Friday, December 09, 2016

An Overview: Health Care Sharing's Tremendous Growth


For those of you who are long-time readers, I've written quite a bit in the past about health-care sharing and our experience as a family with this different method of dealing with health-related expenses. With constant changes in the health care field, I thought I'd take some time to explore some of the growth this concept has had in the past eight years.

Over the last few weeks, I've gathered information from the six nationally-available health care sharing ministries, but before I share the statistics let me explain what exactly "health care sharing" is, for those who are unfamiliar with the term.

An Introduction to Health Care Sharing

Health care sharing is based on a Biblical principle found throughout the Scripture (see Acts 2:44-45), with Galatians 6:2 being a key verse: "Bear ye one another's burdens, and so fulfil the law of Christ." Applying this principle to health care means Christians banding together to share each other's medical costs.

While there are some minor differences among the major health care sharing ministries, the basic system is the same. Members usually affirm a statement of faith and agree to live a lifestyle that fits certain moral guidelines (including but not limited to: no sexual activity outside of Biblical marriage, restrictions on tobacco and alcohol, and usually a minimum church attendance or involvement level). Members commit to a set amount each month, which is sent to fellow members who have submitted their medical bills to the ministry, which assigns those medical needs to specific members each month.

Health Care Sharing Ministries (HCSMs) "are operated by not-for-profit religious organizations acting as a clearinghouse for those who have medical expenses and those who desire to share the burden of those medical expenses." They are not insurance, but HCSMs and their members are exempt from the insurance mandate in ObamaCare and pay no penalty or tax. HCSMs are legal and operate in all 50 states, U.S. territories, and even have international members (such as missionaries).

HCSM members are considered cash or self-pay patients, and can generally use any physician or hospital that will accept cash/self-pay patients (one or two of the ministries use networks for extra savings, but they're not required). Most of the ministries also work with third-party groups to negotiate deep discounts on larger bills.

Health care sharing in a modern sense traces back to the Amish and Mennonites in the 1960's, but in the 1980's and 1990's several new non-denominational (generally evangelical Protestant) groups started which accepted membership nationwide regardless of church affiliation, provided they agreed to the statement of faith and guidelines (as mentioned previously).

According to a 2014 article by Politico's Brett Norman says "53 health-sharing groups have been certified by CMS (Centers for Medicare and Medicaid Services) as qualifying for the individual mandate exemption. Many are small churches with fewer than 100 members."

There are currently six main, nationally-available HCSMs. Christian Healthcare Ministries began in 1981. In 1993, Christian Care Ministry started Medi-Share. Samaritan Ministries started sharing in 1994. Altrua HealthShare (2000, 1997 through merger), Solidarity HealthShare (2012, 1990s through affiliation), and Liberty HealthShare (2013, 1995 through affiliation) started sharing more recently, but are affiliated with older groups in order to qualify under the ObamaCare restrictions on HCSMs (continual existence since before 2000 is one rule).

According to a paper published by the Charlotte Lozier Institute last December, there were just over 100,000 participants in HCSMs in 2005. Growth since that time has been exponential, particularly since ObamaCare began to be implemented. I reached out to the six aforementioned ministries and obtained some statistical information to share about their growth.


The Nation-wide Ministries

Christian Care Ministry - Medi-Share

As of November 2016, there were about 212,400 individuals participating in Medi-Share; in December 2008, there were 37,900, for an eight-year increase of about 460%. There are currently about 3,170 members in Oklahoma.

Monthly membership with Medi-Share is a little more complicated, a little more like traditional insurance. It depends on age, health, and varying pre-sharing levels ranging from $500 to $10,000. It looks like it ranges from $36 (17, healthy, $10,000 personally responsible before sharing) to between $1,060 and $1,925 (head of household older than 65, family, $1,250 pre-sharing). Medi-Share is not available in Montana.

