Practice English Speaking&Listening with: Health Care Sharing Ministries: Last Week Tonight with John Oliver (HBO)

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Moving on. Our main story tonight

concerns health care.

The field responsible for repairing organs,

treating cancer, and removing foreign objects from rectums,

which have recently included...

...which, credit where its due,

is the most promising advancement in cat hiding places

since under the dresser.

Access to health care is a big problem in America,

and one of the key reasons is that health insurance

is often linked to employment. Why is that the case?

Well, because we do it wrong.

There is a right way to do it, but we don't do it that way.

We do it the wrong way.

And this is a particular problem at the moment

because employment is still down...

...from its pre-pandemic level. All of which means

that many are struggling to find health care coverage right now.

So they might be intrigued

if they stumble on an ad like this.

My health care costs were gonna double this year.

-Doubled. -Doubled.

It was down to health care or my student loans.

I found a better way.

It's neighbors helping neighbors.

Liberty HealthShare.

It's freedom from insurance.

At Liberty HealthShare, we support each other

and keep health costs down.

We're changing the way you're paying for health care.

This is the way it should be.

We're all in this together. Together.

Well, hold on, because I'm not sure how "together" you all are.

What I saw there was a bunch of people together

with warm lens flares, and then one weird older man

very much on his own in black and white.

He's in a slightly different thing,

and we're not going to say why, but on some level,

I think we all know.

That ad is for something called a health care sharing ministry.

And if you haven't heard of them before,

you may have come across one and not even realized it.

Because they've been growing fast in the U.S.

And the key phrase in that ad is "freedom from insurance."

Because the most important thing to know

about health care sharing ministries or HCSMs,

isn't just that they can be cheaper than health insurance,

which they can,

it's that they're also not health insurance.

Generally, they are non-profits

where people who share religious beliefs,

usually Christianity,

agree to help cover each other's medical bills.

Here's a heartwarming story about what one of them looks like in practice.

BOB STEDMAN: We're praying for a young lady named Kimberly.

JASMINE VIEL: Bob Steadman and his family are praying

for someone they've never met.

She had a shunt installed in her brain.

VIEL: They've also prepared a card with a check for 561 dollars.

STEDMAN: bear her burden by sending them some money.

VIEL: A scene like this plays out here once a month.

It does take a measure of faith to do it.

We are sharing. This is so different

than what we're used to in our society.

He's right.

People actually looking out for each other

does sound better than our current system,

which is get sick, have insurance decline coverage,

and then hope Debra Messing Retweets your GoFundMe.

That's great, Debra, but did you donate? Did you?

Did you, Debra?

And it does feel more personal, sending 500 dollars a month

to a stranger in need than to a company that sounds

like someone made up a word after getting a shitty Scrabble hand.

Perhaps that is why the local news team who covered

that story seemed so moved after it ended.

I mean, can you imagine being that person

and getting the check in the mail?

You know, not knowing that someone was gonna help you

and then suddenly you have all this help?

Right. It's all about faith, isn't it?

Faith that it's gonna get paid. Faith in God.

-and it's just amazing. -It's incredible.

Yeah, of course, they're into this shit.

Faith? Strangers? Coming together?

Throw in a runaway dog who found his owner

in the hospital even though he'd never been to the hospital,

and you've got yourself a schedule one local news thirst trap.

And HCSMs are definitely an alternative.

But as you've probably guessed because you're only learning

about them on this show, not "What if John Oliver

Was Somehow Less Angry, Less English,

and Had Jack Ryan Money?"

there are also some significant drawbacks,

which, depending on the company in question,

can range from the disquieting to the disqualifying.

So tonight, let's talk about health care sharing ministries,

what they are, what they do and more importantly,

what they don't do.

And the first thing to know is HCSMs have actually existed

in the United States for decades,

traditionally serving small, insular communities

like Mennonites and the Amish. However,

the 2010 Affordable Care Act included a loophole

that exempted uninsured people from paying the tax penalty

if they were a member of an HCSM.

