News Aggregation

Alycin Berry’s husband had just started a new job in early 2018 when the couple started to dig into his benefits. The amount they’d have to pay for health insurance, they realized, was “ridiculously expensive” — more than they could reasonably afford. Neither Berry, a stay-at-home mom, nor her husband had any major health conditions. They didn’t use medical care often. She had just had her first child and hoped to get pregnant soon with another. She just wanted to make sure they could get coverage for her maternity care.  The couple looked for something cheaper, ultimately settling on a health care sharing ministry. They would contribute hundreds of dollars per month, which was still less than the insurance premium. With major medical bills, participants in the ministry paid upfront, seeking discounts medical providers often offer to people who don’t have insurance. The health care sharing ministry would reimburse them after the fact. The benefits weren’t as generous as health insurance, but the ministry fit better in Berry’s family budget. The organization advertised its maternity benefits, specifically, and more broadly promised coverage for hospital visits and surgeries. There were stipulations: To enroll, members had to sign a declaration that they would align their lifestyles with its Catholic values. Those religious views played out in policy too: The health share wouldn’t cover a pregnancy conceived through in vitro fertilization, for instance. But Berry, a Catholic herself, wasn’t worried.  “It did feel like it was comparable to health insurance if not better than health insurance. They pitched it that way,” she said.  Then she tried to use it.  In 2019, Berry, now 37, miscarried at home, her first of three lost pregnancies. After visiting a doctor for follow-up care, Berry sought reimbursement from her health share. She was eventually able to get payment, but doing so required reams of paperwork, she said, including verifying that her pregnancy was conceived without fertility treatment. The process took several months. “It was kind of like, ‘What? This is crazy. We’re grieving this loss, we’re jumping through hoops to get this miscarriage care covered,’” she recalled.  Ministries like the one Berry joined are part of a constellation of alternatives to health insurance, cheaper and less regulated than those covered by the Affordable Care Act, and with far fewer consumer protections. Now, as Congress struggles to make a deal to extend subsidies for plans offered via the health law’s individual marketplace, those alternatives could see a surge in interest and enrollment. Tax credits used to help lower what consumers pay for marketplace insurance, which covered about 25 million Americans last year. But those credits expired at the end of 2025. Without them, marketplace premiums skyrocketed — many are more than doubling.  Final figures won’t be available for months, but preliminary government data suggests that enrollment in health insurance has fallen as a result, down by at least 1.4 million. A December survey from KFF, the nonpartisan health policy research, polling and journalism group, found that 1 in 4 marketplace enrollees said they would go without insurance if their premiums doubled. And historical trends suggest that some will try to fill in the gaps with skimpier but cheaper alternatives, including ministries like the one Berry used. “Whenever the costs go up, it’s just a golden marketing opportunity for sellers of anything other than comprehensive coverage to make the pitch they have a more affordable option,” said JoAnn Volk, a research professor at Georgetown University’s Center for Health Insurance Reforms, who has studied these organizations extensively. ”Health care sharing ministries are one of those.” Under the Affordable Care Act, health insurance is required to cover particular sets of benefits, including preventive care, maternity, mental health. Plans cannot impose lifetime caps on coverage. They can’t discriminate against preexisting conditions. They must spend at least 80 or 85 percent of premiums on medical care, depending on the type of plan. Insurance offerings that could violate those requirements face government scrutiny or even penalties. Those requirements don’t exist for health care sharing ministries, and there is no regulatory body tasked with overseeing them. Health care sharing ministries work on a theoretical sharing model: members pool resources, and the ministry decides what health expenses to cover. Ministries or health shares are usually religious, and allowed to deny coverage if it doesn’t align with their stated values. That in practice means significant limitations for women and queer people: Ministries typically don’t cover contraception or pregnancies that are not conceived by a heterosexual couple. Many won’t cover injuries or illnesses they deem the result of immoral choices —  including drug and alcohol use, which is more common among LGBTQ+ people. And ministries often exclude coverage for mental health needs, another area where LGBTQ+ people and women are more likely to require care. The Alliance of Health Care Sharing Ministries, a trade group that represents the vast majority of these groups, declined to comment. Enrollment in these ministries has soared since the passage of the Affordable Care Act, more than 15 years ago. The health law, which required individuals to have insurance, included an explicit carveout for these ministries. People wouldn’t be subject to the mandate if they used a ministry, so long as it existed prior to 1999. The idea was to accommodate small religious cost-sharing arrangements, which at the time only counted maybe 200,000 members. A 2023 report published by the Colorado Department of Insurance identified at least 1.7 million people across the country using ministries for their health coverage, though the authors said that was likely an undercount. Many of these arrangements instructed members to first ask medical providers for charity care — free or discounted treatment, which is reserved for those who don’t have health insurance, typically lower-income people — before submitting bills for reimbursement. A report that same year from the Government Accountability Office suggested that a disproportionate share of participants are from low-income households. National data is difficult to come by because no federal body tracks health care sharing ministries.  “There’s

Alycin Berry’s husband had just started a new job in early 2018 when the couple started to dig into his benefits. The amount they’d have to pay for health insurance, they realized, was “ridiculously expensive” — more than they could reasonably afford. Neither Berry, a stay-at-home mom, nor her husband had any major health conditions. They didn’t use medical care often. She had just had her first child and hoped to get pregnant soon with another. She just wanted to make sure they could get coverage for her maternity care.  The couple looked for something cheaper, ultimately settling on a health care sharing ministry. They would contribute hundreds of dollars per month, which was still less than the insurance premium. With major medical bills, participants in the ministry paid upfront, seeking discounts medical providers often offer to people who don’t have insurance. The health care sharing ministry would reimburse them after the fact. The benefits weren’t as generous as health insurance, but the ministry fit better in Berry’s family budget. The organization advertised its maternity benefits, specifically, and more broadly promised coverage for hospital visits and surgeries. There were stipulations: To enroll, members had to sign a declaration that they would align their lifestyles with its Catholic values. Those religious views played out in policy too: The health share wouldn’t cover a pregnancy conceived through in vitro fertilization, for instance. But Berry, a Catholic herself, wasn’t worried.  “It did feel like it was comparable to health insurance if not better than health insurance. They pitched it that way,” she said.  