The Daily Item, Sunbury, PA

January 3, 2010

Amish eye loophole in health care proposals

Exemption could prevent fines for sect over insurance

By Tricia Pursell

SUNBURY — While selling food at an area farmer’s market Wednesday, a Valley Amish man said his community opposes the national health care bill which, if passed by Congress and signed by President Barack Obama, could mandate that all Americans have medical coverage or face a fine.

“We try and not depend on the government for any type of insurance,” the Amish man said. “However, if it is going to happen, we are hoping something can be worked out for us.”

Pennsylvania is home to 381 Amish church districts, 12 of them in Montour, Northumberland, Snyder and Union counties, according to a study by The Young Center for Anabaptist and Pietist Studies at Elizabethtown College.

The commonwealth is second only to Ohio with nearly 52,000 Amish residents.

Many of those in the Amish man’s Valley community participate in optional insurance coverage through their church — not from private or public firms, as would be required by the legislation.

The Senate bill would phase in an eventual $750 fine in 2016 for those who have not purchased qualifying health care coverage, unless they could not find a plan that would cost less than 8 percent of their income. The House bill would require a fine equal to 2.5 percent of a person’s income if he does not carry insurance. Those who cannot find a plan that costs less than 12 percent of their income would be exempt.

For the Amish, however, there appears to be a loophole through which they can escape the possible mandate.

“There is a religious exemption in the bill,” said Roseanne Placey, spokeswoman with the Pennsylvania Department of Insurance, “which would apply to them, since they believe the religious duty of communities is to provide for one another when they are sick.”

Josh Drobnyk, spokesman for U.S. Rep. Chris Carney, D-10 of Dimock, confirmed the existence of the exemption, which would release an Amish person or Old Order Mennonite from the individual mandate.

“The bill uses the same religious exemption that was used for Medicare, which exempts certain groups if they have religious objections and belong to a recognized religion,” Drobnyk said.

Many Amish and Old Order Mennonites refuse Medicaid and Medicare coverage, Placey said.

The groups were granted exemptions from paying Social Security in 1965 — which will likely be a requirement for exemption from the health care mandate, said Donald B. Kraybill, professor and senior fellow for the Young Center for Anabaptist and Pietist Studies at Elizabethtown College.

“It has to be a long-standing historical exemption based on religious beliefs,” Kraybill said Thursday.

To qualify for the exemption, a person will have to prove he is a member of a qualifying religious group that has been in existence continuously since 1950, Drobnyk said.

The details of the bill, such as how to apply for such an exemption, have yet to be determined, said Andrew Wimer, press secretary for U.S. Rep. Joe Pitts, whose district includes Lancaster, Chester and Berk counties and 169 Amish church districts.

Pitts’ legislative assistant made it a point to consider how the Amish would be affected by the new bill, since his constituency contains such a high number of them, Wimer said.

“There was legislative language referencing religious sects that the Amish have fallen under in the past,” Wimer said.

According to Kraybill, the Amish are not only exempt from Social Security, but from the workers’ compensation program tax and military service, and may terminate their schooling at the age of 14, as compared with the national requirement of 16, due to a Supreme Court decision in 1972.

Currently, the Amish and Old Order Mennonite often pool their resources for catastrophic health care coverage, Placey said.

“The basic philosophy is mutual aid,” Krabill said, “based on the religious understanding of the responsibilities and duties of church members. Based on biblical teaching, members of the church should help to take care of each other.”

In some settlements, the Amish do have nonbureaucratic plans in which a cluster of churches combine to form insurance plans, Kraybill said.

Amish families may have a deductible of $5,000, and the churches may help to pay up to 80 percent of a medical bill, he said.

“Some feel that is too organized, and it’s just voluntary,” he said.

For families not covered by the Amish insurance plan, or covered and yet still struggling with a large medical bill, the churches may take up a special offering, or conduct a benefit auction or fund-raising event, the Elizabethtown professor said.

Those in Amish and Mennonite communities have become “savvy purchasers” of health care, Placey said.

“Generally, when you go into a hospital or to a doctor, the amount you are charged is sometimes based on how you are going to pay,” Placey said.

The Amish who enter Lancaster General Hospital — which receives more than most, because of the county’s large Amish population — pay their bills out-of-pocket, said John Lines, spokesman.

Payments plans are offered to all the uninsured, he added, and financial assistance is offered, depending on how close patients are to the poverty line.

“Oftentimes, those discounts for the uninsured are better than what insurance companies receive,” Lines said.

Though still not sure how the health care bill would affect the hospital’s relationship with its Amish patients, Line said, “We have really strengthened our communication, particularly with the Amish community, because we understand, depending on the situation, it can be a significant cost to a family or a church. Their financial health is as important to us as their medical health.”