When Meehan’s doctor recommended that he undergo back surgery, Meehan asked Aliera/Trinity whether the procedure was approved. He was advised that no pre-approval was necessary. After the surgery, Meehan sought payment for approximately $200,000 in medical bills. Aliera and Trinity then declined to pay, claiming that his back surgery was due to a “preexisting condition.”

At the time, Meehan did not fully understand that his monthly premiums were not for actual “insurance,” but rather a Christian-oriented “healthcare cost-sharing ministry” which, like others of its type, pools individual monthly contributions from members to cover (in theory) the medical expenses incurred by those same members when they get sick or are hospitalized. Over one million Americans are enrolled in these “faith-based” healthcare sharing “ministries” (referred to by the insurance industry as HCSMs), which operate legally in nearly every U.S.state.

These plans, which resemble large, coordinated GoFundMe operations, take pains to highlight their “faith-based” origins; nearly all of them make a point of refusing to pay for conditions traceable to a “sinful” lifestyle, such as substance abuse, out-of-wedlock pregnancies, or even sexually transmitted diseases. But the primary draw of HCSMs, for many Americans, is affordability: They are usually cheaper than the “normal” insurance plans covered by the Affordable Care Act, a fact that’s conveyed by slick advertising that’s at best seriously misleading, and at worst wholly fraudulent.

Because they are generally less expensive, health-care sharing arrangements also appeal to younger, healthier (and generally less affluent) Americans—the people most likely to think of themselves as immune to serious health problems. Unlike traditional insurance plans, these companies can and do discriminate on the basis of such things as weight, sexual orientation, and religion. As a general rule, you must affirm that you are a Christian just to be enrolled. Some plans actually require members to sign an affidavit attesting to their morality and “clean” lifestyle (abstaining from drugs, alcohol, or “illicit” sexual behavior are common requirements) or adherence to a specific denominational set of beliefs. New members, once approved, pay a monthly premium set by the non-profits that generally operate these plans. When any given member requires medical care, that person submits their medical bills directly to the plan administration, whose principals decide whether the expense will be covered. Money is then paid directly to the member from the collective accumulation of the HCSM membership’s payments.

During negotiations leading up to the passage of the ACA, these religious-based “health sharing ministries” were explicitly exempted from the individual mandate. Why? To mollify Democratic senators from conservative states, who were afraid that loud and public objections from religious groups would effectively kill the act. According to Harvard professor John McDonough, who advised former Sen. Ted Kennedy in drafting the legislation, “[W]ith all the disruption and opposition to the legislation, we were also concerned about the public response and impact on wavering Democratic Senators if this became a public controversy, which seemed more than possible.”

What this meant in practice was that persons who purchased one of these plans were able to dodge the penalty for failing to have insurance. In 2017 the Trump administration, aided by congressional Republicans in their endless efforts to sabotage the ACA, managed to repeal the individual mandate provision. By executive action, Trump also explicitly permitted lesser-regulated types of insurance with substandard coverage (“junk insurance”) to propagate. As a result, these types of plans have flourished in most states, with little to no regulatory oversight. While many of these “healthcare ministries” operate legitimately under the law, the reality is that, to the unsophisticated healthcare shopper, these products look just like insurance.

But they aren’t “insurance,” and that means they’re not subjected to any meaningful federal or state regulation. Most importantly, they are not legally obligated to pay for any type of medical expense whatsoever. They can generally deny any claim they choose to, which is carefully spelled out in the contracts that members sign. Specifically, they are not obligated to pay for any claims relating to a “preexisting condition,” however they choose to define it, even though someone who has such “preexisting conditions” is not barred from joining. Another New Hampshire resident, Joanne Morganti, was denied coverage for surgery on a broken arm on that basis, under a “health-sharing” plan issued by Aliera. “I’m like, ‘How can a broken arm be a pre-existing condition?’ ” she said. “I had the insurance effective Oct. 1 and I broke my arm Oct. 5. It’s not like I broke my arm Sept. 28.” Aliera still refused to pay, and now the 64-year-old is forced to work bagging groceries in order to make monthly payments on her surgery bills.

Unsurprisingly, preventative care is barely covered under HCSMs. Ditto for most mental health care. And unlike traditional insurance plans, which cannot deny coverage to certain groups of people, these plans cover whom they want, when they want. Even adopted children who may have some type of “preexisting condition” are denied coverage, a cruel policy that is against the law for traditional insurers.

Persons victimized or fooled into believing they have coverage with these plans have little recourse when a medical emergency hits. Using model template legislation drafted by ALEC at the behest of these companies, thirty states have explicitly exempted HCSMs from the regulation and oversight required of traditional insurers, provided that they include a disclaimer stating that they are not, in fact, health insurance companies, and that the products they sell are not “insurance.” And since they are not subject to state or federal regulation, there is no avenue of appeal for members who are denied coverage; an aggrieved member can try to sue, but the contracts they sign spell out these drastic limitations and refer any “disputes” to binding arbitration, (usually in cleverly buried legalese not read by the average subscriber).

