Americans Turn to Risky Health Cost-Sharing Plans Over Insurance

15 hours ago7 min read6 comments

A quiet, desperate migration is underway within the American health care landscape, one born from a profound and systemic failure. More Americans, fed up with unaffordable costs and the Kafkaesque denials of conventional insurance, are fleeing the traditional system entirely, turning instead to health cost-sharing ministries.These arrangements, where members pool their money to cover each other’s medical bills, represent a uniquely American response to a crisis, a DIY solution that speaks volumes about the erosion of trust in our institutions. Originally a faith-based alternative for those with religious objections to insurance, these ministries have undergone a significant secularization over the last decade, shedding their explicitly Christian requirements for more generic ethical principles like personal accountability and mutual support.This rebranding, coupled with aggressive marketing and the conservative backlash to the Affordable Care Act, has fueled a staggering surge in membership. From a niche community of 200,000 in the mid-2000s, enrollment has exploded, with an estimated 1.7 million Americans now members of these programs. The story of Tony and Felicity Dale’s company, Sedera, perfectly charts this evolution.A British-born doctor shocked by the cost of his own knee surgery in the US, Dale and his wife, drawing from their missionary background, first consulted for Christian ministries before founding Sedera in 2014. Stripped of direct religious references—its guiding principle is a simple ‘do unto others’—Sedera exemplifies the new model: a health cost-sharing program marketed as an affordable, community-driven alternative, often partnering with direct primary care clinics to create a seemingly full-service medical ecosystem outside the insurance paradigm.Yet, this salvation is a perilous mirage. Legally, these ministries are not insurance; they do not guarantee payment, are largely unregulated, and are explicitly exempt from state insurance laws in over 30 states.The consequences for individuals are devastatingly personal. We see it in the story of Rachel Kaplan and Andrew Sheffield, who, upon the birth of their child via C-section, discovered their Sedera plan denied their claims due to a fine-print exclusion for childbirth in the first year of membership, leaving them with $7,000 in bills.We see it in the Christian pastor who faced nearly $38,000 in debt after a heart procedure was deemed a preexisting condition. And we see it in the ProPublica investigation into Liberty HealthShare, where the owning family diverted hundreds of millions of member dollars to their own businesses while terminally ill patients were left with unpaid bills.This is the grim reality of a system where patients, particularly women seeking maternity care, are left vulnerable by design. The political dimension is stark.A quiet crusade by influential conservative groups has led to ‘safe harbor’ laws protecting these ministries from oversight, and a potential ally in a second Trump administration could further facilitate their expansion, much like the push for ‘short-term’ skimpy insurance plans during his first term. This creates a morbid circularity: the ACA sought to eliminate such inadequate coverage, but its unaffordability for many drove them right back into the arms of products that can once again deny for preexisting conditions.The fundamental problem, as the eminent economist Uwe Reinhardt noted, is that the United States alone treats health care as a commercial product rather than a social good. Every other developed nation spreads risk and manages costs across all of society; we tinker with a patchwork where risk is narrowly pooled and care remains unaffordable.These health-sharing ministries, whether sincere communities or outright frauds, are not the cure. They are a symptom of a deeper sickness, a testament to a broken system that forces its citizens to gamble on their own health, hoping a small group of peers will be enough to save them when the bill comes due.

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