/ 共享利益，共享社区? 订阅

How do we both respect the values of religious communities in 卫生保健 AND share responsibility for the 卫生保健 benefits that come with membership in state and national communities? How do religious beliefs, practices, and communities shape individual and 公共卫生?

的 growing health equity movement in the United States is working to shift health and 卫生保健 conversations from their common emphases on individual patients, 他们的基因和行为以及医生和他们的技术, 到 健康的社会决定因素那些曾经出现在社交场合的人, 政治, and economic relations that promote health and/or illness on individual and community levels. 种族歧视, 贫困, and gender discrimination are perhaps the most studied 健康的社会决定因素. 也许是最不被认可的, 是健康的社会决定因素之一, 是宗教.

宗教-源自拉丁语 ligare meaning “to bind” or “to tie” – affects health in three key ways (according to one well known 类型学). Religion serves as a source of social support, of 社会控制, and of social capital. Members of religious communities often support one another “in sickness and in health,也就是说, 需要的情感, 精神上的, and material care as well as in health promotion activities ranging from simply being together to organized group exercise. We experience religion as 社会控制 in rules and norms that influence health behaviors such as what foods are eaten, 多么鼓励的性行为啊, 以及禁止使用哪些物质. And religious communities can promote social capital – the creation of new institutions and activities that strengthen the social fabric of the larger community by, 例如, 建立信任. 值得注意的是, religious communities may also affect health negatively by these same means – by marginalizing persons, 限制健康行为或鼓励不健康行为, 削弱了社会秩序.

卫生保健 sharing ministries (HCSMs) are charities formed by groups of Christians to enable them to join together to “bear one another’s burdens,换句话说, to voluntarily share expenses related to 卫生保健 as well as to pray for one another in times of need. Applicants to HCSMs affirm a particular statement of Christian faith and agree to live a “biblical” lifestyle (little/no tobacco and alcohol use, 以及“基督教婚姻”之外的性行为). 接近100万人(主要是美国人).S. 居民)现在属于这些群体(主要是三个大群体), 可以这样说, are a form of social capital: new societal institutions that offer social support and assert 社会控制 in the name of health and a faithful life.

As charities, HCSMs are not subject 到 state regulatory oversight required of health insurance. 此外, the Affordable Care Act (ACA) grants HCSM members an exemption from the individual mandate to carry health insurance as well as from the “shared responsibility” penalty for not carrying it. 的 关键豁免标准 州 that HCSM members must “share a common set of ethical or religious beliefs and share medical expenses among members in accordance with those beliefs.” Each HCSM defines the expenses eligible for sharing and given that they are not tethered 到 ACA, they omit sharing expenses for many ACA-required services including for preexisting conditions. 此外, HCSMs do not share expenses for most routine preventive care services (physical examinations), 生殖服务(包括避孕), 以及精神卫生保健服务.

While HCSMs work extensively at the state and federal levels to distinguish themselves legally from health insurance, 与此同时，他们还在为医疗保险的税收平等而游说. 没有同意健康保险的问责标准, and without sharing expenses for services deemed essential minimum benefits by the ACA, HCSMs”寻求平等与健康保险公司和雇主的税收优惠.

进入宗教自由问题. Should private religious charities formed to serve a limited group of persons be enabled by the ACA to “opt out” of otherwise mandatory contributions 到 good of all? 的 ACA’s policy goals simply put, are affordable, quality coverage for nearly everyone. 的 individual mandate is an ACA attempt at creating a shared national responsibility, a kind of social solidarity for the fair distribution of 卫生保健’s benefits and burdens. This mandate functions to spread the financial risk and costs of 卫生保健 across as large a group as possible. To exempt HCSM members from this national risk-sharing pool means that the risk and costs are spread across a somewhat smaller group, 导致那些留下来的人面临更高(即使最低限度)的风险和成本. 简而言之，HCSM成员从医疗保健系统中获益 without fulfilling corresponding responsibilities for adequate insurance coverage or for payment of the shared responsibility penalty.

卫生保健, 我建议, 是一种社会公益, 涉及包括家庭在内的多个集体层面的社会关系, 宗教团体, 当地社区, 州, 这个国家. 每个级别都提供医疗保健福利，并产生相应的责任. 而hcsm则强调个人和基督徒的责任, HCSM成员也是州和国家社区的成员. 凭借他们在这些更大的社区中的成员身份, they receive 卫生保健 benefits provided by state and national government (Medicaid, 医疗保险, VA), 私营保险公司(工伤赔偿), 以及其他医疗保健提供者(通过折扣/“免费护理”).

Do HCSM members “give up” their commensurate national/state responsibilities for 卫生保健 upon joining a ministry? hcsm享有的“自由”是否促进了社会支持, 社会控制, 以及促进健康的社会资本? This ACA exemption for HCSMs was not debated in Committee or on the floor of the House or Senate before the ACA’s passage in 2010. 在美国的医疗保健中，宗教自由的界限应该是什么? 我们很想听听你的想法!

图片来源:Sage Ross，A young man with a sign reading "WE ARE OUR BROTHERS' KEEPERS" at a town hall meeting on 卫生保健 reform led by Rep. 约翰B. 拉尔森，”来自Shutterstock, 2009年9月2日.