When John Uit de Flesch was uninsured last year, his children鈥檚 vaccines were covered by the state.
When he took the children for shots this year, he produced the Medi-Share card he鈥檇 gotten to comply with the Affordable Care Act mandate that everyone must have health coverage. He was billed $1,080 for shots and checkups for his two tots.
Uit de Flesch (pronounced 鈥渋te-de-flesh鈥�), pastor of on Charlotte鈥檚 North Tryon Street, says he feels like he鈥檚 being penalized for obeying the law. 鈥淎s a Christian I don鈥檛 believe it鈥檚 right to disobey the government,鈥� he said.
But he doesn鈥檛 actually have health insurance. Instead, he鈥檚 among a small but growing number of Christians joining health care sharing ministries, in which members agree to abide by Christian lifestyle principles and contribute to each other鈥檚 medical expenses.
John Uit de Flesch is among a small but growing number of Christians joining health care sharing ministries, in which members agree to abide by Christian lifestyle principles and contribute to each other鈥檚 medical expenses. (Photo by T. Ortega Gaines/Charlotte Observer)
Four long-standing ministries 鈥� , , and 鈥� qualify as an alternative to health insurance under the ACA. That means members won鈥檛 face tax penalties.
Coverage is literally a matter of faith. Organizers make it clear there are no guarantees and no government oversight. Members depend on each other鈥檚 commitment to provide help when it鈥檚 needed. Those allowed to join must agree to religious beliefs and lifestyle standards, which can include limits on sexual behavior, drinking and use of drugs and tobacco.
As with insurance, they make monthly payments, though they鈥檙e called shares rather than premiums, and pay a fixed amount out of pocket, much like deductibles. Methods of getting that money to members with covered medical bills vary: Some ministries handle the billing, while one oversees a system in which payments are sent directly from one member to another.
The ministries say the federal insurance mandate has driven up membership in the past year, in North Carolina and across the nation. The three that responded to the Observer鈥檚 request for numbers (Liberty did not) have a combined membership of about 325,000 nationwide.
That鈥檚 tiny compared with roughly 170 million people who have private insurance and 101 million on Medicare, Medicaid or other public coverage. In 2014 more than 7聽million people bought insurance through the ACA exchange.
For many local doctors, that makes patients like the Uit de Flesches a new twist in an already complex coverage scene.
鈥淲e鈥檝e really only seen a few of these,鈥� said Chris Kiser, vice president of patient financial services for . said it has just over 200 Medi-Share patients in the four states it covers.
The growth spurred by the ACA could be a mixed blessing, says one expert.
The ministries have built a record of honoring their claims, but that could be jeopardized if new members don鈥檛 show the same commitment as those who joined earlier, says Gary Claxton, vice president for the and a former insurance regulator.
鈥淚f you鈥檙e just doing it because you don鈥檛 want to buy health insurance or you don鈥檛 like President Obama, that鈥檚 not the purpose of these groups,鈥� Claxton said. 鈥淚f they鈥檙e growing rapidly, they have to be vigilant about finances,鈥� such as ensuring that enough money comes in to cover bills for growing membership.
Sharing burdens
Cost-sharing ministries predate the ACA by decades. Founders share a belief that the church should be the source of support for fellow Christians. A verse from Galatians, 鈥淐arry each other鈥檚 burdens and so fulfill the law of Christ,鈥� is often cited.
Participants share a desire to avoid subsidizing abortion and health care costs that stem from living outside a Christian lifestyle, such as issues related to extramarital sex and drug or alcohol abuse.
To be accepted, members must profess a belief in Jesus and a willingness to abide by the rules. A faith leader might be required to vouch for them.
Once accepted, members commit to a monthly 鈥渟hare鈥� that鈥檚 used to pay bills for members with medical expenses that meet each ministry鈥檚 guidelines. Payments, deductibles (which go by different names) and methods of handling the money vary by ministry.
The mutual support goes beyond money. Prayers for members in crisis are central to the mission.
鈥淭he community aspect is huge,鈥� says Anthony Hopp, director of member development for the Illinois-based Samaritan Ministries. The ministry manages a database that matches promised payments with covered costs, and each member gets a notice instructing them on where to send that month鈥檚 鈥渟hare.鈥� Those payments usually arrive with notes, cards and promises of prayer, Hopp said.
Ministries also tout lower costs in exchange for personal responsibility. Medi-Share, for instance, offers family coverage averaging about $300 a month.
