ACA exemption of health care sharing ministries: Ethical concerns
Tuesday, November 5, 2013
Among the many things that Congress and President Obama have to account for in the Patient Protection and Affordable Care Act (ACA) is a little known feature called by one physician, the Miracle on Page 327, the miracle being the exemption of the more than 160,000 members of three Christian health care sharing ministries from the ACA requirement that nearly all U.S. residents carry minimum essential insurance coverage. These health care sharing ministries (HCSMs) are private tax-exempt, Christian organizations that coordinate the sharing of some of their members' medical expenses through insurance-like plans (absent health financing regulatory oversight). Persons wanting to join HCSMs must apply for membership and meet theological, behavioral, and in some cases health status criteria. Justification for the ACA exemption of HCSM members from the individual mandate and from the shared responsibility payment is not found in the legislation. Generally little is understood about the nature and operations of HCSMs as well as about their medical, moral, and financial effects. This paper begins with an examination of key characteristics of HCSMs and their ACA exemption, followed by an ethical analysis that finds several ethically concerning dimensions of HCSMs and the exemption. Given ACA's commitment to universal participation and affordable financing, I argue that the ACA exemption of HCSMs is unjust due to 1) the inequitable responsibility and risk it places on non-HCSM members (the broader US public) and 2) multiple exclusionary features of HCSM membership and coverage. For example, HCSMs typically do not share (or cover) medical expenses for preventive care, mental health services, and for many pre-existing conditions. To conclude, I explore the parallel notions of social solidarity and individualism that exist in tension within HCSMs and within the ACA.
Ethics, professional and legal requirements
Provision of health care to the public
Describe the ACA exemption of health care sharing ministries
Discuss the ethical issues raised by this exemption
Formulate one's own ethical position relative to the exemption
Keyword(s): Health Care Reform, Ethics
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I have a PhD in religious ethics and US health policy and have done extensive research on this specific topic. My research interests include justice and health policy as well as public health ethics more generally. I have taught medical ethics in a medical school and undergraduate seminar courses on religion, health, and health care.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.