Although Aliera/Trinity HealthShare was fined $150,000 this month for deceptive practices, and banned from practicing in Washington state, Meehan will not see any of that money. As of this past November, he was contemplating filing for bankruptcy to escape his back surgery bills.

Meehan is hardly the only person victimized by Aliera and Trinity HealthShare. In April 2018, David Martinez found himself between jobs. After scouring the available insurance market in Texas, Martinez and his wife settled, like Meehan, on Aliera. Unlike Meehan, they were fully aware of the “Christian” sensibility marketed by the company; that appealed to Martinez, who assumed that as a “Christian” company, Aliera would take good care of its members. When his wife underwent emergency surgery, Martinez made a claim for medical coverage. Aliera refused to pay, claiming that Mrs. Martinez had a preexisting condition (her doctors denied this was the case). It was only after an article highlighting his case appeared in the Houston Chronicle that Aliera stated it would make payment. As of July 2019, the Martinezes owed $129,000 in medical bills and were facing collection agencies.

Something similar happened to the Collie family of North Carolina. When eight-year-old Blake complained of a severe headache one day, his parents took him to the ER, where he was diagnosed with a brain aneurysm. Blake spent the next two months in the hospital, with medical bills totaling hundreds of thousands of dollars. Samaritan Ministries, the company whom the Collies expected to pay those bills, refused to pay anything beyond $250,000, pointing to the agreement his father, Mark Collie, had signed when he purchased his ”health plan.”

Like Aliera, Samaritan represents itself as a Christian healthcare sharing venture. According to an article appearing this month in The New York Times, Samaritan’s advice, provided in a statement about its coverage, was to “Just trust God,” and the Collies confirmed that “every single person” they dealt with in the company had “prayed for us.” The Collies, for their part, opened a GoFundMe account in an attempt to pay for their child’s bills. Fortunately, the Collies have since qualified for Medicaid, which is expected to fund Blake’s’ care.

So with all these horror stories (and there are many more), why are these plans allowed to exist? One reason is the hold that the Christian right has on American politics. All of these plans contain implicit appeals to so-called “Christian” values, and most deliberately gauge a person’s attitudes toward legal abortion as a litmus test. For a certain segment of the population, this has enormous appeal. As pointed out above, these plans specifically grew out of political concerns of appeasing religious conservatives who object to any healthcare funding being “shared” with those whom they feel are morally deficient, such as women who want to control their reproductive health.

Yet religious dogmatism is not the entire explanation. Indeed, one rare issue that cuts across party lines in this politically polarized country is the inadequacy of our healthcare system. Voters, both Republican and Democratic, consistently rate health care as their number one concern. Additionally, there is a stark divide between the wealthiest 1% of the population, most of whom are satisfied with the system as it is, and the vast majority of the rest of us, many of whom find our system to be unsatisfactory, if not utterly untenable. By far, the biggest source of dissatisfaction with American health care is the cost. During the past decade, as more and more large employers opted for “high deductible” insurance plans, families whose income places them in the amorphous category of “middle class” have found the quality of their lives squeezed more and more by rising healthcare expenses.

The Affordable Care Act (also known as “Obamacare”) was intended to make health care more affordable. And while millions of Americans have taken advantage of the ACA, it has proved to be an imperfect fix. Ultimately, the insurance industry threw its qualified support behind the ACA; it was correctly assumed that with more people insured, the industry would still continue to profit handsomely. As a result, the number of Americans with healthcare coverage has increased dramatically, while the rate of those uninsured has plummeted. Yet even though more people are getting the health care they need, costs remain too high, particularly for lower-income people, making room for these “faith-based” healthcare plans to offer a considerably cheaper, if vastly inferior, alternative.

Into this stable but uneasy situation stomped Donald Trump, who has used every means at his disposal to sabotage or weaken affordable healthcare for Americans. As a result of Trump’s efforts, premiums for ACA plans remain high, while the number of “healthy” people available to subscribe to them shrinks, costing insurers more in medical coverage expenditures. Again, this simply feeds the need for lower-cost alternatives.

Because the Trump administration is dependent on white evangelicals and the Christian right for its political existence, these healthcare sharing ministries not only remain legal, they are encouraged as viable alternatives to the ACA. As a result, the top five HCSM companies—Samaritan, Medi-Share, Christian Healthcare Ministries, Solidarity HealthShare, and Liberty HealthShare— “shared” in exponential growth since 2013. Meanwhile, their impact on the broader insurance market (where most Americans find their health insurance, whether through their employers or through the ACA marketplace) has been decidedly negative.The pool of those who have legitimate health insurance is now “smaller, sicker and more expensive,” raising costs for the vast majority of us.

As for anyone enrolled in these plans who has the misfortune of developing a serious medical condition, or suffers an unexpected accident to themselves or their family? They will discover far too late that they’ve made a bargain with the devil … and it’s a deal which no amount of prayer is likely to change.