Samaritan Ministries International

As of November 2016, Samaritan Ministries had 209,650 individuals participating; in December 2008, that number was about 40,500, for an eight-year increase of about 418%. There are 3,425 members in Oklahoma.

Monthly membership runs from $180 (single individual under 26, young adult discount) to $495 (for a family of three or larger). Samaritan's pre-sharing level is $300 per submitted need, with a pre-sharing limit on the first three needs (none of additional needs), for a max of $900.

Christian Healthcare Ministries

Christian Healthcare Ministries was not particularly helpful in responding to my questions, only confirming that they have "well over 150,000 actively participating members", likely between 175,000 and 200,000 nationally. In December 2008, they probably had around 18,000 members, for an eight-year increase of about 872%. They have "over 3,000 members" in Oklahoma.

Monthly membership runs from $45 (one individual on 'Bronze' program) to $450 (family of three or larger on the 'Gold' program). CHM's pre-sharing level is $500 per unit per year for their 'Gold' level, to $5,000 per incident on 'Bronze'.

Liberty HealthShare and Solidarity HealthShare (National Coalition of Health Care Sharing Ministries)

Liberty and Solidarity are affiliated organizations, with Liberty being the larger of the two. Solidarity is exclusively for practicing Catholics. The two groups comprise the "National Coalition of Health Care Sharing Ministries", which administers Solidarity and helps with their operations, utilizing Liberty's wider experience. As of November 2016, the two groups totaled over 90,000 individuals participating; in December 2008, their parent groups had about 3,000 members, for an eight-year increase of about 2900%. Approximately 1,000 members are in Oklahoma.

Monthly membership runs from $107 (single individual under age 30 on lowest program) to $499 (senior adult couple on 'Complete' program). Liberty and Solidarity have the same prices and programs. Their pre-sharing level ranges from $500 for an individual to $1,500 for a family.

Altrua HealthShare

Currently, Altrua HealthShare has about 25,000 individuals participating; in 2008, that figure was about 1,500, for an eight-year increase of about 1567%. Altrua originally began as a Mormon-oriented HCSM in 2000, but changed structure and leadership in 2005 to became non-denominational in reach. They currently have about 300 members in Oklahoma.

Monthly membership runs from $10 (single individual under 40 on 'Bronze' program) to $780 (family on 'Gold Standard' program; add $50 on any program for the 6th and following family members). Their pre-sharing level is from $500 per person ("Gold Standard" program) to $4,000 ("Bronze" program) per year.


Tremendous Growth since 2008

When combining figures I've collected online and through direct requests, we see that for a period of several years (at least 2005-2010), there were between 100,000 and 120,000 members of health care sharing ministries nationwide. However, once the Affordable Care Act began to be implemented in 2012 and 2013, HCSM growth exploded like a rocket. There are now over 712,000 individuals participating in health care sharing across the country, a growth of over 600% since 2008.

I used 2008 as the starting point of this overview for several reasons: 1) The election of Barack Obama started a period of new health care policy under a new presidential administration. 2) Obama made his health care plan a key part of his first campaign, and when he won plans began immediately to make a complete change to the American health care system. 3) Those changes began disrupting a fairly settled, existing system (one that need some reforms, albeit of a completely different bent), forcing people to explore other options, and particularly bringing attention to the previously little-known concept of health care sharing.

Here's a chart I put together with the membership information I've gathered from the previously-discussed ministries:

CCM = Medi-Share, SMI = Samaritan Min., CHM = Christian Healthcare Min., Lib/Sol = Liberty+Solidarity

As you can see, beginning in 2013, the figures simply take off. The years with asterisks ('09, '11, '12, '14) were dates I had few official figures from, and are based on the general trends. Otherwise, I was able to directly obtain figures from the various ministries or else glean them from news reports and documents online.

The "big three" (Medi-Share, Samaritan, Christian Healthcare Ministries) all had a modest amount of members to begin with, while Liberty/Solidarity and Altrua didn't really start enrolling until 2013 and 2015.