Then she tried to use it.  In 2019, Berry, now 37, miscarried at home, her first of three lost pregnancies. After visiting a doctor for follow-up care, Berry sought reimbursement from her health share. She was eventually able to get payment, but doing so required reams of paperwork, she said, including verifying that her pregnancy was conceived without fertility treatment. The process took several months. “It was kind of like, ‘What? This is crazy. We’re grieving this loss, we’re jumping through hoops to get this miscarriage care covered,’” she recalled.  Ministries like the one Berry joined are part of a constellation of alternatives to health insurance, cheaper and less regulated than those covered by the Affordable Care Act, and with far fewer consumer protections. Now, as Congress struggles to make a deal to extend subsidies for plans offered via the health law’s individual marketplace, those alternatives could see a surge in interest and enrollment. Tax credits used to help lower what consumers pay for marketplace insurance, which covered about 25 million Americans last year. But those credits expired at the end of 2025. Without them, marketplace premiums skyrocketed — many are more than doubling.  Final figures won’t be available for months, but preliminary government data suggests that enrollment in health insurance has fallen as a result, down by at least 1.4 million. A December survey from KFF, the nonpartisan health policy research, polling and journalism group, found that 1 in 4 marketplace enrollees said they would go without insurance if their premiums doubled. And historical trends suggest that some will try to fill in the gaps with skimpier but cheaper alternatives, including ministries like the one Berry used. “Whenever the costs go up, it’s just a golden marketing opportunity for sellers of anything other than comprehensive coverage to make the pitch they have a more affordable option,” said JoAnn Volk, a research professor at Georgetown University’s Center for Health Insurance Reforms, who has studied these organizations extensively. ”Health care sharing ministries are one of those.” Under the Affordable Care Act, health insurance is required to cover particular sets of benefits, including preventive care, maternity, mental health. Plans cannot impose lifetime caps on coverage. They can’t discriminate against preexisting conditions. They must spend at least 80 or 85 percent of premiums on medical care, depending on the type of plan. Insurance offerings that could violate those requirements face government scrutiny or even penalties. Those requirements don’t exist for health care sharing ministries, and there is no regulatory body tasked with overseeing them. Health care sharing ministries work on a theoretical sharing model: members pool resources, and the ministry decides what health expenses to cover. Ministries or health shares are usually religious, and allowed to deny coverage if it doesn’t align with their stated values. That in practice means significant limitations for women and queer people: Ministries typically don’t cover contraception or pregnancies that are not conceived by a heterosexual couple. Many won’t cover injuries or illnesses they deem the result of immoral choices —  including drug and alcohol use, which is more common among LGBTQ+ people. And ministries often exclude coverage for mental health needs, another area where LGBTQ+ people and women are more likely to require care. The Alliance of Health Care Sharing Ministries, a trade group that represents the vast majority of these groups, declined to comment. Enrollment in these ministries has soared since the passage of the Affordable Care Act, more than 15 years ago. The health law, which required individuals to have insurance, included an explicit carveout for these ministries. People wouldn’t be subject to the mandate if they used a ministry, so long as it existed prior to 1999. The idea was to accommodate small religious cost-sharing arrangements, which at the time only counted maybe 200,000 members. A 2023 report published by the Colorado Department of Insurance identified at least 1.7 million people across the country using ministries for their health coverage, though the authors said that was likely an undercount. Many of these arrangements instructed members to first ask medical providers for charity care — free or discounted treatment, which is reserved for those who don’t have health insurance, typically lower-income people — before submitting bills for reimbursement. A report that same year from the Government Accountability Office suggested that a disproportionate share of participants are from low-income households. National data is difficult to come by because no federal body tracks health care sharing ministries.  “There’s

Alycin Berry’s husband had just started a new job in early 2018 when the couple started to dig into his benefits. The amount they’d have to pay for health insurance, they realized, was “ridiculously expensive” — more than they could reasonably afford. Neither Berry, a stay-at-home mom, nor her husband had any major health conditions. They didn’t use medical care often. She had just had her first child and hoped to get pregnant soon with another. She just wanted to make sure they could get coverage for her maternity care.  The couple looked for something cheaper, ultimately settling on a health care sharing ministry. They would contribute hundreds of dollars per month, which was still less than the insurance premium. With major medical bills, participants in the ministry paid upfront, seeking discounts medical providers often offer to people who don’t have insurance. The health care sharing ministry would reimburse them after the fact. The benefits weren’t as generous as health insurance, but the ministry fit better in Berry’s family budget. The organization advertised its maternity benefits, specifically, and more broadly promised coverage for hospital visits and surgeries. There were stipulations: To enroll, members had to sign a declaration that they would align their lifestyles with its Catholic values. Those religious views played out in policy too: The health share wouldn’t cover a pregnancy conceived through in vitro fertilization, for instance. But Berry, a Catholic herself, wasn’t worried.  “It did feel like it was comparable to health insurance if not better than health insurance. They pitched it that way,” she said.  Then she tried to use it.  In 2019, Berry, now 37, miscarried at home, her first of three lost pregnancies. After visiting a doctor for follow-up care, Berry sought reimbursement from her health share. She was eventually able to get payment, but doing so required reams of paperwork, she said, including verifying that her pregnancy was conceived without fertility treatment. The process took several months. “It was kind of like, ‘What? This is crazy. We’re grieving this loss, we’re jumping through hoops to get this miscarriage care covered,’” she recalled.  Ministries like the one Berry joined are part of a constellation of alternatives to health insurance, cheaper and less regulated than those covered by the Affordable Care Act, and with far fewer consumer protections. Now, as Congress struggles to make a deal to extend subsidies for plans offered via the health law’s individual marketplace, those alternatives could see a surge in interest and enrollment. Tax credits used to help lower what consumers pay for marketplace insurance, which covered about 25 million Americans last year. But those credits expired at the end of 2025. Without them, marketplace premiums skyrocketed — many are more than doubling.  