That has led to a debate pitting the state’s largest insurer against a small group of Vermonters who don’t buy traditional insurance – members of “health care sharing ministries,” which pool money to cover medical costs but are unregulated by the government.
Blue Cross and Blue Shield of Vermont says sharing ministries are not insurance and shouldn’t be exempt from the state’s forthcoming individual mandate. But members of those ministries are speaking up, arguing that Vermont should extend the same protections afforded to them under federal law.
Among them is Craftsbury Common resident Laura Beebe, who said she joined a sharing ministry “because it supports my lifelong religious vows, whereas current insurance providers ask me to compromise them.”
Imposing a state insurance mandate on her organization, Beebe said, would be sending a clear message: “We’re going to penalize you for living the life you feel called to live.”
Vermont lawmakers approved a state health insurance mandate in response to a change happening at the federal level: As of next year, there will no longer be a financial penalty for the federal individual mandate.
Officials predict that the end of the federal penalty will cause some people – likely, the young and healthy – to drop their insurance. That could lead to higher premiums for those who retain health coverage – an effect that insurers like Blue Cross already are budgeting for.
Those who successfully advocated for an individual mandate in Vermont say it will help counteract such price increases by keeping the uninsured rate low.
But state legislators delayed implementation of the mandate until officials could figure out the details of administration and enforcement. A working group created by the Legislature recently issued its draft report with recommendations for lawmakers.
On the topic of who should be exempt from the state’s mandate, the group largely recommended that Vermont follow federal law, with a few tweaks. But one member of the group – Blue Cross – maintains that the state shouldn’t continue the federal practice of exempting health care sharing ministries.
The debate shines a light on a growing, though still small, segment of the population.
Health care sharing ministries typically have been religion-based, though not all members have to subscribe to a particular denomination. Generally, members make monthly payments, and that money is shared to cover the health care costs of other members.
A lack of governmental oversight means health care sharing ministries aren’t required to cover pre-existing conditions or “essential health benefits” under federal law.
“The issue is that it’s being sold and marketed as insurance,” said Sara Teachout, a spokeswoman for Blue Cross and Blue Shield of Vermont. “It’s largely unregulated. I think people don’t understand that they are not getting the equivalent of health insurance coverage.”
Teachout also noted that, if a health care sharing ministry member receives treatment that’s not covered by their organization, “then it becomes an expense to the system” via bad debt and uncompensated care costs for health providers.
Similar concerns were raised in an August report from the Commonwealth Fund.
That report also documents a lack of governmental oversight across the U.S.: No state currently regulates health care sharing ministries as insurers, and 30 states have “safe harbor” rules that specifically exempt sharing ministries from regulation.
The Commonwealth Fund said officials interviewed for the study couldn’t say for sure which health care sharing ministries were operating in their states. Nor could they pinpoint how many people were enrolled.
But it’s generally believed that health care sharing ministry membership has been growing rapidly, particularly since enactment of the federal Affordable Care Act. The Commonwealth Fund estimated nationwide sharing ministry membership at 1 million, a number that roughly corresponds with statistics from the Alliance of Health Care Sharing Ministries.
The Florida-based alliance’s president, Dr. Dave Weldon, was among those who submitted comments on the Vermont Individual Mandate Working Group report. In an Oct. 10 letter, Weldon noted that a majority of the working group recommended that the state carry over all exemptions from the federal individual mandate.
“These exemptions acknowledge that there are several ways for Americans to meet their medical expenses,” Weldon wrote. “Health care sharing is one of those ways, and it has helped people access affordable, quality health care for decades.”
Weldon doesn’t mention Blue Cross’ opposition to health care sharing ministry exemptions in Vermont. But the possibility of losing that exemption looms large in other comments sent to the working group.
Of the 18 comments submitted on the working group’s draft report, 13 were about health care sharing ministries.
E. Ward Bitter of Stowe urged state officials to “allow our Christian/religious beliefs to be respected as they are clearly granted by the Constitution.”
“Without this right, we (our family and business) would be forced to move to a new state while our business, Bitter Lacrosse, brings close to $5 million in related revenues to Vermont each summer,” Bitter wrote. “Clearly, that would be a big loss to Vermont.”
Michele Doucette of Wilmington wrote that state officials should exempt health care sharing ministries from the mandate and “continue to work on solutions to the exponential rise in health care costs.”
“I belong to a health care sharing ministry, and it has worked beautifully for my family,” Doucette wrote. “It aligns with my Christian values, my preference for natural and preventative health care and my moral and ethical beliefs.”
Tricia Gustafson of South Burlington, a member of Ohio-based Liberty HealthShare, said she didn’t join based on adherence to any organized religion. Rather, she classifies herself as a “spiritual, values-based person,” and she said health care sharing ministries emphasize values like integrity, transparency, healthy living and helping others.
Contrary to the concerns raised by others, Gustafson said she is well aware that Liberty is not insurance. “I’m OK with that, because it serves the same purpose for me and my family,” she said in an interview. “I like the idea of people helping people directly.”
Gustafson has experienced some of the potential downsides of health care sharing ministries – for example, spotty coverage for pre-existing conditions, and a deductible that’s been rising in recent years as more people joined the ministry. But she doesn’t count those as negatives, and she said she’s still saving money that she can put into preventative care.
Beebe, who also is a Liberty HealthShare member, said she, too, spends less than she would on a traditional insurance plan. Any money saved, she said, “goes directly back to my church.”
In an interview, Beebe likened her health care sharing ministry to a co-op – one that aligns with her commitment to healthy living. She says she also has “a bias against health and wellness being an industrialized, profit-making industry.”
Beebe is aware of the coverage limitations of health care sharing ministries. Still, she said, “I trust 100 percent that if something happens, it will be covered.”
