Health Care: At What Cost?

Health Care: At What Cost?

The Patient Protection and Affordable Care Act (PPACA), also known as "Obamacare," has been upheld by the United States Supreme Court and will affect all Americans as it is implemented. The leadership of churches and ministries across the country need to understand how the provisions of PPACA will affect them.

Employer Requirements

PPACA requires employers who employ an average of 50 full-time employees during the previous year to provide health insurance coverage for all of its employees. Churches and other tax-exempt organizations are not exempt from this provision. A full-time employee is defined as an employee who works an average of 30 or more hours per week. Thus, any church, including any ministries which are not separately organized, employing 50 or more full-time employees must provide health insurance to all of its employees.

If an employer has 50 or more employees, then it has the option of providing coverage or paying a penalty. If the employer wants to avoid the penalty, then the employer must provide at least 60% of the premium cost of insurance coverage that is at least "minimum essential coverage" for employees.

Employers with fewer than 50 employees are not subject to PPACA and are NOT required to provide health insurance to its employees. However, should a small employer decide to provide health insurance to its employees, then it may receive a refundable tax credit for premiums provided on behalf of employees. Tax-exempt employers, such as churches, are able to receive a refundable credit of up to 25% of premiums paid for health insurance. However, the credit is limited to the total amount of income and Medicare taxes required to be withheld from employees and the employer's share of Medicare taxes withheld for the year. For an employer to be eligible for the credit, the employer must:

(1) pay at least half of the cost of insurance premiums for its employees;

(2) have fewer than 25 equivalent employees (including the pastor(s) in the count); and

(3) average annual wages of less than $50,000 per employee (without counting the salary of any of its pastors).

Individual Mandate

All individuals are required to have health insurance, whether or not their employer provides health insurance coverage. This requirement is the so-called "individual mandate." Beginning in 2014, all "applicable" individuals must maintain at least "minimum essential" health care insurance coverage or pay a penalty. There are many forms of insurance coverage which meet the requirements of "minimum essential" health care, including: government sponsored plans; employer-sponsored plans; exchange plans; grandfathered plans; and share plans. There is no exception for ministers, even if the minister has opted out of the Social Security system.

Contraceptive Mandate

PPACA requires employers to offer employees health insurance that provides some preventative medical services free of charge. Part of this mandate includes reproductive health services, such as birth control (including the "morning after" pill), sterilization and emergency contraception (abortion). The Department of Health and Human Services has promulgated a regulation which exempts churches from this so called "contraception mandate." On February 1, 2013 HHS issued new regulations that expanded the previous exemption to exclude religiously affiliated organizations, such as schools, hospitals and social service providers, from the contraceptive mandate. Under the new regulations, these religiously affiliated organizations may purchase insurance plans for their workforce that do not offer contraception services. If the religiously affiliated organizations do so, their insurance provider must enroll the employer's female employees in a separate policy that only provides contraception services. The insurer will be required to provide these services to employees at no cost and the insurer, rather than the employer, will have to administer the policy and cover its entire cost. However, the new regulations do not allow for any exemptions for businesses whose owners have a religious conviction against providing certain services required by the contraception mandate.


The guidance provided above is intended to provide churches and ministries with a general understanding of how PPACA will affect their organizations. Please contact the Christian Law Association if you have questions about PPACA. In addition, PPACA will be specifically addressed at upcoming seminars which will be provided by the Christian Law Association.

New Health Care Mandates?

The implementation of the affordable care act places a huge moral strain on Christian employers. The new law requires coverage to employees free of charge for abortion inducing drugs. This is a sad day. Rather than it being a day of choice as the unwise declare it, it is a day of death for many unborn children. With such evil being spread across our land...

What do we do in these upsetting times? How should we respond as a Christians?

God gave us great words of hope and comfort in the Psalm 37. It reads: Fret not thyself because of evildoers, neither be thou envious against the workers of iniquity. For they shall soon be cut down like the grass, and wither as the green herb. Trust in the Lord, and do good; so shalt thou dwell in the land, and verily thou shalt be fed. Delight thyself also in the Lord; and he shall give thee the desires of thine heart.... Rest in the Lord, and wait patiently for him: fret not thyself because of him who prospereth in his way, because of the man who bringeth wicked devices to pass. The best response is to remember that none of man's laws are final. God is the Supreme Ruler! He Who sits in the heavens is in control over these mandates! God has forewarned us for just such a time as this.

Our action?

Trust in the Lord and do good! Trust God to work on the behalf of these things that are being placed into law, and rather than allowing them to discourage you, keep on doing what is right! Find your voice and speak. Put your hands to work for the kingdom of God with a renewed effort. Invest your resources in the causes of religious liberty; love and serve in your local church! You just do what is right and trust God for the ultimate outcome!

Click here to download the March Legal Alert:

Click here to download the Legal Alert for March 2013

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