PBS NewsHour | Why many Americans use unregulated health care sharing plans | Season 2023

JOHN: WE ALL KNOW THAT NAVIGATING HEALTH INSURANCE PLANS CAN BE COMPLICATED, TIME CONSUMING AND FRUSTRATING.

BUT HUNDREDS OF THOUSANDS OF AMERICANS HAVE ENROLLED IN AN ALTERNATIVE TO TRADITIONAL INSURANCE.

IT’S CALLED HEALTH CARE SHARING PLANS.

MEMBERS OF THESE PLANS WHO OFTEN SHARE SIMILAR RELIGIOUS BELIEFS AGREE TO MAKE MONTHLY PAYMENTS TO HELP PAY FOR OTHER MEMBERS’ MEDICAL EXPENSES.

UNLIKE INSURANCE, THESE PLANS ARE UNREGULATED AND THEY DON’T HAVE TO COVER PREEXISTING CONDITIONS OR MEET THE OTHER MINIMUM HEALTH BENEFITS MANDATED BY THE AFFORDABLE CARE ACT.

KATE HARRIS IS CHIEF DEPUTY COMMISSIONER FOR LIFE AND HEALTH POLICY AT THE COLORADO DIVISION OF INSURANCE AND MARKIAN HAWRLUK IS THE SENIOR COLORADO CORRESPONDENT FOR KFF HEALTH NEWS.

WELCOME TO YOU BOTH.

MARKIAN, LET ME START WITH YOU.

YOU’VE WRITTEN ABOUT THESE PLANS ACROSS THE COUNTRY.

HOW WIDESPREAD ARE THEY AND WHO ENROLLS IN IT?

MARKIAN: IT IS A GREAT QUESTION, JOHN, AND UNTIL RECENTLY WE REALLY DIDN’T HAVE A GREAT ANSWER.

UNTIL COLORADO SURVEYED 16 SHARING PLANS IN COLORADO, AND ACROSS THE NATION AND FOUND 1.7 MILLION PEOPLE HAD ENROLLED IN THESE PLANS.

AND THAT WAS MORE THAN EVEN INDUSTRY INDIVIDUALS HAD REALIZED.

THESE PLANS APPEAL TO PEOPLE WHO LOOK FOR A LOW COST ALTERNATIVE HEALTH CARE INSURANCE AND APPEAL PARTICULARLY TO PEOPLE WITH A PARTICULAR RELIGIOUS VIEWPOINT WHO WANT THEIR HEALTH INSURANCE TO REFLECT THEIR MORAL VIEWPOINTS.

A LOT OF PEOPLE LIKE THE FACT THAT IT’S A SORT OF NEIGHBORLY ARRANGEMENT, THAT YOU ARE HELPING YOUR NEIGHBOR WITH THEIR HEALTH CARE COSTS AND THEY WILL HELP YOU WITH YOUR HEALTH CARE COSTS WHEN YOU INCUR THEM.

JOHN: THE PLAN MEMBERS YOU TALKED TO WHAT COMPLAINTS DO , THEY HAVE?

WHAT DO THEY SEE AS THE DOWNSIDE?

MARKIAN: YEAH.

EVERYBODY REALLY HAS TO SORT OF READ THE FINE PRINT OF WHAT’S COVERED AND WHAT’S NOT COVERED.

AND SOMETIMES YOU HAVE TO JUMP THROUGH A LOT OF HOOPS TO GET YOUR HEALTH CARE COSTS REIMBURSED BY THE PLAN.

LOTS OF THESE PLANS ALSO REQUIRE MEMBERS TO FIRST ASK THE HOSPITAL OR A GOVERNMENT AGENCY TO COVER THIS HEALTH CARE AS CHARITY CARE BEFORE THEY GET THEIR BILL SUBMITTED.

SO JUST MORE HOOPS THAN A TRADITIONAL HEALTH INSURANCE MIGHT HAVE.

JOHN: KATE HARRIS, DOES YOUR OFFICE OR ANY OTHER OFFICE IN THE STATE GOVERNMENT OF COLORADO HAVE OVERSIGHT OF ANY OF THESE PLANS IN COLORADO?

