GOP Lawmakers Pressure Administration Over Obamacare ‘Bailout’ for Insurers

GOP lawmakers in the House and Senate are pressuring the Obama administration for additional information on whether they plan to settle with insurance companies suing the government over a program written into Obamacare, which they warn would serve as a “multibillion dollar bailout” of those insurers.

Republicans in the House and Senate sent separate letters to top officials with the Department of Health and Human Services, Department of Justice, and Centers for Medicare and Medicaid Services raising concerns over the possibility of the Justice Department tapping into the Judgment Fund to settle lawsuits filed by insurance companies over Obamacare’s risk corridor program.

The risk corridor program was written into the Affordable Care Act and designed to provide insurers with stability during the first few years of the law’s implementation.

“This program was originally intended to be implemented in a budget neutral manner,” Republican Sens. John Barrasso of Wyoming, Mike Lee of Utah, Marco Rubio of Florida, and Ben Sasse of Nebraska wrote in a letter to Attorney General Loretta Lynch, Department of Health and Human Services Secretary Sylvia Mathews Burwell, and Acting Administrator for the Centers for Medicare and Medicaid Services Andy Slavitt.

“This intention was confirmed when Congress passed, with presidential approval, two separate provisions of appropriations law confirming its budget neutrality,” the letter continued. “It now appears the administration is preparing to circumvent these actions.”

The Republican senators said they have “grave concerns” about the potential for settlements with insurers.

Insurance companies filed lawsuits earlier this year after learning they would receive a small fraction of the money requested from the risk corridor program.

But Rubio and Senate Republicans included an amendment in 2015 and 2016 government spending bills prohibiting the government from using any taxpayer dollars to fund payments requested by insurers through the program. Under Rubio’s provision, the federal government could only use money collected from insurers to make those payments.

Because of those restrictions, insurance companies participating in Obamacare’s exchanges received just 12.6 percent of the money they intended to get from the risk corridor program—a collective $2.5 billion less than originally anticipated.

Many smaller insurers, including at least four of 23 consumer operated and oriented plans, ended up closing their doors because of lower-than-expected risk corridor payments.

Congressional Republicans began to sound the alarm over use of the Judgment Fund after insurers filed the lawsuit. Settling with insurers, they warned, would give the White House a way to provide the companies with their full risk corridor payments, effectively circumventing Congress.

“Any attempt to settle these cases out of court as a backdoor way to direct taxpayer dollars to insurance companies through the Judgment Fund will be met with the strictest scrutiny from Congress,” more than 40 GOP lawmakers wrote in one of the letters, sent to Burwell last week.

The Republicans go on to signal they would be willing to file their own lawsuit against the administration.

“Should the administration seek to make settlements in any pending lawsuit regarding risk corridor payments, we remain committed to exhausting all legislative and judicial options to ensure the power of the purse vested in Congress under the Constitution is respected and maintained,” the letter continues.

Republicans further stepped up their pressure on the Obama administration regarding potential use of the Judgment Fund following the release of a Sept. 9 memo from the Department of Health and Human Services on risk corridor payments for the 2015 benefit year.

In its memo, the agency addressed the lawsuit filed by insurers over the risk corridor payments for 2014 and said it would be “open to discussing resolution of those claims.”

Then, in a hearing before a House Energy and Commerce subcommittee earlier this month, Slavitt indicated officials from his agency had discussed with the Justice Department a potential settlement with insurers over the risk corridor program.

Nicole Navas, spokeswoman for the Justice Department, said the agency declines to comment because of pending litigation.

Health Republic Insurance of Oregon, a co-op, filed the first lawsuit against the Obama administration over the risk corridor program in February. The nonprofit is seeking class-action status.

Highmark Inc. and Blue Cross and Blue Shield of North Carolina followed, filing their own individual lawsuits in May and June, respectively.

The insurers allege that the federal government violated the Affordable Care Act and the risk corridor payment obligations outlined in the health care law.