Final figures won’t be available for months, but preliminary government data suggests that enrollment in health insurance has fallen as a result, down by at least 1.4 million. A December survey from KFF, the nonpartisan health policy research, polling and journalism group, found that 1 in 4 marketplace enrollees said they would go without insurance if their premiums doubled. And historical trends suggest that some will try to fill in the gaps with skimpier but cheaper alternatives, including ministries like the one Berry used. “Whenever the costs go up, it’s just a golden marketing opportunity for sellers of anything other than comprehensive coverage to make the pitch they have a more affordable option,” said JoAnn Volk, a research professor at Georgetown University’s Center for Health Insurance Reforms, who has studied these organizations extensively. ”Health care sharing ministries are one of those.” Under the Affordable Care Act, health insurance is required to cover particular sets of benefits, including preventive care, maternity, mental health. Plans cannot impose lifetime caps on coverage. They can’t discriminate against preexisting conditions. They must spend at least 80 or 85 percent of premiums on medical care, depending on the type of plan. Insurance offerings that could violate those requirements face government scrutiny or even penalties. Those requirements don’t exist for health care sharing ministries, and there is no regulatory body tasked with overseeing them. Health care sharing ministries work on a theoretical sharing model: members pool resources, and the ministry decides what health expenses to cover. Ministries or health shares are usually religious, and allowed to deny coverage if it doesn’t align with their stated values. That in practice means significant limitations for women and queer people: Ministries typically don’t cover contraception or pregnancies that are not conceived by a heterosexual couple. Many won’t cover injuries or illnesses they deem the result of immoral choices —  including drug and alcohol use, which is more common among LGBTQ+ people. And ministries often exclude coverage for mental health needs, another area where LGBTQ+ people and women are more likely to require care. The Alliance of Health Care Sharing Ministries, a trade group that represents the vast majority of these groups, declined to comment. Enrollment in these ministries has soared since the passage of the Affordable Care Act, more than 15 years ago. The health law, which required individuals to have insurance, included an explicit carveout for these ministries. People wouldn’t be subject to the mandate if they used a ministry, so long as it existed prior to 1999. The idea was to accommodate small religious cost-sharing arrangements, which at the time only counted maybe 200,000 members. A 2023 report published by the Colorado Department of Insurance identified at least 1.7 million people across the country using ministries for their health coverage, though the authors said that was likely an undercount. Many of these arrangements instructed members to first ask medical providers for charity care — free or discounted treatment, which is reserved for those who don’t have health insurance, typically lower-income people — before submitting bills for reimbursement. A report that same year from the Government Accountability Office suggested that a disproportionate share of participants are from low-income households. National data is difficult to come by because no federal body tracks health care sharing ministries.  “There’s

Alycin Berry’s husband had just started a new job in early 2018 when the couple started to dig into his benefits. The amount they’d have to pay for health insurance, they realized, was “ridiculously expensive” — more than they could reasonably afford. Neither Berry, a stay-at-home mom, nor her husband had any major health conditions. They didn’t use medical care often. She had just had her first child and hoped to get pregnant soon with another. She just wanted to make sure they could get coverage for her maternity care.  The couple looked for something cheaper, ultimately settling on a health care sharing ministry. They would contribute hundreds of dollars per month, which was still less than the insurance premium. With major medical bills, participants in the ministry paid upfront, seeking discounts medical providers often offer to people who don’t have insurance. The health care sharing ministry would reimburse them after the fact. The benefits weren’t as generous as health insurance, but the ministry fit better in Berry’s family budget. The organization advertised its maternity benefits, specifically, and more broadly promised coverage for hospital visits and surgeries. There were stipulations: To enroll, members had to sign a declaration that they would align their lifestyles with its Catholic values. Those religious views played out in policy too: The health share wouldn’t cover a pregnancy conceived through in vitro fertilization, for instance. But Berry, a Catholic herself, wasn’t worried.  “It did feel like it was comparable to health insurance if not better than health insurance. They pitched it that way,” she said.  Then she tried to use it.  In 2019, Berry, now 37, miscarried at home, her first of three lost pregnancies. After visiting a doctor for follow-up care, Berry sought reimbursement from her health share. She was eventually able to get payment, but doing so required reams of paperwork, she said, including verifying that her pregnancy was conceived without fertility treatment. The process took several months. “It was kind of like, ‘What? This is crazy. We’re grieving this loss, we’re jumping through hoops to get this miscarriage care covered,’” she recalled.  Ministries like the one Berry joined are part of a constellation of alternatives to health insurance, cheaper and less regulated than those covered by the Affordable Care Act, and with far fewer consumer protections. Now, as Congress struggles to make a deal to extend subsidies for plans offered via the health law’s individual marketplace, those alternatives could see a surge in interest and enrollment. Tax credits used to help lower what consumers pay for marketplace insurance, which covered about 25 million Americans last year. But those credits expired at the end of 2025. Without them, marketplace premiums skyrocketed — many are more than doubling.  Final figures won’t be available for months, but preliminary government data suggests that enrollment in health insurance has fallen as a result, down by at least 1.4 million. A December survey from KFF, the nonpartisan health policy research, polling and journalism group, found that 1 in 4 marketplace enrollees said they would go without insurance if their premiums doubled. And historical trends suggest that some will try to fill in the gaps with skimpier but cheaper alternatives, including ministries like the one Berry used. “Whenever the costs go up, it’s just a golden marketing opportunity for sellers of anything other than comprehensive coverage to make the pitch they have a more affordable option,” said JoAnn Volk, a research professor at Georgetown University’s Center for Health Insurance Reforms, who has studied these organizations extensively. ”Health care sharing ministries are one of those.” Under the Affordable Care Act, health insurance is required to cover particular sets of benefits, including preventive care, maternity, mental health. Plans cannot impose lifetime caps on coverage. They can’t discriminate against preexisting conditions. They must spend at least 80 or 85 percent of premiums on medical care, depending on the type of plan. Insurance offerings that could violate those requirements face government scrutiny or even penalties. Those requirements don’t exist for health care sharing ministries, and there is no regulatory body tasked with overseeing them. Health care sharing ministries work on a theoretical sharing model: members pool resources, and the ministry decides what health expenses to cover. Ministries or health shares are usually religious, and allowed to deny coverage if it doesn’t align with their stated values. That in practice means significant limitations for women and queer people: Ministries typically don’t cover contraception or pregnancies that are not conceived by a heterosexual couple. Many