Prayer - Free Mandates Removed from Federal Health Care Bills

In 2009 both the U.S. House and Senate included mandates to pay for “religious and spiritual health care” in their health-care reform bills, but both removed them after widespread publicity and protest.

Anticipating a national health-insurance mandate, the Christian Science Church placed scores of op-eds in newspapers arguing for “inclusion” of “spiritual health care” in health-care plans. Aping medical terminology, the church calls the faith healers “practitioners,” their prayers “treatments,” and the people they pray for their “patients.” The bottom line, however, is that their “spiritual health care” consists only of prayer.

Church lobbyists told the press that about 300 insurance companies used to reimburse for Christian Science “treatment,” but with the advent of managed care, most insurers now require a medical diagnosis before they will pay for “health care.”1 The church wants public and private insurers to pay for the prayer treatments without a medical diagnosis. They argued that the goal of health-care reform was to include everyone, and therefore it ought to provide “all Americans the opportunity to use the method of care that best meets their needs.”2

In July, 2009, the U.S. Senate Health, Education, Labor, and Pensions Committee (HELP) passed its health-care reform bill. An amendment added by Senator Orrin Hatch, R-Utah, required insurers participating in a “Gateway” to reimburse charges “for religious or spiritual health care” that the Internal Revenue Service allowed to be deducted as a medical-care expense.3 Congressman John Shimkus, R-Illinois, whose district includes a Christian Science college, got a similar provision in the House Energy and Commerce Committee’s health-care bill.4 The provisions in both bills were couched as nondiscrimination clauses. The House bill section was titled “PROHIBITION OF DISCRIMINATION IN HEALTH CARE SERVICES BASED ON RELIGIOUS OR SPIRITUAL CONTENT.”

It was clever of the Christian Science church to tie the reimbursements to religious methods that the IRS allowed to be deducted as medical-care expenses. Congressional staffers likely assumed that the IRS had some standards related to effectiveness.

Iowa-based Children’s Healthcare Is a Legal Duty (CHILD, Inc.), a nonprofit national membership organization established to protect children from abusive religious and cultural practices, especially religion-based medical neglect, went into high gear fighting the prayer-fee mandates.5 CHILD officers pointed out that the IRS had no quality standards. The Internal Revenue Code provides that medical expenses are deductible from federal income tax and defines medical expenses as amounts paid “for the diagnosis, cure, mitigation, treatment or prevention of disease, or for the purpose of affecting any structure or function of the body.”6 In 1949 the U.S. Tax Court ruled that the determination of what is medical care does not depend on the experience, qualifications, or title of the person rendering it.7 In 1955 the IRS made a revenue ruling that the bills Christian Science practitioners send for their prayers are a tax-deductible medical expense.8

It does not matter to the IRS whether anyone besides the taxpayer believes the service will heal, prevent, relieve, or diagnose disease.9 He can engage Christian Science practitioners “or any other practitioners who perform the service even though they are not required by law to be, or are not (even though required by law) licensed, certified, or otherwise qualified to perform such services,”10 and the services will be deductible from federal income tax as medical-care expenses.

The IRS’s definition of medical care is thus astonishingly broad. It has laid down a few caveats over the years, but none has limited deductibility for bills sent by Christian Science practitioners for their spiritual treatments. An important criterion is that deductible medical expenses must be “incurred primarily for prevention or alleviation of a physical or mental defect or illness” and that “an expenditure which is only beneficial to the general health or an individual, such as anexpenditure for a vacation, is not an expenditure for medical care.”11

Another criterion is that the person paying for the service must believe its primary purpose is to heal, prevent, relieve, or diagnose disease. Thus, the IRS refused to allow deductions for the expenses of prayers and massages with leaves by a Samoan “native doctor” in part because the husband did not have a ”reasonable expectation” that such treatments would improve his wife’s condition. The couple had been to twenty U.S. physicians and had been given no hope.12

The taxpayer’s belief in a healing can be trumped by the provider’s disclaimer. A member of the Church of Scientology claimed the expenses of Scientology “auditing” as a deductible medical care expense on the grounds that he believed it had healed him of gallbladder problems, nervous disorders, and ulcers. The IRS prohibited the deduction because the Church requires participants to sign a statement acknowledging that the Church’s methods do not treat or diagnose “human ailments of body or mind.”13

“Scientologists,” the IRS reported, “do not make healing claims, Christian Scientists do. . . . When some organic defect surfaces, Scientologists recommend treatment by conventional physicians, a practice fundamentally disallowed to Christian Scientists. Unlike conventional medical practitioners and Christian Science practitioners, Scientologists do not treat particular ailments. Their function is the total spiritual uplifting of the human being.”14

Tailoring the method to a particular ailment is another criterion. And it ruled against the Samoan doctor’s prayers and herb massages in part because the doctor allegedly used the same methods for everyone.15 The IRS ruled against a Scientology couple because the church’s auditing was not specific to their psychological problems.16 Later the Church of Scientology was ruled a religion and the IRS now allows the “fixed donation” the church requires for auditing to be deducted from income tax as a charitable contribution.17

The IRS loose definition of deductible medical care may not have cost the public much money yet because most religious ministers do not send bills for prayer or ritual, and also because a taxpayer can deduct only medical-care bills that exceed a certain percentage of his adjusted gross income in a given year.

