FILE - Texas capitol

Texas state capitol in Austin

(The Center Square) – A bill currently in the Calendars Committee of the Texas Legislature, if passed and signed into law, would make Texas the first state to regulate religious-based health care sharing ministries, and potentially eliminate options for 150,000 Christians and Jews in Texas relying on them.

At issue is HB 573, proposed by state Reps. Tom Oliverson, Rep. Scott Sanford and Rep. Jacey Jetton, all Republicans. The bill passed the Texas House Insurance Committee, chaired by Oliverson.

Approximately 150,000 Texans have chosen to join health care sharing ministries (HCSMs), opting not to purchase health insurance for various reasons. HCSMs facilitate the voluntarily sharing of health care-related finances, as well as provide emotional and spiritual support to members. They do not provide insurance and have no contractual transfer of risk.

Federal and state laws have special exemptions for HCSMs, known as safe harbor laws, from insurance regulations and the Affordable Care Act’s individual mandate. In 30 states, HCSMs are recognized by law as not being insurers under state insurance codes. As 501(c)(3) charities they are regulated by the IRS and state attorneys general.

Legitimate ministries receive federal certification letters from the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services stating they meet the federal requirements to be exempt from the ACA. More than 100 ministries have CMS certification, according to the Alliance of Health Care Sharing Ministries, an advocacy organization representing 1.5 million Americans.

Evelio Silvera with Christian Care Ministry/Medi-Share explains that HCSMs provide “Texans the only 100% pro-life health care solution that is consistent with their Biblical beliefs.” Medi-Share, which has been serving members nationwide for nearly 30 years, has never experienced criminal or bad actors, he says.

Katy Talento, executive director of the Alliance, told The Center Square that HB 573 imposing regulatory requirements of insurance on HCSMs would destroy the voluntary, ministerial nature of the organizations.

Although HCSMs were invited to participate in the deliberations over the bill for months, HB 573 became “a product of a closed door, behind the scenes political deal” that excluded all input recommended by “legitimate, religious health care sharing ministries,” Silvera argues. “Unfortunately, Christian ministries are now the unwarranted target of this bill.”

Sanford and Jetton did not respond to multiple requests for comment.

But Eiman Siddiqui, chief of staff for Oliverson, did, saying, the bill “is not discriminatory, anti-religious freedom, or punitive to good actors. In fact, it maintains the status quo with regard to which ministries are included in the safe harbor regulation as unlicensed insurance, meaning that every healthcare sharing organization that currently operates in the state, both the religious ones and those that align themselves along ethical principles, will be included in these new regulations.”

Initially, concerns about HCSMs were raised in 2019 after charges were brought against a for-profit secular company, Aliera Healthcare. In June 2019, Texas Attorney General Ken Paxton sued Aliera, alleging it misled consumers. California, Washington, and other states also sued Aliera alleging it was misrepresenting one of its subsidiaries as an insurance plan, which Aliera denied.

Because of existing law, Aliera was sued, Talento argues, and there is no need to replace a law that works. “Legitimate health care sharing ministries go to great lengths to inform prospective members about their sharing guidelines, make them publicly available on their web sites, and work and to clarify that their sharing program is not an insurance plan,” the Alliance maintains.

Instead of targeting for-profit bad actors, HB 573 “singles out faith-based groups for regulation,” Silvera argues, targeting “only religious, non-profit health care sharing ministries. It leaves for-profit, non-religious sharing organizations untouched. Those non-religious organizations will continue to operate outside the scope of HB 573 while the bill’s burdensome framework will discourage Christian sharing organizations from offering Texas Christians a health care option that matches their budget and their beliefs.”

Siddiqui argues that “Ministries have raised concerns about the idea that non-religious sharing entities will not be included, but because the common-law definition of faith in Texas defines a faith as a religious or ethical principle, they will. In fact, those organizations have worked hard to be included in this bill because they know that if they are not included they will be shut down by Section 101.051 (b)(7) of the Insurance Code.”

Those opposed to the bill argue HB 573 violates the Texas Religious Freedom Restoration Act and the First Amendment to the Constitution. Oliverson’s bill “impairs the ability of people of faith to associate for the purpose of sharing health care costs and thereby tramples religious exercise protections under federal and state law,” Silvera argues.

According to the bill language, HB 573 prohibits ministries from communicating factual information about their programs, including free or discounted services included in membership, compels disclosure of member demographics, and dictates how HCSMs write the content of their advertisements, including the font size, among numerous requirements and disclosures only imposed on religious, not secular, organizations, critics argue.

“HB 537 is the exact opposite of limited government and ending government overreach,” Silvero adds. It “proposes costly and burdensome government regulations. It utilizes the heavy hand of government to mandate onerous operational requirements specifically to religious-based health care sharing ministries” that have faithfully followed the law, he argues.

But Siddiqui says the bill “is not punitive to good actors” but “mandates that their bad actor competitors must publicize just how much money they are not returning to members through sharing requests.” As a result, “the disclosures in this bill serve to help good actors and hurt bad actors, exactly as intended,” he adds.

Oliverson’s office also maintains that the bill does not violate the RFRA and that the state Department of Insurance “currently has the ability to shut down a healthcare sharing ministry that violates Chapter 1681 Insurance Code, which serves as precedent that the regulation of these actors will not violate RFRA.”

Currently, there are 32 safe harbor states, roughly 4 additional states that allow exemptions from their own individual mandates, and three states with some form of regulation, in addition to the federal ACA safe harbor exemption of HCSMs, according to the Alliance’s calculation.

The Commonwealth Fund has provided an online resource explaining the risks and benefits of HCSMs, which includes an overview of state regulations and comparisons of programs offered.