KATE: WHAT WE’VE DONE IN COLORADO IS WE STARTED COLLECTING DATA FROM THESE PLANS TO LEARN MORE ABOUT THEM AND WHAT THEY OFFER.

WE ALSO TAKE COMPLAINTS FROM CONSUMERS DIRECTLY WHO HAVE PERHAPS STRUGGLED TO GET THEIR CARE COVERED BY THESE PLANS.

JOHN: WHAT ARE THE MOST COMMON COMMON COMPLAINTS YOU HEAR?

KATE: IT’S REALLY TWOFOLD.

THE FIRST WE HEAR IS THAT WHAT THEY THOUGHT THEY WERE BUYING WAS INSURANCE.

AND THEN THE SECOND THING WE HEAR MOST OFTEN IS THAT EVEN IF THEY KNEW THAT IT WASN’T INSURANCE, THEY THOUGHT IT WOULD GUARANTEE COVERAGE OF THEIR MEDICAL BILLS.

AND WHAT WE FIND IS THAT’S JUST OFTEN SOMETIMES NOT THE CASE.

JOHN: WE REACHED OUT TO THE ALLIANCE FOR HEALTH CARE SHARING MINISTRIES, WHICH REPRESENTS THE FIVE LARGEST AND LONGEST OPERATING PROGRAMS.

THEY GAVE US A STATEMENT FROM KATIE TALENTO, THEIR EXECUTIVE DIRECTOR.

SHE SAYS, “THE PURPOSE OF HEALTH CARE SHARING MINISTRIES IS TO PROVIDE CHRISTIAN INDIVIDUALS AND FAMILIES WITH THE FREEDOM TO CHOOSE THE HEALTH CARE PROGRAM THAT BEST SUITS THEIR NEEDS.

THE ALLIANCE FOR HEALTH CARE SHARING MINISTRIES STRIVES FOR OPEN, HONEST COMMUNICATION WITH ITS MEMBERS AND ONLY ACCEPTS MINISTRIES THAT ARE DEDICATED TO BECOMING ACCREDITED THROUGH THE NEWLY FORMED INDEPENDENT HEALTH CARE SHARING ACCREDITATION BOARD.

THEY ARE TRANSPARENT WITH THEIR MEMBERS EVERY SINGLE MONTH ABOUT HOW MUCH MONEY HAS BEEN SHARED BETWEEN THE MEMBERSHIP AND HOW MUCH THE ORGANIZATION HAS USED FOR OVERHEAD EXPENSES.”

THE PEOPLE YOU’VE TALKED TO, THE PLANS YOU’VE LOOKED AT, DOES THAT RING TRUE TO YOU?

MARKIAN: THEY DO CLAIM THAT THEIR MEMBERS UNDERSTAND THAT THIS ISN’T TRADITIONAL HEALTH INSURANCE, THAT THE RULES ARE A LITTLE BIT DIFFERENT.

BUT WE ALSO HEAR FROM CONSUMERS THAT THEY THEY DON’T NECESSARILY UNDERSTAND WHAT IS BEING COVERED.

FOR EXAMPLE, IN THE REPORT FROM COLORADO, MEMBERS HAD IN 2021 SUBMITTED $362 MILLION OF HEALTH CARE BILLS THAT THEY WANTED COVERED.

YET THE HEALTH CARE SHARING PLANS ONLY COVERED ABOUT $132 MILLION OF THAT.

THEY SAID, WELL, THAT’S BECAUSE, YOU KNOW, NOT EVERYTHING ON A SINGLE BILL IS COVERED, AND PEOPLE UNDERSTAND THAT.

SOMETIMES THERE’S DUPLICATIVE THINGS.

THERE MAY BE THINGS THAT WE ARRANGED THAT WE WEREN’T GOING TO COVER.

AND YOU HAVE TO REMEMBER THAT THESE WON’T COVER PREEXISTING CONDITIONS.

THERE ARE MORALS CLAUSES IN HERE.

FOR EXAMPLE, THEY WON’T COVER THINGS LIKE ABORTION, BIRTH CONTROL, OFTEN MENTAL HEALTH CARE.