Though the Obama administration has signaled it would be willing to use the Judgment Fund to settle insurers lawsuits against the government, the nonpartisan Congressional Research Service issued two separate memorandums to Rubio and Barrasso on the legality of the use of the Judgment Fund.

In a memo sent to Rubio in January, the Congressional Research Service said the administration wouldn’t be able to use the Judgment Fund to award payments to insurers who filed suit.

Congress, the memo concluded, would have to appropriate additional funds for “any payment to satisfy a judgment secured by plaintiffs seeking recovery of amounts owed under the risk corridors program.”

In a separate memo to Barrasso, the Congressional Research Service said that even if the insurance companies won their case, either insurers would need to pay additional money into the risk corridor program or Congress would need to appropriate additional money for companies involved in the litigation to recover additional funds.

“Consequently, it would be inappropriate for the Judgment Fund to be used to settle any litigation stemming from the risk corridor program,” the letter from Barrasso, Lee, Rubio, and Sasse continues.

The post GOP Lawmakers Pressure Administration Over Obamacare ‘Bailout’ for Insurers appeared first on The Daily Signal.

Conservative Groups Put Spotlight on Obamacare ‘Bailouts’ for Insurers

Bemoaning “insurer bailouts,” conservative groups warn of a possible fight in a lame-duck session of Congress over two programs written into Obamacare to give extra money to insurance companies.

Freedom Partners, a nonprofit chamber of commerce, launched a campaign last week urging lawmakers to allow the two Obamacare programs to expire, as they are set to do.

Their fear is that insurance companies and the Obama administrationneedham could persuade congressional leaders to extend the lifespans of the programs.

““The fact of the matter is government, at this point, is looking for any and every way in order to protect their interests, their legacy, which is Obamacare, and also give thanks and make sure their buddies, their cronies, and the special interests aren’t bailing out on these health exchanges,” Nathan Nascimento, senior policy adviser at Freedom Partners, told The Daily Signal, referring to insurance marketplaces set up under the Affordable Care Act.

Conservative groups say they are worried about the future of two programs, the risk corridor and reinsurance programs, written into the Affordable Care Act.

The government designed the programs to mitigate the risks insurers incurred by potentially covering consumers who were uninsured prior to Obamacare’s implementation.

Republicans, though, say the programs have served as a “bailout” for insurers struggling to turn a profit under the health care law.

“Insurers must, from [the administration’s] perspective, be prioritized because if insurers bail out of the exchanges, Obamacare can be deemed a failure, a complete and utter failure,” Nascimento said. “That’s the reason why we’ve seen a lot of these insurers pull out of the exchanges. They’re hemorrhaging dollars, and they’re not getting the love [from the government]. The only way to feel the love is to make sure they’re getting all the money.”

Keeping in line with Freedom Partners’ concerns, Heritage Action for America, the lobbying arm of The Heritage Foundation, warned against any changes to the programs.

“Rather than do the bidding of the insurance companies, conservatives should force President Obama and his congressional allies to explain Obamacare’s failures and why they want to funnel more taxpayer money into a failed law,” Mike Needham, chief executive officer of Heritage Action, said.

According to Morning Consult, several Democrats said it’s unlikely insurers will see more money from Congress.

A spokesman for Senate Majority Leader Mitch McConnell said the majority leader doesn’t support reinstating the risk corridor program.

AshLee Strong, press secretary for House Speaker Paul Ryan, said House Republicans are aware of the issue.

Despite comments from Democrats, Rep. Mark Walker, R-N.C., said, there is a “fear” of congressional leaders extending the risk corridor and reinsurance programs when they return to Washington after the election but before the next Congress is sworn in.

“That’s why we’re trying to make quite a hullabaloo of saying this is a gross injustice that’s burdening our constituents, the taxpayers, once again,” he told The Daily Signal.

Both the risk corridor and reinsurance programs expire at the end of the year, while a third, the risk adjustment program, is permanent.

The reinsurance program has received little attention from Republicans until recently, but GOP lawmakers limited the money available to insurers through the risk corridor program over the past two years.

