State Squares Off Against Health Care Sharing Ministry Program

The organization served as a gold-level sponsor for the Inter-Company Marketing Group's 2019 annual conference, in Scottsdale, Arizona, in February.

In June, Aliera was the only top-level sponsor for the National Association of Health Underwriters' 89th annual convention, in San Diego.

Health Care Sharing Ministry History

Nonprofit religious groups have been helping members share health care expenses through modern health care sharing ministries since at least the 1960s.

Drafters of the Affordable Care Act created a new role for the ministries in 2010, by exempting the ministries from ACA major medical coverage rules, while classifying participation in certified health care sharing ministries as being equivalent to having ACA-compliant major medical insurance.

Consumers could use ministry memberships to avoid having to pay the ACA "individual shared responsibility" penalty, or the amount the ACA imposes on individuals who fail to have what the government classifies as "minimum essential coverage," or solid major medical insurance.

A group for ministries, the Alliance of Health Care Sharing Ministries, says the federal government has certified 104 ministries.

The ministries appear to have about 969,000 members in 29 states, according to alliance figures.

Regulators who support the ACA framework, and some health insurers, have argued that secular organizations could use health care sharing ministries, along with other arrangements exempted from the ACA major medical insurance rules, such as short-term health insurance, to sell major medical insurance-like coverage outside the ACA framework.

ACA supporters contend that letting consumers buy non-ACA major medical-like products may leave consumers without critical ACA consumer protection rules, such as requirements that plans cover prescription drugs, and may hurt issuers of ACA-compliant coverage, by pulling the youngest, healthiest consumers outside of the market for ACA-compliant coverage.

Supporters of the non-ACA major medical alternatives, including many officials in the administration of President Donald Trump, say that individual major medical insurance is now much too expensive for typical consumers who fail to qualify for large premium tax credit subsidies, and that ACA-compliant policies are often a poor fit for consumers' needs.

What the National Association of Insurance Commissioners Says

The NAIC — a group for state insurance regulators — recently posted a consumer alert emphasizing that health care sharing ministries fall outside the usual insurance regulation framework.

Health care sharing ministries, or HCSMs, "do not have to comply with the consumer protections of the federal Affordable Care Act (ACA), like covering treatments for pre-existing conditions or capping your out-of-pocket costs," officials say in the notice.

"HCSMs are not insurance, and they can't guarantee payment of claims," officials say. "That means that, while they may share funds with members who have health needs, they are not legally required to do so. State insurance regulators don't supervise HCSMs."

A copy of the alert is available here.

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