Here's the chart for the combined figures from these six nationally-available HCSMs:



There's been an increase of over 600% since 2008, and membership in these six HCSMs has doubled in just the last eighteen months.

Not included in these figures are members of the several dozen other organizations who have no online presence, predominately small, localized churches and ministries in the Amish and Mennonite communities. I've reached out to the Centers for Medicare and Medicaid Services (which certifies HCSMs) for more information, which I hope to receive soon, but we all know how slow the wheels of government can move. Taking these additional ministries into account, there could be as many as 750,000 Americans participating in health care sharing organizations across the nation.

Oklahoma has a 25% higher participation rate than the nation at large, with a total of around 11,000 Oklahomans being members of different HCSMs.


Expectations with the Trump Administration

When I reached out to the different ministries, I asked them what they hoped or expected to see regarding HCSMs in the upcoming Trump administration. Here are a few of their comments.

Samaritan Ministries:
Joel Noble, Public Policy Department: We are optimistic about the upcoming political climate. We will plan on passing legislation to amend the tax code so health care sharing membership qualifies for a health savings account (HAS). We will also seek to clarify existing tax law to permit taxpayers to deduct health care sharing amounts and any fees. Additionally, we are positioned well to be involved in whatever repeal/replace looks like for the ACA as it would relate to health care sharing, if and when that happens.
Medi-Share:
Any changes to the Affordable Care Act will take some time to implement, and we’ll keep our members well-informed of any potential impact to them. In the meantime, our members will continue to faithfully share in one another’s healthcare burdens as they have since 1993.
Christian Healthcare Ministries:
We trust our future, regardless of administration, will be the same as our past, which is that we will be able to fulfill our purpose of glorifying God and serving His people. That’s all we do and want to do.
Liberty HealthShare/Solidarity HealthShare:
We are expecting continued recognition of healthcare sharing as a means of sharing medical costs, a method chosen by people wishing to live their faith by sharing in each others’ time of needs.
Altrua HealthShare:
Randall Sluder, Executive Director: "There's nothing negative that I see coming [regarding health care sharing] from the Trump administration."

Conclusion

Health care sharing has been around for quite some time, and is poised to continue rapid growth in this era of constant changes in health care and health insurance. For Christians, it's an exciting non-insurance method that deserves consideration. Tens of millions of dollars worth of medical needs are shared each and every month by three-quarters of a million individuals across the country, testifying to the fact that this really does work.

My wife and I are members of Samaritan Ministries, and it works for us. I have a relative who is in Christian Healthcare Ministries, and it works for them. I go to church with a Medi-Share member, and it works for them. I have a carpet cleaning customer who is a member of Liberty HealthShare, and it works for them. You might not be aware of it, but you probably know members of health care sharing ministries yourself! Regardless of the ministry, these are all good options that should be looked into.


More Information and Links

If you are interested in more information about health care sharing, or the specific ministries I've mentioned in this article, feel free to utilize these links, or contact me via email.

Nationally-available health care sharing ministries (alphabetical order so nobody gets upset 😉):

Alliance of Health Care Sharing Ministries: Samaritan Ministries and Medi-Share have formed this public policy organization to advocate and provide information about health care sharing to government officials and the general public. They have a handy page detailing the legal status of health care sharing in all 50 states, viewed here.

Health Care Sharing Ministries: An Uncommon Bond, published by the Charlotte Lozier Institute, is an informative 35-page report on HCSMs and the savings experienced by members.

My personal experience with Samaritan Ministries: two different medical needs in four years, about $50,000 in medical bills were shared in full by over 70 families across the country. If you look into Samaritan and decide to join, I'd appreciate being listed as your referral (we get a credit), if you've found my information helpful. The other ministries also give referral credits, so if you decide to join a different ministry, I may know someone you could list in that ministry as well.

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