Health care sharing ministry

A health care sharing ministry is an organization 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and Affordable Care Act,^[1] often referred to as Obamacare (the individual shared responsibility provision was repealed in December 2017, effective in 2019).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.^[2]

Approximately 30 states have safe harbor laws that distinguish healthcare ministries from health insurance organizations.^[3]

History

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.^[4] 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.^[5][6]

Several states have tried to block health care sharing ministries on the grounds that they are selling unauthorized insurance.^[7] 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).^[8]

Membership

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, sharing more than $670 million in medical bills annually.^{[9][lower-alpha 1]} 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.^[6] The Seattle Times also reported that membership has grown significantly in recent years.^[10]

Some of the larger health care sharing ministries are: Christian Healthcare Ministries (established around 1981),^[11] Medi-Share, a program of Christian Care Ministry (1993),^[12] Samaritan Ministries (1994),^[13] Liberty HealthShare (1998),^[14] MCS Medical Cost Sharing^[15] and Altrua HealthShare.^[16][17]

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.^[18]

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^[19]

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.^[20] Altrua HealthShare has also been recognized as an qualifying health care sharing ministry, due to its merger with Blessed Assurance Bulletin.^[21][22] Anabaptist Healthshare, founded in 2015,^[23] claims to be recognized as a health care sharing ministry by the U.S. Department of Health & Human Services^[24]. 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).^[25]

Tax deductibility

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.^[26]

See also

• Benefit society

Notes

References

Further reading

External links

• Brase, Twila (1 April 2010) [2009]. "Medical Sharing Ministries (MSM): Comparison chart" (PDF). Citizens’ Council on Health Care.
• Alliance of Health Care Sharing Ministries