The federal health care bills of 2009, however, forced the insurance industry to pay for prayer, however, and likely would have encouraged a new cottage industry to spring up. As a Presbyterian minister wrote, the mandates in the federal bills had “‘Welcome, Charlatans’ written all over them.”

Christian Science founder Mary Baker Eddy directed church “practitioners” to “make their charges for treatment equal to those of reputable physicians in their respective localities” (First Church of Christ, Scientist, and Miscellany, p. 237). These practitioners set their own rates, but sometimes their charges are indeed comparable to medical bills.

In 1989, Christian Science healer Mario Tosto charged parents $446 for two days of prayer-treatment for Ian Lundman, an 11-year-old Minnesota boy with diabetes. The boy died.18

In Michigan, an insurance company balked at paying a Christian Science practitioner’s bill of $1,775 for her prayers on top of medical bills for the patient. The couple sued the company. The company settled out of court.19

Beyond the money, however, CHILD’s main concern was that provisions forcing insurers to pay for prayer, and calling prayer and other religious rituals medical care could preempt the states’ child-abuse and neglect laws. If federal law called prayers medical care, then religious objector parents might have grounds to claim that they were providing medical care and could not be charged with child abuse or neglect for withholding scientific medical care.

The Christian Science church pointed out to Congress that “spiritual care” was already reimbursed through Medicare and Medicaid. The argument was misleading in that those public programs reimburse only for Christian Science “nursing” not prayer. In 1996 CHILD and two taxpayers filed suit against the federal government for its reimbursements for Christian Science services. The church entered the suit as a defendant-intervenor and argued strenuously that their unlicensed nurses were being paid only for physical care of the sick and not for prayer, and the courts upheld the payments as constitutional on that basis.20

The church also pointed out that costs of prayers by Christian Science spiritual healers are reimbursed in some insurance plans for federal employees, such as TRICARE for military personnel, the Mail Handlers Benefit Plan, and the Special Agents Mutual Benefit Association, and that some states, such as California, Colorado, Illinois, and Kansas, have health insurance plans for their employees that reimburse the bills for their prayers.

CHILD pointed out that there is a difference between a health insurance plan that is paid for by the contributions of a relatively small, distinct group of federal or state employees and the federal health care reform bills, which had the government compelling the entire insurance industry to pay for anybody’s prayers and to some extent subsidizing those payments.

CHILD rejected the church and bill sponsors’ argument that the prayer-fee mandates prevented discrimination against religion. Those provisions are, we wrote to Congress, “a special privilege for religion, not an anti-discrimination measure. The bills do not require the insurance industry to reimburse for everything that unqualified people claim will affect a function or structure of the body, but only religious and spiritual practices.”21 CHILD also argued that Congress should have obtained credible evidence that prayers and rituals healed disease before mandating that the insurance industry pay for them.22

The American Humane Association, American Professional Society on the Abuse of Children, Every Child Matters Education Fund, and the American Academy of Pediatrics signed on to one of our letters to Congress. Later, the Child Welfare League of America wrote its own letter to Congress against the prayer-fee mandates.

Secular humanist organizations, including Freedom from Religion Foundation, American Atheists, and Secular Coalition for America, asked their members to voice their opposition to Congress, and many did so. Americans United for Separation of Church and State met with congressional staffers and watch dogged the committee processes.

On October 29, CHILD officers got the wonderful news from a House staffer that the prayer-fee mandate had been dropped. She wrote, “Your dedication is an inspiration. This is an important issue to our staff, and we’re very glad the provision was finally removed.”

The Christian Science church asked every member to write an e-mail to the Senators who had to merge two Senate committee bills into one. The church provided a sample letter claiming that the member had found Christian Science to be “an effective form of health care” and insurers must be prohibited from “discriminat[ing] against religious or spiritual health care” that the IRS allows to be deducted as a medical care expense.23 The church delivered 11,000 e-mails to the Senators. The church also paid the Mayer Brown law firm in Washington $150,000 in 2009 to lobby for the prayer-fee mandates.24

In December the merged Senate health-care bill appeared. The prayer-fee mandate in the HELP Committee bill was not in the merged bill. Thousands of amendments were filed as the bill went to the floor, but the bill passed the Senate just before Christmas with no reference to paying for faith-based health care. The church blamed the removal of its prayer-fee mandate “on vehement and often misleading opposition voiced by a longtime critic of Christian Science as well as a coalition of atheist groups opposed to the notion of anything religious in law.”25

