by Don Ingwerson
Last year the Federal Committee on Publication office put out questions and answers on Christian Science and the Affordable Care Act. I posted it on the blog at the time, but I just noticed that there are some additional questions and answers that have been added, and reviewing all of the answers may be helpful to you as well. So here is the updated Q&A. If you want to read this on the Federal Committee on Publication site, click here: Frequently asked questions.
1. How is the U.S. Federal Office responding to the Patient Protection and Affordable Care Act (the ACA), which was signed into law in March 2010?
We are actively seeking appropriate ways for a religious accommodation and/or exception to be recognized in the new health care reform law. For example, the U.S. Federal Office is continuing to:
A) request that the Department of Health and Human Services (HHS) include the coverage of spiritual care services, including Christian Science practitioner and Christian Science nursing (including facility) services, in the benefits that will be offered by health insurance companies under the new law; and
B) seek a legislative solution with Congress that would allow anyone with a “sincerely held religious belief” against the federally mandated health insurance coverage to be exempt from the tax penalty for failing to have the required coverage.
We feel both of these initiatives are important components of an overall solution to the inequity Christian Scientists face under the ACA.
2. Doesn’t the ACA already contain a religious opt-out or an accommodation for Christian Scientists and others who use spiritual care services for their health?
No. The 2010 Patient Protection and Affordable Care Act includes neither a religious opt-out nor an accommodation from the health insurance mandate for those who use spiritual care to meet their health needs.
Accordingly, there is no requirement that Christian Science practitioners and Christian Science nursing services be covered and reimbursed in health insurance plans under the new legislation. However, neither is there anything in the legislation that would restrict or eliminate existing provisions in the law that recognize spiritual care or that would prohibit insurance plans participating in the new health insurance exchanges from offering coverage for spiritual care.
In earlier stages of the legislation, several committees in the House and Senate adopted a “religious non-discrimination” provision that the Committee on Publication had requested. The provision was designed to prevent insurance companies from arbitrarily discriminating against spiritual care services, including the reimbursement of Christian Science practitioner and nursing services. However, the non-discrimination provision was not included in the final health care legislation.
3. Was there opposition to finding a legislative solution for Christian Scientists under the new law?
Yes. We are working to address misperceptions held by some atheist groups, separation-of-church-and-state organizations, and long-time critics of the Christian Science Church, who do not support accommodating those who use spiritual care services.
4. If there is no religious exemption or accommodation from the health insurance mandate for those who use spiritual care, what effect might this have on Christian Scientists? When does the new law take effect?
Most aspects of the legislation, including the health insurance mandate, do not begin to take effect until 2014. And many of the details of what is included in the legislation will be determined over the next few years by federal regulators and subsequent legislation. Accordingly, the responses we’re providing here are based on information that’s available now and is subject to change.
We’ve been assured by members of Congress that nothing in the new legislation is intended to minimize or reduce existing provisions in the law that recognize spiritual care, and that nothing in the new legislation is meant to prohibit insurance companies from covering spiritual care.
One of the provisions that will impact all Americans, including Christian Scientists, is a requirement that individuals who choose not to obtain the mandated health insurance pay a yearly penalty unless they can show they’re exempt or covered by qualifying health insurance. This penalty will be phased in over a number of years. Starting in 2014, the penalty would be the greater of $95 per year per individual or 1 percent of modified adjusted gross income and would increase annually, rising to $695 or 2.5% of income in 2016.
5. To what extent do U.S. federal, state, and private health insurance plans already provide for the reimbursement of spiritual care and treatment services?
Here are some examples that may be of interest to you:
• 17 Christian Science nursing facilities are Medicare providers. So, individuals who are eligible for Medicare Part A coverage can receive reimbursement for Christian Science nursing care at those facilities. This benefit has been in place for over forty years.
• If you work for the U.S. government as a civilian employee you have the option of choosing from four Federal Employee Health Benefit (FEHB) plans that cover Christian Science nursing/practitioner care: 1) the Government Employees Health Association (GEHA) plan; 2) the Mail Handlers Benefit Plan; 3) the Compass Rose Health Plan; and 4) the Special Agent Mutual Benefit Association (SAMBA) plan.
• If you are a member or a dependent of a member of the U.S. armed forces, you may qualify for the TRICARE insurance program, which covers Christian Science nursing care and Christian Science practitioner treatment.
• If you are a state employee in the following states, then Christian Science nursing and practitioner services may be available to you under your state employee insurance plan: California, Colorado, Illinois, Kansas, Missouri, Oklahoma, Oregon, and Texas.
• Christian Science practitioner and nursing services also qualify as tax-deductible medical expenses under the income tax deduction provided for in Section 213(d) of the IRS code. Because of this designation, individuals who have health savings accounts (HSAs) or flexible spending accounts (FSAs) and contribute money to them may use pre-tax dollars to pay for Christian Science practitioner and nursing services.
• Several private insurance plans and self-insured companies include Christian Science nursing and practitioner services as a reimbursable benefit. A few of these companies are AETNA, Blue Cross/Blue Shield, CIGNA, Ford, GE, IBM, Intel, and the Tufts Health Plan.
Visit our insurance page for more information on this subject.
Currently, trying to get a claim processed for Christian Science nursing and practitioner services under any of these public or private insurance plans is difficult. There are a number of reasons for this. Overall, a small number of claims are made for Christian Science health care services, so public and private insurers are unfamiliar with them. In addition, the health care industry’s coding system for electronically processing these claims does not contain accurate codes for Christian Science health care services. As a result, Christian Science insurance claims have to be processed manually, which is a time-consuming and expensive process for insurance providers. We are diligently working to remove these barriers to achieve the efficient processing of health insurance claims by Christian Scientists.