Robyn and Spencer Hoffman of Charlotte joined Medi-Share in 2009, after Spencer, a homebuilder, lost his job and his company insurance. The monthly share, which was lower than insurance premiums, is what attracted them, Robyn Hoffman says, but they also liked working with a group that 鈥渓ines up so much with our values.鈥�
Medi-Share paid for a complicated pregnancy and delivery, and Robyn Hoffman said every phone call ended with someone asking if she鈥檇 like them to pray with her. While encounters with insurance companies were often adversarial, she said, the ministry feels supportive.
Five years later, the Hoffmans and their three children remain on Medi-Share. They were relieved the ACA didn鈥檛 force them to switch. 鈥淚t just honestly feels good to know that you are helping others while you鈥檙e paying a bill that we all have to pay,鈥� Robyn Hoffman said.
An ACA alternative
The ACA, with its mandate for individuals to get health insurance or pay penalties, infused new energy into the ministries.
Along with an exemption for religious groups such as the Amish that object to insurance, the act exempts members of recognized cost-sharing ministries that have been in existence since 1999.
鈥淚n the months leading up to the March 31 deadline, tens of thousands of Christians opted for faith-based insurance alternatives,鈥� in April. For Medi-Share, the increase was close to 50 percent.
Although the ministries have similarities to health insurance, the differences are crucial and can have big financial impacts for families such as the Uit de Flesches.
John Uit de Flesch says he made a little more than $14,000 as a pastor last year, with a housing allowance that would bump his compensation to $20,000 to $25,000. Had he bought insurance on the federal exchange, he would likely have qualified for subsidies to cover most of his premium and out-of-pocket costs.
But Uit de Flesch says he doesn鈥檛 like taking government aid or paying premiums that would contribute to coverage of sexually transmitted diseases and alcohol-related ailments. He chose the Medi-Share plan that requires him to cover the first $10,000 because he said that鈥檚 all he could afford.
Many employers and individuals are also moving toward high-deductible insurance policies to control costs. But the ACA mandates full coverage of many preventive services, including the well-child checkups and inoculations that led to Uit de Flesch鈥檚 $1,080 bill.
Ministries, on the other hand, generally exclude such coverage as part of the emphasis on responsibility. The thinking is that members can budget for routine care, while other members kick in to help with unexpected costs.
Uit de Flesch said he鈥檚 not complaining about the plan he chose. But he鈥檚 frustrated by a statement at the bottom of the bill from his children鈥檚 pediatrician, who is part of the Novant network: 鈥淣ovant Health provides free care to uninsured patients with incomes of up to 300 percent of the federal poverty level.鈥�
With a federal law requiring insurance or an approved alternative, 鈥渢o say that is to say they only offer charity to lawbreakers,鈥� Uit de Flesch said.
Novant and Carolinas HealthCare both say Medi-Share is especially challenging because even though it is not insurance, it has so many similarities that both systems treat patients as insured. For instance, Medi-Share contracts with Private Health Care Systems, a managed care network.
鈥淎s such, when a Medi-Share patient visits a Novant Health facility and presents a PHCS insurance card, the patient is treated as insured,鈥� a statement from Novant says. 鈥淧atients with insurance do not qualify for charity care unless there are unusual circumstances for medically necessary services leading to a catastrophically large balance.鈥�
Uit de Flesch took his children for vaccines in July. In November, after the Observer and Medi-Share contacted Novant about his case, he says the pediatrician wrote off the vaccine charges, leaving him to pay about $400 for the well-child checkups.
Is it safe?
The ministries currently operating have a good record, says the Kaiser Family Foundation鈥檚 Claxton. But there have been past problems.
In the late 1990s, leaders of the Christian Brotherhood Newsletter, a predecessor of Christian Healthcare Ministries, diverted millions of dollars of donations to their own pockets, leaving $24 million in claims unpaid, .
And the ministries, calling them unlicensed insurance companies. , including North Carolina, have now passed laws exempting the ministries from insurance regulations.
The ACA鈥檚 requirement that ministries must have been in operation since 1999 to qualify for the insurance exemption reduces the chance of untested or untrustworthy groups popping up to offer alternatives, Claxton says. But he warns that consumers should still be alert to possible scams: 鈥淚f there鈥檚 a loophole, there will be bad people who try to exploit it.鈥�
The most important thing is for prospective members to understand exactly what they鈥檙e signing up for. Dr. Andrea Miller, an executive with Medi-Share, says the group isn鈥檛 trying to enroll people who just want cheap insurance. Staffers work to explain the spiritual benefits and the financial trade-offs.
鈥淲e want people for whom this is a very good fit,鈥� she said.