During budget talks in 2014, Sen. Marco Rubio, R-Fla., led efforts to include a provision in a spending bill prohibiting the use of taxpayer dollars for the risk corridor program.

Because of Rubio’s amendment to the legislation, which also was included in a spending bill passed last year, insurance companies received just a fraction of the money—12.6 percent—they hoped to get from the risk corridor program.

Participating insurers received $2.5 billion less than they originally anticipated, and as a result of the shortfall, many of the smaller insurers selling coverage on the Obamacare exchanges closed their doors.

In January, insurers filed a class action lawsuit against the Obama administration for the lower-than-expected payments.

In a Sept. 9 memo, the Department of Health and Human Services said its own preliminary analysis showed the money collected from insurers for the 2015 benefit year will go toward the balance of 2014 payments. According to the agency, there won’t be any money left over for payments for the 2015 benefit year.

In the memo, the Department of Health and Human Services quietly called on Congress to secure more money for insurance companies through the risk corridor program.

“HHS will explore other sources of funding for risk corridor payments, subject to the availability of appropriations,” the agency said. “This includes working with Congress on the necessary funding for outstanding risk corridor payments.”

Conservative groups say they worry that Congress could send more money to insurance companies for the risk corridor program during a lame-duck session, the period after the election and before new members are sworn in.

They also worry that the Justice Department could settle its lawsuit with insurers using something called the Judgment Fund, an indefinite appropriation created by Congress and administered by the Treasury Department.

“We could be looking at several billion dollars that could be given out unlawfully through fiat or by the courts to settle [the suit] and bypass Congress with taxpayer dollars,” Nascimento said.

Republicans on the House Energy and Commerce Committee sent a letter today to Health and Human Services Secretary Sylvia Mathews Burwell, raising concerns about the possibility of the Obama administration settling the lawsuits.

They said that would be a “direct circumvention of the clear congressional intent to prohibit the expenditure of federal dollars on this program.”

Unlike the risk corridor program, Republicans in Congress only recently have shifted their focus to the reinsurance program.

The Affordable Care Act calls for the Department of Health and Human Services to transfer a portion of insurers’ contributions to the reinsurance program to the U.S. Treasury, as well as to insurance companies.

However, conservatives say the department skirted the law by giving $5 billion to insurers, money they say was supposed to be transferred to the Treasury before the government made reinsurance payments.

Walker and Sen. Ben Sasse, R-Neb., both introduced bills that would force the Obama administration to deposit $5 billion to the Treasury by 2017 or face steep cuts to the Department of Health and Human Services’ departmental management fund both this year and next year under a new president.

“The [Department of Health and Human Services] is illegally diverting millions of dollars from the [reinsurance] program to the insurance companies instead of returning it to the taxpayers,” Walker said. “That’s a huge problem out of the gate, and it’s something we need to focus on.”

According to lobbying disclosures, insurance industry giants such as Blue Cross and Blue Shield Association, America’s Health Insurance Plans, and Anthem have been lobbying Congress to oppose the Walker-Sasse bill.

“In some ways, I don’t blame them for trying to cover their costs,” Walker said of the insurers. “Obviously with the premiums shooting sky high, with enough people not signing up and registered, they’re trying to save their backsides as well.”

“But we have to do what’s right by the American people by making sure we hold the line on something that’s been illegally diverting these billions of dollars,” he said.

In addition to opposing Walker’s legislation, one staffer for a Republican lawmaker told The Daily Signal that insurers have been asking for an extension of the risk corridor and reinsurance programs, which they say keep the health care law stable.

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3 Simple Ways to Win the Debate on Obamacare

Before March 2010, health care reform was already a divisive political issue. People chose sides for very personal reasons, which made it a difficult topic to discuss using an indoor voice.

Then Obamacare hit the scene. Promises made were not kept, and Americans are still facing the consequences—including higher premiums, fewer choices of doctors, and waiting periods.