6. Currently, is there any basis on which Christian Scientists may be exempt from the requirement to purchase health insurance under the new law?
Yes, but it depends on their situations. Christian Scientists are not exempt on religious grounds, though various media outlets have incorrectly reported they are. However, under the new legislation, it appears that individuals—including Christian Scientists—who meet the following criteria will not be required to purchase health insurance or pay a penalty for failing to do so:
• individuals aged 65+ (because they’re automatically enrolled in Medicare Part A)
• Medicaid recipients
• members of the U.S. Armed Forces and their dependents
• U.S. military retirees
In addition, there are exemptions from the requirement to buy health insurance for the Amish (see FAQ #7), members of health care sharing ministries (another group that objects to having insurance and provides for the health care expenses of its members), Native Americans, and persons eligible for a hardship exemption due to limited income.
7. Isn’t there some kind of general religious exemption from the requirement to purchase health insurance under the legislation?
No. While there is a “religious conscience exemption” from the health insurance mandate, it applies primarily to individuals who are of the Amish faith. The exemption has the following requirements:
• The individual must be a member of a religious group whose tenets and teachings establish that its members are conscientiously opposed to receiving any benefits of private or public insurance, including Social Security and Medicare benefits.
• The individual must waive all Social Security and Medicare benefits.
• The religious organization must pay for the health care and disability costs of its members.
8. Why did Congress agree to provide a religious exemption for the Amish and not for Christian Scientists?
The ACA religious exemption language was lifted directly from a preexisting exemption included in the Internal Revenue Code, which excluded the Amish and other religious groups from participating in Social Security, Medicare, and other social programs. This exception for the Amish carried over to the ACA because the Amish have a religious objection to carrying insurance of any kind. Furthermore, the Amish often provide for the health care expenses of their own members.
9. What are state exchanges?
The ACA generally requires that all states have health insurance exchanges in place by January 2014. Essentially, state exchanges are health insurance marketplaces where individuals and small businesses can compare and enroll in insurance plans (and can find out if they are eligible for federal subsidies to purchase insurance). Massachusetts and Utah already had exchanges in place before the ACA was passed (Massachusetts’s is most similar to the ACA concept of a state exchange). The Department of Health and Human Services (HHS) has left a fair amount of discretion to the states regarding the creation of their individual exchanges, but if a state fails to create an exchange, it falls to HHS to provide it.
10. Did the Church consider participating in the U.S. Supreme Court case regarding the health care law?
The Church weighed very carefully and prayerfully the idea of filing an amicus, or friend-of-the-court, brief. Two of the factors that led to the ultimate decision not to file a brief were that the none of the lawsuits that were before the U.S. Supreme Court for decision raised any claims involving freedom of religion, and secondly, the Court itself did not designate religious freedom as an issue it wanted the attorneys to brief. (See our article on the Supreme Court oral arguments for more information about the four issues the Supreme Court agreed to hear.) Additionally, though several religious challenges to the law were filed in the lower federal courts (e.g., Mead v. Holder, 766 F. Supp. 2d 16 (2011), and Liberty v. Geithner, 753 F. Supp. 2d 611 (2011)), none had made its way up to the Supreme Court for oral argument, briefing, and hearing.
11. Has the Church considered filing a lawsuit to challenge the health care reform law?
Christian Scientists are neither accommodated nor exempted under the Affordable Care Act. That’s an anomaly because there’s a longstanding history of accommodation and recognition of Christian Science health care services by the federal government. In view of that significant precedent, the Church has chosen for now to participate in the democratic process, working with the Administration and Congress to resolve the dilemma facing Christian Scientists under the ACA, rather than filing suit. Truly, our willingness to work in this way has earned us much good will and has provided significant opportunities to provide accurate information about Christian Science. We’re encouraged by the good progress we’re making.The democratic process can be very rewarding, yet it always requires patience. We will continue to stand firmly for religious liberty; and the Church preserves all options regarding its response to the ACA.
12. Would the Serving Christian Scientists, Inc (“SCS”) plans qualify under the health care reform law?
We recommend that you be in touch with SCS directly about this. As it stands now, it looks like the SCS benefit plans do not cover all of the benefit categories that must be covered by a qualifying plan under the Affordable Care Act. This is true not just of SCS’s plans, but other “high deductible” insurance plans too. That said, it’s possible that SCS could adjust their insurance offerings before 2014 to meet the new standards and regulations that are still being written.
13. Is there a religious accommodation regarding elder care in the health care reform law?
Yes. The legislation creates a new Elder Justice program to help prevent the neglect of elders. This section provides that nothing in the new law is intended to interfere with an elder’s right to practice his or her religion through reliance on prayer alone for healing. This religious accommodation was originally contained in the Older Americans Act and has been a part of several elder justice bills.
14. Does the existing accommodation for Christian Science practitioners and Readers under the Social Security law still continue?
Yes. The new legislation does not appear to affect the ability of Christian Science practitioners and Readers to claim an exemption from paying into and receiving benefits from the Social Security system. The practitioner or Reader must file a form with the Internal Revenue Service that states that he or she is conscientiously opposed to receiving the benefits of any public insurance.
15. I’m already enrolled in Medicare Part A—do I need to purchase additional insurance to meet the requirements of the ACA?
No. Medicare Part A satisfies the ACA’s “individual mandate” requirement.