For Members of Health Ministries, Caring Means Sharing the Bills

DALLAS — Erica and Lance Beiler have found an alternative to federally mandated insurance, but it required a leap of faith.

The Beilers are part of a small but fast-growing number of people who have joined health care sharing ministries, religious alternatives to federally mandated insurance in which members pool monthly payments to help cover one another’s medical expenses. So, unlike most uninsured Americans, the Beilers did not have to buy health insurance or risk a fine under the Affordable Care Act.

When Erica Beiler, 30, gave birth to a girl last month, the roughly $10,000 bill was “all taken care of,” she said. The networks, which have been around for more than two decades, are seeing a jump in membership, particularly among people, like the Beilers, who object to some of the requirements of the health care law.

The purpose of the ministries is for Christians to come together and support each other when needed most, said Anthony Hopp, director of membership development for Samaritan Ministries, a network that includes members in Texas.

To join, members promise to abide by a lifestyle that includes frequent church attendance, little drug or alcohol use, and absolutely no premarital or gay sex. Monthly fees at Samaritan range from $180 for an individual to about $400 for a family, with members paying the first $300 of their medical bills out of pocket.

Samaritan members send medical bills to the ministry, which in turn directs other members to mail their monthly payments to the person in need. If there is not enough money available in a given month, members receive a percentage of their request and hope to be reimbursed later when there is more money to go around.

There are drawbacks. The ministries are largely unregulated because they are not considered insurance groups, though federal officials often refer to them as “alternative health insurance organizations.” In addition, members are essentially putting their faith, and medical bills, in the hands of the network without assurances that they will be paid. Most members also face a lifetime cap of $250,000 per medical condition — an amount that can be easily spent if a person is seriously injured or faces a long-term illness.

Four of the largest ministries in operation since at least 1999, including Samaritan, qualify as alternatives to insurance under the federal health law, according to the federal Centers for Medicare and Medicaid Services.

About 14,000 Texans were members in 2013, said Glenn Hegar, the incoming Texas comptroller and a Republican state senator who has tracked the ministries. Samaritan’s membership alone has grown more than 30 percent since then. Those figures pale in comparison to the more than 700,000 Texans who signed up for private insurance on the federal exchange, and the roughly one million uninsured Texans whose incomes are too low to receive subsidies on the exchange because the state declined to participate in an expansion of Medicaid.

Health policy experts say the ministries rely on the fact that their members are mostly young and healthy and on some limitations of coverage. The ministries do not pay for some of the most expensive care, like treatments for pre-existing conditions, that federal law requires of traditional insurers. And if a ministry member contracts a sexually transmitted disease, he or she has to foot the bill.

“The risk someone is facing if they join one of those groups is those ministries don’t have as deep pockets as the insurance industry,” said Vivian Ho, a health economist at Rice University’s Baker Institute for Public Policy. “You’re at greater risk if you do unfortunately get a very costly illness, such as cancer.”

The Beilers, who joined Samaritan on the recommendation of a children’s minister at their nondenominational church, are all in good health. They get supplemental vision and dental insurance from Erica Beiler’s job at a mental hospital.

Members know they are expected to pay for services like yearly checkups, Hopp, the Samaritan official, said. “You’re dealing with like-minded people who are committed to this concept of helping each other out,” he said. “They don’t have to be supporting something that is in conflict with their values. That’s big.”

Lance Beiler, 27, said he was “not particularly a fan” of the Affordable Care Act because he was uncomfortable paying into an insurance plan that covered services, like some forms of contraception, that he objects to on religious grounds. The couple said the insurance mandate opened their eyes to a Christian alternative. Lance Beiler’s concerns echo a national discussion about the government’s role in regulating health coverage for people with diverse religious beliefs. In June, the U.S. Supreme Court ruled that the federal health law could not force family-owned corporations with religious objections to pay for insurance coverage of contraception.

“This is an important option, a faith-based proposition for a fairly targeted group of people,” said Anne Dunkelberg, an associate director of the Center for Public Policy Priorities, a liberal research group in Austin. “If your faith is strong that one of the ministries is right for you and is not going to disappear when you need them most, then that’s a choice for you.”

Still, she said, it was “critically important for people to understand the limits” of health care sharing ministries, notably that they do not cover pre-existing conditions and can have lifetime limits. “Those are policies the ministries have chosen,” she said. “It’s not dictated by any health insurance model or law.”

Joel Noble, vice president of the Alliance of Health Care Sharing Ministries, which lobbies on behalf of the networks, said many members would most likely qualify for cheaper coverage on the private insurance market with a government subsidy. “I think it’s more about having control over where your check is going every month.”

Health ministry officials say Texas, which has the nation’s highest rate of uninsured people, has been one of the largest markets, in part because of a favorable political climate. Last year, Hegar sponsored legislation that exempted the ministries from state insurance regulations.

“It is impossible to meet regulatory standards of ‘insurance’ without destroying the voluntary, ministerial nature of these ministries,” Hegar said in a written statement, adding that he hoped “to guarantee that this option continues to be available for those who wish to participate.”

Erica Beiler said she and her husband received letters of prayer and congratulations, as well as money, from Samaritan members all over the country when their daughter Arabella was born.

At the Bible college where Lance Beiler works as a guitar instructor, 5-week-old Arabella began to cry, likely because her pricked heel was hurting after a routine blood test earlier that day, her mother said. The test was not eligible for cost sharing under Samaritan, but Erica Beiler said it brought her peace of mind to know she would have support if her daughter got sick. “We’ll be adding Arabella to the family plan for next year,” she said.

Before they joined the ministry, prayer was the couple’s only insurance policy, Lance Beiler said. “Well, that and eating healthy.”

Disclosure: Rice University is a corporate sponsor of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.