Having a baby? Good luck if you rely on a Christian "health care sharing ministry"

Faith-based "health share" companies have left many families in medical debt

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Approximately 1.5 million Americans participate in Christian “Health Care Sharing Ministries,” and every so often, we hear about their horror stories. The latest one, courtesy of Aria Bendix at NBC News, is an important reminder that these HCSMs need to be regulated and held accountable before more people get screwed over.

Christian "health insurance" companies dupe gullible families (via Shutterstock)

To make sense of what’s happening, it helps to understand what HCSMs are.

Groups like Samaritan Ministries and Liberty HealthShare ask everyone in the system to pay a specific amount into the insurance pool every month… but the companies don’t collect all the cash or send it to health care providers. For a fee, the company simply tells individuals where to send their money (e.g. Bob from Nebraska) and how much to send — or they just reimburse members themselves. If you need something covered, you just make a request.

That’s not really different from regular insurance, but it’s not regulated, not all services are covered, and the providers can cut you off at anytime if you become too expensive to insure. Even worse: If you do something they deem “immoral,” you won’t get any money at all. (No contraception. No coverage for your same-sex partner. Definitely no abortion care.)

So everything is fine… until the moment you need them the most. Many participants don’t realize that until it’s too late.

There have been numerous articles written over the years about customers who were denied help precisely when they expected to receive it. The end result is that Christian insurance companies are just like Christian movies and Christian theme parks: They claim to offer suitable alternatives for secular services… but they’re so much worse than the real things.

In 2020, the New York Times‘ Reed Abelson wrote about how some of those Christian groups were so awful that some states were taking legal action to prevent them from offering garbage plans to residents.

… state regulators in New Hampshire, Colorado and Texas are beginning to question some of the ministries’ aggressive marketing tactics, often using call centers, and said in some cases people who joined them were misled or did not understand how little coverage they would receive if they or a family member had a catastrophic illness.

The article noted that Washington fined Trinity Healthshare and banned it in the state. Even Texas sued Aliera Healthcare, which promoted Trinity’s products. In October of 2020, the state of New York filed civil charges against Trinity Healthshare and Aliera (which marketed the plans) for allegedly offering pseudo-insurance to 40,000 residents over the previous four years.

14 states and Washington, D.C. took action against Aliera before California got in the game in 2022, suing The Aliera Companies and the family that founded Sharity Ministries. Attorney General Rob Bonta claimed that Sharity Ministries “routinely denied claims and spent just 16 cents of every dollar in premiums on health care expenses.” By contrast, the Affordable Care Act requires (legitimate) health insurance companies to spend at least 80 cents of every dollar on expenses.

For years now, Democrats in Congress have introduced bills designed to crack down on these companies. In 2023, a bill sponsored by Rep. Jared Huffman (D-CA), the Health Share Transparency Act, would have given customers more information about their HCSMs; after all, he said, recent data showed that Health Share ministries deemed “only half of members’ health expenses eligible for reimbursement.” That’s because they openly reject coverage for “abortions, contraception, mental health, substance use disorders, chronic conditions, certain preexisting conditions, and even maternity care.” But that bill hasn’t gone anywhere since Republicans control the House. (Still, raising the issue repeatedly is the best way to generate support for it over the long-term.)

Even John Oliver of Last Week Tonight spent an episode talking about these faith-based frauds:

The companies have always offered laughable defenses of what they do: They say they’re not providing health insurance at all… therefore it can’t be insurance fraud. They’ve also insisted that, since customers have to sign a contract that says it’s not health insurance, everything is on the up and up.

But obviously the customers don’t really understand that. They think they’re getting health insurance from a company that proudly proclaims conservative Christian values.

There’s a reason they think that: The companies strongly imply they’re health insurance companies. Just look at what the complaint from New York said:

Respondents aggressively advertise in the national and New York insurance marketplaces that these products are “affordable alternatives for health care” that provide comprehensive coverage, targeting consumers who are uninsured. Every aspect of Respondents’ marketing, notwithstanding their false disclaimers, leads consumers to believe that they have purchased legitimate, comprehensive health insurance coverage.

…

Members are issued membership cards, and Trinity maintains a network of providers and provides a search function on its website for participating providers for consumers to search.

It’s a bait-and-switch. Just like so many of their churches, these companies lure people in before telling members the whole truth. This was never insurance; this was gambling. Christians put money into the system with no guarantee that anything would come out on the other side. It’s a whole system that monetizes thoughts and prayers.

Now consider the NBC News report, which focuses on the company Sedera. (While not explicitly Christian, Sedera repeatedly references “faith-based” values and how members are “united by a shared faith.”)

