While the embattled Trinity HealthShare and its affiliate Aliera Companies continue to profess their status as non-insurance health care sharing ministries, Missouri’s former insurance commissioner is busy arguing why they should be regulated by the Missouri Department of Insurance.
“We've gotten complaints from people who say that their claims aren't being paid and that's why we’ve brought the lawsuit,” attorney Jay Angoff told the St. Louis Record. “What makes these people's positions particularly vulnerable is that when an insurance company is regulated by the insurance department, the insurance department has jurisdiction over complaints and it can urge the insurance company to pay the claim. If the company does not pay the claim, the insurance department has the authority to revoke or suspend the company's license.”
He filed a class-action lawsuit in the Western District of Missouri-Southwestern Division on April 15, alleging that Aliera and Trinity sold inherently unfair and deceptive health care plans to Missouri residents, and failed to provide them with the coverage the purchasers believed they would receive.
“We don't know how many are in the class action,” said Angoff, a partner with Mehri & Skalet law firm and former insurance commissioner for the state of Missouri. “That's just one of the many disadvantages of Aliera and Trinity not being regulated by the insurance department. They don't have to file any data with the department or with anyone.”
Trinity HealthShare and Aliera are among a new breed of health coverage alternatives that are exempt from insurance regulation due to provisions under the Affordable Care Act, according to Christianity Today.
“Defendants claimed the health care plans were not 'insurance' in order to avoid oversight by the state insurance commissioner and the minimum requirements mandated by the Patient Protection and Affordable Care Act,” Angoff wrote in the complaint. “At the same time, Defendants created the health care plans to look and feel like health insurance that would provide meaningful coverage for the purchasers’ health care needs.”
Rich AuBuchon, an attorney with the AuBuchon Law Firm in Jefferson City, said increases in healthcare-related costs have driven people to participate in alternatives, such as pooling resources.
"Any plan or pool should be subject to some oversight by a state compliance officer to ensure the plan or pool is providing the product they say it is for the consumer, regardless of the underlying good faith mission of the plan or pool," he said. "We will continue to watch this litigation and look for outcomes of what this may mean for Missouri consumers."
Angoff argues that exemptions under the Affordable Care Act do not apply to Trinity and Aliera because the two companies do not meet the requirements.
“One of those requirements is that the plan must have been an existence in 1999,” Angoff said in an interview. “There's no way that this plan was in existence at that time. It's also got to have people pay the claims of other people. That's not what happens here. Third, it’s got to send the public, their members, an accounting every month or every quarter showing what it's taking in and what it's paying out. That's not the case here.”
Other healthcare sharing ministries don't want to be perceived the same as Trinity HealthShare and Aliera, Angoff added.
“The important point about Trinity and Aliera is that the Healthcare Sharing Ministry Trade Association has criticized them and distanced itself from Aliera and Trinity,” Angoff said.