Connecticut legislators are considering a bill that would bar insurance agents and brokers from marketing and selling plans run by health care sharing ministries, nonprofit religious organizations that pool their members’ contributions with the intent of paying out medical bills, though there is often no guarantee of coverage.
As the health ministries have gained popularity in recent years, drawing new members by marketing themselves as a lower-cost alternative to traditional health insurance, complaints have also multiplied against the groups. In Connecticut, the insurance department fielded 10 complaints from March to December 2020, nearly the same number it received over a two-year stretch before the pandemic. At least four complaints have also been filed with the state Attorney General’s office since the pandemic began, and one has been filed with the health care advocate’s office. Both offices have recorded a growing number of grievances against the ministries in recent years.
Residents who are members of the organizations have complained about denial of coverage and non-payment of medical bills. Some say they were duped into buying the plans, believing they were purchasing health insurance. Others said they were aware the ministries were not traditional coverage but still expected all of their medical bills to be paid – only to find out they weren’t.
Some residents claimed they were denied coverage for heart attacks and appendectomies, medical conditions that the ministries classified as pre-existing conditions, according to the complaints. At least one person in Connecticut was denied coverage by her ministry for a COVID-19 test, leaving her to pay $270 out of pocket.
The bill now under consideration by the General Assembly would prohibit anyone licensed by the state’s insurance department from conducting business with a health care sharing ministry. It also bars everyone – regardless of their position – from accepting money for selling or marketing a ministry plan to Connecticut residents, for negotiating such a plan on behalf of a resident, or for administering such a plan that includes any state resident.
“Nobody is trying to say that people of faith cannot pool their expenses for health or for anything else. That’s not what this is about,” said Sen. Matthew Lesser, a key supporter of the bill and a co-chair of the legislature’s Insurance Committee. “This is about companies trying to evade insurance regulations.
“If you want to engage in health sharing, you can, but we have a lot of concerns about the business of so-called ministries that … are engaged in a lot of profiteering by selling unlicensed insurance products.”
Because the groups are unregulated, there is no way to tell how many people in Connecticut are members of the ministries. Last year, industry officials estimated that more than 5,000 state residents belonged to these organizations. But as the pandemic caused hundreds of thousands here to lose their jobs – and for many, their health insurance – that number could now be higher.
Representatives for the ministries estimated that 1.5 million people nationwide have signed up for their coverage. Many of the plans market themselves as lower-priced alternatives to policies that must meet tougher mandates under the Affordable Care Act, such as coverage for pre-existing conditions. The ministries offer cheaper rates because they are not considered to be insurance and are not required to pay claims.
This is the second year a bill targeting the ministries has been raised in Connecticut. Last year’s proposal, which was voted out of committee but shelved when the session shut down amid the pandemic, would have required ministries selling plans in the state to comply with all provisions of the ACA, including guaranteed coverage for pre-existing conditions.
The latest version cleared the Insurance Committee this week with a vote of 11-7 and now heads to the Senate floor. Lesser is hoping it will win support among his colleagues.
“There have been some scary situations where people were incurring $25,000 medical bills and going in on a wing and a prayer as to whether their health ministry was going to actually cover the expenses,” he said. “That seems crazy to me.”
‘Difficult limitations’
Though the Insurance Committee ultimately advanced the bill, dozens of people wrote to lawmakers urging them to vote down the proposal.
Critics say the measure would effectively make it impossible for health care sharing ministries to continue operating in Connecticut.
“Unfortunately, [the bill] would impose some difficult limitations that would result in the elimination of the availability of HCSMs to the residents of Connecticut and thus violate their rights to exercise their religious beliefs,” Buddy Combs, the interim CEO of OneShare Health, a sharing ministry based in Texas, wrote to legislators.
“In an extreme reading of the language, this provision could be interpreted to ban the practice of enrolling new ministry members,” he said, “[given that] something as benign as answering an inquiry from a prospective member could run afoul of the proposed language.”
Thomas Balzamo, a pastor at the Colonial Baptist Church in Bozrah, urged legislators to amend the proposal “in a way that provides consumer protection while still protecting the ministries’ ability to operate in our state.”
“I speak for many small-church pastors when I say that traditional forms of insurance are often incredibly cost prohibitive for those in our vocation,” he wrote. “For many years, we have turned to health care sharing ministries like Samaritan Ministries. They truly provide an outstanding service, not just for pastors but many Christians. I am not certain what we would do without them.”
Alicia Fernandez, an Easton resident, said her family switched to a health sharing ministry after they had been paying a high monthly premium for “mediocre insurance.” Her husband is self-employed, she said, and health insurance options “tend to be quite expensive.”
“We ask you to please reconsider the language in this bill that might potentially eliminate a health care choice that we and so many other families here depend upon,” she wrote to lawmakers. “Please try to find a way … that would protect consumers yet still allow for participation in this necessary program.”
Ted Doolittle, the state’s health care advocate, has been vocal in his criticism of deceptive practices by the ministries. But he worries the proposal would further confuse consumers by taking away their ability to discuss those plans with an insurance agent.
“The bill may end up causing more harm than good for those who set out on their own, unassisted by expert advice, in search of a low cost health insurance solution,” he said.
But others, like the Connecticut State Medical Society, came out firmly in support of the measure, noting that several ministries use marketing practices designed to mislead consumers into thinking they’re buying health insurance.
“HCSMs frequently market themselves close to traditional insurance plans, offering tiers like ‘gold,’ ‘silver,’ and ‘bronze,’” the organization wrote. “They also use terms like ‘share’ instead of ‘premium’ or ‘need’ instead of ‘claim.’”
The medical society urged legislators to go a step further and impose an outright ban on the organizations in Connecticut.
“These plans prey on naïve and unsophisticated shoppers of health insurance by exploiting their previous, unrelated comfort and experience with a specific group … exploiting that faith in a manner that is not transparent and that may better serve the entity than the individual who has subscribed to it,” members wrote.