You’d be hard-pressed to find many people who like to pay more taxes. That’s what makes the “individual mandate” of the Affordable Care Act (Obamacare) so effective. The individual mandate requires anyone who doesn’t maintain minimum essential health insurance to pay an additional fee when they file their taxes. The idea behind this tax is that people who opt out of buying health insurance place a burden on the healthcare system, since they aren’t paying into it, but still risk getting sick or injured. In other words, those without health insurance increase the cost of health insurance for everyone else and the Affordable Care Act’s individual mandate is meant to offset that cost.
While the individual mandate has already been upheld by the Supreme Court as a legitimate exercise of Congress’s taxing power, that hasn’t stopped religious fringe groups like Christian Scientists from trying to weasel out of paying their share of healthcare costs. On Tuesday, March 11, the House of Representatives passed the “Equitable Access to Care and Health Act” or the “EACH Act” (H.R. 1814), which unnecessarily creates an additional religious exemption to the Affordable Care Act’s individual mandate. And by “additional religious exemption” I mean an exemption in addition to the two religious exemptions that already exist.
That’s right, Congress already exempted certain religious groups and individuals from having to pay taxes for not maintaining health insurance. It created a religious conscience exemption to the individual mandate that applies to anyone who is “a member of a recognized religious sect or division thereof” if that sect “make[s] provision for their dependent members which [are] reasonable in view of their general level of living,” and has been in existence since 1951. While this first religious conscience exemption is limited in scope (and may only apply to the Old Order Amish), the Affordable Care Act also included a second exemption for anyone participating in a “health care sharing ministry.”
Health care sharing ministries are religious organizations designed to provide groups of like-minded Christians with a way to pool resources to pay for each other’s medical expenses. They are not health insurers, which means that 1) they are horribly under-regulated, 2) often members are under no legal obligation to pay any money into the ministry, and 3) there is no guarantee the ministry will pay for a member’s medical expenses. Presumably any Christian with a religious objection to buying insurance, or to receiving medical care, could join one of these ministries to avoid paying the individual mandate without taking on any additional obligations.
Instead of relying on either of the existing religious exemptions to the Affordable Care Act, the EACH Act adds yet another way for religious individuals to avoid paying their fair share into the healthcare system. By allowing certain religious individuals to opt out of maintaining minimum essential health insurance, the EACH Act will interfere with one of the fundamental purposes of the Affordable Care Act: to lower insurance premiums by maximizing the number of participants in the health insurance market. Taxpayers who do not claim this new religious exemption will pay higher health insurance premiums due to uninsured religious freeriders burdening the market.
The EACH Act would specifically allow religious individuals to game the system by swearing that they hold sincerely held religious beliefs against receiving healthcare. They would then be allowed to opt out of paying health insurance, possibly for many years, but nothing prevents them from subsequently receiving care when they do get sick or injured. Preventing sick/injured people from receiving care is out of the question, despite the potentially catastrophic costs for those in the health insurance marketplace. The only practical solution is to deny special treatment to religious objectors in the first place.
The EACH Act is also bad policy because it interferes with other major purposes behind the individual mandate, including protecting the financial security of U.S. families by guarding against the threat that unexpected medical expenses will force them into bankruptcy. While insured families are protected by their policies’ out of pocket maximums, the same is not true of those who opt out of health insurance for religious reasons. The Affordable Care Act is also designed, first and foremost, to protect the health of U.S. families by ensuring that they have affordable access to healthcare when they need it. While adult Christian Scientists may be free to claim a religious objection to receiving care, the state still has a duty to ensure the health and safety of minors growing up in religious households. The EACH Act is an abrogation of that duty.
The EACH Act passed the House without ever being vetted in committee, which means that its potential impact on the health insurance marketplace, family financial security, and family health have not been considered. The Senate has now received the bill. Contact your state’s senators now with your concerns over religious people receiving special exemptions from paying generally applicable taxes.
You can read Sam’s full note Religious Exemptions to the PPACA’s Health Insurance Mandate, published in the American Journal of Law and Medicine in 2011.
Also, see FFRF’s March 6 action alert (emailed before the House suspended its rules on March 11 to take a voice vote, without substantive debate, on this controversial bill).