When Rachel Kaplan became pregnant in 2023, she knew she needed insurance and was directed to the non-profit HCSM. But after her son was born and the bills were due—totaling about $7,000—Sedera said it wouldn’t cover anything:

… to the couple’s shock, they said, Sedera told them they were ineligible, citing a policy near the end of the group’s member guidelines: Within the first year of membership, medical bills for childbirth “are not shareable.”

“We basically gave Sedera our money and received nothing in return,” Kaplan said. “The rug was pulled out from underneath us.”

…

NBC News spoke to four families who said they were denied or struggled to get reimbursed by their health care sharing ministry for pregnancy or childbirth-related expenses. All felt they had been deceived and warned other expecting families not to join, saying that the model can be just as bad — if not worse — than the system they opted out of.

It’s worse by just about every conceivable measure. HCSMs can deny you for pre-existing conditions, they may not cover mental health issues, they might not cap out-of-pocket costs, etc. More importantly, there’s a chance that even if you’re supposed to be covered for something, the HCSM might not have the cash reserves to cover what they promised (unlike real insurance providers, which are required by law to maintain enough money for things like that).

Like I said earlier: It’s a form a gambling. The house is designed to win in the long term.

… some experts and state regulators say many health care sharing ministries promise more than they deliver or take advantage of people seeking affordable coverage, in some cases giving consumers the false impression that they are entitled to reimbursements or are purchasing insurance plans.

“The way they’re marketed and designed, many people buy them thinking they’re insurance and not realizing what the differences are,” [JoAnn Volk, co-director of Georgetown University’s Center on Health Insurance Reforms,] said.

This isn’t just about one family’s bad experience, though. (If that’s all this was, no insurance company would be spared.) This is commonplace for members of these groups. Another woman cited in the report wanted insurance when she got unexpectedly pregnant, but Christian Healthcare Ministries told her she needed to sign up at least 300 days before her due date to receive any reimbursements… which comes out to roughly 10 months before birth. In other words, she needed to sign up with the HCSM before she ever knew she was pregnant; now that she was, she had nowhere to turn.

At some level, that restriction makes sense. You don’t want people joining an insurance program for a specific benefit, then bailing afterwards. It would ruin the system since they’d be taking out far more than they ever put in. But that’s an argument for why we need universal healthcare and why this couple should have had regular insurance to begin with, not merely a justification for why this HCSM’s call was appropriate.

Of all the problems with HCSMs, denying a couple coverage for this reason is arguably low on the list. A better example would have been a couple that had coverage, had a baby, then got rejected for reimbursement due to other problems. And we do get one of those stories elsewhere in the piece:

[Warren] Walborn said he was never reimbursed for his wife’s prenatal care or the delivery of their daughter Sophie in 2021. Walborn said he submitted invoices within 180 days of medical service dates, per Liberty’s policy, but the company then requested itemized charges and additional documentation. That back-and-forth continued, he said, until the 180-day mark passed, after which point Liberty told him he was no longer eligible for reimbursement because of the time limit.

“I kept fastidious records of all of these codes and everything. It was never good enough for them,” he said. “It was like … if I had hair, I would pull it all out.”

“I said to myself, ‘You know, why am I sending them money every month?’” Walborn added. “‘They’re not going to ever send me anything.’”

It’s almost funny, though, in a way. Conservative Christians spend so much time encouraging couples to get pregnant early and often, and yet their HCSMs actively make it harder for some families to have babies at all. If they had normal insurance—Obamacare, for example—they might be able to do the very thing their religious leaders tell them to do.

Is there any upside to these groups? Sure, the monthly premiums are lower and the groups’ stated values might align with conservatives’ beliefs. But you know things are bad when regular insurance providers—including ones currently in the spotlight after the murder of the UnitedHealth Group CEO—look fantastic in comparison to these organizations.

You get what you pay for. And for these (mostly Christian) ministries, that doesn’t amount to much.

The report also points out that Donald Trump’s pick to head up the Centers for Disease Control and Prevention, Dr. Dave Weldon, is the former president of the Alliance of Health Care Sharing Ministries, a trade group representing several of these HCSMs. Earlier this year, the Alliance sued Colorado for demanding that all health care providers report “operating, statistical, and financial information,” basic accountability measures that the Alliance ridiculously claims violates their religious freedom. If Weldon is confirmed, you can expect the next administration to steer even more people into these scams. It’s the Trump Way.

By the way, if you read the NBC News article, it includes a picture of Trump physically embracing an American flag onstage during the 2019 CPAC event… while a banner of sponsors, including Liberty HealthShare, is right behind him. Liberty’s logo is right above that of the NRA. Which tells you a lot about how much conservatives care about your health.

(Large portions of this article were published earlier)

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