THEY WON’T COVER CHRONIC MEDICATIONS.

THEY WON’T COVER OUT-OF-WEDLOCK BIRTHS.

OR IF YOU HAVE AN INJURY DUE TO ALCOHOL USE OR DRUG USE, ILLEGAL DRUG USE, THEY’RE NOT GOING TO COVER THOSE THINGS AS WELL.

JOHN: KATE, IS THERE ANY EFFORT AT ALL IN COLORADO OR ANYWHERE ELSE TO HAVE SOME OVERSIGHT, TO HAVE AGENCIES REGULATE THESE PLANS?

KATE: RIGHT NOW WHAT WE ARE FOCUSED ON IS COLLECTING MORE DATA FROM THESE PLANS TO UNDERSTAND, YOU KNOW, WHAT THEY DO AND DON’T COVER AND WHAT THEIR FINANCIAL VULNERABILITIES MAY POTENTIALLY BE FOR COLORADANS.

AND THEN WE’RE WORKING TO EDUCATE CONSUMERS, YOU KNOW, REALLY PROVIDE THEM THE TOOLS SO THAT THEY CAN MAKE THE BEST DECISIONS ABOUT WHETHER THEY SHOULD PURCHASE ONE OF THESE OR WHETHER THEY SHOULD PURCHASE SOMETHING THAT’S UNDER THE AFFORDABLE CARE ACT WITH FEDERAL AND STATE SUBSIDIES THAT IS OFTEN QUITE AFFORDABLE.

JOHN: A LOT OF THESE PEOPLE ARE PEOPLE WITHOUT INSURANCE WHO SORT OF MAYBE DON’T QUALIFY FOR THE SUBSIDIES IN THE EXCHANGES?

KATE: WHAT WE HEAR IS THAT OFTEN, YOU KNOW, MAYBE THEY CHECKED A FEW YEARS AGO AND THEY DIDN’T QUALIFY FOR SUBSIDIES, BUT THERE’S BEEN NEW SUBSIDIES AT THE FEDERAL AND STATE LEVEL THAT HAVE PASSED RECENTLY WITH THE INFLATION REDUCTION ACT AND THEN WITH SOME OF OUR LOCAL LAWS HERE IN COLORADO.

WHAT WE HEAR MOST OFTEN IS THAT WHEN SOMEBODY ACTUALLY DOES GO BACK TO CHECK WHAT THEY’RE ELIGIBLE FOR UNDER THE AFFORDABLE CARE ACT MARKETPLACE, THAT THEY ARE ELIGIBLE FOR SAVE AND — SAVINGS.

JOHN: MARKIAN, AND ARE THERE PEOPLE THE KINDS OF PEOPLE THAT THIS IS A GOOD THING FOR THEM?

THIS IS A GOOD FIT.

MARKIAN: YOU HAVE TO REMEMBER THAT A LOT OF THESE PLANS HAVE ANNUAL OR LIFETIME CAPS AND A SINGLE CATASTROPHIC ACCIDENT THAT, YOU KNOW, YOU COULD BE, YOU KNOW, IN A CAR ACCIDENT, END UP IN A HOSPITAL AND EASILY RACK UP MILLIONS IN HEALTH CARE COSTS.

AND THAT HEALTH CARE SHARING ARRANGEMENT MIGHT NOT BE ABLE TO COVER ALL THOSE COSTS FOR YOU.

SO THERE’S A TRADEOFF THERE.

YOU REALLY GET WHAT YOU PAY FOR IN HEALTH INSURANCE.

SO, YOU KNOW, IF YOU WANT TO TAKE THAT RISK AND SAVE YOURSELF SOME MONEY ON THE FRONT SIDE, THAT’S A DECISION SOME PEOPLE WILL MAKE.

JOHN: MARKIAN HAWRYLUK OF KFF HEALTH NEWS AND KATE HARRIS OF THE COLORADO DIVISION OF INSURANCE.

THANK YOU BOTH VERY MUCH.

MARKIAN: THANK YOU, JOHN.

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