Tuesday, February 19, 2019

Major Growth Continues in Health Care Sharing

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. Back in December of 2016, I wrote an article entitled An Overview: Health Care Sharing's Tremendous Growth, detailing the surge in participation in health care sharing after the passage and implementation of ObamaCare.

Over the two months, I've gathered the latest 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.

Health Care Sharing - Background

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. Participants commit to a set payment 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 were exempted from the insurance mandate in ObamaCare and thus paid no penalty or tax during the time it was in effect. 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 (some 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. Most HCSMs have limitations on pre-existing conditions, but some have more flexibility on them than others.

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 the Alliance of Health Care Sharing Ministries, HHS lists 104 known and active health care sharing ministries, 97 of which are Mennonite/Old German Baptist churches or associations with closed membership. Most have 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 recent increase in participation.

The Nationwide Ministries

We'll now examine the membership stats and brief cost explanations for each of the nationally-available HCSMs, going from largest to smallest.

As of December 2018, there were about 411,600 individuals participating in Medi-Share; in December 2016, there were 212,400 members. There are currently about 6,800 members in Oklahoma, up from 3,170 in December 2016.

Monthly membership costs with Medi-Share are quite a bit more complicated than with the other HCSMs, more like typical health insurance. It depends on age, health, and varying initial unshareable costs ranging from $1,000 to $10,500. It looks like it ranges from a low of about $44 (single aged 18, healthy, $10,500 personally responsible before sharing) to a high of about $1,246 (head of household aged 64, 3+ member family, $1,750 pre-sharing).

Medi-Share has no per-incident or lifetime cost limits.

Christian Healthcare Ministries was not particularly helpful in responding to my inquiry, and was especially reticent when it came to membership figures, saying "here is our policy on discussing numbers: we don’t" -- although a blog post on their site last month said they have "are serving nearly 400,000 Christians". In December 2016, they had somewhere between 150,000 and 200,000 members. They had "over 3,000 members" in Oklahoma in 2016, and would not indicate current levels, but judging from growth rates they likely have around or more than 5,000 Oklahoma members.

Monthly membership costs run from a low of $45 (one individual on 'Bronze' program) to a high of $450 (family of three or larger on the 'Gold' program). CHM's initial unshareable Personal Responsibility cost is $500 per incident for their 'Gold' level, to $5,000 per incident on 'Bronze'. All three levels share up to $125,000 per incident.

CHM also offers Brother's Keeper, an additional giving program that raises the per-incident cap to unlimited for Gold members, and adds $100,000 per year to the Silver/Bronze $125,000 per-incident cap up to a maximum of $1,000,000 (in year 10).

As of December 2018, Samaritan Ministries had about 264,000 individuals participating; in November 2016, there were 209,650 members. There are currently about 4,500 members in Oklahoma, up from 3,425 in November 2016.

Monthly membership costs run from a low of $100 (single individual under age 30 on Basic, the lower membership level) to a high of $495 (family of 3+ individuals on Classic, the upper membership level). Samaritan's Classic membership level has a $300 initial unshareable cost (pre-discount) and a per-incident cap of $250,000, while their Basic membership level has a $1,500 unshareable cost (pre-discount) and has a $236,500 per-incident cap.

Samaritan also offers Save To Share, an additional giving program that raises the per-incident cap to unlimited. Members of Save To Share set aside between $133 (single individual) and $399 (3+ family) each year for use if needed by other Save To Share members.

As I've mentioned before, my wife and I have been members of Samaritan Ministries since shortly after getting married in 2012.

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 December 2018, they had a combined total of 236,000 members; in November 2016, there were about 90,000 individuals participating. They have about 3,000 members in Oklahoma, up from 1,000 members in late 2016.

Monthly membership costs run from a low of $199 (single individual under age 30 on Liberty Share, their lowest level) to a high of $529 (head of household aged 30+, 3+ member family on Liberty Complete, their highest level). Their initial unshareable cost ranges from $1,00 for an individual to $2,250 for a family. Per-incident caps range from $1,000,000 on their highest level to 70% of eligible medical bills up to $125,000 on their lowest level.

Currently, Altrua HealthShare said they have about 20,000 individuals participating; in December 2016 there were about 25,000 members. 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, which was the same figure I was given in 2016. Altrua seems to be the only nationwide HCSM that has not grown.

Monthly membership costs run from a low of $100 (single individual on 'Copper' program) to a high of $874 (family of 3+ members on 'Gold' program). Their initial unshareable costs are a bit complicated, but range from $500 to $7,500 on the first submitted need, and $2,500 to $5,000 on the second need.

Altrua has lifetime sharing limits of $1,000,000 to $2,000,000, with annual caps of $150,000 to $250,000 for their lowest two levels.

Growth continues significant upward trajectory

Following up from my 2016 survey of the state of Health Care Sharing Ministries, we see continued and significant growth among the nationally-available groups. They have all benefited significantly from the turmoil of ObamaCare and the individual mandate exemption available for HCSM members.

