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“It’s nicer to get a call from someone saying they’re praying for you than a computer slip in the mail from an insurance company that says your bill’s been paid,” Mr. Edwards said.

Unlike insurance, sharing ministries do not pool health risks or face state regulations mandating reserves of capital or surpluses. A local pastor must sign off on membership at Samaritan, and members say they like knowing their dollars will not subsidize practices to which they object, such as abortion.

When the health care law was being written, Mr. Lansberry of Samaritan said House lawmakers weren’t inclined to grant the ministries an exemption, but the bill’s authors in the Senate were willing to accommodate.

“When that passed,” Mr. Lansberry said of the upper chamber’s bill, “there was a little bit of a sigh of relief.”

He said that despite general concerns about Mr. Obama’s law as a government intrusion into health care, they do appreciate their self-described “island of freedom.”

Samaritan’s membership has grown steadily, but there hasn’t been much uptick on the cusp of the individual mandate’s impact in 2014, Mr. Lansberry said. While it could still happen, he thinks it’s unlikely.

“This,” he said, “would be the last thing on people’s minds if they’re trying to get around the mandate.”