The Rise and Scrutiny of Health Care Sharing Ministries in the US
Table of Contents
The number of Americans turning to health care sharing ministries (HCSMs) has exploded in recent years, rising from under 200,000 in 2010 to an estimated 1.5 million today. [[3]] This surge, partly attributed to the Affordable Care Act (ACA), has brought increased attention – and concern – to these faith-based alternatives to traditional health insurance.
HCSMs operate on a principle of shared responsibility, where members contribute to a pool of funds used to assist fellow members with medical expenses. While offering possibly lower costs, they lack the complete coverage and consumer protections of traditional insurance plans. This difference is a key point of contention.
The growth of HCSMs has not gone unnoticed.A Government Accountability Office (GAO) study highlighted potential problems for consumers, including the use of paid sales representatives and high administrative costs – with one ministry allocating up to 40% of funds to administration. [[2]] This raises questions about the efficiency and clarity of these organizations.
Concerns extend beyond financial practices. Some states have already taken action. Colorado implemented new reporting regulations, and a Florida hospital sued a ministry for non-payment, illustrating the growing friction between HCSMs and the established healthcare system. [[3]]
Balancing Choice and Consumer Protection
While some, like former CDC director nominee Dr. Robert R. Redfield, see HCSMs as offering valuable choice and adaptability, he also acknowledged past concerns. “I tried to promote getting all of those ministries together to develop rigorous self-policing standards,” he stated, adding, “They all sort of marched to their own drummer, and I repeatedly reminded them that if they didn’t really clean their act up, that they were going to be regulated by 50 different [state] governments.”
this sentiment reflects a broader tension. Advocates highlight the ministries’ ability to provide affordable healthcare options, particularly for those who find traditional insurance unaffordable. However, critics point to the potential for delayed or denied payments, lack of transparency, and the risk of leaving consumers vulnerable to meaningful medical debt.
The American Hospital Association has voiced concerns to the Consumer Financial Protection Bureau, and over a dozen state insurance departments have issued consumer alerts regarding HCSMs. Furthermore, legal actions against some ministries, alleging misrepresentation of plans, underscore the regulatory challenges.
At the federal level,legislation aimed at increasing transparency through mandatory financial disclosures has been introduced but stalled. This legislative inaction highlights the ongoing debate surrounding the appropriate level of government oversight for HCSMs.
One ministry, Liberty HealthShare, addressed past criticisms regarding delayed bill processing.”We regret that the processing of these members’ bills was delayed, but in an organization that receives hundreds of thousands of bills annually, processing errors may occur despite our best efforts,” said Timothy Bryan, vice president of marketing and communications. He added, “We note these situations occurred over five years ago and Liberty has considerably improved its processes over this time period.” The ministry also noted a 2021 settlement with the Ohio attorney general, though it did not admit wrongdoing. A separate lawsuit alleging refusal to pay for covered procedures and accusations of “massive profits” remains ongoing.
The future of HCSMs in the US remains uncertain. The balancing act between promoting consumer choice and ensuring adequate protection continues to be a significant challenge for policymakers and regulators.
Rise of Health Care Sharing Ministries:
Navigating Choice and Consumer Protection
Health care sharing ministries (HCSMs) are rapidly gaining traction, offering a faith-based alternative to conventional health insurance. With membership surpassing 1.5 million Americans, these organizations are coming under increasing scrutiny, prompting discussions about their benefits, potential risks, and the need for regulation.
World Today News Senior Editor Interviews Dr. Elizabeth Stone,Health Policy Expert
Dr. Elizabeth Stone, a renowned health policy expert and author of “Navigating the Healthcare Maze,” joins us to shed light on the rise of HCSMs and the complex issues surrounding their operation.
The Growing Popularity of HCSMs
World Today News: Dr. Stone, can you explain the recent surge in popularity of HCSMs?
Dr. Stone: certainly.Several factors contribute to this trend. The Affordable Care Act, while expanding coverage, also led to rising premiums for some individuals. HCSMs, with their possibly lower costs and emphasis on shared responsibility, appealed to those seeking more affordable options, especially those whose religious beliefs align with their principles.
Understanding the HCSM model
World Today News: How do HCSMs function differently from traditional health insurance?
Dr. Stone: HCSMs operate on a principle of shared responsibility. instead of paying premiums to an insurance company, members make monthly contributions to a shared pool of funds. When a member incurs eligible medical expenses, thay draw from this pool. It’s crucial to emphasize that HCSMs are not regulated in the same way as insurance companies, and they may not cover all medical
expenses or pre-existing conditions.
Concerns regarding HCSM Practices
World Today News: Critics have raised concerns about transparency and financial practices within some HCSMs. What are your thoughts on these allegations?
Dr. Stone: These concerns are valid and warrant serious consideration. The GAO report highlighted issues such as high administrative costs and the use of paid sales representatives, wich raise questions about the efficiency and financial sustainability of some HCSMs. The lack of standardized reporting requirements also makes it difficult to independently assess the financial health and performance of these organizations.
Calls for Regulation and Goverment Oversight
World Today News:
What measures are being taken to address these concerns and protect consumers who choose HCSMs?
Dr. Stone: We are seeing a growing movement towards greater scrutiny and potential regulation of HCSMs.Some states have implemented reporting requirements, while others, like Florida, have taken legal action against HCSMs for non-payment of medical bills.
At the federal level, there are proposals for increased transparency through mandatory financial disclosures, which would allow consumers to make more informed decisions. Though, the debate over the appropriate level of government oversight for HCSMs is ongoing.
Looking Ahead: Balancing Choice and Consumer Protection
World Today news:
What do you see as the future of HCSMs in the US healthcare landscape?
Dr. Stone:
The future of HCSMs remains uncertain.Balancing consumer choice with the need for robust consumer protection will be critical. It is essential to ensure that individuals who choose HCSMs are fully aware of the potential risks and limitations, while also respecting their right to explore alternative healthcare options aligned with their values.
