View source for Health care sharing ministry

{{short description|Organizations in the United States in which health care costs are shared}}
'''Health care sharing ministries''' (HCSM) are organizations in the United States in which [[health care costs]] are shared among members with common ethical or religious beliefs in a risk-pooling framework in some ways analogous to, but distinct from, health insurance.
Members of health care sharing [[Christian ministry|ministries]] were exempt from the [[individual mandate]] requirement of the U.S. [[Patient Protection and Affordable Care Act]] that [[individual shared responsibility provision|required individuals to have insurance]] from 2010 until 2019 when the federal tax penalty for violating the individual mandate was dropped under the terms of the [[Tax Cuts and Jobs Act]] of 2017.<ref>{{USPL|111|148}} Sec. 5000A(d)(2)(b)(i)</ref><ref name=npr20130928>{{cite news |url=https://www.npr.org/2013/09/28/227238887/the-religious-alternative-to-obamacares-individual-mandate |title=The Religious Alternative To Obamacare's Individual Mandate |work=NPR |accessdate=2015-05-19 |archive-url= https://web.archive.org/web/20150420082550/http://www.npr.org/2013/09/28/227238887/the-religious-alternative-to-obamacares-individual-mandate |archive-date=2015-04-20 |url-status=live }}</ref>
[[Tennessee]] has a law stating that health care sharing ministries are not subject to state regulatory requirements for insurance companies.<ref>"[https://wapp.capitol.tn.gov/apps/BillInfo/default.aspx?BillNumber=HB1163&GA=113 HB 1163: Healthcare Sharing Ministries Freedom to Share Act]". ''Tennessee General Assembly''. March 15, 2024.</ref>
==History==
Predecessors to health care sharing ministries date back to at least the early 1900s. For many decades, "in [[Amish]] and [[Mennonite]] communities across the [US], people pooled their money to lighten the burden of debt for individuals during hard times."<ref name=pbsnh20180116/> In the late 20th century, this broadened out to larger communities by larger cost-sharing ministries within the Christian community.<ref name=pbsnh20180116/>
Most health care sharing ministries are oriented toward practicing [[Christians]].<ref name=philmag20150519>{{cite magazine |url=http://www.philanthropyroundtable.org/topic/philanthropic_freedom/sharing_health1 |title=Sharing Health |last=Whyte |first=Liz Essley |magazine=Philanthropy Magazine |access-date=2015-05-19 |archive-url=https://web.archive.org/web/20150428063915/http://www.philanthropyroundtable.org/topic/philanthropic_freedom/sharing_health1 |archive-date=2015-04-28 |url-status=live }}</ref>
The [[State of Oklahoma]] contested Medi-Share in 2007 for marketing information that promoted the cost-sharing option as "insurance", but that issue was resolved when they changed their approach, and by 2010, Medi-Share was able to operate in Oklahoma once again.<ref name=dmn20101228/> In 2002, [[Kentucky]] obtained a restraining order to stop the sale of Medi-Share memberships because the company was selling unauthorized insurance.<ref>Boodman, Sandra G. (October 25, 2005). "[https://www.washingtonpost.com/wp-dyn/content/article/2005/10/22/AR2005102200046.html Seeking Divine Protection]". ''The Washington Post''.</ref> The president of the group operating Medi-Share has said that Medi-Share is "not promising to pay anyone's bills. It's more of a step in faith. We trust in the Lord."<ref>Roberson, Jason (December 29, 2010). "[https://www.oklahoman.com/story/news/religion/2010/12/29/sharing-ministries-offer-alternative-to-health-insurance/61191926007/ Sharing ministries offer alternative to health insurance]". ''The Dallas Morning News''. Retrieved May 3, 2024.</ref> 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.