With the first presidential debate and open enrollment season just around the corner, health care is poised to be a hot topic yet again. 

Whether you’re talking to a neighbor about your increasing premiums or a co-worker about the latest health care debate on Capitol Hill, here are some tips for talking about Obamacare from a free-market, limited-government perspective that beats back socialism without beating down your opponent.

1. Find Common Ground 

The common denominator on both sides of the argument is the desire for access to quality, affordable health care. Regardless of position, class, income, or location, health care should be cost-effective and accessible for everyone.

Furthermore, the part of the health care debate that nearly everyone agrees on is the need to address what happens to those with pre-existing conditions. For too long, those who suffered with a pre-existing condition were up against a nearly impossible task to find affordable, quality health care—those who needed it the most were often denied. A solution to this issue is something we can seek to solve together.

These well-known aspects of the health care debate create a common goal and make room for a discussion to work toward a solution.

2. Use Examples 

There are numerous facts and statistics that prove Obamacare is not working as we were promised.

Just this year, average premium costs for an employment-based insurance family plan have skyrocketed to $15,500. In just a few years, those costs are projected to increase another 60 percent.

In March, on the sixth anniversary of the Affordable Care Act, The Daily Signal released this video, detailing six broken promises made by President Barack Obama regarding his health care plan.

Use stats and examples that prove Obamacare has achieved the opposite of what we were promised.

Among other promises that were not kept, Americans were assured: you would be able to keep your current plan if you liked it; families making less than $250,000 would see no tax increase; Obamacare would not add to the deficit; premiums would decrease; and federal conscience laws would remain in place.

If you want to cite personal anecdotes, there are plenty. For example, I am a small business owner and therefore purchase my own health care. My premiums have tripled (while my health has remained the same) since the introduction of Obamacare. And I know my story isn’t unique.

Use stats and examples that prove Obamacare has achieved the opposite of what we were promised. Focus on the broken system, higher costs, longer wait times, and less choice.

3. Choose Your Words Carefully

The words and terms you use in this debate have the power to determine how your argument is received.

Even though the president embraced this legislation as his own, use the “president’s health care law” or the “Affordable Care Act” when talking to people who like it. Throwing “Obamacare” around will put liberals on the defensive, and then any chance for a reasonable conversation is harder to achieve.

While we may consider it unconstitutional to mandate that Americans buy a product whether or not they want it or need it, don’t focus on Obamacare being “unconstitutional.” That isn’t a winning argument for someone who is in favor of the health care law. Instead, focus on real-life implications like fewer choices, longer waits, and higher costs—all of which are happening and are the opposite of what we were promised. Proving injustice is easier, and fairness is a term they care a whole lot about.

Obamacare has not turned out to be a good deal for any of us, and this election season is an important time to discuss the law and its long-term implications. Civil discourse may be our best starting point to hold the president accountable and develop a health care system that truly works for all Americans.

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Grand Theft Health Insurance

Recently, the national Blue Cross and Blue Shield Association has been aggressively lobbying Congress to ignore the Obama administration’s illegal diversion of tax dollars into the pockets of—you guessed it—health insurers.

At issue is funding for the “transitional reinsurance” program in section 1341 of the Affordable Care Act. In that section, Congress instructed the Department of Health and Human Services to collect $20 billion in “contributions” over three years from private health insurance plans, apportioned by enrollment, and then use those funds to defray the cost to insurers of their most expensive enrollees with Affordable Care Act compliant individual market coverage.

In the same section, Congress also instructed the Department to collect “additional contributions” of $5 billion over three years, but specified that those additional contributions, “shall be deposited into the general fund of the Treasury of the United States and may not be used for the program established under this section.”

While that latter clause sounds odd, the intent behind it was to improve the legislation’s “score” from the Congressional Budget Office by reimbursing Treasury for the $5 billion spent in 2010 under another provision of the bill (Section 1102) providing separate reinsurance payments for early retirees in large employer plans.

