Fed up by unaffordable costs and insurance denials, more and more Americans are fleeing the conventional health care system. Many are seeking to cut out the government and insurers entirely by pooling their money together to cover their own bills, turning to what are called health cost-sharing ministries. Originally a faith-based alternative for those with religious objections to traditional insurance, this uniquely American way to pay for medical care has been secularizing and surging in popularity over the last decade, alongside growing distrust in our health system.

These plans superficially resemble health insurance and often sell themselves as a more affordable way to cover medical costs. Members pledge to cover each other’s health care expenses, typically making monthly payments to the organization and then submitting their bills to the group when they receive care. They also commit to a set of ethical or moral principles defined by each group, usually reflecting their origins in Christian churches.

These groups have been around for decades; Christian Healthcare Ministries claims to be the first in the nation, founded in 1981, and traces the arrangement’s structure to biblical roots. But for years, health care sharing ministries remained a niche product. By the mid-2000s, membership was a mere 200,000 people, according to the best estimates. (Because they are largely unregulated, data on these plans is limited and may undercount actual enrollment.)

Then the Affordable Care Act (ACA), also known as Obamacare, passed in 2010, generating a fierce conservative backlash. Devout Republicans wanted to opt out. Health cost-sharing ministries offered them a path: In deference to cost-sharing ministries’ traditional role in serving small religious groups, people enrolled in a ministry were exempt from the law’s new individual mandate that required Americans to enroll in an ACA-compliant health insurance plan.

Enrollment in health cost-sharing ministries skyrocketed, up to an estimated 1 million people in 2018. Formerly explicitly Christian ministries began to rebrand with more secular language, loosening their membership requirements to remove requirements for members to adhere to a specific religious faith, instead stipulating that they follow more generic ethical principles such as supporting other people and sharing a belief in personal accountability. Aggressive marketing and rising costs for conventional insurance contributed to the boom: By 2023, an estimated 1.7 million Americans had become members of one of these health cost-sharing programs. Slowly, then quickly, an alternative health care system without conventional health insurance was being built.

But these arrangements are unlikely to be a viable long-term solution to the health care affordability crisis. They may claim to avoid the high costs and administrative headaches of regular health insurance, but they also lose the all-important scale that makes those plans financially sound. News reports of people who joined a health sharing ministry only to face astronomical medical bills or denials when they had a serious health situation have become plentiful. State regulators are increasingly expressing concern about the consequences for consumers, but most states also have laws protecting these plans from oversight because of their ostensibly religious nature.

This is the state of US health care: The traditional system has become so busted that people are willing to bet on themselves and a small group of peers and hope for the best. But that salvation is a mirage, one that leaves them vulnerable to the same overriding problem that Americans with traditional insurance rightfully complain about: Their health care is still too damn expensive.

Why health cost-sharing plans are growing

The story of Tony and Felicity Dale and their company Sedera charts the evolution of health cost-sharing ministries from a niche carveout for the deeply religious to an increasingly competitive alternative to the Aetnas and Anthems of the health care system.

Tony Dale, a British-born doctor who had moved to the US, had major knee surgery in the mid-1990s and, having grown up under the UK’s single-payer system, was shocked by the size of his medical bill and significantly negotiated it down with the hospital.

While navigating that costly bill, Tony came into contact with a Christian cost-sharing ministry, which shared some sensibilities with

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