And that was clearly immediately appealing

to anyone who wanted to opt out of Obamacare.

In fact, some HCSMs, like Liberty HealthShare,

one of the biggest ministries, have specifically targeted

a conservative audience. Liberty has run ads

on The Blaze, and also sponsored CPAC.

In fact, remember that famous moment

when Trump molested the flag?

The Liberty logo was an eyewitness to that crime.

And Liberty even made its sales pitch directly

to the CPAC audience during panels like this one.

If you want the government to take care of you

and you think they do a great job doing it,

health sharing is not for you.

If you wanna stick it to 'em, sign up for Liberty HealthShare.


Okay, on a list of the worst sounds known to man,

self-satisfied CPAC laughter has to be right at the top,

beat only by weeping kitten

and mother's orgasm.

Now, that Affordable Care Act loophole did try to put

some limits in place to keep things from getting out of hand.

It stated that your ministry or crucially...

But unfortunately, that predecessor detail

left room for exploitation.

because new ministries simply started affiliating themselves

with previously existing churches.

Take one called Trinity HealthShare.

It was founded in 2018, which is, and this is true,

after 1999, but it argued that it still qualified

because it derived its existence from the Baptist church...

...which is obvious bullshit.

It's like me claiming that this show has been around

for 13 billion years because the big bang was also

a bright expanse containing extremely dense material.

That's just not how anything works.

So a loophole that was intended to be small got pretty big

and even bigger once Obamacare's individual mandate

stopped being enforced during the Trump years.

And the result of all of this was that the popularity

of these ministries exploded,

from an estimated 200,000 members a decade ago,

to more than a million today.

And while HCSMs will insist they make it abundantly clear

that they're not health insurance,

many do seem to go out of their way to make themselves

appear as insurance-like as possible.

For a start, they're sometimes sold through insurance brokers

alongside actual insurance plans.

And while the Obamacare marketplace

offers plans in four metal categories:

bronze, silver, gold and platinum,

a company called Altrua offered plans in gold,

silver, bronze, and copper, rebranding them last year

to diamond, emerald, sapphire, and ruby.

Although it's still pretty clear what they're trying to do there,

very much blur the line, while also throwing

some extremely unfair shade at ruby,

the objective goat of the cardinal gems.

She's red, known for her flaws, and responsible

for the most iconic slippers in the history of cinema.

Eat your fucking hearts out, sapphire and emerald,

because you could literally never.

But while these HCSMs may have the optics of insurance,

there are some very important differences.

For a start, They don't have to abide

by laws governing insurance products.

Meaning there's nothing stopping them

from placing restrictions on coverage for pre-existing conditions.

Which is exactly what they do.

And not only that,

many won't cover services considered "essential"

under the ACA.

Like treatment for substance abuse,

or mental health care.

In fact, Altrua excludes those,

and also treatment for obesity or autism.

And Samaritan's "Classic" plan

has a list of non-qualified items

including Routine, Maintenance,

Stabilized, Preventive, and Wellness Care.

That is everything,

from regular checkups to vaccinations.

And even for eligible expenses,

the most that can be shared for a given need is $250,000.

Which probably explains their full name

"Samaritan," not the good one though,

just a random Samaritan who might well leave you to die

in the middle of an abandoned road."

And we haven't even gotten

to one of the biggest excuses HCSMs can use to deny coverage,

And that is morality.

Because that means you can be denied coverage

for basically anything.

This is a program of the Christian Care Ministry,

and people who smoke or same-sex couples

need not apply.

The program also won't pay

for illnesses related to alcohol, abortion,

or other lifestyle-related choices.

I need to know that I'm not gonna be paying for someone else

who's decided to sit on the couch and eat bonbons all day.

Wow, that is harsh.

But I will say that judgmental tone

is very much in line with how these ministries operate.

Do people really deserve healthcare coverage

if they eat junk food or don't exercise or are gay?

Just fix it!

