Billwould regulate health care ministries
Texas lawmakers will consider sweeping legislation next session that would tighten oversight of largely unregulated healthcare sharing ministries, some of which have been accused of misleading patients and saddling them with tens of thousands in medical debt.
The ministries, typically Christian-based, are a growing subset of health coverage in this country where like-minded members pay into a fund to help offset future medical costs. With generally lower monthly costs, they have recently exploded in popularity.
Yet because they are not traditional health insurance and remain largely unregulated, the companies are under no legal requirement to pay a member’s medical claims out of the money collected.
A bill introduced Monday by Rep. Tom Oliverson, a Houston Republican and anesthesiologist, would increase regulation of the ministries and force greater transparency of their finances and membership. The bill, HB 573, also provides penalties for abuses.
It is among the deluge of bills now being filed in advance for the 87th Texas legislative session that opens Jan. 12.
Among its provisions, the bill would require health care sharing ministries in Texas to register annually with the state and members must “share a common set of ethical or religious belief.”
Members also cannot lose eligibility if they develop a medical condition nor
can the companies market themselves as traditional insurance. And, health care sharing ministries must make clear to members that there is no guarantee medical claims will be paid, Oliverson said on Monday.
Yearly financial information must also be submitted to show ownership, the number of members and a demographic breakdown, aswell as how much money has been collected, how much paid towards claims and how much is kept for operating costs, according to the bill.
“It’s smart and essential for regulators to keep closer tabs on these health care sharing ministries before they blow up and harm consumers,” Jo Ann Volk, a research professor at Georgetown University Health Policy Institute, said after reviewing the proposed Texas legislation. Volk specializes in the recent and sometimes troubled rise of the industry.
The Texas bill was prompted by stories of patients who submitted claims thinking they had insurance only to later discover they had inadequate coverage — or none at all, Oliverson said. He expects changes to the language and terms of the bill will come as others become involved.
“There are healthcare sharing ministries that are doing the right thing, and I strongly believe we should have a marketplace of ideas for healthcare coverage, but Aliera showed us health care sharing was vulnerable to exploitation,” Oliverson said about a con
troversial Georgia-based company, The Aleria Companies, previously known as Aliera Healthcare.
That company has come under
intense scrutiny both in Texas and in other states for allegations it intentionally misled and confused customers into thinking theywere paying for full health care coverage, including using insurance jargon in sales pitches. The company is also accused of paying little in claims as it pocketed large sums.
In July 2019 the Houston Chronicle investigated the for-profit company, including its founding by a man previously convicted of securities fraud and perjury.
Aliera has vigorously denied any wrongdoing in Texas or elsewhere. “The Aliera Companies have always practiced transparency, and in the best interest of health care sharing ministries (HCSMs) and the families they serve, we trust that Texas legislators will find a commonsense solution to HCSM regulation.,” the company said in an emailed statement on Monday about the proposed state law.
“On behalf of past and current ministries, the Aliera Companies have processed successfully, and to the satisfaction of most HCSM members, more than 1.2 million share requests, totaling more than $250 million shared to help members meet their health care needs,” the statement said.
It is estimated Aliera has had as many as 17,000 customers in Texas and 100,000 nationwide.
Last year the Texas Attorney General’s Office sued Aliera in civil court, alleging fraud and of blurring the line between its for-profit parent company and its non-profit Christian health sharing arm. That lawsuit is still pending.
Four weeks ago New York regulatory authorities filed a similar civil lawsuit against Aliera. At least 10 states have now issued cease and desist orders or warned consumers against the company. In addition, several class action lawsuits have been filed on behalf of former members.
Jill Baine, a breast cancer survivor from The Woodlands and former Aliera member, is thrilled the state is considering a law to crack down on abuses. Last year she sued Aliera after it refused to pay $195,000 for her treatment despite being assured she had comprehensive coverage. The company denied the claim as a pre-existing condition even though she had no cancer history, she said. Her lawsuit is ongoing.
“I am impressed that the spotlight is finally being shined on health share ministries who misrepresent themselves to their clients under the auspices of religious values and principles. Aleria’s actions in response to my breast cancer were far from Christ-centered,” she said on Tuesday, “Legislation like this is an important first step.”
Still, the legislation may be in for a bumpy ride in Texas. Because the companies are faith-based, religion is intertwined with health coverage.
Attempts to regulate the industry are seen by some as an infringement of religious freedom.
Bee Moorhead, executive director of Texas Impact, an interfaith advocacy network, said that concern is misplaced.
“Faith communities have nothing to fear from common sense regulations because they affirm our God-given responsibility to live in community and to care for each other,” she said.