ADF supports donor, trade group for controversial health care sharing industry

ADF filed its amicus brief, also known as a friend-of-the-court brief, in March in a case challenging a 2022 Colorado law requiring the insurance-like organizations to disclose basic data about their services and operations to the public. It supported the Alliance of Health Care Sharing Ministries (AHCSM), an industry trade association.

In the brief to the 10th U.S. Circuit Court of Appeals, ADF asked the court to overturn a district court decision denying a preliminary injunction against Colorado’s health care transparency law. In a press release, ADF claimed the law “specifically targets religious health care sharing ministries with burdensome reporting requirements designed to defame or prosecute them.”

Since 2013, at least one member of the AHCSM, Samaritan Ministries International, has contributed $238,500 to ADF, according to the group’s federal tax returns. ADF’s brief was filed on behalf of three Colorado residents who are members of two other health care sharing ministries that are also members of the AHCSM: Liberty HealthShare and OneShare. Liberty HealthShare is administered by a nonprofit called Gospel Light Mennonite Church Medical Aid Plan Inc. OneShare is a nonprofit whose board of directors included former Arkansas Gov. Mike Huckabee.

Although health care sharing ministries have long existed, after the passage of the Affordable Care Act (ACA) in 2010, HCSMs and their allies in the Christian right worked to ensure the groups could operate under broad religious exemptions that the law required other health insurance providers to follow. The AHCSM — whose corporate members collect billions in premiums or “shares” annually — said in a statement about the case that the law is “akin to subjecting a church to inquiry as to how it distributes from its collection basket for religious programs for its adherents.”

Health care sharing ministries pay out based on beliefs

In recent years, HCSMs have grown into a multibillion-dollar industry. Under the ACA and related federal administrative rules, HCSMs are not considered insurance companies. This means they are not required to guarantee payment of claims, can reject payments for preexisting medical conditions and do not have to cap out-of-pocket health care costs.

The AHCSM claims nearly 700,000 Americans in all 50 states are members of HCSMs. A June 2023 report from Kaiser Family Foundation using data from Colorado shows that nearly 2 million Americans use HCSMs. According to the AHCSM’s data, HCSMs have at least 100,000 members in the Deep South alone.

In a 2023 report, ProPublica described HCSMs as “nonprofit alternative[s] to medical insurance,” but the groups are not allowed to market their products as medical insurance. They are also generally not regulated by state laws — which serve as the primary regulatory authority for health care insurance companies in the U.S., according to the Kaiser Family Foundation.

Yet some state insurance regulators allege that HCSMs such as Aliera Companies and Trinity Healthshare violate state and federal laws, according to National Public Radio. In 2020, The Associated Press reported that a class action lawsuit against Aliera and Trinity Healthshare in Missouri alleged the companies provided “‘inherently unfair’ and deceptive health plans to Missouri residents and failed to provide them with the coverage the purchasers believed they would receive.”

Trinity Healthshare (renamed Sharity Ministries) filed for bankruptcy at a time when the company faced “enforcement action” by the New York Department of Financial Services. According to the state, Aliera, the for-profit affiliate of Trinity, “siphoned off most of Trinity’s member payments rather than leaving them to be used for their intended purpose: the payment of members’ claims.”  

In 2024, Missouri class action members settled claims against one company that sold Aliera sharing plans. Liquidation plans were approved for Trinity Healthshare/Sharity Ministries in 2021 and for Aliera in 2023.

HCSMs are generally organized as tax-exempt, nonprofit corporations with Christian religious missions. Members typically pay a “share” analogous to an insurance premium in exchange for payment of covered health care costs. According to the AHCSM, industry groups paid out or “shared” about $1 billion in covered medical costs in 2024.

Covered costs are generally dictated by conservative Christian principles. According to Samaritan Ministries’ “need sharing” guidelines, “HIV/AIDS, or other STDs contracted due to the actions of others (e.g. blood transfusions or medical procedures) will be shared.” However, the group writes: “We do not share needs for sexually transmitted diseases, including the HIV virus and/or AIDS, when contracted by consensual sex outside of marriage, or through irresponsible behavior such as sharing hypodermic needles for legal or illegal drugs. It is the member’s responsibility to explain how the disease was contracted.”

According to OneShare’s 2024 member guidelines, “Any illness, injury, or condition which is the result of failure to adhere to the Statement of Beliefs” is ineligible for sharing. The group’s statement of beliefs specifies that members agree that “it is our responsibility to God and our fellow Members to engage in accountable, healthy living, and to avoid habits and behaviors which are harmful to the body.” According to the group, abortion, gender dysphoria and “sexual transformation services,” infertility, surrogacy, medical expenses for marijuana, and substance abuse are among the conditions exempted from sharing.

Liberty HealthShare’s 2025 member guidelines specify that to be a member and receive sharing benefits, a person must “meet and satisfy” specific criteria including “Observ[ing] Christian standards” and affirm a set of “Shared Christian beliefs” that include an assertation that “it is our spiritual duty to God and our ethical duty to others to maintain a healthy lifestyle and avoid foods, behaviors or habits that produce sickness or disease to others or ourselves.”

In 2023, a Georgetown University review of HCSM federal tax returns showed on average the groups were “spending in excess of revenues in some years” and had “substantial revenue fluctuations year-to-year.” “This raises questions about the adequacy and stability of funding available to cover members’ health care costs,” the report claimed, noting that Liberty HealthShare “has come under recent scrutiny for their history of not paying their members’ claims.”

ADF and Samaritan Ministries International

The nearly $240,000 in donations from Samaritan Ministries to ADF were mostly earmarked for “program support” or “to assist in their cause,” according to the group’s publicly available federal tax returns. Its donations ranged from $6,000 to $45,000 per year from 2013 to 2023.

According to Samaritan Ministries’ federal tax returns, the group has also funded the anti-LGBTQ+ hate group Illinois Family Institute with annual donations between 2018 and 2021.

In 2014, ADF represented Samaritan Ministries along with the Association of Christian Schools International and two private universities in a lawsuit against the federal government opposing reproductive health care requirements of the ACA.

Among the legal team that filed the case were five ADF attorneys and attorney Brian Heller, Samaritan Ministries’ longtime lead counsel. In December 2024, the group announced Heller was stepping back from some duties, but he would remain legal counsel for both Samaritan Ministries and AHCSM.

“Whether it be the [member] Guidelines, marketing material, or testimony before elected officials, Brian’s foresight, along with a cautious approach and carefully chosen language, has allowed us to protect our members’ ability to continue to care for one another’s medical expenses along with providing emotional and spiritual support to one another,” the group wrote. Heller is also listed as an uncompensated director on AHCSM’s board between 2020 and 2023.