Buried more than 100 pages inside this year's health care overhaul law is a passage exempting any "health care sharing ministry" from the everybody-must-have-health-insurance mandate that goes into effect in 2014.
How that language got into the bill, and the group behind it, represents an interesting footnote to this historic legislation.
The exemption is an exclusive one. It specifically addresses a handful of Christian organizations that cover about 100,000 people nationally -- a tiny slice of the population -- with a system of pooling members' contributions to cover people who have agreed to live a lifestyle in keeping with the organization's prescripts.
These health care sharing ministries say they are not health insurers. Rather what they do is "medical bill sharing," in which families' monthly contributions are used to pay for individual member's approved medical costs, in some cases by sending money directly to another member family.
"These are Christians who are putting their faith in God," said Robert Baldwin, president of the Christian Care Ministry's Medi-Share program. "Instead of using an insurance company with a contract that guarantees coverage, they put their faith in God to provide for their needs through the gifts of other Christians."
Nationally, the two largest groups are Samaritan Ministries International, based in Peoria, Ill., and Medi-Share, part of the Christian Care Ministry based in Melbourne, Fla., which together have formed the national Alliance of Health Care Sharing Ministries. A third major group, the Christian Healthcare Ministries, is based in Barberton, Ohio, near Akron.
Alliance president James Lansberry, a native of Corry in northwestern Pennsylvania, who now lives in Illinois, said the groups' motivation bears no resemblance to what traditional health insurance companies do: "It's based on the biblical principle that we believe we're supposed to bear one another's burden." Mr. Lansberry, who does not take a salary according to tax documents, is also vice president of Samaritan Ministries.
The lobbying effort to include exemption language in the national health care overhaul bill began after Massachusetts adopted universal health care that required everyone to have health insurance -- including Medi-Share members.
"We were too late to the party," Mr. Baldwin said, "but God created a little back door for us." With an eleventh-hour appeal, he said, they were able to get health care sharing ministries included in the list of approved entities.
"In hindsight, Massachusetts was a dry run for the federal exemption," Mr. Baldwin said. "We learned a lot there; it showed us that we needed to work closely with the other sharing ministries, to rally our collective members and to be involved in the process very early on."
They had a lobbyist, and Mr. Lansberry made multiple trips to Washington, D.C., to persuade Senate staff members to exempt the organizations from the individual health insurance mandate. He said that more than just an argument based on freedom of religion, they pointed to the Obama administration's promise that those who were happy with their current health coverage could keep it.
"That and God's grace enabled our members to be protected from the effects of the individual mandate," Mr. Baldwin said.
A Senate Democratic aide, speaking only on background, said Tuesday that like Medicare, "the Affordable Care Act includes an exemption for certain religious organizations." Only those health care sharing ministries operating continuously since Dec. 31, 1999, qualify for the exemption.
Melissa Fox, spokeswoman for the Pennsylvania Insurance Department, said the state asked the ministries to change some language on their website specific to Pennsylvania several years ago. "Our main concern -- for this or any other entity -- is that consumers do not purchase this coverage thinking it is insurance, because we do not regulate these products."
The members of the health care sharing ministries are an exclusive group: Membership eligibility for Medi-Share starts with a requirement that the applicant provide "a verifiable Christian testimony indicating a personal relationship with the Lord Jesus Christ," which will include interviewing an applicant's pastor, professing a "Statement of Faith" and proof of regular church attendance.
Members promise not to use tobacco, abuse drugs or alcohol, and "must not engage in sex outside of traditional Christian marriage" between a man and a woman, Mr. Baldwin said. Potential members may be directed to a health care counselor if they're overweight based their body mass index.
"What I love is that our premiums go to another Christian family in need of medical assistance, to help them with their bills," said Mayra Hoy, 34, of Mount Washington.
She, husband Jeremy and their three children became members of Medi-Share in 2007 after a frustrating experience with a traditional health insurance company. "The premiums were high, and they weren't really covering everything," she said.
The Hoys, who own and operate Finish First Sports Performance in Robinson, were previously self-insured and paid close to $900 for their monthly premium. With Medi-Share, they pay $450 each month.
"We're normally healthy people anyway, so paying $900 a month felt like a waste of money," said Mrs. Hoy, but she added that they like the idea that the money they do pay "is going to someone who needs it more than us."
Last year, the Hoys found themselves in need of Medi-Share members' generosity. They'd planned to go to a midwife center for the birth of their third child but the baby was born prematurely, and they had to deliver at Allegheny General Hospital.
Medi-Share covers up to $8,000 for births, but their hospital bills were nearly double that. Word went out to the other members, and enough responded with additional contributions to cover the hospital charges.
"I never got a bill," Mrs. Hoy said. She did say Medi-Share does not cover well-baby doctor visits, and there is a $250 deductible when they do see a doctor. And Medi-Share will not pay for abortions for any reason.
Locally, Medi-Share's website lists major hospitals such as UPMC Presbyterian, UPMC Shadyside, Children's Hospital of Pittsburgh of UPMC, Magee-Womens Hospital of UPMC, Allegheny General Hospital and West Penn Hospital as part of its network, although officials at those hospitals said they were not familiar with the group, nor is the statewide Hospital and Healthsystem Association of Pennsylvania.
Mr. Lansberry sees that as a sign their members are not causing, or experiencing, problems when they seek medical care. "Our members are paying their bills."
There are instances where Medi-Share will not pay for someone's care, Mr. Baldwin acknowledged, most frequently for not disclosing a pre-existing condition. Usually those issues are resolved by a panel of randomly chosen members who make the final decision.
In one case, however, former Big Fork, Mont., Pastor Michael Rowden sued Medi-Share for declining to pay for his heart valve surgery. Medi-Share said the organization wouldn't pay because Mr. Rowden had not previously disclosed that he had a heart murmur. The parties later reached a confidential settlement.
Robert Zirkelbach, spokesman for the health insurers' professional organization America's Health Insurance Plans, said there was a risk with nontraditional approaches to health coverage that he said "can provide a false sense of security for families."
"If people in these organizations get seriously sick or injured, it could bankrupt these companies, putting at risk the coverage people thought they had. There's no guarantee they're going to have the funds available to pay for claims when they need it."
Mr. Lansberry said the Samaritan Ministries handles about $3.7 million in medical bills monthly. The organization does not keep a cash reserve, he said, so if the bill amounts exceed the contributions, then payouts are apportioned proportionately.
The member needing care is responsible for the rest, though Mr. Lansberry said other members can, and often do, increase their payments to help out.
"We're expressing our religious beliefs in a concrete fashion," he said. "Without that common bond, I don't think the model works well."
Steve Twedt: firstname.lastname@example.org or 412-263-1963.