Hannah Metzger, Colorado Politics
Health care sharing ministries have surged in popularity in recent years, with supporters describing them as cheaper alternatives to insurance and opponents calling them misleading scams.
Now, the Colorado legislature is tackling the issue.
Introduced last month, House Bill 1269 would require non-insurance entities that cover health care costs to submit annual reports to the state, including how much money members pay versus how much in medical bills the entities cover.
“What we’re trying to do is get a better picture of how these programs are operating in our state,” said Adam Fox, deputy director of the Colorado Consumer Health Initiative, which helped to draft the bill. “There are many consumers who play hundreds of dollars a month into these programs and yet there’s no guarantee that any of their medical costs will be covered by these entities.”
“When it leaves somebody exposed to massive medical debt, that’s a significant concern for us,” Fox added.
Health care sharing ministries, also called faith-based health care, are nonprofit organizations that share health care costs among a group of people. The members — who are usually part of the same church or religion — pay monthly dues to the ministry, and, when one of the members receives a medical bill, the ministry can use the collected money to cover the costs.
Health care sharing ministries are not insurance and do not guarantee payment for medical claims. The ministries say they can reject bills for any number of reasons, including moral objections to medical issues resulting from premarital sex, smoking, alcohol use or obesity. They are also not required to cover essential care and can deny coverage based on pre-existing conditions or religious beliefs.
The ministries say that they’re a less expensive, belief-driven and community-orientated way to address medical expenses, comparing themselves to credit unions.
Opponents to health care sharing ministries say the issue is that many members are unaware that the entities don’t have to cover their medical bills until it is too late. Angelique Espinoza, policy director of Good Business Colorado, said businesses often fall victim to this misunderstanding.
“In some cases, a health care sharing plan may suit someone’s needs. Many consumers, however, including small business employers, believe they are getting health insurance for themselves and their employees at a low cost,” Espinoza said. “If something happens and the sharing plan is unwilling or unable to pay, they or their employees find themselves uninsured and facing huge medical bills.”
Fox said the state doesn’t know how many health care sharing ministries are in Colorado or how they operate, including how much of their members’ money actually goes towards paying medical expenses. The proposed bill, he said, would provide information to determine if the state needs to take further action.
Health care sharing ministries have existed in the U.S. for decades. When the Affordable Care Act passed in 2010, it grandfathered the entities in, exempting uninsured people from paying tax penalties if they are part of health care sharing ministries.
This, as well as rising unemployment during the COVID-19 pandemic resulting in many people losing employer-provided insurance, has resulted in a boom in membership. In 2010, less than 200,000 people were part of health care sharing ministries. Today, around 1.5 million people are members, according to the Alliance of Health Care Sharing Ministries. In Colorado, between 50,000 and 60,000 people use health care sharing ministries, the Colorado Consumer Health Initiative estimates.
Some supporters of the sharing ministries argue that the proposed bill “overrides the religious exercise” of the faith communities that use health care sharing.
“This bill potentially subjects these communities to unfair and unwarranted bureaucratic examination, surpassing the scrutiny applied to health insurers, and tramples the First Amendment rights of every Coloradan,” said Katy Talento, executive director of the Alliance of Health Care Sharing Ministries. “(It is) a grant of unlimited power to the Division of Insurance over religious ministries.”
Evelio Silvera, spokesperson for Christian Care Ministry that operates Medi-Share, said the bill would “make our ministry’s ability to serve our members unnecessarily difficult” and “fail to prohibit or deter deceptive or abusive misconduct from bad actors that are not legitimate health care sharing ministries.”
Under the proposed bill, health care sharing ministries would have to report to the Division of Insurance the number and location of all members, how much money is collected from members and how much money is used to cover medical expenses, among other requirements. If they don’t comply, the ministries could be served with an emergency cease and desist order from the Division of Insurance.
Rep. Susan Lontine, the bill’s sponsor, said she was inspired to take action after she heard about the lawsuit filed against Trinity Healthshare, with members claiming the health care sharing ministry refused to cover bills from routine checkups to life-saving surgeries.
“They were using this model to basically rip people off,” Lontine, D-Denver, said. “They were taking people’s money and keeping a huge portion for administrative costs and only using a small portion to pay any medical bills, if any.”
Lontine introduced a similar bill on health care sharing ministries in 2020, but it died when the COVID-19 pandemic hit and caused the legislature to shift priorities. She tried again in 2021, but killed the bill when she learned it would have prevented a lawsuit against one of the entities from going forward.
Lontine said she doesn’t think all health care sharing ministries are bad, but she wants to protect Coloradans from the ones that are. She said, in addition to individual members being misled to think their medical bills will be paid, leaving bills unpaid results in higher health care prices for everyone.
“It’s not fair to the patients, it’s not fair to the providers, it’s not fair to the facilities to have to cover that burden,” Lontine said. “Consumers often don’t understand the risk that they’re taking. We just are trying to ensure that people understand, if they’re buying these products, that they realize they’re not insurance and what it means for them.”
HB-1269 is not the only bill regarding health care sharing ministries this session. Republican-backed House Bill 1198 would require the ministries to make it clear they’re not insurance by providing a public notice that they might not cover some medical expenses and that members are responsible for their own bills. The ministries would also have to get written acknowledgement from members. This bill is supported by the Alliance of Health Care Sharing Ministries.
HB-1269 and HB-1198 are both scheduled to be voted on by the House Health & Insurance Committee on March 23.