However, in implementing these provisions, the Obama administration miscalculated and failed to collect the full amounts specified in the law. Furthermore, the administration combined the collections from the two assessments, instead of keeping them separate as Congress had instructed.


As the table shows, in 2014 the administration was supposed to collect $10 billion to fund the individual market reinsurance program and an additional $2 billion to reimburse the Treasury, but only collected a total of $9.7 billion.

Yet, rather than scale back payments to insurers, the administration actually made the payouts more generous—by about 40 to 50 percent, according to the findings of two recent analyses. Yet even after doing that, the administration still had $1.7 billion left over. Rather than pay even that amount back to the Treasury, the administration carried it forward to use to pay insurers in 2015.

Thus, the administration effectively adopted a policy of putting corporate bailouts of Obamacare insurers ahead of repaying taxpayers—to the tune of about $4.5 billion.

To be sure, it is the Obama administration, and not the insurers, who perpetrated this heist. But for the Blue Cross and Blue Shield Association to now lobby Congress to keep getting the money puts them in the unseemly (to say the least) position of the guy caught with stolen merchandise demanding that he be allowed to keep his ill-gotten goods because he wasn’t the one who originally stole them.

At this point, members of Congress need to do two things to reassert their institutional authority.

First, they need to tell insurers that Congress is not going to continue to bail them out for their Obamacare losses, nor countenance the executive branch playing accounting games to achieve the same end. Insurers lobbying for bailouts should be told to instead come back when they are ready to offer Congress constructive assistance in writing workable replacement provisions that don’t need to be propped up with repeated infusions of tax dollars. In the end, that will produce better solutions for the country, their customers, and their bottom lines.

Second, Congress needs to use the appropriations process to force the Department of Health and Human Services to pay back to Treasury the amounts specified in law. There is simply no ambiguity in the statutory language stating that those monies “shall be deposited into the general fund of the Treasury of the United States and may not be used for the program established under this section.” If Congress writes into law such an explicit directive, but then lacks the will to enforce it, Congress might as well just hand the president a single blank check to spend tax dollars as he, or she, sees fit and adjourn.

Put bluntly, if Congress fails to aggressively defend its constitutional functions and prerogatives it will become an institutional doormat for this, and future, presidents.


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The Obamacare Alternative More Americans Are Turning To

Deirdre Folley is one of more than 600,000 people nationwide who is considered uninsured.

Yet when her daughter suffered a hairline fracture in her leg, requiring visits to an urgent care center, radiologist, and orthopedist, Folley and her family didn’t end up paying anything for the cost of her care even though charges totaled nearly $1,400.

That’s because Folley and her family of four are members of Samaritan Ministries, a health care sharing ministry with members who “share” in the cost of one another’s medical expenses.

Folley, who lives in New Hampshire, is one of the more than 184,000 members of Samaritan Ministries, a Christian-based organization that is one of the three major health care sharing ministries.

Nationwide, membership in health care sharing organizations tops 600,000 people, according to the Alliance of Health Care Sharing Ministries.

Folley, who has blogged about her experiences with Samaritan Ministries, first joined the health care sharing organization in April 2014.

Folley’s family was previously insured through her husband’s employer, but after the couple decided her husband would go back to school, they knew they would have to explore other health care options.

“In our situation, leaving a job, going into being a student and a homemaker and not having any type of benefits, either you’re going to be left out in the cold or you’re going to be doing something like this,” she told The Daily Signal. “Of course, now it’s illegal to be out in the cold, and we knew we weren’t interested in Obamacare.”

A friend of Folley’s husband originally told them about Samaritan Ministries, and when they began to research the organization, the couple was pleased with what they found.

Health care sharing ministries facilitate the sharing of medical costs between members, all of whom have shared beliefs.

The ministries don’t serve as insurance, but rather when a member has a medical “need,” other members “share” that person’s medical costs.

In some ministries, like Samaritan, members are encouraged to negotiate prices directly with providers to bring down the cost of their medical bills, like Folley did, and they pay in cash before being reimbursed by members of the health care sharing ministry.

