@CatDude
It doesn’t matter why, the law is written the way it is written. You would have to go back and find out who was on the committee that wrote the law and ask them what they were thinking.
I can speculate for what it’s worth. HMO‘s were supposed to reduce medical costs by covering everything with a low deductible but making you get all your care approved by your PCP. Your PCP was supposed to coordinate your care and prevent you from over-using medical care. But it didn’t work, because the PCP did not actually have an incentive to control your cost, and because everything had the same low co-pay, HMOs actually led to increased use of medical services. That led to a change in thinking, that maybe high deductible plans were the way to go, because it would make consumers more cost conscious about where they obtain services and what services they obtain. For example, you would go to urgent care for $200 instead of the emergency room for $2000. The tax free health savings account was part of this scheme to put consumers back in control of their own medical expenses. If consumers built up a medical savings account that could be rolled over from year to year, they would have an incentive to control their costs and keep their medical usage low, but they would also have the ability to pay large expenses when they occurred. I think this is the main reason that HSA‘s are only allowable for HDHP‘s and not for HMO‘s.
Health sharing ministries are an entirely different kettle of fish. Under the current regulatory scheme, a health sharing ministry is not considered insurance of any kind. In a health sharing ministry, you pay someone else’s medical expenses on the promise that they will pay your expenses if you become sick. To the consumer, it operates the same as insurance, but in the backend it is a very different legal structure. This is also why you cannot deduct health sharing ministry premiums as an itemized deduction on schedule A. You are allowed to deduct medical expenses you pay for yourself, your spouse, or your dependents. Since the health sharing ministry is paying the expenses for someone other than yourself or your dependents or your spouse, it’s not a deductible medical expense on schedule A. As I mentioned above, I believe the IRS was considering regulations to re-classify health sharing ministries as qualifying insurance plans. I am not aware that that regulation was ever finalized. A good place to check on the progress of the proposed regulations is probably the website for the health sharing ministry, since their customers would have great interest in knowing if the regulations changed.
Anyway, the short answer is that only a qualifying HDHP qualifies for HSA contributions because Congress made it so.
