Crowdfunding platforms such as GoFundMe and YouCaring have turned sympathy for Americans drowning inmedical expenses into a cottageindustry. NowRepublican efforts in Congress torepeal and replace Obamacarecould swellthe ranks of the uninsured and spurthe business ofhelping peopleraise donations online to pay for health care.

But medical crowdfunding doesn't have to wait for Congress to act. Business is already booming,and its leadersexpect therapid growth to continue no matter what happens on the Hill.

"Whether it's Obamacare or Trumpcare, the weight of health-care costs on consumers will only increase," said Dan Saper, chief executive officer of YouCaring. "It will drive more people to try and figure out how to pay health-care needs, and crowdfunding is in its early days as a way to help those people."

The GOPplan could hurt older and sicker Americans and those with preexisting conditions.Above, Speaker of the House Paul Ryanand House Majority Leader Kevin McCarthy.

Photographer: Tom Williams

At industry leaderGoFundMe, medical isone of the biggest fundraising categories.CEO Rob Solomon hassaid it'swhat "helped define andput GoFundMe on the mapand has called the company, founded in 2010,"a digital safety net."

Thatnetgrew wider this year withGoFundMe'sacquisition ofCrowdRise, which wasco-founded by the actor Edward Norton. Itadds to the company's business helping people fundraisefor charitiesandsends those who needfundsfor "medical bills, a friends tuition, a group volunteer trip, or any personal cause"to GoFundMe.

Growth hasbeen rapid.In a September2015LinkedIn post, Solomon wrote that the onemillion campaigns set up over the previous yearhad raised $1 billion from nearly 12 million donors. By February2016, the total was $2 billion. In October2016, it was$3 billion, from 25 million donors. A NerdWallet study of medical crowdfunding said GoFundMehad indicated that $930 million of the $2 billion raised intheperiod the study analyzed was from medical campaigns.

YouCaring,meanwhile, acquired GiveForwardthis year; medicalfundraisersmadeup 70 percent of GiveForward'scampaigns. The combined companies have8million donors who have contributed $800 million to a wide range of campaigns. A big part of that totalwas donatedto medical campaigns, according to the company.It wasapproaching 50 percent of all fundraisers at YouCaringbefore the acquisition,and thegrowth rate is setto triple this year,Sapersaid.

With enough volume, the business of helpingpeople raise moneyfor medical carehas a lot of profit potential. GoFundMetakes 5 percent of each donation, 2.9 percentgoes to payment processing, and there'sa 30transaction fee. Smaller sites, such asFundlyand FundRazr,chargemuch the same.YouCaringdonors pay just a 2.9 percent processing feeplus the 30.

"We rely on voluntary contributions from donors [to run the business], so our big thrust now ishow do we get the word out about it," said Saper. The company is scaling up its team and operationsandhiredthe former global head of engagement and growth of EventBrite, Maly Ly,asits chief marketing officer in March.

Indiegogo, which started outfunding filmmakers, createda separate platform in 2015 called Generosity. Medical is a top category, and users pay a 3 percent paymentprocessing fee and the 30.NowFacebook has jumped into thefray.On May 24, it began allowingusers to launch fundraisers for personal causes or nonprofits on their pages. Medical is one of eight available categories.For personal cause campaigns, Facebook takes6.9 percent of each donation plus 30.

For more and more Americans, vying in a popularity contest for a limited supply of funds and sympathy may be the only way to pay the doctors and stay afloat. House Republicans passed a bill last month to replace the Affordable Care Act, or Obamacare. As is, the Congressional Budget Office estimates, it would leave 23 million more Americans uninsured in 2026 than under the ACA. Even a law just resembling the bill is likely to raise the cost of health care for older and sicker Americans and for those with preexisting conditions, bolstering the medical crowdfunding business.

The industry still represents just a fraction of the hundreds ofbillions of dollarsAmericans pay annuallyout of pocket for health care, said Saper. Medical crowdfundingis "highly, highly scalableand has a ton of runway," he said. "The growth rate of the industry is showing that this can absolutely be an impactful safety net for a lot of individuals and communitiesto help each other."

Siblings Luke and Dana Nowakowski(above in Milwaukee in2015)started a campaign on GoFundMe to raise $25,000 to help their father pay for the care of their mother, who has dementia and mobility challenges.

Photographer: Darren Hauck/New York Times via Redux

The remarkably named Producing a Worthy Illness: Personal CrowdfundingAmidst Financial Crisis, astudy published this yearbythe University of Washington/Bothell,offers a striking perspective on some of those communities. Personal medical campaigns on GoFundMewere likelierto come from people living in states that chose not to expand Medicaid under the ACA, preliminary results of the study showed.Fifty-four percent of 200 randomly sampled campaigns last year came from those states, though theyare home to just 39 percent of the U.S. population.Trumpcarewould sharply curtail Obamacare's expansion of Medicaid.

"We had a huge number of campaigns from Texas, which is often recognized as thestate where it's most difficult to qualify for Medicaid and other public insurance," Professor Nora Kenworthy, co-author of the study, said. "A lot of the campaigns are really using GoFundMe as a safety net,"asking for "help with lost wages, help getting basic health-care services and support."