Eat a carrot, go for a run, rub your penis or vagina

on somebody else's vagina or penis, respectively.

It's really not difficult!

And this is a pattern across HCSMs.

Liberty's materials say,

"an applicant must comply with a Christian lifestyle."

And among the exclusions on Samaritan's "Classic" program,

you'll find that they might pay for treatment for an STD, but...

not if it was contracted by sex outside of marriage,

and that the member

has to explain how the disease was contracted.

Presumably, the hotter the story,

the more money you get for ointments.

Vanilla missionary shit isn't gonna get covered here, bud.

You better have gotten gonorrhea from an earlobe

if you want Samaritan's attention.

But sweeping moral judgment isn't the only leeway

that these organizations have.

Because they're voluntary associations,

you have no guarantee that your bills will get paid.

Although, to hear a founder of Liberty HealthShare tell it,

you've really got nothing to worry about there.

Just listen to him reassure people in a video on their website

titled "Will My Bills Be Paid?"

We've had a successful history of sharing medical bills, 100 percent,

for every eligible need ever submitted.

So, it doesn't depend upon

a written contract where we can sue each other

if someone doesn't send their share amount.

It's really a contract written on our hearts.

Oh, right!

It's a contract written on your hearts.

Figuratively, of course.

Because literally, it's not a contract.

And as for his claim there that liberty successfully shared

a hundred percent of medical bills

"for every eligible need," given, as we've discussed,

they can deem any need ineligible for any reason,

that phrase is essentially as meaningless

as their cardiac non-contract.

And on top of all of this,

there's the practical matter of how exactly you pay for your care

as a member.

The HCSM process typically is you're told to present yourself

as uninsured.

Then, when you get your bill,

the expectation is that you bargain down

the cost of your care as much as you can,

then, pay the bill yourself.

Then, submit your bills to the ministry for reimbursement.

And if you've ever waited for your friends to Venmo you

after paying for dinner,

you know that the reimbursement process can go very wrong.

Participants in Liberty-- you know, the one with the "heart contract"

have found payments can be slow, to nonexistent.

TV REPORTER: In the past three years, Tiffany Schultz

with the Wisconsin Better Business Bureau

says the BBB has taken more than 500 complaints

about Liberty HealthShare.

Many with similar stories.

One claiming 90,000 dollars in outstanding medical bills

that were pre-approved.

Either the consumer is out the money

and hasn't been reimbursed,

or they're ending up going to collections."

That's not great.

And while Liberty claims that 2019 was a particularly difficult year,

or that they're proud of the improvements they've made since then,

it is worth noting that Liberty's members

still seem pretty active on the Better Business Bureau website,

where they've logged 304 complaints in the last 12 months,

which is a lot, especially when you consider

that Cigna, a massive insurer, has just half that amount,

while having 15 times the members.

And imagine having more people complain about you

than about Cigna,

a company whose logo

is a cartoon man standing in a field

as his head explodes

from dealing with their customer service.

And unfortunately, in most states,

a complaint to the Better Business Bureau

is basically all the recourse you have.

And these ministries have worked very hard

to keep accountability at bay,

successfully lobbying for so-called "safe harbor laws"

in more than 30 states,

ensuring that they can operate safely outside

of insurance regulations.

And to see just how much you can get away with,

it's worth looking at a company called Aliera,

which has been heavily involved

with a number of health-sharing ministries over the years.

First, one called Unity,

Then one called Trinity, which now goes by Sharity.

Although, those names sound less like a healthcare organizations

and more like characters in a religious-themed Captain Planet knockoff.

When their powers combine,

they get cancelled after two episodes.

Aliera presents itself as merely an administrator

for HCSMs,

but it's intricately connected

to the ones it works with, and very much by design.

Just six weeks after Trinity was incorporated,

it signed a deal with Aliera

stipulating that Aliera would have

exclusive ownership rights to the membership roster,

and was the sole party developing and marketing the plans,

including the HCSM component.

So, Aliera's relationship with Trinity, is basically

this guy's relationship to his alien costume.