For Folley, one of the most attractive parts of the health care sharing ministry was the fact that the organizations are exempt from Obamacare’s individual mandate, so members aren’t subject to the annual fine for going uninsured.

Folley said she and her husband are opposed to socialized medicine and didn’t have confidence in the government’s ability to manage their health care.

But most importantly, because health care sharing organizations are exempt from the requirements the Affordable Care Act places on insurance policies, Folley said it protected her and her husband, who are devout Catholics, from crossing any ethical boundaries.

“We didn’t want to buy into a plan where we were most likely going to be paying for abortions or not knowing whether or not we were paying for abortions,” she said, continuing:

With Samaritan, we know we don’t pay for anyone’s abortions, we don’t pay for contraception, we don’t pay for sex changes or counseling for things we would object to. We know that our money isn’t taking part in anything that we have a moral objection to.

An ‘Alternative’

Health care sharing organizations have existed for more than 20 years, but membership has grown substantially since Obamacare’s first open enrollment period launched in October 2013.

Samaritan Ministries, of which Folley is a member, has seen its enrollment nearly triple in that time.

In January 2013, the organization had 64,721 members. By January 2016, its membership had grown to 184,247 members, according to the organization.

Christ Meritus Foundation’s CURO, a Catholic health care sharing ministry that partners with Samaritan, launched in 2014 and has grown to have 900 member households, comprised of more than 2,500 individual members, the organization estimates.

Similarly, enrollment in Medi-Share, another health care sharing ministry, more than tripled.

Medi-Share had 59,855 members in June 2013, according to the organization. By June 2016, the health care sharing ministry boasted 200,333 members.

Anthony Hopp, vice president of external relations for Samaritan Ministries, said 2013—when Obamacare’s exchanges launched—was a “pivotal year” for membership growth.

“The Affordable Care Act increased awareness of health care sharing ministries in general,” Hopp told The Daily Signal. “We pretty much collectively, all of the health care sharing organizations, were off the radar for the most part. Then, with the insertion of the exemption, a lot of news outlets picked this up, and whether we wanted to be or not, we were kind of thrust into everybody’s minds.”

The ministries are expecting to see their enrollment continue to grow, particularly as issues continue to arise with the Affordable Care Act.

“It’s lower cost. It’s personal accountability. It lets you see everything you’re doing and the decisions you’re making,” Twila Brase, president of the Citizens’ Council for Health Freedom, told The Daily Signal of the organizations.

Health care sharing ministries are adamant in that their organizations are not insurance, but rather serve as an alternative to the Affordable Care Act.

“The Affordable Care Act provided a lot of different ways for people to meet their health care needs. We view ourselves as just one option—we’re an alternative to health insurance,” Michael Gardner, director of communications at Medi-Share, told The Daily Signal.

“People value the community. That’s one of the key things,” he continued. “It’s a community of like-minded people who come together based on a set of beliefs to share each other’s medical burdens.”

Louis Brown, director of CMF CURO, said the health care sharing ministry started as the “Catholic response to the needs and suffering of today within American health care.”

Like Gardner, Brown said the first thing his organization tells prospective members is that they are not offering insurance, but rather a way for people of the same faith to come together to take care of one another.

“We believe as Catholics that problems are best solved closest to the problem, and here, we are able to solve this problem of medical costs and medical needs and health care needs, this issue of healing, and we’re able to do that as a community of faith coming together across the country,” Brown told The Daily Signal. “It works, and it’s less expensive, and it’s consistent with your faith.”

Prospective members must adhere to a series of guidelines to join health care sharing organizations, which are traditionally in keeping with biblical teachings. Guidelines differ among health care sharing ministries, but many require members to remain drug-free, drink only in moderation, attend church on Sundays, and abstain from sexual activity outside of marriage.

Each month, members “share” in the cost of medical bills through a set monthly payment, and the organizations place restrictions on which sorts of medical costs constitute “needs.”

For example, medical services for pre-existing conditions are often excluded, as are routine physicals and preventive care.