In 2010, at the time the U.S. Patient Protection and Affordable Care Act was passed, there were estimated to be about 100,000 people belonging to some type of medical bill-sharing ministry.<ref name=dmn20101228>{{cite news |url=https://www.dallasnews.com/business/2010/12/28/sharing-ministries-offer-alternative-to-health-insurance/ |title=Sharing ministries offer alternative to health insurance |work=[[Dallas Morning News]] |date=28 December 2010 |access-date=4 December 2019 }}</ref>
By 2014, it was estimated to be 160,000; and by 2018, that number in the US had grown to 1 million.<ref name=pbsnh20180116>{{cite news |url=https://www.pbs.org/newshour/health/1-million-americans-pool-money-in-religious-ministries-to-pay-for-health-care |title=1 million Americans pool money in religious ministries to pay for health care |work=[[PBS NewsHour]] |author=Laura Santhanam |date=16 January 2018 |access-date=4 December 2019}}</ref>
The future of health care sharing ministries after Obamacare's individual mandate repeal was unclear{{when|date=December 2019}}, 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).<ref name=dong20180117>{{citation |title= Health Care Sharing Ministries (HCSMs) after Tax-Penalty Repeal |date=January 17, 2018 |first=Aobo|last=Dong |work=Bill of Health |type=blog |publisher= Harvard Law Petrie-Flom Center |url=http://blogs.harvard.edu/billofhealth/2018/01/17/health-care-sharing-ministries-hcsms-after-tax-penalty-repeal/ |access-date=2018-02-01 |archive-url= https://web.archive.org/web/20180202012625/http://blogs.harvard.edu/billofhealth/2018/01/17/health-care-sharing-ministries-hcsms-after-tax-penalty-repeal/ |archive-date=2018-02-02 |url-status= live }}</ref>
==Membership==
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 significantly 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.<ref name= "nyt2015">{{cite news|url= https://www.nytimes.com/2015/02/01/opinion/sunday/onward-christian-health-care.html|title= Onward, Christian Health Care?|work= The New York Times|date= 31 January 2015|accessdate= May 19, 2015|archive-url= https://web.archive.org/web/20150523111122/http://www.nytimes.com/2015/02/01/opinion/sunday/onward-christian-health-care.html|archive-date= May 23, 2015|url-status= live|last1= Worthen|first1= Molly}}</ref>  ''The Seattle Times'' also reported that membership had grown significantly, in a 2015 article.<ref>{{cite news |url= http://www.seattletimes.com/seattle-news/health/banking-on-faith-cost-sharing-ministries-offer-obamacare-alternative/ |title= Banking on faith: Cost-sharing ministries offer Obamacare alternative |work= The Seattle Times |access-date= 2015-05-20 |archive-url= https://web.archive.org/web/20150520072630/http://www.seattletimes.com/seattle-news/health/banking-on-faith-cost-sharing-ministries-offer-obamacare-alternative/ |archive-date= 2015-05-20 |url-status= live }}</ref>
Most health sharing ministries tend to have restrictions.   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 [[Holy trinity|true God and divinity of Jesus]]; Liberty HealthShare and Freedom HealthShare are more inclusive, accepting members with a wide variety of religious and ethical beliefs.{{citation needed|date=December 2019}}
==Requirements under the Affordable Care Act==
In order for members to be exempt from the since-repealed tax penalties outlined in the Affordable Care Act, ministries must meet the following qualifications:
* Must be a [[501(c) organization#501(c)(3)|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 (or a predecessor 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<ref>{{USPL|111|148}} Sec. 5000A(d)(2)(b)(ii)</ref>
The five ministries that meet these qualifications are Christian Healthcare Ministries, Liberty HealthShare, [[Christian Care Ministry#Medi-Share|Medi-Share]], Samaritan Ministries{{citation needed|date=June 2017}}, and OneShare{{citation needed|date=December 2019}}.
