Religion and medicine have historically gone hand in hand, but increasingly have come into conflict in the U.S. as health care has become both more secular and more heavily regulated. Law has a dual role here, simultaneously generating conflict between religion and health care, for example through new coverage mandates or legally permissible medical interventions that violate religious norms, while also acting as a tool for religious accommodation and protection of conscience. This conference identified the various ways in which law intersects with religion and health care in the United States, examined the role of law in creating or mediating conflict between religion and health care, and explored potential legal solutions to allow religion and health care to simultaneously flourish in a culturally diverse nation.

1. Presented by:
Health Care Sharing Ministries
and the Purposes of the
Affordable Care Act
Rachel Sachs
Academic Fellow, Harvard Law School

2. Overview
I. What are Health Care Sharing Ministries?
II. In light of the disparate health insurance goals embodied
in the ACA, how should we think about the structure of
Health Care Sharing Ministries?
III. Health Care Sharing Ministries as a natural experiment.
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3. What are Health Care Sharing Ministries?
“The term “health care sharing ministry” means an organization—
(I) which is described in section 501(c)(3) and is exempt from taxation under
section 501(a),
(II) members of which share a common set of ethical or religious beliefs and share
medical expenses among members in accordance with those beliefs and
without regard to the State in which a member resides or is employed,
(III) members of which retain membership even after they develop a medical
condition,
(IV) which ... has been in existence at all times since December 31, 1999, and
medical expenses of its members have been shared continuously and without
interruption since at least December 31, 1999, and
(V) which conducts an annual audit which is performed by an independent certified
public accounting firm ... and which is made available to the public upon
request.”
26 U.S.C.A. § 5000A(d)(2)(B)
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4. Operations: Membership
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5. Operations: Sharing
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6. Characterizing the Purposes of the ACA (I)
Social
Solidarity
Actuarial
Fairness
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7. Social
Solidarity
Actuarial
Fairness
Replicating the ACA’s Balance (I)
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8. Characterizing the Purposes of the ACA (II)
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Allison K. Hoffman, Three Models of Health Insurance: The Conceptual Pluralism of the Patient Protection
and Affordable Care Act, 159 U. PA. L. REV. 1873 (2011).

9. Altering the ACA’s Balance (II)
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Allison K. Hoffman, Three Models of Health Insurance: The Conceptual Pluralism of the Patient Protection
and Affordable Care Act, 159 U. PA. L. REV. 1873 (2011).

10. Questions?
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