Health care sharing ministry
A health care sharing ministry is an organization in the United States that facilitates sharing of health care costs among individual members, in the United States, who have common ethical or religious beliefs. A health care sharing ministry does not use actuaries, does not accept risk or make guarantees, and does not purchase reinsurance policies on behalf of its members. Members of health care sharing ministries are exempt from the individual mandate requirement of the U.S. Patient Protection and Affordable Care Act, often referred to as Obamacare (the individual shared responsibility provision was repealed in December 2017, effective in 2019). This means members of health care sharing ministries are not required to have insurance as outlined in the individual mandate.
Approximately 30 states have safe harbor laws that distinguish healthcare ministries from health insurance organizations.Some of the larger health care sharing ministries include Christian Healthcare Ministries (established around 1981), Medi-Share, a program of Christian Care Ministry (1993), Samaritan Ministries (1994), Liberty HealthShare (1998), MCS Medical Cost Sharing and Altrua HealthShare.
Most health care sharing ministries are oriented toward practicing Christians and aligned with ideals or principles found in the Christian Bible, primarily translated to mean that believers have a responsibility to assist in meeting each other's needs. Such ministries often cite a biblical verse in the book of Galatians, from the New Testament, as a mandate applicable to medical costs, specifically Verse 2 in Chapter 6, in which the Apostle Paul wrote “Bear one another’s burdens, and thus fulfill the law of Christ.” Some ministries view verses 44–45 in Chapter 2 of the Book of Acts, also from the New Testament, which states that early Christians "were together and had everything in common" and "gave to anyone as he had need," as the basis for their founding.
Several states have tried to block health care sharing ministries on the grounds that they are selling unauthorized insurance. A majority of states, however, have enacted safe harbor laws specifying that the ministries are not insurance and do not need to be regulated as such. In addition, the U.S. Department of Health and Human Services issues exemption letters to ministries that have met the criteria to operate independently of the Affordable Care Act.
The future of health care sharing ministries after Obamacare's individual mandate repeal was unclear, but a work published by Harvard Law School suggested that many people may continue to use them, and they could even expand for people ineligible for healthcare subsidies (i.e. above the income threshold).
According to Alliance of Health Care Sharing Ministries, a trade association of sharing ministries, over 625,000 Americans participated in health care sharing as of September 2016[update], sharing more than $670 million in medical bills annually.[a] A January 2015 op-ed in The New York Times stated that the four main healthcare ministries in the US have a total combined membership of about 340,000, that membership has grown recently because of the healthcare ministries' exemption to the insurance mandate of the Affordable Care Act, and that monthly cost of membership in a health care sharing ministry is generally lower than the cost of insurance rates. The Seattle Times also reported that membership has grown significantly in recent years.
Most health sharing ministries tend to have restrictions such as abstaining from extramarital sex, excessive drinking, and use of tobacco or illegal drugs. They usually require members to be in good health and make a statement of belief, as well. For instance, Samaritan Ministries requires a statement of Christian faith including belief in the triune God and divinity of Jesus; Liberty HealthShare is more inclusive, accepting members with a wide variety of religious and ethical beliefs. All such ministries require that members subscribe to the principles of individual responsibility for their own health and of helping others in need.
Requirements under the Affordable Care Act
In order for members to be exempt from the tax penalties outlined in the Affordable Care Act, ministries must meet the following qualifications:
- Must be a 501(c)(3) organization
- Members must share common ethical or religious beliefs
- Must not discriminate membership based on state of residence or employment
- Members cannot lose membership due to development of a medical condition
- Must have existed and been in practice continually since December 31, 1999 (a grandfather clause)
- Must be subject to an annual audit by an independent CPA which must be publicly available upon request
Four ministries that meet these qualifications are: Christian Healthcare Ministries, Liberty HealthShare, Medi-Share, and Samaritan Ministries. MCS Medical Cost Sharing, founded after 1999, does not meet the qualifications, but offers to pay the tax penalties incurred by members. Altrua HealthShare has also been recognized as an qualifying health care sharing ministry, due to its merger with Blessed Assurance Bulletin. Anabaptist Healthshare, founded in 2015, claims to be recognized as a health care sharing ministry by the U.S. Department of Health & Human Services. In 2016, Aliera Healthcare/Unity HealthShare joined with AnaBaptist HealthShare (Mennonite Medical Aid Plan), a healthcare sharing ministry recognized by the Centers for Medicare & Medicaid Services (CMS).
Monthly share payments are not deductible from US federal income tax as either a medical expense (because it is not a payment for insurance) or a charitable deduction (because it is a payment for goods and services). Member payment in excess of their required monthly minimum, however, may be deductible as a charitable contribution.
- Pub.L. 111–148 Sec. 5000A(d)(2)(b)(i)
- "The Religious Alternative To Obamacare's Individual Mandate". NPR. Retrieved 2015-05-19.
- "Alliance of Health Care Sharing Ministries: State info". Alliance of Health Care Sharing Ministries. Retrieved 2015-05-19.
- "About Us". Christian Healthcare Ministries. Retrieved May 19, 2015.
- "Medi-Share". My Christian Care. Retrieved May 19, 2015.
- "Samaritan Ministries International". Retrieved May 19, 2015.
- "Liberty HealthShare". Retrieved May 19, 2015.
- "Christian Health Care". Christian Medical Cost Sharing. Retrieved May 19, 2015.
- "Resources". Altrua Health Share. Retrieved May 19, 2015.
- "Health care sharing ministry members share their experiences". Self pay patient. Retrieved May 19, 2015.