The mandate was personally offensive to my husband and me. In 1980 we filed the first wrongful death suit against the Christian Science church and its practitioners. Our complaint charged that they had breached duties they owed to our son Matthew and us.26 Top church officials strenuously denied having any kind of a health-care system or the responsibilities that go with it. They swore under oath that the church has no “supervisory control” over its practitioners; that it does not “ever evaluate a practitioner’s judgment about the condition of sick children”; that it has no training, workshops, or meetings for practitioners that “include any discussion on how to evaluate the seriousness of a child’s condition”; that it has never “named the death of a child as a grounds for revoking a practitioner’s listing”; and that it keeps no records on children who die while receiving Christian Science treatments.27

But in 2009, the church spread word throughout the land that it had a health-care system for which the government should mandate reimbursements. This time it lost.

The Christian Science church has definitely not given up. Gary Jones, the manager of the church’s federal lobbying, wrote in the Huffington Post, “Although spiritual care has not been recognized as a therapy in the new health care reform law, there's every reason to believe it will be in the future.”28 A Texas church lobbyist reported wearing off “plenty of shoe-leather” going to congressional offices to promote the prayer-fee mandate.29 In addition to lobbying Congress the church is meeting with U.S. Department of Health and Human Services officials trying to persuade them to put the prayer-fee mandate in the regulations HHS will write to implement health care reform.30

Notes

1 Terry Goodrich, “Christian Scientists looking at healthcare reform,” Fort Worth Star-Telegram, Feb. 21, 2009.

2 George Gregory, “True reform will include care that’s spiritual,” Des Moines Register, May 30, 2009.

3 S.1679 Section 3103(a)(1)(D).

4 HR3200 Section 125.

5 CHILD’s webpage is at www.childrenshealthcare.org.

6 Internal Revenue Code § 213(d)(1)(A).

7 Wendell v. Commissioner, 12 Tax Court 161 (1949).

8 Revenue Ruling 55-261, 1955-1- C.B. 307. Prior to that the IRS had been allowing Christian Science prayer bills to be deducted as medical expenses by a special ruling letter issued in 1943. The 1955 revenue ruling published the letter.

9 Fischer v. Commissioner, 50 T.C. 164, 194 (1968).

10 Rev. Rul. 55-261,1955-1 C.B. 307, as modified by Rev. Rul. 63-91,1963-1 C.B. 54.

11 Code of Federal Regulations § 1.213.1 (2)e(ii).

12 Tautolo v. Commissioner, 34 TCM 1198 (1975).

13Revenue Ruling 78-190, 1978-1, C.B. 74.

14Loc cit.

15 Tautolo v. Commissioner, 34 TCM 1198 (1975).

16 Brown v. Commissioner, 62 TC 551 (1974).

17 Revenue Ruling 93-73, 1993-2 C.B. 75.

18 The check for the practitioner’s bill was introduced as evidence in Lundman v. McKown, 530 NW 2d 807 (Minn. 1995).

19 Stephenson v. State Farm, 48th Dist. Court, as reported in Michigan Trial Lawyers Association newsletter, October 1986, page 22.

20 CHILD v. DeParle, 212 F.3d 1084 (8th Circuit 20009), cert. denied 121 S.Ct. 1483 (2001).

21 Letter from Rita Swan to Megan O’Reilly, Oct. 20, 2009.

22 Letter from Rita Swan to Kate Leone, Oct. 27, 2009.

23 Letters from Phil Davis and Gary Jones to Christian Scientists, Oct. 2009.

24 Lobbying Disclosure Act Database at soprweb.senate.gov.

25 Eric Nelson, “{Christian Science and Healthcare: Paying for Praying,” San Jose Mercury News, Jan. 6, 2010.

26 Brown v. Laitner, 435 N.W.2d 1, 432 Mich. 861 (1989).

27 Depositions of A. Dean Joki, Ruth Jenks, and Hal Friesen in Brown v. Laitner.

28 Gary Jones, “Spirituality: a Powerful Factor for Health Care Reform,” Huffington Post, May 26,

29 Keith Wommack, “Pay for prayer?” and lots of steps,” Houston Chronicle, Aug. 6, 2010.

30 Mark Barna, “A Springs Christian Science healer talks shop.” Colorado Springs Gazette, Aug. 13, 2010.

About the Author

Rita Swan, Ph.D., is president of Children’s Healthcare Is a Legal Duty (CHILD, Inc.), which works to prevent religion-related abuse and neglect of children, especially medical neglect. She has published articles in the New England Journal of Medicine, Advances in Pediatrics, Pediatrics, and several other journals. She has lectured at 14 national conferences and 12 regional ones, testified 12 times before state and federal legislatures, and conducted training sessions for child abuse investigators.