch Bible Baptist Church in Gladstone. He said he heard about Samaritan through a friend in Peoria, Ill., where the organization is headquartered. He said he decided to try it for both religious and financial reasons.
It’s not for everyone, Drummond said. Members must agree to abstain from tobacco and illegal drugs of all forms and to limit alcohol to “moderate amounts so as to never drink to drunkenness,” abstain from sex outside marriage, profess belief that Jesus Christ is God, attend church at least three times a month and have a pastor or other church leader sign a statement every year confirming they’ve met those requirements.
Drummond said that most of the health sharing ministries he knows won’t cover things like birth control or in-vitro fertilization, for religious reasons. Drummond, who has been on Samaritan’s board of directors since 2015, said he and his wife pledge about $220 per month to maintain their memberships.
There’s no deductible, but unlike traditional insurance, their plan doesn’t cover routine care or prescription drugs. So they also have memberships to direct primary care practices, which costs an additional $50 a month each. And Samaritan only pays out a maximum of $250,000 per injury or illness, so they also have bought into a reinsurance-type plan to cover them for anything catastrophic that might top that.
Unlike ACA insurance plans, the health sharing ministries are also allowed to increase their monthly dues for people who have preexisting conditions like diabetes.
Sheldon Weisgrau, the director of the Health Reform Resource Project for the Kansas Association for the Medically Underserved, said that creates the potential to further destabilize the ACA individual market. People could use a health sharing ministry, and avoid paying insurance premiums, until they develop an expensive medical condition and then jump into the ACA market, where insurers aren’t allowed to charge them more to cover that condition.
“It’s certainly plausible if you’re in one of these (ministries) and it doesn’t cover something like, for example, mental health, then you’re going to turn to the marketplace for that,” Weisgrau said.
With about 10 million or 11 million people purchasing insurance through the ACA exchanges, Weisgrau said 1 million people opting out in favor of health sharing ministries is a large enough number to affect the marketplace, depending on how they’re distributed in each state.
Drummond said joining Samaritan has made him a more diligent shopper when it comes to health care, in order to keep costs down for all the members.
When he needed the hernia surgery one hospital quoted him a price of more than $30,000, but he’s found other hospitals and outpatient surgical centers that will offer steep discounts for patients able to pay cash.
Drummond had the procedure done for about $5,000. He said having that kind of choice, without worrying about insurance networks, is appealing for him. So is receiving the personal notes from other members wishing him well. He’s staying with Samaritan, even though he’s now back with a company that offers health insurance.
“I really can’t see any downsides to it,” Drummond said.