“Health care sharing ministry”的意思、由来-开放百科全书

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and Affordable Care Act,^[1] often referred to as Obamacare (the individual shared responsibility provision was repealed in December 2017, effective in 2019).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]Some of the larger health care sharing ministries include Christian Healthcare Ministries (established around 1981),^[4] Medi-Share, a program of Christian Care Ministry (1993),^[5] Samaritan Ministries (1994),^[6] Liberty HealthShare (1998),^[7] United Refuah HealthShare,^[8] MCS Medical Cost Sharing^[9] and Altrua HealthShare.^[10]^[11]

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.^[12] 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.^[13]^[14]

Several states have tried to block health care sharing ministries on the grounds that they are selling unauthorized insurance.^[14] 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).^[15]

Membership

According to Alliance of Health Care Sharing Ministries, a trade association of sharing ministries, over 1 million Americans participated in health care sharing {{as of |2019|02|df=|lc=y|since=}}, sharing more than $670 million in medical bills annually.^[16]{{efn|Updated statistics are available: {{cite web |title=Data and Statistics | publisher =Alliance of Health Care Sharing Ministries | url= http://www.healthcaresharing.org/about-us/data-and-statistics/}} However, it is unclear who the "affiliates" referred to are. Does this include all Old German Baptist Brethren?}} 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.^[17] The Seattle Times also reported that membership has grown significantly in recent years.^[18]

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.

[https://www.unitedrefuahhs.org/ United Refuah] is the first and only Jewish healthcare sharing organization.

All such ministries require that members subscribe to the principles of individual responsibility for their own health and of helping others in need.^[19]

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:

Four ministries that meet these qualifications are: Christian Healthcare Ministries, Liberty HealthShare, Medi-Share, and Samaritan Ministries.{{cn|date=June 2017}}

MCS Medical Cost Sharing, founded after 1999, does not meet the qualifications, but offers to pay the tax penalties incurred by members.^[21]

Altrua HealthShare has also been recognized as an qualifying health care sharing ministry, due to its merger with Blessed Assurance Bulletin.^[22]^[23]

Anabaptist Healthshare^[24] is recognized as a health care sharing ministry by the U.S. Department of Health & Human Services^[25].

In 2017 [https://www.unitedrefuahhs.org/ United Refuah] entered the scene. They are the first and only Jewish healthcare sharing organization and claims to be recognized as a healthcare sharing organization by the Centers for Medicare & Medicaid Services (CMS) as well.

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

Notes

References

1. ^{{USPL|111|148}} Sec. 5000A(d)(2)(b)(i)
2. ^{{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 |format= |accessdate=2015-05-19}}
3. ^{{cite web |url=https://web.archive.org/web/20160623221407/http://www.healthcaresharing.org/stateinfo/|title=Alliance of Health Care Sharing Ministries: State info |format= |website=Alliance of Health Care Sharing Ministries|accessdate=2015-05-19}}
4. ^{{cite web |url= https://www.chministries.org/aboutus.aspx | publisher = Christian Healthcare Ministries | title = About Us |accessdate= May 19, 2015}}
5. ^{{cite web |url= https://mychristiancare.org/medi-share/ |title= Medi-Share |website= My Christian Care |accessdate= May 19, 2015}}
6. ^{{cite web |url= http://samaritanministries.org/ |title= Samaritan Ministries International |accessdate= May 19, 2015}}
7. ^{{cite web |url= http://www.libertyhealthshare.org/ |title= Liberty HealthShare |accessdate=May 19, 2015}}
8. ^{{Cite web|url=https://www.unitedrefuahhs.org/|title=Healthshare Plans {{!}} Jewish Health Care Sharing {{!}} United Refuah HealthShare|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}
9. ^{{cite web |url= https://medicalcostsharing.com/ |website= Christian Medical Cost Sharing |title= Christian Health Care |accessdate = May 19, 2015}}
10. ^{{cite web |url= http://altruahealthshare.com/resources.php |website= Altrua Health Share |title= Resources |accessdate= May 19, 2015}}
11. ^{{cite web |url= http://selfpaypatient.com/2013/11/27/health-care-sharing-ministry-members-share-their-experiences/ |title= Health care sharing ministry members share their experiences |website= Self pay patient |accessdate=May 19, 2015}}
12. ^{{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}}
13. ^{{cite web |url= http://www.healthcaresharing.org/hcsm/ |title= Alliance of Health Care Sharing Ministries |accessdate= 2015-05-19}}
14. ^{{Citation | title = The Washington Post | url = https://www.washingtonpost.com/wp-dyn/content/article/2005/10/22/AR2005102200046.html}}.
15. ^{{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/}}
16. ^{{cite web | title= What is Health Care Sharing? | publisher =Alliance of Health Care Sharing Ministries | date=10 February 2017 | url= http://www.healthcaresharing.org/hcsm | archive-url= https://web.archive.org/web/20170210154528/http://www.healthcaresharing.org/hcsm | archive-date=10 February 2017 | dead-url=yes}}
17. ^¹{{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|accessdate= May 19, 2015}}
18. ^{{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}}
19. ^{{cite web |url= http://www.christianhealthcareministries-review.com/2016/02/28/healthcare-sharing-mainstream-healthcare-choices/ |title= Healthcare Sharing – Mainstream Healthcare Choices |website= Christian Healthcare Ministries-review |date= February 28, 2016 | archiveurl= https://www.webcitation.org/6g4cBd6sa |archivedate= March 17, 2016 |deadurl= no}}
20. ^{{USPL|111|148}} Sec. 5000A(d)(2)(b)(ii)
21. ^{{cite web |url= https://medicalcostsharing.com/penalties-m-c-s-members/ |title= No Penalties for M.C.S Members | website= Christian Medical Cost Sharing |accessdate= May 19, 2015}}
22. ^{{cite web |website= Altrua HealthShare|title=Altrua Gains Recognition as a Health Care Sharing Ministry |url= http://altruahealthshare.com/images/File/AHS%20Recognition%20announcement%20for%20website.pdf |accessdate= 12 December 2016 |archiveurl= https://web.archive.org/web/20150206014259/http://altruahealthshare.com/images/File/AHS%20Recognition%20announcement%20for%20website.pdf |archivedate= February 2015|date=23 December 2014}}
23. ^{{cite web |last =Parnell|first =Sean|url= http://selfpaypatient.com/2014/10/15/altrua-qualifies-for-obamacare-exemption-plus-more-on-cmf-curo/ |title= Altrua qualifies for Obamacare exemption, plus more on CMF Curo|date=15 October 2014|accessdate=2016-12-12 |website= The Self-Pay Patient}} (Altrua achieved this via a merger with a smaller but older ministry)
24. ^{{cite web |title=Business Entity Details: Anabaptist Healthshare |website=Virginia State Corporation Commission |url= https://sccefile.scc.virginia.gov/Business/0791875 |access-date=14 June 2017}}
25. ^{{cite web | title= Anabaptist Healthshare |date= 19 December 2016 |url= http://anabaptisthealthshare.com/ | access-date= 14 June 2017}}
26. ^{{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}}.