won’t cover injuries or illnesses they deem the result of immoral choices —  including drug and alcohol use, which is more common among LGBTQ+ people. And ministries often exclude coverage for mental health needs, another area where LGBTQ+ people and women are more likely to require care. The Alliance of Health Care Sharing Ministries, a trade group that represents the vast majority of these groups, declined to comment. Enrollment in these ministries has soared since the passage of the Affordable Care Act, more than 15 years ago. The health law, which required individuals to have insurance, included an explicit carveout for these ministries. People wouldn’t be subject to the mandate if they used a ministry, so long as it existed prior to 1999. The idea was to accommodate small religious cost-sharing arrangements, which at the time only counted maybe 200,000 members. A 2023 report published by the Colorado Department of Insurance identified at least 1.7 million people across the country using ministries for their health coverage, though the authors said that was likely an undercount. Many of these arrangements instructed members to first ask medical providers for charity care — free or discounted treatment, which is reserved for those who don’t have health insurance, typically lower-income people — before submitting bills for reimbursement. A report that same year from the Government Accountability Office suggested that a disproportionate share of participants are from low-income households. National data is difficult to come by because no federal body tracks health care sharing ministries.  “There’s

Alycin Berry’s husband had just started a new job in early 2018 when the couple started to dig into his benefits. The amount they’d have to pay for health insurance, they realized, was “ridiculously expensive” — more than they could reasonably afford. Neither Berry, a stay-at-home mom, nor her husband had any major health conditions. They didn’t use medical care often. She had just had her first child and hoped to get pregnant soon with another. She just wanted to make sure they could get coverage for her maternity care.  The couple looked for something cheaper, ultimately settling on a health care sharing ministry. They would contribute hundreds of dollars per month, which was still less than the insurance premium. With major medical bills, participants in the ministry paid upfront, seeking discounts medical providers often offer to people who don’t have insurance. The health care sharing ministry would reimburse them after the fact. The benefits weren’t as generous as health insurance, but the ministry fit better in Berry’s family budget. The organization advertised its maternity benefits, specifically, and more broadly promised coverage for hospital visits and surgeries. There were stipulations: To enroll, members had to sign a declaration that they would align their lifestyles with its Catholic values. Those religious views played out in policy too: The health share wouldn’t cover a pregnancy conceived through in vitro fertilization, for instance. But Berry, a Catholic herself, wasn’t worried.  “It did feel like it was comparable to health insurance if not better than health insurance. They pitched it that way,” she said.  Then she tried to use it.  In 2019, Berry, now 37, miscarried at home, her first of three lost pregnancies. After visiting a doctor for follow-up care, Berry sought reimbursement from her health share. She was eventually able to get payment, but doing so required reams of paperwork, she said, including verifying that her pregnancy was conceived without fertility treatment. The process took several months. “It was kind of like, ‘What? This is crazy. We’re grieving this loss, we’re jumping through hoops to get this miscarriage care covered,’” she recalled.  Ministries like the one Berry joined are part of a constellation of alternatives to health insurance, cheaper and less regulated than those covered by the Affordable Care Act, and with far fewer consumer protections. Now, as Congress struggles to make a deal to extend subsidies for plans offered via the health law’s individual marketplace, those alternatives could see a surge in interest and enrollment. Tax credits used to help lower what consumers pay for marketplace insurance, which covered about 25 million Americans last year. But those credits expired at the end of 2025. Without them, marketplace premiums skyrocketed — many are more than doubling.  Final figures won’t be available for months, but preliminary government data suggests that enrollment in health insurance has fallen as a result, down by at least 1.4 million. A December survey from KFF, the nonpartisan health policy research, polling and journalism group, found that 1 in 4 marketplace enrollees said they would go without insurance if their premiums doubled. And historical trends suggest that some will try to fill in the gaps with skimpier but cheaper alternatives, including ministries like the one Berry used. “Whenever the costs go up, it’s just a golden marketing opportunity for sellers of anything other than comprehensive coverage to make the pitch they have a more affordable option,” said JoAnn Volk, a research professor at Georgetown University’s Center for Health Insurance Reforms, who has studied these organizations extensively. ”Health care sharing ministries are one of those.” Under the Affordable Care Act, health insurance is required to cover particular sets of benefits, including preventive care, maternity, mental health. Plans cannot impose lifetime caps on coverage. They can’t discriminate against preexisting conditions. They must spend at least 80 or 85 percent of premiums on medical care, depending on the type of plan. Insurance offerings that could violate those requirements face government scrutiny or even penalties. Those requirements don’t exist for health care sharing ministries, and there is no regulatory body tasked with overseeing them. Health care sharing ministries work on a theoretical sharing model: members pool resources, and the ministry decides what health expenses to cover. Ministries or health shares are usually religious, and allowed to deny coverage if it doesn’t align with their stated values. That in practice means significant limitations for women and queer people: Ministries typically don’t cover contraception or pregnancies that are not conceived by a heterosexual couple. Many won’t cover injuries or illnesses they deem the result of immoral choices —  including drug and alcohol use, which is more common among LGBTQ+ people. And ministries often exclude coverage for mental health needs, another area where LGBTQ+ people and women are more likely to require care. The Alliance of Health Care Sharing Ministries, a trade group that represents the vast majority of these groups, declined to comment. Enrollment in these ministries has soared since the passage of the Affordable Care Act, more than 15 years ago. The health law, which required individuals to have insurance, included an explicit carveout for these ministries. People wouldn’t be subject to the mandate if they used a ministry, so long as it existed prior to 1999. The idea was to accommodate small religious cost-sharing arrangements, which at the time only counted maybe 200,000 members. A 2023 report published by the Colorado Department of Insurance identified at least 1.7 million people across the country using ministries for their health coverage, though the authors said that was likely an undercount. Many of these arrangements instructed members to first ask medical providers for charity care — free or discounted treatment, which is reserved for those who don’t have health insurance, typically lower-income people — before submitting bills for reimbursement. A report that same year from the Government Accountability Office suggested that a disproportionate share of participants are from low-income households. National data is difficult to come by because no federal body tracks health care sharing ministries.  “There’s

