PARTNER PERSPECTIVE

States Must Regulate Health Care Sharing Ministries

Sarah Levin
Founder/Principal, Secular Strategies; Consultant, Center for Freethought Equality

Across the country, religiously affiliated nonprofit organizations are selling junk health insurance to consumers who often think they’re purchasing traditional health insurance. They’re called Health Care Sharing Ministries (HCSMs).

HCSMs offer to “share” health care costs among their membership. In the fine print, you’ll find language that makes it quite clear that an HCSM is not health insurance, can deny payment to a member for any reason, and is not legally obligated to pay a dime to any of its customers.

You might be wondering how much they do pay out to their customers. That’s a great question we would love to have the answer to.

But because HCSMs are not health insurance and are generally not regulated as such, they are not required to report information like this to state authorities. Legitimate health insurance companies are highly regulated and are required to report quite a bit of information to the government. We have no idea how much HCSMS are paying out to patients and providers and how much they’re pocketing.

While HCSMs have been operating for quite some time, they are now marketing themselves beyond the insular religious communities they initially served.

Without a significant government subsidy, you will not find real health insurance plans at the prices HCSMs are offering, making their scam all the more appealing. Consumers can easily mistake HCSMs for real health insurance due to their misleading advertising. Media reports across the nation have exposed devastating stories of HCSM members stuck with enormous medical bills.

In fact, HCSMs often refuse to cover abortion, birth control, LGBTQ affirming care, and substance use disorder treatment, and some will only cover care for sexually transmitted infections and HIV if patients can prove that they did not contract the disease through “irresponsible behavior.” In other words, HCSMs can and do impose their religious beliefs on participants by refusing to pay for care that they find objectionable. Also, HCSM participants do not gain the benefits of the Affordable Care Act that ensure fair access to services. You may find in the fine print of an HCSM explanation of “benefits,” for example, that a hernia is considered a pre-existing condition, or that if you become pregnant during the first 12 months of being enrolled, you won’t be covered.

So, what can be done?

In 2022, Congressman Jared Huffman introduced the Health Share Transparency Act, which would require HCSMs to disclose critical information about their services to the public and consumers — like enrollment levels, amounts paid to enrollees, and more. Unfortunately, given political gridlock in Congress and how few bills get passed these days, it is highly unlikely we will see federal action on this issue anytime soon.

Colorado is the only state to have taken legislative action on this issue so far. In 2022, the legislature passed a law requiring HCSMs to report information not previously available to the public.

The Center for Freethought Equality, the advocacy arm of the American Humanist Association, is using Colorado’s transparency law as a model for other states. We are educating lawmakers and staff across the nation about HCSMs, and in fact, the vast majority are completely unaware of how HCSMs negatively impact consumers in their states.

We are working with lawmakers to introduce transparency laws that will rein in HCSMs and shine a light on their practices. We are also proud to be building broad coalitions with patient advocacy groups, consumer protection organizations, health care providers, and the nation’s top experts on this topic to coordinate a state-by-state legislative strategy.

Our current legal and policy landscape privileges religion, and as religious nonprofits, HCSMs are taking full advantage of this bias. That’s why it is critical that we shine a light on their operations and empower consumers to make informed decisions about their health care.