HealthLawProf Blog

Get to Know the 9 ACA Exemptions-Health Care Sharing Ministries

Stacey Tovino, a rock-star health law professor and Lincy Professor of Law at the UNLV William S. Boyd School of Law and I were nearly knocked off our chairs at a presentation by Wellesley College Professor Charlene Galarneau, PhD on The ACA Exemption of Health Care Sharing Ministries at the ASBH- American Association of Bioethics and the Humanity’s annual Meeting last month.  If you are a health law professor (or hobbyist) and do not yet know what a Health Care Sharing Ministry is, prepare to be surprised.  It is NOT insurance but rather a non-binding agreement among people of faith to share their health care costs.  As the Alliance of Health Care Sharing Ministries explains, “A health care sharing ministry (HCSM) provides a health care cost sharing arrangement among persons of similar and sincerely held beliefs. HCSMs are not-for-profit religious organizations acting as a clearinghouse for those who have medical expenses and those who desire to share the burden of those medical expenses.”  It specifically does not provide the essential services of an ACA qualified plan.  Yet those without health insurance who are participating in one of these ministries are exempt from the obligation to purchase insurance or pay a penalty—even though it is highly likely that the cost of their care will fall on the community where they become sick and seek treatment.  Read more about it here and here.  Health Care Sharing Ministries are among the 9 exemptions in the Affordable Care Act, yet have not attracted significant attention.  Given their important role in exempting large numbers of people from the obligation of obtaining health insurance, they deserve a place, or at least a shout-out, in all of our classes.

 

Solving Two Federal Problems at Once: Lets Mail Information to Those Losing Their Inadequate Health Insurance

The efforts by both Congress and the President  to ensure that people can keep individual health care policies which  do not meet the Obamacare minimum coverage standards are so misguided that if it weren't for the fact that vulnerable people are being caused needless suffering  it would be comical.

so far, there is no evidence that anyone is going to be worse off with the coverage now available to them on the exchange than they were with the policies being cancelled.   In fact,  information available to us  from sources like the Kaiser Family Foundation, Business Insider, and Families USA about the characteristics of the policies being cancelled is that whatever peace of mind they provided to those paying for them was illusory.

 The fact that this insurance did not meet Obamacare criteria means that it is highly likely that the coverage they had:

•  Excluded the conditon for which they were most likely to need care
• Had a far higher deductible than the policies now available on the exchange
• And if it covered mental illness at all, did not do so at the same level as other covered illness.

Moreover,  these policies were subject to cancellation as soon as they were needed (for example after a diagnosis of cancer or after a debilitating accident).

Yet these facts are of no help to people without access to information about their alternatives.

Here's one thought--instead of requiring insurance companies to continue making these inadequate plans available, why couldn't they be required to send individualized information about alternatives on the exchange at the same time they send the cancellation letters?

The fact that they already have the relevant information about their policy owners means that those individuals don't need the web site to find out about their options.

In retrospect, depending on any web site to provide all the information to everyone who needed it was a bad idea from the beginning.   But letting people continue to pay good money for bad coverage is not the right solution.

Here's a win/win idea--why don't we activate an already existing but underused government resource to get individualized information out quickly to those who need it---the U.S. Postal System.