Whether because of the cost of the policies, or their religious and political principles, many Americans are looking to avoid enrolling in a traditional comprehensive health insurance plan as required by the Affordable Care Act's (ACA) individual mandate. One of the few alternatives is a health care sharing ministry (HCS Ministry). In an HCS Ministry, members make contributions that help other members pay their medical bills. In some Ministries, these payments are made directly from member to member; in others, the money is pooled into a common fund from which the money is disbursed to members with medical bills. The ACA exempts HCS Ministry members from the ACA's individual mandate to purchase health insurance.

The seeds of the ACA exemption were sown by state legislatures, who have exempted HCS Ministries from state insurance regulation for years. Thirty states currently have some form of regulatory exemption for HCS Ministries. Many states exempt HCS Ministries entirely from the state insurance regulatory system, which both protects consumers from improper sales and claims practices, and oversees insurer solvency to guarantee insurers are able to pay claims.

Proponents of these exemptions view HCS Ministries as charitable organizations, not insurance companies, that allow individuals to voluntarily assist with each others' medical expenses, while also providing spiritual and emotional support. Opponents of the exemptions argue that an unregulated environment could encourage scams. Critics also worry that even with the best of intentions, unregulated HCS Ministries could mismanage their finances and wind up unable to meet member needs if too many unhealthy people sign up or claims experience is worse than expected.

In exempting HCS Ministry members from the ACA's individual mandate, federal lawmakers showed their confidence that HCS Ministries will facilitate payment of their members' medical bills. And members themselves describe success stories of receiving money from fellow members along with supportive messages. Nonetheless, HCS Ministries are not insurance providers, their contracts are not insurance policies, and they provide no guaranty of payment for routine or catastrophic health expenses. Nor do they pay for many expenses covered by traditional health insurance, such as preventive care.

Thus, HCS Ministries provide an alternative to the traditional health insurance required by the ACA, albeit one with more risk. At the moment, HCS Ministry membership is growing, showing that many Americans are willing to take that risk.

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