Health Law Daily Wrap Up, GENERAL HEALTH CARE NEWS—10th Cir.: Healthcare sharing ministry fails to show imminent prosecution for standing on §1983 claims, (Oct 16, 2025)

ByJustin Marcus Smith, J.D.

The HCSM did not show any inevitability of fraud claims or formal complaints against it, and it failed to properly plead that any particular result was imminent.

A nonprofit healthcare sharing ministry (HCSM) and ten of its members did not have standing to pursue civil rights claims against the Office of the New Mexico Superintendent of Insurance (OSI), affirmed the United States Court of Appeals for the Tenth Circuit, in a non-precedential decision. In the view of the Tenth Circuit, the HCSM and its members did not plead a credible threat of any imminent enforcement action, never mind one that might be unconstitutional. The applicable New Mexico statute did not proscribe anything the HCSM wanted to do, and prior OSI enforcement actions against other HCSMs appeared to be routine and circumstantial (Samaritan Ministries Int’l v. Kane, No. 24-2187 (10th Cir. Oct. 9, 2025)).

Background. An HCSM and ten of its members (collectively, the HCSM) sued the New Mexico Superintendent of Insurance in her official capacity as the head of the OSI. The HCSM alleged deprivation of civil rights under 42 U.S.C. § 1983.

The ten HCSM members, all New Mexico residents, alleged they were exempt from the Affordable Care Act (ACA) insurance mandate. ACM-exempt HCSM members generally share medical expenses in accord with a common set of religious beliefs. The instant HCSM was among the first and largest, with nationwide membership and about 1,000 members in New Mexico. According to the Second Amended Complaint (SAC), the HCSM collected monthly contributions from members on a voluntary basis with HCSM members remaining legally responsible for their own medical bills.

The SAC raised twelve § 1983 claims alleging that the Superintendent supervised an “anti-HCSM” campaign that violated constitutional rights under the First and Fourteenth Amendments and the New Mexico Religious Freedom Restoration Act. The SAC sought to enjoin the OSI from enforcing New Mexico insurance laws against or exercising regulatory authority over the HCSM and its members; a declaratory judgment that “threatened actions” were unconstitutional and that the HCSM qualified as an HCSM under the ACA; and various damages.

The OSI moved to dismiss for lack of subject matter jurisdiction under Fed. R. Civ. P. 12(b)(1). The Superintendent denied any acts or threats against the HCSM parties and argued they did not have Article III standing. The district court agreed and dismissed for lack of standing inasmuch as the HCSM parties did not allege a sufficiently concrete or particularized actual or imminent injury for standing to pursue any of the twelve counts. On appeal, the Tenth Circuit applied de novo review.

Allegation timing. The first problem the Tenth Circuit noted was that the HCSM argued the district court should have considered alleged statements the Superintendent made, post-complaint, as evidence of standing. The Tenth Circuit noted that standing depends on the circumstances at inception of a lawsuit, not on allegations of circumstances arising post-filing. The Tenth Circuit held the district court correctly concluded post-complaint statements could not perfect standing.

Pre-enforcement challenge. The HCSM raised a pre-enforcement challenge to the OSI’s alleged anti-HCSM policy, but the district court found the SAC failed to identify an alleged OSI policy that proscribed HCSM conduct or constitutional interests. The HCSM also failed to provide authority for its broad view of pre-enforcement concerns.

On appeal, the HCSM argued the policy they challenged was the OSI’s new interpretive policy for applying the statutory definition of insurance to HCSMs. However, as the OSI pointed out, the Tenth Circuit found New Mexico’s statutory definition of insurance did not proscribe any conduct. It simply defined insurance, and the HCSM did not allege that any other statute proscribed their conduct.

Next, the district court correctly determined that the HCSM did not establish any history of past enforcement to perfect pre-enforcement standing. The HCSM argued the OSI’s history of enforcement against five other HCSMs was a strong sign that the instant HCSM faced a risk of enforcement. The HCSM also argued the district court improperly discounted years of serial enforcement against other HCSMs that showed a credible imminent threat.

The Tenth Circuit concluded, in contrast, that two of the five other putative HCMS did not actually qualify as ACA-exempt HCSMs, and the remaining three had various issues that included consumer complaints. In light of that record, the Tenth Circuit said it agreed with the district court that the OSI began investigations that pertained to the parties involved, and it arrived at findings specific to their individual circumstances. The instant HCSM did not show any inevitability of fraud claims or formal complaints against it, and it failed to properly plead that any particular result was imminent.

The Tenth Circuit acknowledged the instant HCSM was correct that a credible threat of prosecution might be inferred in the absence of any actual threat. This can happen when someone raises a facial challenge to proscribed conduct where the state has not disavowed a threat of prosecution. But here, the statute the HCSM challenged was merely definitional. It did not facially proscribe any conduct, “let alone the conduct they wish to engage in.” The HCSM simply did not show imminent risk of substantial harm.

The case is No. 24-2187.

Judge: Holmes, J.

Attorneys: J. Brian Heller (J. Brian Heller, Attorney at Law) and John Matthew Szymanski (Gammon & Grange, P.C.) for Samaritan Ministries International, Zachary Cordel and Rachel Cordel. Stephen P. Thies (Law Office Stephen P. Thies) for Alice T. Kane.

Companies: Samaritan Ministries International

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