Alycin Berry’s husband had just started a new job in early 2018 when the couple started to dig into his benefits. The amount they’d have to pay for health insurance, they realized, was “ridiculously expensive” — more than they could reasonably afford. Neither Berry, a stay-at-home mom, nor her husband had any major health conditions. They didn’t use medical care often. She had just had her first child and hoped to get pregnant soon with another. She just wanted to make sure they could get coverage for her maternity care.  The couple looked for something cheaper, ultimately settling on a health care sharing ministry. They would contribute hundreds of dollars per month, which was still less than the insurance premium. With major medical bills, participants in the ministry paid upfront, seeking discounts medical providers often offer to people who don’t have insurance. The health care sharing ministry would reimburse them after the fact. The benefits weren’t as generous as health insurance, but the ministry fit better in Berry’s family budget. The organization advertised its maternity benefits, specifically, and more broadly promised coverage for hospital visits and surgeries. There were stipulations: To enroll, members had to sign a declaration that they would align their lifestyles with its Catholic values. Those religious views played out in policy too: The health share wouldn’t cover a pregnancy conceived through in vitro fertilization, for instance. But Berry, a Catholic herself, wasn’t worried.  “It did feel like it was comparable to health insurance if not better than health insurance. They pitched it that way,” she said.  Then she tried to use it.  In 2019, Berry, now 37, miscarried at home, her first of three lost pregnancies. After visiting a doctor for follow-up care, Berry sought reimbursement from her health share. She was eventually able to get payment, but doing so required reams of paperwork, she said, including verifying that her pregnancy was conceived without fertility treatment. The process took several months. “It was kind of like, ‘What? This is crazy. We’re grieving this loss, we’re jumping through hoops to get this miscarriage care covered,’” she recalled.  Ministries like the one Berry joined are part of a constellation of alternatives to health insurance, cheaper and less regulated than those covered by the Affordable Care Act, and with far fewer consumer protections. Now, as Congress struggles to make a deal to extend subsidies for plans offered via the health law’s individual marketplace, those alternatives could see a surge in interest and enrollment. Tax credits used to help lower what consumers pay for marketplace insurance, which covered about 25 million Americans last year. But those credits expired at the end of 2025. Without them, marketplace premiums skyrocketed — many are more than doubling.  Final figures won’t be available for months, but preliminary government data suggests that enrollment in health insurance has fallen as a result, down by at least 1.4 million. A December survey from KFF, the nonpartisan health policy research, polling and journalism group, found that 1 in 4 marketplace enrollees said they would go without insurance if their premiums doubled. And historical trends suggest that some will try to fill in the gaps with skimpier but cheaper alternatives, including ministries like the one Berry used. “Whenever the costs go up, it’s just a golden marketing opportunity for sellers of anything other than comprehensive coverage to make the pitch they have a more affordable option,” said JoAnn Volk, a research professor at Georgetown University’s Center for Health Insurance Reforms, who has studied these organizations extensively. ”Health care sharing ministries are one of those.” Under the Affordable Care Act, health insurance is required to cover particular sets of benefits, including preventive care, maternity, mental health. Plans cannot impose lifetime caps on coverage. They can’t discriminate against preexisting conditions. They must spend at least 80 or 85 percent of premiums on medical care, depending on the type of plan. Insurance offerings that could violate those requirements face government scrutiny or even penalties. Those requirements don’t exist for health care sharing ministries, and there is no regulatory body tasked with overseeing them. Health care sharing ministries work on a theoretical sharing model: members pool resources, and the ministry decides what health expenses to cover. Ministries or health shares are usually religious, and allowed to deny coverage if it doesn’t align with their stated values. That in practice means significant limitations for women and queer people: Ministries typically don’t cover contraception or pregnancies that are not conceived by a heterosexual couple. Many won’t cover injuries or illnesses they deem the result of immoral choices —  including drug and alcohol use, which is more common among LGBTQ+ people. And ministries often exclude coverage for mental health needs, another area where LGBTQ+ people and women are more likely to require care. The Alliance of Health Care Sharing Ministries, a trade group that represents the vast majority of these groups, declined to comment. Enrollment in these ministries has soared since the passage of the Affordable Care Act, more than 15 years ago. The health law, which required individuals to have insurance, included an explicit carveout for these ministries. People wouldn’t be subject to the mandate if they used a ministry, so long as it existed prior to 1999. The idea was to accommodate small religious cost-sharing arrangements, which at the time only counted maybe 200,000 members. A 2023 report published by the Colorado Department of Insurance identified at least 1.7 million people across the country using ministries for their health coverage, though the authors said that was likely an undercount. Many of these arrangements instructed members to first ask medical providers for charity care — free or discounted treatment, which is reserved for those who don’t have health insurance, typically lower-income people — before submitting bills for reimbursement. A report that same year from the Government Accountability Office suggested that a disproportionate share of participants are from low-income households. National data is difficult to come by because no federal body tracks health care sharing ministries.  “There’s

Alycin Berry’s husband had just started a new job in early 2018 when the couple started to dig into his benefits. The amount they’d have to pay for health insurance, they realized, was “ridiculously expensive” — more than they could reasonably afford. Neither Berry, a stay-at-home mom, nor her husband had any major health conditions. They didn’t use medical care often. She had just had her first child and hoped to get pregnant soon with another. She just wanted to make sure they could get coverage for her maternity care.  The couple looked for something cheaper, ultimately settling on a health care sharing ministry. They would contribute hundreds of dollars per month, which was still less than the insurance premium. With major medical bills, participants in the ministry paid upfront, seeking discounts medical providers often offer to people who don’t have insurance. The health care sharing ministry would reimburse them after the fact. The benefits weren’t as generous as health insurance, but the ministry fit better in Berry’s family budget. The organization advertised its maternity benefits, specifically, and more broadly promised coverage for hospital visits and surgeries. There were stipulations: To enroll, members had to sign a declaration that they would align their lifestyles with its Catholic values. Those religious views played out in policy too: The health share wouldn’t cover a pregnancy conceived through in vitro fertilization, for instance. But Berry, a Catholic herself, wasn’t worried.  “It did feel like it was comparable to health insurance if not better than health insurance. They pitched it that way,” she said.  