A growing number of people are turning to health-care ministries to cover their medical expenses instead of buying traditional insurance, a trend that could challenge the stability of the Affordable Care Act (ACA).

The ministries, which operate outside the insurance system and aren’t regulated by states, provide a health-care cost-sharing arrangement among people with similarly held beliefs. Their membership growth has been spurred by an ACA provision allowing participants in eligible ministries to avoid fines for not buying insurance.

Ministry officials estimate they have about 500,000 members nationwide, more than double the roughly 200,000 members before the law was enacted in 2010.

Obama administration officials said last month that about 2.5 million new customers had bought insurance through HealthCare.gov since open enrollment began on Nov. 1. The number of new enrollees is 29% higher than last year at this time, suggesting that the threat of a larger penalty may be motivating more people to get covered.

But plenty of healthy holdouts remain, and their resistance helps explain why insurers are worried about the financial viability of the exchanges over time. People who earn too much to qualify for federal subsidies that defray the cost of coverage may be most likely to opt out.

Many insurance companies are losing money selling ObamaCare policies. Unfortunately, the White House wants to make their losses your problem. In December, Congress refused an administration request to provide insurers with $2.5 billion in bailout money to help cover their 2014 losses.

The Obama administration hasn’t given up. It has declared that this $2.5 billion in corporate welfare and potentially billions more for losses insurers have incurred in 2015 is “an obligation of the U.S. government for which full payment is required.”

A new study reveals that many ObamaCare customers pay more than 10% of their incomes toward coverage. And the share of income eaten up can be much greater for some people, particularly if they use a lot of health services under their plan.

One in 10 ObamaCare customers who earn between just two and five times the federal poverty level will have coverage costs that exceed 21% of their incomes, an analysis by the Robert Wood Johnson Foundation and the Urban Institute found.

Even with federal government subsidies under the Affordable Care Act, a typical American buying coverage on public exchanges spends about one in 10 dollars they earn “on insurance premiums and out-of-pocket costs,”according to a new analysis.

Research from the Urban Institute shows typical single enrollees with incomes between $23,540 and $58,850 spend 10% of their incomes on premiums and out-of-pocket costs and the percentage rises if the enrollee has more medical needs.

A group of health policy analysts have collaborated on a set of proposals for replacing the Affordable Care Act (ACA) and also reforming other major portions of health care delivery, such as the tax treatment of employer-sponsored health insurance, Medicaid, Medicare, and Health Savings Accounts. Because so much attention has been paid to the repeal of the ACA by those who have opposed it, we believe it is important to focus on a serious proposal that could both replace this law and provide additional measures of reform, especially to the health care entitlement programs.

We believe our reform agenda represents such a proposal. Furthermore, none of us regards the pre-ACA health care system as an acceptable alternative.

More than 2 million existing customers with insurance under the Affordable Care Act have had coverage renewed automatically for 2016 by HealthCare.gov, after they ignored government warnings to shop around to avoid surprise spikes in prices of health plans. According to data released Tuesday, 8.2 million people already have chosen — or have been automatically assigned to — health coverage next year through the federal insurance exchange.

A group of state insurance commissioners is developing a proposal to limit the amount that health insurers might have to pay out under the Affordable Care Act’s risk adjustment program, New Mexico Insurance Superintendent John Franchini told SNL.

The plan would install a so-called circuit breaker to prevent companies from paying more than 2% of their premium revenue into the program each year. That boundary would make insurers’ financial obligations more predictable and avoid the kinds of surprise payouts that contributed to the destabilization of several health plans in 2015.

Using data from 49 states and Washington, D.C., the Commonwealth Fund analyzed changes in cost-sharing under health plans offered to individuals and families through state and federal exchanges from 2014 to 2015. They examined eight vehicles for cost-sharing, including deductibles, copayments, coinsurance, and out-of-pocket limits, and compared findings with cost-sharing under employer-based insurance.

For people without cost-sharing reductions, average copayments, deductibles, and out-of-pocket limits under catastrophic, bronze, and silver plans are considerably higher than under employer-based plans on average,

Despite advice to shop around before selecting a plan, consumers may find that getting answers about drug coverage can be an exercise in frustration, despite a federal health law requirement that insurers provide lists of the prescription medications included in their plans.

That’s because many treatments — particularly intravenous treatments like those used in cancer, hemophilia or multiple sclerosis — are covered under a separate part of an insurance plan, not the pharmacy benefit.