There are now over 1,300,000 individuals participating in health care sharing in these six ministries (not counting the smaller localized Amish/Mennonite groups), almost double the 712,000 in late 2016, and 13-times larger than the 100,000 members in 2008.

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
The upward trend in HCSM membership began in 2010, picked up speed through 2014, and rocketed skyward from 2014 to 2016. Major growth has continued since then, albeit at a slightly lower pace. The years with asterisks are dates that I have been able to find few official figures from, and are primarily filled in by the general trends (the other years are actual statistical numbers from the ministries).

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

There has been an increase of about 1,200% since 2008, and membership in these six HCSMs has nearly doubled in just the last two years.

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. Taking these additional ministries into account, there are likely near 1,500,000 Americans participating in health care sharing organizations across the nation.

Approximately 18,000 to 20,000 Oklahomans are members of one of the six health care sharing ministries I surveyed, up from around 11,000 in 2016.

Q&A on HCSM challenges and legislation

When I reached out to the different ministries, I asked them two questions dealing with challenges facing health care sharing ministries, and legislative action that could help members of HCSMs. Here are their responses.

Q: What do you perceive to be the greatest challenges facing HCSM growth?

Samaritan Ministries:
The biggest challenge has always been the cultural mindset it takes to switch from insurance. Samaritan Ministries is not insurance and society has an insurance mindset. Making the move from insurance to Samaritan takes a shift in thinking. We take great pains to make sure inquirers understand that Samaritan is not insurance, so that also naturally dampens rapid growth. Also, growth has slowed because there are more options for Americans because of regulatory changes to short-term plans, associations plans, and the economy improved leading to more employment and employer-provided insurance.
Liberty Healthshare:
The greatest challenges facing HCSM growth are a lack of awareness of this option, and the need to build the capacity to better serve larger numbers of members. We were the first to begin using TV to market the health sharing option, and we are intensely focused on growing our capacity to process and pay bills in two months and to answer all member calls, as well as making it easier for members to interact with us and stay informed about how their costs are being shared online. We are also assessing additional options to make health sharing more holistic and customizable.
While there are bound to be changes in healthcare reform and the healthcare market will continue to evolve, our members will continue to faithfully pray for one another and share in one another’s healthcare burdens, just as they have for the past 25 years.
Christian Healthcare Ministries:
One of the biggest, if not THE, biggest enemies we have is the insurance industry and the insurance regulators thinking we are getting too big. They both are determined to shut us down because some of us have been bragging and seemingly gloating about how fast we are growing and how big we are. This is not just a problem, it is the biggest threat to our existence that currently exists.

Q: Are there specific legislative measures that you would like to see passed on the topic of Health Care Sharing Ministries? What are you doing to help push that along?

Samaritan Ministries:
In the states, we would like to have clarification in their insurance codes that health care sharing is not insurance. That clarification is already in 30 states and we look for opportunities to expand that in the future where possible. Also, tax parity on the state and federal level to allow members to deduct their shares on their income taxes. Additionally, access for members of health care sharing ministries to Health Saving Accounts (HSAs). Congressman Mike Kelly (R-PA) and Collin Peterson (D-MN) previously introduced bipartisan legislation, H.R. 2310, which would amend the IRS code to allow health care sharing members to utilize HSAs. We trust that the legislation will once again be introduced in the next session of Congress.
Liberty Healthshare:
The Trump administration is revising the rules for HRAs. We’ve advised HHS and other agencies of the federal government that inclusion of HCSMs as a viable alternative for employers offering HRAs to their employees honors the free exercise of religion, as well as accommodating religious conscience. Under the Religious Freedom Restoration Act, agencies of the federal government have broad discretion to include people of faith in their rule making. Integrating HRAs with HCSMs would accomplish an accommodation of religious practice in healthcare.

Further, some states (i.e. VT) are considering instituting their own insurance individual mandate. We have testified before state committees and advised the state agencies to include an exemption for HCSMs, following the federal model in the ACA.
We recently hired a Government Affairs & Policy Representative who is monitoring healthcare legislation and regulation at the Federal and State levels to ensure that our members’ needs are represented.
Christian Healthcare Ministries:
We are not pursuing legislative initiatives. That doesn’t mean we won’t act to protect our members to preserve their ability to exercise this freedom of religious faith or if we feel action is in their interest.
Sharing Works!

Health care sharing is a mature health insurance alternative that has been proven viable by decades of use and billions of dollars worth of medical bills shared. In this era of constant changes in health care and health insurance, it's an exciting option for Christians to consider. Tens of millions of dollars worth of medical needs are shared each and every month by one-and-a-half 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 friends or relatives who are members of Christian Healthcare Ministries, Medi-Share, and Liberty HealthShare, and have heard positive things about each ministry. Sharing works! 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:

Alliance of Health Care Sharing Ministries: Samaritan Ministries, Medi-Share and CHM are members of this public policy organization to advocate and provide information about health care sharing to government officials and the general public.

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: three different medical needs in six years, about $102,000 in medical bills were shared in full by over 110 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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