Then she tried to use it.  In 2019, Berry, now 37, miscarried at home, her first of three lost pregnancies. After visiting a doctor for follow-up care, Berry sought reimbursement from her health share. She was eventually able to get payment, but doing so required reams of paperwork, she said, including verifying that her pregnancy was conceived without fertility treatment. The process took several months. “It was kind of like, ‘What? This is crazy. We’re grieving this loss, we’re jumping through hoops to get this miscarriage care covered,’” she recalled.  Ministries like the one Berry joined are part of a constellation of alternatives to health insurance, cheaper and less regulated than those covered by the Affordable Care Act, and with far fewer consumer protections. Now, as Congress struggles to make a deal to extend subsidies for plans offered via the health law’s individual marketplace, those alternatives could see a surge in interest and enrollment. Tax credits used to help lower what consumers pay for marketplace insurance, which covered about 25 million Americans last year. But those credits expired at the end of 2025. Without them, marketplace premiums skyrocketed — many are more than doubling.  Final figures won’t be available for months, but preliminary government data suggests that enrollment in health insurance has fallen as a result, down by at least 1.4 million. A December survey from KFF, the nonpartisan health policy research, polling and journalism group, found that 1 in 4 marketplace enrollees said they would go without insurance if their premiums doubled. And historical trends suggest that some will try to fill in the gaps with skimpier but cheaper alternatives, including ministries like the one Berry used. “Whenever the costs go up, it’s just a golden marketing opportunity for sellers of anything other than comprehensive coverage to make the pitch they have a more affordable option,” said JoAnn Volk, a research professor at Georgetown University’s Center for Health Insurance Reforms, who has studied these organizations extensively. ”Health care sharing ministries are one of those.” Under the Affordable Care Act, health insurance is required to cover particular sets of benefits, including preventive care, maternity, mental health. Plans cannot impose lifetime caps on coverage. They can’t discriminate against preexisting conditions. They must spend at least 80 or 85 percent of premiums on medical care, depending on the type of plan. Insurance offerings that could violate those requirements face government scrutiny or even penalties. Those requirements don’t exist for health care sharing ministries, and there is no regulatory body tasked with overseeing them. Health care sharing ministries work on a theoretical sharing model: members pool resources, and the ministry decides what health expenses to cover. Ministries or health shares are usually religious, and allowed to deny coverage if it doesn’t align with their stated values. That in practice means significant limitations for women and queer people: Ministries typically don’t cover contraception or pregnancies that are not conceived by a heterosexual couple. Many won’t cover injuries or illnesses they deem the result of immoral choices —  including drug and alcohol use, which is more common among LGBTQ+ people. And ministries often exclude coverage for mental health needs, another area where LGBTQ+ people and women are more likely to require care. The Alliance of Health Care Sharing Ministries, a trade group that represents the vast majority of these groups, declined to comment. Enrollment in these ministries has soared since the passage of the Affordable Care Act, more than 15 years ago. The health law, which required individuals to have insurance, included an explicit carveout for these ministries. People wouldn’t be subject to the mandate if they used a ministry, so long as it existed prior to 1999. The idea was to accommodate small religious cost-sharing arrangements, which at the time only counted maybe 200,000 members. A 2023 report published by the Colorado Department of Insurance identified at least 1.7 million people across the country using ministries for their health coverage, though the authors said that was likely an undercount. Many of these arrangements instructed members to first ask medical providers for charity care — free or discounted treatment, which is reserved for those who don’t have health insurance, typically lower-income people — before submitting bills for reimbursement. A report that same year from the Government Accountability Office suggested that a disproportionate share of participants are from low-income households. National data is difficult to come by because no federal body tracks health care sharing ministries.  “There’s

Alycin Berry’s husband had just started a new job in early 2018 when the couple started to dig into his benefits. The amount they’d have to pay for health insurance, they realized, was “ridiculously expensive” — more than they could reasonably afford. Neither Berry, a stay-at-home mom, nor her husband had any major health conditions. They didn’t use medical care often. She had just had her first child and hoped to get pregnant soon with another. She just wanted to make sure they could get coverage for her maternity care.  The couple looked for something cheaper, ultimately settling on a health care sharing ministry. They would contribute hundreds of dollars per month, which was still less than the insurance premium. With major medical bills, participants in the ministry paid upfront, seeking discounts medical providers often offer to people who don’t have insurance. The health care sharing ministry would reimburse them after the fact. The benefits weren’t as generous as health insurance, but the ministry fit better in Berry’s family budget. The organization advertised its maternity benefits, specifically, and more broadly promised coverage for hospital visits and surgeries. There were stipulations: To enroll, members had to sign a declaration that they would align their lifestyles with its Catholic values. Those religious views played out in policy too: The health share wouldn’t cover a pregnancy conceived through in vitro fertilization, for instance. But Berry, a Catholic herself, wasn’t worried.  “It did feel like it was comparable to health insurance if not better than health insurance. They pitched it that way,” she said.  Then she tried to use it.  In 2019, Berry, now 37, miscarried at home, her first of three lost pregnancies. After visiting a doctor for follow-up care, Berry sought reimbursement from her health share. She was eventually able to get payment, but doing so required reams of paperwork, she said, including verifying that her pregnancy was conceived without fertility treatment. The process took several months. “It was kind of like, ‘What? This is crazy. We’re grieving this loss, we’re jumping through hoops to get this miscarriage care covered,’” she recalled.  Ministries like the one Berry joined are part of a constellation of alternatives to health insurance, cheaper and less regulated than those covered by the Affordable Care Act, and with far fewer consumer protections. Now, as Congress struggles to make a deal to extend subsidies for plans offered via the health law’s individual marketplace, those alternatives could see a surge in interest and enrollment. Tax credits used to help lower what consumers pay for marketplace insurance, which covered about 25 million Americans last year. But those credits expired at the end of 2025. Without them, marketplace premiums skyrocketed — many are more than doubling.  