In 2017, a healthcare sharing organization tailored to Jews, United Refuah, was launched. The group claims to be recognized as a healthcare sharing organization by the Centers for Medicare & Medicaid Services (CMS).<ref>{{Cite web|last=Images|first=Getty|title=Jews Now Have A Faith-Based Alternative To Health Insurance. But It's Risky.|url=https://forward.com/news/national/419291/healthcare-health-insurance-obamacare-jewish/|access-date=2020-11-05|website=The Forward|date=15 February 2019 |language=en-US}}</ref>
==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.<ref>{{Citation | url = http://www.journalofaccountancy.com/issues/2014/mar/20139238.html | first = Dayna | last = Roane | title = Religious exemptions form health care individual mandate | journal = Journal of Accountancy | date = 1 March 2014 | access-date = 22 January 2017 | archive-url = https://web.archive.org/web/20170119183918/http://www.journalofaccountancy.com/issues/2014/mar/20139238.html | archive-date = 19 January 2017 | url-status = live }}.</ref>  In a proposed rule, dated June 8, 2020 the IRS has proposed to change the deductibility of share payments.<ref>{{Cite web |title= Proposed regulations address direct primary care arrangements and health care sharing ministry memberships |url=https://www.irs.gov/newsroom/proposed-regulations-address-direct-primary-care-arrangements-and-health-care-sharing-ministry-memberships|access-date= 2020-11-16| publisher = Internal Revenue Service}}</ref>
== Criticism ==
Unlike regulated insurance companies, health care sharing ministries do not guarantee payment for members' health care and are not required by law to pay their members' claims for legitimate medical expenses.<ref>Meyer, Deborah L. (August 30, 2018). "[https://www.kiplinger.com/article/insurance/t027-c032-s014-health-insurance-too-expensive-a-cheaper-option.html Health Insurance Too Expensive? A Cheaper Option to Investigate]". ''Kiplinger''. Retrieved May 3, 2024.</ref><ref>Hawryluk (June 12, 2023). "[https://www.msn.com/en-us/money/insurance/more-americans-use-health-care-sharing-plans-despite-lack-of-protections/ar-AA1ctRkK More Americans use health care sharing plans, despite lack of protections]". ''CBS News''. Retrieved May 3, 2024.</ref><ref>Ingalls, Chris (February 27, 2024). "[https://www.msn.com/en-us/health/other/dont-fall-for-it-healthcare-sharing-ministries-look-like-insurance-but-theyre-not/ar-BB1j098P 'Don't fall for it': Healthcare sharing ministries look like insurance, but they're not]". ''KING_TV Seattle''. Retrieved May 3, 2024.</ref>
Health insurance brokers in Massachusetts are not allowed to market health care sharing ministry memberships to consumers, to avoid misleading consumers into thinking they are low-price guaranteed-issue insurance plans. HCSMs are not required to cover pre-existing conditions, which has led to disputes over denial of payment.<ref>{{Cite web|url=https://www.bostonglobe.com/2021/06/01/business/shes-stuck-with-75k-bills-after-her-health-care-sharing-ministry-refuses-pay-up/|title=She's stuck with $75,000 in bills after her 'health care sharing ministry' refuses to pay |website=The Boston Globe}}</ref>
In 2020, the [[California Department of Insurance]] issued a cease and desist order to Aliera Healthcare, Inc., and Trinity Healthshares, Inc., founded by Timothy Moses and his wife Shelley Steele, for violating California law by misleading California consumers into purchasing their products. It is estimated that Aliera and the Moses family pocketed 84% of member monthly plan sharing, allowing for up to 16% to be invested into the healthcare sharing ministry fund and drawing much criticism, as Affordable Care Act health plans require up to 80% of premiums to be paid towards medical plans.