He can claim he isn't technically the costume,

and that's true.

But the costume doesn't really do anything without him.

And customers in multiple states

have claimed that Aliera and its ministries

have been ruthless in denying coverage,

wielding "morality clauses" hard.

When one member was attacked and knocked unconscious outside a bar

and taken to the hospital with serious injuries,

including a skull fracture, cervical spine fracture,

and intercranial bleeding,

Aliera denied her claims,

stating her injuries were "self-inflicted,"

and citing their guidelines, including the line,

"follow spiritual teachings on the use or abuse of alcohol,"

which I'm pretty sure is the benevolent advice

Jesus himself would have given under the circumstances.

And incredibly that's not even the worst story

of a rejected claim involving Aliera

JUSTIN GRAY: Ten-year-old Lola Grae Segars is healthy

just four months after brain surgery.

On September 11th,

she was rushed from the local ER in Greene County by ambulance

to Children's Healthcare Scottish Rite,

where doctors removed a softball-sized brain tumor.

It was just amazing, the care...

GRAY: But last week, came the bill

from their health plan, Aliera Companies.


GRAY: Aliera says Children's is out of network

and won't pay the 325,000 dollar bill.

We had a life-threatening emergency.

They failed us and her.

Holy shit.

They were denied reimbursement for a child

who had a softball-sized tumor removed from her brain,

which is incidentally, exactly the kind of immoral

behavior I'd expect sharing ministries to classify

as fucking disqualifying.

Now, Aliera claims that that family's issues

were ultimately resolved.

But only after that story was featured on the news.

And it shows just how little recourse you have,

that if you don't have a child you can get on TV to shame

the company into action, you could be shit out of luck.

And look, traditional insurance companies

also have their share of horror stories

when it comes to denial of coverage.

But there are important differences here,

not just in the level of protection you have

when that happens, but in the degree

of financial accountability.

Because while the ACA requires actual health insurers

to spend no more than 20 percent of money

on administrative costs, therefore leaving at least

eighty percent for care, there's no such requirement

for HCSM'S. And you can probably tell where this is going.

Because investigations have found

that out of every $100 a Trinity member paid in premiums,

only $16 went towards paying medical expenses,

with the rest being kicked up to Aliera.

And paying out 16 percent of the money you take in

for coverage is a lot different than paying out 80.

Because 80 percent makes you think, "Wait, why exactly

do we have insurance companies?"

Whereas 16 makes you think "Is there a crime happening

to me right now, and if so, why does everyone seem

okay with it?"

And when a local news reporter caught up with

the head of Aliera to ask her about its reluctance to

pay out claims, her response was not particularly reassuring.

REPORTER: Do you have any apologies to the members

-who believe their claims-- -Oh, my goodness.

-ought to be paid -We're not--

-we're not a health-- -and they're not paid?

we're not a healthcare-sharing ministry, Mr. Strickland.

We only administer on behalf of the, of the ministries.

I can't help you out any further.

I need to get out of town.

Okay, it is never a good sign when a CEO has to end

an interview like that. "As I've said before,

our company has never done anything illegal.

Now have you seen a man in a blue fedora?

He's supposed to give me a new identity as I get pulled into

a helicopter that's already taking off.

Tell my daughter I loved her and my husband I didn't! I'm out!"

Now, I should say, other sharing ministries

have tried to distance themselves from Aliera,

claiming that "this sort of deception is not part

of legitimate, authentic healthcare sharing ministries."

And Aliera is definitely bad.

But one thing insurance commissioners

have repeatedly told us in researching this piece,

is how little transparency there is into

how these ministries operate, and just how wary they think

people should be of all of them.

And look, broadly, we have to do more in this country

to reduce the cost of healthcare.

Personally, I'd argue switching to a single-payer system

would remove a lot of these problems instantly,

but that clearly isn't happening anytime soon.

So in the meantime, I do get the appeal of lower-cost

health insurance. The problem is, this isn't that.

