I recently came upon an NPR article covering a slew of lawsuits again healthcare sharing ministry Aliera, and it’s subsidiary, Trinity. The article contained horror stories like this:
One New Hampshire customer who signed up for Trinity’s health care sharing ministry is Keith Meehan, 49, an international rice salesman whose company doesn’t provide health insurance.
After his doctor recommended back surgery for a disk issue, Aliera and Trinity HealthShare assured Meehan the procedure didn’t require preapproval. But after the surgery, it declined to pay approximately $200,000 in medical bills, contending his back pain was a preexisting condition.
“I feel like I was sold a bad bill of goods,” Meehan says. “I had no idea.”
Here’s the thing, though—the lawsuits aren’t actually about this. What Aliera and Trinity did to Meehan—taking his money and then denying coverage—is perfectly legal.
Health care sharing ministries don’t have to follow the same rules as insurers, and they face no requirements to pay claims.
No, really—healthcare sharing ministries can legally refuse to pay literally any medical expense they want. That isn’t the issue here. Joining a healthcare sharing ministry is like purchasing voluntary insurance, and letting the company decide what it wants to cover—and what it doesn’t.
New Hampshire, where Meehan lives, is one of the states that has brought suit against Aliera and its subsidiary, Trinity. What exactly is it suing them for, if refusing to help Meehan pay for his back surgery was totally legal?
Three things, according to the press release:
Trinity was formed on June 27, 2018, with zero members. Federal and state law requires that health care sharing ministries be formed before December 31, 1999 and their members must have been actively sharing medical costs since then without interruption.
Huh. So, apparently, only existing healthcare sharing ministries were allowed. I wonder whether the reason for this is that the utter lack of regulatory framework for these ministries, which people are allowed to join in place of buying healthcare, opens the door for large-scale exploitation. Allowing only existing ministries tries to solve this problem by keeping a lid on the market.
Trinity’s bylaws indicate that the organization adheres to a Christian expression of faith; however, its applications and policy documents only ask participants to believe in nonsectarian religious views. This statement of faith is inconsistent with the religious views purportedly held by Trinity. Trinity fails to establish that it is faith based and limit its membership to individuals who share a common set of ethical or religious beliefs.
What. This just feels … weird. The state of New Hampshire is suing Aliera because it’s not denying membership to people who don’t believe in specific Christian religious tenets.
As weird as this is, I suspect that this was another attempt to keep the lid on healthcare sharing ministries by preventing them from marketing themselves beyond the market they were in at the time the Affordable Care Act went into effect. Because, again, these ministries are not actually health insurance and can deny people coverage for any reason, but because they cost less than half of what conventional health insurance does, if you open it up, people will sign up anyway.
And then they might well end up like Meehan, with $200,000 in hospital bills they didn’t realize they’d be on the hook for. Legally. Because remember, that’s not what Aliera or Trinity did wrong.
Here’s the their violation they’re being sued for:
Aliera offers Trinity plans to individuals and employer groups. State law requires that health care sharing ministry plans only market and sell plans to individuals.
This whole thing is really fascinating.
In effect, Aliera and Trinity broke the law … by marketing their healthcare sharing ministry too widely. But if healthcare sharing ministries offer a quality product, why would it matter how widely they market what they offer? Why would it matter whether they market only to Christians, or whether they market to groups ass well as individuals?
In effect, federal and state regulators have struck a bizarre bargain in which they have decided to let healthcare sharing ministries sell a subpar, shitty product, without requiring them to meet the typical quality standards for this product … so long as they only sell it to Christian individuals and families.
And that’s … weird.
The issue at hand is not that Aliera or Trinity scammed people. If you’re a healthcare sharing ministry, you can deny any claim you want—or refuse to cover preexisting conditions outright (and most do!). The issue at hand is that Aliera and Trinity didn’t require those purchasing their product to be Christian. Which feels rather like saying they’re only allowed to scam Christians.
Because if healthcare sharing ministries aren’t a scam, why this focus on who they’re selling to? Why would it matter? If it’s a sound product, why limit who can buy it?
(By the way, I just checked, and if you’re pregnant already when you buy Medi-Share, one of the most popular healthcare sharing ministries, your pregnancy will not be covered. This seems ironic, given that one of the ministry’s main selling points is that your money won’t go toward covering someone else’s abortion, as they claim it would if you purchased regular health insurance.)
I realize that there are people who swear by these healthcare sharing ministries. In fact, I know people who do. So let me boil my issue down to something sweet and simple.
Health insurance is simply the sharing of medical costs. That’s really all any health insurance is. Indeed, one of healthcare sharing ministries’ main selling points is that if you buy their product, you won’t end up sharing the cost of abortions and other ungodly operations or procedures (like gender reassignment surgeries) like you would if you bought conventional health insurance. In other words, these ministries understand that all health insurance is fundamentally about sharing costs.
Given that healthcare sharing ministries operate the same way other insurance does—they are designed to share costs amongst their members—why are they exempt from the consumer protection requirements laid out in the Affordable Care Act? Why allow them, and not other health insurance providers, to deny people coverage based on preexisting conditions? Why allow them, and not other health insurance providers, to legally decide at whim not to cover a procedure?
I understand that these ministries don’t want to be required to cover, say, birth control, or abortion, or other procedures they say violate their ministry’s religious principles. But not requiring them to cover preexisting conditions, or indeed to cover any cost at all, seems like overkill. To what end?
All of this is how we end up with states suing Aliera and Trinity for marketing to non-Christians, and not for not covering members’ medical costs, because that is perfectly legal.
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