The Real Individual Religious Exemption to the Affordable Care Act
There has been a great deal of attention on various businesses ranging from craft shops to car dealerships suing for a religious exemption to the Affordable Care Act Mandate because they do not wish to provide their female employees with birth control. While those cases wend their way through the various courts, and possibly the Supreme Court, there is a little noticed religious exemption already in place for individuals.
Under the ACA, all individuals are required to have health insurance. Starting in 2015, everyone will have to indicate that they have a qualifying policy or pay a fine. People who cannot find an insurance plan that doesn’t exceed the income threshold are exempt from the fine. A little noticed provision of the law also allows people that indicate they are part of medical-sharing ministries to be exempt from paying a fine.
Medical-sharing ministries are a coalition of like-minded religious people that operate on the biblical principal of taking care of your neighbor by assisting with each others’ medical costs through voluntary giving. They are not insurance plans, are not regulated, nor are they licensed or registered with any state agency. The way the provision was written, eligible qualifying health-sharing ministries had to be in existence as of December 31, 1999. This has given a monopoly to three ministries which serve Christians.
These are also the same three that lobbied for the provision.
Unlike commercial health insurance plans, medical-sharing ministries are not prevented from having requirements for participating. To be a qualifying member, an individual must be a professed and active Christian, proof of which may be requested such as a recommendation from a minister and verification of regular church attendance. Members must not participate in a “sinful” lifestyle, such as drug use, excessive drinking, or sexual immorality (including sex outside of marriage). While giving is deemed voluntary, each member is assigned a minimum monthly giving amount based on family size. This is not a premium and it is either sent to a central office which disperses the funds, or to other individual members who have requested help. The monthly gift is not for the individual or family’s needs. It’s the amount promised to help others in the group with medical expenses.
While the ACA requires commercial insurance plans to cover preexisting conditions and several basic needs, such as preventative health and birth control, medical-sharing ministries are under no such obligation.
Anyone who participates in one of these groups is considered a self-pay patient with a provider, which may or may not provide a discount. After receiving their bill, the member then submits the necessary paperwork to have their expenses reviewed to see if they qualify for assistance. Preventative care is often not covered, as the belief is that there is a certain amount of personal responsibility for one’s own care. There is also no coverage for things that are considered “non-biblical activity“, such as birth control, or the result of “immoral behavior,” such as sexually transmitted diseases, or conditions that existed before membership.
Even if the expenses qualify, there is no guarantee that they will be paid.
There is also usually a “personal responsibility” amount that members must first cover before the expenses will be paid. If they were insurance companies – which they are not – this would be called a deductible. The fact that they aren’t insurance plans, and are allowed to pick and choose who they allow to participate, helps keep the costs lower. In addition to not being regulated by any state agency, they are not regulated for solvency. This means that they are not required to show that they have the money to cover requests. Members participate on faith that others will contribute their monthly gift at the time they are in need of help with expenses.
When then Virginia Democratic congressman Tom Perrillo, along with Senators Max Baucus (D-MT) and Charles Grassley (R-IA) pushed for the exemption provision for the medical-sharing ministries, it was an already existing exemption that motivated them.
The idea of exempting a religious group from government requirements isn’t a new one. In 1965, Congress passed a law that allowed certain Amish and Mennonite religious orders to opt out of Social Security, Medicaid, and other government programs. The Amish have long had their own medical-sharing system as they do not believe in outsiders – including the government – paying for their needs.
The Amish are also exempt from the ACA individual mandate.