<ref>{{cite news |last1=Abelson |first1=Reed |title=California Cracks Down on Alternative Health Plans |url=https://www.nytimes.com/2020/03/10/health/christian-health-care-ministries.html |website=[[The New York Times]] |date=10 March 2020 |access-date=11 July 2021}}</ref>
In 2021 [[John Oliver (comedian)|comedian John Oliver]] set up a mock healthcare sharing ministry in Florida called ''[[Our Lady of Perpetual Health]]'' (following his earlier satire ''Our Lady of Perpetual Exemption''), satirizing what HCSMs are allowed to do by law, essentially having no obligation to provide any care.<ref>{{Cite news |title=John Oliver on healthcare ministries: 'They are not health insurance' |last=Horton |first=Adrian |newspaper=The Guardian |date=28 June 2021 |url= https://www.theguardian.com/tv-and-radio/2021/jun/28/john-oliver-healthcare-sharing-ministries}}</ref><ref name=oliver>{{Cite web |title=John Oliver's JohnnyCare |author= |website=JohnnyCare |date= |access-date=29 June 2021 |url= https://freedomfromhealthcare.org/|url-status=live|archive-url=https://web.archive.org/web/20210629022942/https://freedomfromhealthcare.org/|archive-date=29 June 2021| quote=The JohnnyCare Community provides for all your eligible* medical needs.}} (*The Web site clarifies that ''no'' needs are actually eligible.)</ref>
In 2024 James L. McGinnis and Craig Anthony Reynolds, co-founders of ''Medical Cost Sharing'', both pleaded guilty to wire fraud conspiracy. Their health care sharing ministry had received over $8{{nbsp}}million in member contributions, of which they paid $5{{nbsp}}million to themselves while paying out just $248,000 in health care claims.<ref>"[https://www.newspressnow.com/news/local_news/courts/man-pleads-guilty-in-health-care-fraud/article_a2c067ce-f5ee-11ee-b30e-1b17bdfedf9c.html Man pleads guilty in health care fraud]". ''News-Press Now''. April 8, 2024. Retrieved May 3, 2024.</ref><ref>"[https://www.bizjournals.com/kansascity/news/2024/04/10/medical-cost-sharing-st-joseph-james-l-mcginnis.html Co-founder pleads guilty in $8M Christian health care ministry scheme]". ''Kansas City Business Journal''. Retrieved May 3, 2024.</ref>
==See also==
*[[Benefit society]]
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==References==
{{reflist|2}}
== Further reading ==
{{refbegin|40em}}
* {{cite news |last=Andrews |first=Michelle |title=Ministries allow Christians to share health-care costs |newspaper=Washington Post |date=25 April 2011 |url=https://www.washingtonpost.com/national/health/ministries-allow-christians-to-share-health-care-costs/2011/03/29/AFGHRqkE_story.html}}
* {{cite journal |last=Boyd |first=Benjamin |year=2013 |title=Health Care Sharing Ministries: Scam or Solution |journal=Journal of Law and Health |volume=26 |issue=2 |pages=219–283 |url=http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1341&context=jlh}}
* {{cite journal |last=Boyd |first=Benjamin |year=2013 |title=Obamacare's Silver Lining: Health Care Sharing Ministries |journal=Liberty Legal Journal |volume=21 |url=http://heinonline.org/hol-cgi-bin/get_pdf.cgi?handle=hein.journals/liblej2013&section=11 }}
* {{cite web |last=Brase |first=Twila |date=January 2010 |title=Medical sharing: An inexpensive alternative to health insurance |publisher=Citizens’ Council on Health Care |url=http://www.cchfreedom.org/pdf/MEDICAL_SHARING-FINAL_JAN2010.pdf}}
* {{cite journal |last1=Eastman |first1=Kevin |last2=Ruhland |first2=Joseph S. |last3=Eastman |first3=Alan |year=2010 |title=Regulation of health care sharing ministries |journal=Journal of Insurance Regulation |volume=29 |issue=2 |pages=189–206 |issn=0736-248X |id={{ProQuest|819664966}} }} (or [http://search.ebscohost.com/login.aspx?direct=true&db=lgh&AN=56470438 via EBSCO])
* {{cite journal |title=Faithful flocking to another option for healthcare costs |journal=Nursing |publisher=Ovid Technologies / Wolters Kluwer Health |volume=47 |issue=3 |year=2017 |issn=0360-4039 |doi=10.1097/01.nurse.0000512880.99009.2d |pages=15|s2cid=38045017 }}