Final figures won’t be available for months, but preliminary government data suggests that enrollment in health insurance has fallen as a result, down by at least 1.4 million. A December survey from KFF, the nonpartisan health policy research, polling and journalism group, found that 1 in 4 marketplace enrollees said they would go without insurance if their premiums doubled. And historical trends suggest that some will try to fill in the gaps with skimpier but cheaper alternatives, including ministries like the one Berry used. “Whenever the costs go up, it’s just a golden marketing opportunity for sellers of anything other than comprehensive coverage to make the pitch they have a more affordable option,” said JoAnn Volk, a research professor at Georgetown University’s Center for Health Insurance Reforms, who has studied these organizations extensively. ”Health care sharing ministries are one of those.” Under the Affordable Care Act, health insurance is required to cover particular sets of benefits, including preventive care, maternity, mental health. Plans cannot impose lifetime caps on coverage. They can’t discriminate against preexisting conditions. They must spend at least 80 or 85 percent of premiums on medical care, depending on the type of plan. Insurance offerings that could violate those requirements face government scrutiny or even penalties. Those requirements don’t exist for health care sharing ministries, and there is no regulatory body tasked with overseeing them. Health care sharing ministries work on a theoretical sharing model: members pool resources, and the ministry decides what health expenses to cover. Ministries or health shares are usually religious, and allowed to deny coverage if it doesn’t align with their stated values. That in practice means significant limitations for women and queer people: Ministries typically don’t cover contraception or pregnancies that are not conceived by a heterosexual couple. Many won’t cover injuries or illnesses they deem the result of immoral choices —  including drug and alcohol use, which is more common among LGBTQ+ people. And ministries often exclude coverage for mental health needs, another area where LGBTQ+ people and women are more likely to require care. The Alliance of Health Care Sharing Ministries, a trade group that represents the vast majority of these groups, declined to comment. Enrollment in these ministries has soared since the passage of the Affordable Care Act, more than 15 years ago. The health law, which required individuals to have insurance, included an explicit carveout for these ministries. People wouldn’t be subject to the mandate if they used a ministry, so long as it existed prior to 1999. The idea was to accommodate small religious cost-sharing arrangements, which at the time only counted maybe 200,000 members. A 2023 report published by the Colorado Department of Insurance identified at least 1.7 million people across the country using ministries for their health coverage, though the authors said that was likely an undercount. Many of these arrangements instructed members to first ask medical providers for charity care — free or discounted treatment, which is reserved for those who don’t have health insurance, typically lower-income people — before submitting bills for reimbursement. A report that same year from the Government Accountability Office suggested that a disproportionate share of participants are from low-income households. National data is difficult to come by because no federal body tracks health care sharing ministries.  “There’s

Alycin Berry’s husband had just started a new job in early 2018 when the couple started to dig into his benefits. The amount they’d have to pay for health insurance, they realized, was “ridiculously expensive” — more than they could reasonably afford. Neither Berry, a stay-at-home mom, nor her husband had any major health conditions. They didn’t use medical care often. She had just had her first child and hoped to get pregnant soon with another. She just wanted to make sure they could get coverage for her maternity care.  The couple looked for something cheaper, ultimately settling on a health care sharing ministry. They would contribute hundreds of dollars per month, which was still less than the insurance premium. With major medical bills, participants in the ministry paid upfront, seeking discounts medical providers often offer to people who don’t have insurance. The health care sharing ministry would reimburse them after the fact. The benefits weren’t as generous as health insurance, but the ministry fit better in Berry’s family budget. The organization advertised its maternity benefits, specifically, and more broadly promised coverage for hospital visits and surgeries. There were stipulations: To enroll, members had to sign a declaration that they would align their lifestyles with its Catholic values. Those religious views played out in policy too: The health share wouldn’t cover a pregnancy conceived through in vitro fertilization, for instance. But Berry, a Catholic herself, wasn’t worried.  “It did feel like it was comparable to health insurance if not better than health insurance. They pitched it that way,” she said.  Then she tried to use it.  In 2019, Berry, now 37, miscarried at home, her first of three lost pregnancies. After visiting a doctor for follow-up care, Berry sought reimbursement from her health share. She was eventually able to get payment, but doing so required reams of paperwork, she said, including verifying that her pregnancy was conceived without fertility treatment. The process took several months. “It was kind of like, ‘What? This is crazy. We’re grieving this loss, we’re jumping through hoops to get this miscarriage care covered,’” she recalled.  Ministries like the one Berry joined are part of a constellation of alternatives to health insurance, cheaper and less regulated than those covered by the Affordable Care Act, and with far fewer consumer protections. Now, as Congress struggles to make a deal to extend subsidies for plans offered via the health law’s individual marketplace, those alternatives could see a surge in interest and enrollment. Tax credits used to help lower what consumers pay for marketplace insurance, which covered about 25 million Americans last year. But those credits expired at the end of 2025. Without them, marketplace premiums skyrocketed — many are more than doubling.  Final figures won’t be available for months, but preliminary government data suggests that enrollment in health insurance has fallen as a result, down by at least 1.4 million. A December survey from KFF, the nonpartisan health policy research, polling and journalism group, found that 1 in 4 marketplace enrollees said they would go without insurance if their premiums doubled. And historical trends suggest that some will try to fill in the gaps with skimpier but cheaper alternatives, including ministries like the one Berry used. “Whenever the costs go up, it’s just a golden marketing opportunity for sellers of anything other than comprehensive coverage to make the pitch they have a more affordable option,” said JoAnn Volk, a research professor at Georgetown University’s Center for Health Insurance Reforms, who has studied these organizations extensively. ”Health care sharing ministries are one of those.” Under the Affordable Care Act, health insurance is required to cover particular sets of benefits, including preventive care, maternity, mental health. Plans cannot impose lifetime caps on coverage. They can’t discriminate against preexisting conditions. They must spend at least 80 or 85 percent of premiums on medical care, depending on the type of plan. Insurance offerings that could violate those requirements face government scrutiny or even penalties. Those requirements don’t exist for health care sharing ministries, and there is no regulatory body tasked with overseeing them. Health care sharing ministries work on a theoretical sharing model: members pool resources, and the ministry decides what health expenses to cover. Ministries or health shares are usually religious, and allowed to deny coverage if it doesn’t align with their stated values. That in practice means significant limitations for women and queer people: Ministries typically don’t cover contraception or pregnancies that are not conceived by a heterosexual couple. Many won’t