OPINION:
When American families are straining under the weight of rising health care costs, public policy should expand responsible options, not quietly penalize them.
Nearly two million Americans participate in health care sharing ministries (HCSMs). These ministries are voluntary, faith-based communities in which members contribute monthly amounts to help meet one another’s medical expenses. They are privately funded, rooted in religious conviction and have operated successfully for decades. Federal law expressly recognizes them.
Yet despite that recognition, participants in health care sharing ministries face unequal treatment under the federal tax code compared to Americans who purchase traditional health insurance.
That disparity is not about ideology. It is about fairness and neutrality.
Under Section 213(d) of the Internal Revenue Code, taxpayers who itemize may deduct qualifying medical expenses that exceed the statutory threshold. Families who purchase conventional insurance and incur eligible out-of-pocket costs can benefit from that deduction. Families who contribute comparable amounts through a health care sharing ministry generally cannot.
The economic reality is similar. The tax treatment is not.
Two families may devote $8,000, $10,000, or more each year to meeting medical needs. One family receives favorable tax treatment because its payments flow through an insurance company. The other does not because its payments flow through a faith-based sharing community. The distinction is structural, not substantive.
A neutral tax code should not privilege regulatory form over economic substance.
Health care sharing ministries are not new experiments. They have been serving members since long before the Affordable Care Act. They are structured, accountable organizations governed by published guidelines and clear eligibility standards. They operate without federal subsidies and without imposing taxpayer burdens. Members voluntarily agree to share responsibilities consistent with their religious beliefs.
Critics sometimes argue that, because HCSMs are not insurance, they should not receive comparable tax treatment. That observation misses the point. The issue is not whether ministries are insurance carriers. They are not, and do not claim to be. The issue is whether Americans who lawfully meet medical expenses through a federally recognized arrangement should be disadvantaged solely because their model reflects religious conviction and voluntary association rather than state insurance regulation.
Tax neutrality is a core conservative principle. Government should not use the tax code to steer citizens away from lawful private arrangements simply because those arrangements do not conform to a preferred structure.
The need for parity extends beyond individual taxpayers. Small businesses especially those with fewer than 50 employees are under extraordinary pressure as premiums continue to rise. According to federal data, average employer-sponsored family coverage now exceeds $20,000 annually. For a business with 15 or 20 employees, even incremental increases can determine whether health benefits remain sustainable.
Some employees prefer to participate in a health care sharing ministry because it is more affordable or better aligned with their faith. Yet current regulatory and tax barriers discourage employers from supporting those employees in the same way they support traditional insurance coverage.
Allowing employers to deduct contributions that assist employees participating in health care sharing ministries under Section 162 of the Internal Revenue Code would not create a new entitlement or expand federal spending. It would simply apply existing business deduction principles consistently.
Similarly, policymakers should ensure that participants in HCSMs are not excluded from meaningful access to consumer-directed tools such as health savings accounts (HSAs) and health reimbursement arrangements (HRAs). These vehicles were designed to encourage personal responsibility and cost awareness. Restricting access based on structural distinctions serves no clear fiscal or policy objective.
Importantly, tax parity for health care sharing ministries would not require new federal outlays. It would not mandate participation. It would not alter the regulatory status of ministries. It would merely correct a structural imbalance and treat similarly situated taxpayers in a fair and consistent manner.
Congress has recognized the legitimacy of health care sharing ministries in federal statute. Executive Order 13877, “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” likewise reflected federal acknowledgment of alternative healthcare arrangements, although related regulatory efforts initiated in 2020 were not completed. Finalizing regulatory clarity under Section 213(d) and affirming consistent employer deductibility would align federal tax policy with those established legislative and executive actions.
America’s health care landscape is diverse because the American people are diverse. Families make different choices based on cost, conscience, community and conviction. A pluralistic society should make room for those differences.
Public policy should not penalize citizens for choosing a lawful, faith-based model that helps them meet medical needs responsibly. Nor should the tax code quietly favor one form of private participation over another.
Fairness does not require special treatment. It requires equal treatment.
Neutrality in the tax code strengthens freedom. And in matters of health care where cost, conscience and personal responsibility intersect neutrality is not merely good economics. It is sound public policy.
• J. Craig Brown II is president and CEO of Christian Healthcare Ministries. To learn more, visit chministries.org or call 330-798-8052.
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