SAM DEAN l The Roanoke Times

Melvin and Sandra Adams are members of Samaritan Ministries International and have benefited from the program at least six times, he said.

SAM DEAN The Roanoke Times

Melvin and Sandra Adams of Hardy participate in a health care sharing-ministry as an alternative to traditional insurance.

Chuck Angier, an agribusiness entrepreneur in Pittsylvania County, decided in 2000 that traditional health insurance wasn't for him. Instead he joined a health care-sharing ministry.

As potential health care legislation is shaped, Angier said he continues to worry about his choice and any penalties he might face. And he's not alone.

Thousands of people across the country participate in some type of religious-based, health care-sharing ministry where members send their monthly premiums -- or shares -- directly to other members in need rather than to an insurance company.

Included in new health care legislation before Congress is a 2.5 percent income tax penalty for anyone who doesn't participate in "acceptable" health care coverage. Acceptable coverage is defined as qualified health benefits coverage, Medicare, Medicaid and coverage for members of the military.

A new version of the House's Affordable Health Care for America Act was passed Nov. 7, but it did not include protection for health care-sharing ministries. That would mean participants in the ministries would be required to pay the penalty. The penalty will not exceed the national average premium, according to the bill.

"Since that November nine years ago, we've been blessed with good health while at the same time joyfully helped others in need to the tune of about $30,000," Angier said. "Now Congress wishes to punish us for being prudent, responsible, healthy and compassionate."

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On Oct. 1, Angier made a trip to U.S. Rep. Tom Perriello's office to explain health care ministries and enlist his help in making sure such ministries are included in the list of acceptable options.

On Oct. 15, Perriello, D-Albermarle County, sent a letter to House leaders requesting that health care-sharing ministries have protection in any legislation.

"A major touchstone of our efforts toward comprehensive health care reform has been consumer choice," Perriello wrote. "To that end, individuals who choose to receive their health care coverage through health sharing ministries instead of traditional health plans should not be penalized by the tax provisions of the individual mandate."

Although not included in the legislation the House approved, protection for the ministries is included in the version of the bill before the Senate Finance Committee. If the provision is passed by the Senate, Perriello will appeal to House leaders again when the two legislative bodies meet to reconcile the two bills, his spokeswoman Jessica Barba said.

While members find benefits in health care-sharing ministries, there are some pitfalls, National Association of Insurance Commissioners spokeswoman Vanessa Sink said.

"The biggest thing is they aren't insurance so they're not regulated," she said. "They're not licensed. There's no customer protection."

America's Health Insurance Plans press secretary Robert Zirkelbach agreed.

"There is a risk that these types of organizations don't have sufficient reserves to cover [member] costs," he said. "They can provide a false sense of protection."

Zirkelbach added that he's not against the ministries. "People just need to know what they're getting into," he said.

The Code of Virginia acknowledges health care-sharing ministries, but notes that they are not insurance and do not come under the umbrella of the State Corporation Commission.

Perriello said he favors competition and creativity when approaching the issue of health care. He favors cooperatives, sales across state lines and even a congressional option.

"The more the merrier," he said of health care options. "The key to health care reform is bringing down costs."

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Cost is a major factor for some in joining health care ministries.

"Conventional insurance wasn't an option," said Kristina Jennings of Lynchburg. She and her husband, Chris, are self-employed and couldn't afford coverage options through other insurance companies.

Since she joined the Illinois-based Samaritan Ministries International five years ago, she said she's been treated for kidney stones, made a trip to the emergency room for chest pains and had fertility treatments all covered by the sharing process.

Most recently, the couple welcomed their first child, Jackson, two weeks ago and are in the process of submitting those costs now.

"They've been a bigger blessing to us than we've been to them," she said, adding that every month she sends her family's $240 share to go toward other members in need. "It's very New Testament. It's very much the way Jesus wants us to treat our neighbors."

Along with checks, Jennings said she receives cards, notes of encouragement and promises of prayer.

"It's fantastic," said Melvin Adams of Hardy, who has been a member of numerous health care-sharing ministries over the years. "You can't beat it for the price."

As a member of Samaritan, Adams and his wife, Sandra, pay $285 a month for their family of six and have benefited from the program at least six times in the past nine years, he said.

Jennings' sister, Katherine Seay of Bedford, has had more experience with giving than receiving in the program. With three children and a husband who's an independent contractor, Seay said they've had to request ministry shares only a few times, including two home births.

"We want to be a blessing to other people," she said. "It makes it more special to be a part of this, because we see what other people are going through. It makes us more appreciative."

Both sisters say they will stay with Samaritan and pay the penalty if it's not included in the legislation.

"We don't really have an option," Jennings said. "But I'd fight for it. I'd let them know I didn't like it. We have insurance. We've figured out a way to cover our medical costs so we're not a burden to society or the government."

"We agree with the biblical basis and could afford the penalty," Seay said. "I just feel bad for those who can't afford the fee and their monthly share."

While most of the groups are Christian-based, Adams pointed out that any group could get together and form a similar program.

"These type of people-run programs are way, way more effective than government-run programs," he said.

Samaritan Ministries was created in 1994 by Ted Pittenger. He belonged to another health care-sharing ministry but decided to start his own in a remodeled chicken coop, Samaritan spokesman Mike Miller said. Membership has grown steadily to about 45,000 people across the country, including 1,334 in Virginia, he said.

Members in need request paperwork from the company and return it with their medical bills. Fellow participants are assigned a member and send their premiums directly to him or her; someone with a steep medical bill might receive money from more than one participant in the ministry.

"They don't call it insurance, but it functions in much the same way," said Perriello, who also wants to make sure accountability measures are included and that groups can't pass themselves off as health care ministries if they're really not.