It's not insurance at all. And states need,

at the very least, to pass laws to make sure that people know

what they're getting into with HCSM'S, and to force them

to allocate funds properly. The problem is, some are going

in the opposite direction. Take Florida.

In 2018, after intense lobbying, it loosened

it's restrictions on HCSM'S even further,

going from requiring participants be

"members of the same religion," to merely requiring that

they "share a common set of ethical or religious beliefs."

And that could be basically anything.

At this point, the bar to entry is so low, just about anyone

can become an HCSM. And the reason I know that is,

this anyone did.

You may remember, back in 2015, we founded a church,

Our Lady of Perpetual Exemption, to demonstrate

that tax exemptions for churches enabled some of them

to do terrible things.

Well, just three months ago, we officially founded

a spinoff church called "Our Lady of Perpetual Health."

And we founded it, where else, but Florida.

I'm happy to tell you, that church now has its own

health care sharing ministry, "Johnnycare."

And the whole thing was scarily easy to do.

So, without further ado, please join me,

my most blessed congregants, at church.

- (ORGAN MUSIC PLAYING) -And you know,

I couldn't run an organization as important

as this ministry all by myself. So please welcome,

live from Johnnycare Headquarters

in sunny Florida, the Felicity Huffman

to my Willian H. Macy,

my dear wife and business partner, Wanda Jo.

Praise be to you, my Wanda.

Praise be to you, my John,

and praise be to Florida. That blessed state where

minimally regulated insurance knock-offs go to be born

and retired people go to die.

Amen to that.

I have heard the word of the lord, my John.

Oh, and what did it say, my Wanda?

It said "Thou must free thyself like a gazelle from the hand

of the hunter from the overreaching grasp

of government healthcare. Stick it to 'em."

Stick it to 'em!

Now Wanda, we're running the ministry as a church,

even though in Florida, we actually don't have to be.

Amen, praise Florida!

But we do need to fulfill the requirement that

our ministry provide for the financial

or medical needs of a participant through

contributions of other participants.

The good news is we have done that through our special

Johnnycare First Aid Kit, containing not one, not two,

but three Band-Aids.

It screams "the cheapest option we could find."

And you know what, my Wanda?

What, my John?

It was.

Now, why three Band-Aids? Because we know that in life,

sometimes accidents happen. But if they happen more

than three times, it just stops being our problem.

And let me be clear, when you sign up

for a membership, you're not paying for your own

first aid kit. You're paying for someone else's,

and they are paying for yours.

And that gives you freedom from insurance.

And us freedom from responsibility.

And beyond that, it's a very simple system.

If you need medical care, you go to the doctor,

you receive it, you request the bill,

and then you pay that bill on your own.

Leave us out of it. (LAUGHS)

Oh yeah, because if you submit that bill to us,

we're gonna reject it.

From his lips, to God's bigger lips in the sky.

Testify. Either because you engaged in the sin

of fornication beyond the bonds of matrimony...

You whoring little skeez.

Or you spent the day eating bon-bons on the couch

instead of going to the gym.

Or masturbated ever.

Whatever it is, we're going to reject it.

And it's as easy as that. No deductibles, no claims,

and no contracts, except for the one written on our hearts.


Now you can become a member of our Johnnycare ministry

for just $1.99 and we're limiting membership

to five thousand of you in Florida.

Not because we have to, but because that is the number

of first aid kits that we've bought.

So go to

and see if you qualify to send us money

and get almost nothing in return.

As close to nothing as we could get away with.

And to be clear, we should not be able

to get away with any of this.

Thank you to Wanda Jo, who, if history is any indication,

will disappear for three years and ultimately resurface

with a Canadian-Mohican son answering to Deb.

I just love you so much, my Wanda.

Oh! And I love you so much, my John.

Visit to learn how you

can stick it to 'em!

Stick it to 'em!

That's our show. Thank you so much for watching.

Good night.

The Description of Health Care Sharing Ministries: Last Week Tonight with John Oliver (HBO)