The explosion of health sharing ministries in the last few years has been crazy to watch.
What began as a loophole in the Affordable Care Act, health sharing ministries are both exempt from the individual mandate and don’t have to be ACA compliant (separation of Church and State, amirite?).
Health sharing ministries are cost-sharing pools that “have a shared common ethical or religious belief.” These plans are much cheaper than traditional health insurance and rely on other members to send you payment to help cover your bill.
These plans don’t have to keep reserves to pay future claims, don’t have to have out of pocket maximums, and you can get denied if your expenses are deemed immoral.
Interestingly enough, many of these sites claim they aren’t a type of health insurance. This is likely for legal reasons. Many do, in fact, want to position themselves as alternatives since health insurers have seen their brands erode.
These health sharing ministries have gone from covering 160,000 lives in 2014 to ~1 million today because they’re much cheaper than regular insurance. We’re seeing many different insurance products that are purposefully being structured to attract young, healthy people that don’t have a ton of money to spend, but see their health insurance premiums slowly rising.
Short-term plans, self-insured plans (for smaller and smaller companies), health sharing ministries, Farmer’s Bureau Insurance, etc. are all trying to find ways to get young people cheaper coverage. These plans work until they don’t, like when people have serious healthcare issues or when the economy takes a tumble.
Combine these plans with the repeal of the individual mandate next year and you have a recipe for some serious destabilization of the risk pools. You might also have a recipe for an actual patient shopper, since patients are forced to negotiate rates for health services themselves instead of relying on a third party to do it for them (especially if they go fully uninsured).
The health sharing plans force most of their members to do this too, which is why you’re seeing an interesting combination of direct primary care + health sharing ministries to create makeshift health plans.
Either way, we’re starting to see serious cracks forming in the health insurance market, and 2019 is going to be an important year to see if they get bigger.