Health-care sharing has become an attractive option for many people since the Affordable Care Act came into effect in the U.S., but it’s an arrangement many conservative Anabaptists have had long before.

Whether it’s a formal health-care sharing ministry or multiple congregations pooling resources to meet a specific need, the practice of mutual aid for medical expenses replaces both commercial and government health insurance.

Edsel Burdge, research associate at the Young Center for Anabaptist and Pietist Studies at Elizabethtown (Pa.) College, said Amish groups are granted an exemption from the ACA’s requirement to purchase health insurance based on their exemption from paying into Social Security.

“The government gave them that exemption because they said, ‘We take care of our older people; we don’t want the government to do that,’ ” Burdge said.

For those not exempt from Social Security, the ACA grants an exemption to anyone who is “a member of a recognized health-care sharing ministry,” according to healthcare.gov.

Kevin Ensz, office manager at Christian Health Aid, the health-care sharing ministry of the Church of God in Christ, Mennonite, said membership has grown by about 10 percent since the ACA went into effect in 2010.

“All in all, there continues to be a slow growth,” Ensz said, noting that membership is limited to members of CGCM-affiliated congregations, commonly known as Holdeman Mennonites.

The decision to participate in CHA is left up to each household. Shares are paid on a monthly basis and pooled into a central treasury, from which approved medical expenses are covered. Each household’s monthly share amount is determined by the number of people in the household and their ages, according to the program’s guidelines.

Ensz estimated about half of the CGCM’s members were part of CHA, and said more office staff have been added recently.

“It’s a good problem to have,” he said.

The Conservative Amish and Mennonite Medical Resharing Pool, based in Middlebury, Ind., requires groups of at least 10 people who are “active members or active participants of a Conservative or Amish Mennonite church” to form their own plan in order to join the pool, according to the program’s bylaws. Shares are paid quarterly by each plan depending on how many members each plan has. Amounts vary based on what medical needs are approved for coverage each quarter.

Mike Martin, public relations representative for the pool, said his organization has seen “a significant increase” in membership for the past four years, but he doesn’t attribute all of it to the ACA.

“There are many unaffiliated Mennonite churches that have pitched in for years to help families with medical crises,” Martin said. “In the past several years, many of those churches have seen the benefit of being part of a larger base.”

Martin said the reason so many Americans don’t have health insurance is because they can’t afford it, and he criticized the government’s policy of financially penalizing people who can’t afford to pay.

“It’s really no surprise to me that Christian health-care sharing ministries are expanding by leaps and bounds, because they are more affordable than commercial health insurance policies,” he said.

‘Servants of the poor’

Even more conservative church groups have traditionally shared medical needs without formal sharing ministries, according to Burdge. The details vary among different groups, but the basic idea of sharing is the same.

He said groups like the Groffdale Old Order Mennonite Conference have an organized system of health-care funding administered by deacons, who are “traditionally servants of the poor.”

“There is an assumption that each family will handle whatever medical expenses they can,” Burdge said. “Then the deacon will have some funds to help with that. Beyond that, for very large bills there’s actually a larger fund that is administered by a deacon in the conference.”

In comparison, he called the Amish method of health-care sharing “a little less organized.”

“They get it taken care of, but they have a number of different strategies,” he said.

After the family members, including the extended family, contribute what they can, they may publish a notice in their church community newsletter asking for contributions to a fund they set up at the bank. They also may choose to have benefit sales — which the Old Order Mennonites don’t do, Burdge said — and to simply collect an offering from their congregation or from multiple congregations.

Amish and Older Order Mennonites will negotiate with hospitals for lower pricing when they can, he said.

Burdge said the difference is mainly in polity, describing the Old Order Mennonites as more structured and the Amish as more congregational with no official larger structures except those temporarily formed on an as-needed basis.

“It is part of the Mennonite heritage that our parents and ancestors have taught us — the concept of sharing with each other,” Martin said. “ ‘Bear ye one another’s burdens as fulfills the law of Christ.’ That is our motto.”