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An anti-abortion activist prays outside a Planned Parenthood clinic on February 22, in Austin, Texas. But lobbying efforts earned them protected status under the Affordable Care Act, allowing their members to remain exempt from the individual insurance mandate the ACA established — provided that the ministries existed prior to , underwent annual financial audits, and retained members even after they developed medical conditions.

And membership of health care sharing ministries has seen explosive growth since the passage of the ACA in Joel Noble, Samaritan Ministries' director of public policy and the vice president of the Alliance of Health Care Sharing Ministries, told me that its three member ministries Samaritan Ministries, Medi-Share, and Christian Healthcare Ministries have a total membership of just under , individuals, up from about , in February Medi-Share, the Florida-based ministry, has grown from 35, members in to more than , members in April The ACA requires insurers to fully cover some forms of birth control , for example; Christian sharing ministries have no such obligation.

But there are significant differences between what insurance companies and sharing ministries are legally required to offer consumers. They typically don't always cover pre-existing conditions and often have gaps in critical services, such as coverage for mental health services. A pre-existing condition was a problem for Tara Owens. A spiritual director in Colorado, Owens suffered a heart attack in April The next month, her husband lost his job and they were soon left without insurance.

Health care sharing ministries try to keep costs low for their clients, and, according to Solidarity founder Faddis, sharing the costs of pre-existing conditions would be prohibitive. Ministry members often pay their medical bills out of pocket and wait for reimbursement; they are also encouraged to negotiate discounts with their providers. Do you have a cash rate? There is little to no cost sharing for chronic conditions or preventive care.

If you are diabetic, for example, you will most likely have to cover the cost of insulin on your own. Jones, the South Dakota pastor, was reluctant to join Samaritan at first. Health care sharing ministries, however, make their own rules.

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As Zain got older, Bet and Erik Olson decided to begin the process of adopting again. In November , almost two years after they went to Ethiopia to meet Zain, they were matched with their daughter, Tess, a vibrant young girl with boundless energy. They met her in April , she turned 2 in May, and they brought her home in June. This time, they knew there would be some challenges: Tess had received conflicting test results in Ethiopia, indicating the possibility of a blood disorder. Bet and Erik called Samaritan. Bet and Erik decided to appeal. They wrote an email to the leadership of Samaritan Ministries, asking the organization to reconsider its stance.

A health care company cannot deny coverage to an adopted child that it would have otherwise provided for a biological child. The Olsons also asked Samaritan to consider that to be anti-abortion means to be pro-adoption. It is not an option in the Kingdom of God, but rather a command.

Bet and Erik are aware of these criticisms and have worked to understand them.


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The number of international adoptions in the United States is declining overall from 19, in to just 5, in as other countries increase regulations, but the Christian interest in adoption is going strong. Tess, with her special needs, would require some care that Zain had not, and Bet and Erik felt it was incumbent on them to encourage Samaritan to raise its standards. Health care sharing ministries remained in business after the implementation of the Affordable Care Act only because of extensive lobbying by two groups that work on their behalf: the Alliance of Health Care Sharing Ministries and the National Coalition of Health Care Sharing Ministries.

Ted Kennedy, who worked on the development of the ACA. Aware of their unique position in the health care landscape, these ministries continue to think about how to protect themselves from meddling regulations, and that involves a robust public relations effort. With the ongoing GOP effort to repeal and replace the Affordable Care Act, these ministries are once again concerned for their futures. Sharing ministries might seem like an appealingly stable alternative to traditional insurance coverage, as legislation is up in the air, but what the AHCA or other changes to health care policy would mean for them remains uncertain — and it might not be good.

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Still, ministry leaders have confidence in their continued survival. Which does happen.

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Some ministries have had solvency issues because of clear-cut financial mismanagement. Scandals like this are rare, but some state regulators consider the basic premise of health care sharing ministries misleading, and have tried and mostly failed to exercise oversight. The state passed a bill in that allowed Medi-Share to resume operations, but a number of Medi-Share members faced trouble nonetheless. The Oklahoma Insurance Department said there was nothing stopping Medi-Share from facilitating payments in the state.

The Nileses and Medi-Share underwent a binding arbitration process, which ruled in favor of Medi-Share. Karen Niles died in Every state in the US has a department that regulates insurance, but state policies on health care sharing ministries vary widely, if they exist at all. Insurance commissioners in Washington and Kentucky , as well as in Oklahoma , have all tried at different times to stop certain ministries from operating within their state borders, on the grounds that they are actually insurance companies and should be regulated as such.

But in each case, the ministries were given exemptions by state legislatures that saw the issue as one of religious freedom. In recent years, health care sharing ministries have worked with the conservative legislative forum the American Legislative Exchange Council to prevent the same back-and-forth from playing out in other states. As of last year, 30 do.

At the heart of the debate is the question of how health care sharing ministries differ from traditional insurance, and, ultimately, what the consequences of those differences are. Health care sharing ministries are legally required to disclose the fact that they are not insurance. Which is fine, but to hear them tell it, theirs is still the superior product. In fact, everything is written in such a way that there is no assurance at the bottom line.

We just wish that we had trusted in His provisions sooner. Samaritan Ministries and its members assume no responsibility for your medical bills. Whether you receive any share money to help you with your medical needs will depend on the voluntary giving of your fellow members as an expression of Christian love, but no matter how mu ch money you receive, you always remain solely responsible for payment of your own medical bills.

The Affordable Care Act was written in part to ban certain discriminatory practices that led to people being denied insurance coverage. But health care sharing ministries have retained the right to discriminate, either by not sharing certain costs or by requiring more of certain members they deem unfit. For example, health care sharing ministries uniformly refuse to share costs related to self-inflicted injuries or suicide attempts — an issue that has also plagued traditional insurance companies, despite a health care privacy law requiring them to do so.

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