Mostmedical crowdfunding campaigns are a far cry from Taylor Swift's $50,000 gifton GoFundMe to a young girl with aggressive leukemia,or $1 million in donations for a mother whose cancer returned whenshe was pregnant with quadruplets."Often,funds people are raising are for a huge range of costs that go along with care, like travel to the place where you will get care, because insurance doesn't really cover that,"said Indiegogo'ssenior director of social innovation, BreannaDiGiammarino. In the future, more fundraisers will likely seektocover premiums and deductibles rather than the cost of care itself, she said.

"Crowdfunding is being treated a little like crowd-insurance now," said Daryl Hatton, CEO of Canada-based crowdfunding platformFundRazr.

Yet crowdfunding's business model is a poorfit for the gargantuan, mundane, never-endinghealth-care costs of many online campaigners. Some get just 10 to 20 percent of whattheyaskfor, said Jeremy Snyder, a health sciences professor at Simon Fraser University in Canada, where the need remains even with a national health-care system.Snyder'sresearch, whichincludesanalysis of ethicalissues raised by medical crowdfunding,has focusedon people seeking funding for cancer treatments on Canadian crowdfunding sites.

And, of course, in the U.S. as in Canada, somecampaigners get less than that, or nothing at all.Slightly more than onein 10 health-related online campaigns reached their goal in the NerdWalletreport. The Bothell studyfound that 90 percent of the 200 GoFundMe campaigns didn't reach their goal, and that, on average, fundraisers got 40 percent of what they asked for. That doesn't sound like much of a fixtoSnyder.

"Is this something that is going to be a solution to a lack of health insurance?" he said."Absolutely not."

One reason for the discouraging statistics is that while most of the campaigns are ordinaryand no less urgent for itit is often the extraordinary ones that do best.

The more dramatic the need, the more successful" the fundraiser,said Adrienne Gonzalez, who follows the industry asthe creator ofGoFraudMe.com, a site that exposes fraudulent campaignson GoFundMe.

Among the "most active" campaigns featured on generosity.com on May 30 were one to help pay for treatments for a man diagnosed with acute promyelocyticleukemiaand one fora womanstruggling to cover"co-pays, travel expenses, food, lodging, essentials" as she tends to her 19-year-old daughter, who is scheduled for akidney transplant.A third solicited fundsfor a woman without insurance who had been struck by lightning.

Those appeals are very different from that of anice hockey player who had broken her collarbone in a game and started a campaignongenerosity.com. Sheasked for $1,500 to help cover her $1,000 deductible and other costs, includingbeing sidelined from her landscaping job for at least six weeks. Over a month, she raised $252 from seven people, or 17 percent of her goal. It was something.

I need help with my deductiblethey are not going to be very successful, said Gonzalez, who believes crowdfunding has done a lot of good but presents"this whole socioeconomic problem"because "you almost have to be a marketing guru" to create a successful campaign.

The Bothellresearchers noticed a bias among donors toward funding solvable problems. "Injections that cost $10,000 every six months are a more solvable problem thana campaign for a family citing a litany of challenges, like utility bills that aren't being paid because the family is paying for health care," said Professor Lauren Berliner, Kenworthy's co-author on the study.Media and digital savvy play a big part in attracting donations.The campaigns withhashtags, images, and flashyelements got the most financial support, the study found.

"Most campaigns are paid for by friends, and friends of friends," said Hatton of FundRazr."A lot of it has to do with the strength of your social network," as people you helped now dip into a "karma bank" and help you. People with fewer financial resources may not have been able to build up that goodwilland may not have that wide and deep a social network to call on, he said.

Then there was thewoman in her 30swhowalked into afree clinic where Dr. Edward Weisbart, who chairs the Missouri chapter of Physicians for a National Health Program,volunteers. She was with her mother, appearedunable to speak,and hada "peculiar affect, like a crazed wild animal," he said. It turned out she had lived for years with seizures every two to three days until she founda medication that hadcut the frequency toonce every two months. When she visited Weisbart, she had lost her insuranceand had 10 days of medication left.

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"Her inarticulate state was not a consequenceof the seizures," Weisbart said. "It was terror over what her life would be like if she couldn't get the medication."Once he explainedthat the clinic could mail her the drugand that it would cost $40 instead of $1,500, "she transformed into this normal, lucid, almost friendly person," he said. "But she could never have usedcrowdfunding, because she was literally beside herself."

Hatton isseeing more"fatigue" around crowdfunding efforts. Weisbart observed that"when you get your first request, you probably give a high amount. But as you get besieged and realize how common these requests are, donations will go down. We can't keep on giving to everyone who asks."

Onesite keeping its distanceis Kickstarter, where donors fund creative projects.

"If we had personal health-care campaigns, it could create a strange moral equivalency," saidJustin Kazmark, the company's vice president of communications. "If you see documentary filmmakers trying to get $10,000 for a film alongside a project for someone whose dog needs dental surgery, or for disaster relief,it changes the mindsetand frames the whole thing differently."

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America's Health-Care Crisis Is a Gold Mine for Crowdfunding - Bloomberg