WASHINGTON – When the rules kick in that require most people to buy a health insurance policy, about 40,000 Hoosiers will be exempt.
The landmark law that overhauls the U.S. health insurance system creates a carve-out for people who are members of churches that have a conscientious objection to private or public insurance.
That includes the Amish, who have a long-established practice of not participating in government-run programs.
“They believe the church has the responsibility, actually the divine responsibility, to provide for its own members. In a sense, God is holding them accountable for taking care of their elderly, their disabled, people who might be out of work,” said Steven Nolt, a history professor at Goshen College who studies the Amish and Mennonites.
“If people would turn to either commercial insurance or public welfare programs, they would be going against what God has asked them to do,” he said.
The law requires Americans to buy health insurance policies and provides subsidies for people who can’t afford them. Eventually it will mean coverage for 32 million uninsured Americans, and people who don’t buy insurance will be subject to fines.
The roughly 239,000 Amish in the U.S., however, won’t face fines if they continue their practice of not participating in social welfare programs such as Social Security and Medicare.
But that doesn’t mean the Amish don’t go to doctors or hospitals.
“Of course they do, and they pay for it,” said medical sociologist Denise Reiling, an associate professor at Eastern Michigan University who also is a cultural liaison with Amish communities in northeast Indiana.
Instead of paying a co-pay and deductible before submitting a doctor or hospital bill to an insurance company, an Amish family with a large medical bill pays what it can. Many doctors and hospitals that treat Amish patients offer a reduced rate if the bill is paid in cash within 30 days, Reiling said.
But when that amount is still beyond a family’s means, Nolt said, the church handles the rest.
“Every family is expected to pay as much as they can toward their own bills. The Amish are not a communal society; they don’t just put all their income and all their expenses into a pot together,” Nolt said.
But the Amish community will make sure the bills are paid.
Although the system varies from one enclave to another, Nolt said, it’s common for the church to collect alms on a regular basis to pay for the medical and care expenses of old and ill members and make special collections when something unexpected comes up.
If it’s particularly expensive, he said, the deacons of a church will appeal to deacons at a neighboring church.
It might seem odd that Congress carved out an exception that affects so few, especially for people who traditionally don’t vote and don’t have a lobbying force behind them.
Nonetheless, lawmakers whose states or districts include sizable Amish populations ensure legislative carve-outs when social policy butts heads with Amish traditions. Several of the key congressional committees that wrote the health insurance law have members whose regions include Amish settlements.
Legislation to allow the Amish to keep apart from social programs that other Americans must participate in – such as paying Social Security taxes – “has its own tradition and isn’t really driven by any kind of power politics,” Nolt said.
Despite the religious exemption that’s spelled out in the bill, the Amish know that what really matters is how the regulations are written and administered, said Herman Bontrager, secretary-treasurer of the National Committee for Amish Religious Freedom.
Bontrager, now an executive with a Pennsylvania insurance company, grew up in an Amish family in Elkhart County. He is in regular contact with the Old Order Amish Steering Committee, which works with government officials to develop policies that are acceptable to all the Amish churches.
“The leadership is not particularly anxious now,” he said, because of the religious exemption provision in the law. But he said they are watching how the Department of Health and Human Services writes the regulations that will affect how the law is implemented.
The exemption from the individual insurance mandate does not extend to the employer mandate. Beginning in 2014, companies that don’t provide insurance coverage must pay a penalty of $2,000 per full-time worker per year if they have more than 50 workers and if one of them obtains insurance through state-run “exchanges.”
But because employers who have 50 or fewer employees are exempt from that rule, few – if any – Amish businesses will be affected.
Nolt said he is unaware of any northeast Indiana Amish-owned businesses that have more than 50 workers.
But about half of working-age Amish men in northeast Indiana have jobs in RV and mobile home factories in Elkhart, LaGrange and Kosciusko counties, Nolt said. While those employees don’t have an obligation to buy an insurance package under the new law, their employers will be required to.
Reiling said many people in the Amish community remain confused and concerned about how the 2,000-plus-page law will affect them. But she said one thing that would be a significant benefit to them – even if they stay apart from the insurance mandate – is if the law lives up to its billing of reducing medical costs.
Reiling said that compared with other Americans, the Amish are far more focused on taking responsibility for their well-being and tend to first rely on natural remedies.
But she said the Amish have not been immune from the trend in the U.S. to seek more medical care over the past 50 years. As medical treatment has become more complicated, its cost has also increased.
Anything that would reduce costs, Reiling said, “would be a tremendous boon to Amish people.”