Folley and her family pay $495 per month as members of Samaritan.

The family receives the name of another member to send their “share” to, and Folley typically includes notes of encouragement to the member, and includes him or her in the family’s prayers.

“It is really good to know you’re part of a body of people who are on the same page,” Folley said. “We have received very kind and sweet notes from other people when we’ve been receiving and definitely had a strong sense of them praying for us and knowing they care even though they don’t know us at all.”

Folley and her family have had to submit a “need” four times since joining Samaritan, including one for the birth of her son and another for her daughter’s broken leg.

Each time, the family received “shares” from other Samaritan members, along with notes of encouragement.

“The philosophy at Samaritan is very much promoting independence and taking care of yourself, but also subsidiarity and taking care of your Christian brothers and sisters and relying on the church rather than the state,” Folley said.

Not Without Controversy

Though health care sharing ministries have been functioning for more than 20 years, critics warn that there is no guarantee that medical bills will be paid for.

The National Association of Insurance Commissioners has previously warned that health care sharing ministries are not insurance and therefore don’t have the protections of insurance.

But the health care sharing organizations don’t shy away from admitting that those critics are right.

“When they’re digging at, ‘well there’s no guarantee, there’s no guarantee,’ we don’t argue that. There isn’t,” Hopp, of Samaritan Ministries, told The Daily Signal. “But Samaritan, our core principle is that Jesus Christ is the provider of all our needs. Our mindset is not that Samaritan is a panacea for any and every medical need. That’s not the purpose. This is simply one way that God has used to meet the needs of his people.”

In the past, there have been issues surrounding unpaid medical claims and lawsuits filed by members.

In 2000, Christian Healthcare Ministries, then known as the Christian Brotherhood Newsletter, was found liable for $14 million in damages by an Ohio jury for diverting money from the organization and an affiliated mission.

Before the jury ruled, members of the newsletter had amassed $34 million in unpaid medical claims.

Additionally, Medi-Share members in Montana, Oklahoma, and Nevada sued the health care sharing ministry in the last 10 years over refusal to pay medical bills they argued should’ve been covered.

Gardner, of Medi-Share, said prospective members need to be sure to fully understand which medical services are eligible for sharing and stressed that there is no guarantee of payment because the organizations are not insurance.

“That’s one thing people should be sure to ask about if they’re considering a ministry,” he said.

At Samaritan, members vote on which medical services can be shared, Hopp said.

If an individual disagrees with the result of the vote, the decision can be appealed to a 13-member panel of randomly selected members for arbitration.

Since the ministry was founded in 1994, Hopp said the arbitration process has only been used four times.

“I’m not aware of any insurance company that has that consumer protection,” he said.


Folley, the Samaritan member, said that the idea of membership in a health care sharing ministry may not cross people’s minds until they are left without benefits, as her family was after her husband decided to return to school.

“Once you’re out of that paradigm and you look into it, you realize what a great option it is, and it’s even better than most really good insurance plans,” she said. “I know we spend less money … Even compared to a good insurance plan, it’s better.”

Since joining Samaritan, Folley said she’s found herself immune from some of the complaints consumers with insurance have had in the wake of Obamacare’s implementation: rising premiums and deductibles, narrowing networks and the inability to keep a prior doctor.

“I get to sidestep all of that,” she said. “It’s incredibly liberating. I think, ‘poor them.’ I don’t deal with any of that.”

Hopp said Samaritan typically raises its monthly “shares” once every two to two-and-a-half years, with the most recent increase to $495 a boost from $405.

Folley has had the freedom to choose which doctors she wants to use, she said, which is beneficial for Folley since she has self-described “alternative views” on health care.

And the monthly “share” she does make to fellow Samaritan members doesn’t feel like a bill to her.

“Because you send your money directly to someone who needs it to pay back their medical bills, it doesn’t feel like paying a bill. It feels like charity,” Folley said. “It feels like OK, this person needs this $400 from me. I have to do that, because I know they would do that for me.”

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