- Whyte, Liz Essley. "Sharing Health". Philanthropy Magazine. Retrieved 2015-05-19.
- "Alliance of Health Care Sharing Ministries". Retrieved 2015-05-19.
- "Onward, Christian Health Care?". The New York Times. Retrieved May 19, 2015.
- The Washington Post.
- Dong, Aobo (January 17, 2018), "Health Care Sharing Ministries (HCSMs) after Tax-Penalty Repeal", Bill of Health (blog), Harvard Law Petrie-Flom Center
- "What is Health Care Sharing?". Alliance of Health Care Sharing Ministries. 10 February 2017. Archived from the original on 10 February 2017.
- "Banking on faith: Cost-sharing ministries offer Obamacare alternative". The Seattle Times.
- "Healthcare Sharing – Mainstream Healthcare Choices". Christian Healthcare Ministries-review. February 28, 2016. Archived from the original on March 17, 2016.
- Pub.L. 111–148 Sec. 5000A(d)(2)(b)(ii)
- "No Penalties for M.C.S Members". Christian Medical Cost Sharing. Retrieved May 19, 2015.
- "Altrua Gains Recognition as a Health Care Sharing Ministry" (PDF). Altrua HealthShare. 23 December 2014. Archived from the original (PDF) on February 2015. Retrieved 12 December 2016.
- Parnell, Sean (15 October 2014). "Altrua qualifies for Obamacare exemption, plus more on CMF Curo". The Self-Pay Patient. Retrieved 2016-12-12. (Altrua achieved this via a merger with a smaller but older ministry)
- "Business Entity Details: Anabaptist Healthshare". Virginia State Corporation Commission. Retrieved 14 June 2017.
- "Anabaptist Healthshare". 19 December 2016. Retrieved 14 June 2017.
- Recognition, Alier healthcare.
- Roane, Dayna (1 March 2014), "Religious exemptions form health care individual mandate", Journal of Accountancy.
- Andrews, Michelle (25 April 2011). "Ministries allow Christians to share health-care costs". Washington Post.
- Boyd, Benjamin (2013). "Health Care Sharing Ministries: Scam or Solution". Journal of Law and Health. 26 (2): 219-283.
- Boyd, Benjamin (2013). "Obamacare's Silver Lining: Health Care Sharing Ministries". Liberty Legal Journal. 21.
- Brase, Twila (January 2010). "Medical sharing: An inexpensive alternative to health insurance" (PDF). Citizens’ Council on Health Care.
- Daniels, Scott (22 March 2016). "Health Care Sharing Ministries: An Uncommon Bond". doi:10.13140/rg.2.1.2761.6401.
- Eastman, Kevin; Ruhland, Joseph S.; Eastman, Alan (2010). "Regulation of health care sharing ministries". Journal of Insurance Regulation. 29 (2): 189-206. ISSN 0736-248X – via ProQuest. (or via EBSCO)
- "Faithful flocking to another option for healthcare costs". Nursing. Vol. 47 no. 3. Ovid Technologies / Wolters Kluwer Health. 2017. p. 15. doi:10.1097/01.nurse.0000512880.99009.2d. ISSN 0360-4039.
- Galarneau, Charlene (12 February 2015). "Health Care Sharing Ministries and Their Exemption From the Individual Mandate of the Affordable Care Act". Journal of Bioethical Inquiry. Springer Nature. 12 (2): 269–282. doi:10.1007/s11673-015-9610-3. ISSN 1176-7529.
- Galarneau, Charlene (2016). Communities of Health Care Justice. Critical Issues in Health and Medicine. Rutgers University Press. ISBN 978-0-8135-7768-5.
- Goodnough, Abby (31 January 2015). "Christians Flock to Groups That Help Members Pay Medical Bills". The New York Times.
- Grover, Samuel T. (2011). "Religious Exemptions to the PPACA's Health Insurance Mandate". American Journal of Law & Medicine. SAGE Publications. 37 (4): 624–651. doi:10.1177/009885881103700404. ISSN 0098-8588.
- Henriques, Diana B. (20 October 2006). "Ministry's Medical Program Is Not Regulated". The New York Times.
- Lilienstein, David; Cho, Jessica (September 2016). "When religion gets in the way of health care" (PDF). Plaintiff Magazine. p. 7-14. (As published with advertising)
- Markoe, Lauren (6 October 2014). "Following Evangelicals, Traditional Catholics Create a Health Insurance Alternative". Sojourners.
- Paquette, Danielle (29 August 2014). "'Christians are just healthier': One family's cost-sharing alternative to Obamacare". Washington Post.
- Roane, Dayna (2014). "Religious Exemptions from the Health Care Individual Mandate". Journal of Accountancy. 217 (3): 62.
- Rohrer, K.; Dundes, L. (2016). "Sharing the Load: Amish Healthcare Financing. In Healthcare". 4 (4). Multidisciplinary Digital Publishing Institute: 92.
- Smietana, Bob (23 January 2014). "For some Christians, sharing medical bills is a godly alternative". Washington Post.
- Somashekhar, Sandhya (5 June 2014). "More Americans who oppose Obamacare are turning to faith-based nonprofits to cover medical expenses". Washington Post.
- Worthen, Molly (1 January 2015). "Onward, Christian Health Care?". The New York Times.
- Zamosky, Lisa (19 July 2016). "Healthcare sharing ministries: A leap of faith?". HealthInsurance.org.
- Brase, Twila (1 April 2010) . "Medical Sharing Ministries (MSM): Comparison chart" (PDF). Citizens’ Council on Health Care.
- Alliance of Health Care Sharing Ministries