The Biggest Threat to Health Care’s Brightest Hope
After decades in the relative obscurity of small religious communities, health care sharing ministries have become practically conventional, and a much-needed, low-cost alternative to traditional health insurance. The distinction is that these organizations function through the pooled resources of members based on a shared belief in the biblical principle of bearing one another’s burdens.
Health sharing ministries’ popularity erupted after passage of the Affordable Care Act (ACA), which classified several of them as exempt from the ACA’s Individual Mandate. By doing so, the federal government validated these organizations as adequate forms of medical coverage. The individual mandate’s repeal further opened the health sharing market. Many new organizations sprouted up and membership skyrocketed from 100,000 in 2010 to one million by 2018.
Unfortunately, health care sharing’s mainstream breakout could be its downfall.
Though many were well-intended, bad actors also became attracted to this new market and began to undermine the credibility of honest health sharing organizations. This led to health sharing’s two greatest threats: misunderstanding and fraud.
Misunderstanding is common in all forms of healthcare coverage. The industry’s unnecessary labyrinthine reimbursement procedures frequently catch patients unaware of their coverage parameters, causing unexpected bills—and great frustration, if not despair.
Despite recent vocal reports of coverage gaps, however, health sharing ministries are actually custom-built to cut through much of the coverage confusion inherent in the complex and byzantine coding and billing systems of American health care.
Traditional health insurance companies use documents known as Medical Policies to explain what they won’t cover. Each insurance company has its own unique and changing medical policies— United Health, for one, has a whopping 259 medical policies regarding coverage. These policies may also be inconsistently applied and based on the insurance companies’ determination of medical necessity regardless of the health care provider’s justification.
And these medical policies can be in addition to the prohibitive prior authorization programs of these same insurers. Insurance companies’ payment refusals receive far less publicity than health sharing shortfalls, but they’re so common among Big Insurance that most medical offices require patients signatures acknowledging they will pay for everything insurers will not.
Health Sharing Ministries have similar criteria, but they’re less restrictive and easier to understand. Their religious underpinning and discretion in covering pre-existing conditions sets them apart from traditional insurance. To be sure, prospective members need to be aware of these differences to ensure a satisfactory experience with health sharing. Membership requirements are clearly listed—not using illegal drugs or smoking, for example. So are coverage exclusions; a heath share member who contracts a sexually transmitted disease through an extramarital affair would not be covered by most groups and should not expect such coverage.
Thus, some media coverage of patient complaints about health sharing are falsely placed as they really indicate a patient’s misunderstanding of health sharing not substantive coverage deficiencies.
Fraud is another huge threat. Since the Individual Mandate was removed in 2017, a veritable explosion of start-up health sharing organizations entered the market. While most were well-intended and many are successful, some simply didn’t attain a critical membership mass large enough to absorb catastrophic medical expenses and others were flat out fraudulent.
As with any new or burgeoning industry, health sharing has some growing pains. But health sharing must be preserved. For the patient empowerment, the efficient, streamlined processes, and the financial benefits over traditional health insurance coverage which are nothing less than staggering. My family received better care and saved $86,000 over five years when Healthsharing was combined with the more cost-effective care provided by Direct Primary Care.
The health sharing ministries must continue to look within themselves to help protect members from the biggest threats that they face: fraud and misunderstanding. The health sharing industry, for its part, has responded to the need for further patient protection with the creation of a new, voluntary credentialing organization. Further, accountability for issues that have arisen from bad actors already exist in criminal and contract law. New regulations are not needed but authorities must better police claims of fraud to this ferret out.
It’s up to the rest of us to allow neither a few bad seeds nor misunderstanding to derail greater choice—and autonomy—in caring for ourselves, our families, and each other.
Dr. Chad Savage is the founder of YourChoice Direct Care in Brighton, Michigan and is a healthcare policy fellow for the Docs4Patient Care Foundation.