* {{cite journal |last=Galarneau |first=Charlene |title=Health Care Sharing Ministries and Their Exemption From the Individual Mandate of the Affordable Care Act |journal=Journal of Bioethical Inquiry |publisher=Springer Nature |volume=12 |issue=2 |date=12 February 2015 |issn=1176-7529 |doi=10.1007/s11673-015-9610-3 |pmid=25672616 |pages=269–282|s2cid=10638955 }}
* {{cite book |last=Galarneau |first=Charlene |title=Communities of Health Care Justice |publisher=Rutgers University Press |series=Critical Issues in Health and Medicine |year=2016 |isbn=978-0-8135-7768-5 |url=https://books.google.com/books?id=EbBkDQAAQBAJ}}
* {{cite journal |last=Grover |first=Samuel T. |title=Religious Exemptions to the PPACA's Health Insurance Mandate |journal=American Journal of Law & Medicine |publisher=SAGE Publications |volume=37 |issue=4 |year=2011 |issn=0098-8588 |doi=10.1177/009885881103700404 |pmid=22292214 |pages=624–651|s2cid=10952265 }}
* {{cite news |last=Henriques |first=Diana B. |title=Ministry's Medical Program Is Not Regulated |work=The New York Times |date=20 October 2006 |url=https://www.nytimes.com/2006/10/20/business/20religion.html}}
* {{cite magazine |last1=Lilienstein |first1=David |last2=Cho |first2=Jessica |date=September 2016 |title=When religion gets in the way of health care |magazine=Plaintiff Magazine |pages=7–14 |url=http://www.plaintiffmagazine.com/images/issues/2016/09-september/Reprints/Lilienstein-Cho_When-religion-gets-in-the-way-of-health-care_Plaintiff-magazine.pdf}} ([http://www.plaintiffmagazine.com/images/issues/2016/09-september/Plaintiff-Sept16-issue.pdf As published] with advertising)
* {{cite magazine |last=Markoe |first=Lauren |title=Following Evangelicals, Traditional Catholics Create a Health Insurance Alternative |magazine=Sojourners |date=6 October 2014 |url=https://sojo.net/articles/following-evangelicals-traditional-catholics-create-health-insurance-alternative <!--https://www.washingtonpost.com/national/religion/following-evangelicals-traditional-catholics-create-a-health-insurance-alternative/2014/10/03/71520644-4b20-11e4-a4bf-794ab74e90f0_story.html -->}}
* {{cite news |last=Paquette |first=Danielle |title='Christians are just healthier': One family's cost-sharing alternative to Obamacare |newspaper=Washington Post |date=29 August 2014 |url=https://www.washingtonpost.com/news/storyline/wp/2014/08/29/christians-are-just-healthier-one-familys-cost-sharing-alternative-to-obamacare/}}
* {{cite journal |last=Roane |first=Dayna |year=2014 |title=Religious Exemptions from the Health Care Individual Mandate |journal=Journal of Accountancy |volume=217 |number=3
|page=62 |url=https://www.journalofaccountancy.com/issues/2014/mar/20139238.html}}
* {{cite news |last=Smietana |first=Bob |title=For some Christians, sharing medical bills is a godly alternative |newspaper=Washington Post |date=23 January 2014 |url=https://www.washingtonpost.com/national/religion/for-some-christians-sharing-medical-bills-is-a-godly-alternative/2014/01/23/4efe76ae-8474-11e3-a273-6ffd9cf9f4ba_story.html}}
* {{cite news |last=Somashekhar |first=Sandhya |title=More Americans who oppose Obamacare are turning to faith-based nonprofits to cover medical expenses |newspaper=Washington Post |date=5 June 2014 |url=https://www.washingtonpost.com/national/health-science/opting-out-of-obamacare/2014/06/05/126e03de-df7e-11e3-810f-764fe508b82d_story.html}}
* {{cite news |last=Worthen |first=Molly |date=1 January 2015 |title=Onward, Christian Health Care? |work=The New York Times |url=https://www.nytimes.com/2015/02/01/opinion/sunday/onward-christian-health-care.html}}
{{refend}}
== External links ==
* {{cite web|last=Brase |first=Twila |date=1 April 2010 |orig-year=2009 |title=Medical Sharing Ministries (MSM): Comparison chart |publisher=Citizens’ Council on Health Care |url=http://www.cchfreedom.org/pdf/MEDICAL_SHARING_MINISTRIES-COMPARISON_CHART.pdf}}
* [http://www.healthcaresharing.org/ Alliance of Health Care Sharing Ministries]
[[Category:Healthcare cost sharing organizations]]
[[Category:Health policy in the United States]]