cover injuries or illnesses they deem the result of immoral choices —  including drug and alcohol use, which is more common among LGBTQ+ people. And ministries often exclude coverage for mental health needs, another area where LGBTQ+ people and women are more likely to require care. The Alliance of Health Care Sharing Ministries, a trade group that represents the vast majority of these groups, declined to comment. Enrollment in these ministries has soared since the passage of the Affordable Care Act, more than 15 years ago. The health law, which required individuals to have insurance, included an explicit carveout for these ministries. People wouldn’t be subject to the mandate if they used a ministry, so long as it existed prior to 1999. The idea was to accommodate small religious cost-sharing arrangements, which at the time only counted maybe 200,000 members. A 2023 report published by the Colorado Department of Insurance identified at least 1.7 million people across the country using ministries for their health coverage, though the authors said that was likely an undercount. Many of these arrangements instructed members to first ask medical providers for charity care — free or discounted treatment, which is reserved for those who don’t have health insurance, typically lower-income people — before submitting bills for reimbursement. A report that same year from the Government Accountability Office suggested that a disproportionate share of participants are from low-income households. National data is difficult to come by because no federal body tracks health care sharing ministries.  “There’s

Alycin Berry’s husband had just started a new job in early 2018 when the couple started to dig into his benefits. The amount they’d have to pay for health insurance, they realized, was “ridiculously expensive” — more than they could reasonably afford. Neither Berry, a stay-at-home mom, nor her husband had any major health conditions. They didn’t use medical care often. She had just had her first child and hoped to get pregnant soon with another. She just wanted to make sure they could get coverage for her maternity care.  The couple looked for something cheaper, ultimately settling on a health care sharing ministry. They would contribute hundreds of dollars per month, which was still less than the insurance premium. With major medical bills, participants in the ministry paid upfront, seeking discounts medical providers often offer to people who don’t have insurance. The health care sharing ministry would reimburse them after the fact. The benefits weren’t as generous as health insurance, but the ministry fit better in Berry’s family budget. The organization advertised its maternity benefits, specifically, and more broadly promised coverage for hospital visits and surgeries. There were stipulations: To enroll, members had to sign a declaration that they would align their lifestyles with its Catholic values. Those religious views played out in policy too: The health share wouldn’t cover a pregnancy conceived through in vitro fertilization, for instance. But Berry, a Catholic herself, wasn’t worried.  “It did feel like it was comparable to health insurance if not better than health insurance. They pitched it that way,” she said.  Then she tried to use it.  In 2019, Berry, now 37, miscarried at home, her first of three lost pregnancies. After visiting a doctor for follow-up care, Berry sought reimbursement from her health share. She was eventually able to get payment, but doing so required reams of paperwork, she said, including verifying that her pregnancy was conceived without fertility treatment. The process took several months. “It was kind of like, ‘What? This is crazy. We’re grieving this loss, we’re jumping through hoops to get this miscarriage care covered,’” she recalled.  Ministries like the one Berry joined are part of a constellation of alternatives to health insurance, cheaper and less regulated than those covered by the Affordable Care Act, and with far fewer consumer protections. Now, as Congress struggles to make a deal to extend subsidies for plans offered via the health law’s individual marketplace, those alternatives could see a surge in interest and enrollment. Tax credits used to help lower what consumers pay for marketplace insurance, which covered about 25 million Americans last year. But those credits expired at the end of 2025. Without them, marketplace premiums skyrocketed — many are more than doubling.  Final figures won’t be available for months, but preliminary government data suggests that enrollment in health insurance has fallen as a result, down by at least 1.4 million. A December survey from KFF, the nonpartisan health policy research, polling and journalism group, found that 1 in 4 marketplace enrollees said they would go without insurance if their premiums doubled. And historical trends suggest that some will try to fill in the gaps with skimpier but cheaper alternatives, including ministries like the one Berry used. “Whenever the costs go up, it’s just a golden marketing opportunity for sellers of anything other than comprehensive coverage to make the pitch they have a more affordable option,” said JoAnn Volk, a research professor at Georgetown University’s Center for Health Insurance Reforms, who has studied these organizations extensively. ”Health care sharing ministries are one of those.” Under the Affordable Care Act, health insurance is required to cover particular sets of benefits, including preventive care, maternity, mental health. Plans cannot impose lifetime caps on coverage. They can’t discriminate against preexisting conditions. They must spend at least 80 or 85 percent of premiums on medical care, depending on the type of plan. Insurance offerings that could violate those requirements face government scrutiny or even penalties. Those requirements don’t exist for health care sharing ministries, and there is no regulatory body tasked with overseeing them. Health care sharing ministries work on a theoretical sharing model: members pool resources, and the ministry decides what health expenses to cover. Ministries or health shares are usually religious, and allowed to deny coverage if it doesn’t align with their stated values. That in practice means significant limitations for women and queer people: Ministries typically don’t cover contraception or pregnancies that are not conceived by a heterosexual couple. Many won’t cover injuries or illnesses they deem the result of immoral choices —  including drug and alcohol use, which is more common among LGBTQ+ people. And ministries often exclude coverage for mental health needs, another area where LGBTQ+ people and women are more likely to require care. The Alliance of Health Care Sharing Ministries, a trade group that represents the vast majority of these groups, declined to comment. Enrollment in these ministries has soared since the passage of the Affordable Care Act, more than 15 years ago. The health law, which required individuals to have insurance, included an explicit carveout for these ministries. People wouldn’t be subject to the mandate if they used a ministry, so long as it existed prior to 1999. The idea was to accommodate small religious cost-sharing arrangements, which at the time only counted maybe 200,000 members. A 2023 report published by the Colorado Department of Insurance identified at least 1.7 million people across the country using ministries for their health coverage, though the authors said that was likely an undercount. Many of these arrangements instructed members to first ask medical providers for charity care — free or discounted treatment, which is reserved for those who don’t have health insurance, typically lower-income people — before submitting bills for reimbursement. A report that same year from the Government Accountability Office suggested that a disproportionate share of participants are from low-income households. National data is difficult to come by because no federal body tracks health care sharing ministries.  “There’s